Tag Archives: breast cancer

Hoping for a Cure

After I was diagnosed with breast cancer I wasn’t sure how I felt about pink ribbons.  They were suddenly everywhere I turned.  A lot of people seemed to care about breast cancer and there were certainly a lot of people hoping for a cure.  There were plenty of businesses getting on board too.  I could shop for the cure, bake for the cure, drive for the cure, even vacuum for the cure.  But something made me uneasy about all of this pink and hope.  If all of this shopping and hoping was making a difference why did I get breast cancer out of the blue in the first place?  And why was I being treated with the same toxic treatments of the past that may or may not prevent the cancer from returning?  The best I could do after eight months of surgeries, chemotherapy, and radiation was wait around and see if I died of something else to know if it had worked.  Not a lot different than what happened to women who were diagnosed with breast cancer decades before me.  That didn’t seem like much return for the millions of dollars being raised on pink ribbons and hope for a cure each year.

If hope was enough we would have cured breast cancer years ago.   But instead of curing breast cancer all of this hope and pink has created a huge economy that feeds on the disease and is sustained by people’s fears of the disease.  Cause marketing led to $1.55 billion in spending in 2009, with breast cancer being the greatest netting cause.  And the business of breast cancer extends far beyond cause marketing. The mammography business is expected to surpass $1.1 billion by 2015, according to a report by Global Industry Analysts, Inc.  The US market for vacuum assisted breast biopsies is expected to net $350 million by 2012. Pharmaceutical company Roche brings in $1 billion in revenues each year from Avastin for the treatment of metastatic breast cancer, despite the failure of studies to show it increases survival.

It is time to move beyond hoping and shopping for an end to breast cancer.  We must shift the status quo from the business of breast cancer to the end of breast cancer.  We must replace the complacency. We must bring back the urgency to end this disease.  We must demand accountability from those making a profit off breast cancer, and ensure that resources and efforts are focused in the right places to bring about eradication of this disease.

We’ve never set a deadline before.  It is time. Ten years to get it done.  Breast Cancer Deadline 2020.   www.breastcancerdeadline2020.org

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KnowBreastCancer.org and Advocacy Training Conference

Lots happening this week at NBCC!  KnowBreastCancer.org, our new breast cancer research website has just been launched.  Find in-depth information on controversies in breast cancer, breaking news from research conferences, and access to original research articles.  Check it out!

The Annual Advocacy Training Conference begins this weekend in Washington DC.  Over 90 speakers will be presenting information on breast cancer research and public policy.  Topics range from Pregnancy Associated Breast Cancer to Breast Cancer and the Media – Who Gets in Right? to Update on PARP Inhibitor Research.  See the program here.  If you are not able to be there, sign up to get email updates from an e-advocate!  Find out more here.

Eat fried chicken to cure breast cancer!

Wow.  This is wrong on so many different levels.  KFC is going pink this month for breast cancer awareness.  First of all, is going pink and promoting breast cancer awareness going to invade every month of the year?  But even more disturbing is Buckets For the Cure.  Money will be donated to Susan G. Komen For the Cure for every pink bucket of fried chicken purchased.  KFC is hoping to make the “largest donation ever in the fight against breast cancer.”

The Colonel says pink is the new red.  Is he trying to distract us from heart disease and obesity maybe?

“Another year and I could have been in big trouble”

“Everyone gets busy, but don’t make excuses. I stay in shape and eat right, and it happened to me. Another year and I could have been in big trouble.”

Martina Navratilova was talking about her diagnosis of Ductal Carcinoma in Situ (DCIS) following a mammogram.  She will no doubt be learning the facts about DCIS and breast cancer as she goes through treatment and beyond.    Unfortunately, the public will be stuck with the misinformed messages that Martina has sent out during the early days of her diagnosis.  She will probably learn that DCIS shouldn’t be called breast cancer.  She may learn an NIH consensus panel on DCIS has recently called for a name change to remove “carcinoma” in order to prevent the exact reaction exhibited by Martina – the anxiety, shock, fear, and misunderstanding. 

Cancer means abnormal cells have become invasive.  In most breast cancers, this means abnormal cells have moved out of the milk ducts into surrounding tissue.  DCIS are abnormal cells that haven’t become cancerous or invasive yet.  They may in the future, but often do not.   Researchers estimate that up to 50% of DCIS won’t ever go on to become invasive, and there is some research suggesting that DCIS may even disappear over time.

DCIS is a product of mammography.  The diagnosis was relatively rare before the widespread onset of mammography.  Now, for every four women diagnosed with invasive breast cancer, one is diagnosed with DCIS.  Has this really meant preventing more invasive breast cancer?  Probably not.  There hasn’t been a corresponding  drop in breast cancer incidence following the dramatic rise in the incidence of DCIS.   There has only been a dramatic rise in the number of women experiencing the fear and anxiety, surgery, and radiation therapy that Martina is experiencing.

The Color of Bras

Those of you on facebook probably know about the chain letter that spread like wildfire this week, asking women to post the color of their bras as a facebook status to spread breast cancer awareness.  Millions of women played along.  Even caught the attention of CNN.

At least one company and breast cancer organization figured out how to benefit.  Living Beyond Breast Cancer made an arrangement to receive $1 for every member that became a fan of White House/Black Market and posted their bra color on the store fan page.

Bloggers have been weighing in.  One wrote that she participated but had second thoughts.   Another particularly poignant one was from a woman who  owned no bras and felt left out.  Both of her breasts had been removed because of  inflammatory breast cancer.

The reaction from advocates has been mixed.  Some tentatively played along.  Others announced it was frivolous.  Some were told to lighten up.

To me, it’s another example of what is wrong with how we are approaching the problem of breast cancer.  Publicity for no other disease would be flirtatious or so silly.  Think about it.  What if to spread the word about diabetes people said “Save the feet!”  and asked people to secretly post the color of their socks on facebook.  It would never happen, and if it did, it would be seen as incredibly insensitive.  Breast cancer is a horrid, ugly disease, but somehow, this powerful association has been created of things pretty, pink, inspirational, sexy, and sometimes silly.

But the incredible spread of this facebook chain or meme speaks to how much women care. Women DO care about breast cancer and they want CHANGE.  Sure, some wanted to be part of the group, some wanted to be titillating to the men on their friend list, but mainly I believe that most played along because they do care about breast cancer.

Women want to stop hearing that friends or family members develop the disease.  Women want to stop worrying that they too will develop the disease, or that their daughters will.  Women want treatments developed that won’t be so harsh as the current, and that  will work, preventing the disease from spreading and taking lives.

How to translate all of that energy and passion into action and progress?  The first step is simply to take awareness up a notch.  Let’s become aware of the reality of breast cancer.  Learn that breast cancer is really several diseases.  That breast cancer is often different in younger women and older women.  That many of our preconceived notions aren’t true.  To learn more about the realities, click here.

And to really crank it up a notch, come to the National Breast Cancer Coalition Fund’s Annual Advocacy Training Conference in May.  For more information or to register, click here.

Hope

As most people do this time of year I’ve been spending the last few days thinking about the past year.  The pace of my life just seemed to accelerate with each month culminating with the last six weeks of non-stop activity and travel, as I took on a full-time job for the first time in 17 years.  I am commuting back and forth between Washington D.C. and Cincinnati as Director of Research Programs for the National Breast Cancer Coalition.  It has taken a toll, as my husband and three kids have had to adjust, and as I have felt the consequences of the stress.  I have to confess it would be easy to stop.   I’d have time again to go to the gym.  I would always be here for my kid’s concerts, games, and poetry slams.  I would not have to hear my daughter say “I don’t like it when you go away” as I am dragging my suitcase to the car, or my  son, “Are you leaving AGAIN?”

But like every one of you out there who has chosen to be a breast cancer advocate, I can’t stop.  We all make sacrifices because we have HOPE.  HOPE that what we are doing will help in some small way to lessen the suffering and ultimately lead to eradicating this disease.  Some of you use your vacation days to attend research or advocacy conferences.  You leave your families and arrange babysitters so you can be reviewers on breast cancer research panels.  You use your free time to serve on clinical trial review boards.  You follow the research and write newsletter articles.  You provide support and education for women and families in your communities.

We all have hope that things can change.  Breast cancer has continued to take a serious toll on families for way too long.  In some cases it is the disease, and in some cases it is the treatment for the disease that continues to lead to losses for too many.

I have a dream that in 2020, when we are looking back at the decade, we will be celebrating major progress in breast cancer.  Dramatic improvements have occurred with other diseases, like heart disease and cervical cancer.  Why not breast cancer?  We will look back at the decade and say, wow, breast cancer deaths were cut in half!

How do we get there?  By every one of us continuing to do what we do.  Getting informed.  Understanding the science.  Getting involved.  Pushing for innovation.  Advocating for the right research.

The first six weeks of my new job was dominated by the new screening guidelines.  There was such an incredible reaction and backlash.  Now it’s time to move on.  I’m dreaming that the passion and interest in breast cancer can be harnessed to drive real progress.  I’m hoping that we can all agree that our work is not yet done, that sometimes early detection is not enough, that too many women continue to die from breast cancer,  that we need much more progress to understand this complicated disease, and that we need much, much more than more mammography.

So in 2010, and through the next decade, I have hope that we will move the dialogue beyond screening and mammography, that we will push research in the right direction, that progress will be made, and that lives will be saved.

Happy New Year to all of you.

A Clue on How We Might Be Able to “Do Better”

So many times when we talk about breast cancer screening and treatment, we say “we need to do better.”  Today (Day 2 of the San Antonio Breast Cancer Symposium) I heard a presentation on microRNA’s that made me sit up and take notice – this could be how we do better.

MicroRNAs are a relatively newly defined type of genetic material, first named in 2001.  There has been a burst of research on them and several papers have been published in the last 18 months on circulating miRNAs and various diseases.  Research presented today was the first to look at miRNAs in breast cancer patients.

Dr. Heneghan of the National University of Ireland described her work on the search for miRNAs that could serve as biomarkers for breast cancer.  From blood samples of breast cancer patients compared with the blood from controls, Dr. Heneghan and her co-investigators identified two miRNAs that were significantly increased with breast cancer.  The two miRNAs together predicted breast cancer with a greater sensitivity than mammography.

One of the miRNAs, miR-195 was 12 times higher in those with breast cancer, and the other let-7a, was five times higher.  They both reverted to normal after the tumors were removed by surgery, suggesting this may not only be a tool for discovering breast cancer but also for monitoring of treatment.

The study was done on 148 patients.  Dr. Heneghan plans to continue the work, recruiting larger numbers of patients with different tumor types to investigate the possibility that the miRNAs could also predict the tumor type.

Very exciting line of research to follow.

San Antonio Breast Cancer Symposium

I am excited to be on my way down to Texas this afternoon for the largest national meeting on breast cancer research, the 32nd annual San Antonio Breast Cancer Symposium.  The meeting brings together over 9,000 researchers, physicians, and advocates, all in one room, to hear and discuss the latest research (including my own oncologist – what are the odds I’ll run into him??).

The symposium is a collaboration of the Cancer Therapy & Research Center (CTRC) at UT Health Science Center San Antonio, the American Association for Cancer Research (AACR) and the Baylor College of Medicine.

I’m heading down a day early because the National Breast Cancer Coalition will be holding a continuing education program for advocates before the symposium begins, with a focus on screening, early detection, and where we need to go from here.  We will have the opportunity to hear from some well known researchers in epidemiology and nanomedicine, and then hear what promises to be a lively panel of advocates discuss the current screening controversy.

I’m looking forward to hearing the science, asking questions, learning more, seeing old advocate friends and meeting new ones.

Over 200 advocates from around the world attend each year including about 40 who receive scholarships from the Alamo Breast Cancer Foundation (ABCF).  ABCF was approached by the founders of the symposium many years ago and together they developed a phenomenal program to welcome and include advocates in the meeting.  The advocates attend sessions and write a summary or report on an assigned topic, once they get back home.  ABCF also sponsors mentoring sessions in the evening with renowned physicians and researchers giving their interpretation of the day’s scientific sessions.   To learn more click here.

To learn more about the topics being presented at this year’s symposium take a look at the schedule.

Misplaced Outrage – The New Breast Cancer Screening Guidelines

Outraged breast cancer survivors were heard loud and clear this past week – they weren’t happy with the new breast cancer screening guidelines.  But why the outrage against guidelines based on evidence and science?  Because of deeply held beliefs that have been rigorously promoted and marketed for financial gain. You can’t get out of the grocery store in October without hearing the message – early detection saves lives.

The truth is all breast cancers are not the same, and we don’t have the tools to detect the lethal ones early enough.  Some breast cancers are slow-growing and won’t be lethal, whether found small or large.  Others are aggressive, and fast-growing, and lay the groundwork for metastasis, or spread to other parts of the body, before any of our methods can detect these cancers.

A woman who found a cancer in her 40s by a mammogram can’t know if it saved her life.  She could have found it a year later while getting dressed, and if her cancer is responsive to treatment, would have had the same prognosis.  Or, she could have had a slow-growing tumor that would never have been life threatening.  Or, stray tumor cells may be lying dormant to reappear in five or ten years and still be life threatening.  We can’t know the truth about breast cancer and the effectiveness of screening and treatments by relying on stories and beliefs.  The only way to get to truth is to follow the evidence, the large, randomized, clinical trials of hundreds of thousands of women.

That’s what the Task Force did.  They systematically reviewed all relevant, clinical trials on mammography and breast self exam. After a thorough review of clinical trials and statistical models on risks vs. benefits, they concluded:

To recommend against screening mammography in women aged 40-49

To recommend  every other year screening for women aged 50 to 74

To recommend against teaching breast self examination.

The new guidelines really aren’t so shocking.  The American College of Physicians made similar recommendations a few years ago.  An NIH consensus panel came to similar conclusions in the 90s, but politicians got involved and the consensus panel was overruled by the Senate.  The National Breast Cancer Coalition has been saying for over ten years that we don’t have good evidence to support broad public health policy on breast cancer screening.  NBCC has always said that women deserve the facts, and should have the freedom to make their own decisions regarding screening.

So why the outrage at a panel of prevention experts?  Why not outrage at all those institutions that promoted a simple but false message for financial gain?  Why not outrage that we could have made more progress over the last twenty years if we hadn’t accepted faulty screening as our answer to this disease?  Why not outrage that 40,000 women keep dying of this disease every year?

Maybe, just maybe, this firestorm over the new guidelines will expose the deeply ingrained falsehoods about breast cancer and screening, and allow us to move forward and push for the screening and diagnostic tools that will work, and finally make some progress in eradicating this disease.

Change and progress are often messy and painful, but if we get where we need to go in the end, it will all be well worth it.

To learn more about the guidelines and the science behind them, read NBCC’s analysis.

Lab-on-a-Chip

lab-on-chip

Our methods for detection and treatment of breast cancer still seem so crude.  We can’t really detect breast cancer until it’s been around for several years, and for treatment we remove body parts and give harsh treatments like chemotherapy and radiation.  Then cross our fingers and wait.  And to top it off, our methods of detection and treatment can lead to more cancer!

We need to do better.  It’s time for cancer detection, monitoring, and treatment to enter the 21st century.  But there is hope.  Knowledge from different disciplines, such as physics, chemistry, and computer technology, are meeting up with medicine and biology to create new advances.  One such advancing technology that may mean progress for breast cancer is the Lab-on-a-Chip.

Researchers in Toronto have developed a palm-sized lab-on-a-chip that can measure small amounts of estrogen in blood and tissue.  Estrogen levels of breast tissue have not been routinely measured because doing so with conventional methods required large amounts of tissue.  But the new device, using technology called microfluidics, can analyze the estrogen in samples that are 1000 times smaller than those needed for conventional methods.  Enough breast tissue can be obtained with a small needle prick.

Knowing the levels of estrogen in the breast could be an early indicator of breast cancer risk or of early breast cancer.  Being able to measure levels of estrogen could also provide a sophisticated method for assessing prevention or a method for monitoring of anti-estrogen treatment in breast cancer patients.

The device is in early development and might not be ready for “prime-time” for at least five years, according to Dr. Aaron Wheeler, the research chair of bioanalytical chemistry at the University of Toronto and a co-author of a report on the device published in the debut issue of Science Translational Medicine.  Dr. Wheeler and his colleagues reported using the device to accurately analyze tissue from two postmenopausal breast cancer patients.

Even though it is early, we may be on the verge of an explosion in knowledge and advancements with this technology.  Lab-on-a-chip technology is being developed for many areas of cancer detection and monitoring.  These devices perform different functions on minute droplets of fluid and cells on the surface of a microchip.  Many different lab functions are integrated together onto the chip and results can be ready in a few minutes.

For example, researchers at Johns Hopkins are looking at a chip to measure cancer cells’ ability to “detach” and migrate or metastasize.  Other researchers at the University of California Berkeley are using the technology to carry the vast new knowledge on genetics and cancer to the next level with study of the proteins involved (proteomics).

Let’s hope these advances get translated from benchside to bedside and help bring cancer detection and monitoring into the 21st century.