Most Recent Blog Posts

• "Dancing with the Stars" MAMMO "Dancing with the Stars" MAMMOJAM 2010 Dr. Susan Love with Louis Van Amstel - Jonathan Roberts

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  • 3 months ago
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• In Case You Missed It: See Me In Case You Missed It: See Me on The View

  • From: SusanMLoveMD
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  • 3 months ago
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• Live a Little: Separate Health Live a Little: Separate Health Help From Hype

  • From: SusanMLoveMD
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    Editor's Note: This morning Dr. Alice Domar and Dr. Susan Love, co-authors of the new book Live a Little, joined Dr. Nancy Snyderman on TODAY to bring a dose of realism to the way women view their health habits. Watch it now if you missed it.

    Visit msnbc.com for breaking news, world news, and news about the economy

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  • 6 months ago
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• Dr. Susan Love's Take on the D Dr. Susan Love's Take on the Debate Over Mammography

  • From: SusanMLoveMD
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    Is the American Cancer Society Abandoning Screening Mammography? The short answer is no!

    This Tuesday’s New York Times front-page story suggested that the American Cancer Society was having second thoughts about screening campaigns. The catalyst for the New York Times story was the article “Rethinking Screening for Breast and Prostate Cancer” which appeared in this week’s Journal of the American Medical Association.

    In response to the New York Times story, the ACS issued a press release that stated: The American Cancer Society stands by its recommendation that women age 40 and over should receive annual mammography, and women at high risk should talk with their doctors about when screening should begin based on their family history.

    Clearly, the ACS wasn’t expecting its concerns about screening to be the highlight of the story. That said, it’s good to see a story that focuses the public’s attention on a conversation that has been going on in the medical community for some time.

    Screening is predicated on the notion that all cancers are the same: they grow slowly and then “get out.” This, in turn, suggests that if we can find cancers early we can prevent them from metastasizing.  But all cancers are not the same, there are at least five different kinds of breast cancers and they have different risk factors and different levels of aggressiveness.

    Mammography is best at finding what I think of as the slow growing “good” cancers. It doesn’t do as well at finding aggressive cancers when they are still at a curable stage. If “early detection” worked, we would see significantly less breast cancer deaths. But we don’t. Instead, we see a lot more breast cancer diagnoses. This tells us that mammography is finding many cancers that would not cause death in the first place. In the medical field we refer to this problem as “overdiagnosis.” When you diagnose more “good” cancers, the percentage of women dying of breast cancer will decrease. Yet, as we know, the actual number of women dying from breast cancer hasn’t really changed.

    What does this mean for you? The message to women over 50 is this: There is data that regular (every one to two years) mammography will reduce a woman’s chance of dying from breast cancer by about 30%. That is a lot and is worth it. That’s the benefit.  The risk is that mammography will find a dormant or “good” cancer. What are these lesions? Autopsies of women who have died of something else show that many of these women have dormant breast cancer cells in their breasts that are not clinically significant. If these cancers had been found on a mammogram, these women would have been treated -- in fact, overtreated -- with surgery, radiation, possibly chemotherapy, hormone therapy, and targeted therapy that they did not need! All of these treatments have significant side effects, some of which can be life threatening. These include heart disease from some kinds of chemotherapy or blood clots from hormone therapy.

    We shouldn’t be focusing on ways to do more screening. What we need to be doing is figuring out which cancers are significant and need to be treated and which do not.  And we need to focus on finding the cause of this disease so that we can prevent the aggressive cancers that are slipping past the screening techniques. This is the goal of the Love/Avon Army of Women, and it’s why every woman should join today!

    Should we change public health messages about breast cancer screening? I think that we might want to consider relaxing the schedule of screening. We are the only country that recommends mammography screening in women every year. We are also the only country that recommends women begin mammography screening before the age of 50. I think we should reevaluate both of those recommendations.

    Women over 50 can probably have mammograms every two years. We also should study whether women whose breasts are not dense (we now know that breast density is also a risk factor for breast cancer) might be able to have mammograms even less frequently, since their risk is lower.  In women under 50, there is no data to suggest that mammography saves lives at that age, and it often misses things while exposing you to radiation and giving you a false sense of security.

    The bottom line: We should probably reevaluate mammography in terms of frequency and age but certainly not abandon it.  And we should focus our efforts not on finding cancers that are already there but into finding the cause of the disease and preventing it. Join the Love/Avon Army of Women and become part of stopping the disease once and for all.

     

     

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  • 6 months ago
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• Rock the Vote Today! Rock the Vote Today!

  • From: SusanMLoveMD
  • Description:

    Breast Cancer Awareness Month is just around the corner, and this year my Dr. Susan Love Research Foundation is marking this month by giving YOU the chance to help US!

    
    

    Here’s the back story:

    
    

    Earlier this year the Foundation embarked upon an exciting adventure: It developed a contest that gave film students from the USC School of Cinematic Arts and New York University’s Maurice Kanbar Institute of Film and Television the opportunity to propose their ideas for a Public Service Announcement (PSA) video that would encourage one million women of all ages and ethnicities from across the nation to sign up and be part of the Army of Women movement.

    
    

    The foundation received more than 25 submissions to the contest, and I was incredibly impressed by the passion the students showed for our work and our mission to move breast cancer beyond a cure. It was far from easy to choose the best projects. But after much debate and discussion, four finalists were selected who each received a $5,000 budget to create a 0.30 to 0.60 second PSA video:

    
    

    Brent McHenry & Nick Wenger, University of Southern California, for “One Million Strong”
    Courtney Thompson, University of Southern California, for “Walk in the Park”
    Marc Parees & Ryan Silbert, New York University for “Million in the Mirror”
    Felix Thompson, New York University, for “One Voice”
     
    Now, here is where it gets even more exciting. Glamour magazine has joined forces to promote the Army of Women and the PSA contest by hosting the competition! When I met with the editors of Glamour earlier this year, they told me how excited they were to be able to support this effort. (Go, Glamour!)

    
    

    This is where YOU come in! Starting today, you can go to to http://www.glamour.com and view the first in a series of PSAs. One PSA will be uploaded each day and then you can cast your vote for your favorite starting on September 25th! In addition, Lifetime Networks will be airing the four finalists’ PSAs during the month of October.

    
    

    It is now up to you to vote! And be sure to get your friends and family members to watch the videos and vote, too! The Grand Prize PSA winner will receive an Apple Final Cut Studio Package and a meeting with a studio executive. They will also get to proudly announce that their video is the centerpiece of the Army of Women’s viral marketing campaign!

    
    

    One more thing: After you vote, I hope that you’ll visit the Dr. Susan Love Research Foundation and make a donation. It is the support of women like you that will help us achieve our goal of going beyond a cure (and way beyond awareness) to end breast cancer. As you know, I’m in a hurry to get this done! Your donation will show me that I’m not alone, and that you’re in a hurry too!

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  • 10 months ago
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• What Is Your Risk of Getting C What Is Your Risk of Getting Cancer in the Other Breast?

  • From: SusanMLoveMD
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    We have known for a long time that women who get breast cancer in one breast have an increased risk of getting a second primary tumor in the other breast. This knowledge has resulted in a significant rise in prophylactic mastectomies, as women aim to prevent cancer from occurring in the other breast. The real question is whether the contralateral breast cancer risk is the same for everyone. 

    We know, for instance, that women with lobular cancers have about a 20% lifetime risk of getting cancer in the other breast; the risk for women with ductal cancers is 15%, or 1% per year. And, of course, women who carry the mutation for breast cancer (BRCA 1) have an increased risk of getting a tumor in the other breast. But can we parse the risk further so that we actually know which women would benefit from more surveillance or even prophylactic surgery?

    A group from Northern California made a first step to figure this out.  They looked at all the women who had been diagnosed with breast cancer in the Surveillance, Epidemiology and End Results program (SEER database) and divided them into two groups: those with hormone positive tumors and those with hormone negative tumors. They also had information on ethnicity, age, and whether or not a second tumor developed in the other breast. Unfortunately they did not have information on whether the women in the SEER database were mutation carriers, HER2/neu positive, or took hormone therapy, so the result of this study is the big picture without a lot of nuance. Nonetheless the data are interesting and not surprising. 

    First of all, the younger women (those under 30) have a higher risk of a second cancer. This is expected since they are more likely to be mutation carriers and have a lot of life years ahead of them. The women who had estrogen negative tumors had a higher risk of second tumors compared to those with estrogen positive tumors.  There are several explanations for this. One is that the women with estrogen positive tumors are usually older and often had taken postmenopausal hormone therapy. When diagnosed, they usually stop the hormones and start on Tamoxifen or an aromatase inhibitor, both of which decrease the risk of second cancers.

    On the other hand, the estrogen negative women are usually younger (more time to get a second tumor) and more likely to have hereditary cancer and, therefore, to have both breasts at risk. Although women with BRCA mutations can reduce their risk by having their ovaries removed, it is not clear that this strategy would work for women who are not mutation carriers. This also feeds right into one of my current pet hypothesis: there are probably two different big groups of breast cancer that should be thought of as separate diseases. (I will blog more on that later).

    So should you be scared? Looking at everyone across the whole period of follow up, the risk of a second hormone negative tumor is five times higher than the risk of a second hormone positive one. But these are not huge numbers. (A hormone negative tumor creates a risk of 24/10,000 person years versus hormone positive tumors, which carry a risk of 20 per 10,000 person years.) More interesting are the young women, where risks for a second hormone negative tumor were high in women initially diagnosed under 50 (34/10,000 person years); and highest in women initially diagnosed under 30 (36/10,000 person years).

    The risk of second tumors also varies by ethnicity. Non-Hispanic blacks, Hispanics, and non-Hispanic Asian or Pacific Islander patients had a slightly greater risk of second cancers than non-Hispanic whites. Since these ethnic groups also have more estrogen negative tumors at a younger age, the findings make sense.  

    Whether these levels of risk are enough for you to consider preventative surgery is obviously an individual choice. In the young women (diagnosed with hormone negative tumors under 30 or even 50) it might suggest yearly MRI or other screenings, although this has not been studied. Most importantly it tells us that we need to figure out the causes of breast cancer. Treating a young woman with chemotherapy, surgery, and radiation without figuring out what caused the cancer in the first place is putting her at risk of having it happen again. 

    Join the Army of Women (www.armyofwomen.org) and help us sort this out once and for all!

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  • 1 year ago
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• Notes From ASCO: Day 2 Notes From ASCO: Day 2

  • From: SusanMLoveMD
  • Description:

    It's my second day at the American Society of Clinical Oncology (ASCO) annual meeting down in Orlando, Florida. Here are the highlights:

    
    

    Ovarian Cancer: Regular CA 125 monitoring is NOT beneficial in women with ovarian cancer

    
    

    Researchers reported findings from a study of women who had completed their ovarian cancer treatment and were given the CA 125 blood test every three months. If the test showed that their CA 125 levels doubled, they were randomized to either do nothing or to start chemotherapy. The women who were treated on the basis of rising CA 125 were treated 4 months earlier, but the early intervention did not improve overall outcomes. (In fact, they may have experienced higher toxicity from starting early chemotherapy.) To me, this means it's better to wait to see if any symptoms of recurrence occur. This quandary is just like breast cancer, where monitoring of blood markers makes no difference in the outcome. Either the tumor is sensitive to chemotherapy, in which case it doesn't matter when you do it, or it is not. If it's not, it doesn't matter when you undergo chemotherapy.

    
    

    Breast Cancer: PARP Inhibitors

    
    

    Women with BRCA1 or BRCA2 have a gene mutation that increases their risk of developing breast and ovarian cancer. If the BRCA 1 or 2 gene develops a second mutation, cells can no longer do a double-strand DNA repair. This leaves cells stuck with a single-strand repair (base pair excision) using PARP.

    
    

    In one study from the UK, women with metastatic breast cancer who had had at least three previous treatments with chemotherapy were given an oral PARP inhibitor; some received a high dose, others a low dose. Researchers indicated that 41% of women who received the higher of the two doses responded, and one woman had a complete disappearance of her tumor. There were no side effects reported. This is an important finding, as there are 9,000 newly diagnosed breast cancers in women with BRCA1/2 a year in U.S.

    
    

    Even more interesting was the U.S. study presented by Joyce O'Shaunghnessy on the effectiveness of PARP inhibitors in women with triple negative breast cancer (15% of all breast cancers with a 30% relapse after treatment). 75% of women with BRCA 1 or BRCA 2 breast cancers are triple negative, but most triple negative breast cancers are NOT in BRCA carriers. Researchers did a phase two study of chemotherapy with or without an IV PARP inhibitor in women with metastatic disease. There was a 65% reduction in the rate of relapse and a 60% reduction in the risk of death, both of which were statistically significant. The treatments were also well tolerated. Now researchers will do a phase three of the study. This is important because it suggests that women with this type of cancer may have defects in BRCA in their tumors even though they are not carriers, and that this targeted therapy may work on a broader population of women.  This is the one breast cancer group without a targeted therapy (aromatase inhibitor/tamoxifen for ER/PR+ tumors; Herceptin for HER2-positive tumors).

    
    

    Some additional findings from the sessions:

    
    

    Sentinel Node Biopsy: Studies looked at whether the axilla needs to be treated after a sentinel node biopsy. Findings: If there are just a few isolated tumor cells, then you probably do not. But if there are micrometastases, you do.

    
    

    Post-Mastectomy Radiation: Is post-mastectomy radiation important in women with 1-3 positive nodes and tumors less than 5 cm? A study suggests that it is worth it, but the study was a retrospective, non-randomized one, so more investigation needs to be done.

    
    

    SSRI's and Tamoxifen: Do SSRI's interfere with the benefits of tamoxifen? Tamoxifen is metabolized in the liver into the active ingredient endoxifen. The enzyme that does this can be blocked by certain drugs, most specifically SSRI's such as paroxetine and fluoxetine. One study suggests that the SSRI's did make a difference in recurrence rate and the other study suggests that they didn't. Probably best to avoid them.

    
    

    Aromatase Inhibitors and Chemobrain: Are aromatase inhibitors a bigger cause of chemobrain than tamoxifen? This study did not start with baseline tests, but compared women to normal controls. None the less they found that tamoxifen was worse for your brain then letrozole. Since HRT increases dementia, it may be that estrogen is not so good for the brain after all!

    
    

    Node Negative Breast Cancer: Are there markers that can predict which node negative breast cancer patients do not need hormones or chemotherapy? A European study showed 10 year prospective data that uPAH and PAI levels predict a group with a ten year survival with no systemic therapy. Unfortunately, these markers although approved in this country are not used because they require fresh frozen tissue and we don't usually save that.

    
    

    Oncotopye DX and MammaPrint: The two multiple gene tests available in this country have less data than uPAH and are only starting their large prospective studies.  Mammaprint presented a collection of retrospective studies and has a prospective study MindAct currently underway. Oncotype DX is doing a larger study, the TailorRX, which will answer the prospective question as well. Interestingly all three markers seem to detect about 40-45% of 'good' cancers that don't need chemotherapy.

    
    

    The I-SPY Trial: The final presentation of this breast session was Laura Esserman's report from the I-Spy study. In this large, multi-center trial women with large cancers have multiple samples and images taken before, during, and after neoadjuvant chemotherapy (chemo before surgery). The interesting finding was that they could also differentiate with gene patterns between a 'good' kind and a 'bad' kind of breast cancer.  The women with the good kind do well even if they don't respond that well to the preoperative chemotherapy, while the women with the more aggressive kind do well only if they respond well to the preoperative chemotherapy. This is intriguing and just the first of many important findings that will come from this detailed study. 

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  • 1 year ago
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• Notes From ASCO: Day 1 Notes From ASCO: Day 1

  • From: SusanMLoveMD
  • Description:

    I'm at the American Society of Clinical Oncology (ASCO) annual meeting down in Orlando, Florida. This gathering is a forum for sharing developments in oncology. The first day's sessions were all about education, and were a bit disappointing because there wasn't much new that was presented. Here, though, are the highlights from Day 1:

    
    

    Bispohosphonates:  This session focused on osteoporosis and its treatment, particularly as it overlaps with cancer. I had high hopes for the discussion, though they were quickly dashed. It was a standard talk with nothing new. I was particularly struck with the fact that we are still treating a test (bone density) and not using fractures as an end point when we discuss osteoporosis treatment with bisphosphonate.  

    
    

    The data show that women who take aromatase inhibitors lose bone, but that it returns when they stop the drugs. Do we really have to give them bisphosphonates to prevent the loss if it is temporary, particularly if we don't know the long term consequences of this drug?

    
    

    More intriguing is a study that was done on premenopausal women who were put into temporary menopause with goserilin and then randomized to either tamoxifen or an aromatase inhibitor followed by another randomization, to either a bisphosphonate or a placebo. Apart from the fact that this is a lot of drugs for a cancer that has a 98% survival rate, the results were interesting in what they teach us about this disease. 

    
    

    First there was no difference between the aromatase inhibitor and tamoxifen, probably because the premenopausal women were already in temporary menopause. Second, and more interesting, was the fact that the disease-free survival was better in either group when a bisphosphonate was added. This changes the picture. Maybe we should be giving bisphosphonates as cancer treatment rather than to treat the bone density test. Why would we get this result? I don’t think we know. Could it be that bisphosphonates have an effect not just on osteoclasts, but also on the stroma? Interesting...

    
    

    Sentinel nodes: Really not much new here other than the fact that you can still get lymphedema and/or numbness after a sentinel node biopsy. There's still much controversy about whether to do sentinel node biopsy in cases of DCIS, although it doesn’t appear to add much other than side effects. There was also little consensus on whether to do sentinel node at time of recurrence of the DCIS.

    
    

    MRI:  This session, too, had little new other than the fact that it was a careful review of the data of the use of MRI in women diagnosed with cancer. Basically, MRI can be used to monitor the size of breast cancers that are treated first with chemotherapy, IF they are the right kind of cancer. MRI doesn't work on all cancers and has both false positives and negatives.

    
    

    But what about MRI in women who are newly diagnosed? An excellent review of the data by Dr. Houssami concluded that MRI does not add an incremental benefit in the treatment of the disease. In large part this is because MRI finds two benign lesions for every cancer (mostly small and insignificant in someone planning to have radiation) and leads to conversion to more extensive surgery 11% of the time. In half of these cases, this is based on a false positive. 
    Dr. Houssami looked at whether it improved surgical planning, decreasing the re-excision rate of a biopsy. The answer, again, is that there is no evidence that pre- operative MRI affects clinical outcome. 

    
    

    Dr. Houssami reviewed whether a pre-operative MRI was beneficial in finding disease in the other breast. The use of MRI preoperatively found 9.3% of suspicious lesions in the other breast and only half of them were actually cancer. MRI detects mostly 'good' cancers and it is certainly not clear whether they are clinically significant. 

    
    

    Finally there was a review of whether preoperative MRI leads to a lower local recurrence rate. In other words, does MRI make the surgery better so that the woman will not have a recurrence in her breast? The results were not surprising to those of us who were on the front end of breast conservation. We always knew there were small tumors elsewhere in the breast and that was why whole breast radiation was added. This study showed a local recurrence rate of 3-4% whether an MRI was used preoperatively. A randomized study showed no difference, as well. The point is that the local recurrence rate after breast conservation is very low and MRI does not improve it. The conclusion -- and one I agree with -- is that pre-operative MRI adds little to pre-operative planning and does not improve the outcomes of local treatment. I am sure it is not cost effective (study not yet done) and we really have to stop routinely using this expensive imaging tool.

    
    

    Vitamin D: Saturday morning found me in another educational session, this one on Vitamin D.  After reviewing the data the conclusion was that this topic was complex and that it was not clear that low Vitamin D levels were related to breast cancer risk apart from physical activity and BMI. There is also data that you can have too much Vitamin D, as with everything it is a U shaped curve with problems at both ends of the spectrum. 

    
    

    The session confirmed my suspicion that the hype about Vitamin D is premature.  The best thing we can do to prevent breast cancer is exercise, but maybe doing it outdoors will give double the benefits!

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  • 1 year ago
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• Breast Cancer in a 10 Year Old Breast Cancer in a 10 Year Old?! What's That All About?

  • From: SusanMLoveMD
  • Description:

    When I first heard this story I didn't believe it. But there was the news headline saying a ten year old girl had Stage II ductal breast cancer. It just didn't make any sense! First of all, you need to have breasts in order to have breast cancer -- so she either had a tumor of her breast bud or she had premature puberty, which in itself suggests that she has unusual levels of hormones.

    
    

    As the story evolved, we then learned that the girl did not have the kind of cancer that adult women get, but rather a secretory cancer. These account for less than .15% of breast cancers and are associated with a good prognosis. In fact, this type of cancer was originally called 'juvenile breast cancer' when described in 1966 because the only known patients were children or very young women. Again, these secretory cancers generally have an excellent prognosis particularly in those who are young.
     
    It is too bad for a child to have to go through this. It's sad for any boy or girl to get cancer. We should not, however, get carried away. This is a very rare tumor and certainly does not mean we need to start screening children or young women for breast cancer. It's important that young girls see their breasts as wonderful, nurturing parts of their bodies. The last thing we want to do is turn their breasts into body parts that are going to turn on them at a moment's notice.
     
    So relax, folks. Rare diseases are rare! Let's worry instead about obesity in children and their lack of physical activity. The best way to prevent breast cancer in adulthood (that we currently know of) is with physical exercise, particularly around puberty and the teenage years. If there's an action to take, it's to get physical education back in the schools and prevent the common problems that end up affecting so many.

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  • 1 year ago
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• Who Owns Your Genes? Who Owns Your Genes?

  • From: SusanMLoveMD
  • Description:
    On Tuesday I saw an amazing story that also ran in the New York Times about five cancer patients who -- along with professional organizations of pathologists and several individual pathologists and genetic researchers -- are suing the Patent Office and Myriad Genetics over the breast cancer gene.
    
    The problem is that ten years ago the Patent Office let Myriad Genetics patent not only the test for the BRCA 1 and BRCA 2 gene mutations, but for the actual genes themselves. This means Myriad Genetics is the only company in this country that can do the test. The lack of competition means that they can charge whatever they want ($3000) and that there is no way to get a second opinion. Researchers have also been limited by what they can do. In fact, much of the new research on these genes has come from Europe where there is no monopoly.
    
    As someone who has started companies and invented devices, I realize the benefits of being able to patent your ideas. Nonetheless, this is more than patenting ideas...it is patenting the gene itself; not the test but the gene.
    
    I was surprised to hear that 20% of the human genome has been patented in this country. That's outrageous! There has to be a balance between benefitting a company for its development and safe guarding that which belongs in the public trust.
    
    I think it's terrific that this suit has been filed. Genes should not be owned. And I agree with Dr. Nancy Snyderman who said on Today, 'This will probably go all the way to the Supreme Court.' Stay tuned!
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  • 1 year ago
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• Reese Witherspoon Joins Our Ar Reese Witherspoon Joins Our Army!

  • From: SusanMLoveMD
  • Description:

    Guess who is the newest member of the Love/Avon Army of Women? Reese Witherspoon!

    
    

    Let me tell you how it happened: Yesterday, I was in San Francisco to help the Avon Foundation for Women, our partner in the Love/Avon Army of Women, celebrate the 5th anniversary of the Avon Comprehensive Breast Center at San Francisco General Hospital.

    
    

    Reese Witherspoon is the Honorary Chairman of the Avon Foundation for Women, and she was one of the hundreds of people there celebrating Avon's commitment to ending breast cancer and the amazing work that San Francisco General Hospital has done to bring breast health services to underserved populations.

    
    

    I was one of the event's speakers. Joining me were Dr. Judy Luce, the director of the Avon SFGH Breast Cancer Center of Excellence, Dr. Thea Tlsty, the director of the Center for Translational Research for Molecular Genetics of Cancer at the University of California, San Francisco, and Carol Kurzig, the President of the Avon Foundation for Women. (Talk about a great team!) I spoke about the Army of Women, and the enthusiasm for our work was palpable.

    
    

    Reese spoke last. She talked about the great work Avon has done, and how excited she was to celebrate the fifth birthday of the Avon SFGH Breast Center! Then much to my astonishment, she said, 'I was so impressed by Dr. Love and her Army of Women that I have decided to sign up myself!' I jumped up and gave her an Army of Women t-shirt and pendant. An hour later she made good on her promise, joining at a computer and becoming AOW member number 278,027.

    
    

    See pictures from the spectacular event and watch this great video news clip. 

    
    

    If you have not yet signed up for the Love/Avon Army of Women, I hope you will join me and Reese and all the other incredible women who are part of our amazing million-women movement to end breast cancer! Sign up TODAY!

    
    

     

    
    

    

    
    

    Photo Credit: Avon Foundation for Women

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  • 1 year ago
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• The Road to Revolution The Road to Revolution

  • From: SusanMLoveMD
  • Description:

    'When you invite people to think, you are inviting revolution.' -- Ivone Gebara

    
    

    I'm in Washington, D.C. at one of my favorite meetings of the year, the National Breast Cancer Coalition Fund’s (NBCC) Annual Advocacy Training Conference. For this event, breast cancer advocates gather from around the country to learn about the best of the science, as well as effective advocacy techniques that bring about change. Walking through the halls I've passed many old friends and lots of new faces, and of course there are the spirits of those we have lost. It always reminds me of the work we have yet to do.

    
    

    The NBBC (www.stopbreastcancer.org) is my favorite group. I love it because it's not only a coalition of diverse groups from around the country, but also because it's fearless in taking hard stances and standing up for what is needed to eradicate breast cancer. The NBBC is one of the collaborators of the Army of Women, and all of the advocates in our Scientific Advisory Committee are graduates of Project Lead, a wonderful program that trains advocates in the science. Check it out. It's another way you can work to eradicate breast cancer once and for all.

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  • 1 year ago
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• Lifestyle & Breast Cancer: Pre Lifestyle & Breast Cancer: Preventing Postmenopausal Breast Cancer Is in Our Own Hands!

  • From: SusanMLoveMD
  • Description:

    At the American Association of Cancer Research meeting I heard several sessions on the relationship between diet and breast cancer.  What came through loud and clear is that the three biggest factors for postmenopausal breast cancer are body weight, physical activity, and hormone replacement therapy (HRT). 

    
    

    It would be so much easier if we could point the finger at plastic water bottles in the sun (or something equally simple), but it's really our own activities that make the biggest difference in breast cancer prevention. If you lose weight -- and keep it off -- there will be a 60% decrease in your risk. Overall, regular physical activity and a healthy weight could decrease the total incidence of breast cancer by 30% and cut the mortality rate from postmenopausal breast cancer in half!

    
    

    Other interesting findings are that alcohol increases breast cancer, but not if you have adequate folate levels. There may also be a link between high dairy intake and breast cancer. Dr. Walter Willet, chairman of the Department of Nutrition at Harvard's School of Public Health, stated that 'if you want to find the environmental hormones in the environment, look in the milk!' These studies are ongoing, but opened my eyes to another modifiable risk. Finally he showed us some data suggesting that high meat intake in adolescents may be a risk factor for premenopausal breast cancer.

    
    

    It's great that we are finally getting some guidance in these issues and it is thanks to the wonderful women who have volunteered to take part in the Nurse’s Health Study over the years that we do. I hope that the Love/Avon Army of Women will take the next step to find the cause of breast cancer and eradicate it once and for all!

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  • 1 year ago
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• Hysterectomy News: Keep Ovarie Hysterectomy News: Keep Ovaries, Increase Health

  • From: SusanMLoveMD
  • Description:

    I am very excited about a new study reported in the May issue of the journal Obstetrics & Gynecology about the removal of healthy ovaries during a hysterectomy. When I was trained as a surgeon (many, many years ago), we were told you should always remove a woman's ovaries -- assuming she was finished having children -- because they were otherwise useless and would get cancer if left behind.

    
    

    We did not have very sensitive blood tests for hormones back then, so many thought the ovaries stopped working at menopause and were, therefore, dispensable. I always suspected that that was not true, and would counsel patients and friends to fight for their ovaries.
      
    Now we have more sensitive tests and know that the ovaries do, in fact, produce low levels of estrogen postmenopausally. They also continue to produce testosterone and androstenedione, which are converted into estrogen peripherally in our bones, brains, breasts, muscles, fat, and other organs. Even so the practice has persisted that removal of a uterus should always include removal of the ovaries, unless there was a good reason to keep them. 

    
    

    For the study, William Parker, adjunct faculty member at the John Wayne Cancer Institute in California, and his colleagues looked at all the women in the Nurse's Health Study who had hysterectomies. Their findings show that the women who had their ovaries removed had a higher risk of death from all causes than the women who did not. It is true that there was less ovarian and breast cancer when the ovaries were removed, but that did not outweigh the increase in heart disease, lung cancer, and stroke.
      
    The message is clear: Just because the medical profession has not yet figured out why an organ is still there, doesn't mean we should remove it! 
    

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• Triple Negative Breast Cancer: Triple Negative Breast Cancer: Is It Getting a Bad Rap?

  • From: SusanMLoveMD
  • Description:

    Many of you know that there are at least six different types of breast cancer, depending on whether the cancer is sensitive to estrogen and progesterone or whether it overexpresses HER2/neu. What's so promising is that we're beginning to understand that each type of breast cancer behaves differently and responds differently to the available therapies. In fact, we can now test certain ER-positive tumors, for example, to see if they are sensitive to hormones but not chemotherapy or if they are sensitive to chemotherapy but not hormone therapy. This type of test and targeted treatment can save women from unhelpful and potentially toxic therapies. 

    
    

    One category of breast cancer, however, has been identified merely by the fact that it does not have a targeted therapy. This type is called 'triple negative' breast cancer (in other words, breast cancer that is estrogen receptor negative, progesterone receptor negative, and HER2/neu negative). When women are diagnosed with this kind of breast cancer they are made to feel like it's a terrible type and they're doomed. Yet, at the American Association of Cancer Researchers meeting in Denver, we had a whole session on this type of tumor that was really exciting.

    
    

    First of all, Dan Hayes, clinical director of the breast oncology program at the University of Michigan Comprehensive Cancer Center, pointed out that just because we don't have a targeted therapy for triple negative breast cancer does not mean we do not have a good treatment. These tumors actually respond the best to chemotherapy and women so treated often do very well. In addition, it turns out that there are subcategories within the triple negative group, including basal-like tumors (more common in BRCA1/2 carriers, as well as African-Americans), claudin-low tumors (rare metaplastic breast cancer), and others. 

    
    

    The most exciting news was that there are several treatments currently being studied that are specific to triple negatives, at least for the basal-like tumors. Some old drugs like Cisplatin may work in this subgroup, where they were not as good for breast cancer patients as a whole. Others are being newly developed, including PARP-2 inhibitors, which are given as a pill. In early studies, PARP-2 inhibitors are showing real promise in women with BRCA1/2 with either breast or ovarian cancer. 

    
    

    Finally, in a separate session, my friend Thea Tlsty, professor of pathology at the University of California, San Francisco presented her data suggesting she may soon be able to determine which ductal carcinoma in situ (DCIS) has the potential to develop into these basal-like cancers. She also has data to suggest that Cox-2 inhibitors (aspirin, NSAIDs, and Celebrex) might have potential in preventing this from happening. So stay tuned as we work to figure out how best to test these findings with the Army of Women.

    
    

    To those women who have panicked with a triple negative diagnosis, I say, 'Help is on the way!' 

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• New Insights Into DCIS New Insights Into DCIS

  • From: SusanMLoveMD
  • Description:

    I'm at the American Association of Cancer Research's annual meeting in Denver to spread word among scientists about the Love/Avon Army of Women, my initiative to eliminate breast cancer. While here I've been attending a number of interesting sessions on different aspects of cancer. 

    
    

    Yesterday I attended a great symposium on ductal carcinoma in situ (DCIS) moderated by an old friend, Dr. Stuart Schnitt, a pathologist at Beth Israel Deaconess Hospital. After a good summary of the state of current treatments for DCIS by Monica Morrow, we heard two great talks about new research into understanding what leads to the transition from DCIS (non-invasive breast cancer) to invasive cancer.
     
    We have always thought that breast cancer started in the lining of the milk ducts as extra cells and then slowly progressed to atypical hyperplasia to then DCIS and finally to invasive cancer. Newer studies, however, are suggesting it's not so one-sided. In fact, it probably is NOT that DCIS cells develop the ability to invade outside the duct, but rather the surrounding cells allow -- and maybe even incite -- this invasive behavior.
     
    It seems that the mild mannered myoepithelial cells that surround the duct lining are the barrier between the abnormal lining cells and the stimulating fibroblasts that live in the surrounding area. Anyone who has heard me talk in the past ten years knows that I strongly hold that cancer is a problem of the mutated cells and the local and systemic environment in which they live. This new understanding supports that idea. The fibroblasts allow and, in fact, stimulate the mutated cells to invade, head to the blood vessels, and journey to the rest of the body. The myoepithelial cells separate the two and, when they break down, invasion occurs.
     
    How and when this happens is a topic of feverish research that may hold the key to preventing invasive breast cancer.

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• Are All the Answers in Our Gen Are All the Answers in Our Genes?

  • From: SusanMLoveMD
  • Description:

    A front page story in today's New York Times blurted out: 'Study of Diseases and Genes at an Impasse!'  The article reflected on commentaries from the New England Journal of Medicine discussing whether genetic risk prediction is really worth pursuing for the majority of common diseases. This is a good question not only because companies are offering tests of genetic risk to the public, but also because this line of research is very expensive and may not be worth it.

    
    

    Over the past decade the dogma has been that our genes could be used to figure out what diseases are in our future and maybe even to design drugs to prevent them. This dream may well be just that…a dream. It seems that while some genetic variations -- such as the breast cancer genes BRCA 1 and 2 -- are responsible for a very high risk of subsequent disease in an affected individual, the number of such individuals is low. In the case of the BRCA 1 and 2 genes, they correspond to only 5-10% of all breast cancers. On the other hand, there are many genetic variations that may be responsible for a very small increase in risk for breast cancer, probably not enough to even note. Even combinations of these many variants are probably not yet reliable predictors. 

    
    

    What does this mean to science and to us?

    
    

    For science it means we need to reevaluate this approach as the 'holy grail.'  Maybe figuring out the genes isn't as important as figuring out the causes or conditions that lead to the diseases. A child could have the genes for Type 2 diabetes, but be raised in poverty without enough to eat and never experience it. The DNA doesn’t change, but the way it plays out may be very different in a different setting. As such, it may well be easier to change the environment than the genes!

    
    

    For us, personally, this debate means that we need to be careful of commercial companies and doctors that propose to analyze our genes and tell us what diseases are in our futures. To quote Dr. David B. Goldstein, a Duke University geneticist, 'With only a few exceptions, what the genomics companies are doing right now is recreational genomics.'  The risk estimates from this analysis are unstable and may actually be significantly higher or lower than reported as more research is done. 

    
    

    The picture may well be different in five years, but for now you probably should just ask your grandmother what diseases run in the family and live as healthy a lifestyle as you can.

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• Vitamin D & Breast Cancer: The Vitamin D & Breast Cancer: The New Hot Thing?

  • From: SusanMLoveMD
  • Description:

    It seems that everywhere I look doctors and journalists are talking about how we don't get enough vitamin D. In the breast cancer world, this belief started with studies that showed that women who live closer to the Equator experience less breast cancer. The assumption was made that the reduction in breast cancer rates was linked to the sun and vitamin D. 

    
    

    Even though other studies have been equivocal, everyone is still climbing on the vitamin D bandwagon. A study released last week suggests the issue is more complicated than we would like to believe. In this case, researchers found that giving vitamin D supplements to women with breast cancer did not raise their blood levels of the key breakdown product. Does that mean they should take more? Let's not forget: Too much vitamin D can be dangerous!

    
    

    The whole controversy reminds me of the beta carotene story. It was first observed that people who ate a lot of carrots had a lower rate of lung cancer. The conclusion was made that it must be the beta carotene, which is a key part of a carrot. When researchers performed a study randomly assigning smokers to take beta carotene supplements versus placebo, they anticipated that there would be less lung cancer in the beta carotene group. Much to everyone's surprise, there were more lung cancers in the beta carotene group.

    
    

    This was a reminder then -- and still now -- that we have to be careful about getting carried away on what the key component is of any new miracle finding. In the case of the reduced breast cancer rates for women near the Equator, maybe there's something else about being in tropical climates that is important to preventing breast cancer -- and not just vitamin D and sunshine. I don't know the answer, but moving to Tahiti might not be a bad way to find out!

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• Early Detection of Cancer: A M Early Detection of Cancer: A Myth?

  • From: SusanMLoveMD
  • Description:

    Last week the big news was that the PSA blood test did not reduce deaths from prostate cancer. How could that be? What happened to the line: 'early detection is the best prevention?' 

    
    

    It turns out that 'early detection is the best prevention' may not be true for prostate cancer or breast cancer...and maybe others. Why? Because all cancers are NOT the same, and the cancers more likely to be found by screening with PSA or mammograms are the slower growing ones. It's like having a security guard who circles a building once an hour. A fast crook who could get in and out of the building in ten minutes would likely get away with it, while one that took two hours would be likely to be caught.

    
    

    Screening finds more slow-growing cancers, some of which would never become important or could go away by themselves. We need to not just look for cancers, but the conditions that make them grow -- or make them aggressive -- if we are going to save more lives.
    
    

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• We Need a Real Answer We Need a Real Answer

  • From: SusanMLoveMD
  • Description:

    'Study Shows Best Methods for Assessing Women's Breast Cancer Risk' blurted out the press release referring to an article in the Journal of the National Cancer Institute! With that title, you would think that there was something new and different being heralded. In fact there was no new data at all!

    
    

    What there was, however, was a review of all of the current known risk factors for breast cancer. They looked at all the studies that had been done and combined them with a more recently identified risk factor: breast density. They found that combining breast density with the better known factors of age of first period, age of first pregnancy, age at menopause, family history, and breast biopsies made the prediction more accurate. The authors point out that there are drugs which can reduce the risk of getting breast cancer, implying that they are not being used enough because women do not know their risk.

    
    

    There are two drugs, tamoxifen and raloxifene, which have been shown to decrease the risk of estrogen receptor positive breast cancer by about 50%. This is good but the question is, 'at what cost?' The paper specifically did not say what the risk benefit of these drugs is. As with any drugs, they both have side effects. And it should be pointed out that several of the authors of the paper have received money from the pharmaceutical companies that make tamoxifen and raloxifene, and three of them have a patent for a way to measure breast density.

    
    

    The good news is that the review paper showed that lifestyle practices, exercise, weight management, and reducing alcohol have a moderate effect in reducing cancer risk. Certainly a better bet for most of us!

    
    

    My real problem with this paper is that 70% of breast cancers occur in women who have NONE of the known risk factors! What does that mean? It means that we have no idea what causes breast cancer and therefore no idea how to prevent it. We keep looking at the same risk factors over and over again, adding them up differently or substituting one for another. What we don't seem to do is find new risk factors -- ones that will identify the other 70% of women who will develop breast cancer! This is why we need all of you to join the Love/Avon Army of Women. We are determined to be part of the answer and figure out the real cause of this disease once and for all!

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