Take our Triple Negative Breast Cancer Quiz! (4 of 5)
Tigerlily Foundation’s mission is to make you, your own best advocate! Test your knowledge on Triple Negative Breast Cancer and take our TNBC Breast Health Quiz.
Take it here: TNBC Quiz
Tigerlily Foundation’s mission is to make you, your own best advocate! Test your knowledge on Triple Negative Breast Cancer and take our TNBC Breast Health Quiz.
Take it here: TNBC Quiz
Received from Sarah Kelly, Co-founder of SaltyGirlBeauty, www.saltygirlbeauty.com
In 2015, Sarah was diagnosed with Stage 3 Triple Negative Breast Cancer, at 36 years old and 32 weeks pregnant. When something like this happens, it turns your world upside down. During this time, she and her sister Leah, who is an oncology nurse, started diving into the food they ate and the products they put on their bodies. Our skin is our largest organ, and everything we put onto our bodies gets absorbed into our blood stream and organs, so Leah and Sarah became incredibly passionate about doing the research and understanding the ingredients our bodies consume daily.
While going through chemo, Sarah lost all of her hair. When this happened, she felt like she lost something that made her feel beautiful and confident. As a way to endure this emotional hardship on top of her physical one, she discovered the power that beautiful scarves and lipsticks have in helping her rediscover her groove, confidence and saltiness. Thus, the idea of SaltyGirl Beauty was born…
Sarah and Leah wished there was a beauty brand that focused on organic, nourishing ingredients but also stood for something bigger than beauty! So, using their own experiences as their guide, their goal for SaltyGirl Beauty is for women to feel Beautiful, Confident and a little Badass!!!
Here’s a A Day In Her Life:
The only way to live life is to badass through it! I love what I do, not only because it’s making a difference in a positive way, but because it allows me to channel my fears, worries and positive thoughts into action that can help others change their
Immunomedics’ sacituzumab govitecan drug shrinks tumors of metastatic Triple Negative Breast Cancer Patients
IMMU-132-01 Phase 1/2 clinical trial using Immunomedics’ sacituzumab govitecan drug has revealed that this drug increases survival time and shrinks tumor in metastatic triple negative breast patients.
In this clinical trial, 108 metastatic breast cancer patients who had been previously treated with other medications received the sacituzumab govitecan drug. The sacituzumab govitecan drug is unique in that it combines an antibody with a chemotheraphy drug to better target cancer cells. Specically, when the antibody portion binds to the Trop-2 antigen which is found on most breast cancer cells, the drug is released within those cells and into the areas of the tumor. Thus, sacituzumab govitecan drug provides targeted drug delivery to the cancer cells and reduces the tixic effect of the drug to healthy cell.
After approximately 10 months of treatment with the sacituzumab govitecan drug, tumor reduction was observed in 33% of patients, including three patients with a complete tumor clearance. The positive response to treatment with the sacituzumab govitecan drug lasted for about 8 months, with 6 patients having responses that lasted for more than 12 months. About 45% of patients experienced complete or partial response or stable disease for at least 6 months. The median progress free survival was 5.5 months and the median overall survival was 13 months.
Chemotherapy within 30 days of surgery improves survival rate among triple negative breast cancer patients
A review of data from nearly 700 patients with triple negative breast cancer has revealed that delays of more than 30 days in initiating chemotherapy after surgery were associated with lower disease-free survival, lower distant recurrence-free survival and lower overall survival. These results were presented at the Annual San Antonio Breast Cancer Symposium in December 2018.
In this data analysis study, the researchers reviewed data for 687 women with stage I, II or III triple negative breast cancer. The time to chemotherapy was less than 30 days in 189 patients, 31-60 days in 329 patients, 61-90 days in 115 patients and more than 91 days in 54 patients.
When comparing these 4 groups (eg., one group was the patients who had chemotherapy less than 30 days after surgery), the overall survival at 10 years for patients in the < 30 days of surgery group was 82%, 67.4% for those in the 31-60 days group, 67.1% for those in the 61-90 days group and 65.1% for those in the > 91 days group. Disease-free survival at 10 years was 81.4% for patients in the < 30 days, 68.8% for the 31-60 days group, 70.8% for those in the 61-90 days group and 68.1% for those in the > 91 days group. Distant recurrence-free survival at 10 years was 80.2% for patients in the < 30 days, 64.9% for the 31-60 days group, 67.5% for those in the 61-90 days group and 58.6% for those in the > 91 days group. Overall, patients receiving chemotherapy within 30 days after surgery had more than 10% higher 10-year survival rates compared to patients receiving chemotherapy more 30 days after surgery.
Read more about this study here.
As a Triple Negative Breast Cancer Survivor, I’m thankful for efforts that highlight TNBC. When I was first diagnosed 13 years ago, someone told me it was the good type of breast cancer to have. First of all, no breast cancer is the good breast cancer to have, and TNBC was even lower on that list, because there was no targeted treatment for that type of breast cancer.
Knowing this leaves many TNBC survivors in a place of fear. For many years, I wondered, “if there is no targeted treatment for my type of cancer, will it come back? Is it hiding somewhere and growing? What does this mean?” Thankfully, many researchers are working diligently to help find a treatment to target TNBC. Initially consumed by fear and worry, I turned that energy into action – to help as many young women as possible, to bring awareness to the disparities and challenges that younger women face; and to bring light where is darkness – through education and spreading hope.
One of the best ways to overcome your fear is to step into and act. While some really smart people are working to find a cure, I’ll be shining my love light in all the dark places, helping to inspire others to act and living my best life ever. Whatever your diagnosis is, it doesn’t own you – you decide how to live your life despite it.
We are excited to highlight TNBC this week. Over the next year, we will be working with researchers and will share updates on TNBC as they become available.
Please share your thoughts and your stories with us; and keep the faith!
Much love,
Maimah
By: Jen Hoverstad
Before March of 2018, I led a seemingly vanilla life in Raleigh, North Carolina – the same city where I was born.
I’m 34 and married my high-school sweetheart. We have two daughters, Elin, four, and Halle, one.
However, on Sunday, March 25, 2018, after a hot yoga class, I noticed discoloration on my left breast. It was a blueish purple and slightly raised – kind of like it was a scar that was healing.
But, I had no reason to have a scar.
After noticing the discoloration, I did a breast self-examination and immediately felt the mass. It was dense and distinct. I did not have the same mass or discoloration on my right breast.
I saw my OB/GYN the very next day. By Tuesday, I was sent to see a breast specialist.
On Wednesday, I was diagnosed with invasive ductal carcinoma, HER2+. The tumor was 6cm, and one lymph node tested positive.
Days later on April 10th, my daughter’s first birthday, I had my port placed.
And just two days later on April 12th, my 10th wedding anniversary, I started chemotherapy.
After completing chemo and my bilateral double mastectomy, I learned that I had a complete response to the chemo – both my tissue and lymph nodes were clear of cancer at the time of the surgery.
Immediately following the completion of my chemo, I started six weeks of radiation.
Genetic testing confirmed my cancer was not handed down from a prior generation, which gives me some hope that, perhaps, cancer will not find my girls.
I’m an attorney by trade, but currently taking time off to focus on healing.
Looking back before my diagnosis, I worked out nearly every day and ate in moderation. My physical in January 2018 showed no signs of what would come later in the year – I was considered in “good health.”
Now, it’s time to get back to that good health.
I’ve blogged about my journey on my website: www.jenhoverstad.com.
I created the term “Jenfluence” to remind myself that by sharing my story, I can have an effect on the character and behavior of others.
Whether it’s interacting with people in person or writing a post on Instagram, I’ve become hyper-intentional in hopes that my positivity and perseverance will transfer to others.
Definition of Genomics:
Genomics is the study of all of your genes, including how the genes interact with each other and with your environment. With breast cancer, genomics can be used to increase our understanding of this complex disease. For example, the behavior of the breast tumor is affected by activity and interaction of genes in the tumor. Thus, how likely it is that the tumor grows and spreads, how aggressive the tumor is, or how likely it is that the tumor will respond to particular treatment are all dependent on genomics of the tumor.
Genomics versus Genetics:
Genomics and genetics both play a role in health and disease, and both deal with the approximately 20,000 genes in the human body. Genomics is the study of the genome, which is all of your genes. Genetics is the study of specific and limited number of genes or parts of genes that have a known function. Changes in a specific gene may increase your risk for breast cancer, such as BRCA1 gene mutations.
Therefore, while genomics and genetics are both focused on your genes, genomics is a study of all of the genes and genetics is the study of single genes. Another difference is that genetics looks at how characteristics such as eye color are passed on through DNA from one generation to another generation, while genomics is focused on identifying variations on the DNA that affect health, disease or drug response. The genetics field has been around since the 1860s whereas the genomics field is much newer, with the Human Genome Project being launched in 1990.
Definition of Personalized Medicine
Personalized medicine or precision medicine is treatment that is tailored to an individual patient, so that the patient is treated in the most effective manner. In order words, the treatment plan will target your specific breast cancer or the pathways that your tumor cells use to grow and survive. To accomplish this, the medical team considers the genes or other markers on the cancer cells, your genes, your lifestyle factors, and the molecular characteristics of your disease. Testing for personalized medicine may focus on:
How is treatment personalized?
To personalize your treatment for breast cancer, several factors are taken into consideration:
Importance of personalized medicine for treating Breast Cancer
Breast cancer is a complex disease. It can develop, progress and respond to treatment very differently among patients. Personalized medicine for treating breast cancer provides the most effective treatment as it is tailored to an individual, based on their specific tumor characteristics. This way, the best results are achieved while avoiding unnecessary treatment, risks and side effects.
Factors that Can Increase Your Chances of Getting Breast Cancer
Factors and characteristics that increase your chances of getting breast cancer are called risk factors. The main risk factors of breast cancer are being a woman (breast cancer is rare in men) and getting older (breast cancer is generally found in women who are 50 years old or older), but younger women can and do g. It is important that you understand that having risk factors does not mean that you will get breast cancer. Also, it is important that you know that you may get breast cancer even without any risk factors that they know of. This is why you need to be your best advocate for your health and stay informed about what the risk factors of breast cancer are and how you can lower your risk.
Genetic risk factors associated with Breast Cancer
About 5% -10% of breast cancer cases are associated with abnormalities in genes, which can be passed on from parent to child. Some examples of genes that may become abnormal and lead to breast cancer are:
Personal risk factors associated with Breast Cancer
High-risk individuals for Breast Cancer
Some women have a higher chance of being diagnosed with breast cancer. The factors that increase your chances of having breast cancer include having a personal history of breast cancer. If you have had cancer before, you have an increased risk of developing a new cancer in another part of the same breast or in the other breast. In addition, if you have relatives (e, g., your mother, sister, daughter) who have been diagnosed with breast cancer, you have an increased risk of developing breast cancer. A history of breast cancer in your family may be linked to having an abnormal gene that is passed on over time. For example, mutations in genes such as BRAC1, BRAC2 and PTEN are linked to breast cancer, and these mutations can be passed on from parent to child.
Breast Cancer Screening
For women with a personal history of breast cancer, or a family history of breast cancer and/or a family history of abnormal breast-cancer related genes, you should speak with your health care provider to discuss breast cancer screening guidelines. The doctor will discuss which screening option may be right for you, whether you need to be screened earlier or more frequently than other women. Some screening options include:
Women with an abnormal breast cancer gene have a much higher risk of developing breast cancer in between yearly screenings. For example, women with an abnormal BRCA1 or BRCA2 gene are recommended to have a mammogram and an MRI scan each year, about 6 months apart (for example, a mammogram in January and an MRI in July).
Profiling of Breast Tumor
Like every cell in your body, the cells in a breast tumor have genes that reveal the molecular characteristics of the tumor. This information helps to determine your prognosis and guides treatment decisions. A complete profiling of your breast cancer may include tumor size tumor type, tumor grade, the hormone status of your tumor, the HER2 receptor status of the tumor, and gene mutations.
Determining Hormone Status:
Estrogen and progesterone are a type of protein called hormones that give “fuel” to breast tumor growth. Breast cancers that have high levels of estrogen are called estrogen receptor-positive (ER-positive or ER+). Similarly, breast cancers that have high levels of progesterone are called progesterone receptor-positive (PR-positive or PR+). If the breast cancer has both hormone receptors, it is called ER/PR-positive or ER+/PR+). Your medical team can determine your hormone status as follows:
Determining HER2 Status:
Human epidermal growth factor receptor 2 (HER2) is a type of protein that is on breast cells. Normally, HER2 receptors help control how breast cell grows, divides, and repairs itself. But in about 25% of breast cancers, the HER2 gene doesn’t work correctly and makes too many copies of itself (known as HER2 gene amplification). This in turn leads to overproduction of the HER2 receptors, which makes breast cells grow and divide in an uncontrolled way. Breast cancers that have high levels of HER2 receptors are HER2-positive. Your medical team can determine your hormone status as follows:
Determining Genetic Makeup: The genes in breast tumor cells reveal the molecular characteristics of the tumor. This information helps to determine your prognosis and guides treatment decisions. Your medical team can determine the genetic makeup of your tumor using these four tests as follows:
o Tumor testing: MammaPrint tests a sample of the tumor (removed during a biopsy or surgery) for the activity of a group of 70 genes.
o MammaPrint scores: If the score indicates a fairly high risk of metastasis, your doctor will likely recommend a more aggressive treatment plan that includes both hormone therapy and chemotherapy. If the score indicates a low risk of metastasis, your doctor may recommend treatment with only hormone treatment.
Targeted drug therapies for Breast Cancer
Targeted therapy drugs for breast cancer are designed to attack certain cancer cells or certain cellular pathways that cancer cells use to grow and survive. There are several targeted therapies for breast cancer, based on whether they are hormone receptor-positive or HER2-positive. Targeted therapies are also developed for treatment of breast cancer at early stage and at metastatic stage.
About HER2-positive breast cancers. A number of treatments have been developed to target HER2-positive breast cancers. These include:
About Hormone receptor-positive breast cancers. Treatments that target hormone receptor-positive breast cancers include Everolimus (Afinitor) and CDK4/6 inhibitors.
About Breast cancers with BRCA gene mutations. Treatments that target breast cancers with BRCA gene mutations are PARP inhibitors. PARP proteins normally help repair damaged DNA inside cells. The BRCA genes (BRCA1 and BRCA2) also help repair DNA (in a slightly different way), but mutations in one of those genes can stop this from happening. PARP inhibitors work by blocking the PARP proteins. Because tumor cells with a mutated BRCA gene already have trouble repairing damaged DNA, blocking the PARP proteins often leads to the death of these cells.
The Oncotype Dx Test
The Oncotype DX Test is a genomic test that evaluates specific genes in your breast tumor to provide information that your doctor can use to develop a personalized treatment plan for you. If you have early-stage invasive breast cancer, Oncotype DX test predicts the likelihood that you may benefit from chemotherapy, and the likelihood of your cancer returning. If you have ductal carcinoma in situ (DCIS), the Oncotype DX test predicts the likelihood of your cancer returning in the same breast. The Oncotype DX test is a product of Genomic Health.
Is Oncotype DX for you?
You may be a candidate for the Oncotype DX test if:
Questions to Ask Your Doctor About Oncotype DX
The Oncotype DX test must be ordered by your doctor or a licensed healthcare provider. You and your doctor will decide if the Oncotype DX test is right for you. Some questions that you may want to ask your doctor include:
Take the Oncotype DX Eligibility Quiz
Additional Resources:
Genomic Health has several free guides for Oncotype DX. For DCIS Breast Cancer, see Doctor Discussion Guide for DCIS Breast Cancer, DCIS Breast Cancer Patient Guide, and Patient Guide to DCIS Surgery. For Invasive Breast Cancer, see Doctor Discussion Guide for Invasive Breast Cancer, Invasive Breast Cancer Patient Guide, Patient Guide to Early-Stage Invasive Breast Cancer Surgery and Treatment and Invasive Breast Cancer Patient Guide (Spanish). For general knowledge, see Recently Diagnosed – Inform Yourself.
Mobile Breast Cancer Apps are convenient tools for guiding breast cancer patients, survivors and caregivers. Some examples are:
Genomic Health has a library of videos and websites that provide additional information about breast cancer and treatments. This library also provides guidance for personalizing your breast cancer treatment with Oncotype DX. There are videos about DCIS Breast Cancer, Invasive Breast Cancer and Oncotype DX score, results. There are links to Advocacy, Education and Support, Clinical Trials, Answers from Breast Cancer Experts, Advanced Breast Cancer Information and Breast Cancer Blogs.
Glossary
Biomarker: A biomarker or molecular marker is a biological molecule found in blood, other body fluids or tissues.
Biopsy: Biopsy is the examination of tissue removed from a living body. For example, a biopsy of breast cancer is taken to examine the characteristics of the tumor.
Clinical trial: A clinical trial is a type of medical research study that determines whether an intervention – a new drug, medical device or diagnostic tool – is safe and/or effective.
Companion Diagnostic: A companion diagnostic is a test or measurement that can be used to determine the efficacy and/or safety of a specific drug for a targeted patient group or patient sub-groups.
DNA: Deoxyribonucleic acid or DNA is a cellular component that contains the instructions for most forms of life.
Epigenomics: Epigenomics takes into account how factors, such as the environment, can result in changes in gene expression.
Gene Mutation: This is permanent change in the DNA sequence that makes up a gene. Gene mutations may be inherited from a parent or acquired during a person’s lifetime.
Gene testing: Genetic testing is performed with a laboratory test to identify genetic changes associated with a disease.
Genetic Counseling: A healthcare professional with specialized knowledge of genetics meets with an individual or family to determine if a condition in the family is genetic and estimate the chances that another relative may be affected. Genetic counseling may also involve performing and interpreting genetic tests that estimate disease risk, as well as conveying information so as to help address concerns of the individual or family and provide psychological counseling to help them adapt to the condition or risk.
Genetic Marker: A genetic marker is an alternation in DNA that may indicate an increased risk of developing breast cancer.
Genome: The genome is the complete genetic material of an organism.
Genomic Sequencing: Genomic Sequencing is a method to determine the entire genetic makeup of a single cell or of an entire organism. This method can help determine changes in DNA that may lead to the development of breast cancer.
Genomics: Genomics is the study of the genome – structure, function, evolution and mapping.
GINA: The Genetic Information Nondiscrimination Act or GINA is a federal legislation that prohibits discrimination against individuals on the basis of their genetic profiles in regard to health insurance and employment. The law was passed in 2008.
Personalized medicine: This refers to treatment that is tailored to an individual patient, so that the patient is treated in the most effective manner. Diagnostic tools are used to identify specific biological markers to help determine which medical treatments and procedures will be best for the patient.
Pharmacogenomics: Pharmacogenomics is the field that examines how your genes influence the way your body processes medications used to treat breast cancer.
Proteomics: Proteomics is the analysis of protein structure and function.
Risk factors: A risk factor is a characteristic or exposure of an individual that increases their likelihood of developing breast cancer.
Targeted therapy: Targeted therapy is drugs for breast cancer that are designed to attack certain cancer cells or certain cellular pathways that cancer cells use to grow and survive.
Tumor sequencing: Doctors can sequence the DNA from your cancer cells to identify which mutations are responsible for causing breast cancer.
Your Healthcare Provider and You
Having the right healthcare provider and a strong relationship with that individual is one of the most important relationships you’ll make during your lifetime. Selecting a healthcare provider in your teens when you begin your annual visits and building a connection of open communication and trust, can be the foundation for how you build your healthcare team – whether you’re healthy or have been diagnosed with breast cancer. The right doctor will listen to you, teach you how to be your best advocate, and advocate for you, if and when needed. The right provider also will have a network of other specialists he/she trusts, if you need specialized care.
Your doctor should be someone you feel comfortable with on a personal level and someone who you can talk to openly. A doctor should be open to you getting more than one or two opinions before selecting the one that is best for you. This is a good way to learn about their abilities and to see whether or not you have a personal connection with the healthcare provider. Here are some questions that may help you interview a doctor:
After additional visits with your doctor, you should continue to feel even more comfortable talking with your doctor. Whether you continue to go alone or with someone, it is always a good idea to prepare a list of questions ahead of time for your doctor. This can help you remember everything you want to ask and keep the discussion focused on the issues that are most important to you. In keeping abreast of new and available treatment, be sure to ask your doctor whether they take part in clinical trials. A doctor who participates in clinical trials is likely to know about new therapies and may be more open to future medical treatments, which could make a big difference in managing your breast cancer.
In general, the best relationship you can have with your doctor is one where you are open and do not feel shy about speaking frankly. Be sure to update your doctor about how you are feeling and about your full family history of breast and other cancers. This information helps your doctor understand your risk of breast cancer and your risk of breast cancer returning.
To clarify details about coordinating your care generally or in an emergency, here are some questions to ask your doctor:
Basically, you should feel as if your physician is competent, professional and that he/she really cares about you. Start building this relationship as a healthy young woman; and know that it will benefit you throughout your life journey.
Having Breast Cancer and Managing Mental Health: It is important to be cognizant of mental health after diagnosis and during treatment. While it is important to try to stay positive, sometimes the “over-pinking” of breast cancer or the fact that everyone is cheering you on towards health and may be solely focused on keeping you positive can tend to negate feelings that some wome have – feelings of sadness. It is important to recognize that each woman’s journey is different and that being diagnosed with breast cancer can affect your mental health and that of your loved ones. From anxiety and worry about the future, to the stress of treatment, and fear of recurrence, many breast cancer patients and survivors develop anxiety or depression; and symptoms of post-traumatic stress disorder (PTSD). These symptoms can be short- or long-term. Some women can begin to see the impact on their mental health at the onset of their breast cancer diagnosis. Other women may have pre-existing mental health conditions, which can make it harder for them to cope after a breast cancer diagnosis. Some women who undergo surgery for their breast cancer can experience depression and sadness as a result of substantial change in appearance through mastectomy. Mastectomies can decrease women’s body confidence, impact their relationships to their sexuality, and have a negative effect on overall mental health. In addition, weight loss or weight gain as a result of breast cancer treatment can also alter how a woman feels about herself, which could impact mental health as well. Also, women who are metastatic can have more acute anxiety and/or depression.
Managing mental health can make it challenging to do things that benefit your health, such as eating healthy foods, exercising, connecting with friends and family, and complying with medical treatment. However, the good news is that breast cancer and its emotional impact such as feelings of depression can lift over time, and the level of anxiety is likely to decrease. However, it is important to note that if you feel anxious or depressed, ask your healthcare team for a referral to a mental health provider. Taking care of your mental health should be a priority.
Staying as active as you can and focusing on healthy, eating including lots of fruits and vegetables can help you feel better and more relaxed. Also, reaching out to supportive intimate partners and family members, friends, or a faith-based group can increase breast cancer survivors’ overall mental well-being. Talk to a therapist, who can listen objectively and help you cope. In addition, you may consider a combination of group therapy, which allows women to share emotional support, and individual therapy, which helps women learn problem-solving skills and alter patterns of thinking. You should always communicate your moods and emotions with your doctor and healthcare team as they can connect you with the appropriate help. If all else fails, your doctor may recommend taking anti-depressant medications. There are a variety of effective medications available that you might be prescribed to address any underlying chemical components of your anxiety or depression.