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.