Wednesday, March 31, 2010

Watch Jennifer Griffin on Greta tonight

Jennifer Griffin will be talking about all things Triple Negative on the Greta Van Susteren Show tonight at 10 PM on the FoxNews channel.
Here is Jen's note:

Dear friends,
Get your air popper ready and your green tea brewed (or set your DVR - if you have a Nielsen box put it on all day :) Greta Van Susteren is interviewing me tonight on Fox about Triple Negative breast cancer, what the latest research shows, how we as a family have gotten through the last 5 months (not that you, dear reader, may not already know more than you care to about this process thanks to the "blog"). Seventeen rounds of chemo later, we are gearing up for a double mastectomy on Tuesday (I can't wait to check into Georgetown and finally get some rest!). In the meantime, tonight I'll share whatever I've learned in recent months to help others get through chemo, how to talk to your kids when you get this annoying diagnosis, which wigs work, etc, etc. Tune in at 10 pm Eastern tonight - you may even get to see me do Pilates bald - now that is Must See TV!


Thursday, March 25, 2010

Intimacy After Breast Cancer, Dealing With Your Body, Your Relationships and Sex

The New Book is finally out!

Finding Your Way Back to Life (and Love) After Breast Cancer

Square One Publishers Proudly Presents
A New Book That Gives Hope, Help and Direction to Women
With Breast Cancer and to All Who Love Them

Intimacy After Breast Cancer, Dealing with your Body, Your Relationships and Sex

While medical professionals prepare you for the physical effects of cancer, they seem to forget about your spirit, your emotions, and your sexuality. So how do you put cancer behind you and go back to being the woman you used to be? In Intimacy after Breast Cancer, two-time breast cancer survivor Gina Maisano compassionately discusses this and more in an open, honest way, helping you rediscover the woman you were before your battle with this disease.

Part One of this book is about regaining control of your body and your spirit. It examines ways in which you can deal with the emotional and physical scars of breast cancer so that you can regain confidence and self-esteem. Part Two is about reclaiming your sexual self. In candid detail, and addressing both married and single survivors, it explores how you can rediscover your sexuality after breast cancer. Throughout the book, stories contributed by other survivors offer a wealth of personal perspectives and specific examples of physical recovery and emotional healing.

Love and intimacy do not have to end because of breast cancer. In Intimacy after Breast Cancer, Gina uses expert advice, scientific research, and firsthand experience to help you make the difficult transition from cancer patient to vibrant, self-confident woman.

Available now!

Monday, March 22, 2010

What is in The Bill

A look at the health care overhaul bill
March 22, 2010 by The Associated Press

Congressional Democrats released a final version of President Barack Obama's health care overhaul bill in advance of passage Sunday by the House. Some features of the legislation, which makes changes to the bill the Senate passed on Christmas Eve:
COST: $940 billion over 10 years, according to the Congressional Budget Office.

HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.

INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine. There is an exemption for low-income people. Mandate takes effect in 2014.

INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.

MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016. A special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity is eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisianna worth as much as $300 million, remains.

TAXES: Dramatically scales back a Senate-passed tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed until 2018, and the thresholds at which it is imposed would be $10,200 for individuals and $27,500 for families. To make up for the lost revenue, the bill applies an increased Medicare payroll tax to the investment income and to the wages of individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent.

PRESCRIPTION DRUGS: Gradually closes the "doughnut hole" coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. Seniors who hit the gap this year will receive a $250 rebate. Beginning in 2011, seniors in the gap receive a discount on brand name drugs, initially 50 percent off. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare's catastrophic coverage kicks in.

EMPLOYER RESPONSIBILITY: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker.

SUBSIDIES: The proposal provides more generous tax credits for purchasing insurance than the original Senate bill did. The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges, opening for business in 2014. The exchanges would offer the same kind of purchasing power that employees of big companies benefit from. People working for medium-to-large firms would not see major changes. But if they lose their jobs or strike out on their own, they may be eligible for subsidized coverage through the exchange.

GOVERNMENT-RUN PLAN: No government-run insurance plan. People purchasing coverage through the new insurance exchanges would have the option of signing up for national plans overseen by the federal office that manages the health plans available to members of Congress. Those plans would be private, but one would have to be nonprofit.

ABORTION: The proposal keeps the abortion provision in the Senate bill. Abortion opponents disagree on whether restrictions on taxpayer funding go far enough. The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

Saturday, March 20, 2010

A Closer Look at Health Care Reform

I have spent a good portion of the day watching the last ditch arguments in Congress on the health reform bill that will most likely pass tomorrow afternoon and move on to the Senate.

While there are really no big changes from the last version, there have been revisions that reflect a softening of the language and an attempt to appease certain bases.  I am looking at it only from the view of a cancer survivor and as an advocate for women who have cancer.

One thing I have discovered is very troubling. I hope that this will be fixed when it goes to the Senate, but chances are it won't be.

Here is my concern:

Insurance vouchers or coverage will become available to all Americans. This is not the same as a public plan, but it essentially "gives" coverage to those Americans who do not have it, or who lose their current insurance plan. Right now, this will be in the form of an expanded Medicaid. Anyone who has cancer knows it is hard to find specialists who accept Medicaid patients. There is a great risk that we would receive substandard care. No one has addressed what kind of care Americans will receive with these vouchers. When we are told, "If you like your plan, you will be able to keep it; If you like your doctor,  you will be able to keep him" that is not necessarily true. Here's why:

If you are a single payer, your current insurance carrier can now use a loophole to drop you. If you are a single payer with a serious medical condition, they will find that loophole to drop you as fast as humanly possible.  If your company provides you with health insurance, and they now do not have to do so, you could lose your coverage. So, here you are, with a history of breast cancer, the mother of pre-existing conditions, and no insurance. You can try to find a specialist from the wading pool of Medicaid providers and then try to fight for the kind of chemo, follow-up care and cutting edge treatments that are available to you now but are virtually unknown under Medicaid,  or, you can join another insurance plan.  Right? Yes. In 2014. You see, while they are making it illegal for carriers to deny you coverage if you have a pre-existing condtion, that only takes effect in 2014. With breast cancer, you do not have four years to wait to get Herceptin or get PARP.

When you see that Congressman from Central Casting get up and read a "letter" about Erma-Lou from Podunk who died because she was too poor, what they leave out is that those Americans who have little to no income have Medicaid as their insurance plan. Erma-Lou died because she didn't get proper care under Medicaid... and that is where they want to send us.

What happens to those of us who have life-threatening illnesses? Look up the doctors in your area. Check to see if your oncologist or breast surgeon accepts Medicaid patients and see for yourself. This is one question we need an answer to. This bill will be passed tomorrow. It will then go to the Senate. It is then provisions for US can be added and then the bill would be sent back to the Congress so they can start the process all over again.

This is not Republican or Democrat. This is me, writing to you, my sisters. Our lives are at stake. We need to make sure we are protected, and that those who follow us are protected, too.

Thursday, March 11, 2010

Scientific Proof for our Before Forty Initiative!

 The No Surrender Breast Cancer Foundation's Before Forty Initiative is dedicated to ensuring young women get screened before the age of forty as the current guidelines dictate. It is our mission to have women be screened by breast MRI over mammography because it is more sensitive and can find tumors at their smallest stage and can detect cancers in the densest of breasts, which are more often found in young women. A study now backs up our cause:

Breast Cancer Screening: MRI Sensitive, No Added Value With Mammography, Study Suggests

ScienceDaily (Mar. 8, 2010) — Do we need a revision of current recommendations for breast cancer screening? According to a recent prospective multicenter cohort study published in the Journal of Clinical Oncology, this appears advisable at least for young women carrying an increased risk of breast cancer. The results of the EVA trial confirm once more that magnetic resonance imaging (MRI) is substantially more accurate for early diagnosis of breast cancer than digital mammography or breast ultrasound: MRI is three times more sensitive for breast cancer than digital mammography.

For the EVA trial, almost 700 women were enrolled. Aim of the trial was to refine existing guidelines for surveillance of women at high and moderately increased risk of breast cancer. Findings suggest that in these women, MRI is essential for early diagnosis -- and that a mammogram or an ultrasound examination does not increase the "cancer yield" compared to what is achieved by MRI alone. Researchers conclude that annual MRI is not only necessary, but in fact sufficient for screening young women at elevated risk of breast cancer. In women undergoing screening MRI, mammograms will have no benefit and should be discontinued. Moreover, MRI screening is important not only for women at high risk, but also for those at moderately increased risk.

Between 2002 and 2007, the EVA trial recruited 687 women who carried a moderately increased risk of breast cancer (lifetime risk of 20% and over). Women underwent 1679 screening rounds consisting of annual MRI, annual digital mammography and half-annual screening ultrasound examinations. During this time span, 27 women received a new diagnosis of invasive cancer or DCIS (Ductal Carcinoma In Situ).

Of all imaging methods under investigation (digital mammography, ultrasound and MRI), MRI offered by far the highest sensitivity: MRI identified 93% of breast cancers. 37% of cancers were picked up by ultrasound. The lowest sensitivity was achieved by digital mammography, which identified only one-third of breast cancers (33%). These results confirm once more that MRI is essential for surveillance not only of women at high risk, but also for women at moderately increased risk of breast cancer. Moreover, the results contradict current guidelines according to which mammography is considered indispensable for breast cancer screening. One aim of the EVA trial was to question this concept and to ask whether it is still appropriate to require that MRI should only be used in addition to mammography. The results speak for themselves: If an MRI is available, then the added value of mammography is literally negligible. Researchers conclude that MRI is necessary as well as sufficient for screening young women at elevated risk of breast cancer. Since mammography appears to be unnecessary in women undergoing MRI, its use is no longer justifiable, and current guidelines should be revised to reflect this.

Current guidelines questionable

Current guidelines for women at high familial risk of breast cancer recommend annual MRI (with or without ultrasound) and annual MRI starting at age 25-30. "These guidelines were set up based on little or no scientific evidence, and mainly reflect expert opinion," summarizes Prof. Christiane Kuhl, radiologist at the University of Bonn and principal investigator of the EVA trial. "In the light of the results of the EVA trial, such recommendations should be revisited." This seems even more important because digital mammography uses x-rays (ionizing radiation) to detect breast cancer. "The radiation dose associated with regular mammographic screening is clearly acceptable and safe," underscores Kuhl. "However, regular mammographic screening usually starts at age 40-50." The situation is different if systematic annual mammographic screening is started at age 25-30. "Not only because these women will undergo more mammograms and therefore will experience a cumulative lifetime radiation dose that will be substantially higher, but also because the breast tissue of young women is more vulnerable to the mutagenic effects of radiation." This appears to be especially true for BRCA mutation carriers. "Accordingly, we impose more radiation on less radiation-tolerant breast tissue -- for a very limited, if any, diagnostic benefit." Therefore, Kuhl advocates a revision of existing guidelines: "It is no longer justifiable to insist on annual mammographic screening women in their thirties if they have access to screening MRI."

MRI is a mature technology

In the past, MRI was used strictly in addition to mammography only. The allegedly high rate of "false positive" diagnoses and the allegedly insufficient sensitivity for DCIS were the main reason to discourage its use as a stand-alone method for breast cancer screening. "In this multicenter trial, with basic quality assurance implemented not only for mammography, but also for MRI, we were able to prove that false positive diagnoses are avoidable if MRI studies are interpreted with adequate radiologist expertise." In the EVA cohort, the Positive Predictive Value achieved with MRI was already even higher than that of mammography or breast ultrasound. "Moreover, we found that MRI offered the highest sensitivity especially for DCIS," adds Dr. Kuhl. "It is simply wrong to state that we need a mammogram to detect intraductal cancer."

Kuhl et al. Prospective Multicenter Cohort Study to Refine Management Recommendations for Women at Elevated Familial Risk of Breast Cancer: The EVA Trial. Journal of Clinical Oncology, 2010; DOI: 10.1200/JCO.2009.23.0839

Monday, March 8, 2010

Ms. Theron's Helpful Fashion Tip

Did you forgo reconstruction?
Do you have a formal affair coming up and do not know what to wear?
Look no further than last night's Oscars.
The perfect dress for prostheses wearers...

Friday, March 5, 2010

Targeted Therapy for Certain Triple Negative Cancers

This could be big. Breast cancer is not one disease as we all know. Triple Negative Breast Cancer has been on the back burner in terms of new therapies, until now. PARP treatment is changing the future of metastatic TNBC patients. Now, a new, targeted therapy has identified a sub-type of TNBC tumors...

New Subtype of Breast Cancer Responds to Targeted Drug

ScienceDaily (Mar. 2, 2010) — A newly identified cancer biomarker could define a new subtype of breast cancer as well as offer a potential way to treat it, say researchers at Washington University School of Medicine in St. Louis.

Their findings will be published in the March 1 online early edition issue of the Proceedings of the National Academy of Sciences.

The research could further refine what recent breast cancer research has concluded: that breast cancer is not one disease, but many. So far, research has firmly established that at least five subtypes of breast cancer exist, each having distinct biological features, clinical outcomes and responses to traditional therapies.

The biomarker identified by the Washington University researchers is found frequently in breast cancers and especially in those that have poorer outcomes. It stems from overactivation of a gene called LRP6 (low-density lipoprotein receptor-related protein 6), which stimulates an important cell-growth signaling pathway. LRP6 can be inhibited by a protein discovered in the same laboratory, which could become an effective drug against the breast cancer type, the researchers say.

"We found increased expression of the LRP6 gene in about a quarter of breast cancer specimens we examined, and we think LRP6 overexpression could be a marker for a new class of breast cancer," says Guojun Bu, Ph.D., professor of pediatrics and of cell biology and physiology. "In addition, we found that this biomarker is often associated with breast cancers that are either harder to treat or more likely to recur. We already have an agent that seems to be effective against LRP6-overexpressing tumors, which could someday become a therapy for tumors that right now have few treatment options."
The research was conducted primarily by Chia-Chen Liu, a graduate student in the Bu lab, who is a fellow in the Cancer Biology Pathway Program at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital.

The researchers' analysis of human breast cancer tissue samples found significant increases in LRP6 levels in 20 percent to 36 percent of the tumors. LRP6 was increased more frequently in ER (estrogen receptor)-negative or HER2 (human epidermal growth factor receptor 2)-negative samples. LRP6 was also increased more frequently in so-called triple-negative breast tumor samples, which test negative for ER, HER2 and PR (progesterone receptor).

In general, patients who have triple-negative breast cancers have an increased risk of disease recurrence after initial treatment and a poorer prognosis. Furthermore, although ER-positive and HER2-positive tumors can be targeted with specific therapies, ER-negative and HER2-negative tumors cannot. So it appears that LRP6 overexpression is often associated with tumors that are currently difficult to treat, says Bu.

Research in the lab had earlier discovered a protein that binds to and inhibits LRP6. This study showed that the protein, called Mesd (mesoderm development), was able to slow the growth of breast cancer cells in the laboratory and to inhibit mammary tumor growth in laboratory mice.

Importantly, mice treated with Mesd did not experience any of the known side effects, such as bone lesions, skin disorders or intestinal malfunctions, associated with inhibition of this growth pathway.
"Our work introduces Mesd as a promising antitumor agent that might be further developed for breast cancer therapy," Bu says. "It would be analogous to such successful breast cancer therapies as Herceptin (trastuzumab), which specifically targets HER2-positive breast cancer."

The researchers also found that a small segment of Mesd has the same effect as the larger molecule. This segment, or peptide, is more stable than the whole protein molecule and can be easily synthesized.

The researchers have patented the protein and the peptide through the university's Office of Technology Management. Recently, Raptor Pharmaceutical Corp. licensed Mesd from the university to develop it for clinical use.

Funding from the National Institutes of Health and the Siteman Cancer Center supported this research.