Breast Cancer and Folate - Will it Protect You? Me?

I passed the first diagnostic mammo (required for two years here after treatment.)   So am I in the clear?  Can I do something to prepare for next year's?

Funny thing happened today (not really that funny.)  I zeroed in on another health problem I haven't been able to get a fix for.   And vitamin deprivation including insufficient folate was mentioned on Mayo Clinic as a possible cause of that problem.

Now today I see this Mt. Sinai Medicine Matters article that says folate in my diet might prevent BC. Hank Schmidt, MD, Phd, FACS, the writer, is also  Director of the Cancer Risk Program at Dubin Breast Center of the Tisch Cancer Institute.  He names the very large EPIC study that followed women for 11 years, also says, re Estrogen-receptive cancers:

     "...other studies have suggested the risk of ER- cancers may be
      more sensitive to dietary components, such as B vitamins."  

I found that wording a bit confusing.

So how much folate does a young woman need to try for this protection?

      "Interestingly in the EPIC study, breast cancer risk was lower with
      increasing folate intake, and lowest in women taking
      400 micrograms daily."

That certainly interested me enough to grab my vitamin bottle.  My multi-vitamin, which is not for any particular age, says, you guessed it, that 400 mcg (micrograms) daily is the minimum daily requirement of folate.  So the women studied had not been taking that much before the study?

 Okay, it says younger women but it says "particularly young women" not only young women.   Yes, I was told long ago that we don't need so much folate after we stop having periods.  But at least we need ENOUGH for the age we are.  Wonder if my doc knows how much?

There is also a PubMed article suggesting folate will help:

     Higher dietary folate intake reduces the breast cancer risk: a systematic 

      review and meta-analysis. 2014 Apr 2 

If you are young or just as interested as I am, here's the Mt. Sinai article:

http://blog.mountsinai.org/blog/breast-cancer-in-young-women-new-research-on-choices-for-lowering-your-risk

I wish you health.

BREAST CANCER: HER2 Possible Cure From "Mom's Pills?"

Two recently published studies led by Mt. Sinai researchers may offer new hope from "old medicine" for cancers including a quarter of breast cancers.  Their report: Repurposing a Drug to Prevent and Treat Cancers, refers to their work with bisphosphonates--the osteoporosis drugs.

So it was not a surprise to learn that lead study author and professor Mone Zaidi, MD, PhD, FRCP, also heads the Mt. Sinai Bone Program.  The surprise was reading the cautious statement that

           "Bisphosphonates have been previously associated with slower 

tumor growth in some patients..."  

***

I dug around some.  Found tumors in a bone treatment article on OncoLink, a site of The Abramson Cancer Center of the University of Pennsylvania  Last Modified: December 18, 2014. 

They were cautious, too.  But down in the bisphosphonates section I found:

"Bisphosphonates may have some level of anti-tumor activity in breast cancer. A recent Phase III clinical trial revealed that the addition of Zometa to endocrine therapy, improves disease-free survival...in pre-menopausal patients with estrogen-receptor positive early breast cancer."  

Since my DCIS was hormone receptive, that sounded like good news for me.  However their mention of other clinical trials in progress at the time, does not include HER2.  

***

So I was back to the Mt. Sinai research:

You probably know that HERs are human epidermal growth factor receptors.  The Mt. Sinai article outlines their first study, that revealed how bisphosphonates work.

With that study's discoveries, and with the knowledge that twenty five per cent of breast cancers "proceed from genetic changes that result in excessive amounts of HER2" they started the second study.

The researchers went into the labs, which revealed:

 Giving mice bisphosphonates early on prevented HER-driven tumors from forming, and combining bisphosphonates with the cancer drug Tarceva® not only stopped tumor growth but reversed it. 

So now we wait.  Dr. Zaidi reminds us we may get this Bc treatment 

     "... if we can confirm in clinical trials that this drug class also reduces 

cancer growth in people.”

We can’t know how long it will be before their trials are up and running.  Some women will undoubtedly comb the web and learn more before I do.  Please share what you learn with us.

I wish you health.

PS If you are on Twitter, check out the great"cartoon style" dwgs on immune checkpoints & how they work @JAMAOnc

Breast Cancer - Dense breasts complicate diagnosis

In July, I referred to an article about dense breasts.  Now: 

More sensitive (and expensive) tests increasingly tapped for breast cancer screening     By Jaimy Lee  | December 10, 2014 

This more recent article on modernhealthcare.com sounds like more help is in the works for those of us who have dense breasts.

First, I need to contact the hospital to see if they have documented my dense breasts.

My oncologist has recommended I have my next December diagnostic screening (all cancer survivors in this area have 2 years of "diagnostic" mammos instead of "screening.") somewhere new.  The place he recommended has 3-D screening.

The next question is money.  The article I reference above seems to hint at more likelihood that those of us with dense breasts and high risk may this year even find Medicare willing to pay for 3D screening.

Monday I'll try to call the "new" screening place to see if they know anything about Medicare payment for 3D.  Or maybe I'll wait to see if there is more news later from the med sites on Medicare $$

So far I haven't finished looking to see if the hospital actually documented my dense breasts.

Meantime, you might want to read the article all the way through.

I wish you health.

Save $ on medicine

Be aware of cost savings available to every patient

DIANE SCHEB, RN | MEDS | FEBRUARY 11, 2015

www.kevinmd.com/b

Tamoxifen feet-vein-artery Diary

This Tamoxifen foot pain-and-swelling thing involves more than walking!

Thursday. Last visit to Dr. Neville, for report on the vascular test. Asks me if I've ever been sent to a heart specialist.  (NO)  He says there's a vascular problem--not enough blood to the balls of my feet.  Everyone else is telling me to elevate my swollen feet and get the blood back to the heart.  So is it an arterial problem?  He says:  I want you to walk!

Corie puts a tiny metatarsal pad in my right shoe; gives me a discount card for NewBalance store.  Tells me to see manager.

Friday.  I go on my longest walk for ages, wearing my clogs.  Friday night 2 Gabapentin, but almost impossible to sleep.  Random pains in places I've never had pains.  Is this Tamoxifen or the unaccustomed exercise?  Took Tylenol in the middle of the night.

Saturday.  Woke  hungry and, of course, tired.  Was it partly hunger that kept me awake?

Sunday.   Swollen feet.  What's new?  Got my clogs on, went off to meet a friend and did some walking around the shopping center where I often go to Starbucks.

Monday.   NewBalance Manager will not be in, Walked around the neighborhood - more than a thousand steps, again wearing my old slide-sandal Clarks'.

Tuesday.  Manager doesn't have any walking shoe for me without very lumpy soles that will cause me to break my neck.  I agreed to e-mail him a link on some NewBalance walking shoes I saw online from LLBean.  Sent him the link.  Heavy laundry and kitchen chores.

Wednesday.  Usual foot pain and swelling.  Wore my ancient, sturdy Clark's sandals around the house.  Took a Tylenol, put on clogs, and walked through big department store shoe area - no luck.

Physical Therapy outpatient called me--I have a new assessment tomorrow!

Breast Cancer Survivors-Tamoxifen, sore feet, and our veins. Tennis or ...

Rare craving for ice cream today after studying Medical statistics made easy.  I finally got a Snickers ice cream bar and a quiet moment on the sidewalk to wonder if my sweats had really shrunk (maybe) and why my waist is in danger of disappearing beside my ever-growing abdomen.

Then along comes Dr. Katz and his article that I actually read.

Inactivity kills more than obesity: Let’s go beyond the headline
DAVID L. KATZ, MD | CONDITIONS | JANUARY 29, 2015  in Kevin, MD

 Fat around the waist was mentioned in the article.  Discussed, even.  So was the fact that more activity could mean less fat.  I guess taking heavy pots and bowls out of the dishwasher 2 or 3 times a day and climbing the library stairs isn't enough moderate exercise,

Then there's the foot-pain doctor:

My activity has been way down since my feet started hurting a lot.  The podiatrist, who knows about Tamoxifen, has found a potentially dangerous vascular problem.  I don't want to develop a clot.  His verdict:

WALK.

Yes, that's also what the spine surgeon preaches.  Yes, I'm the one who urged you to read "Cancer Survivors Rest in Peace." *  (The one about exercise to live.) 

Bottom line:  Even though my feet are very swollen when I wake up (not unknown with Tamoxifen) and they're often much smaller in the afternoon or by supper, I have to find some really good shoes that allow me to walk more.  Much more.  Morning and afternoon.

Foot doctor's orthotics specialist gave me a tiny metatarsal pad for my right foot in my everyday shoes. We considered a bonfire for my rainy-day-puddle shoes) after he literally rolled one up in a ball.   Gave me a "prescription" for a discount on some tougher, healthy shoes.  He also showed me some healthy shoes that will not shout "old crip."  And ones without the cute lugs on the bottom that make me fall on my face.

So Monday it's serious shopping for tough, supporting, seriously padded rain-or-shine shoes.  Hopefully I'll be able to walk in the mornings, and then compensate with padded socks as the swelling goes down. And walk some more.  (Need instructions for woman with lumbar fusion changing socks and retying shoes in Starbucks bathroom.)  Anything to make those foot veins healthy.

In short, I might have improved my life expectancy if I'd pushed, fought, for the right podiatrist some time ago, instead of curling up with too many books.

I wish  you health. 

* from Sunrise Rounds  http://sunriserounds.com

Breast Cancer patients and survivors - one doctor understands

This morning, Sunrise Rounds has a post  (scroll to Cancer Care--The Secret Change) about how we feel when a cancer is "cured."  How hard it is to forget that ghost whisper:  It could come back.  That phantom pain that says: Is it back?  Dr. Salwitz shares the words of a survivor and cancer treatment professional who seems shocked at how cancer acts and feels when we're the patient.

Since breast cancer especially has been found to be ever lurking, his post really struck me.

He talks about the parts of us - body and mind - that aren't quite what they were before radiation, before whatever science has done to us as well as to the disease.  And how we feel about those alterations and losses.  

About all this he says one thing that made me feel a deep kinship with other survivors, "The clincher?  None of this is obvious to anyone else." 

Our families, spouses, friends have heaved a sigh of relief for us.  We rang the bell!

And yet... 

I wish you health.