WHY SCREENING HAS NOT STOPPED METASTASIS?

This may explain why more deaths aren't prevented by breast cancer screening

Thus the LA Times titles an article based on an essay by three cancer scientists, published in the New England Journal of Medicine.

  

“The article starts:  “the incidence of metastatic breast cancer — the kind that has already spread to another organ by the time it is found — has remained essentially unchanged since 1975.”

“The idea, of course is to catch cancer before it can spread.”  As we read on, we may want to say instead, ..the idea has been to catch it before it spreads. Not working so well for us.

The article's surprise is a comparison of our BC non-success story with the success, believe it or not, of the prostate cancer screening situation.  Catching prostate cancer early has improved amazingly since discovery of a blood test for an antigen specific to the prostate – PSA.  Metastatic prostate cancer has been basically halved. 

So far it seems there is no similar antigen for breast cancer.  We have been screening, and screening, and our numbers don't change.

The essay suggests two possible reasons why our BC situation fails to succeed.

I’m going to copy their reasons direct from the LA Times:

“The first is that mammograms just aren’t good enough to find metastatic breast cancers before they spread. If there were a breast cancer equivalent of PSA — a biomarker that could be found in blood — perhaps screening outcomes would be different.

A more likely explanation is that breast cancer doesn’t necessarily start in one place and then spread to others.  Indeed, breast cancer researcher extraordinaire Dr. Bernard Fisher argues that by the time the cancer can be detected, it has already become a systemic disease.

To me, Dr. Fisher, seems to be agreeing with the first explanation, seems to say the starting cells are too little to find, and they’re on the move early.

But breast cancer may not start in just one place?!

I know our major hospitals basically seem to agree with Dana-Farber, the one I’ve quoted recently.  D-F states "All breast cancers initially form inside the milk duct near the area where the duct meets the milk gland, or lobule..."

Yet the essayists are not alone in thinking it's how the cells start and how they act.  Their “more likely explanation” has been hinted at before.  

Let’s go back to another article:

  https://www.nlm.nih.gov/medlineplus/news/fullstory_154216.htmlTHURSDAY, Aug. 20, 2015 (HealthDay News)  Early Stage Breast Cancer Far From a Death Sentence: Study  

See HEN BACKTALK post "... AND MAMMOGRAM WARS" October 7, 2015

“… Narod (study author) explained.:

 " 'In all, 956 women in the study ultimately died of breast cancer. Of those, 517 never had invasive cancer in the breast after treatment seemed to cure their DCIS. That means that the cancerous breast cells from their DCIS had escaped at some point and survived in the lungs or bone, later developing into a deadly cancer' “  (Bolding mine)

 "...seemed to cure their DCIS."  That stopped me in my tracks the first time I read it.

But Dr. Narod's explanation is right on point with the essayists from Times/NEJM article.  He,insists that 

         DCIS cells escaped, probably before or during the original treatment, 
         and “survived in the lungs or bone."

Perhaps these two reports are only a tip of the iceberg.  But their bottom line for us is this: that we’ve been mammogrammed, perhaps repeatedly, but perhaps...

AFTER the DCIS cell train had already left the station, bound for the rest of our bodies.

           

More later on possible cancer cells in the blood  

I wish you health.

http://www.latimes.com/science/sciencenow/la-sci-sn-breast-prostate-cancer-progression-20151028-story.html

  

REUTERS health: BC - benefits of timely treatment MIDNIGHT SPECIAL

I guess I'm tired.  Having trouble figuring out who did the second study. One study from Dana-Farber, one using California Cancer Registry figures  Or are they both from Dana-Farber, just with different data sources?

  But you may want to read the article tonight if you haven't already.  JAMA oncology online is listed as a source.

Breast cancer survival odds better with faster treatment

BY LISA RAPAPORT

Read more at Reutershttp://www.reuters.com/article/us-health-breastcancer-speed-idUSKBN0TT2BV20151210#aEIwRfR3BLR8EecV.99

I wish you health.

CANCER FIVE NEW DRUGS - One hospital MIDNIGHT SPECIAL

Dana-Farber-led clinical trials lead to five new drug approvals

"The Dana-Farber-led science and testing of these agents covered the full range of drug development – from earliest discovery and phase 1 studies, in which novel agents are tested for the first time in human patients, to large-scale 3 clinical trials, in which the agents' safety and effectiveness are compared to that of standard therapies."

"and, in some cases, derive from basic research in Dana-Farber laboratories".

 http://www.dana-farber.org/Newsroom/News-Releases/dana-farber-clinical-trials-lead-to-five-new-drug-approvals.aspx

This is from a Dana-Farber release, and BC is not covered specifically.  But thought you might like to see this, since I've quoted them recently (DCIS - LCIS What to treat/what not to treat? Dana-Farber posts about it   HEN BACKTALK Dec. 1)

I wish you health.

WHAT IF THAT FALSE-POSITIVE MAMMO WASN'T FALSE?

"Increased Cancer Risk Seen After False-Positive Mammograms 

Are 'false-positive' scans still picking up something important?"

This is copied from MEDPAGETODAY's ACTION POINTS:

• 
  "Observational study found that a history of a false-positive mammogram was associated with a subsequent risk of breast cancer. December 2,15
• Be aware that the biologic rationale for this observed relationship has yet to be explored."

Another voice from Chapel Hill, Louise M Henderson, PhD, on breast cancer. This time a study of 13 million women (that number certainly gets my attention. ) 

The other number that certainly got my attention was: "The 10-year breast cancer risk was higher by 39% in women who had false-positive mammograms and additional breast imaging as compared with women who had true-negative mammograms," 

39%!

I take it that the "additional breast imaging" means we went back when called back after the "positive" first read.  

 What is your experience with false positives?  I have been called back at least once in CA.  After a very long wait, the MD told me the re-exam was negative.
In 2013, in TX, a positive led to biopsy, and to Dx of DCIS.
In 2014, I had a diagnostic mammo w ultrasound.  It was a tough day, and the ultrasound MD had not read my "cancer survey" where I told them I had suspected scar tissue from a long-ago surgical biopsy.

Now comes this article.  Just what I did not need, since I'm due for another "diagnostic" mammo before Christmas, but in a place my Onco trusts - a place I haven't been before.
So: now MEDPAGETODAY says False positives are often indicating a grim future.

And nobody knows why. 

But we DO want to know; (see the sub-title question above on the MEDPAGE TODAY article)

I wish you health.

 http://www.medpagetoday.com/HematologyOncology/BreastCancer/54978

DCIS - LCIS What to treat/what not to treat? Dana-Farber posts about it

I learn some things about breast carcinoma in situ. Or do I? I certainly had plenty of questions.    How often experts don't agree.


http://blog.dana-farber.org/insight/2015/11/what-is-lobular-breast-cancer/ metastasis

All breast cancers initially form inside the milk duct near the area where the duct meets the milk gland, or lobule –
– a structure called the terminal duct lobular unit."  As long as the abnormal cells remain inside the milk duct they are known as carcinoma in situ."  "When they break out of the milk duct and get into the fatty tissue of the breast, they become invasive breast cancers"

OK. This is fairly new material for me.  I did not know about the first sentence - the "initially form" part.  It goes on with several paragraphs on invasive breast cancer.  Then they continue:

"WHAT IS LCIS?

"Lobular carcinoma in situ (LCIS) is a term used to describe a change in which cells resembling those of invasive breast cancer are contained within the lobule. Although LCIS itself isn’t a form of cancer and is not treated as cancer,"

Wow. Is this what some doctors are thinking of when they call all breast CIS baby cancer?

Okay. If they don't treat LCIS now...

NOW WHAT ABOUT DCIS.  Since I "had" DCIS, I'm certainly interested in this, the newest Dana-Farber article I have found on DCIS.

Treatment - I had questions LCIS VS DCIS.  Does Dana-Farber treat DCIS?  

SO  ANOTHER Article http://blog.dana-farber.org/insight/2013/08/what-should-you-do-if-you're-diagnosed-with-DCIS/  "The reason DCIS is important is..." This article is complex and hard to condense:

They quote a NCI report that suggests redefining cancer. That not calling it cancer "may ease the fears of patients, making them less inclined to seek unnecessary and potentially harmful treatments. "

Yet they say that DCIS cells, though in the duct, ARE cancer cells (unlike the LCIS cells).   Then a doctor says, " The reason DCIS is important is that, if left untreated, it has the potential to become invasive breast cancer."  And he moves to the "potentially harmful treatments."   Hmmmm.

Just when I was going to stop reading, here's a punch line we've seen elsewhere recently:
"although there is a great deal of debate over who should and shouldn’t receive radiotherapy after a diagnosis of DCIS. "   Well, well.. 

Feeling a little foolish, I went back to Google.  A couple Dana-Farber posts were marked -2015, BUT one of them actually used the future tense referring to later in 2013.  

So they did treat DCIS, in 2013.  And so did my hospital, complete with radiation.

 Dana-Farber has email if you want to pursue this.

I think my job now is to check out a few other hospitals' ideas on DCIS.

If you have newer info on this, please share it with us.
I wish you health.

Amazing Places to Exercise

If we don't have an exercise buddy, we might skimp on those exercises where we can't go out and show off our aerobics gear.  But just plain standing too long, like in the checkout lane (where they should show movies to avoid rioting) is not good for you.  So you're trapped in the market and know the danger of coming home without peanut butter and scones.  Don't waste those minutes, exercise (watch out for the customer behind you.) Or, for instance:

Waiting in line at the meat and cheese counter.  Excellent place for back and side leg lifts for osteo hip issues and balance issues (watching out for other customers.)  Don't try to lift your foot 18 inches at a time.

Squat correctly with buns protruding:  The part that saves your spine is 'buns protruding' not tucked in.  A friend of mine paid a trainer $300 to learn that one thing.  Okay, you may have to do this in the ladies' room if you're that modest.  But practicing these squats saves people from falling.  So BE DARING , save your spine and squat with buns out instead of bending to reach the no-sugar muffin mix on bottom shelf. This squat can also be done at home when a bunch of blueberries rolls under the edge of the kitchen counter.

Even after my lumbar fusion, when the doctor went overboard telling me not to lift, he did tell me to stretch, and putting a glass on the very top shelf is the #1 stretch.  In fact, I suspect now that I should have been doing a lot more exercises that he didn't seem to allow.

When you get a little more confident on the sideways walk, you can do it a lot in the grocery store.  I do it up and down an aisle,just searching for my favorite food that they've moved.

Waiting in the exam/consult room at doctor's office.  There's a sturdy counter there to help with toe-to-heel, also sideways walk, and other balance exercises.  (Don't skip toe-to-heel.  Remember, if you have a little fender-bender or do something very unexpected in the car, you may have to get out and walk a straight line.)

In horrid staff meetings or conferences where people sit in rows.  The person at the podium is trying to find out who's texting.  Now's your chance to do some seated foot or leg lifts.  At least practice pressing your shoulders to the back of the chair and holding your gut in. Quiet, unobtrusive deep breath or two, and you're caught up on some very healthy moves.

I wish you health.

LIQUID BIOPSY - No cutting? No kidding?

‘Liquid biopsy’ Promotes Precision Medicine by Tracking Patient’s Cancer says Mayo Clinic News Network

Posted by danasparks, Wed, Nov 4

"Our findings empirically show that ctDNA analysis from blood samples allows us to detect cancer mutations from multiple different tumor sites within a patient and track how each of them responds," Dr. Murtaza of TGen and Mayo Clinic said. 

The words "of TGen and Mayo Clinic" made me able to rely more on this study (that and the fact it was published in Nature Communications.)  So, can we?  Can we know where cancer has spread (or may spread?

The article emphasized that this technique allows more frequent biopsy.  (And safer.)  

Quickly they taught me a new word: ctDNA:  circulating tumor DNA.

This sort of answers my question from an earlier post about cells escaping from DCIS before "cure."  I don't know when they might start using liquid biopsy that early in the process; it's been the "fashion" to assume we're cured after DCIS is treated, that nothing has spread.  

Your comments are welcome  Here's the link to Mayo News Network.

http://newsnetwork.mayoclinic.org/discussion/liquid-biopsy-promotes-precision-medicine-by-tracking-patients-cancer/?linkId=18788499

Nature.com was having technical difficulties this a.m., and I wanted to get this out.

I wish you health.    

How to Read a Medical Press Release: Part 2 MIDNIGHT SPECIAL

1.  Get a phone number of the person or institution sending the release.  Or if all else fails, get email address.

2.  Insist that terms be defined.  No exceptions.  If a term needs definition, repeat step 1.  Call them.

My personal pet peeve is calling something carcinoma in situ, then telling me it's not cancer.  Let us know what medical lingo you don't trust.

I wish you health.

NEW WAY TO STUDY CANCER DRUGS - Will BC be in Sloan Kettering basket studies soon?

I had never heard of basket studies until I ran into them on Sloan Kettering twitter.See twitter November 4    and click for basket studies and Sloan Kettering. I checked today (Nov 15 already.. It's still available)

Basket studies are very new.  This is the quick description I got from the Thursday, August 20, article on the MSKCC site;  https://www.mskcc.org/blog/clinical-trial-shows-promise-basket-studies-drugs:  

• Basket studies focus on a tumor’s gene mutation regardless of type. 

Or:  A clinical trial shows that a drug focused on a single genetic mutation can be effective across multiple cancer types — although blocking the mutation does not guarantee success.

Oncologist David Hyman put it in a way I might remember:  "what works in different tumor types."  

The twitter pictographs shows BC as included in the "basket,"

But the accompanying paragraph indicates other cancers as the ones getting help from the drug in the current clinical trial.

However, the pictograph makes me guess that BC may be in a future basket.  So we need to keep an eye on these basket studies.  .

This is one of many articles and trials that remind me of what Lisa Carey, MD, of Chapel Hill said in Hot Topics BC about some BC cells looking a lot like other cells.. 

I guess we stay tuned for more.  I wish you health.

How to read medical press release

from Twitter: Peter Bach and Leonard Saltz:
if see a press release citing "landmark study" throw in trash - that's for history to judge

WHAT MAMMOS CAN'T DO ALONE

This material originated with NEJM a week before Guardian picked it up from UP.  
http://www.theguardian.com/society/2015/Oct/29/mammograms-not-catching-cancers-before-they-spread-say-us-experts

Mammograms not catching worst cancers before they spread – US Study

Rate of aggressive breast cancers that have already moved to other parts of the body has not fallen in decades despite screening programmes, study finds

 I had trouble with this article.  Spent a lot of time going over this again and again.  Gave me more questions than answers, of course. But  a quote or group announcement from the three leading MD  study authors  tells us the crux:

“ 'Screening offers hope that cancer can be detected in an early, localised phase when it’s more amenable to treatment,' ” they write, 'but that assumes cancer starts in one place, grows and then spreads. If that was always true screening would reduce the rate of advanced cancers,' " they argue.   

So mammograms are not enough!  Not designed to find the breast cancer that may move to other organs almost as soon as it starts.

 And in that case, the problem is we don't look in other parts of the body simultaneously?  Is that why I've ended up in the ultrasound lab twice? (And even the ultrasound was really working only on the breast.) And tomo,  being just more pix of the breast, does not make a big difference to survival?

I'm going back to my earlier October post on  NIH material - "not a death sentence" : This from study author Steven Narod:

" 'In all, 956 women in the study ultimately died of breast cancer. Of those, 517 never had invasive cancer in the breast after treatment seemed to cure their DCIS. That means that the cancerous breast cells from their DCIS had escaped at some point and survived in the lungs or bone, later developing into a deadly cancer,' Narod explained."   (highlighting is mine) "Seemed to cure."  Pretty damn scary!  So the NEJM study wasn't hot news... 

So these women were living a death sentence they didn't know they had.

What else should we be doing on mammo day?  Is there some kind of blood work that would give us more clues?

Who is researching this to give us a better deal?  Anybody?

And this article had to come out while I'm planning a second-year post treatment "diagnostic" mammo.

I wish you health.

ONE MORE DAY...AND MEMORIAL

In memory of Erika E. who died of BC that the mammogram didn't find

Rik and I met one day when two friends and I were on a road trip, and stopped to get a Coke.

Months later I got a new job near the ocean, and moved almost "down the street" from her.  Becoming her friend was a blessing.  We hashed out the common divorced-woman pain, calmed down, and had fun.

One day she called to say she felt something in her breast.  I asked her if she wanted to "wait and watch," but because there was family history of BC, she decided to see the doctor at once.

The months after that are a blur to me now - she had so many tough times.  She had taken a para-legal course, and I believe she got to start her new career.  But almost immediately, she got a new hospital instead.

She spent more and more time in the hospital.  And she told me then about the disc on her chest wall that the mammogram didn't find.  Her roommate was a tireless nurse who was able to be near her in the hospital much of the time.

Years later, I found a note from her in my things:  It said;

"Our friendship is valuable to me.  It may be sorely strained soon."

Before long she was dead.


Now decades later, we are still reading "news" that mammograms are not finding every new cancer.

THIS IS NOT NEWS.



I wish you health.

TAMOXIFEN - the long brain fog, the aches, relief, and aftermath

When I first came to my new state, I was disoriented, and just 10 weeks past a lumbar fusion.   I had lived in CA for more than half my life - felt lost.  Before I was completely "unpacked" I had a scary mammo.  And fell into what sometimes felt like "the breast machine."  The mammo was repeated.  A very kind doctor made a little sketch for me of what looked like a kitchen tool, and told me I should have a needle biopsy.

On biopsy day I looked longingly at the Ultrasound Dept. sign as I went toward the Stereotactic room.

A few days later, the biopsy doc's cheery, happy voice on the phone said, "There was cancer."  (May she get a large zit on the end of her nose for being so jolly.)

Then the wires, the surgery, the pathology report, and the hours on line where I found only one interactive decision aid. And the radiation.  (Thank Heaven for two kind, fun radiation therapists who made me feel normal.  And no real chemo,  Much to be grateful for.

By the time I met my wonderful oncologist and heard him say "You're cured. But we have..."
I had already heard stories from another patient about her uncomfortable meds, and was leaning toward Tamoxifen.

I started the white pills about a month later, and became a nut case, an amnesiac.  With aches.  As I mentioned before, he told me they call Tamoxifen the schizophrenic medicine.  It acts differently in different parts of the body, and the body gets confused. (No kidding!)

Slowly I turned completely absent-minded, freaking out, couldn't find my keys or anything else, couldn't make plans. Worse, I felt like a thousand-year-old woman.  And I thought like a thousand year old woman.

And then my feet started swelling.  A foot doctor was no help.  All shoes were torture.

The oncologist must have thought I was about to quit Tamoxifen.  He reminded me gently that we had a choice, because Tamox was preventive for me.  He gave me a month vacation.  No white pills. It wasn't long enough for a miracle, but I did seem to feel better.  At the next visit, he let me go on 10 mg instead of 20.

It took some time for a real change; sometimes I still feel older than I am. Sometimes I just have to lie down.  At least now I can think, plan, look around at my situation and my world.

But...after those foggy months, I still don't quite trust myself.  Driving to an area I'd never been to took several "trial runs" with my daughter.  If I don't see my keys I'm first slightly panicked. I have to remind myself that they aren't at the library because I got here and unlocked the door.  It may take a while longer before I trust myself again.  Before I get L.A.brave again. I need  to.

WOMEN'S PLAGUE REDUX

 In honor of breast cancer... month, I'm re-running this post from a former year

WOMEN'S (and sometimes men's PLAGUE Still grasping at straws

Tuesday after leaving the surgeon's office, I looked up Breast Cancer Action SF, and read an essay by a woman who had done everything right and found nothing had changed:  No Cure.

This morning, her words were still in my head, and I remembered attending a reading years ago of James Engelhardt's play, Rattus Rattus.  It is a story about The Black Plague or some other plague that nobody could cure.   It seems people of the time were carrying nosegays in front of their faces, perhaps to distract them from the smells of death, or perhaps to ward off the possibility of the disease attacking through the air.  I'm sure the flower vendors had a thriving business.  And in spite of the fear and the death, somewhere in the background I'm sure a jester was singing:

Ring around the rosy
Pocket full of posies
Ashes, ashes
We all fall down.

Now centuries later we're pretty sure posies won't do it.  Yet instead, we carry around pink ribbons on our cars, our clothes, our gifts, our jewelry.  And there is a thriving business for vendors of anything with a pink ribbon on it.  Even on a mammogram machine!  But to be sure their business was thriving, until 2000 one company  that manufactures breast cancer medicine also manufactured a carcinogenic herbicide, acetochlor.

Hospitals give us literature for "runs" and "walks" from companies that won't tell where the money went, and from companies still manufacturing products that may make the plague worse.

We run, we walk, and on Mother's Day, we remember the ones the pink ribbons didn't help.

Too many still fall down.

MAMMOGRAM WARS - And why I still have the damn things

I'm told I'm cured.  Or I was cured of DCIS for a moment in time.  In a couple months, I'll have another "diagnostic" mammo - the more uncomfortable kind.  I take Tamoxifen, I don't use soy.  I don't take estrogen.  So why do I still have mammograms?

The knee jerk answer is that my doctor wants me to.  But I don't automatically do what my MDs want.

One answer is I get mammos because DCIS can come back.  After the suspicious mammo, I had a stereotactic biopsy.  Days later, a cheery voice over the phone just said:  "There is cancer.  Go see Dr. "x"  We use him all the time."  I have a special curse in mind for people who use jolly voices when they announce cancer!  

I saw the doctor. I had the surgery.  But I had never felt a lump!  DCIS usually is not a lump. Those breast ducts are small.  So, if it comes back, I won't know.  Maybe not until too late.

The surgery gave me a major deciding tool - a pathology report.  I dug around in it.  It said the sample was hormone receptive, as most breast cancers are.  It said I didn't have the lowest nuclear grade, which is not good. I can't find this hospital's exact nuclear rating scale on line, but mine was not in the lower half of the scale.  Not good.  Not likely to lie there and get well in my breast.  For some reason, I never see these rating scales discussed when authorities are discouraging mammograms.  Or is it that the famous minds are just talking about an initial mammogram?  Or what?

I have to say, usually respectfully, that the ongoing disagreement between authorities, plus frequently unclear reporting, gives me no grounds for arguing with my oncologist so far.

So when the surgeon said I didn't have to do anything more, he quickly added that he recommended I meet the radiation oncologist and the medical oncologist, who is now my trusted continuing doctor for preventive Tamoxifen.  And that oncologist  has recommended a change to a mammography service he values and trusts.  So before the end of the year, I'll be there.

I wish you health.

Breast Cancer DCIS & Mammogram Wars 2 articles - Weak ammunition? Will you stop having mammos?

More cannon fire on the web today about mammos vs no mammos.  I'll be having another before Christmas because I trust my oncologist.

I ask (beg) you that if you read either of these articles, read the whole thing.  Or print it out so you can mark the iffy parts and parts that don't pertain to you.

http://www.motherjones.com/politics/2015/10/faulty-research-behind-mammograms-breast-cancer

What If Everything Your Doctor Told You About Breast Cancer Was Wrong?

Mother Jones starts with a story about an angry post-surgery patient, Therese Taylor.  Her doctor said her biopsy was "indicative of cancer." The story goes on with a lengthy list of cancers to touch on, and the experiences of famous people.  Included are even numbers from studies MJ admits were not well organized or designed.  As you know, attempting to cover every possible argument can leave us with parts of a whole story.  And the heavy emotional opening ... well.

My questions:  DCIS is not palpable - your doc won't get it by touch and neither will you.  So if you don't have the mammogram, how do you know if you have the start of something else?

And hopping from one cancer to another can lead to over-simplification.

Cancers are not like rabbits or anything else, and the National Institutes of Health (the second) article does touch on possible, slightly possible migrating DCIS cells.


**

https://www.nlm.nih.gov/medlineplus/news/fullstory_154216.html:

THURSDAY, Aug. 20, 2015 (HealthDay News)  

Early Stage Breast Cancer Far From a Death Sentence: Study

 -- Only 3 percent of women diagnosed with an early stage of breast cancer

 will die of their disease within 20 years,

 and more aggressive treatment does not improve that high survival rate,..

Despite the fuzzy title, in the next paragraph, we find they are talking about DCIS.  And that DCIS treatment does not increase life span, which is not really  "news."   I got the same information a couple of years ago when my DCIS was suspected  and confirmed. A cancer hospital interactive"decision aid" advised us then not to hope whatever treatment we selected, if any, would make us live longer.  DCIS can come back. I took the treatment they said would "prevent recurrence" for a certain number of years.  

 Study first author Steven Narod,is quoted as saying "The good news is that death is pretty rare,"    I hate this kind of "for the press" generalization.

I beg you to read the "fine print" in this article.  For one thing,  death rates were estimated.

And don't stop reading before you get to this statement, which is something I've never heard before - scary.  But it reminds me of something I saw in a video from MEDPage Hot Topics.    The doctor who impressed me so much, Lisa Carey, MD, of Chapel Hill said in MedPage Hot Topics Breast Cancer One told us that some breast cancer cells are looking more like other cancer cells ... Now Steven Narod is quoted:

" 'In all, 956 women in the study ultimately died of breast cancer. Of those, 517 never had invasive cancer in the breast after treatment seemed to cure their DCIS. That means that the cancerous breast cells from their DCIS had escaped at some point and survived in the lungs or bone, later developing into a deadly cancer', Narod explained."  "...seemed to cure their DCIS."  This contradicts everything we've read about DCIS not spreading to the rest of the body!  

That's all I can manage on these two articles.   Food for investigation!

I wish you health.

My apologies for the mistakes in the the original of this post.  MLF

BC - Triple Negative - The Midnight Special

If you haven't already, here's a new release (at least new to me tonight)

Scientists target molecular 'addiction' in triple-negative breast cancer

September 28, 2015

14

http://www.dana-farber.org/Newsroom/News-Releases/dana-farber-scientists-target-molecular-addiction-in-triple-negative-breast-cancer.aspx

OSTEOPOROSIS RX - Prolia, and my amazing dentist

This article made me think, but then everything makes me think about my osteoporosis right now.

http://www.kevinmd.com/blog/2015/09/

osteoporosis-a-silent-assailant-turned-me-from-physician-to-patient.html

The writer, an MD, was sure she was taking care of herself until the incident, the snap, the pain. The procedure on her broken vertebra had her back at work quickly and going for long walks.  My spine probably is in danger, too - no spine scan possible for me due to screws from the past lumbar fusion.   She and I both have to be aware of the strain on our spines right above and below the "fix."

And I still have so many questions about my plan to take Prolia.


Fast forward to yesterday at the dentist.  (All dental work has to be complete before Prolia because of possible side effects to the jaw.)

The dentist spent the entire afternoon on one tooth that my previous dentist did not even plan to treat.  An old crown had to be very carefully cut off.  Sure enough, there was decay in a space below that crown.
(The rumor is that some other dentists just won't go to the time and trouble to find and fix that.)

The assistant and I got into a talk about osteoporosis medicine.  She mentioned that some osteoporosis patients have been referred to my dentist because they had the jaw osteonecrosis these meds can cause.  (Think a dragon chewing on your jaw.)  My dentist had thought up a wonderful fix for one of them.

I'm blessed to have him - he takes the time the problem requires, and knows enough to create solutions.    Still, The discussion was uncomfortable.

 My oncologist's other patients have not had any of the scary side effects of Prolia.  And he does require a clearance showing all dental work is complete before the first injection.  I'm blessed to have him, too.

Recently, at my request, my dentist did a long and rigorous check of all my teeth, In two weeks, he'll be done working, and I'll be good to go with Prolia.

Yesterday, he remarked after recovering and rebuilding that tooth that my gum tissue is good.  That's probably thanks to the nightly ritual I learned from the L.A. periodontist.)  So that would help protect my jaw?  Right?


But, still, what makes those referred patients different from me?


Action:  I want to ask my dentist when I get the permanent crown and the last tiny cavity fix:


1.  Does he know if the jaw patients sent to him were taking bisphosphonates (like the advertised pill) or denosumab, like Prolia?  These two kinds of drugs work differently in the body, but both endanger the jaw and certain bones.  WHY?

2. If this necrosis is caused by lack of blood supply, how to I get more blood supply for my jaw? The internet hasn't been much help on that.  If he doesn't know?  What do I do?

I wish you health.

DIABETES - CELL RESEARCH HOPE?

Mt Sinai Medicine Matters emailed me a release on research into possible increase of cells that produce  insulin.

I don't intend to blog regularly on diabetes despite my "pre" status.  But they consider this groundbreaking.  Some recent research on these cells had pertained to Type 1.

The Big News part is:

Now they suspect this beta cell info may also be a help for Type 2.

Included is a clear, simple explanation of how this all works.

After flopping around on Google, I still don't have a link for you for today's release posted to me 28 September 12 a.m.  But you may want go Google it later today.

I wish you health.

BC - Do you really need a pre-op MRI?

ON JAMA Network through Twitter:

Use of Preoperative Magnetic Resonance Imaging for Breast Cancer  A Canadian Population-Based Study

I'm taking this from the study abstract:

" Importance  Contrary to practice guidelines, breast magnetic resonance imaging (MRI) is commonly used in the preoperative evaluation of women with breast cancer. While existing literature has found little benefit to MRI in most patients, potential downstream consequences associated with breast MRI are not well described."

I take that to mean:  nobody tells us the down side of taking this test.

"Conclusions and Relevance  Preoperative breast MRI use has increased substantially in routine clinical practice and is associated with a significant increase in ancillary investigations, wait time to surgery, mastectomies, and contralateral prophylactic mastectomies."

Do you need a test that can delay your surgery, trap you into additional tests, and urge an unnecessary mastectomy?  

There has been more on Twitter lately about over-testing.  I may be putting other links in from time to time.

I searched JAMA directly on Twitter today 9/24/15, and got directly to this study. May not work later.

http://oncology.jamanetwork.com/article.aspx?articleid=2443152&utm_source=TWITTER&utm_medium=social_jn&utm_term=241124969&utm_content=press_release|article_engagement&utm_campaign=press_release&linkId=17296643  Today,9/28  this link did get me back to the article.

 Sorry, but you'll have to cut and paste.


I wish you health.