Cancer

Harry Potter and the Deathly Hallows: Part 2

2011-05-08T12:33:00.003+07:00

Director: David Yates
Writers: Steve Kloves (screenplay), J.K. Rowling (novel)
Stars: Daniel Radcliffe, Emma Watson and Rupert Grint
The end begins as Harry, Ron, and Hermione go back to Hogwarts to find and destroy Voldemort's final horcruxes, but when Voldemort finds out about their mission, the biggest battle begins and life as they know it will never be the same again
Download movie here...

The Social Network

2011-05-01T13:18:00.001+07:00

Director: David Fincher

Writer : Aaron Sorkin, Ben Mezrich

Star : Andrew Garfield , Justin Timberlake , Rashida Jones, Jessie Eisenberg

On a fall night in 2003, Harvard undergrad and computer programming genius Mark Zuckerberg sits down at his computer and heatedly begins working on a new idea. In a fury of blogging and programming, what begins in his dorm room soon becomes a global social network and a revolution in communication. A mere six years and 500 million friends later, Mark Zuckerberg is the youngest billionaire in history... but for this entrepreneur, success leads to both personal and legal complications

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Shaolin

2011-04-21T13:57:00.006+07:00

download movie here

Midas

2011-04-20T10:45:00.001+07:00

[SBS 2011] Midas 마이더스: Jang Hyuk, Lee Min Jung [Vietsub Ep 13 HD - Torrent + MV

Directed by Kang Sin-hyo (강신효), Lee Chang-min-I (이창민)

Screenplay by Choi Wan-gyoo (최완규)

Synopsis

A drama about takeovers between companies in the Korean stocks.

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Nikita

2011-04-20T10:32:00.001+07:00

Stars: Maggie Q, Shane West and Lyndsy Fonseca
The story centers on a secret organization known as Division. Targeting young people from a troubled background, Division erases all evidence of their past lives and molds them into efficient spies and assassins. Nikita is the first recruit to escape and promises to bring down her former employers. Having trained Nikita, Michael, a Division operative, is ordered by his boss Percy to deal with his former student. In the meantime, Division continues training its recruits, Thom, Jaden, and the newest, Alex.
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How is IBC knowledge spread?

2009-07-31T21:56:00.001+07:00

What forms of communication do oncologists use to spread the word about inflammatory breast cancer?
Publications, and presentations at national and regional meetings.

Specialists in inflammatory breast cancer?

2009-07-31T21:56:00.000+07:00

Is there a database of oncologists and surgeons that specialize in IBC?
I don't believe there is. Major cancer centers with strong inter-disciplinary teams would have the necessary expertise, but there is no list that I am aware of.

Look for treatment near home, or travel?

2009-07-31T21:55:00.000+07:00

IBC diagnosed 2 days ago. Trying to decide if it's better to travel 2 hours alone to a major cancer center or stay with my support and go to a local cancer center in our area. How important is the psychological support versus a cutting-edge hospital?
For high-risk and aggressive breast cancers, including inflammatory breast cancer, one usually has a single opportunity for cure. It is critical to find a well-trained and highly interactive team of breast cancer specialists in order to succeed. So especially for inflammatory breast cancer, it would be important to make the extra effort to find such a team. If such a team exists in your local community, then great. If it does not, the 2-hour trip is more than worth it.

Treatment for ulcerating skin metastases?

2009-07-31T21:54:00.000+07:00

What treatment is suggested for ulcerating skin metastases?
Radiation tends to be effective at helping ulcerations heal and helps frequently with pain associated with ulceration.Depending on the timing of these ulcerated lesions in the overall treatment history, as well as the number and location of these lesions, one might select different treatments or treatment combinations. In the presence of a single or limited number of closely clustered ulcerated lesions, radiation might be an excellent choice. If there are multiple, especially widely spread lesions, then systemic therapy alone or in combination with selected local treatments might be a good choice too. Systemic treatments might be chemotherapy or hormonal therapy or something like Herceptin, depending on the type of tumor.

IBC Research Foundation's BioBank beneficial?

2009-07-30T21:53:00.000+07:00

Are you aware of the Inflammatory Breast Cancer Research Foundation's BioBank and do you feel this will be beneficial in the research we need?
For further understanding of the biology of inflammatory breast cancer, it is critical to develop collections of tumors and a well-annotated description of the patients and the treatment used for the treatment of that tumor. The more these selections of well-annotated tumors can be developed, the more rapidly we will learn how to best treat, monitor, and prevent these tumors.

Other options for professional opinion?

2009-07-30T21:52:00.000+07:00

Could you advise whether M.D. Anderson would give second opinions via telephone/email for overseas patients with their new IBC clinic?
The management of M.D. Anderson is very complex and dependent on a closely coordinated team effort. The diagnosis and work-up and treatment decisions also depend on the ability to take a careful history and examine the patient. For these reasons, telephone and email consultations have the risk of providing individual patients less than optimal information. Accordingly, it is not M.D. Anderson's policy to offer such second opinions via email.

Taxol vs. Abraxane in recurrent IBC?

2009-07-30T21:51:00.000+07:00

Can you comment on the use of Taxol vs. Abraxane in the treatment of recurrence in IBC, especially for the triple-negative cases?
Abraxane (chemical name: albumin-bound paclitaxel) is a new formulation of paclitaxel, which is the active component of Taxol. There is a single head-to-head comparison of Abraxane and Taxol which suggests that we can give higher doses of Abraxane and that Abraxane is slightly more effective at those higher doses than a standard dose of Taxol. Whether this applies to inflammatory breast cancer or not is unknown. But clearly Abraxane is an effective drug, although whether the cost differential is justified in the case of an individual patient should be discussed with the treating oncologist.

Post-treatment testing for recurrence?

2009-07-30T21:50:00.000+07:00

What is the normal testing post-treatment to check for recurrence?
For most breast cancers, the follow-up is based on history and physical examination about ever 4-5 months after diagnosis, then every 3-6 months for the next 3 years or so, and yearly thereafter. In addition, one should do a mammogram of the remaining breast tissue once a year. For inflammatory breast cancer, probably the only consideration is that recurrences tend to happen early, within the first 2 years or so, and because it is a more aggressive disease, one might want to consider more frequent visits for examinations. But there is no need for imaging of the brain, liver, or lungs at this point.

High-dose chemo and IBC?

2009-07-30T21:49:00.000+07:00

What's your opinion on high-dose chemotherapy for use with IBC?
High dose-chemotherapy remains a treatment under investigation for any and all types of breast cancer. It is not part of standard treatment. Whether it will have or whether it would have had effects in patients with inflammatory breast cancer remains to be determined, and unfortunately because there is such a small number of inflammatory breast cancers, there will never be a definitive trial of that question.

Repeat chemo for IBC recurrence okay?

2009-07-29T21:48:00.000+07:00

Can chemotherapy for IBC be repeated when there is evidence of recurrence after one year? The first round of chemo was well tolerated, surgery and radiation also performed?
In general terms, when recurrence is detected within about 6 months or less from the last dose of a specific type of chemotherapy, then that same chemotherapy would not be the first choice for treating the recurrence because the time is so short that one would assume the tumor was resistant to that type of chemotherapy and one would select a chemotherapy drug that was not included in that first treatment. Fortunately for the breast cancer patients, there are multiple types of chemotherapy that are effective in managing breast cancer, including recurrent inflammatory breast cancer. Lapatinib, or Tykerb, was recently tested in a clinical trial specifically in patients with recurrent inflammatory breast cancer, and Tykerb was shown to have anti-tumor effects in about 1 in 3 patients if they had the HER2 abnormality.

How does IBC act when metastasized?

2009-07-29T21:47:00.000+07:00

You didn't answer Kat's question re: does the IBC behave the same way in other parts of the body as it did in the primary site? We are not asking about likelihood of recurrence as much as what happens [and] how quickly in a secondary site?
First of all, I think we need to dispel the idea that inflammatory breast cancer looks like inflammation under the microscope. It does not. In terms of the question specifically, once inflammatory breast cancer spreads to other organs, it tends to behave much like other rapidly growing or aggressive breast cancer. Now because it is an aggressive form of breast cancer, it has a pattern of spread that is somewhat different from other forms of breast cancer. It tends to spread more often to the lungs, the brain, and the liver although certainly not exclusively so. Once it spreads, it is an aggressive tumor and tends to grow more rapidly and spread more rapidly than other forms of breast cancer like the hormone dependent non-inflammatory breast cancer.

Twice-a-day radiation more effective with IBC?

2009-07-29T21:46:00.000+07:00

Have there been studies that show that twice-a-day radiation is more effective with IBC? Should it be standard protocol for IBC?
At M.D. Anderson, for many years we've been investigating whether giving radiation twice a day instead of once a day leads to an improved outcome. The information we have from our own institutional experience leads us to be optimistic about this approach. The theory behind giving twice-a-day radiation is that you can complete the treatment in a shorter period of time and therefore have less of a chance of the IBC tumor cells growing during the course of treatment. The treatments, however, have some side effects and risks that also need to be considered. In addition, this approach hasn't been thoroughly studied in a big head-to-head comparative trial, in part because IBC is a rare disease. I would hate to say that giving once-a-day radiation is wrong. It remains the most common radiation delivery schedule given in the United States. I do think it is reasonable to consider twice-a-day radiation, given the good results that have been reported by investigators at M.D. Anderson.

Double mastectomy for IBC?

2009-07-29T21:45:00.000+07:00

Is the presence of IBC in one breast enough justification for the doctor to remove the other breast?
Removal of the other breast does not in any way improve the cure rate for patients with inflammatory breast cancer. Therefore it's not a standard part of treatment.

Risk of IBC recurrence?

2009-07-29T21:44:00.000+07:00

Since IBC is an aggressive form of breast cancer, if it should spread to other areas of the body, does it act the same way there—for example, fast growing? I was diagnosed with it December 2003, completed treatment August 2004 and have had no evidence of disease since?
Kat, I'm happy to hear you're doing well after completion of your treatment. It is true that if IBC were to recur, it tends to reoccur earlier compared to non-IBC breast cancer. For example, non-IBC breast cancer can even recur a decade after treatment. This would be very, very unusual for patients with IBC. I hope yours will never recur.

Gene therapy for IBC?

2009-07-28T21:43:00.000+07:00

What kinds of gene therapy are being looked at for IBC ?
I'm not aware of a gene therapy trial for inflammatory breast cancer. There are ongoing trials for breast cancer in general, but all of them are in the very early stages of development, mostly Phase 1 trial. But nothing specifically for inflammatory breast cancer. When new drugs are developed, the very first step is to establish what is the best way to give the drug, how much should be given, how frequently, and how well patients tolerate that way of administering the drug. The same is true for gene therapy, for gene therapy is, in a way, a drug. So at this stage in the gene therapy trial, they are trying to determine the best way to administer the gene therapy, how frequently, and how much needs to be administered to get the predicted effect. Only later in the second stage do those clinical trials get to be reliable enough so that one knows that the drug or gene therapy is given the best way so one can expect the best possible results. At this point, gene therapy is not considered part of standard treatment of inflammatory breast cancer.

Clinical trials for IBC with brain metastases?

2009-07-28T21:41:00.000+07:00

Are there any clinical trials available at M.D. Anderson Cancer Center that would benefit an IBC patient who has received treatment as you've outlined yet now has evidence of recurrence in the chest and brain metastases? Now evidently a stage IV patient?
In general terms, most clinical trials unfortunately do not include patients with brain metastases, mostly because of safety concerns. So at this point, and without looking at my priority list, I can't think of a specific clinical trial for patients with inflammatory breast cancer and brain metastases. We might have a clinical trial of new drugs for patients with metastatic brain cancer and brain metastases, and whether a particular patient could be a candidate would require a more in-depth assessment for all the relevant information. The right person to call for this would be Dr. Stacy Moulder at 713-792-2817, or Dr. Massimo Cristofanilli at the same number.

Clinical trials for IBC with brain metastases?

2009-07-28T21:40:00.000+07:00

I am the minority with IBC that was also HER2, ER and PR positive. I have completed combination chemo, mastectomy, radiation, Herceptin and am now on Femara. Do you think Femara treatment will be extended beyond the 5-year plan?

That's a crystal ball question. I think we could say that there are ongoing clinical trials to determine whether prolonging the duration of Femara or similar drugs beyond 5 years is useful and well tolerated. The results of those trials will become available probably in the next 3-5 years.

IBC triple negative treatment?

2009-07-28T21:39:00.000+07:00

What's the most current thinking on treating triple-negative IBC? Also, early trial results on Tykerb indicate positive results for IBCers. How does that translate to triple-negative IBCers?
Probably about 40% of inflammatory breast cancers are likely to be triple negative. Those tumors that are triple negative are today treated with a combination of chemotherapy, surgery, and radiation. We have no evidence that any additional treatment is useful. Lapatinib, or Tykerb, is a drug that was developed specifically for tumors that have excess amounts of two specific proteins: HER1 and HER2. It does have anti-tumor activity, and its activity appears especially prominent in those patients that have HER2 abnormalities. In that sense, it is similar to Herceptin in its spectrum of activity. The initial trials with Tykerb that included just a small number of patients with inflammatory breast cancer suggest that Tykerb in the HER2 positive inflammatory breast cancer group was active in 1 in 3 patients. To the best of my knowledge, Tykerb has not been tested in the triple-negative group, nor is there a reason to do so at this time. Until Tykerb becomes commercially available, the treatment of choice for patients with inflammatory breast cancer that have HER2 abnormality would be Herceptin, or trastuzumab, in combination with chemotherapy as well as surgery and radiation therapy.

Symptoms of IBC post-mastectomy?

2009-07-28T21:38:00.000+07:00

Is there any way that DCIS or invasive ductal carcinoma could "turn" into IBC? I was diagnosed with DCIS in 2004, then IDC earlier this year. I'm currently in chemo to be followed by radiation. I have noticed a pink area adjacent to my original mastectomy scar and a hard spot underneath it. Ultrasound and mammogram were clear, but I'm still uneasy about it due to my history?
We don't know whether there is a natural sequence from one type of cancer or precancerous lesions to inflammatory breast cancer. We do know that after breast conserving surgery, there can be redness of the skin and skin edema (swelling) as a result of both the surgical operation and possibly radiation. Sometimes it is difficult to tell whether those changes represent a recurrence of the disease in the form of inflammatory breast cancer or simply post-surgical or post-treatment changes. Depending on the degree of suspicion of whether it is a recurrence or not, and depending on what imaging like ultrasound and mammography show, one might or might not want to do a biopsy to evaluate those changes. This is really a situation where being assessed by someone whose expertise within breast cancer management is really important.
It's important to emphasize that after surgery, especially a lymph dissection, there may often be swelling and redness of the skin. We frequently see it, and it usually gets better with time. If it continues to deteriorate or it gets worse, that's when we'd consider doing a biopsy.

Has the inflammatory breast cancer spread?

2009-07-27T21:36:00.000+07:00

My axillary lymph nodes were removed 11 years ago from first go-around with cancer. I was subsequently diagnosed with IBC in the same breast. There were no lymph nodes to take this time. How do I know for sure that the cancer did not spread?
When inflammatory breast cancer develops in a breast that has already been treated for breast cancer, the first step would be to perform a series of staging tests to assure that the cancer has not spread. It is correct that once the axillary lymph nodes have been removed, there may not be more removed at the time of surgery. But otherwise, the treatments would be the same with initially finding the extent of the disease, beginning with chemotherapy, subsequently performing a mastectomy, and then considering radiation. Some of the chemotherapy and radiation decisions may also depend on the previous breast cancer treatment.

How is extent of IBC determined?

2009-07-27T21:35:00.000+07:00

How does a surgeon determine the extent of the IBC after it has been visually eliminated by the chemotherapy? How do they determine the extent of the disease?
When a mastectomy is performed, the surgeon will generally go in and remove the nipple and areola and as much of the overlying skin that has the inflammatory characteristics as they can. There are certain margins when the breast is removed, such as the collarbone, breastbone, and a line out of the arm that determine the edges of every mastectomy. The additional tissues that are removed under the arm, the axillary lymph nodes, is standard for both regular breast cancer and inflammatory breast cancer. If there are additional tissues involved outside the axillary, they will be removed as well. The final extent is really determined by the pathologist.
There is much interest, although no definitive proof, in using presurgical imaging such as MRI (magnetic resonance imaging) or PET (positron emission tomography) in an attempt to guide the surgeon in finding the extent. Additional research will be needed to validate that.

Non-surgical treatments for IBC?

2009-07-27T21:34:00.001+07:00

I'm 70 and have been diagnosed with IBC. I do not wish at my age to have chemotherapy or radiation unless it is beam radiation. Are there any non-surgical treatments? I have been told I will die if I don't have either surgery, chemo, radiation or a combination of all. Quality of life is more important that quantity. Any suggestions appreciated ?
Terry, I'm sorry to hear about your condition, because I realize it is difficult no matter which way you go. For healthy women who are 70 we still recommend aggressive treatment because inflammatory breast cancer left untreated or just partially treated can have bad effects both on your quality and quantity of life. Radiation treatment alone was tried in the 1970s before chemotherapy was available and most patients had rapid disease progression. Seventy is now considered a young age, and if you're healthy I would still consider seeing a medical oncologist and carefully discussing the risks and benefits of chemotherapy. It may be that some of your fears of chemotherapy are due to misinformation and after getting a comprehensive discussion, you'll be well informed to make the best decision for you.
The life expectancy of a healthy 70-year-old woman in the U.S. is 16 years. The average survival of a person with untreated inflammatory breast cancer is less than 2 years.

Is mastectomy done even when the cancer has spread to, say, the bones?

2009-07-27T21:34:00.000+07:00

In general terms, the standard of care today is that when metastases are present at the time of diagnosis of the primary, then no definitive surgery is performed on the primary unless there is a need to control a bleeding, ulcerated breast for quality-of-life purposes. In recent years, the question has been raised whether removing the breast in the presence of metastasis might favorably affect survival. There is interest in addressing that through additional research and there is at least one ongoing clinical trial outside the United States looking at that, but it is not considered a standard procedure nor is there definitive evidence that it helps. There are no trials currently in the U.S. But there has been some skepticism in the medical community, so there is no trial ongoing or planned for this issue.

Is it commonplace for surgeons not to remove lymph nodes with IBC because it is strictly for staging?

2009-07-27T21:33:00.000+07:00

The standard treatment for IBC first consists of chemotherapy. After a response to chemotherapy is achieved, the standard surgical treatment is to remove both the breast and the axillary (under the arm) lymph nodes. Dissection remains a standard part of the surgical treatment of inflammatory breast cancer. Subsequently patients should receive radiation and, as Dr. Hortobagyi just mentioned, Herceptin and hormonal treatment when appropriate.

My mum was diagnosed with IBC in June 2005 and passed away in August 2006. My sister and I are concerned about whether or not this form of breast canc

2009-07-26T21:32:00.000+07:00

All individuals with a family history of breast cancer do have a greater risk of developing breast cancer themselves. However, the data isn't clear that inflammatory breast cancer necessarily predisposes to the development of inflammatory breast cancer in relatives. It sounds as if you and your sister are still relatively young compared to the age that your mother developed breast cancer. I would follow standard guidelines for screening, mammography, and physical examination beginning at age 40, unless you also have many other relatives with breast cancer history or relatives who have ovarian cancer history.

What causes this type of cancer? How is it normally treated? What is the cure rate? Will I have to take medication for the rest of my life?

2009-07-26T21:31:00.000+07:00

Prior to 1975, inflammatory breast cancer was treated with either surgery or radiation therapy or the two together, but without chemotherapy or hormone therapy. The results of that were very poor because of the very aggressive nature of the disease. So in general terms, less than 5% of patients would survive five years. When the combination chemotherapy was introduced into this combined treatment approach, with surgery and radiation therapy, the five year survival increased to somewhere between 30 and 40% in most reports. That continues to be the case today. So about one in three patients with inflammatory breast cancer will survive five years, and the great majority of those who do are probably cured of their inflammatory breast cancer. Most of the recurrences of inflammatory breast cancer have been very early, within the first couple of years.

The majority of inflammatory breast cancers are not hormone dependent, and if in addition to that they do not have the HER2 gene, the treatment will probably be completed in nine months. If the HER2 gene is amplified, in addition to chemo and surgery and radiation, one would probably use Herceptin for about a year. If the inflammatory breast cancer in a particular patient also has estrogen or progesterone receptors, one would use in addition to chemotherapy, radiation and surgery, an aromatase inhibitor like Femara (chemical name: letrozole). That would require at least five years of treatment, possibly longer, and it is possible that as new knowledge evolves, that might mean for life. But I estimate that applies to a minority of patients with inflammatory breast cancer.

What causes this type of cancer? How is it normally treated? What is the cure rate? Will I have to take medication for the rest of my life?

2009-07-26T21:30:00.001+07:00

The treatment for inflammatory breast cancer really requires a closely coordinated effort from all disciplines involved in breast cancer care. Prior to treatment, it is important to investigate the extent of the disease and stage the disease to determine whether it appears to be confined to the breast and lymph nodes, or whether it has spread to other sites in the body. After the staging studies have been completed, the initial treatment approach is combination chemotherapy. Ultimately, inflammatory breast cancer is best treated with combinations of chemotherapy, surgery (including mastectomy), and radiation treatment. Some inflammatory breast cancer may also respond to trastuzumab (brand name: Herceptin) or hormonal therapy, depending on the molecular features of the disease.

What causes this type of cancer? How is it normally treated? What is the cure rate? Will I have to take medication for the rest of my life?

2009-07-26T21:30:00.000+07:00

The short answer is we don't know what causes inflammatory breast cancer. We do know that there seem to be differences in the frequency with which it is diagnosed in different parts of the world. In northern Africa and sub-Saharan Africa, they report much higher rates than in North America or Western Europe. I'm unsure if that is a real difference or not, but the true cause of inflammatory breast cancer to the best of my knowledge is not known. We have emerging information that suggests the molecular abnormalities that can be found in inflammatory breast cancer might be different in frequency when compared with non-inflammatory breast cancer. So for instance, reports suggest that the frequency of HER2 is more common in inflammatory breast cancer than in non-inflammatory breast cancer. There are reports to suggest that genes that predispose to blood vessel formation are more frequently activated in inflammatory breast cancer. Then there are several additional molecular differences, but that still doesn't give us a cause. But it might in the future give us a lead to develop treatments that are perhaps more specific for inflammatory breast cancer than what we use today.

Do your chances for IBC go up if you have had lots of breast infections while nursing your children?

2009-07-26T21:28:00.000+07:00

I've never seen any data to suggest that is or is not true. The only data we have does show that lactation reduces your risk of developing breast cancer in general, but it's hard to take that data and apply it towards inflammatory breast cancer.

My skin pathology came back negative for IBC. Two months later, I had three tumors and the surgeon said I do have IBC. How was this missed the first t

2009-07-25T21:28:00.000+07:00

When patients present with IBC, they often have congestion of fluid within their skin that's associated with small pieces of the tumor being present in some of the lymphatic channels of the skin. It is possible to take a biopsy of the skin and not find tumor cells associated with the cells that are examined. I'm not sure if this is what happened in your particular case. It sounds as if over the two month period the tumor became more present and therefore easier to detect. Inflammatory breast cancer is a breast cancer that is associated with clinical findings of thickened skin and redness of the breast that have a rapid onset and are associated with the underlying breast cancer. Oftentimes this is confirmed with the finding of a tumor within the lymphatic channels of the skin, but the diagnosis of inflammatory breast cancer is not dependent on proving that the cancer is within the skin. Therefore, inflammatory breast cancer is sometimes referred to as a clinical diagnosis meaning that a lot of the diagnosis is dependent on the history and physical examination findings.

Do the symptoms (rash, etc.) of inflammatory breast cancer come and go? I've had breast cancer in my right breast and got a rash in my left breast two

2009-07-25T21:27:00.000+07:00

It's hard to comment without seeing it, but in general terms a rash that is related to the progression of cancer does not come and go, especially over many months and several years. It is unlikely to be related to cancer. There are many other things that can cause a rash on the chest wall, so one would have to place this in context of all other symptoms and circumstances of that rash.
It sounds like you have had a previous diagnosis of breast cancer, so you may be connected with a breast surgeon who would probably be in the best situation to evaluate that rash.

Symptoms of inflammatory breast cancer?

2009-07-25T21:09:00.000+07:00

I am unsure if I have IBC. I am a 42-year-old female whose right breast inflames, turns red, and has a burning sensation. It has felt "tight," and increasingly so for the past two and a half years. Now the sensations have wrapped around my right upper body, and military doctors refuse to give me an incisional biopsy since nothing shows on mammogram and ultrasound. I was given Zithromax, but it did not help. Could this be IBC?
With those symptoms, you should be seen and examined by an experienced breast physician. If you've had the symptoms for over two years, this is unlikely to be IBC. It's difficult to make a judgment in this type of setting. So I'd recommend you be carefully examined, because as you may be aware, sometimes breast cancer is not picked up with mammography.

Inverted nipple a sign of cancer?

2009-07-25T21:08:00.000+07:00

Is an inverted nipple only associated with inflammatory breast cancer (IBC) or can it be present in other types of breast cancer?
An inverted nipple can be seen in a lot of conditions, some of which are benign and some of which are malignant. It is not always associated with breast cancer, and even when it is, it is not necessarily associated with inflammatory breast cancer. This is the type of condition that you should report to your doctor to be evaluated further.

How much interest is there in the medical community in finding treatments for triple-negative breast cancer? Is this currently a "hot area" of researc

2009-07-25T21:03:00.000+07:00

This is an exceptionally hot area of research in the breast cancer field. From the standpoint of being an unmet medical need, this is an area that many pharmaceutical companies are interested in as the therapeutic niches of estrogen-receptor-positive and HER2-positive breast cancer are already occupied with active agents. Whereas outside chemotherapy, we currently lack any targeted therapies for triple-negative breast cancer. So there is immense interest among drug developers, pharmaceutical companies, and breast cancer laboratory researchers in finding targeted therapies for these patients. Simply to call a cancer a triple-negative breast cancer to a certain extent points to some of the problem that we are dealing with. Imagine walking down the street, seeing a red-headed woman and turning to the person you are walking with and saying, "There is a non-blonde non-brunette who doesn't have a beard!" That is the current status of triple-negative breast cancer. We need to turn it from a negative definition into a biologically positive definition by coming up with therapeutic targeting of growth factors for triple-negative breast cancer. When we do so, we will have certainly advanced therapy for women with this disease.

Do you recommend mastectomy for triple-negative?

2009-07-24T21:01:00.000+07:00

In a patient that is BRCA1 positive, I would discuss what the risk of a contralateral breast cancer would be in her lifetime. Because this risk by the age of 87 can be as high as 70%, in those patients bilateral mastectomy with reconstruction would be a very good option. I do not believe that a mastectomy in a BRCA1 patient is mandatory, but it's important for them to understand what their risk is. Because many of the triple-negative tumors can develop quickly, many of these patients will opt for the surgical treatment of breast removal and reconstruction to be able to move forward with their life and feel they have done everything they can surgically to reduce the change of a cancer developing in the opposite breast. The cosmetic results after current reconstruction procedures are excellent, and therefore bilateral mastectomy is not the disfiguring operation that it was 20 years ago. I always explain to my patients who choose this operation that their risk will never go to zero, as there is approximately a 2% risk of a primary breast cancer occurring in the skin flap, since not every single cell can be removed at the time of surgery.

Do you recommend mastectomy for triple-negative?

2009-07-24T20:59:00.000+07:00

The decision to perform a mastectomy or lumpectomy is not based upon the tumor being triple-negative or being estrogen-receptor positive or progesterone-receptor positive or HER2/neu positive. Lumpectomy followed by radiation therapy and mastectomy are equal treatment options for the local treatment of breast cancer. The determination for whether or not radiation therapy would be required after mastectomy would be determined by whether or not more than three lymph nodes were involved with tumor, or whether the tumor had spread beyond the capsule of the lymph node. Removing a woman's breast does not guarantee that a tumor will not recur elsewhere in the body. I always begin my breast cancer consults with my patients by stating to them that no woman ever died of breast cancer in her breast; women die of breast cancer as a result of cancer cells spreading outside the breast and lodging in other organs. Because of this fact, mastectomy would be the option for the treatment of breast cancer for several reasons. If a breast cancer is what we call locally advanced or inflammatory, where the actual skin of the breast shows signs of edema or actually has cancer cells within the dermis of the breast, then chemotherapy would be given in what we call neoadjuvant or prior to surgery, and regardless of the clinical response of that breast, the mastectomy and radiation therapy would be indicated. If a tumor is identified in the breast that is so large that the cosmetic defect of the breast would be great, mastectomy would also be an option, but neoadjuvant chemotherapy to shrink the tumor would also be an option to preserve the breast. Just because a tumor is triple-negative does not mean a mastectomy is mandatory.

Since triple-negative breast cancer is not fueled by hormones, is it safe for a triple-negative survivor to become pregnant after treatment or could i

2009-07-24T20:58:00.000+07:00

I agree with everything Dr. Dupree mentioned. I approach things slightly differently in my clinic. The first question I think we need to ask is whether a pregnancy subsequent to breast cancer diagnosis increases the risk of recurrence of that cancer. While it is very difficult to say for certain, such evidence as we have suggests that there is not likely to be a major increase in risk of recurrence. The second question is a much more difficult one to my mind, and that is to say should a patient become pregnant knowing that it is possible that the child she brings into this world may grow up without a mother? This gets to the question of risk of recurrence, and in particular the risk of the recurrence that a woman would have with or without a pregnancy. As Dr. Dupree mentioned, one of the reasons for waiting for a pregnancy, especially in triple-negative breast cancer survivors, is that the greatest risk of recurrence in triple-negative breast cancer occurs relatively early on, in the first few years after diagnosis. Other factors that help determine the risk of recurrence are classic factors such as tumor size and number of lymph nodes involved. The patient and her spouse therefore need to consider what degree of risk they are willing to accept prior to a patient becoming pregnant. This is often one of the more difficult discussions that families and physicians can ever have, but certainly a very important one.

Since triple-negative breast cancer is not fueled by hormones, is it safe for a triple-negative survivor to become pregnant after treatment or could i

2009-07-24T20:57:00.000+07:00

Pregnancy after breast cancer is always one of the most difficult topics to discuss with patients. First and foremost, the treatment of the cancer with surgery, chemotherapy, and radiation needs to be the first and foremost important aspect in this discussion, as caring for the woman who has the breast cancer and treating her appropriately to allow her to have the greatest chance for long term disease-free survival is of the utmost importance. Once a patient has completed her treatment, it is recommended in my practice, as well as those of the medical oncologists I work with, that the patient wait for at least a 2-3 year period after treatment of their cancer prior to initiating attempts to become pregnant. If I have patients in their mid-30s who are about to undergo chemotherapy, I will discuss with them prior to their treatment what options would be available to them to help to maintain fertility: to potentially perform egg retrieval and fertilization prior to their treatment if pregnancy is of utmost importance to them after completion of their chemotherapy. In women who are estrogen-receptor positive, the concern about pregnancy immediately after treatment is from the overabundance of hormones such as estrogen and progesterone that are produced during pregnancy that could potentially fuel any cancer cells that may have been left over from the initial cancer. In my patients who are estrogen-receptor positive in a premenopausal setting I recommend that they complete their 5 years of tamoxifen, but there are many medical oncologists who would, after 2 years, allow the patient to go off their tamoxifen to initiate pregnancy. There are many factors beside just estrogen-receptor positivity that would need to be taken into account when considering pregnancy after breast cancer. Each patient needs to be counseled individually and when all of the risks, benefits, and potential rewards of the pregnancy are discussed, that couple can then make an educated decision about how and when to proceed with pregnancy.

I have read that alcoholic beverages are worse for estrogen-receptor-positive patients than estrogen-receptor-negative patients. Is this true? How muc

2009-07-24T20:55:00.000+07:00

Alcohol has been listed as a carcinogen and can have significantly negative effects on women who consume too much alcohol. Alcohol has its greatest effects in inhibiting the liver's ability to clear certain substances from the body. The studies have shown that postmenopausal women, who by virtue of being postmenopausal have a higher incidence of estrogen-receptor-positive breast cancers, are at greatest risk for consuming excess amounts of alcohol. Women who consume 1/2 glass of wine per day in the postmenopausal period increase their risk of developing a breast cancer by 6%. Women who consume 2-3 glasses of alcohol per day increase their risk of developing breast cancer by close to 40%. There is definitely a direct relationship between the amount of alcohol consumed and the increased risk of breast cancer. In the estrogen-receptor-negative patients, there has not been such a direct correlation but looking at the overall detrimental effects of excess alcohol consumption, this is one lifestyle modification that can benefit women in multiple ways. I have been asked by women why their cardiologist recommends they drink a glass of red wine per day, when I recommend moderation in alcohol consumption. The effects on cholesterol in the body that may be beneficial from the red wine need to be weighed carefully by each individual woman, as cardiac disease is very prominent and also a major risk factor for premature death in women. Therefore, this is a subject that should be specifically discussed with an individual patient and their physician team in order to make an educated choice as to what amount of alcohol is deemed to be safe for that woman. Alcohol in excess should be considered an increased risk factor in the development of breast cancer in the average postmenopausal woman.

I have read that alcoholic beverages are worse for estrogen-receptor-positive patients than estrogen-receptor-negative patients. Is this true? How muc

2009-07-23T20:56:00.000+07:00

The data suggesting that alcohol intake increases the risk of breast cancer I think is compelling, and I would agree with everything that Dr. Dupree has said. It is important to distinguish the increased risk of developing breast cancer with the risk of having a recurrence of breast cancer for someone already diagnosed. At present, we have no data suggesting that alcohol intake after a diagnosis of breast cancer increases the risk of recurrence of breast cancer. Some of the epidemiology studies that have demonstrated an increased risk based upon alcohol intake have also suggested that this risk may be decreased by intake of folic acid. As Dr. Leslie Bernstein, one of the epidemiologists at University of Southern California who first demonstrated this link once told me, perhaps what a woman should do is to wash down a multivitamin with her Chablis. Make that Merlot - we want a good red. :-)

How about the p53 gene? Seems that the triple-negative is also commonly associated with the overexpression of p53. What significance does this gene pl

2009-07-23T20:54:00.000+07:00

p53 has been called the “guardian of the genome.” That is to say p53's role in normal cells is to tell a cell to in essence commit suicide if its DNA has been damaged. In many cancers, but particularly in triple-negative breast cancers, p53 may be mutated and may no longer be performing the purpose intended by nature. Unfortunately, while we can measure p53 in cancer cells and while it is clear that mutated p53 is a poor prognostic factor in many human cancers, there is little we can do therapeutically about this problem at present, although this is an active area of pre-clinical research.

How do we stay informed of upcoming clinical trials for triple-negative breast cancer after we're finished with treatment?

2009-07-23T20:53:00.000+07:00

There are a number of wonderful sources for looking at clinical trials. The National Cancer Institute maintains through its Physician Data Query and ClinicalTrials.gov databases great up-to-date summaries of breast cancer trials that are NCI-sponsored and going on around the United States. It's also reasonable to ask your medical oncologist if he/she participates in clinical trials for breast cancer in general and triple-negative breast cancer in particular. Indeed, if your medical oncologist does not routinely participate in clinical trials, you probably need a new medical oncologist.

Do you recommend that triple-negative breast cancer patients take flaxseed and vitamin D?

2009-07-23T20:52:00.000+07:00

I encourage my patients, after testing to determine their baseline level, to have vitamin D replacement to a therapeutic level and I explain to them that although I do not believe that this is the silver bullet to prevent breast cancer recurrence, it certainly won't hurt them and as previously stated by Dr. Sledge, the information that we currently know supports the fact that vitamin D does play a role in this process. Therefore I think the benefits of 1000 I.U. per day certainly outweigh any risk that vitamin D could possibly present for patients.

Do you recommend that triple-negative breast cancer patients take flaxseed and vitamin D?

2009-07-23T20:51:00.000+07:00

At this year's ASCO symposium, Dr. Pamela Goodwin of Toronto, Canada presented an interesting study regarding vitamin D levels. In this study, women with newly diagnosed breast cancer had vitamin D levels drawn, and then these patients were followed for many years. In this study, patients who had low levels of vitamin D at the time of diagnosis were at greater risk for later recurrence of their breast cancer than patients who had normal levels of vitamin D. The difference was quite impressive. While this certainly in no way proves that vitamin D prevents recurrence of breast cancer, as that question would require a prospective study to answer, taking vitamin D at the level of say 1000 units per day is cheap and safe and appropriate from a bone health standpoint. So it is difficult for me to imagine why we couldn't recommend this to women who have been diagnosed with early stage breast cancer.

Do you recommend that triple-negative breast cancer patients take flaxseed and vitamin D?

2009-07-22T20:51:00.000+07:00

A recent study that was published in the July 2008 edition of the New England Journal of Medicine discussed therapeutic levels of vitamin D in the prevention of cancers such as breast cancer, colon cancer, and prostate cancer. The current recommendation is for maintaining levels of greater than 45 nanograms per milliliter. Vitamin D levels can be evaluated by a blood test specifically for 25-hydroxy vitamin D. Patients who are deficient in vitamin D can increase their levels by taking an oral supplement of vitamin D3 or their body can produce vitamin D with 15-20 minutes per day of sun exposure. Flaxseed has been touted in many trials, none of which I believe are randomized, to have anti-cancer properties. But in and of itself, I do not believe it has ever been proven to prevent cancer. Flaxseed can help to eliminate excess fats in the colon from colonic absorption, therefore the decrease in the absorption of fat can lead to decreased body fat being converted to estradiol. Therefore you could postulate the positive effects, particularly in patients with estrogen-receptor-positive breast cancers, through this pathway.

Why isn't radio frequency ablation more often used in combination with chemotherapy as a weapon, especially against triple-negative? Please address th

2009-07-22T20:50:00.000+07:00

Radio frequency ablation is not a standard treatment for breast cancer. It is used in clinical trial settings, but as a standard therapy for breast cancer I would not put it in that list of treatments that would be considered standard of care in our current breast cancer armamentarium

I have triple-negative breast cancer and the pathologist characterized it as basal-like carcinoma. Is it correct to think of basal-like carcinoma as a

2009-07-22T20:49:00.000+07:00

Basal-like cancers and triple-negative cancers overlap with each other. Not all triple-negative breast cancers are basal-like, and not all basal cancers are triple-negative, though most triple-negative breast cancers are basal and most basal cancers are triple-negative. Since the definition of a basal cancer is a definition derived from the area of genomics, my suspicion here is that the pathologist was using basal and triple-negative in the overlapping sense rather than in a well-defined genetic sense. From a prognostic standpoint, if a tumor is basal or if it is triple-negative, that is a tumor that probably puts one at higher risk of recurrence in the absence of systemic therapy. But as we have mentioned earlier, these tumors are frequently very sensitive to systemic chemotherapy in terms of preventing recurrence and death. And as we mentioned, this is only one factor among many that determines prognosis; other factors being the stage and grade of the tumor.

Studies have presented some evidence about greater risk of triple-negative breast cancers among African-American women and Latinas compared to white w

2009-07-22T20:48:00.000+07:00

This is one of those $64,000 questions that we don't know the answer to. It is interesting that if one looks at women in Nigeria, a high percentage of women there have triple-negative breast cancers. So this may indeed be more than just environment; there may be an important genetic component although we have not identified what that is at present. Indeed, the only genetic factor we have identified so far for triple-negative breast cancers (and only in a small percentage) is the BRCA1 mutation.

Is triple-negative breast cancer a fast-growing or slow-growing type of cancer?

2009-07-22T20:47:00.000+07:00

In general, triple-negative breast cancers are characterized by being highly proliferative: that is they are typically faster-growing breast cancers than are, say, estrogen-receptor-positive breast cancers. This may explain both why they are potentially dangerous breast cancers, but also perhaps why they are more sensitive to chemotherapy drugs that affect dividing cancer cells, so that they are in general more sensitive to chemotherapy agents than are estrogen-receptor-positive breast cancers in many cases.
When we characterize tumors, we look at the stage of the disease as well as the grade of the disease when we determine treatment. The stage of a breast cancer is determined by the size of the tumor, whether or not lymph nodes are involved with metastasis of the tumor, and whether the tumor has spread to someplace distant in the body. The grade of the tumor is a characterization of the tumor by the pathologist that allows us to determine how fast the cells are dividing. Women with a high grade, or a grade III, breast cancer may be recommended to have chemotherapy even when they are diagnosed with a very early Stage I breast cancer. Therefore we use multiple factors in determining how we treat each and every patient and not one factor alone can make these determinations. Depending on the biological behavior of the tumor, we may tailor the patient's treatment by trying to prevent a cancer from recurring not only in the breast, but also systemically in the body.

When did the cancer community begin to identify triple-negatives? How long have we been tracking triple-negative survivors?

2009-07-21T20:45:00.001+07:00

When we say triple-negative, we mean estrogen-receptor negative, progesterone-receptor negative, and HER2 negative. Routine HER2 testing did not become possible until a decade ago. Interestingly, if one looks in the medical literature, one never sees the term triple-negative breast cancer prior to 3-4 years ago. Indeed, focused studies for triple-negative breast cancer have almost entirely been conducted within the last 3-4 years. That is not to say that we don't know a great deal about triple-negative breast cancers. Because clinical researchers collect slides and tissue blocks as part of clinical trials, we are able to go back to those blocks and slides, sometimes from decades ago, and look at clinical trials through the lens of triple-negative breast cancers.
The term triple-negative seemed to become quite popular, particularly in distinguishing patients as a subgroup once the drug Herceptin became available to treat patients that were HER2/neu positive and previously thought to be a subgroup of having an incredibly aggressive form of cancer. Once there was a treatment for HER2/neu, the term triple-negative became more used in distinguishing this group from a subset of breast cancer patients.

I am triple-negative. I had a retest done where they found focal areas of progesterone-receptor positive. My oncologist put me on Arimidex -- said it

2009-07-21T09:01:00.001+07:00

If we look at hormone receptor status, women who are estrogen-receptor negative but progesterone-receptor positive represent a true minority and a small minority of breast cancer patients, probably representing less than 5% of all breast cancer patients. Many pathologists looking at this issue feel that estrogen-receptor negative/progesterone-receptor positive may represent an artifact of pathology, i.e., an error in testing. The error could be in two ways -- one could be that the tumor is estrogen-receptor positive and progesterone-receptor positive or the tumor could be truly estrogen-receptor negative and progesterone-receptor negative. So if there is any serious question then it is always reasonable to ask the pathologist to cut another slice from the block and retest. From a treatment standpoint, if a tumor is estrogen-receptor negative and progesterone-receptor positive, it is reasonable to consider hormonal therapy, though one suspects that the benefit for such patients would be less with hormonal therapy than in a patient who is strongly estrogen-receptor positive or progesterone-receptor positive.

Has there ever been an association between use of infertility drugs and triple-negative breast cancers?

2009-07-21T09:01:00.000+07:00

I'm unaware of any. However, recent epidemiological studies suggest that the risk factors for triple-negative breast cancer may be somewhat different than for estrogen-receptor-positive breast cancers. So for estrogen-receptor-positive breast cancers, for instance, risk factors include the age at first birth and how many pregnancies one has. Indeed, for these women, having many children and starting having children at a young age are protective for those tumors. In contrast, recent studies say that for triple-negative breast cancers, higher parity and young age at first birth may in fact be a risk factor (increased risk). This was not observed in older studies because these cancers represent a small minority of all cancers. In addition, there also appears from an epidemiological standpoint for there to be an interaction with race and age, so that younger women and African-American women are more likely to develop a triple-negative or basal breast cancer. In particular, young African-American women are more likely to have a triple-negative breast cancer.

Why is it that some triple-negatives receive Taxol during chemotherapy and some patients do not?

2009-07-21T09:00:00.000+07:00

In my clinic, if I’m going to give a patient chemotherapy for a triple-negative breast cancer, that chemotherapy regimen will virtually always include a taxane.

What is the best chemo combination for the triple-negative?

2009-07-21T08:59:00.000+07:00

Let me answer in general terms. When we have looked at chemotherapy regimens over the past 2 decades in the adjuvant setting or early disease setting, what we have learned is the addition of taxanes such as Taxol (chemical name: paclitaxel) or Taxotere (chemical name: docetaxel) to previous regimens has added benefit. We also have evidence to suggest that using these regimens in what is called a dose-dense fashion, i.e., more frequent administration of the agents, seems to improve benefit. This appears to be true in triple-negative breast cancers as it is in other subtypes, but perhaps more so in triple-negative breast cancers. We are still wrestling with whether specific drugs should be included or excluded for triple-negative breast cancers. For instance, oncologists are currently arguing over the role of Adriamycin (chemical name: doxorubicin) in early stage breast cancer. Over the next few years we are likely to see a number of new agents enter the adjuvant setting. Currently, for instance, Avastin (chemical name: bevacizumab; an agent that targets blood vessels) is being studied in large adjuvant trials for early stage breast cancer including triple-negative breast cancer. There are also robust studies going on to see whether platinum-based chemotherapies, which damage DNA, may work better in triple-negative breast cancers than they do in other cancer types, but we do not yet have an answer to this question for early stage breast cancer patients.

What are the most important recommendations you can make that patients can follow after treatment for triple-negative breast cancer? Aren't there any

2009-07-20T08:58:00.000+07:00

I think that you can refer to the first question regarding diet and exercise and the overall benefit of reducing the risk of a recurrent cancer. Another factor at the completion of treatment, which I always find very difficult for patients, is to go on and live their life. Once the chemotherapy or radiation or treatment is completed, it is often very difficult to stop focusing on the treatment of the cancer, and to begin living their life once again. With the completion of chemotherapy and the surgical therapy for the cancer, you need to be able to get to a place where you can realize you've done everything you can from a medical standpoint to beat the cancer. At that point focus on living each day to the fullest and making the lifestyle changes to promote a healthier lifestyle overall to reduce the risk of a recurrent cancer.

Do you recommend MRI along with mammograms as part of the annual checkup, for someone who has had triple-negative breast cancer high grade, stage I, w

2009-07-20T08:57:00.000+07:00

I think the MRI recommendations made by the American Cancer Society (ACS) are reasonable. In essence, the ACS has recommended MRIs for women who are BRCA1 or BRCA2 mutation carriers, or women who have a lifetime risk of breast cancer of 20% or greater. I think certainly for standard screening, I only recommend MRI for such really high-risk women. For a woman who has already had breast cancer, such as the case you describe, there is no striking reason to believe that that would need to be imaged in a different way than the normal breast cancer patient. It is important to recognize that for any woman with an invasive breast cancer, the greatest risk is not the risk of a secondary breast cancer tumor but rather the risk of a distant metastasis of her first breast cancer. So while continuing imaging of the breast is important, that is likely to be determined by whether or not she has had appropriate therapy to prevent a systemic recurrence.
I agree with the ACS recommendation in the BRCA-positive patients and women with a 20% risk. The other subgroup that I will use MRI for screening is the group of women whose breast cancers were undetectable by mammography, whose mammograms didn't reveal the primary tumor. This is typically a group of women whose mammograms reveal very dense fibroglandular tissue that reduces the sensitivity to detecting an ipsilateral [same breast] recurrence or a contralateral [other breast] primary cancer. This is a small subset of patients, but the inability for the mammogram to have detected the first cancer decreases my confidence in the mammogram to be used as that patient's only screening tool.

If ER/PR/HER2 fuels breast cancer, what is fueling triple-negative breast cancer and when will targeted therapies be available?

2009-07-20T08:56:00.001+07:00

There are some trials that are attempting to develop regimens for triple-negative cancers. They're trying to determine whether antiangiogenic agents can specifically target the triple-negative cancers better than the standard chemotherapy. That would be the drug Avastin (chemical name: bevacizumab). There are other emerging targeted therapies that are working on trying to incorporate aspects of increasing cellular proliferative pathways and cellular repair pathways. These are looking at growth factor receptors such as EGFR (epithelial growth factor receptor) but most of these studies are Phase I evaluations and not quite ready for prime time yet. In order to develop a targeted therapy, we have to know exactly what pathway of cell division and cancer proliferation we're trying to stop. So there is ongoing research but most of those studies are within Phase I and Phase II.
An area that is of real interest now in the laboratory and the clinic are new drugs called PARP inhibitors. These are drugs that interfere with DNA repair in breast cancer and there is laboratory evidence to suggest that particularly for BRCA1 and BRCA2 tumors, these PARP inhibitors may turn out to be active agents for the treatment of these cancers since these cancers tend to have altered and impaired DNA repair. There has already been Phase I data in ovarian cancers presented at this year's ASCO meeting in a fairly heavily pretreated population of BRCA1 and 2 with ovarian cancer, suggesting significant activity with this agent. There are now trials going on in BRCA1 and BRCA2 mutation carriers in breast cancer. What is particularly interesting about this is that the great majority of BRCA1 mutation carriers have triple-negative breast cancers. Indeed, there is certainly a suggestion from some of the laboratory studies that other triple-negative breast cancers may at least share some of these problems with DNA repair that make the mutation carriers more sensitive. So this is an exciting and emerging area of research for which we should keep our eyes peeled over the next few years.

I am a breast cancer researcher. My patient has been diagnosed with Stage IV triple-negative breast cancer. She has open sores on the right side of he

2009-07-20T08:56:00.000+07:00

We have relatively little in the way of studies regarding specific agents for triple-negative breast cancer, but there is some emerging data that I think is interesting. If we look in the E2100 trial of Taxol (chemical name: paclitaxel) alone vs. Taxol with Avastin (chemical name: bevacizumab) as front-line therapy for metastatic breast cancer, Taxol and Avastin was superior to Taxol in triple-negative patients to the same degree it was in estrogen-receptor-positive patients. On the opposite end, we have some very interesting and recent adjuvant data which is from a trial performed by the CALGB (Cancer and Leukemia Group B) in elderly breast cancer patients (age 65 or greater) newly diagnosed and receiving adjuvant chemotherapy. This trial randomized patients to one of two older chemotherapy regimens, AC (Adriamycin [chemical name: doxorubicin] and Cytoxan [chemical name: cyclophosphamide]) or CMF (Cytoxan, methotrexate, and fluorouracil) vs. the use of single agent Xeloda (chemical name: capecitabine). The results of that trial were particularly interesting in that in women who had steroid-receptor-negative tumors, Xeloda appeared to perform particularly poorly with a hazard ratio for recurrence of 4.4 vs. other groups treated with chemotherapy and estrogen-receptor-positive patients. This suggests the possibility that Xeloda is simply not a very good drug for triple-negative breast cancer patients, certainly not in the adjuvant setting. There is another trial that I presented at ASCO a little over a year ago, called the XCALIBr trial, which looked at the combination of Xeloda and Avastin as front line therapy for metastatic breast cancer. While patients who were estrogen-receptor positive did relatively well in this trial, the triple-negative patients did extremely poorly. Putting together the CALGB trial as well as the XCALIBr trial, one lesson I draw from this is that Xeloda would not be my initial therapy for patients with a triple-negative breast cancer.

My mom was recently diagnosed with triple-negative breast cancer. She is Stage I with no lymph node involvement. She underwent six chemo treatments an

2009-07-20T08:54:00.000+07:00

A good place to start is what's a common misconception in that triple-negative breast cancer has a truly awful prognosis. But in fact, that's not really the truth. Factors such as size of tumor and lymph node status are still very important. For a Stage I breast cancer patient, even with a triple-negative breast cancer, most patients live to a ripe old age. In addition, if the patient received adjuvant chemotherapy, there are significant reductions in the risk of recurrence and death due to breast cancer. So I would not consider this a matter of gloom and doom. Beyond this, there is an emerging area of what we can do after chemotherapy for women with triple-negative breast cancer. There are some fascinating recent data from a trial that was conducted by Dr. Rowan Chlebowski of University of California, San Francisco, that looked to see whether or not modifying one's dietary fat intake would have any effect on outcome for early stage breast cancer patients. While dietary fat reduction had relatively little effect in women who had estrogen-receptor-positive breast cancers, in women with estrogen-receptor-negative breast cancers, there was a significant reduction in the risk of recurrence for women with a low dietary fat intake. There's also increasing evidence, most prominently from the Women's Health Study in Boston, that women who exercise regularly (3 hours a week or more) have a lower risk of recurrence of their breast cancer than women who do not exercise regularly. So these studies point to the possibility that lifestyle interventions may be important for the breast cancer survivor.

Hi, I am a 4-year breast cancer survivor. On my last mammogram I was called back for an ultrasound and was told that they had found new breast tissue

2009-07-19T08:53:00.000+07:00

I would be suspicious of that as well. I don't know how old you are, but if you take estrogen, new tissue can appear on a mammogram. If you are not undergoing hormone replacement therapy, then a new area of tissue should be regarded with suspicion. I would ask for a biopsy. When you lose weight, the breast may be smaller and look more condensed on a mammogram, but a new area of tissue should not develop. What I do when there's an area of abnormality on a mammogram is solve it on the mammogram by doing additional views. I then go to ultrasound to see if I can tell if the area of concern is normal breast tissue or a cyst or a mass.
Tonight we have talked a lot about tests—tests performed within the hospital as well as your own breast exams and your doctor's exams. If you find a lump in your breast that persists, even if the mammogram and ultrasound are read as normal, it's important to follow and evaluate the lump. We do have a tendency to favor technology over something as simple as your own breast examination. Of course, you want to be completely reassured by the normal test report, but again, about 20 percent of women are diagnosed with breast cancer based on a palpable or visible abnormality that is not seen by mammography. It's important to take this a step further with ultrasound or the other tests described above by Dr. Brennecke.

What can you tell us about R2 technology and ImageChecker in mammograms?

2009-07-19T08:52:00.000+07:00

Computer aided detection is a way to help the radiologist interpret the mammogram. Several studies have shown that a radiologist may detect more early cancer if a computer is also allowed to analyze the images as a second reader. I used this technology in the past, and found that it aided the general radiologists particularly. Many radiologists interpret mammograms as part of many different exams that they do, including CT scans, chest X-ray, bone films, etc. and having a computer as a second reader can help that radiologist be more accurate in reading mammograms. This is another advantage of the digital revolution making computer detection easier, but it is also available for standard film mammography.

I am 62. I've had a mastectomy, radiation, without chemo (2 nodes involved), and been on tamoxifen for about 4 years. I've been free of cancer until n

2009-07-19T08:51:00.000+07:00

If you have new pain in your back and your joints, and you are suffering without an explanation for why you're having pain, then you need to have further evaluation. In the U.S., a doctor might start with a bone scan to look at the health of your whole skeleton. Sometimes extra films are done of a particular area that may be of concern. If a person has back pain that's severe in a particular area, and also has numbness or a change in her ability to walk after having a diagnosis of breast cancer, an MRI scan would be very useful. Your doctor in Romania might also want to do a blood test to see what your calcium level is.

Of course there are many causes of back pain and joint discomfort besides breast cancer. If you've had breast cancer, your worst fears will always go through your mind. But low back pain is very common, as is arthritis. If you've had chemotherapy, particularly if you've been treated with a taxane, joint and muscle discomfort is not unusual. Some women experience joint and muscle discomfort while taking aromatase inhibitors. It sounds like you need to go back to your doctor and push him/her for some more answers, so you can have a better understanding of what's happening with your body.

Is it true that extreme pressure on the breast for a mammogram can break and spread small tumors?

2009-07-19T08:50:00.000+07:00

No. The compression is necessary to get the X-ray image, and the compression does NOT cause any abnormalities of the breast. I have seen some bruising on occasion, but it has never been shown to cause or spread breast cancer.

I lost my mother to cancer when I was 10. How can I check myself, or what do I need to see? I also have two daughters, and I am worried.

2009-07-19T08:49:00.000+07:00

I start the daughter of a woman who's had breast cancer with screening mammography 10 years earlier than her mother's age at diagnosis. So if your mother was 40, you should start screening at age 30. Screening should include a mammogram and a clinical breast exam and ultrasound if it is needed. Regarding your daughters, they should begin having clinical breast exams at age 18-20, when they start going to a gynecologist, and they should start learning how to do breast self-exams at about the same time.

What about when a breast cancer survivor reaches the magic five years and screening goes back to normal?

2009-07-18T08:48:00.000+07:00

In my practice, breast cancer survivors are always given diagnostic mammograms. That is the standard, as far as I know, in terms of what we use for deciding whether someone is a screening or diagnostic patient, and that is set by the insurance companies. There are codes assigned, and a person with a history of breast cancer can have diagnostic mammograms forever.
A careful exam of a person who's had breast cancer is essential. No matter how many years you are beyond your diagnosis, it's important for the technician to mark the scar on the surface of the breast so that the radiologist can focus in on that area with extra attention, as well as carefully evaluate the whole breast. This is one example of why you always deserve to have extra attention. If the scar tissue is prominent and stable even five years out and you go to a facility that does not pay attention to that area, it is possible that the radiologist might become unnecessarily worried about the tissue in the region of surgery.

Any little thing you can do to maximize the quality of your screening can make a big difference. Another advantage to continuing with diagnostic mammography is that you usually get the result of your mammography while you're there. This can vary from one place to another, but I think in general the chances of your being able to talk to the technician and the radiologist is better if you have a diagnostic study.

I was diagnosed with breast cancer last year at age 41. I've finished eight cycles of chemotherapy and almost eight weeks of radiation. The problem is

2009-07-18T08:47:00.000+07:00

In the early days of mammography, there was some discussion among physicians that the X-ray dose was possibly going to cause more cancer than was diagnosed. That was actually disproved, but it was quite controversial for a time. It even led to a recommendation that a screening mammogram be just one view of each breast because of the perceived fear of the radiation. There's actually been no evidence that breast cancer has been caused by imaging, and the dose has decreased since the beginning.

For this particular woman, I would advise her to continue to have a mammogram, a clinical breast exam, and ultrasound if needed for screening for breast cancer. These are still the most reliable tools that we have for detecting early cancer and recurrence. MRI at this point is a secondary tool. We don't have any evidence of its efficacy over time or how often it should be used. PET scanning is for the entire body rather than just the breast. PET can be used to check for metastatic disease, but not as a routine tool.
You may find that doctors in different institutions and in different parts of the world have different opinions and different styles of practicing medicine. For example, at Memorial Sloan-Kettering in New York, they are integrating MRI scanning into the follow-up of women who've had breast cancer personally, as well as in women who've not had breast cancer, but who are at high risk because of a known inherited gene abnormality. Until the role of MRI scans is better understood, it's hard to come up with strong recommendations one way or the other. It is a very useful tool under a number of different clinical circumstances. These tests in combination are likely to give you the best information.

It's also important for the test results of each of these studies to be correlated with the other studies. For example, you are likely to learn much more about the health of your breast if your radiologist is looking at both your ultrasound and your mammogram and combining the information. If you have each of these tests in two different institutions, it's possible you may not capture the full amount of information available.

For those with a previous breast cancer, are breast MRIs the new standard as a supplement to mammograms, and how often are MRIs recommended?

2009-07-18T08:46:00.000+07:00

MRI is a new technology for the breast and I don't feel that we've sorted out the exact use yet. Right now the accepted use of MRI is in the newly diagnosed woman, to check that breast for a second known site of a breast cancer on the same side, and to check the opposite breast for an unknown site of possible cancer. The use of MRI to screen breast cancer survivors is not yet accepted. It is a very expensive tool. It is difficult to interpret; there is a high rate of false positives—seeming abnormalities that show up on the exams and are not real abnormalities—like a false alarm.
At the recent ASCO (American Society of Clinical Oncology) meeting, a very interesting report was presented on the role of MRI scans in women without a personal history of breast cancer but who were known to have a breast cancer gene abnormality. In this study, researchers compared MRI scanning to mammography and ultrasound, and in this high risk population, MRI scans seemed to be able to find small, invasive breast cancers earlier than mammography and ultrasound. Mammography seemed to be better at finding non-invasive (DCIS) breast cancers. There were nearly 2000 women in this study. This information is promising but still early.

I didn't find a lump, but a dimple. Is this common?

2009-07-18T08:43:00.000+07:00

We talked about what you feel with the self-exam, but an important part is to look in the mirror and look for a dimple. The breast should be outwardly round—it should curve outward and not pull in. A dimple is a pulling in of the skin, and it may occur when you raise your arm or lean forward. When you lean forward and raise your arm, the breast should stay outwardly round; it should not pull back in. That may be a sign of cancer, and it should be checked.
If you've had breast surgery before and you have some scars, you might find that the breast will pull in around a scar. Of course, this is a different situation. Anything that is new or different about your breast is important to make note of. You may also see changes in the color of your breast, such as pinkness or redness. You may see a rash on your breast. Some women may notice that their nipple is getting crusty or irregular. You may also notice a discharge out of the nipple. All of these changes are important to bring to the attention of your doctor. Another important finding is enlargement of the breast. There is a very unusual type of breast cancer called inflammatory breast cancer that involves enlargement of the breast, pinkness or redness of a significant part of the breast, or thickening of the skin, and only half the time is there a lump to be felt.
e should stress here that breast enlargement alone is not necessarily a sign of inflammatory breast cancer. I see a lot of women who are worried about a change in breast size, and inflammatory cancer is rare. If the breast doesn't have any of those other features, if it still looks soft and pale and the color is normal, there may be nothing to worry about.

The American Cancer Society (ACS) has done a very good job instructing women on the proper technique for BSE (breast self-exam). Are the doctors that

2009-07-17T08:43:00.000+07:00

I'm part of a group in Maryland that travels around the state and teaches the "Mammocare" method to practicing physicians, usually primary-care physicians. That work is funded by the CDC (Centers for Disease Control) because Maryland has a very high breast cancer rate. I don't know what medical schools are doing about it, but in my breast center, we offer clinical breast exams performed by the radiologist, and it's a highly sought-after service.
I have patients who complain to me that their doctors do poor breast exams, and they don't know what to say or how to handle it. I think it may be important for you to say just before the exam starts that you really need the doctor to do a very careful exam, that it's very important to you, and that you are really depending on him or her to do this in conjunction with your own self-exam as well as mammography and other tests, as needed. Making this request may make a significant difference, but if the doctor does not respond in a way that is satisfactory to you, maybe you should find another doctor, or at least make sure there are enough other doctors on your team who are providing this important part of your examination.
At the very bottom of the breast, just above the crease or the fold, where an under wire would rest, the breast may have a very smooth or thick consistency, like the rind of a piece of fruit. It's thick and smooth and the edge of it can feel like a ridge. Don't expect our descriptions to fit your breasts exactly. Our only message here is that the breast tends to have different patterns of consistency, depending on the area. Get to know how your own breast tissue feels, and if you have any questions, bring them to the attention of your doctor.

There's been quite a bit of "news" recently suggesting that mammograms and breast self-examination are not particularly valuable in discovering breast

2009-07-17T08:42:00.000+07:00

No. Look to see who wrote the articles; they are not doctors, they are reporters. They are writing to get attention, and they do get attention. I'm married to a reporter, so I know these things.
That's right. In the best hands, mammography is about 85 percent effective in picking up cancer. But if a woman feels there is something wrong with her breast and the test comes back showing that everything is normal, she may think she can ignore what she thought she felt. That's not a good idea; she needs to take things a step further. One of the hardest things about breast cancer is the emotional overlay. It's a very emotional part of the body. I have had women tell me they'd rather have their colons removed than have a biopsy of the breast. It seems obvious to me that if you touch your breasts, you will know more about yourself than if you don't touch your breasts. Women, particularly those under age 40 and not having routine screenings, should be very aware of how their breasts feel, and if they don't feel right, they should bring it to their doctors' attention. Younger women with breast cancer get picked up very late because they're not doing self-exams, and are not getting any screening tests because they're so young.

Mammography is of limited use if the breast tissue is dense, and there's no way to know how dense your breasts are until you've had a mammogram. Your breast can feel lumpy and sore and firm (cystic or fibrocystic), but when we do a mammogram, it may not be a difficult breast to interpret. Younger women tend to have breasts that are harder to interpret on a mammogram, but that's by no means universal. Thinner women tend to have breasts that aren't fatty. Fat is our friend on a mammogram. It helps us out when we're trying to find early cancer because it looks different than the way cancer looks.

Do silicone implants used in reconstruction surgery obscure radiographic exploration for recurrence?

2009-07-17T08:41:00.000+07:00

X-rays cannot penetrate silicone, so silicone implants do limit our ability to see. This is also true for women who have not had cancer but who have had breast augmentation surgery. But if the implant is placed behind the pectoral muscle, our visibility is not limited. So it is beneficial to have the implant placement behind the area where breast tissue would be.

It's been one year since I had a mastectomy and I am due for a mammogram. How are they going to view the mastectomy site?

2009-07-17T08:40:00.000+07:00

About 20 years ago, some interesting research was done which showed that performing mammography on the side of the chest where a mastectomy had been done was of no benefit. If there was a new problem, the researchers found that it would be picked up first with a physical exam. That research was done on women who hadn't had implants or reconstruction.

More recently, research was done on women who'd had reconstruction; in many cases with a so-called TRAM flap procedure, in which abdominal fat and muscle are tunneled under the skin to the breast area. Researchers found that in a few of these women, there was evidence of breast cancer in the TRAM. It is very difficult to remove every cell of breast tissue during a mastectomy, and it's possible that a few remaining cells could be cancer cells that grew after the patient had a mastectomy. However, this situation is very unusual.
Each one of you has a situation that is unique to YOU. You and your doctor should use the information we are giving you this evening to make the best screening and treatment decisions for YOU. If you've had mastectomy for a small cancer and all margins were widely free and clear and there was no lymph node involvement, the risk of recurrence in the area where the cancer developed is very low. If, however, you had a mastectomy for a large breast cancer, or one in which a significant number of lymph nodes were involved, the risk of local recurrence may be significant. In that situation, Dr. Brennecke, what is the best way to evaluate the area?

After breast cancer and appropriate surgery, for how long should women have diagnostic rather than screening mammograms?

2009-07-16T08:40:00.000+07:00

When a woman is a breast cancer survivor, I perform diagnostic mammograms on her for the rest of her life. I used to think that we should stop screening everyone at age 80, but I've changed my mind on this. That's because I see many women over 80, who are in very good health, and deserve to have the best care possible and to get screened. When you are a survivor, you should receive diagnostic mammograms forever. Medicare guidelines state that a unilateral mammogram—a mammogram done on a woman who only has one breast—is a diagnostic exam and not a screening exam.

A friend told me that mammograms are very painful, but that there is another method that is not painful. Do you know which test is she talking about?

2009-07-16T08:39:00.000+07:00

Personally I have a mammogram every year, and I don't think it's painful. But it depends on the technologist. If it's painful where you go, tell the technologist she's hurting you and she can make an adjustment. If you are premenopausal, try to have your mammogram when your breasts aren't hurting, usually in the first half of the cycle. Some women take a Tylenol before they go in. Try refraining from caffeine if that makes your breasts hurt. I work in a center where my technologists only do mammograms. They don't do any other kind of X-rays, and they are good at what they do. So find a place where the technologists are good at what they do and they won't hurt you.

Remember that many factors affect a person's experience of pain. Fear is a big factor; being afraid of the outcome, or of in the test, can heighten fear and pain. The technologist can calm you down and take it slowly. The mammogram has to press the breast tissue down tightly; it has to be tight because in order to get a sharp image, you want the X-ray to travel the smallest possible distance. Cancer can be the size of the head of a pin, and in order to detect it the breast must be compressed. However, your breast is only compressed for a fraction of a second.

There are plenty of tests that don't require compression. One is ultrasound. But ultrasound is not a screening tool because it cannot find the very early stage of breast cancer, which is what we call microcalcification. Microcalcifications are seen inconsistently on ultrasound. I love ultrasound; it's a fabulous tool in the breast, but we can't use it as a screening tool. MRI, interestingly, is performed lying down on your stomach with the breast immobilized. Now we've come to realize we can do the MRI if the breast is compressed, so we're back to compression.

Does digital mammography detect DCIS earlier than conventional X-ray mammography?

2009-07-16T08:38:00.000+07:00

X-ray mammography is the cornerstone screening method when it comes to finding cancer early. Digital mammography produces an X-ray image using digital technology, which is more like a TV monitor. The standard way of producing an X-ray image uses film, which is more like a movie. Film produces an image that is a little bit sharper than a digital image. Digital is still new, and companies that make the equipment want radiologists to buy it. When General Electric came out with the first digital equipment, the company did a lot of advertising, particularly during the Olympics, making all sorts of claims such as digital is the only way to go. A lot of people who were watching believed what they were hearing from GE.

However there's a study that's currently underway in which each woman who signs up has a mammogram with film followed by a digital mammogram. Both mammograms are done during the same visit and compared. The study is showing that there are fewer recalls with the digital method, but that the image quality is a little better with the film. (Editor's Note: A 'recall' is when you are called back into the office following a screening mammogram because the radiologist found an abnormality on the mammogram that requires further evaluation.) A key benefit of the digital method is that we can manipulate the image after it has been obtained. We look at the image on a computer monitor, and we can make it larger or smaller, brighter or dimmer. We can also magnify specific areas. With a film image, on the other hand, once the technologist has taken the image and processed it, it can't be changed. If it's too dark or light, that's it.

The bottom line is that although there are some manipulations we can make with a digital image, at this point digital is no better than film and it's considerably more expensive. Digital equipment is about 10 times the cost of film equipment, and at this point there's no proven benefit to the patient. I think it will eventually be the only way to have a mammogram, but the equipment and monitors still need to be improved. Unfortunately, when we buy new equipment, health care costs go up, so we have to be very cautious about how we develop and use new equipment. We have to be sure it's worth the cost, because the cost is in some way passed on to patients. Screening has to be low in cost in order to be effective. You can't charge a lot of money and expect women to be able to pay for a test every year.

How is a diagnostic mammogram different from a routine or screening mammogram?

2009-07-16T08:37:00.000+07:00

A routine or screening mammogram consists of four views—two views of each breast. The technologist takes the pictures, checks them for quality, and then you leave. With a diagnostic mammogram, you start with four standard views, and then supplement them with additional views, a physical exam, and ultrasound and MRI as needed. So a diagnostic mammogram is for women who are having a problem such as a lump or unusual nipple discharge or pain.

A diagnostic mammogram is generally read by the radiologist right after it has been done; ideally the woman does not leave the radiology facility until she has an answer about what is causing her breast problem. Usually the outcome is that everything is fine, but there is a higher incidence of finding cancer in that situation than in a screening situation.

Why is screening so important?

2009-07-15T08:35:00.001+07:00

We've found over the last 40 to 50 years that survival is much higher when you pick up cancer in the early rather than the late stages. Performing screening mammography is an effort to pick up cancer before there are any symptoms, so screening, strictly speaking, is only for women who are not experiencing any kind of breast problems.

The research that's been done as far back as the 1960s shows that X-ray mammography is the only proven method for finding cancer before anyone suspects that it's there. That research was rigorously done and has never been disproved. This is truer now, I think, than it was in those days because the quality of the images we can obtain is much better and our awareness is much greater.

What do you think about building houses on landfills (garbage sites)? Have you noted an increase of cancer in these areas?

2009-07-15T08:33:00.000+07:00

Landfills are long-term (meaning decades to centuries) active places where there is all sort of leaching of chemicals, runoff, and released gases that occasionally catch on fire. So one should be very cautious about long-term exposure, such as building a house, close to one. Certainly all caution would say that this is not a wise place to build.
When you look at many of these questions, it's really not science but personal opinion. There is power in the consumer avoiding products, and letting industry know you are avoiding them. Money does talk. Through advocacy groups banding together, there is even more power in the purse. That is one kind of power we have as concerned individuals.

However, that isn't enough. Other countries take these concerns at a policy level seriously. We are fortunate in the U.S. to have some extremely active advocacy groups among breast cancer survivors and family and friends who have been pushing our legislative bodies and regulatory agencies to investigate many of these compounds experimentally.

But the unfortunate thing is there are so many chemicals in our environment, and there isn't enough money in the world to study all of them in animal studies, let alone major epidemiological human studies. So policy decisions must be made, absent definitive data.

We must work together, not just the breast cancer advocacy groups, but many other advocacy groups. Many of these chemicals don't just affect breast cancer; often they're harmful to the cardiovascular system, and other systems may be involved too. So we need to think wisely about what we as a nation want to do about many of these compounds. These are really policy level decisions that will have to be made, in the absence of real data.

I read that there is often a triggering event, or perhaps exposure/stress that gets the latent breast cancer to become invasive. Is that true?

2009-07-15T08:32:00.001+07:00

By trigger event we mean an accident, some injury to the breast or other event. When breast cancer is diagnosed soon after that, it is really more related to the timing of seeing a doctor for the stressful event. The breast cancer just happens to be found by medical examination at the same time. There's probably not any biological reason that altered the rate of breast cancer development. There is data that suggests the immunosuppression related to stress can be a factor in cancer development. But having a stressful event per se will not cause a woman's breast cancer to suddenly become invasive.
I think cancer development is so much more complicated than a stressful life event might indicate. The most recent studies looking at stress and breast cancer occurrence have indicated no connection. In other words, although minimizing stress in your life is good for other reasons, stress does not seem to be a contributing factor to breast cancer recurring.

Do you feel that women who have gone through IVF have an increased risk of breast cancer?

2009-07-15T08:32:00.000+07:00

It seems that every study I see contradicts the one before. In other words, a study may come out suggesting an increase in the risk of breast cancer, and then an even better study says the association is not present.

I teach at a school that has had what some would consider a cluster of breast cancer and other cancers. My assistant and I have BOTH been diagnosed ju

2009-07-14T08:31:00.001+07:00

This is one of the most common questions nationally. There do appear to be neighborhoods, buildings, or workplaces where all of sudden you notice many people being diagnosed with breast cancer. Sometimes there is a culprit and sometimes there isn't, and the question is, what do you do about it? Certainly notifying physicians and health officials in your region is appropriate to see if there resources available for investigation.

But what I say often, particularly because of the deep level of concern from families in that cluster area, is to keep in mind that with the extraordinary frequency of breast cancer in our population, just by statistics alone you're going to find some of these clustering events that are really not related to local exposure, but to the fact that this is a very common disease. Many large clusters have been extremely well-investigated, and if you look at some of the websites we've mentioned, you may find information about Marin County, CA and Long Island, NY which are two of the best studies of cluster cohorts.

Having read about artificial estrogens, I store everything in glass containers rather than plastic. I heard that cooking or freezing in plastic can re

2009-07-14T08:31:00.000+07:00

here's much, much concern about plastics. Even in animal studies, it's an issue to make sure we don't contaminate experiments with plastics, especially old ones that have been used and washed many times.

As for water bottles, it depends on the plastic. Polyethylene is relatively safe. If you look at the bottom of your plastic bottle, there is a number in a little triangle. Look at Consumer Reports or The Green Guide for more info.

Generally you don't want to heat or cook with most plastics. It would be a better world if the plastics manufacturers provided us with information on these issues, rather than us having to become experts on what is a good or bad plastic.

Again, human data are just not available. So in personal practice, avoiding heating plastics and going to glassware if possible is wise.

Which has the most growth hormone—chicken or beef? I try to eat organic whenever possible, but would like to know which one is better when organic is

2009-07-14T08:30:00.000+07:00

I'm not an expert on this, but my understanding is that they're still using a growth hormone in beef production, even in milk. Chickens and pigs can have what they call growth additives, but not hormones. There is some risk that the feed for chickens and pigs may actually have beef in it that had growth hormone. That would have to be confirmed with the Department of Agriculture, but that's my understanding. Chicken may have contaminated feed, but it's illegal to add hormones directly to chickens.
I really think—again, it's only personal opinion—that one has to be reasonable with moderation in all things. I certainly don't avoid restaurants that don't serve organic meats. Reduction of your total meat consumption for many health reasons is a good idea. If you're fortunate enough to be able to afford and acquire organic meat, that's fine. But I think that you don't need to feel guilty if you can't afford it or if you want to go out and enjoy meat in a restaurant.

There is a new product called DME Natural which is “generally recognized as safe” by the FDA which is supposed to take heavy metals, toxins etc. out o

2009-07-14T08:29:00.000+07:00

Safety and efficacy for any compound, nutraceutical or pharmaceutical, can only be assessed in a clinical trial. To my knowledge, there have been no clinical trials for this particular product, therefore we have no data at all on safety or efficacy.

Can Teflon on pots cause cancer? What's the risk with microwave use?

2009-07-13T08:28:00.000+07:00

Persistent fluorinated compounds have increased dramatically in harbor seals and other animals in San Francisco over the past decade. They have also increased in breast milk. The Swedish government banned the use of these compounds, such as those used in Teflon, and found a dramatic drop in residues in breast milk within a decade of doing so.

There have been some experimental studies indicating that these compounds disrupt the immune system and could contribute to cancer. Because these compounds are so persistent in the environment, the manufacturers reported some of the evidence on their persistence to the EPA (Environmental Protection Agency) about four years ago. There's a lot of debate about whether or not they could be contributing to a wide range of health problems.

Right now, the Teflon-related compounds are everywhere. They are used to treat draperies and fabrics. A lot of people are working hard on to find less-toxic substitutes. As for the pots, high heat and burning the Teflon should be avoided at all costs. I just don't know if routine use is a problem.

My mother died of breast cancer. She worked at a chain of stores in which she cut cloth materials. Could there be some toxin in the materials that con

2009-07-13T08:27:00.001+07:00

It's such a common impulse to explain things that have happened to us. Much of the conversation now has been a desire to seek answers for something we can't really explain.
All the studies we talk about here, where we have evidence of an increased risk of breast cancer, necessarily look at groups of people over time, and yet cancer affects individuals one at a time. So we are really limited when it comes to understanding the causes of breast cancer in individual women. With respect to textiles, however, many modern textiles are treated with formaldehyde and dyes, and these things have been found to increase mammary tumors. There are some workplace studies as well that indicate that this could be a risk for breast cancer in groups of people with this kind of exposure.

People who work as dry cleaners who were in that industry 20 to 30 years ago were exposed to chemicals that may cause mammary tumors. Women who use dry cleaning may be at a higher risk for developing breast cancer as well. So now there is a move to “green” dry cleaning that uses organic solvents instead of chlorinated hydrocarbon solvents. This is a good development for two reasons: some of these chlorinated solvents contribute to greenhouse gas emissions and some of these contaminate groundwater and are associated with an increased risk of health problems.

I worked for a company for 5 years where 6 women in our department got cancer. The building contained asbestos and other toxins. Could this be coincid

2009-07-13T08:27:00.000+07:00

The asbestos studies that have been done clearly show an increase in a number of respiratory cancers in workers. Most of the workers studied have been men. There is a very clear suggestion of an increased risk in breast cancer in women who did work with asbestos. The number of women concerned is small, so the association did not achieve what we call statistical significance.

There could be an association between asbestos and breast cancer and frankly, if the environment included asbestos, it may have included other [harmful] agents as well. I'm not aware that brain cancer is associated with asbestos, but that doesn't mean there is no association, only that we don't have evidence that there is.

Is there any evidence that use of underarm deodorants/antiperspirants is linked to breast cancer?

2009-07-13T08:25:00.000+07:00

I don't think there are any data that have shown a link. I think the concerns with some of the deodorants as well as other personal care products has been the estrogen products we mentioned earlier, but the animal data are not clear and as far as I'm aware, there are no epidemiological data to support a causal role. That's true and probably going to be true for the rest of our lives. So what do you do in the meantime? I think a prudent avoidance of suspect material is all we can say. The reality is we do not have human evidence of harm. But that should not be confused with meaning that there is no harm. It merely means that, given the tools we have available to us now, we cannot answer the questions with studies in human

What about baby diapers in swimming pools?

2009-07-12T08:25:00.000+07:00

We can't escape germs, and we shouldn't even try to do so. In fact, one concern I have about bactericidal soaps is that they have been shown to increase susceptibility to common bacteria in life. We need some exposure to bacteria for our immune systems. But having said that, I'm appalled that some people don't realize that when you go into a hot tub, you should be clean. Also, you should NEVER think of taking an infant in a diaper into a hot tub. It would be like swimming in a little cesspool.

Does the chlorine in swimming pools promote breast cancer?

2009-07-12T08:24:00.000+07:00

Well, it prevents cholera! :-) We have improved our ability to reduce the amount of free radicals and other byproducts of chlorine right now. But again, there's no question that when you chlorinate water, you do create byproducts that have been shown to increase certain types of cancer. But if we did not treat our swimming pools, we would have outbreaks of infectious diseases. So the challenge is to treat our pools with limited residual chlorine byproducts and there are ways to do that now. These are widely available, and people should ask their municipal water suppliers to tell them they are using the best and latest technologies.

They say Japan has a lower risk of cancer but their air quality is not good. Do you think it is their diet?

2009-07-12T08:23:00.000+07:00

've actually studied the environment in Japan. They have 4 to 5 times less breast cancer, less prostate cancer, and even less brain cancer. But the trends in Japan are also increasing, especially in women in the city, when it comes to breast cancer. There are big dietary differences, and there are also big differences in exercise. People in Japan walk a lot more than we do. They also eat diets that contain a lot more vegetables and soy products, and they do not eat as much saturated fat and animal fat. In addition, until very recently in Japan, women could not even get birth control pills [so they were not exposed to estrogen from that type of medication].

There are lots of things that could explain the differences. In fact, the Japanese, if anything, have better air quality than we do, in part because they can't afford to drive. The toll roads from Tokyo to Kyoto, a trip of about 2 hours, literally costs about $90 for a car. So it's a very different world in terms of some of the pollution patterns they have.

What impact do food preservatives have on breast cancer occurrence?

2009-07-12T08:22:00.000+07:00

We don't know, but at the turn of the century, arsenic and mercury were typical food preservatives. They worked! But they also created other problems. There is no free lunch. So it may be that some of today's food preservatives are problematic, but that may change. After all, we've learned not to use arsenic and mercury in our foods and are no longer poisoning people with those chemicals.

Does hair dye, lipstick, makeup, or house cleaning detergent cause breast cancer? What about canned goods that have chemicals that mimic estrogen?

2009-07-11T08:21:00.002+07:00

there are some studies in animals that have found certain types of plasticizers (compounds put into plastics to make them harder) can accelerate breast cell growth in animals and have a number of other effects on reproduction and the endocrine system, especially in baby boys.

There have also been case reports that we describe on our website, showing that young black baby girls who developed premature breast growth between the ages of 1 and 3 years had been exposed to hormones from personal care products, which their parents had used on their daughters' hair and scalps. When this exposure stopped, the breasts went away in these baby girls. Unfortunately, very few people know about this problem.

But Dr. Chandra Tiwary, who is a pediatric endocrinologist, reported a case series of young girls with premature breast growth and exposure to hormones in hair products. He also documented finding a hormone in a number of widely used personal care products in the African-American community. The FDA does not regulate personal care products unless they are officially called “hormones.” These products are not identified as hormones. Dr. Tiwary made his report about 7 years ago, but these products are still on the market. Certainly anything that can cause a baby girl to develop breasts is a problem.

Does hair dye, lipstick, makeup, or house cleaning detergent cause breast cancer? What about canned goods that have chemicals that mimic estrogen? I w

2009-07-11T08:20:00.000+07:00

There are very few epidemiological data that point to any specific product or any specific chemicals as being a cause of human breast cancer. Many of these products and chemicals, when given to laboratory animals, increase the frequency of mammary cancer and therefore are worrisome. In the world today, we are exposed to many agents, some of them naturally occurring and some of them man-made, that either cause direct genetic damage and therefore might be able to produce cancers, or which alter our hormone levels which might encourage cancerous cells to grow.

But it's very difficult with all of these chemical exposures that are a daily event in our lives to know which are important. And so, when it comes to risk reduction and trying to decide whether to use a particular product or eat a particular kind of food, there are very few hard and fast recommendations other than to cut down on your exposures whenever you can.

Are you saying that those of us who have breast cancer probably developed it in our teenage years?

2009-07-11T08:19:00.000+07:00

Leslie Bernstein, who's done much of this work, was herself a world class swimmer and “vigorous” refers to more than an hour a day of elevated cardio workout. The question of whether more moderate exercise is a benefit is still open, although as you know there are many good reasons why women should exercise regularly.

One of the theories why exercise does work to reduce the risk of breast cancer comes from the work of Brad Lowe and others. They have shown that women who exercise regularly and vigorously have lower amounts of circulating levels of free estradiols, and the lower amounts of free estradiols appear to be associated with a lower risk of breast cancer.

Alcohol has been shown to increase the amount of circulating estradiols, and so does hormone replacement therapy. So women who are on HRT and who drink regularly have an even greater risk of breast cancer, perhaps because both alcohol and HRT increase the amount of circulating estradiols.