Saturday, January 24, 2009

Why is everyone so obsessed with nipples?

January 24, 2009

Current mood: Pissed!

OK, I had a scare last month. I found a lump in my left breast. I freaked out for several reasons. One being that my cancer was in my left breast and second I've had a double mastectomy a little over a year ago so I shouldn't be finding any lumps.

I've just moved to NYC so I had to find a doctor, that was fun. I found a breast surgeon and made the appointment to see her. When I saw her she told me that she thought is was scar tissue around my "flap". See the reconstruction I had was called a DEIP Tram Flap. This is when they take your belly fat and construct the fat into breasts and then take part of your stomach muscle (tram flap) to keep the new breasts alive. The doctor also told me that if I was to have a recurrence that now would be the time but she reassured me that it was probably scar tissue.

So a week later I go for my mammogram and ultrasound. This is when the obsession of the nipple began.

The woman taking my mammogram had me put nipple stickers on me because it was easier for her define the breast in the films. OK that's fine. But no, she had to take it further. She says to me, "Oh, I see you haven't finish your reconstruction." I have to admit I was caught off guard. I was like what? No, I'm finished. I've chosen to not have my nipples added and tattoos. Like this is any of her business!

Next I'm off to get my ultrasound. While doing the ultrasound the technician asks me the same question. What the hell is every one's obsession with nipples?

I have decided at this time in my life that I do not want to have nipples and the tattoos. I feel like I have been through enough with my cancercrapness journey. I'm done being poked and prodded.

I feel like tattoos and nipples are not going to make me whole again. The simple truth is that I will never be whole again.

Wednesday, January 7, 2009

Meeting My New Oncologist

Wednesday, January 7, 2009

Current mood: Emotionally drained

Well today I had an appointment to meet with my new oncologist. It's been hard since moving to NYC to find new doctors.

I hate having to relive everything. It's weird sometimes I can talk about my cancercrapness journey and not get emotional and other times I cry. I hate crying in front of the doctors, I feel like it makes me look weak. Then of course the doctor wants to make sure you are OK and asks if you have a good support group and if your family is supportive. Yes, Yes and Yes! "Enough already!" is what I want to say.

She wants to do blood work to check to see my Estrogen levels. My cancer was ER/PR and HER2 positive so I guess that makes sense. I have to admit I'm a little scared. Anytime they do blood work I get nervous, just hoping they don't find anything "new" shall we say.

We also discussed having my port removed. I have mixed emotions on that one. A part of me wants my port to stay because I know in the future with tests and everything someone will need to get blood from me and that alone can be a procedure. I have a lovely scar on my arm to remind me of that. On the other hand having my port taken out gets me closer to the end of my cancercrapness journey. That has a nice sound to it.

There is a line in the Livestrong manifesto that I love...It reads, Cancer may leave your body, but it never leaves your life. How true is that?

Thursday, January 1, 2009

Thank you Dr. Slamon

Sunday, January 1, 2009

Current mood: Very Thankful

Happy New Year!

Last night I watched a movie on Lifetime called Living Proof.

Living Proof is the true story of oncologist and researcher Dr. Dennis Slamon, the UCLA doctor who helped develop the breast cancer drug Herceptin, and his effort to keep the drug trials afloat. His inspiring journey shows the sacrifices he makes in his personal life and the obstacles that he faces to get the drug approved. Thousands of lives have been saved because of his dedication. (Based on Robert Bazell’s book "HER-2".)

This movie has special meaning and really hits home for me. I was diagnosed with HER-2 positive breast cancer March 8, 2007.

As I watched this movie, of course I cried but I also learned new facts about how Herceptin was created and it was amazing to watch the struggle Dr. Slamon went through to get this drug approved.

I have the utmost respect for those brave women who helped with the clinical trials to get Herceptin FDA approved.

I also look at the company Revlon in a new way. Just when Dr. Slamon was down and out and almost out of money, Revlon donated over 2 million dollars to help him continue his amazing work.

This movie was a real eye opener for me. Without Herceptin I don't know where I would be today. If I was diagnosed 20 years earlier, what would my outcome have been?

It's weird because when I was first diagnosed, the doctor's asked if I wanted to participate in clinical trials and I was like NO WAY! That would be just too scary for me. But without the brave people that do participate in clinical trials, we would be, no where. So thank you to all who try to help these amazing doctors.

Herceptin first received FDA approval in September 1998 for use in metastatic breast cancer, as a first-line therapy in combination with paclitaxel and as a single agent in second- and third-line therapy. In clinical trials of patients with HER-2 positive metastatic breast cancer, Herceptin, in combination with chemotherapy (paclitaxel), was the first anti-HER-2 agent to demonstrate an improvement in survival in a Phase III study. In December 2001, Genentech received FDA approval to include, in the product label, data that showed an improved median overall survival for women with HER2-positive metastatic breast cancer treated initially with Herceptin and chemotherapy, compared to chemotherapy alone (median 25.1 months compared to 20.3 months).

In 2005, the results of four clinical trials showed that Herceptin is also effective in the treatment of early-stage breast cancer that overexpresses HER–2. In all four studies, women who received Herceptin and chemotherapy lived longer and had significantly less chance of the breast cancer coming back than patients who received chemotherapy alone.

In the NewsNews Review
Survival Increased in Early Stage Breast Cancer After Herceptin-Chemotherapy Treatment
Posted Date: 12/15/2006
Faculty: Dennis Slamon, M.D., Ph.D.

Combining the molecularly targeted therapy Herceptin with chemotherapy in women with early stage breast cancer significantly improves disease-free survival for patients with a specific genetic mutation that results in very aggressive disease, a top UCLA researcher reported Thursday.

Dr. Dennis Slamon, whose laboratory and clinical research lead to the development of Herceptin, reported results of the Phase III study of more than 3,200 women Thursday at the 29th annual San Antonio Breast Cancer Symposium.

The three-armed study compared the standard therapy of Adriamycin and Carboplatin followed by Taxotere (ACT), an experimental regimen of Adriamycin and Carboplatin followed by Taxotere and one year of Herceptin (ACTH), and an experimental regimen of Taxotere and Carboplatin with one year of Herceptin (TCH).

The study tested Herceptin with and without Adriamycin, an anthracycline commonly used to treat breast cancer but one that, when paired with Herceptin, can cause permanent heart damage. Researchers wanted to determine whether they could provide a therapy as effective as ACTH without the resulting cardiac problems. The study, Slamon said, showed that the women who did not receive Adriamycin did just as well as those who did, and they experienced a five-fold decrease in significant heart toxicities compared to those who got Adriamycin. Also, some women in the ACTH arm developed leukemias, while none of the women on the non-Adriamycin arm did, Slamon said.

"This study demonstrates unequivocally that the best treatment for early stage HER-2 positive breast cancer is obtained with a non-anthracycline regimen, TCH, that avoids the significant cardiac damage found when Adriamycin is used with Herceptin," said Slamon, director of clinical/translational research at UCLA's Jonsson Cancer Center. "This trial should impact the way early stage breast cancer is treated, with TCH being considered the preferred option."

Herceptin is effective in women with HER-2 positive breast cancer, about one in four diagnosed with the disease every year or about 250,000 women annually worldwide. HER-2 positive breast cancer is more aggressive, results in a poorer prognosis and shorter survival times, said Slamon, who discovered the link between HER-2 positivity and aggressive breast cancer in 1987.

Conducted by the Breast Cancer International Research Group (BCIRG), the study enrolled 3,222 women with early stage breast cancer between April 2001 and March 2004. Patients were randomized to one of the three arms. Slamon's report is the second interim analysis at a three-year median follow-up of the study data.

The study shows a survival advantage for patients in the Herceptin-containing arms, with 92 percent of patients on ACTH and 91 percent of patients on TCH still alive at four years compared to 86 percent in the ACT arm. Risk of death was reduced by 40 percent among patients in the ACTH arm and 33 percent in the TCH arm, Slamon said.

The study's primary endpoint was disease-free survival, but it also measured overall survival, safety, including cardiac toxicities, pathologic and molecular markers and quality of life.

"Now we know we can provide a very effective therapy for women with early stage breast cancer that reduces by five times the risk of heart damage," Slamon said. "And we've shown that women with HER-2 positive early stage breast cancer benefit from Herceptin therapy in that it significantly improves their disease-free survival times."

Herceptin/Avastin Study Results Revealed

Also presented at the San Antonio Breast Cancer Symposium were results of a promising Phase II study that combined two molecularly targeted therapies to treat advanced breast cancer without using conventional chemotherapy.

The study, done at UCLA's Jonsson Cancer Center and in an affiliated network of oncology offices, tested Herceptin with the angiogenesis inhibitor Avastin, which cuts off the independent blood supply that a tumor creates to help it grow and spread.

The study enrolled 37 women with breast cancer that had spread to other organs, the hardest type to treat effectively. Results indicate that 83.8 percent showed a clinical response, Slamon said, meaning their tumors completely disappeared, shrunk in size by more than 50 percent or remained stable - meaning their cancers didn't progress.

"This represents the next generation of studies we're trying to develop at UCLA, which take chemotherapy completely out of the picture," Slamon said. "This is the first study that takes us in that direction and we think we may be ready to try this in the adjuvant setting. These responses are as good as anything we've seen in this group of patients, even with our best chemotherapies."

UCLA's Jonsson Comprehensive Cancer Center comprises more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2006, the Jonsson Cancer Center was named the best cancer center in California by U.S. News & World Report, a ranking it has held for seven consecutive years.

And the Herceptin story may extend beyond breast cancer, since some other cancers also have too much HER-2. Clinical tests with Herceptin are either under way or planned for ovarian, gastric, endometrial, salivary gland, non-small cell lung, pancreatic, prostate and colorectal cancers. And with several other HER-2 blockers also under development, the full story of this designer drug remains to be written.

Thank you Dr. Slamon and continued success in your effort to find a way to help cancer survivors like myself.