Breast Cancer Pill Reduces Risk of Breast Cancer Recurrence
In a groundbreaking study, a drug called Lynparza (Olaparib) wa found to reduce the risk of breast cancer recurrence in BRCA gene mutation carriers. The pill, which is classed as a PARP inhibitor, was developed by AstraZeneca and Merck.
PARP inhibitors block the cancer cell’s ability to repair its own DNA. This means if a cancer cell is damaged by a treatment like chemotherapy or radiation, it will be unable to repair itself and will die.
New England Journal of Medicine Study
The clinical study, published in the New England Journal of Medicine, began in 2014 and enrolled a total of 1,836 women. All the study participants were carriers of a BRCA gene mutation and had a history of early stage HER2-negative breast cancers. All patients had undergone breast cancer surgery and chemotherapy and were also considered at high risk for breast cancer recurrence based on their tumor size or lymph node involvement.
Half of the study participants were given Lynparza daily for a year. The other half received a placebo. A little over two years after the beginning of treatment, the study found that the women taking Lynparza saw a 42% reduction in the risk of breast cancer recurrence or death. The study also reported that at 3 years after beginning treatment, 85.9% of Lynparza users were still living without evidence of a recurrence, compared to 77.1% of women who received the placebo.
As it stands today, AstraZeneca will be submitting the results of this study to regulators to request approval for use in early-stage breast cancer patients with a BRCA genetic mutation. Currently the drug is approved by the FDA to treat advanced-stage breast cancer in BRCA gene mutation carriers.
Single-Dose Intraoperative Radiation Therapy Improving Breast Cancer Care
Many breast cancer patients may be able to avoid lengthy radiation treatment according to research published in the British Journal of Cancer. As an alternative to standard external beam radiation therapy (EBRT) performed after a lumpectomy, TARGIT-IORT is a single-dose intraoperative radiation treatment targeting the tumor site immediately following the lumpectomy. The treatment occurs while the patient is still asleep under general anesthesia. This protocol means patients can have their breast cancer surgery and radiation treatment all at the same time.
By targeting the radiation just to the tumor site at the time of the surgery, patients may be able to avoid potentially harmful effects traditional radiation treatments can have on nearby organs. According to the study, delivering TARGIT-OIRT during the lumpectomy also makes the site of the original tumor less conducive for future cancer growth. Other studies show the benefits of this type of radiation treatment including less pain, better cosmetic results after surgery, and fewer changes to the breast shape and skin compared with whole breast EBRT.
For the study, 2,298 women with invasive breast cancer and a tumor size of up to 3.5 cm in diameter were randomly assigned to receive either TARGIT-IORT during lumpectomy or post-operative extended radiation. The trial was run in 32 hospitals across 10 countries.
Intraoperative radiation is safe and effective
The study showed no difference in local recurrence-free survival between the two methods of radiation treatment. Unlike with EBRT, local recurrence with TARGIT-OIRT was not associated with a higher risk of death.
The study found “no statistically significant difference between EBRT and the approach of risk-adapted TARGIT-IORT during lumpectomy, for local recurrence-free survival, invasive local recurrence-free survival, mastectomy-free survival, distant disease-free survival or breast cancer mortality. The mortality from other causes was significantly lower in the TARGIT-IORT arm”.
Based on these study results, single-dose TARGIT-IORT during lumpectomy is an effective and safe alternative to several weeks’ course of post-operative EBRT. Patients who are candidates for single-does radiation can therefore benefit from less time spent in treatment and a faster recovery without comprising their cancer care.
Please remember, it is important to discuss all treatment options thoroughly with your healthcare team before undergoing surgery.
Confused about your options?
Confused about your breast cancer treatment options? Get the help you need with evidence-based information in the palm of your hand – download Breast Advocate® FREE here.
Why All Breast Cancer Patients Should Be Offered Rapid Genetic Testing at Time of Diagnosis
A breast cancer diagnosis brings with it a need for many different treatment decisions. One of the first decisions to consider, is which operation to have to remove the tumor. Surgical options include a lumpectomy, oncoplastic surgery, a mastectomy, or even a bilateral mastectomy (removal of bth the cancer breast and healthy breast). Many women, particularly in the US, often find themselves trying to decide between the least invasive approach, a lumpectomy, or the most aggressive, a bilateral mastectomy with or without breast reconstruction.
Factors such as tumor size, breast size, the location of the tumor, and the type of breast cancer can greatly impact which surgery is recommended. Patients should be given all options and discuss the pros and cons of each procedure with their healthcare team to determine which treatment plan best serves their individual needs.
Bilateral Mastectomy Recommended for Patients at High Risk Due to Genetic Mutation
For patients with a genetic mutation (such as a BRCA1 or BRCA2 mutation), who have a much higher risk for developing cancer in the future, the removal of both breasts is usually recommended as it significantly reduces the risk of another breast cancer in the future. Patients can of course opt to save their healthy breast and instead have close follow up including 6-monthly MRIs, and can also take risk-reducing medication like Tamoxifen.
However, not all patients undergo genetic testing prior to breast cancer surgery to even know they are at higher risk of developing another breast cancer in the future.
Rapid Genetic Testing Offers Patients More Insight When Planning Breast Cancer Surgery
A study published in Annals of Surgical Oncology found that women with a recent breast cancer diagnosis who are offered a rapid genetic test, and who received their results prior to their initial breast surgery, oftentimes chose to have a bilateral mastectomy. In the study, more than 1,000 women were offered a rapid genetic test following a breast cancer diagnosis. Of those who tested positive for a BRCA mutation, over 70% chose to have a bilateral mastectomy, with or without reconstruction.
These test results demonstrate the need for further evaluation of the current model of breast cancer care. Currently, not all women with a breast cancer diagnosis are routinely offered genetic testing. Only those who also have a family history of breast cancer, or are very young at the time of diagnosis are typically referred to a genetic counselor for gene testing.
By offering all women the option of a rapid genetic test at the time of diagnosis, patients would be better informed when making surgical treatment planning decisions.
Personalized Treatment Recommendations in the Palm of Your Hand
The Breast Advocate® app is another great resource for patients weighing their options for breast cancer surgery or breast reconstruction.
Co-created by leading specialists and patient advocates, Breast Advocate® is a free breast cancer surgery app that provides ALL your surgical options along with evidence-based recommendations, personalized for you.
Download the free app HERE.
Breast Cancer Patients Needing Radiation Therapy Face Higher Risk of Implant Reconstruction Complications Requiring Additional Surgery
Implant-based breast reconstruction is the most commonly performed method of reconstruction in the United States today. While the procedure can be performed in one surgery (known as ‘direct to implant’), most women have a 2-stage approach beginning with tissue expanders. These are replaced with a permanent implant a few months later at a second surgery (stage 2).
Implants are a good option for many women but may not be the best choice for some patients. In particular, patients needing radiation therapy as part of their breast cancer treatment should know that radiation increases the risk of complications after reconstruction with implants. Potential complications include infection, capsular contracture (breast hardening), asymmetry, seroma, pain, implant rupture, and implant exposure. In many cases, additional surgery is required to address the complication.
Implants often need to be removed
A recent study published in The Breast Journal found that 44% of women with locally advanced breast cancer who had implant reconstruction needed unplanned implant removal when radiation therapy was part of their treatment plan.
The study followed 52 patients who had mastectomy, implant-based breast reconstruction, and radiation therapy from 2010 to 2017. 44% of the patients in the study had stage III disease, 77% were estrogen receptor positive, and 75% were HER2 positive.
Patients were followed for just over 3 years following surgery and treatment. The average time between treatment and implant removal was only 5 months. In this study, implant removal was required before starting radiation in 17% of the patients, and after radiation was completed in 27% of the patients.
Reasons for implant removal before radiation began were infection (44%), wound breakdown (33%), hematoma (11%), and concern about planned radiation (11%). Reasons for implant removal after radiation included significant breast asymmetry (57%), infection (21%), a deflated expander (14%), and seroma (7%). Some women had bilateral mastectomy and reconstruction – most of the complications in these cases occurred in the breast that underwent radiation therapy.
This study is yet another example of why it is important for patients to be fully informed of the potential risks associated with surgery they choose. Fully-informed patients also tend to have more realistic expectations, which in turn can also improve recovery and the overall satisfaction with the final outcome.
You have other options!
Fortunately, implants are not the only reconstructive option and most women are candidates for alternative procedures. These include other types of breast reconstruction using the patient’s own tissue (known as ‘flaps’), and aesthetic flat closure (going flat).
“Despite the relatively high rate of implant removal reported in this study, salvage reconstruction is feasible,” the study authors noted. “Of the 23 patients who experienced unplanned implant removal, 78% were able to undergo salvage reconstruction with only 5 patients pursuing no further reconstruction at the time of last follow-up.”
If you are facing a similar situation and would like to learn more about your options, the Breast Advocate app can help – download it today!
The Importance of Knowing All Your Breast Cancer Surgery Options
Breast Advocate founder Dr. Minas Chrysopoulo recently joined the C-Sessions podcast for a discussion on breast cancer surgery, breast reconstruction, the potential adverse effects, and the importance of knowing all your surgical options throughout any stage of the breast cancer treatment journey.
Randall Broad graciously hosted the conversation which included Christine, a breast cancer survivor. Christine openly shared her experience of multiple lumpectomies, an eventual mastectomy, and then multiple attempts to reconstruct her breast with implants. A major contributing factor to Christine’s frustration has been the lack of access to all the information she felt she needed to make fully-informed surgical decisions from the get-go following her breast cancer diagnosis.
Christine’s experience unfortunately isn’t unique. When it comes to breast reconstruction in particular, 1 in 3 women feel they don’t have enough say in their treatment decision-making. The Breast Advocate® app was created to address this problem. Breast Advocate provides all the information patients need to make fully-educated decisions about which procedure is best for them after a breast cancer diagnosis. Download it free here.
Listen to the C-Sessions podcast here.
WHO Global Initiative Aims To Improve Breast Cancer Survival
For patients diagnosed with breast cancer, the 5-year survival rate is above 80% in most “wealthy” countries. Unfortunately, not all countries can boast such statistics. Likewise, even in higher-income countries there are still areas of underserved communities with much lower survival rates.
The World Health Organization (WHO) has announced a new campaign to help improve survival rates in underserved areas. The campaign is called the Global Breast Cancer Initiative. The goal is to reduce breast cancer mortality by 2.5% per year until 2040. These efforts could save the lives of up to 2.5 million people!
The global effort comes at a crucial time. Breast cancer now outranks lung cancer as the world’s most common type of cancer, and is responsible for 1 in every 6 cancer deaths in women.
Breast Cancer Initiative key elements
The Global Breast Cancer Initiative will be comprised of three elements: health promotion, timely diagnosis and treatment, and supportive care.
Health promotions will drive campaigns focused on public education to identify the early signs of breast cancer. Another key focus will be educating the public on lifestyle changes that could reduce their risk of developing breast cancer.
The push for timely diagnosis and treatment will require local government officials and their healthcare providers to address local needs and develop plans of action to provide better patient care. This includes access to surgery, chemotherapy, radiation treatments and pain management services.
“An evidence-based technical package will be provided to countries, linked to online learning platforms and other types of support, and rolled out over the next year. The package will incorporate existing WHO cancer tools and products to promote an integrated approach across cancers and to strengthen health systems more broadly,” shared the WHO when discussing the strategy behind the new campaign.
This campaign will hopefully reach the lives of many women and men across the globe. The importance of education as well as access to breast cancer care and patient support are crucial in making a global impact and saving lives. We applaud this incredibly important initiative and look forward to seeing its efforts come to fruition!
1 in 3 Women Don’t Have Enough Say in Their Breast Reconstruction Decision-Making
Patient’s relationships with their healthcare team can play a major role when it comes to planning medical procedures. In the setting of breast cancer surgeons can greatly influence surgical decision-making. This is particularly the case when it comes to breast reconstruction.
In the largest ever behavioral study focused on breast surgeons and breast cancer patients, results suggest surgeons play a bigger role in breast reconstruction planning than many patients would prefer. The study, published in the British Journal of Surgery, surveyed 53 surgeons, 101 breast cancer nurses, and 689 patients diagnosed with breast cancer.
According to the study, “approximately one in every three women (32%) stated their surgeon had more input than they did, when deciding which type of breast reconstruction to undergo.” Additionally, 16% of women felt they had zero input in the choice of reconstructive procedure they had. We find it very concerning that so many women in this study feel they played little to no role in deciding which type of breast reconstruction was best for them.
The Importance of Shared Decision-Making
This study is yet another example of why shared decision-making is so important, and why we created the Breast Advocate app!
We believe patients should be fully informed of all their breast reconstruction options, as well as the option of aesthetic flat closure (no reconstruction with a nicely-contoured, truly flat result). It is only once all the options are fully discussed, that patients can take part in a shared-decision-making conversation with their surgical team.
Shared decision-making occurs when the health care professional and patient work together to make a treatment decision that is best for the patient. The best decision takes into account evidence-based information about treatment options, the physician’s knowledge and experience, and the patient’s preferences and values. Multiple studies show this collaborative approach improves patient outcomes and satisfaction.
Co-created by leading breast cancer specialists and patient advocates, our free breast cancer surgery app provides evidence-based information and customized surgical recommendations, personalized for each individual user based on diagnosis and personal preferences. Regardless of an individual’s situation, users will have all the information and tools they need to take a more active role in decisions about their treatment.
World Cancer Day 2021
February 4th is World Cancer Day. The purpose of this day is to “inspire change and mobilize action” in the cancer community across the globe. For the past three years, the campaign focus has been “I Am And I Will.” In 2019, the campaign highlighted individuals’ “Commitment To Act”. The inspirational message of “Progress Is Possible” followed in 2020. This year marks the final year of the three year “I Am And I Will” campaign and the focus is “Together, All Our Actions Matter.”
This year’s spotlight reminds us all that our actions have an impact on the world around us. The campaign demonstrates how when we all choose to come together, we can achieve a “healthier, brighter world without cancer.”
Breast Advocate® works with organizations across the globe to help educate and empower women and men during their breast cancer journeys. Through this collaborative approach, our app users can access a vast array of support resources. These include emotional and financial support, legal advice and travel assistance.
Breast Advocate’s mission is to empower patients to have a voice in their breast cancer treatment decisions. Connecting people with resources to help support them in their treatments journeys is part of that purpose.
“We believe our efforts to provide educational and supportive information and resources to individuals navigating breast cancer make a difference in the lives of many,” says app founder Dr. Minas Chrysopoulo. “We hope to continue to brighten the futures of breast cancer communities across the globe and expand our resources to further meet their needs.”
So, this World Cancer Day, how will you try to make a difference in your cancer community?
Resources for Navigating Breast Cancer Care During the COVID-19 Pandemic
The COVID-19 pandemic has impacted everyone across the globe. Confusion, fear, and safety protocols continue to make navigating breast cancer screenings and treatment more difficult than ever. Although data and recommendations are constantly evolving, we present some helpful information below to address the most common questions we see relating to breast cancer care during the pandemic.
Breast Cancer Screening
Leading health organizations and medical professionals agree it is safe to resume breast cancer screening. The importance of resuming annual screenings and/or diagnostic imaging tests cannot be understated. With safety protocols in place at every medical facility, patients can more confidently go to these appointments as long as they adhere to the recommended guidelines, such as wearing a face mask/covering and physical distancing as much as possible.
Treatment Options
Many patients today are reporting delays in their breast cancer surgery due to the limitations in place within hospital systems. These limitations help ease the burden on the healthcare system created by COVID-19. The impact of these delays has raised obvious concerns from patients and medical professionals alike.
Luckily, more hospitals and surgical centers are opening up and breast cancer surgery delays are becoming less frequent. Currently, treatment options like chemotherapy and radiation are continuing as normal and patients should follow their healthcare team’s recommendations.
As a helpful resource, the American Society of Breast Surgeons has published recommendations to help guide physicians and their patients through the common scenarios related to breast cancer treatment during the COVID-19 pandemic.
COVID-19 Vaccines
Vaccine distribution regulations vary by state, but in many areas breast cancer patients are eligible to receive the vaccine now. Before receiving the COVID-19 vaccine, patients should consult with their medical team.
There’s a lot of confusion among breast cancer patients as to whether the vaccine is a good idea or a bad idea for somebody undergoing treatment. Reports of lymph node swelling after a vaccine that mimicks breast cancer spread (metastasis) has obviously caused a lot of concern. However, this should not be mistaken for disease progression. It is also very understandable for some of you to feel uncomfortable receiving a vaccine that is so new and has been developed so quickly. However, please know that new vaccines cannot be released for public use without the appropriate safety protocols being followed.
Breast Reconstruction Timing
For many, breast reconstruction has had to be rescheduled or postponed due to their local hospital infection rates and bed capacities. This can be extremely frustrating to say the least. However, please know that delayed reconstruction is still possible any time after a mastectomy (or lumpectomy).
For current scheduling availability and recommendations in your area, please keep in close touch with your plastic surgery team.
Related content:
Coronavirus: What Breast Cancer Patients Need To Know
The Impact of COVID-19 on Breast Cancer Treatment
Breast Advocate Founder Answers Your COVID-19 Breast Cancer and Breast Reconstruction Questions
Rescheduling Elective Breast Surgery After COVID-19
COVID-19 Patient Outcomes After Breast Cancer Treatment
Breast Cancer Vaccine set for Clinical Trials
The new year is kicking off with hopeful news about a breast cancer vaccine. The US Food and Drug Administration (FDA) approved a new vaccine for triple-negative breast cancer to enter clinical trials. Invented and developed by Cleveland Clinic immunologist Dr. Vincent Tuohy, the vaccine has been 10 years in the making.
Triple-negative breast cancer is an aggressive form of breast cancer with limited treatment options. According to the Center for Disease Control (CDC), triple-negative breast cancer (TNBC) does not have any of the receptors that are commonly found in other types of breast cancer. This makes this type of breast cancer more difficult to target and treat with drugs. So far, chemotherapy has been the mainstay of treatment. The demographics of TNBC is also different from other breast cancer subtypes, targeting predominantly women under 40yrs of age, Black women, and women who carry the BRCA1 gene mutation.
The Cleveland clinic is partnering with Anixa Biosciences, who has an exclusive worldwide license to the new technology. Pre-clinical trials conducted on animals showed 100% of mice that were not vaccinated and got a placebo drug, developed breast cancer and died. Phase 1 of the human clinical trials will begin as soon as possible. The trials will include both women and men and will hopefully be completed within two years.
Women who intend to breast feed in the future will not be candidates. This is because the vaccine is designed to attack alpha-lactalbumin-expressing cells. By attacking these cells, there will likely be damaging effects to milk production. “Most triple-negative breast cancers express alpha-lactalbumin,” Tuohy says. “It is a mistake that the tumors make because they have no default inhibition mechanisms through progesterone and estrogen signaling that would ordinarily prevent the expression of this protein.” He describes the vaccine mechanism as “simply taking advantage of this mistake.”
Dr. Amit Kumar, President and CEO of Anixa stated, “We are pleased that the FDA authorized human clinical trials of our potentially paradigm-shifting vaccine for the prevention of breast cancer. This approval will eventually lead to recruitment of patients and initiation of the trial.”
There are several breast cancer vaccines currently in development across the globe. Although these potential advances are very exciting, unfortunately it will likely be a while before patients interested in a vaccine will have access to it.
