Treatment & Side Effects

In recent years, there's been an explosion of life-saving treatment advances against breast cancer, bringing new hope and excitement. Instead of only one or two options, today there's an overwhelming menu of treatment choices that fight the complex mix of cells in each individual cancer. The decisions — surgery, then perhaps radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy — can feel overwhelming.

Breastcancer.org can help you understand your cancer stage and appropriate options, so you and your doctors can arrive at the best treatment plan for YOU.

In the following pages of the Treatment and Side Effects section, you can learn about:

Planning Your Treatment

What types of treatment are available and which might be appropriate for you.

Surgery

Breast-conserving surgery (lumpectomy), mastectomy, and lymph node dissection, and what to expect from each.

Chemotherapy

Who should get it, how it works, different types, side effects, and how to manage them.

Radiation Therapy

What it is, who it's for, advantages, side effects, and what to expect when you get it.

Hormonal Therapy

The link between hormones and breast cancer and how different groups of drugs — including ERDs, SERMs, and aromatase inhibitors — can affect that link.

Targeted Therapies

Including Herceptin: How they work, who should get them, how they're given, side effects, and major studies.

Complementary & Holistic Medicine

How complementary medicine techniques such as acupuncture, meditation, and yoga could be a helpful addition to your regular medical treatment. Includes research on complementary techniques and ways to find qualified practitioners.

Treatment Side Effects

A reference list of side effects and their explanations.

Clinical Trials

What clinical trials are and how to find trials if you would like to participate.

New Test May Predict Breast Cancer Metastasis

Researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have identified a new marker for breast cancer metastasis called TMEM, for Tumor Microenvironment of Metastasis. As reported in the March 24 online edition of the journal Clinical Cancer Research, density of TMEM was associated with the development of distant organ metastasis via the bloodstream -- the most common cause of death from breast cancer.

The National Cancer Institute (NCI) funded translational study could lead to the first test to predict the likelihood of breast cancer metastasis via the bloodstream -- a development that could change the way breast cancer is treated.

An estimated 40 percent of breast cancer patients relapse and develop metastatic disease. About 40,000 women die of metastatic breast cancer every year.

"Currently, anyone with a breast cancer diagnosis fears the worst -- that the cancer will spread and threaten their lives. A tissue test for metastatic risk could alleviate those worries, and prevent toxic and costly measures like radiation and chemotherapy," says senior author Dr. Joan G. Jones, professor of clinical pathology and laboratory medicine at Weill Cornell Medical College and director of Anatomic Pathology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

"If patients can be better classified as either low risk or high risk for metastasis, therapies can be custom tailored to patients, preventing over-treatment or under-treatment of the disease," adds first author Dr. Brian D. Robinson, resident in Anatomic Pathology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

The Weill Cornell investigators set out to build on previous research by co-author Dr. John S. Condeelis of the Albert Einstein College of Medicine. Working in animal models, he identified a link between blood-borne or systemic metastasis and a three-part association between invasive carcinoma cells, perivascular white blood cells (macrophages) and the endothelial cells that line vessel walls. To confirm this finding in humans, Drs. Jones and Robinson developed a triple immunostain for human breast cancer samples that simultaneously labels the three cell types that together they named TMEM (Tumor Microenvironment of Metastasis).

In a case-control study, they performed a retrospective analysis of tissue samples from 30 patients with invasive ductal carcinoma of the breast who developed systemic, distant-organ metastases. These samples were compared to matched controls that had only localized disease (i.e., invasive ductal carcinoma limited to the breast or with regional lymph node metastasis only). All patients were female and underwent primary resection of their breast cancer at NewYork-Presbyterian Hospital/Weill Cornell Medical Center between 1992 and 2003.

They found that TMEM density was more than double in the group of patients who developed systemic metastases compared with the patients with only localized breast cancer (median of 105 vs. 50, respectively). Offering further evidence in support of the TMEM concept, they found that in well-differentiated tumors, where the outcome is generally good, the TMEM count was low.

Notably, TMEM density was associated with the development of distant-organ metastasis, independent of lymph node status and tumor grade.

"Traditionally, the likelihood of breast cancer metastasis is estimated based on tumor size, tumor differentiation -- how similar or dissimilar the tumor is compared to normal breast tissue -- and whether it has spread to the lymph nodes. While these are useful measures, TMEM density directly reflects the blood-borne mechanism of metastasis, and therefore may prove to be more specific and directly relevant," says Dr. Jones.

The researchers say the next step will be to validate the findings in a larger sample group. Also on the agenda is identifying a threshold TMEM density for metastasis risk, and streamlining the process for measuring TMEM.

Breast cancer is the most prevalent malignant disease of women in the developed world, apart from non-melanoma skin cancers, with approximately one in eight women in the United States being diagnosed with breast cancer at some time in their lives. While an estimated 10 percent to 15 percent of patients have an aggressive form of the disease that metastasizes within three years after initial diagnosis, metastasis can take 10 years or longer to occur. To decrease the risk for the emergence of metastatic tumors, approximately 80 percent of breast cancer patients are treated with adjuvant chemotherapy. The clinical benefit is a 3 percent to 10 percent increase in 15-year survival, depending upon the age of the patient at diagnosis.

Study co-authors include Drs. Gabriel L. Sica and Yi-Fang Liu of NewYork-Presbyterian/Weill Cornell; Dr. Thomas E. Rohan of the Department of Epidemiology and Population Health at Albert Einstein College of Medicine; Dr. Frank B. Gertler of the Department of Biology, Koch Institute for Integrative Cancer Biology at Massachusetts Institute of Technology; and Dr. John S. Condeelis of the Department of Anatomy & Structural Biology, Program in Tumor Microenvironment and Metastasis, Albert Einstein Cancer Center at the Albert Einstein College of Medicine.

The study was funded by the Integrative Cancer Biology Program (ICBP) of the National Cancer Institute (NCI).

NewYork Presbyterian Hospital/Weill Cornell Medical Center

NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances -- from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial for gene therapy for Parkinson's disease, the first indication of bone marrow's critical role in tumor growth, and, most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. NewYork-Presbyterian, which is ranked sixth on the U.S.News & World Report list of top hospitals, also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian Hospital/The Allen Pavilion. Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit also this site.

NewYork-Presbyterian Hospital
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Breast cancer costs poor people more

As a percentage of family income, money spent by U.S. women with breast cancer is much greater for low-income patients than for those who are well off, according to research presented December 12 in Texas at the San Antonio Breast Cancer Symposium.

Public health researcher Lisa Lines of the consulting firm Boston Health Economics in Waltham, Mass., and her colleagues analyzed expenditures made by 806 breast cancer patients from 1996 to 2005. Out-of-pocket costs included insurance premiums, payments to meet deductibles, co-pays and any other payments made to meet medical or drug costs associated with treatment.

The average annual out-of-pocket expenditure was about $2,300 per breast cancer patient, about half of which was spent on prescription drugs.

“Breast cancer is actually not the most expensive cancer for out-of-pocket expenditures,” Lines says. This and other data suggest that breast cancer costs patients more than colon or prostate cancer, but less than lung cancer, she says.

But breast cancer has a large proportion of people with a “high burden,” she says. The researchers classified patients as having a high burden when their out-of-pocket costs for coping with the cancer exceeded 10 percent of the family’s income. Roughly 70 percent of low-income breast cancer patients fell into the high-burden category in this analysis, compared with about 15 percent of middle-income and less than 5 percent of high-income breast cancer patients — apparently the result of better insurance, she says.

Cancer patients in general are disproportionately affected by a high out-of-pocket burden. That’s because many cancers have come to be treated more like a chronic disease than they used to be and are treated on an outpatient basis, Lines says. In the past, most cancer patients were treated in hospitals, where major medical insurance covered much of the cost.

Source: Science News By Nathan Seppa

About Mastectomy

Definition: A mastectomy is a surgical procedure in which most or all of the breast tissue is removed, in order to treat breast cancer.

• a simple, or total mastectomy is the removal of all of the breast tissue, but none of the underlying muscle nor the lymph nodes are removed
• a modified radical mastectomy is the removal of all of the breast tissue, as well as the lymph nodes on the same side of the body as the breast
• a radical mastectomy, also called a Halsted mastectomy is the removal of all of the breast tissue, the underlying muscle, as well as the lymph nodes on the same side of the body as the breast (this is rarely done now)
• a skin-sparing mastectomy is one in which the breast tissue is removed, but the breast skin is kept, so that in the case of immediate breast reconstruction (plastic surgery) no skin grafts will be needed, to cover the breast implant.

Pronunciation: mas-TEK-tu-mee
Also Known As: breast removal surgery
Common Misspellings: masectomy, massectumy
Examples: A mastectomy is used to treat any breast cancer that has spread, or invaded, breast tissues beyond the original tumor site. It is important that the surgeon be experienced in breast surgery, and that the surgical margins of the tissue that is removed are clear of cancer cells. A well-done mastectomy helps to prevent breast cancer recurrence.

More About Breast Cancer Surgery

• More about Mastectomy
  
• About Lumpectomy
• Quadrantectomy

Suggested Reading

• Female Breast
  
• Recovery from Mastectomy
• Mastectomy Risks

Related Articles

• Mastectomy Surgery for Breast Cancer - Mastectomy Surgery
• Mastectomy for Breast Cancer
• Treating Breast Cancer: What are the Options?
• Radical Mastectomy Surgery– What is a Radical Mastectomy Surgery
• Mastectomy - series

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Breast Cancer Medication For Bipolar Disorder

By pointing to PKC as a target for new medications, the study raises the possibility of developing faster-acting therapys for the manic phase of the illness. Current medications for the manic phase generally take more than a week to begin working, and not everyone responds to them. Tamoxifen itself might not become a therapy of choice, though, because it also blocks estrogen the property that makes it useful as a therapy for breast cancer and because it may cause endometrial cancer if taken over long periods of time. Currently, tamoxifen is approved by the Food and Drug Administration for therapy of some kinds of cancer and infertility, for example. It was used experimentally in this study because it both blocks PKC and is able to enter the brain.

Results of the study were published online in the recent issue of Bipolar Disorders by Husseini K. Manji, MD, Carlos A. Zarate Jr., MD, and his colleagues.

Almost 6 million American adults have bipolar disorder, whose symptoms can be disabling. They include profound mood swings, from depression to vastly overblown excitement, energy, and elation, often accompanied by severe irritability. Children also can develop the illness.

During the manic phase of bipolar disorder, patients are in overdrive and may throw themselves intensely into harmful behaviors they might not otherwise engage in. They might indulge in risky pleasure-seeking behaviors with potentially serious health consequences, for example, or lavish spending sprees they cant afford. The symptoms sometimes are severe enough to require hospitalization.

People think of the depressive phase of this brain disorder as the time of risk, but the manic phase has its own dangers, said NIMH Director Thomas R. Insel, MD. Being able to treat the manic phase more quickly would be a great asset to patients, not just for restoring balance in mood, but also because it could help stop harmful behaviors before they start or get out of control.

The three-week study included eight patients who were given tamoxifen and eight who were given a placebo (a sugar pill); all were adults and all were having a manic episode at the time of the study. Neither the patients nor the scientists knew which of the substances the patients were getting.

By the end of the study, 63 percent of the patients taking tamoxifen had reduced manic symptoms, compared with only 13 percent of those taking a placebo. Patients taking tamoxifen responded by the fifth day which corresponds with the amount of time needed to build up enough tamoxifen in the brain to dampen PKC activity.

The scientists decided to test tamoxifens effects on the manic phase of bipolar disorder because standard medications used to treat this phase, specifically, are known to lower PKC activity but they do it through a roundabout biochemical route that takes time. Tamoxifen is known instead to block PKC directly. As the scientists suspected would happen, tamoxifens direct actions on PKC resulted in much faster relief of manic symptoms, compared with some of the standard medications available today.

We now have proof of principle. Our results show that targeting PKC directly, rather than through the trickle-down mechanisms of current medications, is a feasible strategy for developing faster-acting medications for mania, said Manji. This is a major step toward developing new kinds of medications".

Findings from another recent NIMH study strengthen the results. This prior study showed that the risk of developing bipolar disorder is influenced by a variation in a gene called DGKH. The gene makes a PKC-regulating protein known to be active in the biochemical pathway through which standard medications for bipolar disorder exert their effects another sign that PKC is a promising direct target at which to aim new medications for the illness.

Mania isnt just your average mood swing, where any of us might feel upbeat in response to something that happens. Its part of a brain disorder whose behavioral manifestations can severely undermine peoples jobs, relationships, and health, said Zarate. The sooner we can help patients get back on an even keel, the more we can help them avoid major disruptions to their lives and the lives of people around them.


Posted by: JoAnn Source

Another Chicken Soup

Chicken Soup for the Breast Cancer Survivor's Soul, from the highly acclaimed and ever-popular Chicken Soup for the Soul series, features 101 "Stories to Inspire, Support, and Heal." A must-read for anyone recently diagnosed. A great read for anyone who has survived breast cancer or knows someone who has. You'll want to get one for every woman on your list! Check out this book's companion book, "#1 Best Tools & Tips from the Trenches of Breast Cancer." One of our pink ribbon bookmarks would go great with Chicken Soup for the Breast Cancer Survivor's Soul!

Back Cover
Along with the shock, fear and loss many women face upon a breast cancer diagnosis comes unexpected strength, wisdom and strong networks. In Chicken Soup for the Breast Cancer Survivors Soul, survivors and their family members talk openly about their difficult fight with breast cancer and how they made it through the dark times with a belief in a higher power and the support of those closest to them.

Find strength in the encouraging stories of how loved ones confront their fears and show genuine affection for one another through gestures, such as a granddaughter cutting the hair off of all her dolls so that they will look more like her grandma, who is bald from chemotherapy; the gentle touch of a three-year-old son on his mother’s back, giving comfort to his sick mommy; and a husband who shows his wife the depth of his love during a weekend getaway after she heals from a mastectomy.

Chicken Soup for the Breast Cancer Survivors Soul will spark the optimism sometimes masked in the midst of an illness. It is for everyone with breast cancer and everyone who loves someone touched by the disease.

Introduction
Going through the experience of breast cancer is no picnic, but with loving support, helpful advice and the healing power of laughter, it can be achieved. It is our fondest hope that you will be encouraged, buoyed, uplifted and instructed by the stories contained in this book. Other breast-cancer survivors wrote them for you—to bring you hope, to give you strength and courage.

Research has shown that those who attend support groups tend to have higher survival rates. Those who reach out to family and friends for love and support make it through the medical journey of breast cancer more successfully. We have so much to learn from each other as we face the challenges of healing ourselves; often someone who has gone through the journey before us shares the thing we need to learn.

We all have a story to tell. Our stories are healing and have power. We encourage you to tell your story, too. Who knows? Your story might encourage someone to go for a mammogram, even save someone’s life.

Melissa Etheridge talks about how she prepared for the journey of breast cancer by gathering her “flashlights”—her friends and family members who would help her shine light into the fearful darkness.

This collection of stories can be one of those flashlights for you—shining light and making your way easier, helping you to feel stronger, more filled with love and encouraged by the knowledge that you’re not alone in your journey.