Thursday, May 14, 2009

Breast Cancer Research

Picture provided by WIKIPEDIA
Mammogram Of Breast Cancer
For those of you who don't know. I worked for a year doing lifestyle coaching and breast cancer rehabilitation research out of the Ottawa Health and Research Institution (OHRI) in Ottawa. I worked with post menopausal obese breast cancer patients on adjuvent therapy.

Now I didn't particularly enjoy the whole job but I did love the concept and some of the things that I was doing. My boss wasn't a very good boss and she wasted a lot of the research money that was given for the study. Now I think twice about donating to research, but that's a different story. A lot of the patients I came in contact with touched my heart so I will always admire and respect a cancer survivor. They are some of the strongest people on this earth.

So yesterday as I was reading my daily dose of fitness, exercise, health and lifestyle news I came across an article that particularly interested me. Because it is related to the study that I was working on and is definitely a break through in treatment for breast cancer patients. But before I get into that I want to discuss what exactly happens when someone gets diagnosed with breast cancer...and men don't forget you too can get breast cancer. I have taken some time to create a timeline for better understanding...

Breast Cancer Timeline

1. Initial Presentation of Lump (Ductal or Lobular)

o Self- breast examination

o Family doctor

o Mammogram (screening):

· Detectable – micro calcifications of ductal carcinoma - 90% of breast cancer.

· Undetectable – Lobular carcinoma

· Coned Down Views – request for magnification of Mammographic images.

o Ultrasoundif mammography is inconclusive.

o MRI (occasionally) – if both mammography and ultrasound are inconclusive and suspicion is high (i.e. gene carrier).

2. Diagnosis

o Biopsy

· FNA (Fine Needle Aspiration) – small lump – possibly benign cyst = drain fluid.

· Core Biopsy – larger lump – suspicious of malignancy – larger piece of tissue removed.

3. Referral to Surgeon

o Breast Conserving Surgery

· Lumpectomy (requires additional radiation treatment).

· Quadrantectomy (requires additional radiation treatment).

· Wedge Resection (requires additional radiation treatment).

o Mastectomy

· Simple Mastectomy – older women or profilatic surgery on contralateral breast.

· Modified Radical Mastectomy – complete removal of breast tissue.

o Node Dissection

· A node dissection will accompany both breast conserving surgery and a mastectomy.

· There are two types: Sentinal node biopsy and Axillary node dissection.

Ø Sentinal Node

· Early stage, small tumor, low risk disease.

· If positive – woman must return for a complete Axillary clearance.

· If negative – assumed other nodes are clear as well.

Ø Axillary Node

· Complete Axillary Clearance – Complete removal of Axillary lymph nodes.

4. Pathology

o Tumor

· T1-T4

o Lymph nodes

· NX-N3

o Metastasis

· MX-M1

o Receptor Status


o Her2/neu Status

o Grade

Stage Grouping

· Stage 0 – Stage IV

5. Staging

o Chest X-Ray

o Bone Scan

o CT – Scan


6. Referral to an Oncologist

o Clinical Trials discussed with patient.

o Treatment decisions (based on staging, age, lifestyle, family history, co-morbid conditions, psychological profile and other related factors).

7. Radiation Treatment

o External Beam.

o Boost.

o Brachytherapy.

8. Chemotherapy Treatment

o FEC 100 – T (3 cycles FEC, then 3 cycles Taxol)

o AC – T (4 cycles AC, then 4 cycles Taxol)

o TAC (6 cycles, both AC & T at same time)

o FEC100 (6 cycles)

Experimental Chemotherapy occasionally used in Breast Cancer:

o Xeloda

o Vinorelbine

9. Hormone Treatment

o Tamoxifen (5 years)

o Raloxifen (5 years)

o Aromitase Inhibitor

· Letrozole (Femara)

· Anastrozole (Arimidex)

· Exemestane (Aromasin)

10. Targeted Agent

o Herceptin (Trastuzumab) (1 year of treatment).

o Lapatinib (Tykerb)(possibly in near future).

Ok so now that you have a better uderstanding of what is involved with the diagnosis and treatment of breast cancer I want to discuss the article that I stumbled upon yesterday. The article can be read HERE. It has been published and written on the Mayo Clinic's site, this is a leading facility in research out of the US.

They are reporting that Herceptin which is a novel therapy targets HER2-positive breast cancer. What does this mean you ask? Well it means that with using this treatment more women can now have better odds at treating their cancer and survival. HER2 use to just be used for women who had metastatic cancer. Metastatic means that it has metasticised and has usually infected the lymph nodes of the surrounding area and has begun to spread throughout the body. NOWWW with the new research on the drug HER2 being able to stop cancer earlier this could save thousands of women their lives each and every year.

Approximately 20 percent to 30 percent of breast cancer has been found to be HER2-positive. HER2 is a protein in the body and it stands for human epidermal growth factor receptor 2. It is known to stimulate the growth of a cell in getting it to divide. Unfortunately when comparing with people who have been diagnosed as HER2 negative the patients that tested positive are known to not respond as well to adjuvant therapies. Now a standard adjuvent therapy is what is better known to the public as chemotherapy or hormone therapy. Depending on the patient it can also be a combination. This means that patients with this particular type of cancer have a high risk of their cancer recurrence, and the possibility of dying from their cancer.

Thus with this breakthrough so many lives can be saved. However in the United States because they don't have universal health care the cost of Herceptin is reported by the Mayo Clinic to be about $3000 dollars a month plus your doctors fees etc. So glad that we are Canadian!

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