October is the month when we acknowledge the existence of breast cancer
and mourn our friends and family members who have succumbed to this truly
awful attack on the essence of our femininity.
In 2012 we saw pink buckets of The Colonel's chicken, pink bags at
burger joints - and we still see pink ribbons everywhere. We walk the
Susan G Komen walk to raise money for research, secure in our faith that
research is supplying ever more effective treatments, and that the death
rate from breast cancer is progressively lowering.
To learn about
integrative treatments for breast cancer, keep reading...
Are the rates in fact getting less? What are the statistics?
After the introduction of screening mammography, the incidence of early
stage breast cancer more than doubled from 1976 through 2008. The incidence
of late stage cancer diagnosis only decreased by 8%. The authors of this
study suggested that "Despite substantial increases in the number
of cases of early-stage breast cancer detected, screening mammography
has only marginally reduced the rate at which women present with advanced
cancer. .. , the imbalance suggests that there is substantial overdiagnosis,
accounting for nearly a third of all newly diagnosed breast cancers, and
that screening is having, at best, only a small effect on the rate of
death from breast cancer."
In 2005, more than 250,000 new cases of breast cancer were diagnosed. Over
40,000 women died of breast cancer. In 2005, the United States had a population of about 295,000,000.
In 2012, approximately 230,480 new cases of invasive breast cancer and
39,520 breast cancer deaths are expected to occur among US women. As of September 1, 2012 the United States had a population of 314,483,000.
The National Cancer Institute estimates that, based on rates from 2007-2009,
12.38% of women born today will be diagnosed with cancer of the breast
at some time during their lifetime. This number can also be expressed
as 1 in 8 women will be diagnosed with cancer of the breast during their lifetime.
Who is at risk? Women from Western Europe and the United States - more
specifically white women - are more likely to get breast cancer, but African-American
women are more likely to die of the disease.
Do genes play a part?
Mutations in two tumor suppressor genes, BRCA1 and BRCA2 (in chromosomes
17 and 13) are associated with high incidence of breast cancer as well
as ovarian cancer. These mutations account for less than 10% of all cases
of breast cancer.
Female carriers of these mutations have a 70% chance of developing breast
cancer during their lifetimes. Male carriers have a 6% lifetime risk of
developing breast cancer. Angelina Jolie chose not to play the odds, and
had a bilateral mastectomy.
What are the current commonly used modalities of therapy?
Surgery - lumpectomy vs mastectomy (removal of the entire breast) vs radical mastectomy
(removal of breast, underlying chest wall muscle, and often the axillary
lymph nodes as well). Some women even elect to have a bilateral mastectomy
- remove both breasts, just in case...
Radiation - ionizing radiation in high dose to the chest wall, with the thought
that any stray cancer cells might be more susceptible to death by radiation
than the normal cells are to new mutation by radiation, potentially causing
the very problem the treatment is aimed at preventing. This is typically
used for DCIS after lumpectomy. I have patients whose DCIS was treated
in this way - lumpectomy followed by radiation therapy - whose cancers
did not recur in the breast, but did recur in the lungs.
Chemotherapy - with toxic drugs which we hope will kill cancer cells before they kill
normal cells. There are many chemotherapeutic agents which have been used
in breast cancer - over 12 pages of protocols are found in the Cancer
Chemotherapy Drug Manual. That makes one wonder whether any one therapy is better than any other...
or whether it's just a game of darts, picking the protocol of the week.
Targeted therapy - aimed at specific genes which may be over- or under-expressed in cancer
cells, as compared with normal cells. Everolimus (Afinitor®) and trastuzumab
(Herceptin®) are two such targeted therapies. These therapies tend
to stave off the evil day (the day when the cancer progresses) but do
not appear to have much effect on increasing the life span of the cancer
sufferer. There are studies underway using vaccines against the Her2/neu
protein - the body producing its own form of Herceptin®.
And what are the "new" therapies for breast cancer?
– A trend toward less surgery, according to Clifford Hudis, MD, the
upcoming President of the American Society of Clinical Oncology. He clarifies
the statement by saying that surgeons are taking only one or two nodes
(called "sentinel nodes") instead of dissecting out the entire
set of axillary nodes. Thus, surgeons are avoiding creating a major chronic
problem, lymphedema of the arm, by simply doing less extensive surgery
in the first place.
– Development of anti-HER2 drugs. To quote Dr. Hudis: "... it’s
exciting to have so many agents that really can contribute to improved
outcomes." In my experience, when there are many forms of treatment
for a disease, or when many different drugs have been developed to treat
the disease, that generally means that none of the therapies or drugs
is really effective, so we keep looking for a better mousetrap.
– Development of drugs targeted at the molecular biology of cancer
- for example Everolimus, aimed at the hormone-insensitive population
- the people who do not respond to hormone therapy. "the ... drug
prolongs progression-free survival and offers, therefore, an ability to
delay the use of chemotherapy for these patients. And that represents
a potential advance in terms of quality of life, if nothing else."
Well, it's a start, and quality of life is pretty significant for
most of us.
– To quote Dr. Hudis again: "...we are now seeing is the beginning
of a new era where our increasing understanding of the molecular biology
of breast cancer is finally translating into meaningful clinical advances
in treatment." And yet, the official word from the American Society
of Clinical Oncology is that we should not be testing for the molecular
biology of the tumors because the tests are still experimental.
An interesting editorial published in the New England Journal of Medicine
back in 2004 remarked about how surprising it was that circulating tumor cells had
not been studied or used for monitoring of residual tumor load and response
to therapy. The editorial referenced a study published in the same edition which concluded (no big surprise to the logical mind) that more circulating
tumor cells heralded poorer survival statistics.
In the same edition of the New England Journal we also read a study on
what makes cancer cells metastasize.
And we begin to realize that it's not the cancer that kills, it's
the metastatic disease. The cancer, as it spreads around the body, requires
ever more nourishment, eventually robbing our normal body cells and organs
of what they need to sustain our lives.
Current staging and treatment decisions for solid tumors like breast cancer
are predicated on the following theory: "Metastases of tumors originating
in different sites, such as the breast or lung, are treated differently
because they are thought to behave like the tissue of origin, with characteristic
patterns and kinetics of spread, and distinct profiles of chemosensitivity."4
Maybe it's time to start predicating cancer therapy from a new point
of view. What is weakened in the body that we can strengthen, so that
it can actually do its job and keep cancer cells from taking over?
At the Arizona Center for Advanced Medicine, that is exactly what we do.
We recommend a
nutritional program which is aimed at preventing future development of cancer, and restoring
the body's metabolism to the point where it will no longer support
the growth of cancer cells.
We promote the consumption of
anti-angiogenic foods, so that those cancer cells which have metastasized are unable to grow
tumors because they cannot develop new blood vessels.,
We strengthen the
immune system so that it can better recognize and destroy previously friendly cells
which are now foreign invaders.
We strengthen the
digestive system so that inflammation is reduced, and healthy nourishment is absorbed.
Weremove impediments to healing - inflammatory foods, chemicals, chemicals added to our foods, insecticides,
pesticides, artificial colorings and flavorings, petrochemicals used to
"improve" the texture, the appearance, the taste, the shelf life .
We provide the body with
We fill in the nutritional potholes with vitamins, minerals, antioxidants,
and other substances which the body needs in order to function correctly.
botanicals and substances found in nature which are known to affect the growth and spread of cancer cells.
We even use chemotherapy - but at very low dose,
potentiated by insulin, and chosen based on
chemosensitivity testingwhere the circulating tumor cells are actually grown with chemo agents,
and a kill rate is measured.
There are many choices besides the standard surgery, radiation and chemotherapy.
They are worth exploring.
Call us at 480-240-2600 and we will be happy to explore your options with you.
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Effect of three decades of screening mammography on breast-cancer incidence.
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 Handbook of Cancer Chemotherapy, 7th edition, Roland T. Skeel, editor.
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Breast cancer statistics, 2011. CA: A Cancer Journal for Clinicians, 61: 408-418. doi: 10.3322/caac.20134
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Cancer Chemotherapy Drug Manual. Jones & Bartlett Learning, ©2012. ISBN:978-1-4496-4683-
 Wernicke AG, Goodman RL, et al.
A 10-year follow-up of treatment outcomes in patients with early stage
breast cancer and clinically negative axillary nodes treated with tangential
breast irradiation following sentinel lymph node dissection or axillary
clearance.Breast Cancer Res Treat. 2011 Feb;125(3):893-902. Epub 2010 Sep 19.
 Braun SB, Marth C.
Circulating Tumor Cells in Metastatic Breast Cancer - Toward Individualized
Treatment? N Engl J Med 2004; 351:824-826 (August 19, 2004).
 Cristofanilli M, Budd T et al.
Circulating Tumor Cells, Disease Progression, and Survival in Metastatic
Breast Cancer. NEJM 351;8
 Chiang A.C. and Massagué J.
Molecular Origins of Cancer: Molecular Basis of Metastasis. N Engl J Med 2008; 359:2814-2823 (December 25, 2008)
 Raica M, Cimpean AM, Ribatti D.
Angiogenesis in pre-malignant conditions.
Eur J Cancer. 2009 Jul;45(11):1924-34.
 Li WW, Li VW, Hutnik M, Chiou AS.
Tumor angiogenesis as a target for dietary cancer prevention.
J Oncol. 2012;2012:879623. doi: 10.1155/2012/879623. Epub