Breast Cancer

Aromasin Pills Photo © Karl Stephan

Aromasin (exemestane) is an important drug for estrogen-positive breast cancer patients.But, like many cancer drugs, it comes loaded with trade-offs. It helps many patients prevent a recurrence of estrogen-sensitive breast cancer by blocking your body's estrogen production. But taking Aromasin produces menopausal symptoms: the classic hot flashes, fatigue, joint pain, and even bone thinning. A recent study was published in The Lancet by a group of oncology scientists in Canada and America, looking at the effects of Aromasin on bone health. They concluded that, "Exemestane worsens age-related decreases in bone mineral density by about three times, even in the setting of adequate calcium and vitamin D intake."

Chemotherapy as well as hormonal follow-up therapies can cause bone density loss (osteopenia) and sometimes when a women takes an aromatase inhibitor after her primary treatments, her bones may continue to thin out until she has osteoporosis. This loss of bone density and strength can take place even if she is taking sufficient calcium and Vitamin D to guard her bone health. The study, led by Dr. Angela Cheung, followed 242 women over 2 years on Aromasin (exemestane). All of the women had a baseline bone density scan and none of them were taking medicine for osteoporosis. These women were divided into 2 groups - one took Aromasin and the others took a placebo. While all the women showed some bone thinning at the end of two years, the group on Aromasin fared worse in their bone density.

Most women lose some bone density as they age, even if they never have cancer treatments. Estrogen levels drop during menopause, when your ovaries stop making the female hormones. Taking calcium and Vitamin D can help delay bone thinning, as well as weight-bearing exercise. If you can't tolerate calcium carbonate very well, try calcium citrate instead (it is easier to digest). Your doctor may recommend preventive drugs such as Fosamax or Actonel, to help treat bone loss. You may also need to have annual bone density scans as part of your well woman checkups, to monitor your bone health.

I was diagnosed with breast cancer almost 10 years ago, and took Tamoxifen for 2 years, then Aromasin for 3 years. Many women complain of the side effects of both these drugs - I know I did! - but we keep taking them because we want to avoid the return of cancer. I haven't taken hormonal therapies for 5 years now, but my bone density loss continues to progress. Who knows how long the effects of Aromasin will be with me? My latest mammogram showed no signs of cancer (Hooray!) but my bones are weakening like a much older lady. The good news is - I hope to live longer after breast cancer than I would have 20 or 30 years ago, but I must be more vigilant over my brittle skeleton. That's a tradeoff I'm willing to take, hot flashes and all.

Has Aromasin given you any trouble? Let me know by leaving a comment here.

_{Source: Bone density and structure in healthy postmenopausal women treated with exemestane for the primary prevention of breast cancer: a nested substudy of the MAP.3 randomised controlled trial.  Dr Angela M Cheung MD,Lianne Tile MD,Savannah Cardew MD,Sandhya Pruthi MD, et al. The Lancet Oncology - 7 February 2012.}

After a 3-day, hot pink, social media blitzkrieg, Komen for the Cure went back to Plan A. Instead of de-funding Planned Parenthood Federation of America (PPFA), they are continuing to provide the money that is earmarked for breast health services for 2012. Nancy Brinker, CEO of the Komen Foundation issued this statement: "We will continue to fund existing grants, including those of Planned Parenthood, and preserve their eligibility to apply for future grants, while maintaining the ability of our affiliates to make funding decisions that meet the needs of their communities."

The furor  was set off by a change in Komen's grant eligibility requirements. Komen's board had decided not to fund organizations were currently under government investigation. Because PPFA is currently under  congressional investigation, they could not count on the $680,000 that they expected to receive from Komen in 2012. Armed with that news, PPFA set up an emergency fund - featured on their website - and collected the missing funds (and more) within 24 hours. Outrage spilled over onto social media sites Twitter and Facebook, bloggers suddenly bled many shades of pink, forum discussions went into high gear, and both organizations were blasted as well as praised for their actions. Misunderstandings, misstatements, and a few facts flew across the networks.

I did some fact-checking, and so you will get the story straight, here's some critical points:

• Komen never funded abortions. They provided funds to PPFA (about $680,000 in 2011) for breast health exams only.
• A breast health exam is a clinical breast exam and a health history. No mammogram included.
• Planned Parenthood never provided mammograms. They gave out referrals to local radiology clinics.
• Komen would like to fund mammograms for low-income women - with grants given to mammogram facilities.
• PPFA will receive Komen funds in 2012 for breast health services.
• The U.S. Government gave Planned Parenthood $487.4M in tax dollars in 2010 (about 48% of their total income).
• Assuming abortions cost around $450, PPFA provided 329,455 abortions in 2010 at a cost of about $148,250,000.

What can you learn from this tempest? Check your facts before you blog, tweet, or post anything sensitive or potentially inflammatory. Social media outlets are powerful - but please use them responsibly. Once a storm like this blows over, wait to see how it settles out. There's no need to shred all your pink ribbons, because that symbol belongs to us all. We can keep moving forward to end the beast that is breast cancer. Let's not let anything stand in the way of that important goal.

Donors Replace SGK Funds in 24 Hours

Komen for the Cure, a well-established breast cancer charity, has stopped funding clinical breast exams and mammograms at Planned Parenthood affiliates and clinics. Komen's spokeswoman Leslie Aun told the media that their foundation has recently adopted a rule that prohibits the giving of grants to  organizations that are under government investigation. Planned Parenthood is currently under a congressional investigation by the House Oversight and Investigations subcommittee, led by Rep. Cliff Stearns of Florida. In 2011, Komen granted $680,000 to Planned Parenthood for breast health exams.

About 24 hours after the announcement, donors provided $650,000 to Planned Parenthood, nearly replacing the Komen funds for breast health services. According to The Chronicle of Philanthropy, Dallas philanthropists Lee and Amy Fikes sent a $250,000 gift. That gift may have helped bear fruit in the form of $400,000 in additional donations, an overwhelming response to Planned Parenthood's emergency fund request which dominated their website on Wednesday. Uninsured and low-income women will still be able to receive breast health services from Planned Parenthood, due to this support.

The Komen - Planned Parenthood partnership started in 2005, and has been under pressure since the beginning, primarily by pro-life groups. Thursday, Nancy Brinker, CEO of Komen, said in a video aimed at setting the record straight, "We are working to eliminate duplicative grants, freeing up more dollars for higher impact programs, and wherever possible we want to grant to the provider who is actually providing the life-saving mammogram." Planned Parenthood provides mammogram referrals - the actual breast imaging is done by other clinics in the local communities. Planned Parenthood does not provide mammograms.

Planned Parenthood has said that Komen's decision to defund them is politically motivated, and that this will hurt uninsured women who need breast health screenings. Nancy Brinker said, "We will never bow to political pressure, and we will always stand firm in our goal to end breast cancer forever. We will never turn our backs on women who need us the most." Brinker's statements suggest that grantees in addition to Planned Parenthood will be cut, but that, "We are not pulling any existing grants - current grants are not affected."

Both Komen for the Cure and Planned Parenthood are international organizations, with sizable budgets, partially funded by donations - and both offer help with women's reproductive health services. Both organizations offer services, support and health information to women. It remains to be seen how their financial bases will be affected by the split, and  how funds will be allocated to help poor and uninsured women in the fight against breast cancer.

What do you think? Does this funding split-up affect where your future donations will go? Does it change how you feel about either organization? Have these organizations done the right thing, in order to serve the people that benefit from them? Please leave your comments below.

• Will Susan G. Komen Backlash Hurt Walkers?
• How Do You  Decide Where Your Donations Go?

Meditation in Pink Photo © Microsoft

At my breast cancer support group, the leader always used a meditation or guided visualization to help us relax into the moment and become more present at the group. All of us had early stage breast cancer, and had been diagnosed within the last year, so you can imagine how high our stress levels were! Most of us were holding down jobs and caring for families when we were diagnosed - cancer was an unwelcome item on our list of worries and fears.

Research done at the University of Missouri confirms that our group leader was on the right track. Jane Armer, a member of the faculty on Nursing led a study on Mindfulness-Based Stress Reduction (MBSR) and its impact on breast cancer survivors. "MBSR is another tool to enhance the lives of breast cancer survivors," Armer said. "Patients often are given a variety of options to reduce stress, but they should choose what works for them according to their lifestyles and belief systems."

Two groups participated in the study - 19 women used Mindfulness-Based Stress Reduction and 17 did not. The MBSR group were tested and found to have lower blood pressure, heart rates, and respiratory rates than the other group. The research measured the participants' cortisol levels and found that stress was reduced in the MBSR group. MBSR has been shown to reduce physical pain and boost immune function, as well as improve mood by lowering anxiety, anger, and confusion.

All of the women in this study had been diagnosed and treated for early stage breast cancer. They had not taken medication for high blood pressure nor had they done meditation in the year prior to the study.  Women in the MBSR group met for 8 weeks to practice breathing exercises, gentle yoga, body awareness, and meditation. Each week the participants agreed to practice MBSR techniques for 45 minutes daily, on their own, though not all of them were compliant. During week six, they met for a full day retreat. All participants were evaluated before the study began, and the end of the 8-week program, and one month after it was completed.

Most of these women benefitted from the Mindfulness-Based Stress Reduction practices while they were in the program and doing their daily practice. However, when they were re-evaluated one month after the program ended, their benefits had begun to fade away. Once out of the structure of the group setting, they stopped doing MBSR on their own and did not join a formal meditation group that would have encouraged them to do regular Mindfulness practices. The researchers compared their study results with larger studies and found that when breast cancer survivors continue to use mindfulness meditation, their stress levels are lower. Transcendental meditation was found to yield similar stress-reducing effects.

Jane Armer's team thinks that the study would merit further research, especially if done with a larger group of newly diagnosed breast cancer patients, with a longer follow-up period and a different schedule for measuring cortisol levels. Yaowarat Matchim, a recent doctoral graduate at University of Missouri who worked on the study said, "I hope this research will be beneficial for other people, especially cancer patients."

• Everyday Mindfulness Exercises For Stress Relief
• Mindfulness Based Stress Reduction
• Free Healing For Your Body, Mind, and Spirit

_{Source: Matchim, Y., Armer, J.M., and Stewart, Bob R. (2010). Effects of Mindfulness-Based Stress Reduction (MBSR) on Health Among Breast Cancer Survivors. West J Nurs Res Nov 15, 2011 .}

"Will I survive breast cancer?" is the question that every patient asks. But when the patient is a college student, a young mother, or a rookie career woman, she faces choices and issues that menopausal women may not have to deal with.

Chemo may cause infertility in a woman who had planned on a family. Treatments for breast cancer can catapult a young woman into early menopause, complete with all the symptoms. She may go from feeling 20-something to more like 50-something (not that 50 is a bad thing!) Side effects of treatments may knock her energy down and keep her away from the gym while extra pounds may pile onto her previously trim figure. As she loses breast tissue and possibly her hair, body image issues may challenge her - and affect her relationships with friends, coworkers, and family members. What's more - her peers who are cancer-free may not understand her struggle and support groups for young women may be scare.

Dr. Patricia Ganz, of UCLA's Jonsson Comprehensive Cancer Center has just published research that confirms that when younger women are diagnosed with breast cancer, they face more mental and emotional issues that their cancer-free peers. Oncologists don't always provide information or direct their younger patients to support resources for these issues, and often don't discuss the common stresses and anxiety that comes during and after breast cancer treatment. To be fair, many oncologists probably aren't trained to counsel patients on emotional, relational, and mental health issues. But a thoughtful doctor - with some communication training - might make it a point to refer his patients to resources that are equipped to deal with, and offer support for such issues.

"We know that educating and providing younger breast cancer patients with information about what they might experience once their treatment ends is very helpful," said Dr. Ganz. "If they know what to expect, their anxiety level will be greatly reduced. Up to now, oncologists have not done a good job of preparing these women for what will come."

In order to help younger breast cancer patients, Dr. Ganz is working on a program that will be developed specifically for  young women. She's putting this together with help from Jonsson Cancer Center, the UCLA-LIVESTRONG Survivorship Center of Excellence and the Simms/Mann - UCLA Center for Integrative Oncology. The resources and services that Ganz's team builds will first be used with women in California, and she hopes that the program will become a model that can be used nationwide. Since Dr. Ganz has been doing research on quality of life after cancer treatment for 25 years, it is likely that she will put together a great package that will benefit many women.

_{Source:
University of California - Los Angeles Health Scie. "In Breast Cancer, The Quality Of Life For Younger Patients More Adversely Affected Than For Older Women."Medical News Today. MediLexicon, Intl., 24 Jan. 2012. Web., 25 Jan. 2012.}

For breast cancer patients with a p53 genetic mutation may someday start taking statins -- drugs that lower cholesterol -- to help fight their disease.  While BRCA gene mutations usually make the headlines, those are not the only genes that affect the risk and the development of breast cancer.  Having a customized treatment for carriers of p53 mutations could help treat, or perhaps prevent, cases of breast cancer.

Dr Carol Prives worked with an international team of biologists and oncologists on a laboratory study of human breast cancer cells that had the p53 genetic mutation. The scientists observed that these cells, which can develop into invasive breast cancer, responded to treatment with statins by either dying or becoming less aggressive. Statins take a route known as the mevalonate pathway to slow down your liver's production of cholesterol. These drugs lower your risk of heart attack and death, if your good and bad cholesterols are out of balance.

Dr. William Freed-Pastor took the study further by finding that the p53 breast cancer cells also used the mevalonate pathway to produce malformed, disorganized, aggressive cells and tumors. Cancer cells have irregular shapes and do not follow the normal life cycle of a healthy cell - instead, they multiply quickly and highjack your body's resources. When statins interfered with the mutant p53 cells, they either stopped growing or began behaving like much less aggressive cells.

Don't expect your oncologist to start you on statins soon, though. The research on statins and breast cancer has not made it to human clinical trials yet. Dr. Prives notes, "The study is adding the possibility that there may be classes of breast cancer patients who will respond better to statins than others." More research is needed in order to understand how well statins may work on preventing or reducing breast cancer. "The next step could be a trial of statins in women with breast cancer who have a mutated copy of the p53 gene."

_{Mutant p53 Disrupts Mammary Tissue Architecture via the Mevalonate Pathway. Cell, 20 January, 2012 Volume 148, Issue 1, p 244. William A. Freed-Pastor, Hideaki Mizuno, Xi Zhao, Anita Langerød, Sung-Hwan Moon, Ruth Rodriguez-Barrueco, Anthony Barsotti, Agustin Chicas, Wencheng Li, Alla Polotskaia, Mina J. Bissell, Timothy F. Osborne, Bin Tian, Scott W. Lowe, Jose M. Silva, Anne-Lise Børresen-Dale, Arnold J. Levine, Jill Bargonetti, Carol Prives.}

Barbie has been around since 1959 but she has yet to develop any sags, bags, or wrinkles. Indeed, no matter what time or what day it is, Barbie always looks flawless, confident, and ready to handle anything. Now a group on FaceBook is asking Barbie to think of going bald - in order to help out girls who have suffered from hair loss due to cancer treatments.  The group also sees the bald beauty as a coping aid for children whose mothers have lost their own hair to chemotherapy.

Mattel, makers of the iconic doll, have indeed made at least one Bald and Beautiful Barbie. She was made for a four-year-old girl who had lost her hair to chemo. Jane Bingham and Beckie Sypin started the FaceBook page as a way to lobby Mattel for a Bald and Beautiful Barbie - and that page now has over 133,000 "likes" from supporters. Bald dolls are not without precedent - my mother gave me baby dolls who were hair-free (as some real babies are), but Barbie has always been crowned with a variety of luxuriant hairstyles. Barbie has always been a fashion plate, and has often taken on good causes. She's been loaded with accessories from head to her tiny little toes, and accompanied by boyfriends, sisters, and girlfriends. Barbie, you might say, has a wide social network and a great support team. She never lacks for company or for clothes!

And Barbie's "mom" had breast cancer - that's inventor Ruth Handler - so you know that Mattel understands how chemo and hair loss can impact a child or a woman. Ruth Handler also invented a realistic breast prosthesis, "Nearly Me," which was a great improvement over the models available in 1970, when she had her mastectomy.

Children do have a hard time coping with the changes that cancer and its treatments bring to the body. The loss of health, energy, and hair - often a defining part of a parent's -- or one's own appearance -- is a jolt to the secure, normal world we are used to living in. How often does a child sit near a parent and play with their hair, or try to style their own hair like Mommy's?  Sue Glader, a breast cancer survivor, wrote the book "Nowhere Hair" to help her little boy cope with her sudden hair loss. Teresa Miriam Van Hoy lost her long brown hair to chemo, which upset her sons - they felt lost without her lovely locks. Likewise, headgear such as wigs, scarves, and caps can cause confusion for a young child as their parent copes with physical changes and side effects. We don't realize how much of our visual identity is contained in our hair, until we lose it -- and that seems more so, when it is lost to disease or chemo.

Bryan Stockton, Mattel's CEO, hasn't responded to the request -- some call it a demand -- for a Bald and Beautiful Barbie. It's not unusual for the company to make short-run collector's edition Barbies. From what I understand, Mattel hasn't turned down the idea -- and they haven't said yes -- yet. So sit tight -- if Mattel doesn't come up with a Bald and Beautiful fashion doll, then we may be seeing Bald Bratz or a Disney princess sporting a bare head -- by next Christmas!

So what do you think? Would having a bald doll help a child cope with their own, or a parent's chemo hair loss? Or would it cause confusion and sorrow? Let me know by leaving a comment.

Woman Using Lipstick Photo © Microsoft

Since around 2004, when Dr. Philippa Darbre published research on finding parabens in human breast tumors, scientists and cosmetics producers have wondered how those substances got there and if they caused breast cancer.  Dr. Darbre and others theorized that antiperspirants and deodorants that contained parabens - a common preservative - might have soaked into breast tissue through armpit skin. At the same time, the idea that antiperspirants sometimes contain aluminum salts - and that this metal might be carcinogenic - was also a subject of interest.

Dr. Darbre has teamed up with a surgeon, Mr Lester Barr, to study tissue samples from 40 women who has mastectomies between 2005 and 2008. A total of 160 tissue samples were taken from all areas of the breast, from armpit to breast bone. Most breast tumors had originated in the upper outer quadrant of the breast, nearest the axillary region. Even though few of these women had used antiperspirants or deodorants, 99% of the samples contained one or more paraben, while 60% of the tissue samples contained traces of all five of the most commonly used parabens. But this research doesn't nail down parabens as a cause of breast cancer.

"The fact that parabens were detected in the majority of the breast tissue samples cannot be taken to imply that they actually caused breast cancer in the 40 women studied," said Dr Philippa Darbre, Reader in Oncology at the University of Reading, who also led the 2004 study. "However, the fact that parabens were present in so many of the breast tissue samples does justify further investigation."

Parabens are used as preservatives in food, drugs, and cosmetic products such as shampoos, shaving cream and skin creams. They are usually used to prevent the growth of microorganisms in consumer products. Methylparaben, propylparaben, butylparaben, or benzylparaben may be found in many products that are already on your shelves, but unless you read the complete list of chemicals on every label, you may not realize that they are so common. While nobody wants to use moldy makeup or slimy shampoo, there are paraben-free products available, if you want more choices.

Parabens do have estrogen-like effects in the body, which cause some concern because 80% of all breast tumors are fueled by this key female hormone. Estrogen-receptor positive breast tumors require this hormone in order to develop, grow, and spread. Many breast cancer treatments act by lowering the circulating levels of estrogen during and after primary therapy.

The jury is still out as to whether or not parabens can cause breast cancer. "Our study appears to confirm the view that there is no simple cause and effect relationship between parabens in underarm products and breast cancer" said Mr Lester Barr, consultant surgeon at the University Hospital of South Manchester and Chairman of the Genesis Breast Cancer Prevention Appeal, which partly sponsored the study.

_{Source: Barr. Lester, Metaxas. George, Harbach. Christopher, Savoy. Luc-Alain, Darbre. Philippa, "Measurement of paraben concentrations in human breast tissue at serial locations across the breast from axilla to sternum", Journal of Applied Toxicology, Wiley- Blackwell, Janurary 2012, DOI: 10.1002/jat.1786.}

Wine, Glass, and Bottle Photo © Microsoft

Before you stock up on Cabernet Sauvignon - red wine that was used in a study about breast cancer risk - sit down and think it over. The study, published in the Journal of Women's Health, was based on a group of just 36 women. These gals were healthy premenopausal women, not pregnant or breastfeeding, not alcoholics, not taking any hormone therapies of any kind, had never had estrogen-fueled cancers, and none had any chronic health conditions. These women also had a healthy body mass index (BMI) which tells us that they were not overweight. All had healthy, regular menstrual cycles, and healthy livers.  This is a small study, done with a very select group of subjects, all of them living in fitness-conscious California.  I'm saying these women were not your average American moms on a fast-food diet with a beer chaser, a stockpile of ice cream, some excess weight on their frames and a prescription for birth-control pills.

The study aimed to find out if red wines were more effective at lowering the risk of estrogen-dependent breast tumors than white wines.  This is controversial because many studies show that alcohol consumption boosts your risk for breast and other cancers, while some components of red wine may act as natural aromatase inhibitors (AIs).  White wines don't have the same effect - they don't contain the same phytochemicals and isoflavones that are found in red wines.  However, both wines used in this study did contain alcohol, which can degrade your health.  This poses quite a difficult set of trade-offs for those who like a glass of red wine with supper.

Most breast tumors, especially in young women, are fueled by female hormones.  Alcohol tends to boost levels of estrogens in your bloodstream - a habit which can be as bad for your health as a daily pack of cigarettes or more than 5 years of hormone replacement therapy (HRT).  So what can you do?  Get the benefits of the phytochemicals and isoflavones from red wine by using unfermented grape juice, taking resveratrol supplemets,or eating red grapes.  If you really want a glass of wine with your meals, find a good-quality alcohol-free red wine and keep it on hand.  It just might help you keep a New Year's Resolution, and it could boost your health!

_{Red Versus White Wine as a Nutritional Aromatase Inhibitor in Premenopausal Women. Chrisandra Shufelt, M.D., M.S., C. Noel Bairey Merz, M.D., YuChing Yang, Ph.D., Joan Kirschner, M.S.N., N.P., Donna Polk, M.D., Frank Stanczyk, Ph.D., Maura Paul-Labrador, M.P.H., and Glenn D. Braunstein, M.D. Journal of Women's Health, Volume 00, Number 00, 2011.}

Chemo on IV Pole Photo © NCI, Linda Bartlett, photographer

During my treatments, I was in four different chemo clinics. They all had big, well-padded recliners, little tray tables, televisions, magazines, and ladies circulating around the room giving each of us individual attention. So far, that sounds like a beauty salon or an exclusive lounge, right? Only my hair never looked better after a visit to the chemo lounge, and yes, it was very exclusive!

After my first all-afternoon, multi-drug, educational chemo session, I realized that I had nothing much to do while stuck in that big chair, unless I liked watching daytime TV. I got bored in chemo, very bored. And since my side effects on Adriamycin, Cytoxan, and 5-Fu were rotten, I spent my time trying not to dread the trip home and the evening I would spend in the bathroom.

So in order to kill off my boredom while the chemo killed off my breast cancer, I came up with a variety of things to do. I looked around at what the other lucky patients were doing, and tried some of their activities.  I discovered Jackie Chan movies and went on a spree at our video rental store. A friend loaned me flicks from her extensive Hallmark movie collection. My boss let me take a laptop from the office, and I caught up on work. I sewed little pillows by hand. For loads of very distracting humor and mystery, I read Kinky Friedman's books.

Keeping occupied or at least engrossed in something unrelated to cancer and chemotherapy helped me get through the infusion sessions. It made the time pass more quickly, and I eventually felt better about going to chemo appointments. If you're going stir-crazy during chemo, try some of these 10 Best Things To Do During Chemo - I'll bet it will help you, too!