Breast Cancer Update: Radiation or Not?
July 10, 2010 by admin
Filed under Cancer, Health & Fitness
Many women with breast cancer want to do anything and everything to fight the disease as aggressively as possible — in fact, more and more are choosing preventive mastectomies even when their cancer is the noninvasive kind that hasn’t spread. But sometimes less treatment may be the healthiest decision — for instance, new research pinpoints a group of women who will do just fine and, in fact, far better without adding radiation to their breast cancer treatment program.
Who Needs Radiation Therapy?
The latest research, from The University of Texas M.D. Anderson Cancer Center, shows that most early-stage breast cancer patients do not need radiation after their mastectomies because there is such a low risk for recurrence. But because what one woman sees as “low risk” can seem “too risky” to another, I contacted Henry Kuerer, MD, PhD, professor and training program director in M.D. Anderson’s department of surgical oncology and senior author of the study, to get some perspective.
Researchers reviewed the records of more than 1,000 women (average age 54) whose stage I or II breast cancer had spread to three or fewer lymph nodes. Each woman had had a mastectomy, 77% had also received postoperative chemotherapy and/or hormone therapy, and none had received postoperative radiation. After an average follow-up time of seven-and-a-half years, this group’s rate of recurrence was quite low — just 2.3%.
“Radiation therapy has so many risks — we have to decide if it’s really a benefit when we consider that the risk for recurrence is so low,” Dr. Kuerer told me. The risks of radiation therapy include injury to the cardiopulmonary vessels, the neurological system, the skin and the musculoskeletal system, plus a higher risk for lung cancer, esophageal cancer and leukemia. Meanwhile, he said, surgery and chemotherapy for early-stage breast cancer are better and more effective than they used to be, so there’s less need to add radiation to the mix.
Making a decision
Of course, some women really do need radiation treatment for their breast cancer. According to Dr. Kuerer, radiation is advised — and very effective in decreasing the risk for recurrence — for many breast cancer patients with advanced disease (stage III and IV), because their risk is far higher, between 10% and 15%. Radiation should also be strongly considered for women with tumors of more than 5 centimeters… more than four positive lymph nodes… positive margins (indicating that cancer cells have spread to the edge of the biopsied tissue) … and/or extra-capsular extension (a tumor growing from the lymph node into the underarm). Also, it should be considered for breast cancer patients under age 40 (who typically have an aggressive form of the disease), for patients with metastatic breast cancer and for those whose cancers are at borderline stages, such as between stage II and stage III.
Dr. Kuerer advises asking your doctor to assess your risk of recurrence, adding that it’s important to make sure he/she is using current data. Also, he suggests seeking another doctor’s opinion if you feel uncertain. “You need to feel comfortable with your team of doctors and confident that they understand the true risks and benefits of radiation therapy for you.” In the end, there’s no single “right” answer — just what’s right for you.
Source(s):Henry M. Kuerer, MD, PhD, professor and director breast surgical oncology training program, The University of Texas M.D. Anderson Cancer Center, Houston.
The Anticancer Diet
May 27, 2010 by admin
Filed under Cancer, Health & Fitness
David Servan-Schreiber, MD, PhD
University of Pittsburgh School of Medicine
At any given time, the average person might have thousands of cancer cells in his/her body. Individually, these abnormal cells are harmless, but any one of them could potentially proliferate and form a mass of cells (a tumor) that damages normal tissues and can spread to other parts of the body. About one-third of us eventually will get full-fledged cancer.
Often people who get cancer have created impairments in their natural defenses, allowing cancer cells to survive and proliferate. About 85% of all cancers are caused by environmental and lifestyle factors. We can’t always control our environments, but we can control what we eat. Diet is one key factor that determines who gets cancer and who doesn’t.
Example: Asian men have just as many precancerous microtumors in the prostate gland as American men, yet they are as much as 60 times less likely to develop prostate cancer. It’s not a coincidence that their diets are far healthier, on average, than those consumed by men in the US. Asian men eat far more fruits and vegetables than Americans and relatively little red meat. They also tend to eat more fish and soy foods, and they drink more tea, especially green tea. These and other dietary factors allow their immune systems and other natural defenses to prevent cancer cells from proliferating.
My story: I was a physician in Pittsburgh when I was first diagnosed with a brain tumor in 1992. With the benefit of hindsight — and years of research into the origins and development of cancer — I have come to understand that my previous lifestyle, particularly my poor diet, fostered a procancer environment. For example, a typical lunch for me was chili con carne, a plain bagel and a can of Coke.
CAUSES OF CANCER
It can take years for cancer cells to turn into tumors — assuming that they ever do. This lag time means that we have many opportunities to create an anticancer environment in our bodies.
There are three main factors that promote the development of cancer…
- Weakened immunity. The immune system normally patrols the body for bacteria and viruses, as well as for cancer cells. When it spots something foreign, it dispatches a variety of cells, including natural killer cells, to destroy the foreign substance. In people who eat an unhealthy diet — not enough produce, too much alcohol, very little fish and so on — the immune system works less efficiently. This means that cancer cells can potentially slip under the radar and eventually proliferate.
- Inflammation. Millions of Americans have subclinical chronic inflammation. It doesn’t cause symptoms, but it can lead to heart disease and cancer. Chronic inflammation can be caused by infection, a diet low in antioxidant nutrients and even emotional stress. It’s accompanied by the release of cytokines and other inflammatory chemicals. Inflammation also prevents the immune system from working efficiently.
- Angiogenesis. Cancer cells, like other cells in the body, need blood and nourishment to survive. They send out chemical signals that stimulate the growth of blood vessels that carry blood to and from the cancer.
This process is called angiogenesis — and it can be strongly influenced by what we eat.
Example: People who eat no more than 12 ounces of red meat weekly can reduce their overall risk for cancer by 30%. Red meat stimulates the release of inflammatory chemicals that inhibit apoptosis, the genetically programmed cell death that prevents uncontrolled growth.
CANCER FIGHTERS
The best cancer-fighting foods…
- Fatty fish. The omega-3 fatty acids in fish reduce inflammation. Oncologists in Scotland have measured inflammatory markers in the blood of cancer patients since the 1990s. They have found that patients with the lowest levels of inflammation are twice as likely to live through the next several years as patients who have more inflammation.
Laboratory studies indicate that a high-fish diet can reduce the growth of lung, breast, colon, prostate and kidney cancers. And naturally, people who eat more fish tend to eat less red meat.
Important: The larger fatty fish, such as tuna, are more likely to be contaminated with mercury and other toxins. The best sources of omega-3s are smaller fatty fish, such as sardines, anchovies and small mackerel.
- Low-glycemic carbohydrates. The glycemic index measures the effects of the carbohydrates in foods on blood glucose levels. Foods with a high-glycemic index, such as white bread and table sugar, cause a rapid rise in insulin as well as a rise in insulin-like growth factor (IGF). IGF stimulates cell growth, including the growth of cancer cells. Both insulin and IGF also promote inflammation.
Data from the Harvard Nurses’ Health Study indicate that people who eat the most high-glycemic foods (these same people tend to be sedentary and overweight) are 260% more likely to get pancreatic cancer and 80% more likely to get colorectal cancer.
Recommended: Unprocessed carbohydrates that are low on the glycemic scale, such as whole-grain breakfast cereals and breads (with whole wheat, barley, oats, flaxseeds, etc.)… cooked whole grains, such as millet, quinoa and barley… and vegetables, such as broccoli and cauliflower.
Also important: Reduce or eliminate refined sugar as well as honey.
Better: Agave nectar, available at most health-food stores. Extracted from cactus sap, it’s sweeter than sugar or honey, yet it has a glycemic index four to five times lower. You can use agave nectar just as you would sugar or honey — by adding it to cereals, tea and so on. Because of the liquid content of the syrup, you’ll generally want to reduce the amount of other liquids in baked goods. Substitute three-quarter cup of agave nectar per one cup of any other sweetener.
- Green tea. Between three and five cups daily can significantly reduce your cancer risk. A chemical in green tea, epigallocatechin gallate (EGCG), inhibits angiogenesis. Green tea also contains polyphenols and other chemical compounds that reduce inflammation and activate liver enzymes that break down and eliminate potential carcinogens. In men who already have prostate cancer, consuming five cups or more of green tea daily has been associated with reduced risk of progressing to advanced cancer by 50%. In women with certain types of breast cancer, three cups daily reduced relapses by 30%. Because black tea is fermented, it has a lower concentration of polyphenols and is less protective than green tea.
- Soy foods. The isoflavones in tofu, soy milk, edamame (green soybeans) and other soy foods help prevent breast cancer, particularly in women who started eating soy early in life. These compounds, known as phytoestrogens, have estrogen-like effects. They occupy the same cellular receptors as the body’s estrogen yet are only about one-hundredth as active. This means that they may slow the development of estrogen-dependent tumors.
Recommended: Three servings of soy per week — but only for women who are cancer-free. Avoid soy if you have or had cancer — there’s some concern that the estrogen-like compounds in soy might promote tumor growth in women who have a type of breast cancer that is sensitive to estrogen’s effects.
- Turmeric. No other food ingredient has more powerful anti-inflammatory effects. In laboratory studies, the active ingredient curcumin in the spice turmeric inhibits the growth of many different cancers. It helps prevent angiogenesis and promotes the death of cancer cells.
In India, people consume an average of one-quarter to one-half teaspoon of turmeric daily. They experience one-eighth as many lung cancers as Westerners of the same age… one-ninth as many colon cancers… and one-fifth as many breast cancers.
- Asian mushrooms, such as shiitake, maitake and enokitake. They’re available in most supermarkets and gourmet stores and are one of the most potent immune system stimulants. Among people who eat a lot of these mushrooms, the rate of stomach cancer is 50% lower than it is among those who don’t eat them. One to two half-cup servings weekly probably is enough to have measureable effects.
- Berries. Berries contain ellagic acid, which strongly inhibits angiogenesis. Aim for one-half cup per day.
- Dark chocolate. One ounce contains twice as many polyphenols as a glass of red wine and almost as much as a cup of green tea. Laboratory studies indicate that these compounds slow the growth of cancer cells. Look for a chocolate with more than 70% cocoa. The “lighter” milk chocolates don’t contain adequate amounts of polyphenols — and the dairy component of milk chocolate blocks the absorption of polyphenols.
Source(s):
Bottom Line/Personal interviewed David Servan-Schreiber, MD, PhD, a neuroscientist and clinical professor of psychiatry at University of Pittsburgh School of Medicine. He is cofounder of the university’s Center for Integrative Medicine and author of “Anticancer: A New Way of Life” (Viking). www.anticancerbook.com.
Financial Aid for Cancer Patients
February 8, 2010 by admin
Filed under Cancer, Health & Fitness
What’s scarier — dying of cancer or paying for cancer treatment? It sounds like the punch line to an unfunny joke, but in fact, Americans are divided about half and half when asked to answer that question, according to a recent survey commissioned by the Community Oncology Alliance (COA).
Even if you have what you consider to be good health insurance, the financial burden on cancer patients can be overwhelming, notes Deborah E. Hoffman, MSW, LCSW, associate director of the Shapiro Center for Patients and Families at Dana-Farber Cancer Institute (www.dana-farber.org) in Boston. Most insurance policies have significant limitations, yearly caps and lifetime maximum payouts that can create financial disaster. Even middle-class professionals are not immune from the pressure. In 2007, three out of four Americans who filed for bankruptcy cited medical expenses as a key factor even though most had health insurance and were well-educated, owned homes and held good-paying jobs… and that number has been going up, not down.
However, there is help to be had. An increasing number of medical institutions are realizing that financial help for patients can be nearly as important as medical help. At Dana-Farber, for example, cancer patients are now offered free financial coaching from the Financial Planning Association of Massachusetts (www.fpama.org) to help figure out how to handle medical costs, debt and other issues.
Ask For Help — It’s Available
While not every medical center is equipped to offer full-service counseling such as that offered by the Dana-Farber program, most do have specialists on hand to help you overcome the daunting financial obstacles that accompany cancer – a list of challenges that may include how to cover the cost of required treatment versus available coverage… unexpected out-of-pocket expenses, often including the need to travel some distance for treatment… how to afford complementary and alternative treatments that are often not covered by health insurance… lost income, etc. Though it can be difficult to focus on anything but how to get better, the best strategy is to begin looking at treatment costs as soon as you can after diagnosis — or ask a capable family member or friend to do so. Follow these steps to help stay on top of cancer costs…
- Meet with your hospital’s designated professional (the title may be something like “financial information officer” or “resource specialist”) to discuss your practical concerns. He/she will be familiar with what’s available to help with your financial burden. It’s important to neither overstate nor understate your financial health, as some assistance is based on need.
- Ask your insurer to assign you to a case manager. It’s usually easier to call a particular person with your questions about billing and coverage than to shuttle from one person to another each time you call.
- Learn the details of what your health plan will pay for and what it won’t cover. For example, take note of the amount of your deductible (what you must pay before your coverage kicks in)… the covered length of any hospital stays (some pay for only 30 days, others for more)… annual or lifetime coverage limits (most plans have such limits on what they pay toward treatment for specific health conditions)… co-pays (the cost you are expected to cover at each visit)… and whether or not you are covered by another policy, such as your spouse’s, and if so what are the different percentages each insurer will cover.
- Stay in close touch with your insurer. Even if the firm denies a claim or says it will not cover a particular treatment, keep asking… and ask your doctor to call on your behalf, too. The first answer isn’t always the final answer — for instance, if you’ve been denied coverage for a type of treatment, it may help if you’re able to provide evidence from your physician that it is most effective for your type of cancer.
- Explore supportive programs and possible no-cost services. Depending on your income, you may be eligible for free or low-cost drugs from pharmaceutical companies or treatment from providers. Cancer institutes such as Dana-Farber also have access to donor funds to help strapped patients with hidden cancer costs, such as paying for transportation, gas, parking and meals associated with hospital visits. Also, many private and hospital foundations provide assistance with treatment costs as well. Ask your specialist to outline the possibilities.
- For particular types of cancer, these organizations may provide additional financial support:
The Leukemia & Lymphoma Society
800-955-4572
www.lls.orgThe CancerCare Co-Payment Assistance Foundation
866-552-6729
www.CancerCareCopay.orgThe HealthWell Foundation
800-675-8416
www.healthwellfoundation.org
- Maintain your liquidity. The standard financial advice to pay off credit card balances may not be the right path for those who have cancer. It’s an expensive disease to treat, and during this time, it might make sense to make only minimum payments and keep higher credit lines available to pay bills.
- See a financial professional. A financial planner can assist you with matters like budgeting, debt management, estate planning and insurance. If you have extensive credit card debt, a credit counselor can help you bundle three or four credit card payments into one monthly amount and, depending on your circumstances, negotiate for smaller or suspended payments.
- Get a patient advocate. The nonprofit Patient Advocate Association (www.patientadvocate.org or 800-532-5274) offers free case-management services to help resolve insurance and financial difficulties.
