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BCAC Chair Libby Burgess reflected on this question after attending the premier international breast cancer research conference, SABCS 2023, in San Antonio Texas last month. Triple negative breast cancer (TNBC) is an aggressive subtype lacking HER2 or hormone receptors. It is the most challenging type of breast cancer to treat, particularly at the advanced stage. However, research over the last 20 years has broadened treatment options and improved patient outcomes.
At SABCS, Libby was able to gain an in-depth understanding of current treatments offered overseas and the scientific evidence backing them, as well as learning about where the research is heading next. Libby noted with dismay how far New Zealand has fallen behind the rest of the developed world in treating both the…
BCAC is delighted to see the Royal Australian and New Zealand College of Radiologists (RANZCR) recommend mandating of breast density reporting in both breast screening and diagnosis. The updated position statement notes that those with extremely high mammographic breast density (MBD) are at a 2.1-fold increased risk of breast cancer, and this is associated with higher rates of breast cancer death.
BCAC’s Louise Malone was among 10,000 attendees at this premier international breast cancer research conference held in Texas, 3-8 December. She shares some of the key themes she observed among the many workshops, posters and sessions.
“De-escalation” of therapies
Doing less, while still achieving good results, continues to be the driver behind much of the research in surgery and radiation therapy, with less invasive and time-consuming procedures being investigated. This trend is less evident in medical oncology, although there is a growing awareness that, with success in extending the lives of patients with breast cancer there is also now a need to reduce the toxicity of long-term side effects of treatments that can severely affect quality of life.
Treatment holidays, where therapy is temporarily stopped, are something that those living with advanced breast cancer sometimes have to contemplate. Perhaps there is an important occasion coming up – a wedding or other family celebration, or an overseas trip – where the side effects of the treatment would interfere with enjoyment of the occasion. In discussing this with their oncologist, it’s important to take into account the current evidence – for or against – taking treatment holidays.
Here's BCAC’s report of a talk on this topic at the recent ABC7 international advanced breast cancer conference:
Not all patients are ready to discuss their prognosis soon after a diagnosis of advanced breast cancer (ABC) – and that is their choice – but the earlier this is discussed the more influence patients can have on their treatment plan and end of life options. Oncologists are not necessarily starting the conversations early enough but it is important that they do, taking into account their patients’ values and preferences. So, how do oncologists provide prognostic information to their patients, and how useful and accurate is the information when given?
Claire has been living with HER2-positive advanced breast cancer since 2016; since her cancer progressed she has been processing the fears that inevitably accompany this. Claire’s story is one of overcoming her fears by facing them, and taking control.
Here's BCAC’s report of Claire’s talk at the recent ABC7 international advanced breast cancer conference:
Overcoming fear: Don’t lose the joy of living in the fear of dying
Claire Myerson, ABC Patient and Patient Advocate, Breast Cancer Now, UK
Very few studies have looked at the impact of diet or exercise in patients with advanced breast cancer (ABC). On a biological level, repeated exercise may limit tumour growth, and some dietary interventions, e.g., plant-based diets, can help improve fatigue. But more research is needed in all these areas. Until there is more evidence, there are things that patients can do to improve their quality of life with a diagnosis of advanced breast cancer. Avoid sitting still – and if you can, aim for 150 minutes per week of moderate exercise (that’s a half hour walk 5 days a week). Even seated exercises help. The usual recommendations relating to increasing plant-based foods and reducing red/processed meats and sugar apply.
October 13th is Metastatic Awareness Day in the United States, thanks to Shirley Mertz, a metastatic breast cancer survivor from the United States.
October is breast cancer awareness month, so Shirley and two other patients approached their Senator, whose mother had passed away from breast cancer, and ask him to promote their cause in the Senate; they then approached the House of Representatives with the same request. This resulted in a motion being passed through the US government to specifically commemorate ABC on October 13th. [Since then, President Joe Biden designated October 17 to October 23 Men’s Breast Cancer Awareness Week]
Many patients with advanced breast cancer develop lymphoedema either after surgery or as a result of cancer itself. It is swelling on the arm, back or chest on the side of the breast surgery, and can occur at any time after diagnosis, even years later. There are four phases of lymphoedema, ranging from almost completely asymptomatic to debilitating, where it can cause severe pain and reduce a person’s inability to work or perform normal activities. The good news is that oncologic physical therapy can reduce or prevent lymphoedema in the first place. Even in patients with severe lymphoedema, it can be controlled, with complete elimination of pain and complete recovery of movement and strength.
Many patients with advanced breast cancer use herbs and supplements, as well as other treatments like relaxation and massage, to relieve symptoms. However, many patients are taking herbs or supplements that may be harmful or interact with their cancer medications. Most cancer drugs and most foods, herbs and supplements are broken down by the same liver enzyme pathways; a particular example is grapefruit, which therefore interacts with trastuzumab and paclitaxel (among many others). Two supplements that don’t appear to interact with any medications are melatonin and omega-3. Patients should always tell their doctors what supplements and herbs they are taking (and don’t forget to mention grapefruit!). However, it’s a ‘two-way street’, as doctors also need to remain open-minded or their…
