BREAST CANCER

OCTOBER 2012

BREAST CANCER AWARENESS MONTH

 

One in eight women develops breast cancer. More than half are over age 50.

 Early detection correlates with better long-term health and cure.

The founding goal for Breast Cancer Awareness Month focused on educating women about the importance of obtaining mammograms for early diagnosis. The campaign began in 1985 as a partnership between the American Cancer Society and the drug division of Imperial Chemical Industries (now AstraZeneca). Awareness and evaluations have improved since its inception. Many supportive organizations have partnered to raise money for breast cancer research and help women obtain life-saving diagnosis and treatment.

Doing self breast exams can identify abnormalities and trigger life-saving interventions by a physician. Breast cancer experts may not agree on the frequency of mammograms, but women in high-risk categories typically start having mammograms by age 40 and continue annually. Nearly 75% of all women who develop breast cancer, have zero risk factors.

Recognized risk factors are: cancer in one breast increases your risk for additional unrelated or same type cancer in the other breast, family history, (familial breast cancer genes increase a woman’s risk to 85% chance of developing breast cancer, ovarian, pancreatic and other cancers over a lifetime). Other slight increased risk occurs in women who: give birth to their first child at age 35 or older; have early onset menses (before age 12); are overweight; experience late menopause (over age 55); consume alcohol daily. There are additional factors. For more information consult reliable websites such as: www.webmd.com/breast-cancer/guide

Most abnormalities found on mammograms are not breast cancer. Calcifications are usually non-cancerous and are related to aging. However, tiny specs appearing in clusters called “microcalcifications” raise concerns for cancer.

Mammograms often detect fluid-filled sacs called cysts. Sometimes an ultrasound of the breast is required to further evaluate the abnormality.  An ultrasound exam using noninvasive sound waves helps determine whether a lump is a solid mass requiring a possible biopsy or a benign cyst requiring no further treatment.

Breast cancer is not generic – there are many unique cell types, some more aggressive than others. Breast tissue consists primarily of lobules which produce milk and ducts that carry milk to the nipple. Fatty tissue enhances size, but the functional part of the breast is two fold: lobules and ducts. Most cancer originates in these two sites. Each cancer cell carries different protein markers on the cell surface. It is from these markers, called receptors that specific cancer types are identified and appropriate treatment of cancer determined. For more details on breast cancer see: www.cancer.org/cancer/breastcancer/detailedguide/

Breast cancer is a complex disease. There are many different cell types and treatment protocols available. Information on treatment plans and outcomes are shared by physicians internationally. Your local cancer specialist has current detailed information to provide the best treatments. Additional diagnostic methods are used including a breast MRI.

On a personal note, after having annual mammograms for years and a few weeks before my next scheduled mammogram,  I felt a lump. A needle biopsy revealed a high grade cell type: negative progesterone and negative estrogen receptors plus positive HER-2 receptors.  Approximately 200,000 new breast cancer cases are found each year; 25% of these are HER-2 + (Human Epidermal Growth Factor-2). This is an aggressive, fast growing form of breast cancer. I believe a self breast exam plus mammography, resulting in early detection, may have saved my life. Time will tell. There is a monoclonal antibody drug targeted specifically to HER-2 cell receptors. In fact there are two similar drugs now available. Following a double mastectomy, I opted for aggressive chemo therapy and a year of Herceptin, (a monoclonal antibody drug).

The over-all survival rate for women with breast cancer is 90%, a big improvement from a rate of 63% – 50 years ago. If the cancer is identified and treated before it spreads to the lymph nodes, survival at 5 years is 98%. Even if it has spread to local lymph nodes the survival rate at 5 years  is 84%. Knowing the incidence of breast cancer and the potential for long-term survival, if it is treated early, I encourage all women to do self breast exams, discuss any findings with a physician and obtain regular mammograms.
Betty Kuffel, MD

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Helping Your Heart and Your Memory

Resveratrol: Its Beneficial Effects

Would you like to make a simple healthful change to benefit your heart? Resveratrol elevates HDL levels, the good cholesterol. Having a high HDL doesn’t mean you are protected against developing heart disease, but those with high HDLs appear to have reduced risk for coronary artery disease. Two human studies have also shown resveratrol can boost insulin activity in Type II diabetics and reduce harmful blood vessel disease leading to diabetic blindness. Another effect is the reduction in fat cell production of inflammatory compounds that contribute to heart disease and tissue damage associated with diabetes.

This natural product, obtainable in most pharmacies and health food stores, stimulates a family of sirtuin proteins in the body that are gene regulators. Metabolic and biological aging processes are affected by sirtuins, especially the protein SIRT1. Researchers at Howard Hughes Medical Institute found SIRT1 plays a roll in decreasing aging and aids learning and memory. Most of us could benefit from that!

Another protein resveratrol stimulates is CREB, which  strengthens connections between neurons. The CREB activity is increased by SIRT1.  There won’t be an SIRT1 pill coming soon, but understanding this relationship shows promise in understanding and reversing degenerative processes causing memory loss. Resveratrol in your diet may help your memory.

Diets rich in resveratrol protect the heart, increase fat burning and reduce weight gain—and in mice, extend lifespan. The compound is found in grapes, grape products, wine, peanuts and some plants. A trade product containing resveratrol called Reversitol comes in both pill and liquid forms. It tastes like grape juice and is easily tolerated as a food supplement.

Betty Kuffel, MD

INNOVATIONS IN CANCER TREATMENT

Understanding Cancer: Targeted Treatments

Cancers develop from multiple causes including genetic factors, infection, environmental toxin exposure and lifestyle factors such as tobacco use. Some are very slow growing while others grow and spread rapidly. No cure-all for cancer is likely in the near future. A strong immune system efficiently suppresses cellular and precancerous changes. With age and reduced immunity and sometimes for unknown reasons, abnormal cells grow and spread by direct extension to surrounding tissues, and metastasize throughout the body via blood and lymph. Each year treatments improve and many more of them are targeted at mutations and cell surface markers.

Two heritable disorders are mutations in the human genes that belong to a class of genes that are tumor suppressors, the BRCA1 and BRCA2 genes. The normal genes help stabilize DNA and prevent uncontrolled cell growth. Mutations block the stabilization and lead to early breast and ovarian cancer.

BRCA= BReast CAncer Susceptibility gene 1 and 2, affect both men and women. Men who carry this gene are also at risk for breast, and possibly pancreatic, testicular and early prostate cancer.

Other harmful mutations in the BRCA 2 gene increase risk of many other cancers including melanoma skin cancer.

Knowing you carry the BRCA gene can allow you to make decisions before the cancer develops. In women without the abnormal gene, the lifetime risk of developing breast cancer is 12% or 120/1000. In women with the harmful BRCA1 or BRCA2 mutation, they have a 60% chance or 600/1000, of developing the cancers. Many affected women make the decision to have both breasts and ovaries removed before cancer develops. This may sound drastic, but it is life saving.

An example of targeted treatment based on cell surface receptors is the Human Epidermal Growth Factor Receptor 2 (HER2) an abnormal protein found on breast cancer cells. The abnormal cancerous cell growth is triggered by an excess of HER2 due to a gene mutation and is found in other cancers, not just breast. This form of breast cancer tends to be more aggressive than other types. It is also less responsive to hormonal treatment.

Luckily there are two very specific drugs that target HER2, killing the abnormal cells but not the normal ones. These are Herceptin (Trastuzumab) and Tykerb (Lapatinib). Both may be used in combination with other chemo therapy drugs. They are not without side effects as both can cause heart toxicity and allergic reactions.

Other examples of innovations in the treatment of cancer patients are a vaccine that targets a particularly aggressive brain tumor (glioblastoma). This new treatment significantly prolongs life.  Another is melanoma skin cancer.  40-60% of them contain a mutation that encodes BRAF gene. The BRAF mutation is associated with features of high risk aggressive melanoma. This gene makes a protein (B-Raf) which is involved with directing cell growth. Inhibitors have been developed to target the abnormality; one year ago Vemurafenib was released to treat late-stage melanoma.

Betty Kuffel, MD