Don’t Make Me Set Myself on Fire: A Breast Cancer Surgeon Talks Revolution
By Dr. Kathleen T. Ruddy
Published by Vera Viner at Smashwords
Copyright 2011 Dr. Kathleen T. Ruddy
Smashwords Edition, License Notes
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
Table of Contents
1) Introduction
2) Winter 2008/2009
3)Spring 2009
4) Summer 2009
5) Fall 2009
6) Winter 2009/2010
7) Spring 2010
8) Summer 2010
9) Fall 2010
10) Winter 2010/2011
11) Spring 2011
12) Summer 2011
13) Fall 2011
Introduction
I know this may sound melodramatic, but I believe we’re just about out of time. The rising tide of new cases of breast cancer, like everything else in this great country, is racing toward a wall of insolvency. We still don’t know what is causing all of this disease, we’re far from curing it, and we’re going to run out of money to spend on it very soon. It may not seem so, but the situation is dire. Let me explain.
Whereas the overall survival from breast cancer has improved over the past forty years, the improvement is largely due to early diagnosis – the result of mammogram screening – and the use of chemotherapy and targeted therapy in patients with early-stage disease. In general, survival has increased about 25% since 1970 as a result of these two factors, that is, stage migration and chemotherapy. But for the tens of thousands of survivors who now have Stage IV disease survival hasn’t budged in decades. The five-year survival for women with Stage IV breast cancer is 20%, just where it was in 1970! Forty thousand women will die of breast cancer this year, and another forty thousand plus will take their deathbed places next year. Despite some progress and abundant promises, the War On Cancer is in a state of siege with no end, or cure in sight. But what’s worse is that the incidence of breast cancer has doubled since President Nixon signed the National Cancer Act in December 1971.
The race to cure breast cancer has become a marathon, while the cost of treatment rises like a hot air balloon. The myriad ways we can diagnose and treat the disease has grown faster than inflation, which is saying a lot. This is not sustainable. Very soon, perhaps in just a few years, our country is going to flat run out of money to treat this or any other disease.
The United States government has three general fiscal bills to pay: fixed obligations, military discretionary spending, and non-military discretionary spending. Our fixed obligations are things like Medicare, Medicaid, and Social Security. At the present time, the cost of these obligations exceeds tax revenues by 10% per year. How long do you think you’d last if the bills you absolutely had to pay exceeded your income and were growing by 10% per year? Not long, the other two general categories, military and non-military discretionary spending, are funded entirely with borrowed money – our global credit card, call it Master World. And like any credit card obligation, the interest payment grows as the debt grows – and soon become unsustainable. In this case, soon is very soon. Right now, the world is more than happy to lend us all the money we need to cover the 10% rise/year in fixed obligations costs, as well as all the costs of military and non-military spending. But this debt addiction is about to come to a crashing end whether we like it or not. It’s not a matter of if, but when; and when is soon. Where does that leave funding for breast cancer research, in its present form or, for that matter, even basic care for breast cancer patients? God only knows, but I’d say nowhere good.
There is no point in trying to petition Congress to save the day for breast cancer research or treatment. Congress is going to be very busy trying to save the day for grandma, grandpa, and the disabled– and they’re going to have a hard time doing it, try as they might. Breast cancer research funding won’t even appear on the list of things to save or do. If you want to see what Capitol Hill will look like when we’ve maxed out the federal credit cards and can’t make the minimum monthly payment and our creditors cut us off, look to Greece. Keep an eye on Europe. That horror show is coming to a theater near you, sooner than you think. What will this do to breast cancer? Bad things.
What about the big pink breast cancer foundations, will they be able to save the day? No. Those foundations are funded primarily by the healthcare industry: big pharma, big diagnostics, big treatment corporations. Races and donations don’t really fund the large breast cancer foundations; corporations are what keep wind in their sails. And corporate interests are trained on diagnosis and treatment – despite the slick marketing about a cure – and they have no intention of taking their collective eyes off the money ball. It’s not a matter of a vast whatever conspiracy – though there is no doubt in my mind that executives at the highest levels of governance make decisions that perpetuate rather than prevent the disease – but rather a cast of collective self-interests converging on ways to keep the disease going rather than take the suicidal pill to it. This is a real problem for women who already have breast cancer, and it will become an even greater problem for the millions of other women who are going to get the disease unless we do something about it now, before the problem falls off the cliff into fiscal chaos and becomes unsolvable.
In May 2010, Professor Vincent Tuohy of the Cleveland Clinic announced in the prestigious journal,, Nature Medicine, that he had created the world’s first preventive breast cancer vaccine capable of preventing breast cancer in 100% of mice tested. Tuohy’s vaccine was also observed to slow the growth of tumors that had already formed, and it was effective in slowing the growth of a line of triple-negative cancer cells. Tuohy’s vaccine is ready for safety testing in women. If it is safe, thn clinical trials to test efficacy (dosing and duration of effect) will begin. If Tuohy’s vaccine is as safe and effective in mice as it is in women, it will eliminate 95% of all breast cancer. Theoretically, all this can be accomplished within ten years. Testing Tuohy’s vaccine in women with Stage IV breast cancer who are death’s door could begin within two years.
So here’s the tragedy: no one in a position of power, with money to spend on such things, is willing to fund Tuohy’s vaccine to test its safety and efficacy in women. The Susan G. Komen For The Cure Foundation has turned him down three times. And this is a man who has received prestigious R01 National Institutes of Health grants in the past. This is a man who received the prestigious Sonnes Innovation Award in Medicine from the Cleveland Clinic in 2010. This is a man whose research has always been funded, that is ,until he created a vaccine that might prevent breast cancer entirely.
The Avon Breast Cancer Crusade won’t even consider funding Tuohy’s vaccine. And the federal government has made it clear they are not interested in it either. So the world’s first preventive breast cancer vaccine, with the potential to prevent 95% of breast cancer, sits on the shelf at the Cleveland Clinic, collecting dust. I say, we need a revolution!
There’s no point in petitioning Congress for the money to fund Tuohy’s vaccine. There is no leadership there, no vision, and no preparation for the inevitably contracted future on the horizon. It’s obvious from the nature of grant awards that the big pink breast cancer foundations would prefer to treat breast cancer and, thereby, perpetuate it than prevent it. Shall we allow that to be the end of the story? No, definitely not.
If we are going to end breast cancer, it will be because we have discovered a way to prevent it. In order to test Tuohy’s vaccine, we are going to have to take matters into our own hands and fund it ourselves. And, as I’ve said, we don’t have a lot of time to get this project done. We don’t need a fortune, but we do need at least $24 million dollars to cover the enormous costs of manufacturing and testing Tuohy’s vaccine through three phases of clinical trials. Surely, we can find 24 million women willing to each donate one dollar. That’s why I’ve written this book, a compilation of my best blogs: to raise awareness about Tuohy’s vaccine and to generate the money we need to fund his research. Any additional money raised above and beyond what Tuohy needs for his research will be spent funding the work of Professor Beatriz Pogo of Mt. Sinai School of Medicine. She’s been working on the human mammary tumor virus, thought to be involved with at least 40% of all human breast cancer, another worthy avenue to pursuit in looking for the causes of breast cancer.
The PURE CURE for breast cancer is prevention. But time is running out; the window of opportunity to fund this research is narrow and closing fast. If we don’t fund this vaccine now, I’m afraid it won’t get done when the streets begin to run with blood. As for me, I’d much prefer a peaceful revolution, one marked by a grassroots upheaval of single dollar bills spent to answer two simple questions: is Tuohy’s vaccine as safe and effective in women as it is in mice, and does a virus cause breast cancer in women?
Six months after Professor Tuohy announced the development of the world’s first preventive breast cancer vaccine, a twenty-six year old man set himself on fire in Tunisia. Mohamed Bouazizi had a university degree but the only work he could find was selling fruits and vegetables on the street. Apparently, he could not even afford to pay for the required license for his concession and so a local official confiscated his produce. His desperate act resonated across the country and then across the region. Three dictators fell as a result of his immolation. Free elections have just taken place in Egypt because one man had finally had enough and was willing to die to protest his exasperation. One man set himself on fire and that started the revolution. Please, don’t make me set myself on fire. Let’s see if we can do this without the flames. Our victory will be brighter for being peaceful.
Chapter 1: Winter 2008/2009
Breast Cancer Research – In Plain English
December 2nd, 2008 at 10:40pm
Title: Anaplastic Large-Cell Lymphoma in Women With Breast Implants
Published in JAMA, November 5, 2008, from the Department of Pathology at the Netherlands Cancer Institute
These researchers found two patients with breast implants who also developed a form of lymphoma, called Anaplastic Large-Cell Lymphoma, in the fibrous capsule that forms around the implants after they are surgically placed behind the breasts. The researchers were intrigued by this unusual finding so they decided to see if they could find any other such cases.
The investigators looked into the records of all female patients in the Netherlands who had been diagnosed with lymphoma of the breasts between 1990 and 2006. Then they matched these lymphoma patients to other normal patients for a comparison. They wanted to see if women with breast implants had a higher risk of developing Anaplastic Large-Cell lymphoma.
They found 11 women with Anaplastic Large-Cell lymphoma of the breast. Five of these women had breast implants. The found 35 other women with breast lymphomas that were not the Anaplastic type. Only one of these women had breast implants.
The researchers performed a statistical analysis and found that the odds ratio of a patient with breast implants also having Anaplastic Large-Cell lymphoma was 18.2, (compared to the odds of having Anaplastic lymphoma if the patient did not have breast implants) suggesting that there was an association between the implants and the development of Anaplastic Large-Cell lymphoma.
Finally, the authors felt it was important to point out that the absolute risk, for a woman with breast implants, of developing Anaplastic Large-Cell lymphoma was low overall, and that the results of this study should be confirmed by other researchers.
Commentary: This is very interesting. The development of Anaplastic Large-Cell lymphoma in the fibrous capsule (essentially the scar that forms around the breast implant after it has been placed) of the breast implant is just plain weird. How and why would that happen? I don’t have any idea, and I expect it might be a long time before anyone figures out the answer to these questions. Yes, it would seem that the risk of developing this unusual form of lymphoma (Anaplastic Large-Cell) is quite small. However, since it is impossible to predict ahead of time who will get the cancer and who will not, it might be wise for a woman who is considering having breast augmentation to think about this study before she makes her final decision.
December 18th, 2008 at 2:26am
One of my patients, a woman in her sixties, was treated for breast cancer four years ago. She had lumpectomy, sentinel node biopsy, radiation therapy and tamoxifen: very standard, routine treatment for early breast cancer. She has been completely well – until her recent mammogram showed a new, suspicious area in the other breast. Long story short: she has another breast cancer and is now in the middle of another round of treatment.
What caused her first breast cancer? And why did she develop a second breast cancer? Other than her sex (female) and her age (post-menopausal) she has no specific risk factors. So, why did she get the disease – twice.
Did this woman get breast cancer from a virus? This is not a strange question. In 1936 John Bittner discovered a virus in mice that caused breast cancer. This virus was passed, via breast milk, to other mice. Some researchers believe that this virus might also exist in cats. And a few scientists are studying whether a similar breast cancer virus exists in women. If it does, where does the virus originate? Does it come from mice, or cats? If so, how?
While I was talking with my patient I asked her if she had a cat. She said “yes” and that she had always had cats, most of them were the outdoor variety, not the domestic housebound type. It made me wonder.
Does a virus cause breast cancer in women? I would like to know…and I think my patients would like to know. If the answer is “yes” then a whole new world of prevention, and changes in treatment, are in store. But first, we must answer the question.
December 21st, 2008 at 3:34pm
I saw a patient last week who was treated for a small breast cancer several years ago. Her tumor contained estrogen receptors and so we gave her an anti-estrogen medication, tamoxifen, to prevent other such breast cancer cells in her body from growing. After five years of tamoxifen therapy she was well: but this year, six years after her first breast cancer, she developed a new breast cancer.
Did her breast cancer cells develop “resistance” to tamoxifen?
This year’s San Antonio Breast Conference, as usual, produced an entire universe of new research. Over the coming weeks I will try to help American women digest some of this important information, most of which will never appear in the mainstream media. Summarized below is one of the articles from San Antonio. It relates to my patient who had taken five years of tamoxifen, but developed another new breast cancer nevertheless.
—-
Estrogen and progesterone, female sex hormones, cause some breast cancer cells to divide. ”Endocrine therapy” for breast cancer works to block these hormones so that the cancer cells do not divide and proliferate. A cancer is hormone-responsive if it contains hormone receptors: either estrogen receptors or progesterone receptors. Endocrine therapy blocks these receptors, so cancer cells do not proliferate.
The most common medications used to block the estrogen receptors are Tamoxifen and Arimidex – but there are others.
Unfortunately, breast cancer cells are smart. They have ways of developing resistance to the hormone-blocking drugs, Tamoxifen and Arimidex.
Is there anything that can be done to overcome this resistance ?
Perhaps. There are pathways other than estrogen receptors that can trigger growth and proliferation of the breast cancer cell. Scientists at San Antonio report using another type of medication, that blocks another growth pathway, in combination with hormone-blocking drugs, in an effort to overcome resistance. The other growth pathway is referred to as a “signaling pathway”. I suppose it is like a biologic traffic light: GREEN is GO, RED is STOP.
Scientists are hopeful that, in the future, they will be able to tell which cancer cells will develop resistance to anti-hormone medication, like Tamoxifen and Arimidex, and which of these resistance-prone cancer cells might be prevented from developing resistance if their “signaling pathway” can also be blocked – making it harder for the cancer cell to overcome both blockades.
January 7th, 2009 at 3:42pm
I have just read the synopsis of the recent report about the increased risk of ovarian cancer associated with obesity. I am confused.
The researchers studied about 95,000 women between the ages of 50-71 and followed them for seven years. During this time they found 303 new cases of ovarian cancer. So, of course, they looked to see if there were any “dots” in their data set that could be “connected” to see if there were clues as to why some of the 303 women got ovarian cancer. So far, so good.
They found that women who were obese, BUT DID NOT USE POST-MENOPAUSAL HORMONE THERAPY, had an 80% increased risk of ovarian cancer. They thought this might be related to the KNOWN FACT that fat cells make estrogen, and a lot of fat cells make a lot of estrogen, so perhaps all of this estrogen was contributing to the production of ovarian cancer cells – thus explaining the increased risk of ovarian cancer on obese women in their study.
BIG PROBLEM: The researchers then reported that obese women WHO NEVER USED POST-MENOPAUSAL HORMONE THERAPY did not have an increased risk of ovarian cancer. But they didn’t say why. If an obese woman, who is already making “a ton” of estrogen in her fat cells, does not increase her risk of ovarian cancer by adding more estrogen logs to the fire by way of hormone replacement therapy, then I question the relationship between estrogen, per se, and increased ovarian risk.
Did anyone else have a problem with this study’s conclusions?
Perhaps, instead of high quantities of estrogen circulating in the bodies of obese women, it is another hormone that is tipping the balance in favor of ovarian cancer: perhaps insulin, or another hormone?
Estrogen, in all its forms, increases the risk of breast cancer. Obesity certainly is a risk factor for breast cancer, as is hormone replacement therapy. Even birth control pill increase a woman’s chance of breast cancer.
But I think the researchers of this study need to clarify, or at least propose, an explanation for why HRT did not add to the increased risk of ovarian cancer that obesity confers.
I am waiting……..and I welcome your thoughts.
The New Milleneum: Viruses and Cancer
January 11th, 2009 at 9:06pm
This week’s issue of Science contains a fascinating article about the possible viral cause of gliobastoma, the highly lethal brain cancer Senator Kennedy is battling at the moment. I am encouraged by other researchers like myself who are taking a fresh look at how we treat cancer – by trying to understand its causes – in particular, considering viral causes.
A retrovirus associated with breast cancer in mice was identified over seventy years ago. Since then there has been slowly accumulating evidence that a similar virus may cause breast cancer in women. Since breast cancer is such a common disease, the most common cancer in women, it seems reasonable to place a very high priority on answering the question, “Does a virus cause breast cancer in women?”
Is there a Pink Virus that is causing as much as 40% of breast cancer around the world? Let’s answer that question – as soon as we can, because if the answer is “yes” then we can begin to PREVENT the disease.
That’s a CHANGE we need. See breasthealthandhealing.org for more information on the Pink Virus.
Metahederin – Making Breast Cancer “stick”
January 12th, 2009 at 1:58pm
Interesting discovery last week: a gene found in approximately 30% of the cancer cells in patients with breast cancer appears to do two things:
1. Increase the ability of the cancer cells to attach to blood vessels
2. Increase the ability of cancer cells to resist chemotherapy drugs
These two things are probably related. If cancer cells can attach to blood vessels then they can “go with the flow” – they can circulate widely in the body – they can move and set up additional “terrorist” colonies in other organs, organs that are vital to life, like the liver/lungs/brain etc.
And if cancer cells are able to attach to blood vessels, they can establish a personal nutritional-ATM machine that they can draw upon for oxygen, “food” and other essential ingredients to “live long and prosper.”
And, the longer cancer cells survive, the more time they have to develop resistance to cancer drugs. Developing drug resistance is one of the hallmarks of cancer cells, (they are REALLY good at this) so anything that increases their survival gives them precious additional time to defend themselves against the menu of drugs we use to try to kill them
Researchers found that about 30% of breast cancer cell have multiple copies of this gene, located on Chromosome 8q22. The product of this gene, the substance that is responsible for enhancing blood vessel attachment and increased resistance to chemo, is called METAHEDERIN.
Researchers are hoping that if they can find a way to block metahederin they will reduce the chances that cancer cells can successfully set up shop in other organs and thereby reduce the likelihood that cancer cells will live long enough to develop drug resistance.
Nice job!
My Take on Oprah and the HRT Debate
January 26th, 2009 at 6:44pm
The public have followed Oprah through the many phases of her life – the ups and downs, the weight losses and the weight gains – and now we are witness to the turmoil she is facing as she passes through another crisis: mid-life and menopause. The hot spot in this crisis appears to involve the question of whether she, or any of the millions of baby-boomer women, should use hormone replacement therapy (HRT) to help offset the troubles that menopause brings. Please allow me to provide my strong opinion on this subject.
First of all, it is not easy “getting into” the life of the fertile female. Remember how difficult life was when you first got your period? Do you remember those tumultuous years? Have you ever lived in the house with a teenage girl as she is passing into the lifecyle of the fertile female? It is rough, to say the least. But in the end it is very worthwhile. After the hormonal storms have passed a young fertile woman is born.
It is rough getting into the fertile lifecycle, and (no surprise) it is rough getting out of it. And it takes about as long to get out as it did to get in – several years. Personally, I think it is a very worthwhile life on the other side of fertility, a gloriously less-complicated life for the wise woman.
The advantages of getting out of it the life cycle of the fertile female is that once you have reached your new non-fertile “steady state” there are no further cyclical waves to endure, no further hormonal swings and arrows. After the post-menopausal storms have passed, the seas are quiet and the sailing much smoother.
Taking estrogen, or estrogen and progesterone, after your ovaries have shut down and no longer make these hormones is referred to as “hormone replacement therapy” – HRT. It is replacement because there is a loss of hormones (estrogen and progesterone) that is “replaced” by the ingestion of these substances – either synthetic or naturally made. HRT is dangerous business. Even though some of the symptoms of menopause may be relieved by HRT, a woman who uses HRT puts herself at risk, a specifically unknown but generally documented increased risk for cancer and stroke and blood clots. HRT is a dangerous business for many reasons, but before I get to that, let me first define and describe exactly what a hormone is and what it does. Neither of these important distinctions was made in any of the material offered by Oprah in her recent, sensational discussion on the use of HRT. I think it is always helpful to define the terms before you discuss the concepts that relate to them. So, let’s begin at the beginning and define and nraveli them, and then take it from there.
A hormone is a substance that is made in the cells
of one tissue in the the body, like the ovaries, and then
released into the general circulation. The hormone circulates
until it finds its “receptor” – a kind of “lock” that sits
on the surface of other cells in the body. The hormone is like a
“key” and the mechanism of a lock-and-key works nicely to
describe what the hormone does. It circulates until it finds its
“lock” and then it open’s the lock, enters the cell, moves into
the central command center of the cell and delivers a message: DO
THIS…………..
In the case of the hormone, estrogen, made by
the ovaries (and also in fat cells and in the adrenal glands) the
message DO THIS specifically causes breast cells to grow and divide,
it causes cells in the uterus to grow and divide, and it cause a
whole host of other changes in many other cells and tissues in the
body. (It makes blood clot more quickly, which is useful when a
woman is in a “bleeding” state, like menstruation and when
deliverying a baby – but less useful when she is not.)
When you are young and healthy, the hormone messages that cause growth make sense. When you are older, when your biologic clock has moved toward the “evening hours,” when fertility and child-bearing are no longer on the “menu,” the estrogen message to breast cells that trigger them to grow and divide is hazardous to your health.
You do not want breast cells, especially those older breast cells that have been exposed to many years of accumulating carcinogens from the environment, to “grow or divide” when the rest of your body is winding down it’s work as a reproductive factory. This is one of the reasons that estrogen is particularly hazardous in older women – it pushes abnormal cells over the edge and accelerates change to cancer formation. Multiple studies have shown that women who use HRT have an increased risk of breast cancer. If they use HRT that contains only estrogen, they have an increased risk of uterine cancer. There are no studies that show that using hormones of any kind is not associated with an increased risk of some form of cancer, or other problems. Keep in mind, your entire body is closing down the fertility factory as you pass through menopause, and some parts of your body are getting older no matter what you do. Using HRT pushes cells to do things that are really unnatural, given the rest of the aging process underway all around them.
To summarize:
HRT is associated with either an increased risk of breast cancer (if it contains progestin) or an increased risk of endometrial cancer (if it does not).
HRT is associated with an increased risk of stroke.
HRT is associated with an increased risk of blood clots.
HRT does not protect against Alzheimer’s disease.
HRT does not protect against heart disease.
Now, here is some good, if not easy, news:
There are other ways to offset the troubling symptoms of menopause. Diet and exercise are the two most beneficial. And since the symptoms of menopause tend to eventually pass, they do not last forever, it seems imprudent to exchange a reduction in menopausal symptoms for an increased risk of cancer and stroke.
I cannot support the use of HRT for women. I appreciate the difficulties associated with the change of life, but I cannot condone the use of HRT because I do not think the increased risks of cancer and stroke are worth the benefits. I am willing to take a stand on this. I am prepared to be wrong about this in the future: but I do not think I am wrong about this now. Given the preponderance of the accumulated data collected from thousands of women, I think HRT is hazardous to your health.
When, just a few years ago, a study showed unequivocal evidence that HRT increased the risk of breast cancer, millions of women stopped taking the pills. A few years later the incidence of breast cancer, for the first time in decades, began to decrease. Most investigators believe that the reduced use of HRT explains the reduction in new cases of breast cancer.
In 2005, the World Health Organization declared that, after a thorough review of the world’s literature by a host of international experts, exogenous hormones, in the form of birth control pills and HRT were Group I carcinogens: known to cause cancer in humans. Lead, benzene and HRT – all grouped together. The 2005 WHO report is little known in the USA. More women should be made aware of this report and should examine the report themselves. It is available on the WHO website.
I AM VERY CONCERNED THAT OPRAH’S TAKE ON HRT WILL INCREASE THE NEW CASES OF BREAST CANCER AGAIN, AS WOMEN RETURN TO HRT BECAUSE OPRAH THINKS THEY MIGHT BE USEFUL “FOR SOME WOMEN – CONSULT YOUR DOCTOR.”
When the advice is, invariably, “Ask your doctor” this is just a way to punt the problem back into the patient’s lap, for her to bring to her doctor. In my humble opinion this advice doesn’t really help women make the informed decision. They want advice: my advice is this = don’t use HRT.
As a doctor, as a breast cancer surgeon, as a woman who has successfully passed through menopause into a new, post-fertile steady-state — this is what I tell my patients: avoid HRT. Find other ways to deal with the symptoms. They won’t last forever. You will get through it. You will be glad you did. The post-fertile steady state is a fine, calm place to be – even if it takes a few years to get there.
And, by the way, if you choose to take HRT and you get a breast or uterine cancer, or have a stroke, or get a blood clot, you will be stopping HRT anyway: why not avoid it altogether. If you get a breast cancer, or have a stroke, at least you won’t feel guilty, you won’t wonder whether you gave yourself a cancer that you could have avoided.
This is my opinion. I know it is a strongly worded opinion, and I know it differs from others. But, nevertheless, it is my considered opinion – as a breast surgeon and as a post-menopausal female who would like other women to be as healthy as possible, in as natural a way as possible, free of regrets and remorse down the road. I have had too many patients on HRT who have developed breast cancer and they will never know if they gave it to themselves or not. Don’t go there. It is not a peaceful place to be.
February 9th, 2009 at 11:31pm
There is a growing buzz on the internet about IBC – inflammatory breast cancer – as a result of a recent posting on You Tube. If you go to the informational websites to learn more about IBC you will discover that it is an aggressive form of breast cancer that first appears like a infection in the breast: the breast is red and warm and the skin is thickened. Because both breast infections and IBC are more common in younger women, and because they both look similar, IBC is usually mistaken for a breast infection and is typically treated initially with antibiotics. Once it is clear that the antibiotics are not working the patient is usually referred to a specialist, a biopsy is done and the diagnosis of IBC is confirmed.
What is new and interesting about IBC is that there is some evidence that a virus similar to mouse mammary tumor virus (MMTV), “the Pink Virus” seems to be related to IBC. Several researchers have been working on this link for a few years and more evidence is accumulating that points in the direction of the Pink Virus.
Hopefully some day soon we can post a video on You Tube that announces the discovery of the viral cause of breast cancer, especially IBC, along with innovative ways (including a vaccine) to treat it and prevent it.
March 2nd, 2009 at 1:56am
Alcohol Is Not Your Friend
Drinking alcohol on a regular basis increases a woman’s risk for breast cancer. The evidence for this has been accumulating for years and has just been reinforced by a new study of more than one million women in the United Kingdom where researchers found that alcohol consumption, even in moderation, increased the risk of breast cancer. The UK researchers concluded that alcohol was responsible for 5000 new cases of breast cancer every year, a truly remarkable finding. So why does alcohol cause breast cancer?
The same pathways in the liver that metabolize alcohol are used to metabolize estrogen. When your liver is busy metabolizing alcohol it is less able to metabolize estrogen and, therefore, the blood estrogen levels rise. If you consume alcohol on a regular basis, even in small quantities (1/2 glass per day) then the rise in blood estrogen becomes a relatively chronic condition. Since estrogen is a well-known promoter of breast cancer scientists believe that the elevated blood estrogen produced by regular alcohol ingestion is responsible for the increased risk of breast cancer.
It would be wise for women to restrict their consumption of alcohol to just the occasional treat. Save money. Save your breasts. What’s not to love about that?
Chapter 2: Spring 2009
Unnecessary Mastectomies All the Rage
March 30th, 2009 at 7:17pm
Why So Many Unnecessary Mastectomies?
As if the collapse of the world financial system isn’t enough to set one’s nerves on edge, a study just published in the Journal of Clinical Oncology reveals yet another alarming trend: during the past several years the percentage of women with non-invasive breast cancer (DCIS) who have their breasts removed entirely (mastectomy) has increased 188%! Since mastectomy is not at all required to treat the vast majority of patients with DCIS, the looming question then becomes “Why are all of these women having their breasts removed?”
Allow me to review some important facts. Non-invasive breast cancer (DCIS, commonly known as ductal carcinoma in-situ) is not life threatening. It is the earliest stage of breast cancer and it does not have the ability to move beyond the breast tissue to invade other organs of the body. Unless DCIS is very large at the time of diagnosis, which is seldom the case these days, it is very adequately treated with lumpectomy and radiation therapy. Most of the time DCIS is diagnosed by mammography and is relatively small in size. Typically, it cannot be felt as a lump and is seen only as microcalcifications on a mammogram. The chance that DCIS will recur after proper treatment is approximately 1 in 100 women diagnosed with the disease per year. Which is to say, at ten years of follow-up, 10 women in 100 with DCIS might have had a recurrence and the other 90 will be completely free of disease. So why are all of these breasts coming off? And, furthermore, why are so many women having their other perfectly normal breast removed at the same time?
The study reported in the Journal of Clinical Oncology was not meant to try to answer these questions but rather it was meant to report the “state of play.” Nonetheless, I think it is fair to wonder why all of these breasts are being removed if they don’t have to be. My own suspicion, after spending the past fifteen years rescuing women and their breasts from overly aggressive surgeons, is that women are being unnecessarily frightened and coaxed into aggressive surgery in the false belief that this will provide an improved survival. Of course, most women are naturally afraid of breast cancer. And when they are diagnosed with the disease they are usually surprised and alarmed. They are vulnerable to any suggestion they think might improve their chances of “cure” and they want to do everything they think might help them “beat the disease.” I believe these women are being subtly encouraged to have mastectomies that they do not need and that will not add one day to their life.
A few more facts: women who have been diagnosed with DCIS have an increased risk of developing a similar breast cancer in the opposite breast. However, the risk of “contralateral” breast cancer is also very small – only about 1 in 100 women with DCIS will develop disease in the opposite breast every year following their initial diagnosis. (And medications, like tamoxifen and arimidex, reduce this already small risk even further.) To put it another way: after 10 years of follow-up, 90% of women have not developed disease in the opposite breast. And those that do can be treated with lumpectomy and radiation therapy – as can be done for the original tumor. Mastectomy is not necessary to properly and adequately treat DCIS! Furthermore, it is certainly not necessary to remove a perfectly normal breast that in 90% of women will not develop a breast cancer over the subsequent ten years following diagnosis of the original disease.
If 90% of women with DCIS do not develop disease in the opposite breast during the ten years following their first treatment, why (all of a sudden) is there such a stampede for contralateral prophylactic mastectomy? Does this have something to do with the increasing numbers of plastic surgeons on the market? Perhaps, I can’t be sure. But I do know one thing – these mastectomies are not necessary. The fact that prophylactic mastectomies have increased by 188% is nothing short of alarming.
In the recent report even women with DCIS in one breast who underwent breast-conservation in the breast that had the cancer had a 148% increased incidence of prophylactic mastectomy in the opposite breast – the perfectly normal breast! So, the breast with the cancer is “saved” and the perfectly normal breast is removed! This is just plain crazy. The breast that has the cancer gets to “live” and the opposite breast, without the cancer, has to go. What planet are we living on?
Even though removal of the breast certainly reduces the likelihood that a breast cancer can grow there, it does not add one day to the overall survival of the patient. So, what’s the point? If prophylactic mastectomy is offered in order to reduce the anxiety and worry that the cancer might come back, or that it might occur in the opposite breast, I think women need to know that the risk of this happening is rather small: only 1% per year for every 100 women with the disease. This fact ought to reduce the patient’s anxiety considerably. It certainly has for my patients.
The proof that overall survival is not compromised by breast-conservation and radiation therapy has been documented repeatedly in dozens of studies conducted all over the world. In my own experience, when the Cancer Registry at my hospital, Clara Maass Medical Center in Belleville, New Jersey, reviewed my patients with DCIS they found that I performed 50% fewer mastectomies than other surgeons at my hospital, in my state and (on average) around the country. They also discovered that the recurrence rate for my patients was ten times lower than elsewhere in the state or the nation.
Again, in the vast majority of cases mastectomies for DCIS are not necessary. Recurrence of breast cancer is low if the disease is treated properly; overall survival is well maintained. Women do not have to sacrifice their breasts in order to save their lives. In summary, women with DCIS should not be frightened into having unnecessary surgeries that are risky, mutilating and provide no survival advantage.
I am certainly in favor of preventing breast cancer. I am particularly interested in preventing the recurrence of breast cancer. But the most important thing is to reassure women and give them the correct information about their true risks. DCIS is a non-invasive breast cancer. It does not threaten a woman’s life. It can be treated very well with lumpectomy and radiation therapy. A woman with DCIS can keep her breast. She does not need mastectomy. She can keep her opposite breast also. If she should develop breast cancer in the opposite breast she can have breast-conservation with radiation therapy on that breast, too.
If women understood that mastectomies do not increase their survival, if women fully understood that breast-conservation is perfectly acceptable as treatment for DCIS, then I believe there would be far fewer therapeutic or contralateral “prophylactic” mastectomies. Those few women who feel that they cannot tolerate the anxiety that DCIS might recur can surely have mastectomy: but they will be few and far between, I am sure.
I wish more women were given the proper counseling, reassured about the relatively low risk of recurrence of DCIS and offered the least treatment that will provide cure and relative peace of mind – breast conservation and radiation therapy. Hopefully, this message will gain enough currency in cyberspace to help new patients with DCIS save their breasts as they strive to save their lives.
Reference
Tuttle, TM. Increasing Rates of Contralateral Prophylactic Mastectomy Among Patients with Ductal Carcinoma In-Situ. Journal of Clinical Oncology, 2009. 27: 1362-67.
The Truth about Pregnancy-Associated Breast Cancer
April 2nd, 2009 at 1:02am
“It’s not that people are ignorant, but that
they know so many things that just ain’t true.”
MARK TWAIN
The banner headline on the Susan G. Komen For The Cure website homepage, “Pregnant Women with Breast Cancer Do Not Have Worse Outcomes” is unfortunately somewhat misleading. Perhaps the editor should have read the paper published by Dr. Beadle more closely. What Dr. Beadle actually reported in her article published in the March 15, 2009 issue of Cancer was:
“The lack of a statistically significant correlation between the diagnosis of pregnancy-associated breast cancer and a worse outcome does not necessarily preclude a true association.”
Which is to say, Dr. Beadle cannot say for certain that young women who are diagnosed with breast cancer when they are pregnant have the same prognosis as non-pregnant women their same age. Dr. Beadle goes into great detail to explain the many flaws in her otherwise excellent study of 652 women, less than 35 years old, who were treated at M.D. Anderson Cancer Center between 1973 and 2006. Dr. Beadle was very thorough in explaining that the data, though suggestive, were not definitive. Indeed, it is too soon to jump to conclusions. We’ve been down that wrong road before – with hormone replacement therapy and, more recently, with daily use of alcohol – and it is not yet clear what the true story is regarding pregnancy and breast cancer; so, beware banner headlines that proclaim conclusions that are not yet certain.
In fact, young women who develop breast cancer when they are pregnant may, indeed, have a worse prognosis and a decreased survival. We’ve not studied enough women to be certain about this. Dr. Beadle went to great lengths to make sure the reader understood that there are still some missing pieces to this puzzle, still many things to learn and discover about breast cancer that occurs in young women when they are pregnant.
Overall, all young women who develop breast cancer have a dismal prognosis. Pregnancy may or may not make things worse. I hope that Dr. Beadle and other researchers will be able to clarify the true character of pregnancy-associated breast cancer in the near future. But at the present time we simply do not know for sure whether or not a pregnancy confers a worse outcome for young women with breast cancer.
The news media and their ambitious headlines typically try to grab for a hook that will capture a reader, but in their clamor to be noticed they often fall short of the mark of accurate reporting. We may forgive CNN for these hungry oversights for we know they are going for the sensational, not the substantive. But when the leading breast cancer foundation falls short in reporting the results of an important paper such as this it leaves all women less, not more informed. It is a disappointment, to say the least.
Walk and Talk to Prevent Breast Cancer
April 12th, 2009 at 12:07am
Walking for 30 minutes 4 times per week reduces your risk of breast cancer 30-50%.
If you are a breast cancer survivor, walking for 30 minutes 4 times per week reduces your risk of death from breast cancer by 50%.
These are impressive statistics but, unfortunately, not enough women are aware of the great power residing in a pair of sneakers!
If you are not a walker, and otherwise do not take regular exercise, it can be hard to get started. I think it helps to have a walking partner to jump start your effort and to keep you to task, but finding a walking partner can be difficult to arrange.
So here is a tip: recruit a friend or family member to be your wireless walking partner. Make a “date” to walk together and keep that date by talking to each other on your cell phones while you walk separately, in your own environments. The wireless “walk and talk” is a handy way for friends and family to partner up in the most convenient way and, in the process, PREVENT BREAST CANCER or PREVENT ITS RETURN!
Give it a try. What do you have to loose, except breast cancer?
April 12th, 2009 at 1:34pm
You learn best during the day when you are awake, but the process takes a great deal of energy and it creates “biological waste” – like trash at a construction site.
GET YOUR SLEEP! During sleep the brains cleans up the waste from the learning construction sites and thus helps strengthen the “learning connections” you make during the day, enhancing and consolidating new material.
GET YOUR SLEEP! Sleep is not only a respite from the challenges of the day, it is a critically important part of the day if you want to build upon what you learn, and become sharper and wiser overall.
April 13th, 2009 at 2:10am
First, let me warn you – this is a long blog. But I think it is worth reading, so get comfortable.
The National Cancer Institute is funding research at the University of Pennsylvania that will evaluate the metabolic effects of regular exercise to reduce the risk of breast cancer. But this is nothing new: exercise is a known risk reduction strategy – but they’ve decided to study it again.
This is their plan:
The researchers will be looking for evidence (in daily urine samples) for a reduction in serum estrogen levels in women who exercise regularly. Their hypothesis is that the reason that exercise reduces the risk of breast cancer (a fact that has been proven again and again, in multiple studies, involving hundreds of thousands of women – but seems to remain woefully under-reported and under-emphasized by public health policy makers) is that exercise lowers serum estrogen levels, and because it is well known that estrogen promotes the growth of breast cancer, estrogen reduction via exercise should lower the risk of breast cancer.
The researchers will study women who are at high risk for breast cancer, including those who carry the BRCA mutation, known to impart an 85% lifetime risk for breast cancer in those who carry this gene. The women will be separated into three groups: an observational group who will not change their lifestyle whatsoever, a group of women who will do moderate treadmill exercise, and a group of women who will do high treadmill exercise. They will follow these women for the better part of a year, measuring their urine estrogen levels along the way.
Though this is an interesting study, it is not innovative; such studies have been done before and other researchers have noted lower estrogen levels in women who exercise regularly. So, though worthwhile per se, it really won’t add new information to the large and impressive data that have already been reported in the scientific literature.
I would like to propose a more interesting study, one that is more current and innovative:
Take a large group of women (say 2000) all of whom carry a specific BRCA1 mutation. Half of these women will have already had breast cancer, but at entry into the study will be free of disease. The other half of the women will not have had breast cancer (and will be screened to make sure there is no evidence of breast cancer at entry into the study.) The study should run for several years, at least.
None of the women who enter the study will have a history of regular exercise – they will all be sedentary BRCA 1 carries, half with a history of breast cancer and the other half without a history of breast cancer. (It shouldn’t be hard such a cohort here in the United States.)
Half of each group of non-cancer participants will be provided with personal trainers who will assist them, and document, regular (brisk) exercise 4 times per week. The other half of the non-cancer participants will be followed with observation.
Likewise, half of each group of cancer participants will have personal trainers monitoring and supporting their regular exercise routines, and the other half will be observed only.
Since all women in the study will be selected based on a very specific BRCA1 mutation, and since there are ways to study epigenetics (behavior of the genes), researchers should be able to examine, precisely, what is happening to the specific BRCA1 mutation and/or surrounding genes, when patients exercise versus when they don’t. (I think perhaps mouth swabs would provide such information – but must leave it to the experts to discover the best way to track any changes in the mutation.)
Understanding how exercise lowers the risk of breast cancer, at the level of the gene – the specific gene that increases the risk of breast cancer – would be more state-of-the-art than reworking old, and now somewhat tired, data.
If the lowered estrogen levels in exercising women has an impact on the BRCA1 mutation, or its epigenetic behavior, that would be highly interesting and worth understanding. But there may be other explanations for the benefit of exercise – not the least of which may be something as simple as the level of oxygen delivery to breast tissue and its impact on gene expression.
Willie Horton, a famous bank robber, was captured and asked why he robbed banks. He said, “Because that is where the money is.” If you want to know how exercise reduces the risk of breast cancer in women who carry the BRCA mutation, find a way to look at the gene and understand what exercise is doing to change the gene.
I would approach Craig Mello’s lab and ask him if he could help put together a team to design and tackle this study.
Just a suggestion……for the web universe. Let’s see where this idea lands.
BRCA Carriers Prefer Prophylactic Mastectomy – for a good reason!
April 13th, 2009 at 11:36pm
An article just published in CANCER discusses the finding that women who are BRCA carriers, and are at a very high risk of eventually developing breast cancer in their lifetime, prefer to have prophylactic mastectomy to reduce their anxiety about one day contracting the disease. These findings are also reported on the Komen website. Unfortunately, the Komen writer failed to point out a most important consideration: BRCA carriers who undergo prophylactic mastectomy reduce their risk of getting breast cancer by as much as 90%. These women are not only making this choice because they “feel” that it is the most effective way to reduce their risk – it DOES REDUCE THEIR risk significantly. Furthermore, and most important of all, prophylactic mastectomy in these BRCA carrier women adds years to their lives – prophylactic mastectomy increases their overall survival. But this is not the case for women who do not carry the BRCA genes.
As I pointed out in another recent blog, a survival benefit does not nrave to women who do not carry the BRCA genes who (nevertheless) elect prophylactic mastectomy. There is a big difference between women who carry the BRCA genes and those who do not, a difference that is important to distinguish and understand.
Physicians, writers and patients must be cautioned against the tendency to mix “apples and oranges” regarding prophylactic mastectomy. Those women who are BRCA carriers reduce their risk of breast cancer by 90% and increase their overall survival (and relieve their anxiety) when they have prophylactic mastectomy. Those women who are not BRCA carriers will certainly reduce their risk of breast cancer if they have no breast – but their baseline risk is FAR LOWER (only about 1% per year) than their sisters who carry the BRCA genes. Women who do not carry the BRCA genes gain no survival benefit from prophylactic mastectomy – they do not live longer as a result removing their perfectly normal breasts.
Prophylactic mastectomy needs to be applied appropriately, to those women it will benefit the most. Non-BRCA women should not be frightened by the statistics that apply to BRCA women. The two groups should be clearly demarcated, one from the other, saving as many lives as possible on the one hand, and as many breasts as possible on the other.
Discovery! Rak gene protects PTEN that protects against Breast Cancer
April 14th, 2009 at 1:45pm
Very good news out of MD Anderson, published in April issue of Cancer Cell: scientists have discovered a gene, Rak, that when “expressed” (meaning that the gene is “turned on”) protects a protein, PTEN, that itself protects against the transformation of a normal breast cell into a cancer cell. (A friend of my friend is my friend.)
PTEN is a protein that acts as a tumor suppressor – it prevents breast cancer formation. When there is a lot of PTEN around, there is less breast cancer formed.
In about half of patients with breast cancer, their PTEN levels are very low. Without the powerful tumor suppressor action of PTEN, breast cancers grow and become more aggressive, more likely to metastasize.
The Rak gene creates a product that protects the tumor-suppressing PTEN from destruction. You see, something in the cancer cell is destroying the PTEN, thus lowering the levels and creating more aggressive disease. One of the things that destroys PTEN is a cellular villain known as NEDD4-1.
NEDD4-1 is Darth Vader to the normal breast cell.
The Rak gene goes to battle with NEDD4-1. The Rak gene makes a product that attaches to PTEN and protects it from the destructive effects of NEDD4-1. THE PTEN LEVELS STAY HIGH AND BREAST CANCER IS AVERTED. That is the beauty and function of Rak. It works like a “Palace Guard” to protect the precious and vital PTEN from the Darth Vader NEDD4-1.
Congratulations to the team at MD Anderson!
Now, I have a few questions:
Is there a relationship between NEDD4-1 and proviral sequences of HMTV, what I call the Pink Virus, in the half of women with breast cancer who have low levels of PTEN?
What part, if any, do estrogen or HER2-neu play in the process whereby NEDD4-l is elevated, or PTEN is lowered, or Rak is turned on or off?
That should keep them busy at the bench for quite a long time – but hopefully, not too long. 1.5 million women will be diagnosed with breast cancer around the world this year: we must clarify causes so the we CAN PREVENT THE DISEASE.
Driveway Danger – Sealants Produce Environmental Toxins
April 16th, 2009 at 10:02pm
Dr. Bellestro, Professor of Engineering at the University of New Hampshire, has identified a potential hazard of driveway and pavement sealants: rainwater washes away the sealant into the water supply. The sealants contain polyaromatic hydrocarbons (PAH), known carcinogens, and these are spread into the environment.
The PAHs from the sealants’ rainwater runoff attach to organic material in the environment and can be ingested and passed along the foodchain, creating carcinogenic multiplier effects as they go.
Once they are created and distributed the PAHs stay in the environment for decades because they do not break down easily. So this is a growing problem that will stay with us for quite a while.
Professor Ballestro cautions that although the carcinogenic consequences of pavement sealant PAH contamination of our water supply does not pose the kind of imminent danger of, say, a lightening strike it “could be a cumulative exposure problem that gets uglier over time.”
This is just one more thing to keep in mind as we work together to reduce environmental carcinogens and prevent as many cancers as possible.