Breast cancer patient Sharon was diagnosed with triple-negative invasive lobular carcinoma after she found a lump after working out. Watch as she shares her breast cancer journey through two stages along with treatment – and what she learned and experienced with clinical trials and her advice to other patients. In Sharon’s words, “I do think that patients should be given all of their options upfront. I don’t think that clinical trials should be the last resort.”
Tag Archive for: Breast Cancer
From: NCI Cancer Currents Blog
May 15, 2020, by NCI Staff
Getting regular exercise may increase how long some women with breast cancer live, results from a new study show. Women who engaged in regular physical activity before their cancer diagnosis and after treatment were less likely to have their cancer come back (recur) or to die compared with those who were inactive, the study found.
The study was unusual in that it collected information on the physical activity levels of women with high-risk breast cancer (cancer that is likely to recur or spread) at multiple time points—shortly before their diagnosis, during chemotherapy, and after completion of treatment.
“Our data strongly suggest that the more consistently active patients were, the better they did,” said lead study author Rikki Cannioto, Ph.D., Ed.D., of Roswell Park Comprehensive Cancer Center in Buffalo, NY.
And while survival was extended in women who consistently met federal Physical Activity Guidelines for Americans over time compared with those who did not meet the guidelines, “there was still a survival advantage for women who [were active but] didn’t quite meet the guidelines,” Dr. Cannioto said.
These results “provide evidence that physical activity at any point in time appears to be beneficial for breast cancer survivors,” said Joanne Elena, Ph.D., M.P.H., of the Epidemiology and Genomics Research Program in NCI’s Division of Cancer Control and Population Sciences (DCCPS), who was not involved with the study.
“This study gives us further evidence that being more physically active after a diagnosis of breast cancer is one of the ways that breast cancer survivors can take matters into their hands and improve their health and decrease their likelihood of dying,” said Kathryn Schmitz, Ph.D., M.P.H., an exercise oncology researcher at the Penn State College of Medicine, who also was not involved with the study.
The new study was published April 2 in the Journal of the National Cancer Institute.
Looking at Exercise Over Time
The findings come from the NCI-funded Diet, Exercise, Lifestyle, and Cancer Prognosis (DELCaP) study, led by Christine Ambrosone, Ph.D., also of Roswell Park. The study was embedded in a large clinical trial, led by the NCI-funded SWOG Cancer Research Network, that compared different chemotherapy regimens for women with high-risk breast cancer.
The physical activity analysis by Dr. Cannioto and her colleagues included 1,340 patients from the SWOG trial who also enrolled in the DELCaP study. Participants completed questionnaires about the type, frequency, and duration of recreational physical activity they engaged in at four time points: during the month before diagnosis, during treatment, and at 1 and 2 years after study enrollment. Participants were followed for up to 15 years or until death, with a mean follow-up time of 89 months (7.4 years).
Much, though not all, previous epidemiologic research describing the link between physical activity and cancer outcomes is based on physical activity data collected at only one time point, Dr. Cannioto said.
Using the questionnaire responses, the researchers determined whether participants had met the minimum 2018 Physical Activity Guidelines for Americans at each time point. The guidelines recommend that adults engage in at least 2.5 to 5 hours of moderate-intensity physical activity or 1.25 to 2.5 hours of vigorous-intensity aerobic physical activity per week.
Women with breast cancer who met the minimum physical activity guidelines both before diagnosis and at the 2-year follow-up (after treatment) had a 55% reduced chance of their cancer returning and a 68% reduced chance of death from any cause (not just breast cancer) compared with those who did not meet the guidelines at both times.
Among patients who did not meet the guidelines before diagnosis but met them at the 2-year follow-up, the chance of recurrence or death was reduced by 46% and 43%, respectively, compared with those who did not meet the guidelines at both times. The finding, Dr. Elena said, suggests that “it’s never too late to start exercising to derive benefits.”
The researchers also performed “time-dependent analyses,” which help to account for the fact that physical activity data was collected over multiple time points,” Dr. Cannioto explained.
These analyses showed that, compared with inactive patients, the likelihood of death from any cause was reduced the most among highly active patients, but even patients who regularly engaged in low levels of physical activity saw a substantial survival benefit.
These findings “are good news for breast cancer patients, who can be overwhelmed by the physical activity guidelines, especially during treatment,” when they may be severely fatigued or in pain, Dr. Cannioto said. However, she emphasized, to achieve optimal health benefits, patients and survivors should still strive to meet the guidelines when they are able.
Reducing Self-Reporting Inaccuracies
Although physical activity information that people report themselves is not always accurate, the detailed questionnaire used in this study is likely to provide a better estimate of the amount of exercise that people do than a single question or brief survey would, “giving stronger credence to the findings,” Dr. Schmitz said.
In addition, evaluating the findings according to whether participants did or did not meet the physical activity guidelines, as the study authors did, rather than on how many minutes of physical activity people did each week, is also likely to reduce inaccuracies, said Richard Troiano, Ph.D., also of DCCPS’s Epidemiology and Genomics Research Program.
One limitation of observational studies like DELCaP and the many other epidemiologic studies that form the basis for the latest exercise guidelines for cancer survivors, Drs. Troiano and Elena said, is that such studies cannot definitively prove a cause-and-effect relationship between physical activity and improved survival or reduced risk of recurrence.
That’s because it’s also possible that “the people who feel better are more likely to be able to be physically active than those who are sicker,” Dr. Troiano explained.
Another limitation is that the DELCaP study only had information on patient deaths due to any cause, rather than on deaths due specifically to breast cancer, and physical activity may have less of an impact on breast cancer mortality, Drs. Schmitz and Troiano noted.
Move as Often as You Can, Whenever You Can
“This study comes at a time when we already have national and international physical activity recommendations for cancer survivors, for the purpose of reducing the risk of recurrence and mortality,” Dr. Schmitz said, and the new findings reinforce these recommendations.
It’s important to keep in mind, however, that “physical activity is not the only factor that determines whether breast cancer will recur, and it certainly is not the only determinant of death. It’s just one piece of the puzzle,” Dr. Elena said.
“We don’t want someone to think, ‘If I exercise enough, I won’t have a recurrence,’” she continued. “But if you can add physical activity into your day, it is likely to influence many types of health outcomes for breast cancer survivors.” That includes quality of life, anxiety, fatigue, and the ability to tolerate treatment, as well as the risk of dying.
The bottom-line message for breast cancer survivors, Dr. Elena concluded, is “Move as often as you can, when you can.”
TMIST (Tomosynthesis Mammographic Imaging Screening Trial), the large NCI screening study to learn about the best ways to find breast cancer in women who have no symptoms, is ramping up with 16,505 participants enrolled to date at 84 certified mammography clinics in the United States, Canada and Argentina.
The number of women and sites participating is likely to increase rapidly in the months ahead. Etta Pisano, MD, chief research officer at the American College of Radiology, and the principal investigator of TMIST, heads the efforts to get clinics involved. “We have 15 approved clinics working on the logistics to begin enrollment, and another 34 have committed to joining. We are pleased that there has been a great deal of interest from international sites and expect to bring on additional sites in Europe and Asia in the next 6 months,” Dr. Pisano said.
TMIST is a randomized phase 3 trial comparing standard digital mammography (2-D) with the newer tomosynthesis mammography (3-D). The goal is to follow all participants to see if they are diagnosed with breast cancer or a precancerous condition, and to record their treatment and outcomes from the time of randomization until the end of the study.
TMIST was designed to provide evidence about the role of mammography screening in reducing the incidence of life threatening, advanced breast cancers. This is a stand-in for breast cancer mortality, the usual endpoint for screening trials, because a trial using that endpoint would take many more years to complete.
All told, 164,946 healthy women ages 45 to 74 who are already planning to get routine mammograms will be enrolled. Women will be randomized to either 3-D or 2-D screening mammograms for 5 years. Each woman is assigned to a screening frequency of every 1 or every 2 years, based on her individual risks for developing breast cancer.
While Medicare and many private insurance programs provide full cost coverage for screening mammograms, with no co-pay, copays are still allowed for some mammograms in some states. Based on requests from women taking part in TMIST, some states are now funding co-payments or completely covering the participants’ cost for mammograms, according to the American College of Radiology (ACR). The study also has some funding for uninsured patients subject to the charity care policies of the participating institutions.
|States with Laws that Mandate
NO Co-pay for Screening Mammograms
|States with Laws that Allow
Co-pays for Screening Mammograms
|Arizona, Colorado, Connecticut, Illinois, Kansas, New Hampshire, New Jersey, New York, Oklahoma, Pennsylvania, Texas, Vermont, Washington||Kentucky, Louisiana, Maryland, Montana|
TMIST is supported by the NCI Community Oncology Research Program (NCORP) and co-led by the ECOG-ACRIN Cancer Research Group. “About 50 million screening mammograms occur every year in the U.S. and it’s important to note that despite the technology disbursement, there is a research study going on to inform the science and the clinical practice,” said NCORP Director Worta McCaskill-Stevens, MD, MS.
Toward Personalized Screening Recommendations
TMIST researchers also are collecting evidence of significant secondary endpoints including false positives, recall rates, biopsy rates, and overdiagnosis. Data is collected on the results of every mammogram, whether the imaging shows no signs of cancer, findings suspicious of cancer, or a breast cancer. Medical follow-ups, such as more imaging or biopsies, also are reported.
A key component of the trial is a biorepository with detailed clinical annotations. The subsequent molecular characterization of specimens and accompanying demographic information could help advance a personalized approach to screening recommendations that determines mammography use and intervals for each person based on their genetics and individual risk factors for developing breast cancer.
“The molecular evidence is the first step to personalizing breast cancer screening recommendations,” Dr. McCaskill-Stevens said. “The resulting dataset of clinical images and biospecimens will help us tailor future screening to each woman’s individual risk.”
More information and a list of participating sites is available from NCI and ECOG-ACRIN. For a discussion about the science involved in the study, see the article “Why I choose to play a dual role in TMIST” by Dr. McCaskill-Stevens in The Cancer Letter. “TMIST Trial Aims to Provide Clarity on Breast Cancer Screening Approaches” in the NCI Cancer Currents Blog offers more background on 2-D vs 3-D technology.
For more information about cancer clinical trials near you, click here.
TMIST Ramps Up to Illuminate Breast Cancer Screening was originally published by the National Cancer Institute.
Immunotherapy vs. Breast Cancer. In a landmark study, a patient’s advanced breast cancer regressed completely after treatment with immune cells that recognized products of mutations specific to her cancer.
In an ongoing NCI-led clinical trial at the NIH Clinical Center, a patient with metastatic breast cancer has experienced complete regression of her disease after treatment with an experimental immunotherapy developed in CCR. Despite multiple prior cancer treatments, her cancer continued to enlarge and spread until she received this new treatment. The case report, published in Nature Medicine, highlights the potential of immunotherapy for difficult-to-treat solid tumors.
Although cancer immunotherapies have brought about complete regression of disease in some patients, certain types of cancer, including breast cancer, have been difficult to treat with these approaches. The experimental approach being tested in the current trial, developed by CCR Surgery Branch Chief Steven A. Rosenberg, M.D., Ph.D., and colleagues, uses immune cells selected for their ability to recognize cells with mutations specific to a patient’s tumor to fight their disease—a strategy that Rosenberg says may serve as a blueprint to treat many cancers.
This type of immunotherapy, called adoptive cell transfer (ACT), uses cancer-fighting cells from a patient’s own immune system that are grown in large numbers in the laboratory and then infused into the patient. The specific form of ACT being investigated uses immune cells that have been isolated directly from a patient’s tumor, known as tumor-infiltrating lymphocytes (TILs). The key to this approach is the identification and use of only TILs that specifically recognize proteins encoded by genetic mutations present in the patient’s cancer.
The TILs used to successfully treat this patient’s breast cancer were selected after researchers compared the DNA and RNA from one of her tumors to her normal tissue and identified 62 mutations unique to her cancer. Next, the TILs isolated from her tumor were tested for their ability to recognize the products of these mutations. TILs recognizing proteins encoded by four different cancer-specific mutations were then selected for treatment. Along with the tumor-specific immune cells, the patient was given pembrolizumab, an immune system checkpoint inhibitor that allows cancer-fighting cells to remain active in the microenvironment of a tumor, and interleukin-2, which promotes immune cell growth.
More than three years after the treatment, the patient’s breast cancer has not returned. The team has also seen this type of immunotherapy trigger tumor regression in patients with liver cancer, colorectal cancer and cervical cancer, offering hope that it might be a broadly effective treatment strategy.
October 1, 2019
PINEHURST – The American Cancer Society estimates that by the year’s end in the United States 268,600 new cases of invasive breast cancer will be diagnosed in women and 41,760 will die from the disease. In North Carolina, where breast cancer ranks at the top of all new cancer diagnoses, that breaks down to 8,870 new cases and 1,390 deaths.
“There is a one in eight chance that a woman will be diagnosed with invasive breast cancer during her lifetime,” said Sushma Patel, M.D., a radiation oncologist with FirstHealth of the Carolinas. “While rates of death due to breast cancer are declining due to better screening and improved treatment options, we still have a long way to go.”
To aid in the battle against breast cancer, FirstHealth of the Carolinas joins National Breast Cancer Awareness Month, a campaign held every October to increase awareness of the disease and the importance of early detection.
“Early detection of breast cancer, when it’s small and contained, is the key to improved survival,” said Patel. “It’s essential that women have an annual mammogram, conduct a (monthly) self-exam and watch for changes in their breasts, including swelling, skin thickening or redness, breast warmth or itching and nipple discharge.”
ACS recommends women with an average risk of breast cancer to have yearly mammograms by age 45, but women at a high risk for the disease should talk with their physicians about starting mammograms earlier. Contributing factors to a higher risk include a family history of the disease; a known BRCA1 or BRCA2 gene mutation in the patient or in a first-degree relative (parent, brother, sister or child); radiation therapy to the chest between the ages of 10 and 30 years; or have Li-Fraumeni syndrome, Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, or first-degree relatives with one of these syndromes.
As men have breast tissue, they are also at risk for the disease, although at a much lesser rate; their lifetime risk is 1 in 833. The ACS estimates that by the end of 2019 about 2,670 new cases of invasive breast cancer will be diagnosed in American men and 500 will die from the disease.
Fortunately for patients in the Sandhills, the FirstHealth Cancer Care team offers comprehensive breast cancer care including screening and diagnostic imaging, breast biopsies, breast cancer surgery, medical and radiation oncology, genetic testing and clinical trials. For patients with any cancer diagnosis, a deep and wide array of support services is at the ready, including oncology nurse navigators who support and guide patients through their cancer journey, a financial navigator, nutritionists, social workers, support groups and spiritual counseling, cancer wellness programs, CareNet volunteers and many other supports that patients are referred to as necessary.
“Patients need to focus on getting well, not worry about barriers to care,” said Lynn Lanier, MSN, R.N., ONN-CG, an oncology nurse navigator at the FirstHealth Outpatient Cancer Center. “These supports are carefully designed to help lessen the anxiety associated with a cancer diagnosis and treatment.”
Sandhills residents can join FirstHealth in the fight against breast cancer in a number of ways:
— Participate in the 1in8k Run for Moore, a 1k fun run and 8k run/walk on Saturday, October 12. This annual community event in the Village of Pinehurst raises funds to fight breast cancer, increases public awareness and allows individuals to honor and support those who have battled or are currently battling the disease. Information is available at www.firsthealth.org/1in8k.
— Get a mammogram at any FirstHealth facility in October and receive a free pink lunch bag. Find locations at www.firsthealth.org/imaging and call (866) 415-2778 to schedule.
“I am looking forward to the day when the ‘1 in 8’ statistic changes to ‘1 in a million’,” said Patel. “We just need to keep working to achieve that goal.”
FirstHealth of the Carolinas is a SCOR member site located in the Pinehurst, NC area.