Breaking Research News from sources other than Breastcancer.org
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Lumpie, I wouldn't wait for insurance... it's just $300 (was $150 when I did it).. just pay for it on your credit card and the genetics test comes to you... it's an amazing test.
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I've seen a lot of conflicting info about Resveratrol and BC-
https://www.mskcc.org/cancer-care/integrative-medicine/herbs/resveratrol
“Do not take if-
- You have a hormone-sensitive cancer: Resveratrol has hormone-like properties that may stimulate some types of cancer cells."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059820/#!po=24.6667“These studies suggest that caution must be applied in adapting resveratrol for human use and may indicate that resveratrol can promote mammary tumor growth and formation depending on cell type and other factors."
These articles came up in a quick search of BC and Resveratrol.
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I think the Resvretrol only matters if you have the Tp53 or p53 gene (same thing). I took the Color Gen test and negative for P53.
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Lisey, thanks for the suggestion re the tests. I have one to their websites and hope that they will send me info.
So disappointed to learn that red wine will not cure cancer!! I was looking forward to doing my part!
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Long-Term Impact of Regional Nodal Irradiation in Patients With Node-Positive Breast Cancer Treated With Neoadjuvant Systemic Therapy
https://www.practiceupdate.com/C/69971/56?elsca1=e...
- This study evaluated the impact of regional nodal irradiation on locoregional recurrence and disease recurrence in 1289 women with stage II/III breast cancer with cytologically confirmed axillary metastases who received neoadjuvant systemic therapy.
- Adjuvant regional nodal irradiation reduced the risk of locoregional recurrence and disease recurrence across subtypes and particularly decreased the risk of disease recurrence in patients with HER2+ disease treated with trastuzumab.
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*Collateral Damage Associated With Metastatic Breast Cancer*
https://www.practiceupdate.com/c/69781/67/13/?elsc...
- In this study, 515 participants with metastatic breast cancer completed questionnaires related to collateral damage and associations with health behaviors, illness management, and psychological health. The most prominent concerns were related to mortality/uncertainty. The most collateral damage was reported in participants aged 49 years or younger, those with limited financial resources, and those with children under age 18 at home. Significant associations between collateral damage and compromised psychological health, poorer health behaviors, and lower illness management efficacy were reported.
- These results highlight long-term consequences of metastatic breast cancer.
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Lumpie, Thank you for the information on the radiation treatment of local recurrence. I had recurrence in the axillary (10/14) and was told at the time that radiation will reduce local recurrence by 90% but didn't have an effect on distant. BS!!! I think the surgeon and the RO had the guts to recommend it before adjunct chemo and the Onc conceded. Here I am 2.5 years later...still NED. Not bragging, just relieved I made a strong choice.
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7of9: Very glad to know that you found the article and research reassuring! There is so much research... and so many studies... it's hard to keep up. I hope that this forum provides some shortcuts for those interested but with limited time (or inclination) for keeping up. Hoping the NED continues!!
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Lumpie, here's a shout out from Vienna, Austria. I can't tell you how grateful I am for your (and other folks') posts. It is so empowering to have access to this information. I have 2 tween kids to keep up with and am living in a foreign country, so I don't have time to do too much research myself. I really value the time and energy you put into this. Just wanted to let you know that your posts are sending positive ripple effects half way around the world. Thank you!
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Yeah - Thanks, so much for the kind words and encouragement AlabamaAustria! My brother and his family were in Europe for a while so I have an appreciation for what a big undertaking and adjustment that is! I loved getting to visit. Take care and enjoy while you are there (if it is temporary)!
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Aromatase Inhibitors for Preventing Breast Cancer RecurrenceArimidex, Femara, and Aromasin Comparison and Side EffectsBy Lynne Eldridge, MDUpdated December 11, 2017
https://www.verywellhealth.com/aromatase-inhibitors-for-preventing-breast-cancer-recurrence-4153970
Arimidex, Femara, and Aromasin Comparison and Side Effects
Updated December 11, 2017
If you have finished primary treatment for early-stage, estrogen receptor-positive breast cancer, your doctor will likely recommend hormonal therapy for a period of 5 to 10 years. The choice of drugs will depend on your menopausal status, with aromatase inhibitors usually the first choice for post-menopausal women as well as some premenopausal women along with ovarian suppression therapy.
What is the difference between Femara, Arimidex, and Aromasin, what are the side effects might you expect, and how do these medications differ from tamoxifen? How effective are they in preventing the recurrence of breast cancer?
Aromatase Inhibitors: Definition
Aromatase inhibitors are medications that block the production of estrogen in the body. In doing so, they reduce the risk of breast cancer recurrence (and increase survival) for women who have early-stage estrogen-receptor positive breast cancer and are postmenopausal. They may also reduce the risk of recurrence for some women with premenopausal breast cancer more than tamoxifen. There are three different medications in this class of drugs.
Aromatase inhibitor treatment is begun after the primary treatment of a breast cancer is complete. This includes breast cancer surgery and possibly chemotherapy and/or radiation therapy. Treatment is continued for 5 to 10 years depending on an individual's risk of recurrence and tolerance of side effects.
Hormone Therapy for Breast Cancer
Breast cancers that are estrogen receptor positive are essentially fed by estrogen. Breast cancer cells, like normal breast cells, have estrogen receptors on the surface. Cancers that are considered "positive" for estrogen or progesterone receptors are those in which these estrogen receptors are primarily responsible for the growth of the cancer.
The role of estrogen in these tumors is to bind to estrogen receptors to stimulate the growth and division of the cells.
In order to slow or stop the growth of breast cancer cells, we thus need a way to either reduce estrogen in the body or block the estrogen receptors so that estrogen that is present can't bind.
Mechanisms of Hormonal Therapy: Tamoxifen and Aromatase Inhibitors
Before menopause, the ovaries are the main site of estrogen production in the body. The drug tamoxifen works by blocking estrogen receptors on breast cancer cells (and other cells) so that estrogen cannot bind. Tamoxifen actually has anti-estrogen effects on some parts of the body such as the breast, but pro-estrogen effects on others, such as the bones (it can reduce bone loss). First approved in 1998, tamoxifen has been the mainstay of hormonal therapy for breast cancer for over two decades.
After menopause, the primary source of estrogen is from the peripheral conversion of androgens (male type hormones found in fat cells) into estrogen. This reaction is facilitated by an enzyme known as aromatase. Aromatase inhibitors work by blocking aromatase so that androgens cannot be converted to estrogen in the body.
Since the primary source of estrogen before menopause is the ovaries, not the peripheral conversion of androgens, aromatase inhibitors alone would be ineffective in women who remain premenopausal (and a woman may still be menopausal even if her periods go away from chemotherapy).
Understanding Aromatase Inhibitors: Arimidex, Femara, and Aromasin
There are currently three different aromatase inhibitors that are approved for reducing the risk of recurrence for women with early-stage, estrogen receptor-positive breast cancer. These include:
- Arimidex (anastrozole)
- Femara (letrozole)
- Aromasin (exemestane)
These medications appear to be roughly as effective in preventing recurrence but do have some differences. Aromasin is a steroid, whereas Arimidex and Femara are not. The toxicity of these three medications also appears to be similar.
Tamoxifen and Breast Cancer Recurrence
We have a vast amount of information at this time looking at the use of tamoxifen and the risk of breast cancer recurrence. Overall, when used for early-stage, estrogen receptor-positive tumors, the drug reduces the risk of recurrence by roughly 50 percent. Tamoxifen also lowers the odds that you will develop another tumor in your breast (if you had a lumpectomy) or that you will develop a second breast cancer in your other breast.
Aromatase Inhibitors and Breast Cancer Recurrence
Aromatase inhibitors appear to reduce the risk of recurrence even more than tamoxifen and are now considered the drugs of choice for postmenopausal women or those who are premenopausal and have undergone ovarian suppression therapy.
Updated Guidelines for Hormonal Therapy
For postmenopausal women taking an aromatase inhibitor, 2017 guidelines now recommend using the bisphosphonate Zometa (zoledronic acid) along with the aromatase inhibitor. The combination of the two drugs together appears to reduce the risk of breast cancer spreading to the bones more than that of the aromatase inhibitor alone. Learn more about the use of bisphosphonates for early-stage breast cancer.
Aromatase Inhibitors in Premenopausal Women With Ovarian Suppression
The question of whether adding ovarian suppression therapy (using gonadotropins to medically cause menopause) to tamoxifen has been a matter of some debate. A study published in the New England Journal of Medicine in 2015, however, seems to indicate that premenopausal women who are treated with ovarian suppression therapy so that they may use an aromatase inhibitor instead of tamoxifen may have better survival rates.
Another study published in the same journal in 2014 found that Aromasin (exemestane) combined with ovarian suppression therapy significantly improved survival compared with tamoxifen plus ovarian suppression therapy.
Since aromatase inhibitors have significantly more musculoskeletal side effects and can lead to bone loss, many oncologists recommend reserving this approach for premenopausal women who have Stage 2 and Stage 3 breast cancers, which are more likely to recur.
Side Effects of Aromatase Inhibitors
As with any medication, side effects and adverse reactions may occur for some women on aromatase inhibitors.
Some of the more common side effects are those related to the reduction of estrogen in the body (menopausal symptoms) and include hot flashes, night sweats, vaginal dryness, and vaginal discharge. While these symptoms can be annoying, studies suggest that hot flashes are a good sign in women with breast cancer, and those who experience these side effects have better outcomes.
Joint and muscle pain is also a very common side effect of aromatase inhibitors. It is these body aches that are one of the greatest reasons for women discontinuing these drugs.
One of the more serious concerns on aromatase inhibitors is bone loss, with the use of these drugs potentially leading to osteoporosis and fractures. Many oncologists recommend testing bone density prior to beginning these medications as a baseline, and follow-up depending on the results of this initial test.
The addition of bisphosphonates (Zometa) to aromatase inhibitor therapy may significantly reduce this risk. Bisphosphonates were first approved as treatments for osteoporosis, and Zometa has been found to reduce the risk of both spine and hip fractures (and the disability which often goes with these fractures). Zometa was then recommended for people with metastatic cancer, as it could reduce bone pain and the risk of fractures related to bone metastases. Further studies suggest that Zometa alters the microenvironment of the bones so that breast cancer cells can't "stick" as easily. In clinical use, it appears to reduce the chance that a person's breast cancer will spread to their bones.
Aromatase inhibitors are also associated with an increased risk of heart problems. While this is true, it's been found that serious and life-threatening cardiovascular diseases such as heart attacks and strokes are not any more common in women who take aromatase inhibitors than in those who do not take these drugs. Heart conditions that occur more commonly on these medications include heart rhythm disorders, heart valve problems, and pericarditis (inflammation of the membranes surrounding the heart).
If Side Effects Make You Want to Stop Your Medication
The side effects of aromatase inhibitors, especially the body aches, can be challenging at times. Unfortunately, these side effects result in too many women discontinuing their treatment prematurely and losing out on the recurrence prevention (and improved survival) they offer.
If you are suffering side effects, talk to your oncologist. Even though the safety and toxicity of the three drugs in this class are similar, roughly a third of women are able to tolerate a different medication in this class.
Switching From Tamoxifen to an Aromatase Inhibitor
Some people who are premenopausal and treated with tamoxifen may become postmenopausal during treatment. This is especially true for women who develop breast cancer around the time of menopause. Since chemotherapy often results in amenorrhea (absence of periods), blood tests may need to be done to determine whether you are truly in menopause. Studies have found that switching to an aromatase inhibitor following 2 to 3 years of tamoxifen therapy results in better survival than continuing on tamoxifen.
Length of Treatment With Aromatase Inhibitors
While it was recommended that people continue tamoxifen or an aromatase inhibitor for 5 years in the past, newer data suggest that taking these medications for 10 years further reduces the risk of recurrence. It's fairly well known that breast cancer may recur many years or even decades after the primary tumor is treated, and this risk is particularly high in women who have had estrogen receptor-positive tumors. We don't know why some breast cancer come back after years or decades, but we know this happens too often.
Both tamoxifen and aromatase inhibitors appear to continue working after they are discontinued, though some researchers believe that continuing hormone therapy may be extended to even longer than 10 years in the future. That said, the possible benefits need to be weighed against the risks.
Cost of Aromatase Inhibitors
Unlike tamoxifen which has been around a few decades and has generic forms, the aromatase inhibitors can be expensive. Insurance plans often cover part of the cost, though they may only offer coverage for one of the medications in this class. If you are having difficulty affording your AI, check out these tips on managing the cost of hormonal therapy.
A Word From Verywell
Aromatase inhibitors work by preventing the production of estrogen in fat cells, the primary source of estrogen in postmenopausal women. We've known for a few decades that tamoxifen can significantly reduce the risk of breast cancer recurrence and these numbers appear to be even better with the aromatase inhibitors.
Unfortunately, and as with any medication, side effects are common, and the body aches may be the most annoying. If you are experiencing these, work with your oncologist. Sometimes it's helpful to switch to a different drug in this class. Integrative treatments ranging from massage to meditation may also be helpful. It's also important to remind yourself why you are taking the drug. Side effects can be annoying but are preferable to having a recurrence. Now that bisphosphonates are recommended along with aromatase inhibitors, the concern of reduction of bone density and osteoporosis may be less of a problem then in the past.
Keep in mind that every woman is different and there is not a "magic" duration of time for which everyone should take these drugs. For each person, it's important to weigh the potential benefits against the experienced side effects and potential risks. Make sure to ask a lot of questions and be your own advocate in your care. Nobody is more motivated that you are to live your life free from cancer.
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June 06, 2018
Why Medicine Leads the Professions in Suicide, and What We Can Do About It
https://www.empr.com/features/suicide-rate-twice-a...0 -
Marijen - really thought provoking article. Thanks for posting.
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You mean the one about the Physician’s? Page two is a blank but page three is there. I think it’s just the two pages. On page three it talks about the physicians spending most of our appointments on the computer which is not good doctoring. And the interference of outside interests between the doctor and patient.
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I actually got all three pages. Must agree that docs don't have the training anymore, or the time, to just sit & look at the patient. I go in with a list and won't be put off.
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Yes, I’m so tired of that. By the time they are done with their checklist and agenda there is not time for my concerns. I try to squeeze them in knowing that. I think my MO might be burnt out. Not good
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Easy on the Eyes:
Protecting Eye Health Through Cancer Treatments
https://www.curetoday.com/publications/cure/2018/s...
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Barriers to Chronic Pain Treatment Shared with FDA – Part One
Posted on July 3, 2018 in Governmentwith 33 Comments
Read more @ http://nationalpainreport.com/barriers-to-chronic-...
By Ed Coghlan.
The results of a robust survey authored by Terri Lewis, Ph.D. and promoted by the National Pain Report have been shared with the U.S. Food and Drug Administration in advance of the July 9th public meeting for Patient-Focused Drug Development on Chronic Pain.
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Chronic pain patients, overlooked in opioid crisis, getting new attention from top at FDA
Jayne O'Donnell and Josephine Chu, USA TODAYPublished 3:17 p.m. ET July 2, 2018 | Updated 4:29 p.m. ET July 3, 2018
The Food and Drug Administration is working to address how the opioid epidemic response has affected chronic pain patients, who often can't get relief. Ja'Kayla Mordecai
Chronic pain patients and the groups that represent them suay the escalating government response to opioid addiction ignores their need for the painkillers and doctors who will prescribe them, leaving some out of work, bedridden and even suicidal.
Tough state laws on prescribing that took effect Sunday, Centers for Disease Control and Prevention (CDC) dosage guidelines and state and federal charges against doctors who prescribe opioids are an overreaction to addiction, according to several dozen people with unremitting pain who contacted USA TODAY.
CDC researchers said in an article in April in the American Journal of Public Health that they overestimated the number of Americans who have died of prescription opioid overdoses. Because of inaccurate tracking methods, the CDC said it incorrectly counted many overdoses from illicitly manufactured synthetic opioids such as fentanyl as prescription drug deaths.
The CDC had estimated 32,445 Americans died from overdoses involving prescription opioid pain medication in 2016. The CDC's new estimate of fatal overdoses from prescription opioids is 17,087, or 53 percent of the original estimate.
Even though state laws say chronic pain patients who need medication will receive it, "that's not what's happening," says Lauren Deluca of Worcester, Massachusetts, who founded the Chronic Illness Advocacy & Awareness Group last year after her own challenges getting the opioid painkillers she needed.
The Food and Drug Administration (FDA) is trying to undo some of the damage through a host of actions that include a public meeting July 9 on chronic pain drug development and the challenges pain patients face in getting the treatment they need.
Moriah White of Braxton County, West Virginia, calls herself an "opioid war casualty" and said she welcomes any help the government is willing to offer. She had to leave a job teaching special education because of the condition fibromyalgia, which makes her skin feel like "a sunburn scrubbed with a wire brush."
Danny Elliott's pain doctor was charged last week in a "takedown" in Florida and Georgia of 600 doctors accused of health care fraud and illegal opioid prescribing by Justice Department and Drug Enforcement Administration officials. The former pharmaceutical industry salesman was electrically shocked in 1997, which left him with a traumatic brain injury that was so painful he contemplated suicide. He is trying to find a new doctor. His previous one was the first "who actually gave me some relief from my pain."
DEA Miami Field Division Deputy Special Agent in Charge Jaime Camacho said last week that the agency is "committed to ending the opioid crisis that continues to plague Florida and endanger the welfare of our communities."
Faces of Chronic Pain
Clinical psychologist Michael Schatman, editor in chief of the Journal of Pain Research, who describes himself as an "opioid moderatist," said about 90 percent of people are better off without opioids.
But it's the 10 percent who need them that are terribly harmed by policy and enforcement actions pushed by groups he said are "radically anti-opioids."
"For years, federal and state legislators did nothing, leaving it up to state medical boards and the regulatory agencies, which was the problem," said Schatman, research director at Boston Pain Care, which has treated hundreds of patients without an overdose or suicide. "Now all of a sudden, state legislators are passing incredibly draconian laws that are and have the future potential to literally kill people."
Food and Drug Administration Commissioner Scott Gottlieb during an April 5, 2017 interview in his office. (Photo: Ja'Kayla Mordecai)
He cited laws, such as one that took effect July 1 in states including Florida, that tighten regulation of doctors who prescribe opioids and other controlled substances. End-stage cancer patients and the elderly don't have long enough to live to become addicted and suffer needlessly because of the law, Schatman said.
Florida House Speaker Richard Corcoran, who attended the bill signing, defended the approach, according to the Orlando Sentinel.
"Is that an inconvenience? Yes," said Corcoran. "Is an inconvenience worth saving 50,000 lives nationwide? Absolutely."
That attitude has led some doctors whose patients have had no problems with opioid prescriptions to back away from prescribing them. Schatman said there's a big difference between depending on opioids to survive and becoming addicted to them.
Moriah White is a former special education teacher who is now disabled due to fibromyalgia. (Photo: Courtesy of Moriah White)
Cathy Mitchell, a disabled registered nurse, suffers from a long list of injuries and diseases, including osteoarthritis, post-major lumbar surgery for ruptured discs, cervical scoliosis and bilateral carpal tunnel syndrome.
Disabled since 2013, she said only opioids provide the pain relief that allows her to "function daily."
She has to go to a pain clinic every 28 days and her primary care doctor every three months. After 10 years of being treated for pain and anxiety "without causing any problems," Mitchell can no longer be treated for both.
Making matters worse for what's estimated to be millions of patients, the Centers for Medicare and Medicaid Services plans to drop coverage of opioid medications above a certain dosage starting next year.
Elsewhere at the Department of Health and Human Services, the FDA's plans include encouraging medical device development for pain and hosting a drug development meeting July 9 that focuses on how hard it is for patients with chronic pain to get treatment and what solutions exist.
"The reality is that the opioid drugs work for certain patients, and there are certain situations where the opioids are the only drugs that work for those patients," FDA Commissioner Scott Gottlieb said.
The FDA's success will be tested by the fact that physicians are largely policed by states and that even as opioid prescriptions go down, overdose deaths increase as many suffering from addiction have moved on to heroin, often in combination with other drugs. The FDA recommended that doctors reduce opioid prescriptions, but doctors and their medical societies remain opposed.
Clinical psychologist and pain researcher Michael Schatman says opioid painkillers are not appropriate for about 90 percent of people. (Photo: Courtesy of Michael Schatman)
State medical boards have been especially aggressive in some states going after the licenses of doctors for overprescribing opiate painkillers.
Chronic pain patients across the country said that when physicians lose their license or stop treating pain patients, it can be difficult, if not impossible, to find a new doctor willing to take them on as a patient.
In Virginia, then-Governor Terry McAuliffe boasted on a panel in October that the state led the nation in reductions in opioid prescribing, including a drop of a third in the prior six months. Doctors aren't allowed to prescribe or refill a prescription for opioids for longer than 10 days without a written explanation.
Two years ago, the state medical board suspended the license of Jenny Austin's primary care doctor.
Austin, a former investment banker, had to take so much time off from work for crippling pain from migraines and a neurological disorder, she sought a higher dose of painkillers. She continued to see her Virginia doctor even after she moved to Louisiana, because she was "desperate to find a solution that would reduce my hospitalizations."
Instead, she's out of work and bedridden much of the time.
To help remedy this, the FDA is considering encouraging medical professional societies to develop evidence-based guidelines on appropriate prescribing and the possibility of incorporating new prescribing information on opioid painkiller labels.
Schatman is skeptical the efforts will make much difference, in part because he said "there's no empirical evidence that apps and other 'medical devices' can improve the quality of pain medicine in the United States."
"The opioid pendulum has swung awry," Schatman said. "This current climate of opiophobia is ... leaving patients more dysfunctional, with diminished quality of lives, severe hopelessness and increasing suicidality in the chronic pain patient population."
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Recommendations to the FDA About How to Improve Chronic Pain – Part Two
Posted on July 4, 2018 in Government with 14 comment
By Ed Coghlan.
http://nationalpainreport.com/recommendations-to-t...
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Marijen - THANKS for the article on Aromatase inhibitors. It answered s lot of questions I’ve had. Thanks for your dedication to this thread!!
Lanne
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Thanks Lanine, glad to help. Lynne Eldridge has written a lot of good articles.
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Thanks so much for the research, ladies. i read this thread religiously and I appreciate your continued dedication to keeping us up to date.
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Top oncologist to study effect of diet on cancer drugs:
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Lumpie, The Medscape article about Starbucks coffee is so interesting. I just recently became aware of the California warning (late to the game, I guess) and now I'm seeing it all over the place. I just returned a lawn sprinkler to Ace hardware (to corporate, not the store) because it has the warning. I'm guessing there are many, many items with the warning. Now that I know to look I'll probably see it everywhere.
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aterry, wait! What? A lawn sprinkler may cause cancer!?
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marijen, my reaction exactly. Whaaatttt?
Although here in Arizona, because we are in terrible drought, we don't water anything much anyway.
And where was this Starbucks article (Lumpie)? Did I miss it somewhere?
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Marijen, There is a warning on some products that I refer to as the California warning. It's not new but I just recently became aware of it. I was buying car cleaning stuff and one item I looked at (didn't buy) had a big yellow warning "This product was manufactured using one or more chemicals known to the State of California to cause cancer and or birth defects. Wash hands after using." Since then I've been looking to see where else the warning pops up. I bought a new lawn sprinkler at Ace hardware (DoItBest) and didn't see the tiny warning until I got home and was reading the set up instructions. I was mad at myself for buying it. I packed it up and mailed it back to the company with a letter; I didn't want to return it to the store to be purchased by some other person. I'm sure the manufacturer will say that the risk is minimal, but....... Now I use a 30-year-old sprinkler that is made from cast iron.
Mostly I'm bummed because it's clear that many, many things that are in our daily orbit are questionable. I'm sure it's not possible to avoid them all and even making informed choices is confusing.
Here's a piece from the American Cancer Society about the warning: https://bit.ly/2ldsDg9
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Aterry, thanks for the clarification. I wonder if the sprinkler was made in China. I think it’s great we are getting warnings. Especially if on kitchen utensils and toys. I don’t live in CA. If they keep up these warnings maybe manufacturers will get the message. I agree we are exposed to too much toxins in our environment. And now the animals are going extinct because of the way we are degrading the planet. Smog is my pet peeve. I just want clean air and clean water to start. Not adulterated water. Not filthy air. We are all entitled to that at the least.
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