Chemo Brain and More Chemo Brain

Research has proven that breast cancer survivors can experience problems with certain mental abilities several years after treatment, regardless of whether they were treated with chemotherapy plus radiation or radiation only.   In fact, there are indications that there may be common and treatment-specific ways that cancer therapies negatively affect cancer survivors’ mental abilities.
To compare the effects of different types of cancer treatment on such mental abilities, a study examined 62 breast cancer patients treated with chemotherapy plus radiation, 67 patients treated with radiation only, and 184 women with no history of cancer.  Study participants completed neuropsychological assessments six months after completing treatment and again 36 months later, which is further out from the end of treatment than most previous studies of this type.
The study confirmed that chemotherapy can cause cognitive problems in breast cancer survivors that persist for three years after they finish treatment. In addition, the investigators found that breast cancer survivors, who had been treated with radiation and not chemotherapy, often experienced problems similar to those in breast cancer survivors treated with both chemotherapy and radiation.  (They did not find that hormonal therapy, such as tamoxifen, caused cognitive difficulties.)
These findings suggest that the problems some breast cancer survivors have with their mental abilities are not due just to the administration of chemotherapy. The findings also provide a more complete picture of the impact of cancer treatment on mental abilities than studies that did not follow patients as long or look at mental abilities in breast cancer survivors who had not been treated with chemotherapy.  This study gives voice to the many women who believe that they suffer from chemo brain.

Inflammatory breast cancer tends to be diagnosed at younger ages when compared to other cancers; and it’s more common and diagnosed at younger ages in African-American women than in white women.  The median age at diagnosis in African-American women is 54 years, compared with a median age of 58 years in white women.  It’s also  more common in overweight women than in women of normal weight.
Often times, treatments such as tamoxifen aren’t effective against inflammatory breast tumors because they are hormone receptor negative.   Inflammatory breast cancer can strike men as well as women, but usually it strikes at an older age.    Remember that inflammatory breast cancer is a very rare, but aggressive type of cancer and it’s important to always notice any changes in your breast whether you’re a male or female.  Because this disease is so relatively rare, people with inflammatory breast cancer are encouraged to enroll in clinical trials in which new treatments are being tested simply to take any advantage such medicine or techniques may offer in conjunction with those currently in use.   This disease accounts for only one to five percent of all breast cancers diagnosed in the United States.  Typically there’s no lump to be felt, and the disease escapes diagnosis until it has progressed to stage III or IV, at which point it has already spread only to nearby lymph nodes, stage III,---or to other tissues as well, stage IV.
Inflammatory breast cancer usually progresses rapidly, often in a matter of weeks or months.  Symptoms include swelling and redness that affect a third or more of the breast.  The skin of the breast may also appear pink, reddish purple, or bruised.  In addition, the skin may have ridges or appear pitted, like the skin of an orange.  These symptoms are caused by the buildup of lymph fluid  in the skin of the breast.   This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue.  Sometimes, the breast may contain a solid tumor that can be felt during a physical exam, but, more often, a tumor cannot be felt.
Other symptoms include a rapid increase in breast size; sensations of heaviness, burning, or tenderness in the breast, or a nipple that is inverted.   Swollen lymph nodes may also be present under the arm, near the collarbone, or in both places.
Inflammatory breast cancer can be difficult to diagnose.  Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram.  In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult.   Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis or another form of locally advanced breast cancer.
There are published guidelines to help you choose the best course of treatment and how the disease is diagnosed.

Hormone-Sensitive Breast Cancer

Hormones are substances that function as chemical messengers in the body.  The hormones, estrogen and progesterone, can stimulate the growth of some breast cancers.   These breast cancers are called hormone-sensitive (or hormone-dependent) breast cancers.
Hormone-sensitive breast cancer cells contain proteins known as hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can lead to the stimulation of cell growth.
Breast cancers that lack estrogen receptors are called estrogen receptor-negative (ER-negative). These tumors are estrogen-insensitive, meaning that they do not use estrogen to grow. Breast tumors that lack progesterone receptors are called progesterone receptor-negative (PR-negative).
Hormone therapy is used to stop or slow the growth of these tumors.  Therapy is used to treat both early and advanced breast cancer, and to prevent breast cancer in women who are at high risk of developing the disease.
Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the body’s ability to produce hormones or by interfering with hormone action.  With that said, tumors that are hormone-insensitive do not respond to hormone therapy.
Hormone therapy for breast cancer is not the same as menopausal hormone therapy, in which hormones are given to reduce the symptoms of menopause.
Several strategies have been developed to treat hormone-sensitive breast cancer, including blocking ovarian function, ovarian ablation, and temporarily suppressing ovarian function by treatment with drugs.  These medicines interfere with signals from the pituitary gland that stimulate the ovaries to produce estrogen.
Drugs called aromatase inhibitors are used to block the activity of an enzyme named aromatase, which the body uses to make estrogen in the ovaries and in other tissues.  Aromatase inhibitors are used primarily in postmenopausal women because the ovaries in premenopausal women produce too much aromatase for the inhibitors to block effectively.   However, these drugs can be used in premenopausal women if they are given together with a drug that suppresses ovarian function.
Several types of drugs interfere with estrogen’s ability to stimulate the growth of breast cancer cells.  Tamoxifen is one of them and has been approved by the FDA.   Tamoxifen has been used for over 30 years to treat hormone receptor-positive breast cancer.
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer.   Research has shown that women treated for early-stage ER-positive breast cancer benefit from receiving at least 5 years of adjuvant hormone therapy.
Adjuvant therapy may include radiation therapy, a combination of chemotherapy, and targeted therapy.
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years.  However, with the advent of newer hormone therapies, some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common.  For example, some women may take an aromatase inhibitor every day for 5 years, instead of tamoxifen. Other women may receive additional treatment with an aromatase inhibitor after 5 years of tamoxifen.   And, some women may switch to an aromatase inhibitor after 2 or 3 years of tamoxifen, for a total of 5 or more years of hormone therapy.