Arizona Advanced Medicine Clinic

Breast Cancer 101 - Integrative Cancer Care

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.

Breast cancer awarenessIn 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."[1]

Breast cancer awarenessIn 2005, more than 250,000 new cases of breast cancer were diagnosed. Over 40,000 women died of breast cancer.[2] In 2005, the United States had a population of about 295,000,000.[3]

In 2012, approximately 230,480 new cases of invasive breast cancer and 39,520 breast cancer deaths are expected to occur among US women.[4] As of September 1, 2012 the United States had a population of 314,483,000.[5]

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.[6]

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.[7] 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.[8]

– 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[9] 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[10] 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.[11]

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.[12], [13]

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 healthy nutrition.

We fill in the nutritional potholes with vitamins, minerals, antioxidants, and other substances which the body needs in order to function correctly.

We use 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.

[1] Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med. 2012 Nov 22;367(21):1998-2005. doi: 10.1056/NEJMoa1206809.

[2] Handbook of Cancer Chemotherapy, 7th edition, Roland T. Skeel, editor.

[3] Downloaded 9/30/2012 from http://www.census.gov/popest/data/national/totals/2005/tables/NA-EST2005-01.csv

[4] DeSantis, C., Siegel, R., Bandi, P. and Jemal, A. (2011), Breast cancer statistics, 2011. CA: A Cancer Journal for Clinicians, 61: 408-418. doi: 10.3322/caac.20134

[5] Downloaded 9/30/2012 from http://en.wikipedia.org/wiki/Demographics_of_the_United_States.

[6] Downloaded 9/30/2012 from http://seer.cancer.gov/statfacts/html/breast.html

[7] Chu E, DeVita VT. Cancer Chemotherapy Drug Manual. Jones & Bartlett Learning, ©2012. ISBN:978-1-4496-4683-

[8] 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.

[9] 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).

[10] Cristofanilli M, Budd T et al. Circulating Tumor Cells, Disease Progression, and Survival in Metastatic Breast Cancer. NEJM 351;8

[11] 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)

[12] Raica M, Cimpean AM, Ribatti D. Angiogenesis in pre-malignant conditions. Eur J Cancer. 2009 Jul;45(11):1924-34.

[13] 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

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