Milk-producing protein, ELF5 Linked To Aggressive Breast Cancer

Australian scientists have shown how a ‘transcription factor’ causes breast cancer to develop an aggressive subtype that lacks sensitivity to oestrogen and does not respond to anti-oestrogen therapies such as Tamoxifen and aromatase inhibitors
http://www.garvan.org.au/news-events/news/the-factor-that-could-determine-future-breast-cancer-treatment.html (Click link to story)

Now An Angel, Marie Anello-Algeri Educated Of Her Illness, Inflammatory Breast Cancer- "I Never Heard Of IBC Before Being Diagnosed And Always Assumed Breast Cancer Only Presented Itself With Lump."

"A tiny flower, lent not given,
to bud on earth and bloom in heaven."

Friends, though absent, are still present.

Shortly before Christmas, It took me by surprise that a dear breast cancer friend, Marie Anello-Algeri's health has a taken a turn and was receiving Hospice Care. I knew for at least a year that Marie was stage 4 but never really had spoken much of her illness for she was always so upbeat and joked often with us in our online group. Marie had Inflammatory Breast Cancer (IBC) that has spread to her brain believed to be a Triple Negative Breast Cancer (TNBC). Hearing of Marie's passing the day after Christmas, December 26, 2012 at  age 42, heartbreaking... Been feeling the sadness among us TNBC sisters in our online support group. Marie was a one-of-a-kind very sweet, beautiful and caring woman and a mother who hurts leaving her 4 children behind. May your memory lives on within our hearts, and may God Bless your Children as you shine down upon them. No more worries, no more treatments, no more pain... just peace I pray for you, Marie. I will treasure the kindness and thoughtfulness that Marie had shown in our friendship. I feel a need to bring more awareness to Marie's original diagnosis of Inflammatory Breast Cancer.  

"no lump, still cancer"  ~Terry Lynn Arnold

Inflammatory breast cancer is a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed.”
Inflammatory breast cancer accounts for 1 to 5 percent of all breast cancers diagnosed in the United States. Most inflammatory breast cancers are invasive ductal carcinomas, which means they developed from cells that line the milk ducts of the breast and then spread beyond the ducts.
Inflammatory breast cancer progresses rapidly, often in a matter of weeks or months. Inflammatory breast cancer is either stage III or IV at diagnosis, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well.

Signs and symptoms of inflammatory breast cancer include:

• Rapid change in the appearance of one breast, over the course of several weeks
• Thickness, heaviness or visible enlargement of one breast
• Discoloration, giving the breast a red, purple, pink or bruised appearance
• Unusual warmth of the affected breast
• Dimpling or ridges on the skin of the affected breast, similar to an orange peel
• Tenderness, pain or aching
• Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
• Flattening or turning inward of the nipple

Inflammatory breast cancer doesn't commonly form a lump, as occurs with other forms of breast cancer.

* Inflammatory breast tumors are frequently hormone receptor negative, which means that hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fueled by estrogen may not be effective against these tumors.

* A disproportionately higher percentage of IBC patients have triple-negative breast cancer. From a study of 144 patients diagnosed with IBC at MD Anderson, 36% were TN IBC.

http://cebp.aacrjournals.org/content/21/3/564.1.abstract

For more information on Inflammatory breast cancer, please follow this link, no lump-still cancer www.theibcnetwork.org Terry Lynn Arnold, founder, The IBC Network-Inflammatory Breast Cancer Network

dx Triple Negative Inflammatory Breast Cancer, summer 2007

"Perhaps they are not stars,
 but openings in heaven,
where the love of our lost ones
pours through and shines down upon us,
to let us know they are happy."

"Important for people to know any change in your breast should be reported to your doctor and have IBC ruled out. I only had very slight swelling, barely noticable and was diagnosed at stage IV. Awareness is key, I never heard of IBC before being diagnosed and always assumed breast cancer only presented itself with lump."  ~ Marie Anello-Algeri

Marie Anello-Algeri | Moloney Family Funeral Homes

www.moloneyfh.com/obituaries/2012/marie-anello-algeri

Merry Christmas!

Wishing all my beautiful sisters a magical and blessed Christmas. Thank you ladies for your love and support. Merry Christmas with much love! xoxox Melissa

Triple Negative Breast Cancer Day Inaugural 3.3.13

JOIN THE FIGHT! Triple Negative Breast Cancer Day is a national awareness day to be held on 3-3-13. The mission of this iconic inaugural event is for the Triple Negative Breast Cancer Foundation to bring together communities across our nation to plan fundraisers and awareness events in each state to take place on (or around) Triple Negative Breast Cancer Day. Events of all sizes are welcome! Visit the TNBC Day microsite to start planning your event:
http://tnbcfoundation.org/tnbcday/index.html

All I Want For Christmas Is...

What Are The Effects Of Caffeine On Triple-Negative Breast Cancer Survivorship?

November 2012 Ask the Expert: Diet and Nutrition After Breast Cancer

Suzanne Dixon, MPH, MS, RD, is a registered dietitian, epidemiologist, author and speaker. She is an internationally recognized expert in nutrition, chronic disease prevention, cancer epidemiology and health and wellness.

http://www.lbbc.org/Learning-From-Others/Ask-the-Expert/2012-11-Nutrition-and-Diet

Question: What are the effects of caffeine on triple-negative breast cancer survivorship?

Ms. Dixon: Regarding caffeine, you’re in the clear in terms of breast cancer risk. This applies to both estrogen receptor-positive and triple-negative breast cancer subtypes.

Studies do not show a measurable link between caffeine consumption and risk of breast cancer or recurrence. Even in countries with very high intake of caffeine from coffee and tea, such as the Scandinavian countries, research does not support a link between caffeine and breast cancer.

However, I do believe the source of caffeine matters. If your caffeine comes from coffee and tea that is fine, as long as you are not having so much that you experience negative side effects such as insomnia or anxiety. Also, if you have high blood pressure, a rapid heart rate or other cardiovascular issues, you should keep caffeine intake moderate. Talk to your doctor about how much caffeine is safe for you to have.

Caffeine from soda, however, should not be a regular part of anyone’s diet. If you enjoy soda, you should have it as an occasional treat, but drinking soda daily is not a healthy habit. With both coffee and tea, you get some added benefit in the form of antioxidants and other nutrients that are linked with better health.  You get excessive amounts of sugar if you drink regular soda or synthetic sweeteners if you drink diet, neither of which are linked with good health.

Hope For Tomorrow...

When asked what was on her bucket list, she replied... tomorrow.
~Unknown

Clinical Trial Targets Androgen Receptor In Triple Negative Breast Cancer

In fact, 75 percent of all breast cancers and about 20 percent of triple negative cancers are positive for the androgen receptor. Blocking the androgen receptor may stop the growth of some triple negative breast cancers – these aggressive cancers for which chemotherapy, radiation, surgery and hope have long been the only treatments.

This week, after seeing, “no additional toxicities,” Elias expects an ongoing Phase I clinical trial of Enzalutamide for triple-negative breast cancers to flip to a Phase II trial – from proving safety to demonstrating results. In addition to the CU Cancer Center, the trial is being offered at Memorial Sloan-Kettering Cancer Center and the Karmanos Cancer Institute. 
http://www.coloradocancerblogs.org/clinical-trial-hits-new-target-in-war-on-breast-cancer/
(Click link to story)

San Antonio Breast Cancer Symposium 2012

News from the San Antonio Breast Cancer Symposium I

" ...emphasis on understanding the biology of triple negative breast cancer and using that knowledge to develop new, more targeted treatments. There are a number of important studies that focus on the specific factors that make TNBC different from other types of breast cancer. More and more, researchers are zeroing in on biology and genetics, on identifying subsets of patients who respond to specific therapies-and understanding why that occurs."

News from the San Antonio Breast Cancer Symposium II

Among the key points that the panel made were:

• TNBC is a "very diverse, heterogeneous" group of diseases-not a single disease entity. Dr. Pietenpol's group has identified at least six or seven different subtypes of TNBC, and other groups have discovered a wide range of genetic mutations that occur in different TNBC subtypes.


• The clinical behavior of these different subtypes-how aggressive they are, how they respond to specific treatments depends to a very large extent on their molecular profile.


• The genetic mutations found in individual tumors change as the tumor grows and progresses-tumors evolve in a way that Thomas Westbrook, PhD, compared to the Darwinian process of selection in which the "fittest," most adaptable cells grow and divide successfully.

News from the San Antonio Breast Cancer Symposium III

"At yesterday's Educational Session, for example, one study analyzed data from 21 different sources and eight different countries. Virtually every panel and session features presenters from countries around the world. International clinical trials have now become the norm. The ability of major organizations from every corner of the world to collaborate and share data means that trials can not only be done faster, but that they are also more likely to take into account the very real differences that exist in diverse populations."

News from the San Antonio Breast Cancer Symposium IV

Dr. George Sledge

Expert Perspective: An Interview with George Sledge Jr., MD
Dr. Sledge is a Distinguished Professor at the Indiana University of Medicine and the co-leader of the Breast Program. In January 2013, he will move to Stanford University where he will be the Chief of Oncology.
What is the most important news about TNBC coming out of this meeting?
To be honest, there isn't any one study or one group of studies that represents a major change in the way we treat TNBC today. The real news has been more directed at ER+ and HER2 positive breast cancers. In the last year and a half though, we are seeing some very promising work that I believe will lead to significant improvements in treatment and outcomes over the next five years.
These include some excellent work presented yesterday by Jennifer Pietenpol whose group has identified six distinct subtypes of TNBC. This provides the opportunity to develop therapies that are targeted to the specific genetic profiles of these subtypes.
Some of these cell lines may respond very well, for example, to platinum based chemotherapy. For years, we have been using these drugs and seeing some patients respond very well, and others, not at all. It is very possible that these differences can be explained by identifying the subtype of TNBC that is involved.
Other subtypes may respond to PARPs that inhibit the cancer cell's ability to repair DNA damage. One subtype, which Dr. Pietenpol calls Luminal Androgen Receptor positive actually has a target receptor that we can shut down. The biology is going to be therapeutically very relevant in the future.
Why is TNBC so complicated?
Triple negative breast cancer is a genomic grab bag, a large collection of different diseases. In addition, it really is genomic chaos. When you do sequencing on these tumors, you find multiple genetic mutations that occur in different combinations. This means that it is a very complex group of diseases-and it makes designing clinical trials very complicated as well.
Why can't you target these mutations the way you do with other cancers?
First, we have to identify the driver mutations, and then they have to be actionable. That means we need a drug that targets the specific mutation. One complicating feature of TNBC is that many of the mutations represent a loss of function or cell regulation. It is much harder to fix something that is lost than it is to shut down something is being over expressed, the HER2 gene, for example. We know that a mutation in the P53 gene is linked to a number of cancers, including TNBC-but we don't have a way yet of turning that into something biologically actionable, in other words a treatment.
We also know that TNBC is linked to the loss of the cell's normal ability to repair damage to its DNA-and that is a very hard thing to fix. It also contributes to the large number of diverse mutations that we see in these tumors.
The other thing to remember is that the molecular profiles of cancers change. I tell my oncology fellows that cancers are like criminals tying to escape. If you set up a roadblock but only at one point, they will find a different way out. To outsmart the cancer, we need multiple roadblocks-and frankly, right now, we are not very good at doing that.
Why does this make clinical trials so hard to design and do?
When you have multiple subtypes and multiple driver mutations, it becomes increasingly difficult to design trials that will have achievable end points and involve a sufficient number of patients. The logistics are difficult, obtaining patient consent and participation is difficult, persuading drug companies to fund these trials is difficult. We may know that there are as many as five driver mutations involved in TNBC, but we have never done a trial in which we inhibited more than two.
What are the most promising areas?
Kinases have been the golden road to progress against cancer in the last decade. We can continue to work hard in that area, developing combination therapies that combine our knowledge of genetics with drugs-just like we do for HER+ cancers. Or we can look at different approaches, including immunologic therapies. If you had asked me even three years ago whether immunotherapy would be promising, I would have said no way, but there is very interesting work right now in that area.
I also think that PARP inhibitors have promise for TNBC. Two years ago, the big news was the failure of the PARP inhibitor trial, but that turns out to be more of a drug failure than a concept failure. I think these drugs will prove useful in the BRCA 1 and BRCA2 populations.
I also see some rapid therapy advances using the new information about subtypes. The key will be to define the subpopulations that will respond to specific approaches.
What is the importance of having a global approach to tackling TNBC?
TNBC really does have a huge global impact. In sub-Saharan Africa, it is the dominant type of breast cancer-and that is true in many low and middle income countries throughout the world. In those countries, you have young women being diagnosed with this disease. They have no access to screening or early diagnosis, it can take literally months to get into the medical system and get a biopsy-and no one has thousands of dollars to pay for treatment. So, it is devastating, and presents a real world challenge.
A final word?
We don't need a magic bullet for TNBC. We need a magic shotgun. It is going to be a long haul and it's not going to be easy-but I really believe that we will see real progress on multiple fronts in the next few years.

Christine Wilson for TNBC Foundation

News from the San Antonio Breast Cancer Symposium VI

Neoadjuvant Therapy is More Effective for Very Young Breast Cancer Patients
A study done by the German Breast Group reviewed the data from eight trials in which patients with breast cancer received neoadjuvant chemotherapy prior to their surgery. Their goal was to compare the rates of complete pathologic responses-meaning that there was no evidence of disease at the time of surgery-and then compare the overall disease free survival, local recurrence free survival and overall survival by groups.
Approximately a third of the patients of the very young patients (35 and under) had TNBC, with the percentage decreasing in the older age groups. The study found that the youngest patients, those in the 35 and under group had the highest rate of pathologic complete responses. In that group, the TNBC patients had the highest response rate of all, 35%.
The group concluded that very young women were more likely to achieve a complete response after neoadjuvant therapy and that this response improved their survival. They also concluded that breast cancer in the very young is biologically different than in older patients.
This is a strong argument for having neoadjuvant chemotherapy, an approach that is becoming the standard of care for young patients and those with TNBC.

HDAC Inhibitors Enhance Treatment with PARPs and Cisplatin
HDACs or histone deacyetylase inhibitors work by damaging DNA and depleting the levels of special proteins in the cells that repair this damage. A study done by a group at the University of Kansas provides evidence that combining these HDAC inhibitors with PARP inhibitors and cisplatin creates a synergistic effect that causes TNBC cells to die. The trial supports beginning new trials that combine these agents.
Kapil N. Bhalla, MD, who presented the study said, "Complex biology requires complex combinations of therapy."

Profiling TNBC after Neoadjuvant Chemotherapy Identifies Targetable Molecular Changes
This study relates directly to the emerging information about the biological and genetic character of TNBC, and has direct clinical implications. In this study reported by Justin Balko, MD, of Vanderbilt-Ingram Cancer Center, researchers did molecular profiling for TNBC patients who had residual disease after they finished their neoadjuvant therapy. Having residual disease after finishing pre-surgery chemotherapy is generally associated with a poorer prognosis, but as Dr. Balko stated, "Up to now, we have not known how to treat these patients. We don't have any targeted therapies."
This work represents a step towards changing that picture. The group analyzed 114 TNBC tumors and found a wide range of mutations. Approximately 90% of patients had at least one mutation that could potentially be targeted with drugs. They also identified a mutation, JAK2, not previously known to exist in TNBC, in 11% of patients. While patients with this mutation appear to have a worse prognosis, it is a potentially targetable with new therapies.
One important finding is that many patients have more than one mutation which means that in order for treatment to be effective, it will probably be necessary to use more than one agent. The key, according to Balko, is to distinguish the true driver mutations, the ones that are essential to cancer growth, from those that do contribute to cancer growth and spread.
This study provides strong support for doing genetic sequencing on TNBC tumors, and initiating new clinical trials using molecular targets as adjuvant therapy for women with residual disease following surgery.

Christine Wilson for TNBC Foundation

http://www.tnbcfoundation.org/sabcs/index.html  (Click link for more)

What Are The Effects Of Alcohol On Triple-Negative Breast Cancer Survivorship?

November 2012 Ask the Expert: Diet and Nutrition After Breast Cancer

Suzanne Dixon, MPH, MS, RD, is a registered dietitian, epidemiologist, author and speaker. She is an internationally recognized expert in nutrition, chronic disease prevention, cancer epidemiology and health and wellness.
http://www.lbbc.org/Learning-From-Others/Ask-the-Expert/2012-11-Nutrition-and-Diet

Question: What are the effects of alcohol on triple-negative breast cancer survivorship?

Ms. Dixon: Several large observational studies show an association between drinking alcohol and increased risk of breast cancer and breast cancer recurrence. Alcohol is most strongly linked with increased risk of estrogen receptor-positive breast cancer. This connection is not surprising, because health experts note that when a woman drinks alcohol, the level of estrogen circulating in her body increases.

There haven’t been enough studies to know with certainty whether or not alcohol increases risk of triple-negative breast cancer recurrence. However, it is a good idea to limit alcohol consumption anyway, because alcohol itself is known to becarcinogenic, or cancer-causing.

Studies suggest, at least for ER-positive breast cancer, that risk of recurrence increases when a woman has more than one or two drinks per week. This is far below the standard health recommendation that women consume no more than one drink per day.

Also, keep in mind that one drink may be smaller than most people realize. A single drink is five ounces of wine, 12 ounces of beer or 1½ ounces of hard liquor. A typical large glass of wine often contains eight or even 10 ounces. This would be two servings.

If you have a history of breast cancer and truly enjoy a glass of wine or a cocktail, I suggest that alcohol be saved for special occasions or enjoyed once per week with a nice dinner. If completely avoiding alcohol is not difficult for you, then you should avoid it.

I believe it’s important to consider all of the things you can do to take care of yourself. For example, even for women who are overweight or obese, the combination of five or more servings of vegetables and fruit per day and 30 minutes per day of moderately vigorous exercise has been shown to reduce the risk of recurrence by nearly 50 percent.

Despite this, many women are strongly advised not to consume alcohol but are never told the importance of healthy eating and regular exercise. This focuses only on the negative—“don’t drink”—but fails to empower women with the positive things they can do to reduce risk, such as eat well and exercise regularly.

All women with a history of breast cancer, but especially ER-positive breast cancer, should limit alcohol intake or eliminate it altogether. However, it would be a mistake to focus only on one thing, such as alcohol. If all of the other healthy lifestyle choices are in place—a good diet, regular physical activity, avoiding tobacco, getting adequate sleep, managing stress,and so forth—an occasional alcoholic beverage is unlikely to have measurable impact on risk of recurrence. Just remember that “occasional” means special occasions, not every day.