When an unqualified “news story” unnecessarily causes stress by scaring rather than informing – Diabetic women are more likely to be diagnosed with advanced stage breast cancer.

I always wonder about my health. Is there is anything else I can do to keep on top of my various illnesses? I suspect I’m not alone with that concern. Most of us would like to stay healthy, but where is the line between being so attentive as to be obsessive and so inattentive as to be neglectful?

  • When does one become complacent or neglectful about health/illness?
  • How much attention to one’s illness is too much or too little?
  • After you weather the first 5 years, how much attention and focus should you spend on BC?
  • Is there ever a point at which one can back-burner a treated life-threatening illness?
  • Is BC still a threat if you continually receive clean scans?
  • Is cancer something that just hides in the crevices until the next round of attacks?
  • Is there ever a point at which you can mentally put it aside?
  • Is there such a thing as being cured of BC?
  • Doesn't the stress of obsessing about an illness in iteself cause problems?

Not being a medical professional, I’m not qualified to answer these questions, but that doesn’t mean they don’t plague me – every day.

I read as much as I can to check for breakthroughs, promising treatments, new medications, etc. Perhaps a bit obsessive, but I do try to keep up with the latest research and findings – just in case they could help me or anyone with BC. Here’s my current gripe – poor news stories that sensationalize and don’t inform.

In addition to having had BC, I also have Type 1 Diabetes brought about by Lyme Disease. So what do I read a few days ago:  Diabetic Women More Likely to be Diagnosed with Advanced Stage Breast Cancer… great. One more thing I can do nothing about but worry.

What got me started was that none of the articles was sufficiently informed and informative. None for example said if this was a caution for Type 1s, Type 2s, Type 1.5s, or Gestational diabetics. Considering that most (95%) of the diabetic world is comprised of Type 2s, are we as readers to assume this means only Type 2s should worry or all diabetics? The news articles simply ignore the defining “fact” of diabetic type.

Most people don’t even know the difference between types of diabetes or even how the different diseases occur; or like many cancers, that they are very different diseases with the same name. Of the articles referring to this Canadian study published on the web several days ago, the risk was not defined by diabetic type on any site including the following:

  • Breastcancer.org
  • Cancernetwork.com
  • Sciencedaily.com
  • WebMD.com
  • NIM-NIH.gov

My hunch was that this “news” story was aimed at Type 2s. I did a bit more poking into abstracts and articles by the lead researcher, Lorraine L. Lipscombe, MD, MDc, FRCPC, Adjunct Scientist at ICES and Women’s College Research Institute to discover it is most likely Type 2s. However, without spending $39.95 to get a copy of the research, I can’t know for sure. But I did find a very informative article on the topic: Double Jeopardy: The complex relationship between breast cancer and diabetes, from Women’s College Hospital – where the study was conducted.  

Based on an earlier study by the same researcher, apparently all Type 2s should be extra vigilant. The link between the two diseases is not well understood. I’d say the message here is make sure to get regular screenings and be super careful to keep your diabetes under control. If I was a Type 2, I’d ask my endocrinologist and my oncologist just in case they have professional access to more than the relatively lightweight abstract on which the “news” item was based. Does this study affect the rest of us with other forms of diabetes or those of us with any type of diabetes who also have had BC?

Another note for anyone who takes drugs for Type 2 diabetes: Diabetes drugs may have an effect on BC because they affect insulin levels and breast cells are known to be sensitive to insulin. High levels of insulin might be a risk factor for BC, so Type 2s (insulin resistant) may develop BC when insulin levels are high.

One last kicker for all diabetics who have had BC: Estrogen may protect against diabetes. Therefore taking anti-estrogen therapy may increase the risk of diabetes. I’m sure that’s not a comforting caution for any of us. I  took 5 years of AI medication in the form of Arimidex. Now I’m worried what it did to me besides improve my chances of surviving BC. I had Type 1 before I was diagnosed with BC which was the same time as the article above was published. You’d have thought my oncologist at the time would have mentioned this fact to me.

Dr. Lipscombe’s caution “These (BC and Type 2 Diabetes) are both growing populations who are going to require ongoing chronic care. We need more information regarding their long-term risks so we can optimize their health.”

It's hard to get genuine and meaningful nuggets of information from the mostly superficial sensation "news" stories. Are the hours I spent digging through from one article to the next obsessive or are they reasonable research time?

So, back to my original gripe: Isn’t researching one’s story the role of a journalist and the publishing media or is an article's purpose just to sensationalize the story to make money? Thanks media mavens… as a Type 1 I suppose this is one more thing I should worry about… or maybe not? Should I schedule a $200+ doctor visit to find out (assuming the doctor knows the answer) or pay to get the full study and hope I can understand it? I thought reporting useful, understandable, news was the media’s job, not mine as a blogger. But more often than not, the roles might just be reversing.

Mind, Scars and Healing

We’ve all at some time in our lives suffered physical injuries that cause lasting scars. As a kid, I was hit with a tree  branch that cut the edge of my left eyebrow nearly off - requiring many stitches. Sure, like everyone, I too have the small pox arm scars and I’ve accumulated many more scars resulting from years of sports related injuries. My throat was even sliced from ear to ear because of thyroid cancer.

However, nothing quite prepared me for the mental and physical effects of BC (breast cancer) surgery.

In a very real sense, I consider those of us who have faced BC surgery akin to war veterans because our damage is both mental and physical. Sure, you’ll get over the body injuries caused by the surgery, but getting over the mental scarring requires professional help. Don’t kid yourself like I did. I thought I could get over it alone. I had before. I’d already had parts of me removed. Why was BC surgery so different?

I didn’t know it at first because I chose to focus on the illness and every other issue in my life, but BC surgery changed me. It altered an important part of what makes me female; gave me constant reminders by: creating a lump of scar tissue that can be very sensitive; required additional damage via radiation; and even more serious damage from five years’ worth of hormone blocking medication which removed my ability to function or even see myself as a sexual being. Yes, the entire process was physical, but the end result was a sliced up cake of physical damage iced with severe mental scaring. I became a sickness torte, and as result, completely lost “me.”

Thankfully, my surgeon was good and my body healed well. I didn’t need an implant, so unless I look for the scarred area, my body looks normal. Problem was it didn’t function normally. That was actually my first introduction to a serious flaw in the medical industry’s lockstep strategy of treating the symptoms rather than the whole person. If there is no drug to eliminate the symptom, then “you just have to live with it.” Yes, I heard those words from an oncologist. I walked out of that office and never looked back. Then I started looking for answers elsewhere.

But like most people, I had more than one or two worries. So, let’s add a few more reality layers to my self-cake: my mother had died in August , just 5 months before my BC diagnosis the following March. Her death naturally caused the stress of loss and sibling issues surrounding the death of a parent. Six weeks after my mom died I was suddenly diagnosed with Type 1 diabetes as a result of Lyme disease. In November I started having grand mal seizures also a result of having Lyme disease. Sprinkle in day-to-day work related problems, add a pile of unfortunately-timed, very expensive neighborhood/HOA legal stressors…then add BC diagnosis, surgery, and treatment to that mix. It’s now easy to understand why at the end of 12 months, I was an emotional mess and seriously depressed.

Naturally, most of us opt to deal with the easiest problems first. I chose to focus on my physical health problems along with work, property related troubles, and family – in that order. Finally I found a psychologist who would eventually treat me for nearly two years before I was able to get through a day without crying. Therapy is not a quick, inexpensive cure. It takes time, self-reflection, and a lot of work and money. Yet it was only though therapy that I discovered a way to address the important things – losing and finding my female self, constantly worrying about losing my husband, and of course, the threat of BC cancer returning. That last one never really goes away. It lurks in the shadows of everyday life.

Psychological scars are very deep. Don’t neglect the mind just because the body is more obvious.

Thoughts on Life, Breast Cancer, and The Sheltering Sky by Paul Bowles

Many, many years ago I read The Sheltering Sky by Paul Bowles. Despite the dark, intricate storyline, for a long time I only remembered isolated scenes and the seemingly fragmented lives of the characters. Over my years, time and circumstances caused scars, each reminding me of the victory of conquering the impossible, but of losing something valuable in the process. It wasn’t until 35 years later, after my second bout with cancer, that I realized how well Paul Bowles conveyed the brevity of life and how most of us waste our seconds on earth. After that bout with breast cancer, I thought I knew exactly what he meant. But just last week, after learning that I might have lost my husband to a foolish accident, I finally understand.

“One never took the time to savor the details; one said: another day, but always with the hidden knowledge that each day was unique and fatal, that there never would be a return, another time."

As humans, we are well adapted to wasting time. Our lives are crammed with “shoulds and have-tos.” Our days are full of urgent responsibilities that we either self-assign or are thrust upon us. We live as if there will always be tomorrow. But do we just wander through the day begging a cricket to call so that once again we can steal back into our dreams? 

Even when circumstances paint a picture, we continue to delude ourselves with excuses and needs. Such as the time I was frustrated while driving to work in a horrible traffic jam only to hear the highway was closed because of a fatal accident. I made the requisite excuse for being late to a meeting but someone else never made their destination. There was the time I was having difficulty with my children when a distant relative was t-boned one winter morning losing her two small children in the crash. How does one survive that anguish? Or the day I was dealing badly with my second cancer diagnosis and could no longer bear to see my friend dying of cancer, so I failed to visit her and she died before I was “able” to return. Sometimes there are no tomorrows.

“Because neither she nor Port had ever lived a life of any kind of regularity, they had both made the fatal error of coming hazily to regard time as non-existent. One year was like another year. Eventually everything would happen.” 

Why is anger more compelling than calm, war more important than peace, rivalry more captivating than beauty, fear more motivating than rationality… are all of those more real than a touch? I don’t paint in fear or anger. But unless I paint every day, I lose grip on that “reality.” Will the sun ever set like that again? Will the clouds ever again filter the light to create such colors and shapes? Will the night sky ever display “falling stars” like that again? Responsibilities crowd out everything else as the moments slip into a mountain of mist and are gone.

“And it occurred to him that a walk through the countryside was a sort of epitome of the passage through life itself. One never took the time to savor the details; one said: another day, but always with the hidden knowledge that each day was unique and final, that there never would be a return, another time.” 

Those of us who have survived cancer are not unlike soldiers who survive combat. In our dimensionless state nothing is more important than whatever fuels our need for self-preservation so that we might live to fight another day. We all pretend to be tough and strong but we are all at times afraid. We survive scarred, desperately trying to patch the rip in our universe.

“Someone once had said to her that the sky hides the night behind it, shelters the person beneath from the horror that lies above. Unblinking, she fixed the solid emptiness, and the anguish began to move in her. At any moment the rip can occur, the edges fly back, and the giant maw will be revealed.” 

But reality is that every day will be someone’s last. It’s the conundrum of being mortal.

"Death is always on the way, but the fact that you don't know when it will arrive seems to take away from the finiteness of life. It's that terrible precision that we hate so much. But because we don't know, we get to think of life as an inexhaustible well. Yet everything happens a certain number of times, and a very small number, really. How many more times will you remember a certain afternoon of your childhood, some afternoon that's so deeply a part of your being that you can't even conceive of your life without it? Perhaps four or five times more. Perhaps not even. How many more times will you watch the full moon rise? Perhaps twenty. And yet it all seems limitless.” 

As 2014 closes, 2015 stretches before us full of possibilities, opportunities for great accomplishments, discoveries, and health. But there is also looming war, failure, and illness. Now is the time to do exactly what we unceasingly feel the need to postpone - make every day count… or when it’s too late, be left to wonder why we didn’t. Carpe diem.

Follow Research or Follow Tradition?

At 67 and nearly eight years after being diagnosed with BC of the single site, stage1, DCIS variety, I’ve made the decision to eliminate one mammogram every other year from my life. With my oncologist’s approval, my plan is to have an MRI one year and one mammogram the following year instead of one MRI and one mammogram each year. My decision was based on all of the studies I’ve mentioned in previous blogs in combination with new information, my age and the type of cancer.

Breast cancer is big business and mammography is one of the most profitable cancer tests in history. The US still favors yearly mammograms from 40 onward, while in the UK, it is once every three years for those 50-70. Considering that the new 3-D tomosynthesis scans give you (according to computations by my radiation oncologist) the equivalent of about 10 round trip airplane trips to the West Coast. The older mammograms expose you to slightly less radiation but come with the added distress of increased compression, and the oftentimes the requirement for more scans because of poorer images. I realize that my decision is not for everyone. I’d just simply prefer to skip every other year.

Many countries are beginning to question the logic of their breast screening programs. A US task force now suggests that women should receive screening starting at 50, not 40. The 2012-13 British (Marmot Study) and Canadian (Canadian National Breast Screening Study: randomized screening trial) studies have been influential in questioning the logic and usefulness of constant breast cancer screening. Example - for every 200 women screened, 1 will be saved from breast cancer, and 3 women will be diagnosed with cancer that would not have harmed them if left untreated. New Scientist magazine, Unwitting Women in Cancer Scan Trial, Clare Wilson, 11/12/14.

OK. Who wants to be either one of the three, or one of the 197 that received years of radiation for no reason? It seems to me that making this choice is like rolling the statistical dice with the odds on our side. Yet we are trained to believe that if you take every precaution you’ll never get sick – be it cancer or a cold, and that simply isn’t true. Science and the human body don’t always work in harmony. We know a lot more than we once did about BC, but we certainly don’t know the whole picture. Fact remains, that mammography may be one of the better low cost tests currently available for women. But it’s been proven that mammography is definitely not the best or even the safest screening test.

Even the new Cure magazine has an article on “The DCIS Dilemma”, Charlotte Huff, Fall 2014. The medical world is still up in the air as to whether or not DCIS is cancer or a condition the might not cause any damage, might be controlled by the immune system, or might actually turn cancerous. As a result, “some women decide to use the surgical equivalent of a sledgehammer on a not-quite-cancerous lesion – getting a double mastectomy.” Most women follow my opted route, not that I’m saying I made the correct choice: lumpectomy, radiation, and 5 years of taking estrogen receptor blockers. I can attest that taking those drugs have their own horrific side effects. The only reason I capitulated was because my mother and sister both had the same type of cancer – which the doctors now believe was from some sort of exposure because none of us had any genetic tracers. One thing all doctors agree on is that very few patients die from DCIS.

DCIS is detected only by mammograms. It is seldom found as a palpable lump. This is one case where being older is better. According to the article, “One difficulty in advising patients is that relatively little is understood about the natural course of DCIS and how frequently it progresses to invasive cancer if left alone and closely monitored.”

I mentioned several blogs ago that a good friend of mine who is 34 was diagnosed with DCIS this year. She opted for surgery and radiation but said “No” to tamoxifen because of the long and short term side effects. She is also questioning the frequency of having mammograms going forward. Ultimately, we must forge our own paths in life which is easier to understand when you are selecting a major in college or whether to take a job offer, but rolling the dice with one’s health is not a decision is for the faint of heart or those who refuse to research their health problem. If you don’t do either, you run the risk of choosing unwisely. I must admit that for the most part I did what was suggested by a trusted surgeon. Everything else I questioned but to this day I wonder if my research fell short because I was in shock and afraid.

Interesting aside on LCIS

Also covered in this issue of Cure is an article on LCIS which is lobular carcinoma in situ. LCIS is considered a marker of elevated risk for invasive cancer…not at the moment but potentially in the future. LCIS doesn’t show up on mammograms. It’s usually found during a biopsy for other reasons. It isn’t cancer and doesn’t necessarily develop into cancer. It seems to be a marker of future invasive breast cancer. Those most likely diagnosed with LCIS have a family history of breast cancer, took hormone replacement therapy or are women in their 40’s… strange, because it appears to effect women just prior to or after menopause.

Does that mean you must have surgery? Apparently if it’s in one place, probably not say the articles I’ve read, but if it’s scattered throughout the breast, probably so. It all depends on the doctor’s evaluation of the site plus the patient’s particular age, health status, family history, etc. The general treatment at the moment is taking estrogen receptor blockers such as tamoxifen or raloxifene. Surgery is also an option but only if you are at high risk of breast cancer because of a very strong family history.

Interesting book on the cost of burying our traumatic experiences

OK, count me as obsessed with New Scientist this week but I’ve ordered a book based on their review: The Body Keeps the Score: Brain, mind, and body in the healing of trauma, Bessel van der Kolk, published by Viking books. One line caught my attention: “Excess stress can predispose us to everything from diabetes to heart disease, maybe even cancer.” According to the review, the book speaks to all kinds of trauma/stress and its effects on the human psyche and body. But did you ever consider what it might do to your children in the short term or later in life: “If your parents’ faces never lit up when they looked at you, it’s hard to know what it feels like to be loved or cherished. Neglect creates mental maps used by children and their adult selves, to survive.”

I can identify with that statement as it relates to my mother. Small wonder why after the added stress surrounding her death, I was diagnosed with BC. Could it have been that my autoimmune system gave up at that point because no matter how hard I tried to experience that look, once she was gone so was the hope to enjoy acceptance? Our bodies are such interdependent networks that it stands to reason stress, especially long term, deep stress, can cause serious illnesses.

What have we got to lose...quite possibly our lives?

In this blog, I’d like to assess the logic behind promoting the use of medical marijuana to treat and possibly prevent breast cancer, and the reason why medical research using cannabinoids should expand. This blog is my personal opinion and not necessarily that of the Cherry Blossom Breast Cancer Foundation, whose Directors and Officers may or may not agree with me.

I will avoid discussions regarding the legality/illegality of the use of medical marijuana. Either the Federal Government will decide for the entire country or each state will decide for itself. Matt Ferner in an article in the Huffington Post, August 2014, states that “eleven states have legalized CBD (cannabinoid) for medical use and research, plus 23 others have more broadly legalized marijuana for medical purposes. “ According to Joycelyn Elders, MD, former US Surgeon General “The evidence is overwhelming that medical marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS – or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day.”

Cannabis sativa or marijuana has been used as a medicine for nearly 5,000 years. Its recorded use in Indian and Chinese texts goes back well over 3,000 years. Marijuana has been used to beat beriberi, malaria, rheumatism, depression, muscle and joint pain, angina, epilepsy, muscle spasms, and a host of other ailments. Yet the modern day clinical use of plant derived preparations or pure cannabinoids, is very limited.

Cannabinoids are a complex family of chemicals that lock on to cannabinoid receptors - protein molecules on the surface of cells – within the body. Humans have two main types of cannabinoid receptors, CB1 and CB2. Both are found in different locations of the body and do different things. CB1 is found mainly in the nervous system, and CB2 is found in the immune system. There is also a family of receptors known as GPR (gene protein receptor) that are indicated in cancer research of which the main type is GPR55. Additionally, the human body also produces cannabinoid-like chemicals called endocannabinoids that form the endocannabinoid system, which affects relaxation, eating, sleeping, as well as some reactions.

It’s no secret among the research community that marijuana can block cancerous cell growth by preventing the growth of blood vessels that supply tumors, by causing cancerous cell death, and blocking cancerous cell growth. Most of the scientific research has been done using cancer cells grown in the lab or using animals. However, in the last few years, there has been an increase in the number of human studies. According to what I’ve read, the best results so far seem come from using a combination of highly purified THC and CBD (a cannabinoid found in cannabis plants that counteracts the psychoactive effects of THC). In his article, Matt Ferner states “A growing body of research suggests CBD may also be effective in reducing inflammation brought on by multiple sclerosis, stopping metastasis in many kinds of aggressive cancer, killing cancerous cells found in people with leukemia and serving as an alternative antipsychotic treatment.”

In laboratory studies, Delta-9-THC (the active ingredient in marijuana) has been shown to damage or kill liver cancer cells, lung cancer cells, and breast cancer cells. In fact, a laboratory study of CBD in estrogen receptor positive and estrogen receptor negative breast cancer cells showed that it caused cancer cell death while having little effect on normal breast cells. The article: Caffarel MM et al.Cannabinoids: A new hope for breast cancer therapy? Cancer Treat Rev (2012) summarizes that “our current knowledge on the anti-tumor potential of cannabinoids in breast cancer, suggests that cannabinoid-based medicines may be useful for the treatment of most breast tumor subtypes.”

In addition to tumor reduction, the NCI says that “Delta-9-THC has been proven to reduce cancer pain, nausea, anxiety and distress when compared with no treatment.” Yet the USFDA has not approved cannabis or cannabinoids for use as cancer treatment. You must ask yourself why, when the government allows the sale of highly treated, strain modified, lung, throat, neck, and mouth cancer causing tobacco for everyday use.

According to the NIH, two cannabinoids dronabinol (Marinol) and nabilone (Cesamet) both of which use synthetic Delta-9-THC have been “approved by the FDA for the treatment of chemotherapy-related nausea and vomiting in patients who have not responded to standard therapy.” Marinol is used as an appetite stimulant for AIDS patients and to ease neuropathic pain of multiple sclerosis. Sativex (derived from natural extracts), released in the UK in 2010 was the first cannabis-based prescription medicine. It is approved for use in several European Countries, Canada and New Zealand for relief of spasticity associated to multiple sclerosis, in Canada for the treatment of neuropathic pain in the same disease, and in 12 countries for the treatment of cancer-associated pain. In the context of cancer, it is well established that cannabinoids have antiemetic properties, and in fact, Marinol and Cesamet can be prescribed to prevent nausea and vomiting elicited by standard chemotherapeutic regimes.

Caffarel MM et al. stated in their study that “A general feature of cannabinoid anti-tumor action in breast and other types of tumors is the lack of toxicity on non-tumor cells… An additional characteristic of cannabinoids, which may have important clinical implications, is their safety. Cannabinoid-based medicines have been proven very safe in thousands of patients enrolled in multiple clinical trials in the last years and in cancer patients that use them for the management of pain, nausea, and vomiting.”

The paper discusses uses in the treatment of hormone sensitive breast cancer and HER2-positive breast cancer. It also covers the subject of cannabinoids and triple-negative breast cancer, for which there is no current treatment. Those patients, “whose prognosis is very poor as a group” are most often treated with chemotherapy.

The study concludes with the analysis that “There is compelling evidence showing that cannabinoids have anti-tumor activity in preclinical models of breast cancer. The data come not only from cell culture systems but also from more complex and clinically relevant animal models. This anti-tumor action is produced by the blockade of several hallmarks of cancer rather than by the targeting of a unique process, and the compounds are not only effective but safe.”

As for chemotherapy, the following table was extracted from a pooled analysis of 60 randomized clinical trials with a total of 28,764 women analyzed by age and survival rates by the Susan G. Komen Society, updated as of 2014. It shows the percent surviving adjuvant chemotherapy (after surgery), percent surviving without chemotherapy, and absolute improvement in the number of people surviving with chemotherapy when breast cancer is caught early and followed over a 15 year timeframe indicated low improvement rates:

Early Breast Cancer Trialists' Collaborative Group - Pooled Analysis

  15-Year Overall Survival
Age and Prognosis Percent Surviving -  Chemotherapy Percent Surviving - No chemotherapy Absolute Improvement in Survival with Chemotherapy
By age at diagnosis
<40 years 70% 64% 6%
40-49 76% 69% 7%
50-59 70% 66% 4%
60-69 69% 66% 3%
70 years or older 74% 68% 6%
Among women <50 at diagnosis
Lymph node negative 84% 79% 5%
Lymph node positive 55% 46% 9%
Among women 50-59 at diagnosis
Lymph node negative 86% 83% 3%
Lymph node positive 62% 59% 3%

 According to Julie Gralow, MD, Director of Breast Medical Oncology at Seattle Cancer Care Alliance, “chemotherapy is the most toxic of all the therapies.” It comes with a huge list of side effects. I have seen friends and family members opt for chemotherapy that made the end of their lives extremely painful and very miserable. Ultimately you must question the effectiveness of chemotherapy for certain breast cancers and wonder, how taking cannabinoids could possibly cause greater harm than chemotherapy – which has, depending upon the study you reference, a dismal “success” rate of between 1 – 3%, or as in the previous table 3% - 9%.

A new study from the University of East Anglia, UK released in the Journal of Biological Chemistry, discovered the exact compounds in marijuana that slow tumor growth. Earlier studies found that THC is responsible for slowing tumor growth. In 2007, two scientists, Dr. Pierre Desprez and Dr. Sean McAllister, at California Pacific Medical Center in San Francisco “found that a marijuana compound could stop metastasis in many kinds of aggressive cancer, potentially altering the fatality of the disease forever.” Their original research was on breast cancer, but “now we’ve found that cannabidiol works with many kinds of aggressive cancers, any kind in which high levels of ID-1 are present.” ID-1 is the gene that causes cancer to spread. Dr. McAllister’s research has already shown that CBD can reduce the spread of cancer to other parts of the body and they are in the process of initiating clinical trials. Additional studies on breast cancer, such as the one from the University of East Anglia, found that THC activated the CB2 receptors.

The recently published study found similar results on slowing tumor growth. Dr. Peter McCormick, researcher from the University of East Anglia’s school of pharmacy and co-author of the new study Targeting CB2-GPR55 Receptor Meteromers Modulates Cancer Cell Signaling 2014, said in a statement, “This compound (THC) is known to act through a specific family of cell receptors called cannabinoid receptors. However, it was unclear which of these receptors were responsible for the anti-tumor effects of THC.” He goes on to say, “Our findings help explain some of the well-known but still poorly understood effects of THC at low and high doses on tumor growth. So, the ideal would be either the purified THC in an effective dose provided by a health care provider to reduce the known cognitive side effects and still deliver the appropriate reduction in tumor growth, or a synthetic homolog that provides the same effects.” This isn’t the first time scientists have found that marijuana can be effective in fighting cancer. “Previous studies have found that THC cuts tumor growth in lung cancer in half and also prohibited the cancer from spreading. THC has also been shown to induce death in brain cancer cells.”

In a 12/1/13 article by Lara Stielow entitled Breast Cancer Patients Helped With Marijuana – “Breast cancer patients can be helped by marijuana if they merely want to have it as an adjunct to more standard Western medical practices. A patient does not smoke or eat marijuana, nor do they exhibit a sense or euphoria, time distortion or short-term memory loss from cannabinoids uses to combat cancer. In order for the anticancer effects to be optimized, highly concentrated extracts are put into capsules and administered to patients.”

Apparently human studies are underway but treatments have not been approved by the FDA. She goes on to say. “The production of these medications is much cheaper than standard current therapies and they also do not require ongoing intensive monitoring by healthcare professionals. A patient can safely self-administer a cannabinoid medication at home, as it has extremely low toxicity and has virtually no associated side effects….A breast cancer patient can be helped with marijuana to beat the illness while maintaining a normal day-to-day life. It is extremely necessary that the general population and those affected by cancer push for more research and have that research acknowledged by the FDA.”

Researchers have yet to identify cannabis treatments that definitely cure cancer when used at a specific strength, in a specific mix, and/or within a specific timeframe. But they also can’t prove that chemotherapy or any of the other treatments for breast cancer definitely cures the disease.

Because of the lack of medical research with cannabinoids it’s not clear if either natural, synthetic or combination of both types of cannabinoids are more effective, what doses might be required, or how specific cancers will respond to them. The correct course of treatment might very well be individualized treatment based on one’s biochemistry in conjunction with the type of cancer. So we’re far away from “take two every 8 hours for the next 4 weeks and we’ll test again.”

Clinical research and treatment is not done with street drugs. It is done with purified drugs in controlled, high dose treatments. Centuries of human experimentation proves that naturally occurring cannabinoids are broadly safe and exhibit relative few side effects beyond dizziness, fatigue, and increased heart rate and appetite. Not bad, when considering the very scary lists of drug related side effects you constantly hear on TV or read about in drug ads.

I am not a doctor. I am a 67 year old breast cancer survivor who did not take chemotherapy. However, taking cannabinoid medication for preventing and treating breast cancer makes sense to me. If my cancer were to reappear tomorrow, I would certainly want access to any and all breast cancer and immune boosting cannabinoid medication (trial or other) that I could get my hands on – immediately. As breast cancer patients, we should collectively speak out for increasing the clinical trials of cannabis medications for boosting the immune system to prevent the breast cancer from recurring, and to help our bodies kill it when it returns.

Women 55+ aren't the only ones wearing pink ribbons!

I've struggled greatly writing this blog because of hearing recently about 2 friends with breast cancer. Nothing brings home the indiscriminate terror of breast cancer more than learning in the same week about two "non-typical" individuals with the disease.

Joe is an athletic male friend from my high school days. He was diagnosed with breast cancer six years ago. Agnes is a very dear young female friend who recently received a breast cancer diagnosis. (Not their real names). Joe has the BRCA2 gene. It runs in his family  - one of his four daughters carries the gene and his mother died of breast cancer. Agnes does not have a BRCA 1 or 2 gene mutation nor does she have a family history of breast cancer. Joe has lived his entire life in Northern NJ, whereas Agnes has lived all of her life in rural Northern VA. Joe is 67 and Agnes is 34.

After hearing from Joe and while waiting for Agnes to receive her diagnosis, I set about scouring the web for information on breast cancer in men and younger women. That's when I realized the overwhelming focus on the standard 55+ female version of an illness that can and does afflict others outside of the norm. Breast cancer in both groups is mentioned at best in passing on most websites, but not often addressed in any depth. The most apparent reason is because neither group has been as closely studied as women 55+.

The National Cancer Institute projects in 2014 there will be:

• 232,670 females and 2,360 males diagnosed with breast cancer
• 40,000 female deaths and 430 male deaths from breast cancer

While writing this blog I amassed pages of stats on breast cancer, its victims, and cancer in general. Trying to make sense of the numbers and put them into perspective was even more difficult. A report on breast cancer by the US DoD (Department of Defense) states a caveat for all statistical survival rate estimates:

Survival rates are skewed by screening: the more women that are screened, the more early cancers are found, resulting in a larger denominator of breast cancer cases, i.e., more women will be counted as alive at 5 years. Evidence suggests that many women would not have died of breast cancer in that time frame, even if they had not been screened. In addition, these numbers do not take recurrence into account. A sizable proportion of the women reported to have survived for 5 years will have their breast cancer recur... and there is no known method to prevent recurrence.

90% of deaths due to breast cancer are a consequence of metastatic disease and there is no cure once metastatic disease has occurred. While the risk of recurrence is greater in the first 5 years after a diagnosis of estrogen receptor (ER)-negative breast cancer, patients with ER-positive tumors have a consistent long-term risk of death from breast cancer and a greater risk after 7 years. Approximately 75% of breast cancer is ER-positive, and most breast cancer deaths occur in ER-positive women.

What’s going on with breast cancer in men and younger women?

According to an article in the Journal of Clinical Oncology, Dr. Carey Anders, MD states that "More and more evidence tells us that breast cancer (in women) before age 40 differs biologically from the cancer faced by older women." The American Cancer Society says that compared to older women, young women generally face more aggressive cancers and lower survival rates.

Like young women, men have worse odds than the average older woman with breast cancer. Even those with early-stage breast cancer are more likely to die from the disease than women. Moreover, the lower breast cancer survival rate in men was only seen in those diagnosed with early-stage breast cancer. For men with advanced-stage breast cancer, survival was about the same for men and women.

What are the possible causes of breast cancer in men and young women?

One possible cause is radiation exposure. According to the Radiological Society of North America, researchers now believe that use of nuclear medical examinations and the increased use of CT scans between 2000 and 2010 may result in an increased risk for breast cancer. When I asked Joe (a lifelong athlete) about CT scans, he groaned and admitted he had had a lot of chest CTs over the years.

Females have been studied for 10 years but unfortunately not males. However, when a body undergoes a CT or nuclear medicine imaging of the chest, abdomen or spine, the breast tissue will absorb some radiation. Breast tissue is one of the body tissues known to be sensitive to developing cancer as a result of radiation exposure. This fact grounds one of my personal fears. 

How are men diagnosed and how does their treatment differ from females (of any age) with breast cancer?

Breast cancer usually strikes men between ages 60-70. Male breast cancer is usually ductal carcinoma (DC) not ductal carcinoma in situ (DCIS) which is very common in women of the same age group. Male breast cancer is more likely to be hormone-receptor positive. Men do not usually receive post-surgical hormonal medications as part of their treatment plan. They also do not normally receive radiation.

Joe’s cancer evidenced as a non-painful lump. His doctor’s first response was “wait and see” but Joe insisted on a biopsy. It turns out he was wise to have followed his instinct because the cancer had already moved into his lymph nodes. Considering he tested positive for BRCA2, he opted for a double mastectomy. As a result, Joe went through 2 months of chemotherapy and no radiation. He then took 5 years of hormone therapy in the form of Tamoxifen tablets and continues to take them on the advice of his oncologist. 

Because so few men get breast cancer, there is no clinical data on what is the best course of treatment. In fact, there have been no clinical trials in men to determine what medicine, if any, would be effective in fighting the disease. There is also no information on the effects of using these follow-up medications, although some men have reported the same symptoms as women.

According to MD Anderson Cancer Center, “On average, men are diagnosed at an older age and at a more advanced stage of the disease than women. However, when comparing patients of the same age and the same stage, the survival rates are similar. The overall 5 year survival rate for men was 63%, whereas the survival rate for older women is over 89%.”

Peter Criss, drummer and co-founder of the rock group KISS is a 7+ year breast cancer survivor. Like Joe, he too noticed a lump on his breast. Both men had the common sense to investigate rather than to ignore what must seem like an out-of-the-blue alarm bell. 

Despite being considered a female cancer, the fact remains that men have breast tissue and should not treat or put off any lump or other sign of breast cancer as something to ignore. Better safe than sorry is a better plan of action.

Why is breast cancer in young women and men hard to diagnose?

Naturally, men have less breast tissue than women. However, men can have the same diagnostic tests as women including: mammograms, sonograms, MRIs, needle biopsies and lymph node biopsies.

One reason diagnosing breast cancer in younger women is more difficult is because they have denser breasts. Standard mammograms miss cancer detection in dense breasts. Another reason is that like men, symptoms are often ignored and the disease becomes more aggressive because of detection delay. Like men, younger women's cancer might be likely to have been instigated by a mutated gene (BRCA1 or BRCA2), or exposure to radiation. Again, like men, it has also been linked to having a disease that causes high levels of estrogen such as cirrhosis, certain autoimmune diseases (in both sexes) or Klinefelter syndrome (in males). Cirrhosis can be caused by alcohol abuse, but it can also be the result of viral hepatitis or certain genetic conditions.

Aggressiveness of Breast Cancer in Young Females

Breast cancers in younger women tend to be fast-growing, higher grade and hormone receptor negative. All of these are factors that make the cancer aggressive and more likely to require chemotherapy. Increasingly, according to the National Institute of Health paper “Breast Cancer Before Age 40 Years," evidence suggests that breast cancer before age 40 is biologically different from the majority of breast cancer that occurs in older women.

Young women have a poorer survival and higher risk for recurrence compared with their older counterparts. Again, a key factor is that regular mammography is not an effective diagnostic tool for young women. The newer 3-D tomosynthesis mammography which uses new density software and imaging hardware makes it easier to spot tumors in the dense breast tissue of younger women. Is it perfect? No, but it's better than nothing or traditional mammography.

How does the treatment of young women with breast cancer differ from that of older women?

Breast cancer in young women is also treated differently than in older women. Not because of the cancer but mainly because of the cancer stage and tumor characteristics such as larger sizes, HER2 status/BRCA1 or BRCA2/hormone receptor status, and a higher incidence of lymph node involvement. 

Hormone therapies like AI's (aromatase inhibitors) are only used for post-menopausal women and chemo can cause menopause, which is why Tamoxifen is usually prescribed until there is no chance the patient is still premenopausal. Treatment options include lumpectomy, mastectomy (very common option), radiation following a lumpectomy, chemo/and or hormone therapy...but with way different consequences than with older women. 

According to the Oxford Journals Annals of Oncology, “Chemotherapy remains an important and frequently used treatment option for younger women.” Everyone is aware of the short term effects of chemo, but there is little study data on the long-term effects on younger women. Researchers do know that some long-term effects of breast cancer treatments include cardiac toxicity, congestive heart failure, hypertension and coronary artery disease, secondary cancers such as leukemia, wound infections, peripheral neuropathy, lymphedema, impaired cognitive function, neurotoxicity and psychological distress. 

Chemo and hormonal therapy can and do effect fertility and sexual functioning in all women with more serious QoL (Quality of Life) effects on younger women resulting in impaired fertility and early menopause (both temporary and permanent). For younger women, the higher the age at diagnosis and the higher the number of chemotherapy cycles, the lower the age of developing menopause. The newly released gel form of Tamoxifen apparently does not carry the side effects of oral Tamoxifen. Because of the side effects of oral Tamoxifen, Joe is planning to ask his oncologist about switching from the pill to the gel from.

The Oxford Journals Annals of Oncology advises "Current evidence suggests that sexuality is often not addressed with breast cancer patients, and even when discussed, it is done at an unsatisfactory level. Interest in sexual activity is one of the most relevant problems regarding QoL issues that remains altered over time.”

Most websites and doctors never mention the problem or at best, skirt the issue when discussing breast cancer treatment options to patients. When you’re more focused on life vs. death, statements like “might cause psychological distress or QoL issues” are easy to ignore. That in my personal experience is a grave disservice to all breast cancer patients. The patient is a key part of any treatment decision making process. To omit what might be for some physicians and patients alike an uncomfortable discussion of all the facts and consequences does not provide the patient with sufficient data on which to make personal, life altering decisions.

Although this blog is rather long, it only touched on several serious and disturbing topics for which information is scarce and results are uncertain. As the numbers of positive diagnoses continues to grow, so does the need for information, answers, solutions, treatments and prevention. Hopefully research and treatment approaches will broaden outside of the current focus on the usual suspects. If medical professionals are reluctant to fully discuss all aspects of cancer treatment, perhaps the media will step up and fill in the blanks.