Health Education: breast cancer

Showing posts with label breast cancer. Show all posts

Breast Cancer Rise and Significance

Last week it was reported in the popular press that a new study had found a rise in the number of younger women (ages 25-39) who were being diagnosed with advanced breast cancer.  I did not seek out the actual research, but what I did hear on the news (likely NBC Nightly News) is important to clarify.  We were told that in the last 30 years, the rate of diagnoses per 100,000 women went from 1.5 to just about 3.  That means for every 100,000 women in that age group, almost 3 were found to have advanced breast cancer in 2009.  The news reporters and scientists have noted that this is a small but significant increase in cases. (the significance statement is being questioned by some researchers, but lets say it is not).    When you read a study and see that it is significant what that means is that it is 'real'.  It does not mean it is big or even important. You need both the effect size and whether or not it was 'real' to make your assessment.  Is 1.5 more cases a big deal?  That is for you to decide. In the statistics world, the significance means that the finding (here more cases of breast cancer) is very likely due to something other than chance.      When comparing two values (here at two time points) the assumption is that there is no difference.  The p value tells you the percent of times you could expect to find a real difference if there  wasn't one.  How many times you'd be making a mistake.   The study researchers think that the finding in this case is real.  It could be that more women are obese and that obesity somehow increases the risk, or that as women are starting puberty earlier this could be upsetting hormone levels and increasing the risk.  The scientists who published this current study do not KNOW the reason.  They are only saying that the cases increased and something is behind it.  (Usually scientists or statisticians set a level of .05 or .01 at the start of a study and only accept 'significance' if they have a p < .05).   I am thinking you wish I had stopped talking about a paragraph ago! Just eat right and exercise, ok!?  ( and of course, don't expose yourself to cigarette smoke, first hand or otherwise)

Breast Cancer Rise and Significance

L ast week it was reported in the popular press that a new study had found a rise in the number of younger w omen (ages 25-39) who were ...

7:16 PM

Does a BMI number cause Breast Cancer Death?

The headlines read that obesity increases the risk of cancer recurrence and death in women who are diagnosed with breast cancer.  The actual study involved an evaluation of several groups of women who had stage 1, 2 or 3 breast cancer and were themselves enrolled in clinical research trails.  The purpose of those research trials was not to determine if weight impacted recurrence or mortality, but to evaluate the efficacy of new chemotherapy drugs.  This is important.  Who were the women in the sample, how much are you like them, and how much are other breast cancer patients like them?     The women who were studied all received chemotherapy and had operable cancers (I do not know if they had surgery, only that they had operable tumors and received chemotherapy).  A consideration to make is whether or not the people who chose to enroll in the study are different from people who did not enroll.  Also, only certain types of people were allowed to participate.  Usually, and it is true here, the people in drug studies have the condition the drug is trying to treat, but are usually otherwise healthy.  This study left out people with "significant" co-morbidities (other diseases occurring at the same time), but I do not know what 'significant' includes.    The headlines refer to BMI as the risk factor, but having a BMI of 30 or higher isn't the problem.  What that number might reflect is the problem.  For most people BMI mirrors waist circumference (WC) - they mean the same thing.  However, in some people the BMI does not reflect their weight status well.  Waist circumference over 35 inches or higher is a very good indicator that a person also has insulin resistance, high triglycerides and high blood pressure.  It is those issues - collectively called 'metabolic dysfunction', that puts people at greater risk of disease and death.  Consider that those conditions; high blood pressure, trouble with sugar, high blood fats,  make the body less robust, less able to fight off infection, less able to rebound from injury and disease.  Metabolic dysfunction is deconditioning and a person with these conditions (including a WC 35+ and a high BMI) is at a disadvantage before treatment for cancer ever begins.    This way, obesity and smoking are similar - both increase the risk of disease and death from any disease - just know that BMI and obesity are not the cause - it is the metabolic dysfunction.  Maybe they are the cause of the cause.     Here is a <a href="http://onlinelibrary.wiley.com/doi/10.1002/cncr.27527/abstract" target="_blank">link</a> to the study regarding the outcomes of the 3 drug trials that were used for the headline making stories. Study reference:  Sparano, J. A., Wang, M., Zhao, F., Stearns, V., Martino, S., Ligibel, J. A., Perez, E. A., Saphner, T., Wolff, A. C., Sledge, G. W., Wood, W. C., Fetting, J. and Davidson, N. E. (2012), Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer.

Does a BMI number cause Breast Cancer Death?

The headlines read that obesity increases the risk of cancer recurrence and death in women who are diagnosed with breast cancer. The act...

7:46 PM

Breast Cancer Report

I will be brief here because I am going to link you to a handout that should answer most of your questions.  The best part in highlighting this report by the Institute of Medicine(IOM) is that it was commissioned and certainly funded by, the Susan G Koman foundation.  I have donated and raced for Koman, so my money and probably some of yours, helped to pay for this.  We made this report on the environmental factors associated with breast cancer happen.  How AWESOME. In this report, instead of reviewing the non genetic or non changeable factors (i.e. age and family history), things that we may have some control over, either personally or publicly (policy) were explored.  Remember though, there is always the unknown element and the under-the-skin piece.  The environmental factors in the report were broken down into the categories below.  I will give a quick overview and then I encourage you to go to the handout.  There are also plenty of news stories on this topic today. <ul><li>Evidence of Cause - certain types of hormone therapy, excess weight, esp. after menopause, alcohol consumption and medical radiation (yes, those scans I keep warning you about and railing against)(ionizing radiation), and to a less conclusive but still suggestive extent, smoking</li><li>Evidence to Prevent - physical activity  - meaning that women who are the most physically active (but exactly the same in other ways) have less breast cancer</li><li>Things that do NOT cause it - hair dyes and the other kind of radiation (non ionizing) found in microwaves and other electrical devices like cell phones</li><li>Possible Associations- second hand smoke, any tobacco smoke and chemical pollutants, such as we find in gasoline fumes and the air we breathe</li><li>Probable or Plausible Factors - scientists believe that the chemical BPA (discussed here recently) used in the making of plastics and banned in some countries could cause the cancer.  In other words, it makes scientific sense when studying it in the lab and in animials.</li></ul>Please do not stop here - also read the <a href="http://www.iom.edu/%7E/media/Files/Report%20Files/2011/Breast-Cancer-Environment/IOM_breastcancer_QandA.pdf" target="_blank">handout</a> which has more  information. Disclaimer:  I am not sure if I have been open about all of this in my blogging, but heart disease, arthritis and breast cancer are in my family history.  I have at least two relatives who are breast cancer survivors and my paternal grandmother died of breast cancer long before my birth.  That being said, it is always a personal issue for me.

Breast Cancer Report

I will be brief here because I am going to link you to a handout that should answer most of your questions. The best part in highlighting t...

7:45 PM

Prevent or Reduce Cancer Recurrence

Exercise and maintaining a health promoting weight have been recommended as ways to prevent many cancers. A growing body of evidence is available to support that exercise can reduce some symptoms associated with cancer treatment - first and second line - and that continuing to exercise and eat moderately after treatment is suspended, can reduce the recurrence of cancer. I have blogged on this in the past, I say it again today because it was the topic of an article in the ACSM Certified News this month. Dr. Jonathan Ehrman explored the existing research which was mostly focused on breast, colon and prostate cancer. One study regarding physical activity in women with breast cancer found a link between positive treatment outcomes and moderate physical activity. The study followed the women for two years. In that study, the positive benefit was found whether the women had begun exercising before diagnosis or after. Though not all cancer patients receive radiation or chemotherapy, most are prescribed an oral medication after or instead. We are not used to hearing about weight gain with regard to cancer, but that is exactly what happens to many persons. The weight gain that occurs with treatment or after, is especially harmful if it leads to obesity and related diseases. Exercise can reduce the chances of weight gain, muscle wasting, diabetes and hypertension. Physical Activity and Healthful Eating are elements that we should include in our lives at all times.

Prevent or Reduce Cancer Recurrence

Exercise and maintaining a health promoting weight have been recommended as ways to prevent many cancers. A growing body of evidence is avai...

3:57 PM

A New Cancer Mindset

We have made significant progress over the years in regards to cancer prevention, identification and treatment. With the help of technology, we are able to diagnose more cancers so the absolute numbers of cases may have gone up. However, the actual death rate for most, but not all, cancers has gone down. The hardest cancer to treat is still lung cancer (and possibly pancreatic), the hardest to differentiate appears to be prostate while the cancer with the greatest cure rate is breast cancer. Here is something else that has had an almost 360* change – lifestyle recommendations for prevention of initial cancer, during acute and or chronic treatment of cancer and to prevent cancer recurrence in original or distal site. By that last bit I mean that sometimes a person is seemingly cured of one cancer only to have it reappear in another part of the body. I wonder if you are going to be surprised by the newer medical advice – maybe it will depend on your age. The research continues to grow and a body of evidence exists to support that what one eats, how much one eats, the weight of a person and the amount of exercise they engage in will affect all of the situations noted earlier. Being overweight WILL increase the risk of cancer in all locations. Eating high fat and high salt foods can affect the inner mechanisms or metabolism of a body and put it at risk for cancerous conditions and exercise is something that is protective. In other words, regular daily exercise creates a system that is better able to fight off disease. Thus, overweight persons with cancer are often encouraged to lose weight – I KNOW – we have the old image in our heads of people getting chemo and losing a bunch of weight – wasting away, but the treatments have changed and even those that do cause loss of appetite are mediated by drugs that treat the side effects. All of us, cancer patients or no, are encouraged to eat a diet that is more plant than meat based and low in saturated fat, processing, simple carbs and salt. As soon as possible after any invasive treatment, cancer patients are encouraged to begin an exercise program. Research exists to support that this lifestyle change can prevent recurrence of cancer. It is therapeutic. It is a change in thinking but it works.

A New Cancer Mindset

We have made significant progress over the years in regards to cancer prevention, identification and treatment. With the help of technology,...

4:51 PM

Chapter Four

In the most recent President's Cancer Panel (PCP) report, chapter four covers the issue of radiation from medical sources, and tonight I want to offer a synopsis from the first part of that chapter which covers medical imaging and nuclear medicine. I continue to read in the hopes of understanding this better myself so that I can share my new found knowledge. At times , while reading, I feared that I would instead only succeed in making it more confusing for all of us. The upshot and upside is that there are initiatives in place to educate not only patients, but physicians, technicians and other health care professionals on the dangers of over exposure to medical radiation. As indicated in previous posts on this issue, machines need to be calibrated, and doses lowered. Additionally, this report states that newer imaging machines have built in sensors that can reduce the amount of radiation used based on organ and person size. Of special concern has been reducing radiation to children. This is an issue for several reasons. One is that time of exposure is related to incidence of cancer, independent from frequency or amount. In other words, radiation causes damage and if that cellular damage is not corrected on a molecular level, then mutant cells continue to multiply over time and the more time they have - i.e 60 years of life vs 10 - the greater the chance that a cancer could develop. Secondly, children have smaller bodies to absorb the radiation, have more rapid cell changes at certain ages due to developmental issues, and if things don't get reined in, will have a life time of exposures that will accumulate. Another concern is the increased risk of breast cancer. The PCP report notes that breast cancer from radiation is an "important and controllable risk factor." The problem is that any imaging of organs or bones beneath the breast can expose the breast to this known carcinogen. Bear in mind that a mammogram exposes the patient to approximately .4 mSv of radiation while a coronary angiography can expose the breast and heart to 16 mSvs. The FDA is also working on a plan to have electronic or paper cards (smart cards) that we can use to keep up with all our imaging and dosing. This could reduce multiple scans of the same body part i.e lost records, patient recall, etc. There is also a program in the works that is intended to help patients talk to their doctors - much as I have suggested - why do I need this exam? Perhaps an alternative test can be used, such as ultra sound, MRI or a blood test. This is meant to address both sides of the unnecessary scan issue. The scans doctors order because they are afraid not to, and the ones they order because the patient insists that they do. One scientist from Columbia University suggested that a third of CT scans could be replaced by other tests. Even though this chapter explains the different units of measurement with regard to ionizing radiation - it doesn't provide a layperson with the tools necessary to fully grasp what is measuring what. I can tell you with certainty that whether it is an mGy, mSv , rads or rems - MORE of any of them is what you are trying to avoid. It does seem like most measures come back to the Sievert and then the millisievert or mSv. Several examples in the text use the mSv and that helps me make some good points. Remember there is no known safe dose of radiation - we just try to find what is sometimes referred to as the amount that will provide a result - the "as low as reasonably achievable" dose. Example one: the exposure to radiation from the atomic bomb(s) dropped on Hiroshima can be measured in mSv. It is expected that people were exposed to between 5 and 100 mSv. Regular xrays and mammograms expose people to less than 1mSv. CT scans will have a very wide range based on where the scan occurs, but also on the other factors which have been noted, so a coronary angiography CT can expose a person to 16 mSv and a PET scan even more. In nuclear medicine, where the radiation comes from within - i.e you take the radioactive isotopes into your body orally or through IV, the dose can be double that - esp. if the isotope is thallium 201. But I believe that my Aha moment really came when I read about the limits that are proposed for radiology technicians. Example two: there are two groups that cover this issue and the US one, OSHA allows workers to receive more annual and cumulative mSvs than the International Commission on Radiological Protection does. Well I think we should limit our exposure to the ICRP worker standard, at the very least (or most, depending how you look at that sentence!). So that is 20 a year and no more than 100 within 5 years. A chest CT may deliver 7 mSv with a range of 4-18. The virtual colonoscopy that I used to think was a neat idea, delivers 10 mSv with a range of 4-13. To learn more values, see chapter four of the current <a href="http://deainfo.nci.nih.gov/advisory/pcp/pcp.htm">President's Cancer Panel </a>annual report. Ionizing radiation comes from other sources as well, but about 48% of it comes from medical exposure. In the 1980s the medical amount was closer to 15% and that is the concern - the growing concern, regarding cancer incidence from medical imaging and nuclear medicine.

Chapter Four

In the most recent President's Cancer Panel (PCP) report, chapter four covers the issue of radiation from medical sources, and tonight I...

4:53 PM

Did She Have Chemotherapy?

Almost every person that I have ever told about my family member's breast cancer has asked me if she had chemotherapy. I am pretty sure that she did not - though I might be mistaken - if she did, she took the drugs for only a very short amount of time. (if she reads this blog and decides to respond, I hope she will come to the website and post her comment so everyone can see it!) Anyway - because people ask me so often and because I had not not always understood the treatments involved in breast cancer, I wanted to take a moment to explain very briefly and Unscientifically what can happen with breast cancer. Usually a person has a tumor and that tumor, if possible, can be cut out of the breast through surgery. Sometimes the tumor is large and the oncologist would rather address it somehow BEFORE surgery. The patient may have radiation or chemotherapy before surgery in that situation, but usually chemotherapy comes after surgery - i.e. adjuvant, if at all. If radiation is done after surgery, it is usually because all of the tumor could not be removed or because the cancer has spread to other parts of the body. Radiation is just what you think it is. High dose Xrays. Interestingly, there is external and internal radiation. The internal involves using needles or catheters to target an area with radioactive substances instead of radiation from a machine. Chemotherapy is also used in different ways and in different circumstances. The first thing to note is that it is not always the IV chemo that we see on TV. There are also oral medications that can be taken. What is true is that chemo and radiation can have serious, weakening side effects on the body. Chemotherapy can also be spread through the body or targeted in a certain area. It is meant to affect cancer cell proliferation either by killing cancer cells or stopping cancer cells from dividing (multiplying). Chemotherapy that is used this way (instead of surgery when the cancer is beyond the breast and lymph nodes or after surgery for the same reasons)is meant to prolong the patients life and reduce suffering if possible. If chemo is used after a mastectomy it is usually done in a two to four week cycle and is meant to kill remaining cells or prevent recurrence. Other drugs are also used (in my loved ones case - her treatment was surgery and a hormone drug). More people have heard of tamoxifen which is an estrogen blocking drug, (but only in breast tissue), another drug class is the aromatase inhibitor which is used in post menopausal women. This drug keeps the hormone androgen from being converted to estrogen. Not all tumors are fueled or fed by estrogen however. There are other growth factors and drugs that inhibit them. The other drug I am familiar with is a HER2 protein inhibitor. There are more drugs in clinical trials. The American Cancer Society projected over 190,000 new female breast cancer cases for 2009 with just over 40,000 deaths. I know that sounds bad, but the new lung cancer cases for women in 2009 was estimated at just over 100,000 and over 70,000 of those cases end in death. You see, breast cancer, because it can be found early, is treatable.

Did She Have Chemotherapy?

Almost every person that I have ever told about my family member's breast cancer has asked me if she had chemotherapy. I am pretty sure...

5:02 PM

Alcohol and Breast Cancer Recurrence

I learned from a family member that women who have been diagnosed and treated for breast cancer are advised by their oncologists to limit alcohol intake as it could increase the risk for recurrence of the cancer. Breast cancer can be related to genetics but there are also several lifestyle factors that increase risk. These risk factors are the same for recurrence. They include but may not be limited to being overweight, not exercising and consuming alcohol in excess. For those of us who do not have breast cancer, the recommendation for alcohol consumption includes no more than one drink a day or seven per week. I have said it before and it is important enough to repeat - one drink is 12 oz of beer, 4 oz of wine or 1.5 oz of liquor. I have found several references to one research study in regards to alcohol consumption AFTER treatment for breast cancer and in that study the threshold for risk was much lower. The final recommendation after the nearly 2000 breast cancer survivors were followed for eight years, was that more than three glasses a week was harmful. The women in the study were mostly wine drinkers, but experts suggest that the same would hold true for beer or liquor. In the study, over a third of the women who drank more than three glasses of wine a week did have a recurrence of their cancer and over 50% of those women died from the disease. WHY? Probably because alcohol can increase the levels of estrogen in the body and estrogen fuels many types of breast cancer. In a Web MD article, oncologist Jeffrey Peppercorn from Duke University states that it is not clear that ANY amount of alcohol is safe and so it should be limited to rare occasions in this population.

Alcohol and Breast Cancer Recurrence

I learned from a family member that women who have been diagnosed and treated for breast cancer are advised by their oncologists to limit al...

4:47 PM

Lifestyle vs. Genetics vs. Chance vs. Risk

And so forth and so on. The European Breast Cancer Conference is being held in Barcelona Spain this week. News came out yesterday regarding a significant reduction in annual breast cancer incidence if certain lifestyle factors or conditions were modified. So the way the research is presented, and I can link you to the conference abstract, is that a certain amount of risk is related to these factors - through scientific causation - obesity and overweight (though it is a higher risk if the weight gain comes in middle age than if it is constant), use of hormone replacement therapy and drinking more than two drinks a day. There is also evidence to suggest that being physically inactive increases breast cancer risk. What the researchers did next was to take a population of women, in this case, French women, and consider the percent of those women who were, overweight/obese, who had used HRT, who drank 2+ a day and who were inactive. Each condition raised their risk for breast cancer and the quote that made the papers was that 30% of new cases could be avoided if women were lean and active. A lot of number crunching is going on not just in the research article but with reporters - but even so.... Women have about a 12% risk of getting breast cancer and the American Cancer Society states that obesity in and of itself increases the risk of getting any cancer by 60% . I believe I have my math right when I say that an obese person would then have about a 20% risk of breast cancer. I have breast cancer in my family. A grandmother, aunt and sister - one had a terminal or fatal case. Genetics cannot be dismissed on an individual level, but a scientist responding to this research noted that genes are not causing the increase cases, something else is and that has to be environment - or exposure to hormones and possibly toxins as well as what has been mentioned. At the time of diagnosis, the women in my family would not have been described as lean (though none obese either) and to the best of my knowledge, none of them had a regular exercise routine. I am certainly not overweight and have not taken HRT - so I suppose I have just the 12% risk with a little extra for family history. But I have another sister and she would medically be described as obese. She also smokes. She is inactive. She is at increased risk because of this, but even if it were DOUBLE it would still be less than 25% risk. Hypothetically, she has a 75% chance of not getting breast cancer and she may not. Of course, I pray that she does not - surgery is not so safe for smokers! I use her for an example for another reason however. There are many people who do not get a disease that they are at high risk for - smokers and lung cancer for example. That NEVER means that the risk does not exist or that the behavior is safe. It has to do with odds. If the outcome is simply- breast cancer diagnosis - okay, but it isn't. Not having a disease does not make one fit and healthy - it does not make them well. Regardless of the chances for specific disease outcomes, not exercising and being overweight can significantly reduce the quality of the years that you live. The <a href="http://ex2.excerptamedica.com/ciw-10ebcc/index.cfm?fuseaction=CIS2002&hoofdnav=Abstracts&content=abs.details&what=AUTHOR&searchtext=la%20vecchia&topicselected=*&selection=ABSTRACT&qryStartRowDetail=1">abstract</a> of the article noted in the press and presented in Barcelona.

Lifestyle vs. Genetics vs. Chance vs. Risk

And so forth and so on. The European Breast Cancer Conference is being held in Barcelona Spain this week. News came out yesterday regardin...

5:01 PM

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