Breast cancer risk after supradiaphragmatic radiotherapy persists beyond 40 years

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Everything...and I mean EVERYTHING comes with a price tag.

I came upon this, and my breath caught. This has nothing to do with my personal health journey. It has everything, however, to do with dear sweet 16 year old Hannah...just another potential battle you may have to face down the road. Hannah was diagnosed with Hodgkin's Lymphoma this past spring when she was 15, and has been undergoing very aggressive treatment since. Her last round is scheduled for erev Rosh Hashanah. Her mother (Andrea), whom I got to shared a hug with this past Thursday, was looking at the poetic and positive portend associated with this timing.  Andrea has always been a 1/2 glass full lady.

I, on the other hand, have been trained to be the consummate cynic (4.5 years of law school and nearly two decades practicing law). I listen to the treatment regimen Hannah's young body has had to endure these past six months; I recall my own fears of cumulative radiation exposure;  I stumble across the following abstract; and I viscerally cringe.

And, again, I ask the question constantly on my lips - why must anyone sacrifice their long term health as the cost of being "cured" today?  ####

1:35 | Jun 29, 2012 | Oncology, Reuters Health • The Doctor's Channel Daily Newscast, Women’s Health

NEW YORK (Reuters Health) – The increased risk of breast cancer in women who received radiotherapy above the diaphragm for treatment of Hodgkin’s lymphoma (HL) persists for at least 40 years after treatment, according to a national cohort study from the United Kingdom.

These women need to be followed for at least 40 years, perhaps with more-intensive screening regimens, say the investigators from the England and Wales Hodgkin Lymphoma Follow-Up Group in a report online June 25 in the Journal of Clinical Oncology.

“Supradiaphragmatic radiotherapy is still widely used although techniques and doses keep changing,” first author Dr. Anthony J. Swerdlow, from the Institute of Cancer Research, Sutton, Surrey, England, commented in an email to Reuters Health.

He and his colleagues documented the clinical characteristics, treatment, and subsequent outcomes of 5,002 women with HL treated with supradiaphragmatic radiation (mantle-field in two thirds of the population) in England and Wales from 1956 to 2003. The women were younger than 36 at the time of treatment and were followed through the end of 2008.

The researchers used modeling to describe specific, cumulative breast cancer risk at given time points during follow-up according to age at diagnosis, treatment type (inclusion of alkylating agents or pelvic radiation), radiation dose, and time from first treatment.

A total of 373 women developed breast cancer or ductal carcinoma in situ during follow up, yielding a standardized incidence ratio (SIR) of 5.0.

SIRs were greatest for those treated at age 14 years (47.2) and “continued to remain high for at least 40 years. The maximum absolute excess risk was at attained ages 50 to 59 years,” the investigators report. Alkylating chemotherapy or pelvic radiotherapy diminished the risk, but only for women treated at age 20 or older, not for those treated when younger.

The authors tabulated “in detail” cumulative risks of breast cancer based on various factors. For example, the cumulative risk of breast cancer in a woman 20 to 24 years old at the time of treatment with supradiaphragmatic radiation is 3.5% at 20 years and 29.2% at 40 years. For those treated with supradiaphragmatic radiation plus alkylating chemo and/or pelvic radiotherapy, the corresponding risks are 3.6% and 11.5%.

“I think the clinical implications (of the article) are in the provision of risk statistics to use to advise patients,” Dr. Swerdlow said.

In an accompanying commentary, Dr. Michael Crump, from Princess Margaret Hospital and University of Toronto in Canada says, “The legacy of curative extended-field radiation for HL is a large survivor population that is at an increased lifetime risk of second cancer, in particular breast, lung and GI cancer. The article by Swerdlow et al … offers additional information to address the challenge of individual risk assessment.”

This is largest cohort of survivors of HL yet evaluated for breast cancer risk, Dr. Crump notes, and the results confirm those of others. Namely, that breast cancer risk is “highest in women treated with mantle radiotherapy around puberty, decreases with increasing age at treatment (although still elevated for women treated in their thirties, the median age at diagnosis of HL in most countries), and decreases with smaller radiation field sizes and lower radiation doses. Gonadotoxic therapy (alkylating agents or radiation) reduced subsequent breast cancer risk but only for women treated after age 20 years.”

Dr. Swerdlow and colleagues say the “large cumulative risks of breast cancer we found 20 to 39 years after supradiaphragmatic radiotherapy, especially in patients treated at age 20 years, are similar to or higher than the risks by the same ages in BRCA1 and BRCA2 carriers. They suggest that intensive breast screening programs for such women may need to continue for 40 years and longer after initial radiotherapy.”

They also say their data showing maximum absolute excess risk at ages 50 to 59 years suggest that “more-intensive screening (eg, annual screening with magnetic resonance imaging) may be needed.”

In his editorial, Dr. Crump points out that “Both the American Cancer Society and the United Kingdom Notification Risk Assessment and Screening Programme recommend magnetic resonance imaging (MRI) as an adjunct to annual mammography for women who have received thoracic irradiation younger than age 36 years, starting 8 years after treatment. Available data suggest that efforts to enroll high-risk women onto screening programs are falling short, and less than half of women treated during adolescence or as young adults currently receive annual mammography.”

Continuing, Dr. Crump says, “The United Kingdom guideline recommends commencing screening at age 25 years but returns women to standard mammography once every three years once they have reached age 50 years. The report by Swerdlow et al suggests that this upper age limit should be reconsidered in light of the very high cumulative risk faced by women even beyond 30 years of follow-up,” he concludes.

SOURCE:

Toward Risk-Based Breast Cancer Screening and
Prevention Strategies for Survivors of Hodgkin’s
Lymphoma: One Step Closer?

Breast Cancer Risk After Supradiaphragmatic Radiotherapy for Hodgkin’s Lymphoma in England and Wales: A National Cohort Study

J Clin Oncol. 2012.

 

Coley's Controversial "Cancer / Fever" Connection

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As a result of my month-long battle with flu, pneumonia, bacterial infections and high fevers (102.5+), my partner reminded me of an interesting theory regarding the benefits of high fevers in combatting cancer cells. I started to dig around to find a reader-friendly summary and history of the "cancer/fever theory" and found the following two articles. They are a good introduction to the controversial hypothesis. The url for the source website is listed at the end.

Fever can save lives and heal cancer. Here is a possibly life-saving article detailing the vital importance of non-interference with the body’s self-healing in the case of fevers healing the body, especially in virus (lung) infections, together with articles on the strong connection between fever or induced hyperthermia and cancer healing (including spontaneous remissions).

Fever and Cancer Healing
Fever, Cancer Incidence and Spontaneous Remissions
Kleef R, Jonas WB, Knogler W, Stenzinger W., Office of Complementary and Alternative Medicine, NIH, Bethesda, MD, USA.

Summary: [T]he occurrence of fever in childhood or adulthood may protect against the later onset of malignant disease; spontaneous remissions are often preceded by feverish infections.

OBJECTIVE: Accumulating evidence exists for (1) an inverse correlation between the incidence of infectious diseases and cancer risk and (2) an inverse correlation between febrile infections and remissions of malignancies. This review is part of an effort of the Office of Alternative Medicine at the National Institutes of Health to examine this evidence.

METHODS: A review of the literature to a key word search was undertaken, using the following key words: fever, infectious diseases, neoplasm, cancer incidence and spontaneous remission.

RESULTS: The data reviewed in this article support earlier observations on the topic, i.e. that the occurrence of fever in childhood or adulthood may protect against the later onset of malignant disease and that spontaneous remissions are often preceded by feverish infections.

CONCLUSION: Pyrogenic substances and the more recent use of whole-body hyperthermia to mimic the physiologic response to fever have successfully been administered in palliative and curative treatment protocols for metastatic cancer. Further research in this area is warranted.

Copyright 2001 S. Karger AG, Basel Dec 22 2003

Compare Terminal Colon Cancer Patient Healed Via Complete Budwig Protocol, Healthy Today. His healing journey involved multiple fever spells, both spontaneous and self-induced by epsom salt baths, each of which left him feeling better. Also see the powerful confirming observations reported in Homeopathy, Carcinosinum and Cancer: Cancer patients are regularly recorded as stating: "I cannot remember that I ever had fever." As their bodily defenses are rekindled (such as by homeopathic [= energetic] treatment), RESTORATION OF REACTIVITY, from the tumoral stage back to the infectious stage, takes place: "A process of cleaning out at all levels takes place, poisonous relationships are broken off or corrected, ... and a marked influenza or inflammation with high fever for the first time in twenty years cleans the poison from his body. All this means that the reactivity is increasing. ... Also the suppression of fever, a defense mechanism par excellence, the use of antibiotics and corticosteroids can lower the defense mechanisms.”

Microbially Induced Fever and Spontaneous Cancer Remissions (“Coley's toxins”) -- excerpted from The Promise of William B. Coley

by Ralph W. Moss, Ph.D., September 2002

NOTE: Readers can find out more about this program by calling Gar Hildenbrand of the Issels Treatment Center at 858-759-2966.

Last week I spoke about the promise represented by the phenomenon of "spontaneous remissions." These are cures of cancer that occur without medical intervention. While rare, they are well documented. For centuries, doctors have dreamed of harnessing this phenomenon to create a natural cure for cancer.

In the 1890s, a young New York surgeon, fresh out of Yale University and Harvard Medical School, made a fascinating discovery. Desperate to find a cure for bone cancer, he searched the records of New York Hospital to see if anyone had ever been cured of the advanced form of that disease. He discovered that one man with advanced sarcoma had contracted an infectious skin disease called erysipelas in the hospital. He not only survived the infection but his cancer went into a "spontaneous" remission.

Most doctors would have shrugged their shoulders and moved on to the next case. But William B. Coley was no ordinary doctor. He was the Sherlock Holmes of cancer. He went to the address listed on the man's records, but the man had moved. And so he tracked him from tenement to tenement until finally in 1888 he found the man alive, well, and cancer-free seven years after the spontaneous cure.

This was an event that changed the course of Coley's life. In 1891, he began treating patients with the same organism that caused erysipelas, a germ called Streptococcus pyogenes. His first patient developed a raging fever, and then the "miracle" occurred: the tumors of his tonsils and neck completely disappeared, and only a scar remained. This man, who could only swallow liquids and whisper when Coley started the treatment, made a complete recovery. (Ten years later he was still free of cancer.) Coley inoculated nine more patients with live erysipelas microbes and discovered that physicians in Germany, such as Dr. Busch, were doing the same thing independently of his own discovery. In 1893, he tabulated the first results and published his first article on the method. Out of seventeen cases of advanced cancer, four were permanently cured, ten showed improvement, while three showed no improvement at all.

While some people saw their cancers regress with the use of live bacteria, others died. In addition to its risks for the patient being treated, using live bacteria was dangerous to other patients and to the staff. So Coley conceived the idea of using killed bacterial byproducts. He added a nonpathogenic organism called Serratia marcescens to the "soup" and started treating patients with this mixture.

The world quickly dubbed this combination "Coley's toxins," since they represented the toxic byproducts of the bacteria without the bacteria themselves. However, the word "toxins" was an unfortunate choice. (A more acceptable name for the treatment is "mixed bacterial vaccine.") The bacteria deliberately caused side effects, such as fever and malaise. But they were not toxic in the sense that radiation or chemotherapy is toxic. They did not destroy the immune system but put it through a rigorous drill that often resulted in the shrinkage or disappearance of the tumor.

Over the years Coley published dozens of articles in the best medical journals. These recorded his success (and sometimes his failure) in applying the mixed bacterial vaccine to people with advanced cancer. In sarcomas, he claimed 41 percent complete cures. In other kinds of cancer there were many astounding remissions.

There were drawbacks to the treatment, however. Having frequent fevers is trying on the patient. The preparations (mostly made for Coley by Parke-Davis) were variable in their potency. This led to much confusion and disappointment. Some doctors, initially enthusiastic about the treatment, became disillusioned when they used less effective preparations. Oftentimes, doctors did not use the toxins aggressively enough. It took a tremendous belief to persevere with this treatment. Nevertheless, despite the difficulties and drawbacks, there is no doubt in my mind that Coley's toxins represented one practical application of the idea of spontaneous remission to treatment.

The subsequent history of Coley's toxins is rather sad. Coley died in 1936. He never wrote a book about his amazing life experience, and his journal articles began to gather dust in medical libraries. His son, Bradley Coley, MD, continued to use the vaccine at Memorial Sloan-Kettering into the 1950s, but in an increasingly hostile environment. First radiation and then chemotherapy became directly competitive with this more natural approach. Coley's daughter, Helen Coley Nauts, founded the Cancer Research Institute of New York to save and promote his work. She was an amazing presence in the cancer field for many decades. But although she got her father removed from the American Cancer Society "quack list" in the mid-1970s, she was never able to get his treatment used widely.

I first heard of Coley from his Memorial colleague, Kanematsu Sugiura, DSc, who compared his own problems with laetrile to those experienced by Coley in the 1920s and 1930s. Through Lloyd Old, MD, then vice president of Sloan-Kettering Institute, I interviewed Mrs. Nauts at her home on Park Avenue in 1975. This was an eye-opener, to say the least. Mrs. Nauts remained a good friend for many years. She had a vast influence on cancer, befriending and supporting many young researchers. She died on January 2, 2001, at the age of 93.

At the present time, there are few clinics that use Coley's toxins as part of a comprehensive treatment protocol. One that interests me very much is an inpatient program in Tijuana, Mexico, that combines Coley's toxins with the Gerson diet [also compare Juicing & Juicers] and other forms of immunotherapy.

Copyright © Ralph W. Moss, Ph.D. CancerDecisions®

Compare Terminal Colon Cancer Patient Healed Via Complete Budwig Protocol, Healthy Today. His healing journey involved multiple fever spells, both spontaneous and self-induced by epsom salt baths, each of which left him feeling better.

Also see the powerful confirming observations reported in Homeopathy, Carcinosinum and Cancer: Cancer patients are regularly recorded as stating: "I cannot remember that I ever had fever." As their bodily defenses are rekindled (such as by homeopathic treatment), RESTORATION OF REACTIVITY, from the tumoral stage back to the infectious stage, takes place: "A process of cleaning out at all levels takes place, poisonous relationships are broken off or corrected, ... and a marked influenza or inflammation with high fever for the first time in twenty years cleans the poison from his body. All this means that the reactivity is increasing.”

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http://www.healingcancernaturally.com/nature_heals2.html#Fever and Cancer healing

It's the Little Things...

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"Don't Sweat the Small Stuff"

"Stop and Smell the Flowers"


"It's the Simple Things in Life"
...each of these are absolutely correct (albeit trite) adages.


I have had my own epiphany. A variation on these age-old themes, if you will, since my diagnosis with Invasive Lobular Carcinoma. If I appear to wax in a rambling poetic manner (a la Jabberwocky), or a perpetrator of TMI, please indulge and forgive - it is not intentional...at least the poetic part.

For me, it truly has been the little things that I have noticed since dealing with my diagnosis of breast cancer.


I noticed that I did NOT know that there are two types of breast cancer: Lobular & Ductal.

I noticed that I did NOT know that there are subsets to Lobular & Ductal, i.e. Invasive and Non-Invasive.

I noticed that I felt strangely compelled to look up the definition of invasive ten times.

I noticed that not knowing these things was only the proverbial tip of the iceberg.

I noticed the irony that the lobules in the breast are the source of the most nutritious food you can provide your newborn child. I breast-fed three - the last one just 7 years ago.

I noticed the irony that breast feeding is supposed to be a prophylactic against breast cancer.

I noticed that when I was going through all of the diagnostic measures I was always the youngest in the waiting room. (I do acknowledge that being in Arizona means I reside in one of the retirement capitals of the nation.)

I noticed that each and every med-pro that I interrogated started each and every conversation with the unquestioning assumption that because I was young (so relative) that I was going to jump into the toxic-soup. As they stood outside the pot--in their protective gear, holding the ladle.

I noticed that even as an organic, rarely meat-eating, fruit, nut, veggie-consuming type I had no idea of the nutritional deficiencies that can contribute to breast cancer. E.g. a lack of Vitamin D.

I noticed the irony that I live in a climate that has triple-digit sunshine weather 9 months out of the year. Hell, we can export Vitamin D.

I noticed that the my medical issues over the years have been "stressed-related": migraines, miscarriages, pre-term labor, cancer ...THINK (?)

I noticed that I was immediately aware of and repulsed by the ridiculous amount of "pink-ribbon" merchandising that is thrust upon us by retailers - especially during my birthday month.

I then noticed that I had been a good little consumer of some of these pink trinkets (under the misconception that I was contributing to the CAUSE...I mean...CURE somehow??).

I noticed that the CAUSE is making millions for pharmaceutical companies, so there really is no true motivation for a CURE.

I noticed that for some reason I cannot don my pink-ribbon running cap...and forget the Race for the Cure this October...I am so not going to be there. First, and permanent, absence in 15 years.

That's when I noticed that I really am not a good card-carrying member of this exclusive, yet expansive, club of "breast cancer survivors."

I noticed that I am having a hard time coming to terms with the concept of "survivor."

I noticed that I might have subversive tendencies. (If W were in office I might be more concerned that my blog would be monitored for typing (and pinging) the word S-U-B-V-E-R-S-I-V-E.)

I noticed that people are surprised by my appearance. Not because that I appear sickly, its because I don't.

I noticed that my 8-year old has a hard time taking his eyes off the "d-bombs." Even though I have tried to conceal them in a jewelry gift-bag that I lace through a pirate belt I sport at my hips.

I noticed that I am obscenely fascinated by the red-stringy stuff that gets sucked out by, and stuck in, the "d-bombs" (OOOOO, I DID HEAR THE COLLECTIVE 'EWWWWW' CHIME FROM MY LAPTOP.)

I noticed that in the sometimes awkward conversations regarding my recent mastectomy and diagnosis people are really "punny" (pronounced: pun-nee).

I noticed how much better I felt in just having the surgical oncologist remove the operative tape that covered the stitches from my sentinel node biopsy. The underarm is really an "ouch" area.

I noticed what a thrill it was to find out that without the surgical tape my shower-mobility increased two-fold -- no more Bohemian pits. (THERE'S THAT 'EWWWW' AGAIN.)

I noticed that I am thrilled with the bizarre and sometimes painful feel of nerve-endings firing in my surgical area.

I noticed that most everyone you meet or speak with has had their life touched by cancer.

I noticed that for me (so far) a breast cancer diagnosis has not been my emotional "rock bottom." It dawned on me that dealing with my child's eating-disorder diagnosis years ago was way more emotionally, psychologically and physically draining.

I also noticed that at times I cannot bear to hear yet another cancer story.

I also noticed that I listen nonetheless, because I know that they are retold for all the right reasons: to demonstrate courage; because humans believe in the power of healing by sharing; and that connecting through communication is essential for us as a species -- even those of us in the subversive subset.