Personal Growth Following Breast Cancer Diagnosis

As National Breast Cancer Awareness month draws to a close, and the world becomes a little less pink, we share with you some positive news to help sustain the momentum until next October.

Although breast cancer is usually an extremely stressful experience for most of the 300,000 or so women in the US diagnosed each year, a new study by researchers at Wake Forest Baptist Medical Center has found that there also can be unexpected benefits.

“Many women who have breast cancer often experience distress but sometimes are surprised that they also may experience a variety of positive outcomes following diagnosis,” said Suzanne Danhauer, Ph.D., lead author of the study.

The study, which is published in the current online edition of the journal Psycho-Oncology, examined change in post-traumatic growth (PTG) over two years in 653 women.

PTG is defined as the positive psychological change experienced as a result of a struggle with highly challenging life circumstances. Commonly reported aspects of PTG include enhanced interpersonal relationships, increased appreciation for life, a sense of increased personal strength, greater spirituality and changes in life priorities or goals.

Participants completed surveys within eight months of diagnosis and also six, 12 and 18 months after that. The survey results were assessed using the Post-Traumatic Growth Inventory (PTGI) – an instrument for assessing positive outcomes reported by persons who have experienced highly stressful or traumatic events.

According to the researchers, total PTGI scores increased over time mostly within the first few months following diagnosis. Greater PTGI scores were associated with education level, longer time since diagnosis, greater baseline level of illness intrusiveness and increases in social support, spirituality, use of active-adaptive coping strategies and mental health.

“Our findings suggest that there are women who see a variety of positive changes during and after breast cancer treatment,” Danhauer said. “Our study showed just how common it is for women to talk about the good things that have happened in their lives because of this illness, and it doesn’t seem to be related to how optimistic a person is or not.”  The study also showed that an increased amount of social support was associated with more post-traumatic growth in these women.

Way to go ladies.  A great example of when life gives you lemons…make lemonade?!?  Better yet, find somebody else whose life has given them vodka, and throw a lemon drop party.

Putting the squeeze on breast cancer

UC Berkeley and the Lawrence Berkeley National Laboratory have literally put the squeeze on malignant breast cancer cells to guide them back into a normal growth pattern.

The findings, presented last month at the annual meeting of the American Society for Cell Biology, showed for the first time that mechanical forces alone can revert and stop the out-of-control growth of cancer cells.

And, it seems, this change happens even though the genetic mutations responsible for malignancy remain, setting up a nature-versus-nurture battle in determining a cell’s fate.

“We are showing that tissue organization is sensitive to mechanical inputs from the environment at the beginning stages of growth and development,” said principal investigator Daniel Fletcher, professor of bioengineering at Berkeley. “Compression, appears to get these malignant cells back on the right track.”

Throughout a woman’s life, breast tissue grows, shrinks and shifts in a highly organized way in response to changes in her reproductive cycle. For instance, when forming the berry-shaped structures that secrete milk during lactation, healthy breast cells rotate as they form an organized structure.

One of the early hallmarks of breast cancer is the breakdown of this normal growth pattern. Not only do cancer cells continue to grow irregularly when they shouldn’t, recent studies have shown that they do not rotate coherently.

While the traditional view of cancer focuses on genetic mutations within the cell, scientists at the Berkeley Lab showed that a malignant cell is not doomed to become a tumor. Instead, its fate is dependent on its interaction with the surrounding microenvironment. Better still, manipulation of this environment can tame mutated mammary cells into behaving normally.

“People have known for centuries that physical force can influence our bodies,” said researcher Gautham Venugopalan. “When we lift weights, our muscles get bigger. The force of gravity is essential to keeping our bones strong. Here we show that physical force can play a role in the growth and reversion of cancer cells.”

Venugopalan and collaborators grew malignant breast epithelial cells in a gelatin-like substance that had been injected into flexible silicone chambers. The flexible chambers allowed the researchers to apply a compressive force during the first stages of cell development. Over time, the compressed malignant cells grew into more organized, healthy-looking structures, compared with malignant cells that were not compressed.  Notably, those cells stopped growing once the breast tissue structure was formed, even though the compressive force had been removed.

“Malignant cells have not completely forgotten how to be healthy; they just need the right cues to guide them back into a healthy growth pattern,” said Venugopalan.

While researchers are not proposing compression bras as a treatment for breast cancer, they say their work provides new clues to track down the molecules and structures that could eventually be targeted for therapies.

All of which is good news for the girls!

A Breath of relief for Colorectal Cancer diagnosis

According to the American Cancer Society, colorectal cancer is the second leading causes of cancer-related deaths in the United States.  In 2008, 142,950 people were diagnosed and 52,857 people died from it.

Although early diagnosis can often lead to a complete cure, many people who should get tested, don’t.  Maybe it’s because the current diagnostic tests for colorectal cancer include colonoscopy and sigmoidoscopy.

Few people in America will forget that day almost 12 years ago when  Katie Couric underwent a colonoscopy, live on the “Today” show in an effort to encourage screening after her husband, Jay Monahan, died of colon cancer in 1998.  And while she did her best to show that the procedure does not have to be either uncomfortable or embarrassing, and there was a 20% spike in colonoscopies in the years that followed, according to the CDC half of colorectal cases are still being diagnosed in the late stages

This is, please excuse the pun, a huge bummer, because if found in the early stages, colon cancer has a survival rate of over 90 percent.

Which is why SRxA’s Word on Health was excited to read a new study, published in a supplement to the British Journal of Surgery, which showed that a simple breath analysis could be used for colorectal cancer screening.

Apparently, cancer tissue has different metabolism compared to normal healthy cells and produces some substances which can be detected in the breath of these patients. Analysis of the volatile organic compounds (VOCs) linked to cancer represents a new frontier in cancer screening.

Donato Altomare, MD, of the Department of Emergency and Organ Transplantation and his team of researchers at the University Aldo Moro of Bari, collected exhaled breath samples from 37 patients with colorectal cancer and 41 healthy controls.

Results showed that patients with colorectal cancer have a different selective VOC pattern compared with healthy controls. Tests based upon these VOC’s are able to discriminate patients with colorectal cancer with an accuracy of over 75%.

“The technique of breath sampling is very easy and non-invasive, although the method is still in the early phase of development,” Altomare notes. “Our study’s findings provide further support for the value of breath testing as a screening tool.”

A previous pilot breath test study showed that the technique is not only able to detect cancer, but it can also differentiate between the four most common forms of cancer: lung, bowel, breast and prostate.

While this is all still at an early stage there is no doubt that simplifying the methods for early diagnosis of cancer, will have a significant impact on cutting death rates.

Beating the Mets?

As fans of the New York Mets know all too well, in recent years they’ve been all too easy to beat.  However, another type of mets have remained somewhat harder to beat.

Metastatic cancer, more commonly referred to as “mets” is cancer that has spread from the place where it first started to another place in the body. The process by which cancer cells spread to other parts of the body is called metastasis.

Although some types of metastatic cancer can be cured, most cannot. In general, the best that can be done is to control the growth of the cancer or to relieve symptoms caused by it. In some cases, metastatic cancer treatments may help prolong life, but sadly, most people die of metastatic disease.

Now it seems there may be a way to beat the mets off the baseball field as well as on it.

Researchers are harnessing viruses to infect and subsequently destroy cancer cells without affecting normal tissue. Several types of viruses have been developed to date: adenovirus, poxvirus and picornavirus.  Even the herpes simplex virus is under consideration.

As are reoviruses, which are currently being studied by the National Institutes of Health (NIH).  Early results indicate that reoviruses could be especially effective in treating metastatic cancers.

Reoviruses are found everywhere in nature. They have been isolated from untreated sewage, river and stagnant waters. These viruses choose to colonize certain types of mutated cancer cells while sparing normal cells that lack these mutations. Approximately two-thirds of human cancers have the mutation that makes them a prime target for reoviruses.

One of the new drugs based on reovirus is known as REOLYSIN^®, an acronym for Respiratory Enteric Orphan Virus, which is widely found in the environment. By adulthood, most people have been exposed to this reovirus. As it is non-pathogenic, infections are typically asymptomatic.

REOLYSIN^®  was developed, based upon research conducted by Dr. Matt Coffey.  He found that the reovirus was able to infect and selectively destroy cancer cells. When a normal cell is infected with the reovirus, an antiviral response is activated, which prevents the virus from replicating within the cell. However, inside a cancer cell with one or more mutations on a growth pathway called the Ras pathway, there is an aberrant antiviral response that is unable to prevent the virus from replicating. This abnormality allows the reovirus to multiply to an extent that is fatal to the cancer cell.

Additionally, reovirus appears to spread particularly easily to organs where metastasis is common, so a concentration of the drug can be built up in those regions of the body.

REOLYSIN is currently being studied in combination with the chemotherapy drugs in six of the ten most common cancers diagnosed in men and five of the ten most diagnosed in women, including patients with head and neck cancer, non-small cell lung cancer, colorectal cancer, castration-resistant prostate cancer, drug-resistant ovarian cancer and pancreatic cancer. All of these indications are associated with metastatic disease.

The American Cancer Society estimates there will be more than 1.6 million new cancer cases diagnosed in the United States alone in 2012; more than 1,500 people a day are expected to die from the disease.

So, could a sewage water virus be the answer? SRxA’s Word on Health will be watching out for the results of these studies and let our readers know if they’ve truly found a way to  “beat the mets.”

The Elephant in the Pink Room

October, as I’m sure you’ve noticed by the sea of pink sweeping the US is Breast Cancer Awareness Month – an annual campaign to increase awareness of the disease.

How times have changed. Thirty years ago, when I lost my first friend to the disease “breast cancer” was rarely discussed. Women didn’t openly talk about it because it was considered a death sentence. Today, we not only speak openly about breast cancer we talk about living with it, rather than dying from it.

However, while this is good news, approximately 30% of patients with breast cancer will develop metastatic disease. By this we mean cancer that has spread beyond the breast.  Ultimately around 97% of those patients, 40,000 a year, will die of the disease. Yet only about 5% of total cancer research funding goes toward metastatic disease of any cancer type and less than 2% to metastatic breast cancer.

And those women living with metastatic breast cancer, also referred to as stage IV breast cancer, face a unique set of concerns.  It’s the most advanced stage of disease and one for which there is no cure.  But it is considered treatable.  The goal of treatment is to delay the progression of symptoms.

While few programs are devoted to these concerns hopefully this will start to change tomorrow.

National Metastatic Breast Cancer Awareness Day was officially recognized by the U.S. Congress on October 13, 2009, and has been an annual feature on the breast cancer calendar since then.  It’s a day that aims to recognize and raise awareness about the approximately 156,000 U.S. women living with metastatic breast cancer.

“While there have been advances in the treatment and management of metastatic breast cancer, the disease continues to end the lives of patients each year,” says Shirley Mertz, board member of the Metastatic Breast Cancer Network (MBCN) and a metastatic breast cancer patient since 2003. “Women living with this disease need it to be recognized, no longer ignored and misunderstood. We need more resources and support as we try to live each day while being in constant treatment.”

MBCN is a national, independent, nonprofit, patient advocacy group dedicated to helping people living with metastatic breast cancer.

The organization raises awareness of metastatic breast cancer by putting a public face on the metastatic experience. By giving those living with stage IV disease a greater voice and visibility in the breast cancer community, the medical community, the research community, and with the public-at-large.  Their education and advocacy programs help to end the experience of isolation, ease the fear of the disease, provide information to enable patients to participate in decision making with our medical team, and defy the myths of stage IV breast cancer.

Their driving mission is to take the metastatic breast cancer population out of the shadows and have them be acknowledged, accepted, and heard.  So join with us in recognizing National Metastatic Breast Cancer Day, this Saturday.  Maybe together we can move this elephant.

An Unexpected Exercise in Exercise

Despite the fact that numerous studies have shown the powerful effect that exercise can have on recovery from cancer, including reducing tumor recurrence rates by up to 50%, a new study has shown that many cancer patients are reluctant to exercise, and fewer still discuss it with their oncologists.

According to the Mayo Clinic study published in the Journal of Pain and Symptom Management, patients took exercise advice most seriously when it came directly from their oncologists, but none of those studied had discussed it with them.

The study was part of a series of investigations looking at exercise habits among 20 adult lung cancer patients. Researchers found that patients who exercised regularly before their diagnosis were more likely to exercise than those who had not. Many patients considered daily activities, such as gardening, sufficient exercise.

“There was a real sense of what I do every day, that’s my exercise,” said lead author Andrea Cheville, MD.

Most of the patients thought that their daily activities equated to exercise, whereas in reality, most of these activities required minimal effort.  Such inactivity can contribute to weakening of the body and greater vulnerability to problems, including cancer recurrence.

“Generally, patients are not being given concrete advice about exercise to help them maintain functionality and to improve their outcomes,” added Dr. Cheville.

Exercise can improve patients’ mobility, enable them to enjoy activities and keep them from becoming isolated in their homes. It can contribute to overall feelings of strength and physical safety, ease cancer-related fatigue and improve sleep.

The researchers now plan to investigate how to make the message about exercise meaningful to cancer patients so that they can optimize symptom relief and enhance their own recovery.

Incy Wincy Spiders could kill cancer

Do tarantulas terrify you?  Are funnel web spiders your foe?  These eight-legged, multi-eyed critters – all venom and sticky webs – have long provoked fear and loathing.  And while we can’t promise this blog will cure your arachnophobia, we can perhaps give you one good reason to be a little less afraid.

SRxA’s Word on Health learned this week that Australian scientists are looking at the use of spider venom to fight breast cancer.

Researchers from James Cook University in Cairns, Queensland will determine if venom from funnel web spiders and tarantulas can kill breast cancer cells.

Queensland Science Minister Ros Bates said the research was initiated on the back of international studies that suggested certain toxins in spider venom could offer an untapped suite of natural molecules to kill breast cancer cells.

“With more than 40,000 species of spiders, it’s estimated there are more than four million  different toxins in spider venom,” Bates said.  “Those toxins will now be screened, to look at their potential to treat cancer in humans.”

Venom molecules are already used to prevent chronic pain, and scorpion venom has already been shown to bind to cancer cells in mice.

The minister said the work being done by James Cook University researchers had cemented Queensland’s place as a global scientific leader.

SRxA’s Word on Health applauds any  move that will put these heinous creatures to good use and we’ll keep you informed on any developments in this story.

In a Muddle About Mammograms?

As all of our female readers know, breast cancer is one of the leading causes of premature death in women.  We’ve also been brought up to believe that annual mammographic screening, unpleasant as it is, significantly reduces our risk of dying from breast cancer.

So, it may come as a surprise that mammography screening is now one of the greatest controversies in healthcare.

Those who are unconvinced of the risk:benefit profile of mammograms believe that researchers have sacrificed sound scientific principles in order to arrive at politically acceptable results.

Even neutral observers increasingly feel that the benefits of screening have been oversold and that the harms are much greater than previously believed.

A new book by Professor Peter Gøtzsche entitled Mammography Screening: truth, lies and controversy is certainly going to add further fuel to this already heated debate. Gøtzsche, who heads up the Nordic Cochrane Centre in Copenhagen, has repeatedly published on breast screening over the last decade.

Even those who have been following the debate over breast cancer screening will be surprised by the degree of acrimony, personal attack and bad statistics described by Professor Gøtzsche.

Sure, there have been professional arguments over screening before, but this takes it to a whole new level.

He demonstrates that the evidence on which breast screening programs were set up was inadequate and concludes that breast screening probably doesn’t work.  According to him, the benefits – if any – are marginal and the harm is great.

He also describes the hostility he and his team have been subjected to during their decade-long research in the area. Attacks have come from three groups:

• disinterested experts
• oncologists who have spent their careers recommending mammograms
• those who earn money in the $1 billion screening industry

All in all, this book is painful reading to those of us who believe that research is all about the science. Gøtzsche claims that when there is emotional investment, it becomes harder to disentangle risks and benefits clearly. As a society, we have become attached to screening, despite evidence demonstrating how marginal the benefits and how frequent the harms.  He claims that the lure of ‘catching it early’ and the emotive hard sell seems to have circumvented the usual rigorous review of the evidence.

And he’s not alone.  A few years ago Professor Michael Baum, a surgeon who was involved in setting up the breast screening program in the UK, wrote the book Breast Beating, in which he described the personal cost of opposing the unrelenting push for more screening.

He also criticized the UK’s Breast Screening Program saying:

“Whatever the number, that one woman who benefits from a decade of screening has a life of infinite worth and if screening were as non‐toxic as wearing a seat belt there would be no case to answer. However, there is a downside to screening, namely the problem of the over‐diagnosis of “pseudo‐cancers”.  For every life saved ten healthy women will, as a consequence, become cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy and sometimes chemotherapy.”

Following this, an independent review of breast screening in the UK was announced. The review is hoping to answer two fundamental questions: firstly, if it is worthwhile to continue at all, and secondly, if women should be, as they currently are, encouraged to have breast screening or – more simply and more ethically – to consider whether they would like it.

Writing in Pulse Today, Dr Margaret McCartney, a GP in Glasgow suggests that if more women read Professor Gøtzsche’s book, they too would decide not to be screened. She goes so far as to predict that in a few decades, doctors will look back on breast screening with the same raised eyebrows that they currently reserve for Reiki.

To screen or not to screen?  That is the question.  Let us know what you think.

The battle of bone marrow versus breast cells

Forget who’ll win the X-Factor, Dancing with the Stars or even the Superbowl.  SRxA’s Word on Health brings you hot, breaking news from a world class content of microscopic mobility. We have to admit we almost missed this story and want to thank one of our regular readers, Jeff Boulier, for bringing it to our attention.

In an astonishing fear of athleticism, a line of bone marrow stem cells from Singapore beat out dozens of competitors to claim the title of the world’s fastest cells. They whizzed across a petri dish at the breakneck speed of 5.2 microns per minute — or 0.000000312 kilometers per hour!

Results of the World Cell Race were announced last week at the annual meeting of the American Society for Cell Biology in Denver, Colorado. Organizers declared the competition a success: “50 participating labs all over the world! 70 cell lines recorded! Without a single dollar to fund the project!” said Manuel Théry from Institut de Recherche en Technologies et Sciences pour le Vivant (iRTSV) in Grenoble, France. Behind the fun is a serious goal: looking at how cells move. Ultimately, it is cell migration that helps embryos and organs to develop and allows cancer to spread. The contest provided a lot of new information.  For example, stem cells and cancer cells seem to be faster than their mature and healthy counterparts. Rather than actually racing the cells, teams shipped frozen cells to designated laboratories in Boston, London, Heidelberg, Paris, San Francisco, and Singapore. Thawed cells were placed in wells containing “race tracks”. Digital cameras then recorded the cells for 24 hours to determine the fastest run down the track for each cell line. In total, about 200 cells of each cell type were timed to see how long it took the fastest individual cell of each type to reach the end of its track.

The key to victory?  According to Théry, who co-organized the race with colleagues from Institut Curie in Paris, the secret is to  avoid changing direction.  Cells that went back and forth along the track took longer to finish. Coming in second were a line of breast epithelial cells from France, with third place going to the same cell type tweaked to reflect patterns observed in cancerous cells. They clocked 3.2 and 2.7 microns per minute respectively.  Finishing fourth, at a still respectable 2.5 microns per minute, was the UK team of cultured human skin cells derived from patients with a rare genetic skin disorder. The winners received Nikon digital cameras and coveted World Cell Race medals.

What next?  Cellular showdowns in swimming and weightlifting or perhaps a full scale Cyto-lympics!

Guys in Bras

Would you pay to see a guy in a bra?

What if it was a strapping linebacker modeling the abovementioned undergarment, complete with blinking lights, and other assorted bling?

If you live in Detroit, in exchange for a donation, your chance to see not just one, but 20 or so athletes and future army officers in bras is coming soon.

Every year, since 2004, the student chapter of the Society of Intellectual Sisters at Michigan Technological University puts on its annual guys-in-a-bra fashion show to raise funds for the National Breast Cancer Research Foundation.

The event also features a speech by a breast cancer survivor and an auction of the hand-decorated bras sported by members of the football team, Reserve Officer Training Corps (ROTC) and the Society of African American Men.

“It’s fun to watch the guys strut their stuff,” says organizer Lydia Brame.  Last spring, the theme was candy; next spring it will be Las Vegas. Expect bras decorated with dice, chips and roulette wheels.

For all the fun, the Bra Show is serious stuff. “Support the cause,” the Michigan Tech women say. “Uplift the world, a woman at a time.”

SRxA’s Word on Health thinks this is a great idea and one that could be adopted by colleges all over the country. Would you be man enough to step up to the challenge?