Breast Cancer Newsletter

Breast Cancer Newsletter

“On behalf of everyone at Huntington Hospital Cancer Center, we hope this information is helpful to all women – whether you’re a breast cancer fighter, survivor, or someone who just wants to learn more about breast health.”


Ruth Williamson, M.D., medical director, Breast Cancer Services & Radiation Oncology

The Huntington Cancer Center produced a quarterly newsletter, focusing on breast health, from 2016 to 2018. While we no longer produce this publication, we keep past issues available on this website as a resource for breast cancer fighters and their families.

Physical activity and breast cancer.

There are many reasons why exercise is encouraged for the breast cancer patient. Physical activity can improve or maintain your physical abilities. It can improve your balance and lower your risk of falls and broken bones. It can keep your muscles healthy and prevent wasting of muscles if there is inactivity due to cancer treatments.

Exercise can lower your risk of heart disease as well as the risk of osteoporosis. It can also increase blood flow and lower your risk of blood clots. Exercise can decrease nausea, lessen symptoms of fatigue, improve your mental outlook such as self-esteem, and reduce anxiety and depression. Physical activity will help you control your weight and can overall improve the quality of life for breast cancer patients.

Hormone receptor positive breast cancer patients are often treated with anti-estrogen therapy such as Tamoxifen or an aromatase inhibitor such as Arimidex. Tamoxifen is very well tolerated but sometimes can have side effects – the most common being hot flashes and weight gain, which physical activity has been found to reduce. Aromatase inhibitors block the production of estrogen in postmenopausal women and have very common side effects such as hot flashes and bone loss or osteoporosis. Regular physical activity can help reduce some of this bone loss.

It is very important to encourage physical activity for women with breast cancer. Exercise can significantly improve her quality of life during and after cancer treatment!

Alcohol and Breast Cancer

  • Multiple studies have demonstrated an increased risk of breast cancer with alcohol use.
  • When compared to teetotalers, women who drink the equivalent of a half of a glass of wine per day were 6% more likely to develop breast cancer. Women who drank 1-2 glasses a day have an increased risk of 21% chance of developing breast cancer. Women with heavy alcohol use of 2 or more drinks a day were 37% more likely to be diagnosed with breast cancer.
  • In women, breast cancer comprises approximately 60% of all alcohol-related cancers.
  • Research shows that drinking alcoholic beverages consistently increases a women’s risk of breast cancer, especially hormone receptor positive breast cancer. This makes sense because alcohol can increase levels of estrogen in the body, which is related to hormone receptor positive breast cancer.
  • If you want to do everything you can to lower your breast cancer risk, you can stop drinking alcohol completely. If you plan to continue drinking, try to have two or fewer alcoholic beverages per week.
  • Drinking is social for most of us. If you want to have a drink, consider some of the drink options that don’t include alcohol – the makers of nonalcoholic beverages have improved the taste of their products and they are now widely available.

The link between breast cancer and gut health.

Do you know that ER+ breast cancer is one of the most common breast cancers diagnosed (about 70-80%)? ER+ breast cancer means the cancer cells respond to and get growth signals from estrogen. Some very interesting research has looked at all the microorganisms in our gut and their relationship to the estrogen in our body. One of the key indicators of having a healthy gut is to have diverse and abundant microbiome (DNA of gut flora).

Recent studies suggest that gut microbes play a crucial role in regulating circulating estrogen levels. The estrobolome, a subset of microbiome, controls estrogen through two mechanisms: (1) increasing gut permeability (aka. leaky gut) for estrogen to slip out into the blood stream and (2) secreting an enzyme, called β-glucuronidase, that breaks down estrogen into their active forms to bring estrogen back to the body instead of being eliminating in the feces. As a result, your body becomes more estrogen dominant and therefore, the hormone sensitive tissue like the breasts can be affected.

This is still a new concept in research but has an exciting application for us. Taking care of our microbiome is one of the ways that may have a major impact on reducing the risk of breast cancer and recurrence, and overall wellbeing may be improved by reducing inflammation and obesity.

Having a diverse and balanced microbiome is critical in gut health and the immune system. Simply speaking, promoting a healthy balanced microbiome may help you regulate estrogen naturally. Here are a few tips you can try:

1. Eat plenty of vegetables, composed of ALL colors, plus introduce fermented vegetables to boost your gut flora.

2. Avoid trans-fat and corn syrup, which will increase inflammation in the gut and also liver, which are the major detox systems in your body.

3. Reduce sugar consumption — bad bugs tend to like “sweet treats.”

4. Reduce stress which can significantly compromise a diversity of gut microbes.

5. Walking in nature: did you know spending time in nature can actually diversify a healthy microbiome without taking probiotics?

6. Go green: try to minimize plastics, which can contain a lot of toxic chemicals, such as bisphenol-A(BPA). Good bacteria can’t thrive in the chemical environment.

7. Be aware of some medications which can disturb a healthy microbiome such as antibiotics, acid reducers and steroids.

8. Try to have a good bowel movement daily to make sure you are excreting an excess of estrogen.

9. Lastly, get adequate sleep at night. Research shows that the disrupted or shifted circadian rhythm can compromise your gut flora.Reference: Maturitas 103 (2017) 45–53; JNCI J Natl Cancer Inst (2016) 108(8)

Huntington Hospital offers free support groups, programs, as well as educational and exercise classes — CLICK HERE to see the dates and times they’re offered.

Interested in learning more about a certain topic?
CLICK HERE to email us.

Extending hormonal therapy to treat breast cancer.

Approximately two-thirds of all breast cancer is positive for estrogen receptors (ER) and progesterone receptors (PR). These receptors are the proteins in the cell that estrogen and progesterone bind to. This binding has to occur before estrogen and progesterone can act on the cell. In breast cancers that are ER and/or PR positive, the presence of these receptors allows hormones to stimulate the cancer cell, thus essentially fueling the growth and survival of the cancer. Medications that block either the body’s production of estrogen and progesterone, or the action of these hormones on the cell, are a crucial part of the treatment for breast cancer patients whose tumors are ER and/or PR positive.

The optimal duration of hormonal therapy has been the subject of many studies over the years. Early studies with tamoxifen (a drug which prevents estrogen from binding to its receptor) indicated that treatment should continue for at least five years, because shorter durations of treatment were clearly inferior. However, more definitive studies which were reported this decade clearly showed that extending the length of tamoxifen use from five years to ten years reduced the risk of breast cancer recurrence.

Another approach to hormonal therapy for breast cancer, which is used only in postmenopausal women, is the use of any of the drugs which belong to the class known as aromatase inhibitors. Even after menopause, the body still makes some estrogen in tissues other than the ovaries, and aromatase is an enzyme that is required for this estrogen production. The currently used aromatase inhibitors are anastrozole, letrozole and exemestane.

Some women take tamoxifen for two to five years and then switch to an aromatase inhibitor (AI). Many studies have looked at this strategy, and the data clearly show that treatment with an AI after tamoxifen decreases the risk of breast cancer relapse. However, the optimal duration of AI therapy remains unclear. Aromatase inhibitors can also be used as stand-alone hormonal therapy in postmenopausal women. However, optimal duration of treatment with an AI alone is also unclear.

The approach of many oncologists is to make a recommendation based in part upon the patient’s risk of relapse. For a very low risk patient, the risks and side effects of extending treatment beyond five years may be difficult to justify, but in a patient with a very high risk of recurrence, the risk/benefit ratio probably favors continuing therapy for up to ten years, and perhaps even fifteen. There is a test which can be performed on the original tumor specimen to estimate the patient’s risk of a late relapse (i.e., after five years). All of the available information about the characteristics of the patient’s tumor, and knowledge of her other health issues, if any, need to be taken into consideration by the patient and her physician so that they can make a well informed joint decision about the best course of action in treating her cancer.

FDA approves pertuzumab for treatment after surgery in HER2+ breast cancer.

  • While surgery is a fundamental part of treating early stage breast cancer, HER2+ breast cancers are additionally treated with a combination of chemotherapy and targeted agents.
  • Targeted agents like trastuzumab and pertuzumab are antibodies that recognize the HER2 protein on cancer cells and help lead to cell destruction.
  • For many years the standard of care was chemotherapy with trastuzumab followed by trastuzumab alone to complete a year of therapy.
  • Due to data presented in the APHINITY trial, pertuzumab has now been approved for treatment after surgery in operable breast cancer in combination with chemotherapy and trastuzumab, and continued with trastuzumab to complete a year of treatment.
  • Patients treated with both trastuzumab and pertuzumab lived longer without a relapse of their cancer compared to those patients treated with trastuzumab alone.
  • Based on these results, pertuzumab is now approved for use in high risk, operable, HER2+ breast cancer in conjunction with chemotherapy and trastuzumab to complete a year of treatment.

Breast cancer clinical trials.

Clinical trials are research studies conducted in order to help doctors discover new treatments for breast cancer, as well as new ways to detect, diagnose, and reduce the risk of disease. Clinical trials also help researchers and doctors decide if the side effects of a new treatment are acceptable when weighed against the benefits offered by the new treatment.

Clinical trials are just one type of research that’s done before a new treatment becomes available to people. New medicines must first be discovered and tested in preclinical trials before researchers even think about clinical trials. According to the American Cancer Society, about 1,000 potential medicines are tested before one makes it to clinical trials. On average, a new medicine to treat breast cancer has been studied for at least 6 years (and sometimes many more) before a clinical trial on it is started.

Researchers don’t know what the results of clinical trials will be. This uncertainty can make it hard to decide if you want to participate in one. In rare cases, clinical trial volunteers have been hurt by the treatment or procedure being tested. At the same time, hundreds of thousands of people have been helped and are alive because other people chose to participate in a trial that resulted in a new, more effective treatment. While clinical trials are important, the choice to participate in one is very personal and depends on your unique situation. As with any breast cancer treatment, you and your doctor need to weigh the benefits against the risks and decide what’s best for you.

Today, fewer than 5% of breast cancer patients receive treatment for their disease in a clinical trial. Why? One factor is that information about current trials and how to enroll in a trial are often not well understood. In the U.S., the National Cancer Institute provides information on clinical trials – visit www.cancer.gov or call 1-800-4CANCER for more information on nationally available clinical trials. For more information about clinical trials currently available through Huntington Cancer Center, visit www.huntingtonforher.org or call the Clinical Research Department directly at (626) 397-3877. Remember to always talk to your doctor. He or she may know of a trial that is right for your unique situation.

Huntington Hospital offers free support groups, programs, as well as educational and exercise classes — CLICK HERE to see the dates and times they’re offered.

Interested in learning more about a certain topic?
CLICK HERE to email us.

Advancements in radiation therapy in treating breast cancer.

Major advancements in radiation therapy have occurred over the past decade. Radiation therapy uses high dose x-rays to deliver external beam radiation therapy, or radioactive isotopes to treat with internal radiation. Breast cancer cells have long been known to be sensitive to radiation treatments. Radiation therapy is given to the breast after lumpectomy to allow a woman to keep her natural breast. Radiation therapy can also be recommended to some women after mastectomy to prevent the cancer from returning and prolong survival.

Radiation therapy techniques have dramatically improved over time. There is now stereotactic radiosurgery (SRS) as well as stereotactic body radiation therapy (SBRT) to treat tumors that have spread to the brain or body. These techniques use multiple beams targeting tumors to deliver a high dose to the tumor with excellent local control. At Huntington Cancer Center, patients can be treated on our Elekta treatment machine, which uses 4D imaging to allow us to monitor and treat a tumor in the lung while the patients’ lungs are moving. This helps our patients with cancer that has spread to have a much better quality of life, avoid surgery, and control small tumors.

New “hypofractionated” (shorter courses of) radiation therapy has shown to be effective with the same cosmetic results in post lumpectomy patients. Large trials in the UK showed that three weeks of treatment was equal to five weeks of whole breast radiotherapy. Side effects were similar and cosmetic results were identical. Of course, a shorter course of treatment is more cost effective and certainly much more convenient for patients. Hypofractionated radiation therapy is now the standard of care for women over 50 with early stage breast cancer, and recent studies have shown that it is actually better tolerated.

Selected early stage breast cancer patients may also be candidates for partial breast irradiation (radiation). This can be delivered with an implant approach with internal radiation therapy using a radioactive isotope, or with external beam techniques. Huntington Cancer Center is the center of excellence for the SAVI (strut adjusted volumetric implant) partial accelerated breast irradiation therapy. Patients are treated twice a day over a 5-day course of therapy. However, with the new shorter courses of radiation, partial breast external beam radiation is extremely convenient and is usually the treatment of choice.

Multiple recent clinical trials have shown that radiation therapy to the axilla, or armpit area, can be given instead of surgery to remove the lymph nodes. Radiation to those nodes offers equivalent control with less complications such as nerve pain or chronic swelling of the arm (lymphedema). Even in patients who have cancer that has spread to the nodes, radiation can control the disease and help avoid surgical removal of them, which improves quality of life. Women with large tumors and nodes positive for cancer spread, post-lumpectomy or post-mastectomy, are often offered radiation to the chest and regional nodes to avoid a local recurrence and improve survival.

Overall survival for breast cancer patients has been improving over the past decade with extremely effective treatments reducing the risk of recurrence. Ongoing trials, in which Huntington Cancer Center participates, will continue to define the future of radiation therapy for breast cancer.

Radiation therapy is no longer a “one-size fits all” treatment.

Radiation treatments are now customized for each particular patient.

  • Hypofractionated radiation techniques with shorter courses of treatment have dramatically improved the quality of life for patients undergoing radiation therapy.
  • Shorter courses are better tolerated with the same long-term control and certainly greater convenience.
  • For early stage breast cancer patients, shorter courses of radiation therapy have been shown to be effective and more convenient with equal cosmetic results.
  • Stereotactic radiation techniques can treat tumors in the brain or body eliminating the need for surgery and drastically improving the quality of life for patients living with cancer that has spread.
  • Radiation therapy can be used to treat the axilla (armpit) instead of removing the lymph nodes in that area.
  • Major improvements in radiation therapy for breast cancer patients are decreasing the risk of chronic lymphedema (buildup of fluid in the body’s tissues) in patients’ arms, as well as decreasing pain after surgery and preventing nerve issues like numbness or weakness.

Huntington Hospital offers free support groups, programs, as well as educational and exercise classes — CLICK HERE to see the dates and times they’re offered.

Interested in learning more about a certain topic?
CLICK HERE to email us.

Surgical treatment for breast cancer.

Being diagnosed with breast cancer is a life changing experience. Among the many decisions patients will make regarding their cancer treatment, is the choice regarding the best surgical treatment option.

The role of surgery in breast cancer treatment is to remove the tumor in the breast, as well as determine if the cancer has spread to the lymph nodes under the arm (axilla). Multiple large clinical trials have demonstrated that the overall survival rates for patients undergoing breast-conserving surgery (lumpectomy) and radiation versus total mastectomy are the same. At Huntington Cancer Center, breast surgeons work with the patient to help her decide what the best option is, based on:

  • type of tumor
  • size of the tumor
  • molecular features of the tumor (estrogen receptor, progesterone receptor, HER2/neu status)
  • overall health
  • family history
  • patient’s personal preferences

Breast cancer surgery does not have to be disfiguring or deforming. Advances in surgical techniques for breast cancer have allowed women to complete their cancer treatment without sacrificing their body image or self-esteem. Balancing cancer treatment with the cosmetic outcome can be an important consideration when determining the best choice.

Breast Reconstruction

  • A type of surgery for women who have had all or part of a breast removed. It is performed by a plastic reconstructive surgeon.
  • The surgery rebuilds the breast mound and restores the patient’s breast shape and look.
  • The nipple and the darker area around the nipple (areola) can sometimes be saved, or reconstructed in a subsequent surgery.
  • Women who have had only the part of the breast around the cancer removed (lumpectomy) usually do not need reconstruction.
  • Most women who have had the entire breast removed (mastectomy) can have reconstruction.
  • Breast reconstruction can be done with 1) breast implants (filled with saline or silicone), 2) natural tissue flaps (using skin, fat, and sometimes muscle from another part of her own body, or 3) the combination of a flap and implant.
  • It can be performed at the time of mastectomy (immediate) or at a later point in time (delayed).
  • Because each patient and her breast cancer are unique, the ideal timing of each reconstructive surgery is unique.

Clinical trial: Decreasing pain after breast surgery.

Mastectomy with immediate breast reconstruction is associated with increased operative time, increased time in the hospital, and prolonged recovery due in part to increased pain and discomfort after surgery. Post-operative pain is treated with pain medications, which may result in side effects — including nausea, sedation, and constipation — that can slow the overall recovery process. Therefore, anesthetic techniques which reduce the side effects resulting from general anesthesia and opioid medications, while optimizing perioperative (all three phases of surgery) pain control are needed.

The pectoral nerve block is a safe, easy, and reliable nerve block which can be administered at the time of surgery, and may provide complete pain relief during breast surgery. The pectoral block has been shown to result in lower perioperative opioid consumption, and lower rates of nausea and vomiting in women with breast cancer undergoing modified radical mastectomy without reconstruction.

Huntington Cancer Center is currently studying the effect of a pectoral nerve block on postoperative pain, nausea, and vomiting, and perioperative opioid consumption in women undergoing mastectomy with immediate breast reconstruction. Results from this study will hopefully help doctors reduce post-operative pain and improve the overall experience for women who need or choose to undergo these surgeries. For more information about this clinical trial, and others being offered through Huntington Cancer Center, call (626) 397-3877.

Huntington Hospital offers free support groups, programs, as well as educational and exercise classes — CLICK HERE to see the dates and times they’re offered.

Interested in learning more about a certain topic?
CLICK HERE to email us.

Post-traumatic growth and hypnotherapy.

Post-traumatic growth (PTG) is a positive, often transformative, change experienced as a result of a struggle with a major life crisis, such as cancer or a traumatic event. Patients sometimes use the words “blessing” or “gift” when describing their cancer experience.

There is increasing evidence that shows PTG is linked to higher quality of life, positive coping skills, healthy lifestyle changes, less psychological distress, increased quality of social relationships, engagement in spirituality, and increased compassion for others.

Mind-Body Medicine (MBM) is the field of medicine focused on the ways the mind and emotions influence the body and physical health. One of the most effective MBM techniques is hypnotherapy. Hypnotherapy has been demonstrated as an effective supplementary therapy to lessen the side effects of cancer treatment.

Huntington Cancer Center is currently conducting a study to determine if early use of hypnotherapy in cancer survivors can decrease stress and facilitate PTG. Ultimately, promoting the development of PTG may serve as an important cornerstone of cancer therapy, so that patients not only survive cancer, but also develop positive changes in their attitude, lifestyle, and quality of life as well as in brain volume and biochemistry.

Integrative oncology (IO) is:

  • an evolving evidence-based specialty that uses complementary therapies along with medical treatment to improve quality of life and clinical outcomes.
  • patient-centered (the therapy is chosen according to the patient’s preferences).
  • multi-dimensional (addressing mind, body, and spiritual aspects of health simultaneously).
  • safe (uses the least invasive and pharmacological treatments).

The purpose of IO is to:

  • improve quality of life.
  • enhance effectiveness of cancer treatment (i.e. surgeries, chemo/radiation therapy).
  • minimize complications from cancer treatment such as peripheral neuropathy, hot flashes, pain, lymphedema, fatigue, anxiety, insomnia, nausea, diarrhea, constipation, and much more.
  • educate patients on self-empowerment and lifestyle modification that could potentially reduce both cancer recurrence and increase quality of life.
  • reduce cancer distress and stress in general.

A holistic approach.

Debbie Saale was diagnosed with breast cancer following a routine mammogram at Huntington Hospital’s Jim and Eleanor Randall Breast Center. “After my screening, I was called back to undergo diagnostic testing,” says Debbie, “and results confirmed that I had cancer.” She went on to have breast surgery and chemotherapy here.

Debbie later developed edema in her legs and feet — a common side effect of cancer treatment, involving swelling caused by a build-up of fluid. At the suggestion of her nurse navigator, Nancy Cushing, RN, Debbie turned to Suzie Kline, manager, integrative oncology, for help. “Suzie suggested that I begin a regimen of acupuncture to treat the edema,” says Debbie. “I felt much better after just one session!”

Debbie voices enthusiasm about the integrative oncology services such as acupuncture that are readily available to our cancer patients. “It would never have occurred to me to pursue that kind of support if it wasn’t in the same facility as the rest of my appointments,” she says.

Today, Debbie is cancer free and grateful for the full range of compassionate care she received. “The support and encouragement from my entire care team was incredible,” she says. “They showed they really cared – and that means everything.”

Huntington Hospital offers free support groups, programs, as well as educational and exercise classes — CLICK HERE to see the dates and times they’re offered.

Interested in learning more about a certain topic?
CLICK HERE to email us.

Comprehensive, lifesaving care.

Thanks to care received at Huntington Hospital Cancer Center, Anita Chavez is now cancer-free. When she found a lump during a breast self-examination, “I knew immediately that it was cancer,” she says. “I had a history of developing cysts — and the lump I found felt different.”

Anita’s physician referred her to our Jim and Eleanor Randall Breast Center. Diagnostic tests confirmed that the lump she had found was cancer — and she went on to receive treatment here, via breast surgery as well as radiation therapy and chemotherapy.

Over the course of her care, Anita took advantage of some of the many supportive services — including acupuncture and hypnotherapy — available to our cancer patients. She also turned to our Constance G. Zahorik Appearance Center for help managing the aesthetic side effects of cancer treatment.

“Huntington Hospital Cancer Center treats the whole person — mind, body and spirit,” Anita says. “My entire care team was devoted to helping me fight breast cancer and I can’t thank them enough.”

  • Breast cancer treatments can lead to bone loss, so there is an increased risk of osteoporosis in breast cancer survivors.
  • Osteoporosis is a disorder of the skeleton that weakens bones and results in frequent fractures (breaks).
  • Estrogen plays an important role in preserving bone health. Unfortunately, endocrine therapy or anti-estrogen therapy is necessary in the majority of breast cancer patients as estrogen drives the growth of cancer cells.
  • Chemotherapy in premenopausal patients can cause premature ovarian failure, which results in less years of circulating estrogen to help protect bone health.
  • Steroids are utilized in many of the chemotherapy regimens and can also cause bone loss.
  • To prevent bone loss, take calcium and vitamin D supplements, perform weight-bearing exercises, quit smoking, and reduce heavy alcohol consumption.
  • For more severe cases, talk to your doctor about medications that can help preserve bone density.

Nurse navigators’ role in the breast cancer journey.

Nurse navigators are registered nurses who assist patients through every aspect of their cancer journey. They are patient educators, care coordinators and mostly patient advocates. They support patients and their families throughout a critical time – from initial diagnosis to post cancer care.

Nurse navigators provide information to help patients and their families fully understand treatment options, while at the same time working closely with doctors and other members of the multidisciplinary care team to ensure coordination of services and the highest quality of care.

When I received the diagnosis of breast cancer, I felt as if my life had been turned upside down. From day one, my nurse navigator has been there for me – I talked to her on the phone the day I received by diagnosis. Through my tears, she reassured me that she would help me through it all. She has MORE than lived up to her words. At every step of the way, she has made it a point to check in with me either by phone or in person. She has answered the countless questions I’ve thrown her way or directed me to the proper resource if needed. She has literally held my hand, been a shoulder to cry on, as well as someone to share an occasional laugh or just talk with. I will forever remember the extraordinary, heartfelt care I received from my nurse navigator at Huntington Hospital Cancer Center.”

GRATEFUL BREAST CANCER PATIENT

Huntington Hospital offers free support groups, programs, as well as educational and exercise classes — CLICK HERE to see the dates and times they’re offered.

Interested in learning more about a certain topic?
CLICK HERE to email us.

COVID-19 UPDATE: Elective surgeries cancelled. Classes/events cancelled. Restricted visitor policy. COVID-19 line (626) 397-3777. Learn how you can help.   >> READ MORE
close
open