I promise

"I promise, Suzy... Even if it takes the rest of my life." - Nancy G. Brinker, founder of Susan G. Komen for the Cure

What is Triple Negative Breast Cancer?


Just in recent years, Triple Negative Breast Cancer has sparked interest in the news where instead of calling the tumor as ER-negative, PR-negative, and HER2-negative; researchers began using the shorthand term, "Triple Negative," dubbed the "new type" type of cancer. Being Triple Negative, you don't have a targeted therapy and that your only treatment option is chemotherapy.

Triple Negative is seen in about 15% of all breast cancers. Triple Negative is a very aggressive cancer that tends to strike younger women, pre-menopause, especially among African-American women and women who have BRCA1 mutations. The tumor tends to be fast growing and is less likely to show up on an annual mammogram. TN is more likely to metastasis early on; has a high rate of recurrence in the first 2-3 years from diagnosis and has a poorer prognosis than other types of breast cancer due to lack of specific, targeted treatment for TNBC.

Carpe diem

Seize Each new Day with Renewed Strength,
Believe in Yourself, Go forward with
Courage and faith
to face whatever Tomorrow may bring.

Chicks For Charity motto:

Enjoy life. Laugh a lot.
Work hard. Play hard.
Be thankful for our blessings.
Share the wisdom. Give back

Friday, April 29, 2011

Dr. Lisa Carey, World-Wide Expert In Triple Negative Breast Cancer

Lisa A. Carey, M.D.
Associate Professor
Breast Cancer

Clinical Interests
Dr. Carey is board-certified in both Internal Medicine and Medical Oncology. Her clinical interest is in breast cancer, and she is the Medical Director of the UNC Breast Center.
Research Interests
Dr. Carey's research interests also focus upon breast cancer, including examination of different subtypes of breast cancer, evaluation of new chemotherapy agents in early breast cancer, and examination of tumor characteristics that predict response to therapy.

Dr. Carey has worked extensively with scientists across Lineberger Comprehensive Cancer Center and the UNC Gillings Global School of Public Health to better understand and characterize the molecular subtypes of breast cancer so that we may develop better prevention and treatment strategies. With Drs. Perou and Millikan, she identified the elevated risk of the poor-prognosis basal-like breast cancer subtype in young African-American women. She is a world-wide expert in triple negative breast cancer, and led the first trial looking at a new drug regimen in this breast cancer subtype. She is now the leader of a group of UNC clinician researchers using a variety of new drugs in different molecular subtypes of breast cancer based upon biologic information learned from scientists at Lineberger.

For example, the members of the UNC Breast Center have a long commitment to improving treatment of early (nonmetastatic) breast cancer, and have been early investigators in the use of neoadjuvant, or preoperative, chemotherapy for breast cancer. In part based upon work performed at UNC, we now know that women do just as well if their chemotherapy is given before surgery as after, however the chemotherapy-first approach means that they are more likely to save their breast. In addition, with preoperative therapy it is possible to tell if the drugs are working since the tumor is still measurable when the chemotherapy is given first. Part of Dr. Carey's clinical research program investigates new drugs and combination of drugs in preoperative therapy. As part of this neoadjuvant chemotherapy program, she is involved in several studies, including a multiinstitutional trial sponsored by the National Cancer Institute, of genetic and molecular markers in breast cancer as predictors of response to chemotherapy, and she is the lead investigator of a national study of new drug combinations in HER2-positive breast cancer.

Dr. Carey is also the principal investigator of a highly collaborative study examining genes that might interact with other genes or with the environment to impact on a woman's risk of developing breast cancer.
Recent Accomplishments and Honors

For her work, she was awarded a Doris Duke Clinical Scientist Award in 1999, a career development award from the National Cancer Institute in 2000, was inducted into the Johns Hopkins Society of Scholars in 2008, and was honored to serve as UNC?s commencement speaker in December, 2009.

M.D., Johns Hopkins School of Medicine 1990
Resident, Internal Medicine, Johns Hopkins 1990-3
Fellow, Medical Oncology, Johns Hopkins 1993-8
Sc.M., Clinical Investigations, Johns Hopkins School of Public Health 1994-8

Lisa Carey is an Associate Professor in the UNC Department of Medicine, Division of Hematology-Oncology. She graduated from Wellesley College in 1984 with a BA in Biology and Art History, before receiving a MS in Physiology from the University of Kentucky. She received an MD from the Johns Hopkins University School of Medicine in 1990. After a residency in Internal Medicine also at Johns Hopkins, she stayed at Johns Hopkins for a fellowship in Medical Oncology. During her fellowship she completed a ScM. in Clinical Research. Dr. Carey joined the UNC faculty in 1998. She has served since 2003 as the Medical Director of the UNC Breast Center and is the UNC-Lineberger Comprehensive Cancer Center (UNC-LCCC) Protocol Office Executive Committee Breast Disease Group Leader as well as the UNC-LCCC Protocol Review Committee Breast Cancer Chair.

Dr. Carey has a well-defined interest in clinical/translational research in breast cancer, with a particular interest in the clinical implications of different molecular subtypes of breast cancer. She both designs and leads clinical trials as well as working often and well with laboratory investigators. She has successfully translated bench efforts from laboratory science collaborators into clinical research. She was the lead author of a recently published article in JAMA examining racial disparities among breast cancer subtypes. She is the principal investigator (P.I.) of several clinical trials, including a multicenter inter-SPORE (Specialized Program of Research Excellence, National Cancer Institute [NCI]) Phase II study of targeted therapy in metastatic basal-like breast cancer (a subtype identified by gene expression array). This heavily funded trial includes both clinical and laboratory participation from UCSF, Dana Farber, Duke University, Georgetown, Johns Hopkins, Baylor, Washington University, University of Alabama-Birmingham, Mayo, and M.D. Anderson Cancer Center, and is a testament to her ability to provide clinical leadership in translational and early clinical research.
Dr. Carey is the P.I. of a recently published multicenter Phase II study incorporating biologic therapy into chemotherapy for locally advanced breast cancer as well as a proposed cooperative group neoadjuvant trial examining several HER2-targeted strategies for Stage II-III HER2-positive breast cancer. She is the clinical liaison for several correlative science collaborations, including both institutional and cooperative group trials that correlate nucleic acid and protein characterization of breast cancers with response to neoadjuvant therapy.
Dr. Carey has served on the American Society of Clinical Oncology (ASCO) Scientific Program Committee and as faculty for the ASCO annual meeting for several years. She was named to the Cancer and Leukemia Group B (CALGB) Breast Core Committee in 2003. She was awarded a Doris Duke Clinician Scientist Award in 1999 and a Career Development Award from the NCI in 2000. 

Telephone: (919) 966-4431
FAX: (919) 966-6735
Address: 3009 Old Clinic Bldg. Chapel Hill, NC 27599-7305 

Biologic Differences in Breast Cancer: An Expert Interview With Dr. Lisa Carey http://www.medscape.org/viewarticle/572082

Next Generation Treatment for Triple-Negative and Basal-Cell Breast Cancer http://www.cancernetwork.com/conference-reports/mbcc2011/content/article/10165/1817148

List of Triple-Negative Sensitive Genotoxic Agents
Cyclophosphamide (Cytoxan)
Carboplatin (Paraplatin)
Cisplatin (Platinol)
Doxorubicin (Adriamycin)
Epirubicin (Ellence)
Mitomycin C (MTC / Mitomycin / Mutamycin)
Radiation (Radiotherapy
PARP Inhibitors

In Memory Of Joanne Wattam...


One of my TNBC Support group pink sisters has gotten her wings on April 29, 2011... may you be at peace now, Joanne.

Quoted from a post ion January 18, 2011 in our support group 
"I can remember my onco saying to me last year after my op... if you go 2 yrs without a recurrence then you are doing well... how are you supposed to put that to the back of your mind... he was right... 7 months later i was re-diagnosed.. so am back on chemo again.. but you pick yourself up, dust yourself down and carry on for the sake of your kids, hubby, family and friends..."  - Joanne Wattam

Joanne was diagnosed at age 39 with TNBC, Stage 2, 7 mos out of chemo with a recurrence, found lump in neck.  Joanne just turned 40 and she did develop infections that the doctors couldn't get under control... pneumonia in her lungs for one. Fluid gathered in lungs. 

Sunday, April 24, 2011

Lisa Spitler - GBMC Breast Cancer Patient

Lisa Knauer Spitler, a friend that I connected with online in a Triple Negative Breast Cancer Support Group, She is a 1 year TNBC survivor. Lisa and her family tells her story of survival and her care at GBMC. Lisa gives back by making a blanket to be given to other breast cancer patients when she comes back to visit. Lisa also donated a bell that will be place outside of Radiation Oncology for patient to ring on their last day of their radiation treatment.

Monday, April 18, 2011



I have
and lost.
I have
I have
and true
I am a

Friday, April 8, 2011

Triple Negative Breast Cancer, The Ugly Truth

I have been advocating the importance of self breast exams especially among younger women since most triple-negative tumors are not detected by mammograms due to the breast tissue density in women. Also, triple-negative tumors may be growing rapidly between image screenings. Many women that have asked me about my cancer, I have told them that if you suspect a lump, don't delay, you need to see your doctor and get a mammogram; early detection is the key to having a better outcome with a triple-negative diagnosis.

Tho, we do not know what fuels Triple Negative Breast Cancer, I have been told that changing my life style; low-fat diet, regular exercise, less stress and being physically fit significantly reduces your chance of TNBC recurrence.

We need to bring awareness to this sub-type,Triple Negative Breast Cancer and BRCA testing; helping younger women realize the importance of self breast exams and that early detection will save more lives from this dreaded disease. Women need to be educated and many are not; on the importance of BRCA genetic counseling which is highly recommended at time of TNBC diagnosis to determine the best course of treatment. Patients having both TNBC and being BRCA1 positive; doctors often recommend the option of bilateral mastectomy and removal of ovaries and fallopian tubes as part of their treatment to greatly reduce the risk of further breast cancer and ovariarian cancer in which BRCA is associated with.

Just a few years ago, no one even heard of TNBC, a type of breast cancer that researchers knew a little about. Triple-Negative is one of the most aggressive tumors ever seen by doctors. The first reference of "Triple Negative" Breast Cancer in medical literature was in October 2005. Focused studies for TNBC had only been conducted in the last few years. Triple Negative Breast Cancer had recently become a hot area of research for targeted therapy and the latest in clinical trials in the study of breast cancer at all of the big research institutions including top-rated cancer center in the country, MD Anderson, which is the first institution to look exclusively at women with Triple Negative Breast Cancer.

Triple Negative tumors lacks expression of estrogen receptor (ER) and progesterone receptor (PR), along with the absence of human epidermal growth factor receptor-2 overexpression (HER2) portraying a critical clinical challenge because this type of cancer doesn't respond to hormone therapy or other available targeted agents; Standard Chemotherapy remains the only treatment available and only effective in about 40% of patients; and in those that do relapse, the cancer becomes highly resistant and quickly results in death.

Triple Negative Breast Cancer accounts for about 15% of all breast cancers and is responsible for about 25% of all breast cancer deaths. Triple-Negative is characterized as a rapid growing breast cancer with a relatively poorer outcome; usually diagnosed at a late stage, shorter survival rate, more likely to metastasize and has a high risk of early recurrence between 2-3 years after diagnosis. One study on distant recurrence concluded that 56 out of 61 TNBC patients that had relapsed had died, and the average time from recurrence to death is about 9 months.

Pre-menopause women in their 20's or 30's are more susceptible to Triple Negative Breast Cancer and, African-American women are at highest risk. The 5 year survival rate among African-American women with TNBC is about 14% and is the #1 cause in breast cancer deaths in African-American women . "Dr. Nanda said it’s not entirely understood why African American women are more susceptible to triple negative breast cancer. It could be genetic or environmental causes. The causes of the disease are just as mysterious for young women."

Many women who are diagnosed with Triple Negative Breast Cancer are often left in the dark about what triple-negative means for them at time of diagnosis. Often, these women turn to the internet searching for answers and are terrified with learning the aggressiveness of triple-negative and poorer prognosis due to no effective targeted therapy for this type of breast cancer. Also, TNBC " shows substantial overlap with basal-type and BRCA-1 related breast cancers, both of which also have aggressive clinical courses." Inherited BRCA -1 gene mutation carriers has an upward 80% life time risk of developing breast cancer and about 50% risk of developing ovarian cancer. 90% of BRCA-1 carriers are also Triple Negative but 20% of TNBC has BRCA mutations.

The clinical drug, PARP inhibitors that prevents cancer cells from repairing it's own DNA; are showing promising results in improving prognosis for Triple Negative Breast Cancer and BRCA Positive patients. "Important limitations still need to be overcome in the next few years if any significant clinical strides are to be made."

A research study conducted at The City of Hope's Division of Tumor Cell Biology of the natural fruit, blueberries gave preliminary promising results of controlling tumor growth, reduction of metastasis, and causing cell death in triple-negative breast cancer cells, at more than double the rate observed in untreated cells.

In 2009, Susan G. Komen for the Cure and Triple Negative Foundation teamed up to fund a $7.5million Promise Grant over 5 years to researchers looking at an antibody in hope of developing a targeted long-term therapy for triple negative tumors.

News correspondent, Jennifer Griffin and news anchor, Robin Roberts are TNBC survivors. I've link you to their stories.

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