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TREATMENT FAQ Medical Treatment Articles
I got back my pathology report on my tumor. The report says a lot of things about
the properties of my tumor. What do they mean?
If you’re doing conventional therapy, your oncologist will factor in all the
elements of the pathology report and decide on a treatment course of radiation,
chemotherapy, hormone modulation, etc. But most alternative and
complementary practitioners don’t believe the lion’s share of this information
is vital or relevant because they may reject the premise of chemotherapy's survival
value for most breast cancers. Usually, only the tumor’s hormone receptor status is
addressed and even then, there is controversy between alt med practitioners about
how to treat that.
My doctor has recommended radiation to prevent recurrence after my
lumpectomy. What can I read about this?
Although it's been known for years that radiation does not offer any survival
advantage, an article published in the prestigious British medical journal The
Lancet in 2000 shows that while it may reduce deaths from breast cancer by
13.2%, death from all causes is 21.2 % higher in radiation-treated women.
Mostly, these women die from heart disease probably caused by radiating the
chest.
There is no question that radiation will “sterilize the area” around the
tumor site and reduce local recurrence in the short term. But then radiation-
induced breakdown of the coronary arteries begins to take its toll and overall
survival statistics go south. Also, should you drop dead from a heart attack
four years after radiation treatment, you are still counted as a breast cancer
radiation success statistic since you did not die from breast cancer.
Risks of Radiation May Outweigh Benefits in Some Breast Cancer Patients
By Merritt McKinney [Excerpt]
WESTPORT, May 19 (Reuters Health) - A meta-analysis of randomized trials of
radiotherapy in breast cancer patients shows that the treatment is
associated with reduced local recurrence and breast cancer mortality, but
also with increased mortality due to other causes.
For older women as well as women of any age who have a low risk of
recurrence, the risks of radiation may outweigh the benefits, researchers
report in the May 20th issue of The Lancet.
Dr. Rory Collins, of the Clinical Trial Service Unit at Radcliffe
Infirmary, in Oxford, England, and other members of the Early Breast Cancer
Trialists' Collaborative Group reviewed the 10-year and 20-year results of
40 unconfounded, randomized radiotherapy trials that included 19,582 women.
All of the trials began before 1990.
Overall, radiation prevented about two thirds of local recurrence,
regardless of patient characteristics or radiation type, Dr. Collins told
Reuters Health. According to Dr. Collins, radiation therapy appears to
translate into "moderate improvement in avoidance of breast cancer deaths."
He noted that the benefits of radiation tended to be greater in
node-positive women.
When the results of all studies were combined, women who received radiation
did not have lower breast cancer mortality in the first 2 years, but after
that, the annual breast cancer mortality was about 13% lower than that of
women who did not undergo radiation, according to the report.
Despite the reduced breast cancer mortality associated with radiotherapy,
however, overall mortality was actually higher in radiation-treated women.
Beginning 2 years after randomization, the annual non-breast cancer
mortality rate was 21.2% higher in women treated with radiation.
This increased mortality "appeared chiefly to involve an excess of vascular
deaths, perhaps due to inadvertent irradiation of the coronary, carotid or
other major arteries," the authors write.
Overall, the 20-year survival rate was 37.1% in women treated with
radiation and 35.9% in controls.
Lancet 2000;355:1739-1740,1757-1770. [See article abstract in Medical Studies]
My doctor has recommended chemotherapy treatment, because I will gain
a "30% benefit" from undergoing this treatment. What does this mean?
Chemotherapy research is done drug by drug and often difficult to evaluate. Most
doctors try a “cocktail,” a combination of toxic agents called polychemotherapy to
achieve “response.” But each recommendation you receive must be evaluated.
Consider the following study from the prestigious medical journal,The Lancet ,
[highlighted emphasis added for clarity] which factors quality of life into its calculations.
Lancet 2001 Jul 28;358(9278):277-286
Polychemotherapy for early breast cancer: an overview of the
randomised clinical trials with quality-adjusted survival analysis.
Cole BF, Gelber RD, Gelber S, Coates AS, Goldhirsch A.
Dartmouth College Medical School, Lebanon, NH, USA.
BACKGROUND: Overview analysis involving 18000 women with breast
cancer in 47 randomised trials showed that prolonged chemotherapy
significantly reduces the risk of relapse and death compared with no
chemotherapy. Here we express the size of the benefit in terms of
quality-adjusted survival time gained. METHODS: We used the Q-
TWiST method (Quality-adjusted Time Without Symptoms of disease
and Toxicity of treatment) to provide treatment comparisons within 10
years' follow-up, incorporating differences in quality of life associated
with times patients spend with chemotherapy toxic effects, after relapse,
and without symptoms of relapse or toxicity.
FINDINGS: Within 10
years' follow-up the benefit of increased relapse-free and overall
survival for younger women (<50 years old) who received
polychemotherapy balanced the burdens in terms of acute toxic side-
effects, especially among women enrolled in trials that did not include
tamoxifen. Overall, chemotherapy-treated younger women gained
an average of 10.3 months of relapse-free survival and 5.4 months
of overall survival within 10 years (p<0.0001 for both) compared with
the no-chemotherapy group.
Polychemotherapy provided more quality-adjusted time than control
across nearly all values of utility weights for time spent undergoing
chemotherapy and time after relapse. The range of benefit was from -
0.6 to 10.3 months. For older women (50-69 years) overall,
polychemotherapy also provided significant benefit compared with no
chemotherapy but, compared with younger women, the size of benefit
was less and the range of utility-weight values favouring
polychemotherapy was smaller.
Average gains for older women treated with polychemotherapy
(with or without tamoxifen) were 6.8 months of relapse-free
survival (p<0.0001) and 2.9 months of overall survival (p=0.0001)
within 10 years. The range of quality-adjusted benefit was -3.1 to 6.8
months. For older women with oestrogen-receptor-poor tumours who
did not receive tamoxifen (9% of the total), the benefit of
polychemotherapy was significant and similar to that observed for
younger women. INTERPRETATION: The benefits of adjuvant
chemotherapy within 10 years outweigh the burdens especially for
younger women (<50 years old) and among older women (50-69 years)
to a lesser degree. Additional studies to compare the quality-adjusted
survival of chemotherapy plus endocrine therapy versus endocrine
therapy alone are required for younger patients with tumours that
express steroid-hormone receptors.
----------------------------------------------
How can I find out about the risks of doing chemotherapy treatment?
The risks of chemotherapy are listed in the consent form that you sign prior to starting
treatment. There may be some variation with each drug but please see a generic
consent form at this link Generic Chemotherapy Consent Form.
Can I ask my doctor to give me something for hormone modulation for my cancer?
Several women on Amazon have shown good results with this approach. You may
want to research hormone options and tell your doctor about your findings. Be aware
Tamoxifen clearly has a documented downside. You may want to look at Sherrill
Sellman’s article, “The Dark Side of Tamoxifen.” at: www.innerself.com.
Health/tamoxifen.htm. or see the MEDICAL ARTICLES TREATMENT section.
Can I design my own alternative protocol or should I find a practitioner to guide
me?
In the first couple of years, most alternative therapy patients function best under the
guidance of an experienced practitioner. Others feel confident to research and design
their own protocols.
Has any one protocol been proven to cure breast cancer?
No. What works for one person may not work for another, whether it is conventional or
non-standard.
Somebody suggested the AMAS test to monitor the status of my cancer.
Speaking from ten years on the Amazon Email Group, we’ve seen an
extraordinary number of false negatives with this test, that is, it missed a cancer
determination when there was active, disease verifiable by biopsy or scans.
I’ve been taking HRT. Should I stop?
The majority of studies show that taking HRT after breast cancer diagnosis,
paradoxically, does not effect survival. Click on HRT after Breast Cancer for
documentation on this and review the information with your doctor. That being said,
those taking Prempro before diagnosis appear to be at increased risk for lobular
cancer. (JAMA 2003; 289:1421-1424.)
The alternative medicine community does not look kindly on synthetic hormones and
prefers bioidentical hormones when hormones are prescribed. Taking hormones of
any kind remains controversial, so review the studies and make this choice along with
your doctor.
What about DIM, I3C, progesterone or calcium glucarate instead of Tamoxifen for
hormone modulation?
There are many strategies reputed to reduce your risk of recurrence. Consult a
practitioner experienced with these supplements. Also go to Healing Strategies.
My family is pressuring me to take chemo and radiation therapy. How have the
women on Amazon handled this?
Join the Amazon Email Discussion Group group and ask.
Update: What is the rate of side effects for chemo?
Of 4075 breast cancer patients who had chemotherapy, roughly one in six of these
patients showed up in the emergency room or were hospitalized due to side effects,
such as low blood pressure, dehydration, or nausea. (See Hassett M et al., Frequency
and Cost of Chemotherapy-Related Serious and Adverse Effects in a Population
Sample of Women with Breast Cancer, JNCI 2006.)
If I have chemo, will I have brain fog, called "chemo-brain"?
Update: 21 patients who had chemotherapy within the past 5-10 years were asked to
perform a short-term memory task. PET scans revealed a link between chemo-brain
symptoms and lower metabolism in the frontal cortex. The lower the metabolism in
the frontal cortex and the cerebellum, the more difficult it is to perform a short-term
memory exercise. (See Silverman D et al., Altered Frontocortical, Cerebellar and
Basal Cranial Activity in Adjuvant-Treated Breast Cancer Survivors 5-10 Years After
Chemotherapy, Breast Cancer Res Treat 2006.)
Specifically, what is the neurological effect of taking three mainstream chemo
drugs?
Update: Taking carmustine, cisplatin, and cytosine arabinoside have been found to be
more toxic for the progenitor cells of the central nervous system and cells that help
myelinate the nervous system than they are for multiple cancer cells lines.
(See Dietrich J, CNS Progenitor Cells and Oligodendrocytes are Targets of
Chemotherapeutic Agents In Vitro and In Vivo, Journal of Biology 2006.)
I’ve just finished chemotherapy and my tumor markers are back to normal. Is
there anything more I can do?
Congratulations on getting through your treatment. No matter what treatment we
started out with, we are all trying to prevent recurrence. You may want to join Amazon
to explore the ways our members try to boost their immunity by cleaning up toxins
from their households as well as their bodies. Chlorine,fluoride, benzenes and a host
of other chemicals are all around us. Part of our clean up strategy is to reduce the
toxic load on our immune systems.
This website is intended as information only. The editors of this site are not medically-trained.
Please consult your licensed health care practitioner before implementing any health strategy.
The information provided on this site is designed to support, not replace, the relationship that
exists between a patient/site visitor and his/her existing physician. This site accepts no
advertising. The contents of this site are copyrighted 2006 by Breast Cancer Choices, Inc.
Contact us for reprint permission.
Web page updated January 4, 2008.
I got back my pathology report on my tumor. The report says a lot of things about
the properties of my tumor. What do they mean?
If you’re doing conventional therapy, your oncologist will factor in all the
elements of the pathology report and decide on a treatment course of radiation,
chemotherapy, hormone modulation, etc. But most alternative and
complementary practitioners don’t believe the lion’s share of this information
is vital or relevant because they may reject the premise of chemotherapy's survival
value for most breast cancers. Usually, only the tumor’s hormone receptor status is
addressed and even then, there is controversy between alt med practitioners about
how to treat that.
My doctor has recommended radiation to prevent recurrence after my
lumpectomy. What can I read about this?
Although it's been known for years that radiation does not offer any survival
advantage, an article published in the prestigious British medical journal The
Lancet in 2000 shows that while it may reduce deaths from breast cancer by
13.2%, death from all causes is 21.2 % higher in radiation-treated women.
Mostly, these women die from heart disease probably caused by radiating the
chest.
There is no question that radiation will “sterilize the area” around the
tumor site and reduce local recurrence in the short term. But then radiation-
induced breakdown of the coronary arteries begins to take its toll and overall
survival statistics go south. Also, should you drop dead from a heart attack
four years after radiation treatment, you are still counted as a breast cancer
radiation success statistic since you did not die from breast cancer.
Risks of Radiation May Outweigh Benefits in Some Breast Cancer Patients
By Merritt McKinney [Excerpt]
WESTPORT, May 19 (Reuters Health) - A meta-analysis of randomized trials of
radiotherapy in breast cancer patients shows that the treatment is
associated with reduced local recurrence and breast cancer mortality, but
also with increased mortality due to other causes.
For older women as well as women of any age who have a low risk of
recurrence, the risks of radiation may outweigh the benefits, researchers
report in the May 20th issue of The Lancet.
Dr. Rory Collins, of the Clinical Trial Service Unit at Radcliffe
Infirmary, in Oxford, England, and other members of the Early Breast Cancer
Trialists' Collaborative Group reviewed the 10-year and 20-year results of
40 unconfounded, randomized radiotherapy trials that included 19,582 women.
All of the trials began before 1990.
Overall, radiation prevented about two thirds of local recurrence,
regardless of patient characteristics or radiation type, Dr. Collins told
Reuters Health. According to Dr. Collins, radiation therapy appears to
translate into "moderate improvement in avoidance of breast cancer deaths."
He noted that the benefits of radiation tended to be greater in
node-positive women.
When the results of all studies were combined, women who received radiation
did not have lower breast cancer mortality in the first 2 years, but after
that, the annual breast cancer mortality was about 13% lower than that of
women who did not undergo radiation, according to the report.
Despite the reduced breast cancer mortality associated with radiotherapy,
however, overall mortality was actually higher in radiation-treated women.
Beginning 2 years after randomization, the annual non-breast cancer
mortality rate was 21.2% higher in women treated with radiation.
This increased mortality "appeared chiefly to involve an excess of vascular
deaths, perhaps due to inadvertent irradiation of the coronary, carotid or
other major arteries," the authors write.
Overall, the 20-year survival rate was 37.1% in women treated with
radiation and 35.9% in controls.
Lancet 2000;355:1739-1740,1757-1770. [See article abstract in Medical Studies]
My doctor has recommended chemotherapy treatment, because I will gain
a "30% benefit" from undergoing this treatment. What does this mean?
- There are certain words used in the cancer field that can be misleading. Two
of them are “response” and “benefit.” A tumor may shrink with
chemotherapy or lower your tumor markers but not prolong your life. When
reading any study keep in mind that the phrase, "disease-free survival" is
only the amount of time until recurrence.
- Remember to consider only "overall survival." It won't do any good to get a 30%
cancer response rate but no improved overall survival because of a possible
chemotherapy-related side effect such as leukemia or heart disease. Check
out all recommended chemotherapy drugs on rxlist.com.
- Ask your doctor for the “overall survival” statistics for the recommended
therapy. Ask to see the published articles, the actual studies which spell the
overall survival numbers out. Put them in your Patient Portfolio to read carefully
later.
- If the doctor says you won’t understand them, you can say, “That’okay. I have
smart friends." If the doctor brings in a colleague and they both say they would
recommend the therapy for their own daughters, you can thank them for their
frankness, but get the studies in your hands before leaving.
 | The take home question is: when your survival and quality of life are at | |
| stake do you really want to take somebody's word for it about what's good for you? Or do you want to see it in black and white? |
Chemotherapy research is done drug by drug and often difficult to evaluate. Most
doctors try a “cocktail,” a combination of toxic agents called polychemotherapy to
achieve “response.” But each recommendation you receive must be evaluated.
Consider the following study from the prestigious medical journal,The Lancet ,
[highlighted emphasis added for clarity] which factors quality of life into its calculations.
Lancet 2001 Jul 28;358(9278):277-286
Polychemotherapy for early breast cancer: an overview of the
randomised clinical trials with quality-adjusted survival analysis.
Cole BF, Gelber RD, Gelber S, Coates AS, Goldhirsch A.
Dartmouth College Medical School, Lebanon, NH, USA.
BACKGROUND: Overview analysis involving 18000 women with breast
cancer in 47 randomised trials showed that prolonged chemotherapy
significantly reduces the risk of relapse and death compared with no
chemotherapy. Here we express the size of the benefit in terms of
quality-adjusted survival time gained. METHODS: We used the Q-
TWiST method (Quality-adjusted Time Without Symptoms of disease
and Toxicity of treatment) to provide treatment comparisons within 10
years' follow-up, incorporating differences in quality of life associated
with times patients spend with chemotherapy toxic effects, after relapse,
and without symptoms of relapse or toxicity.
FINDINGS: Within 10
years' follow-up the benefit of increased relapse-free and overall
survival for younger women (<50 years old) who received
polychemotherapy balanced the burdens in terms of acute toxic side-
effects, especially among women enrolled in trials that did not include
tamoxifen. Overall, chemotherapy-treated younger women gained
an average of 10.3 months of relapse-free survival and 5.4 months
of overall survival within 10 years (p<0.0001 for both) compared with
the no-chemotherapy group.
Polychemotherapy provided more quality-adjusted time than control
across nearly all values of utility weights for time spent undergoing
chemotherapy and time after relapse. The range of benefit was from -
0.6 to 10.3 months. For older women (50-69 years) overall,
polychemotherapy also provided significant benefit compared with no
chemotherapy but, compared with younger women, the size of benefit
was less and the range of utility-weight values favouring
polychemotherapy was smaller.
Average gains for older women treated with polychemotherapy
(with or without tamoxifen) were 6.8 months of relapse-free
survival (p<0.0001) and 2.9 months of overall survival (p=0.0001)
within 10 years. The range of quality-adjusted benefit was -3.1 to 6.8
months. For older women with oestrogen-receptor-poor tumours who
did not receive tamoxifen (9% of the total), the benefit of
polychemotherapy was significant and similar to that observed for
younger women. INTERPRETATION: The benefits of adjuvant
chemotherapy within 10 years outweigh the burdens especially for
younger women (<50 years old) and among older women (50-69 years)
to a lesser degree. Additional studies to compare the quality-adjusted
survival of chemotherapy plus endocrine therapy versus endocrine
therapy alone are required for younger patients with tumours that
express steroid-hormone receptors.
----------------------------------------------
How can I find out about the risks of doing chemotherapy treatment?
The risks of chemotherapy are listed in the consent form that you sign prior to starting
treatment. There may be some variation with each drug but please see a generic
consent form at this link Generic Chemotherapy Consent Form.
Can I ask my doctor to give me something for hormone modulation for my cancer?
Several women on Amazon have shown good results with this approach. You may
want to research hormone options and tell your doctor about your findings. Be aware
Tamoxifen clearly has a documented downside. You may want to look at Sherrill
Sellman’s article, “The Dark Side of Tamoxifen.” at: www.innerself.com.
Health/tamoxifen.htm. or see the MEDICAL ARTICLES TREATMENT section.
Can I design my own alternative protocol or should I find a practitioner to guide
me?
In the first couple of years, most alternative therapy patients function best under the
guidance of an experienced practitioner. Others feel confident to research and design
their own protocols.
Has any one protocol been proven to cure breast cancer?
No. What works for one person may not work for another, whether it is conventional or
non-standard.
Somebody suggested the AMAS test to monitor the status of my cancer.
Speaking from ten years on the Amazon Email Group, we’ve seen an
extraordinary number of false negatives with this test, that is, it missed a cancer
determination when there was active, disease verifiable by biopsy or scans.
I’ve been taking HRT. Should I stop?
The majority of studies show that taking HRT after breast cancer diagnosis,
paradoxically, does not effect survival. Click on HRT after Breast Cancer for
documentation on this and review the information with your doctor. That being said,
those taking Prempro before diagnosis appear to be at increased risk for lobular
cancer. (JAMA 2003; 289:1421-1424.)
The alternative medicine community does not look kindly on synthetic hormones and
prefers bioidentical hormones when hormones are prescribed. Taking hormones of
any kind remains controversial, so review the studies and make this choice along with
your doctor.
What about DIM, I3C, progesterone or calcium glucarate instead of Tamoxifen for
hormone modulation?
There are many strategies reputed to reduce your risk of recurrence. Consult a
practitioner experienced with these supplements. Also go to Healing Strategies.
My family is pressuring me to take chemo and radiation therapy. How have the
women on Amazon handled this?
Join the Amazon Email Discussion Group group and ask.
Update: What is the rate of side effects for chemo?
Of 4075 breast cancer patients who had chemotherapy, roughly one in six of these
patients showed up in the emergency room or were hospitalized due to side effects,
such as low blood pressure, dehydration, or nausea. (See Hassett M et al., Frequency
and Cost of Chemotherapy-Related Serious and Adverse Effects in a Population
Sample of Women with Breast Cancer, JNCI 2006.)
If I have chemo, will I have brain fog, called "chemo-brain"?
Update: 21 patients who had chemotherapy within the past 5-10 years were asked to
perform a short-term memory task. PET scans revealed a link between chemo-brain
symptoms and lower metabolism in the frontal cortex. The lower the metabolism in
the frontal cortex and the cerebellum, the more difficult it is to perform a short-term
memory exercise. (See Silverman D et al., Altered Frontocortical, Cerebellar and
Basal Cranial Activity in Adjuvant-Treated Breast Cancer Survivors 5-10 Years After
Chemotherapy, Breast Cancer Res Treat 2006.)
Specifically, what is the neurological effect of taking three mainstream chemo
drugs?
Update: Taking carmustine, cisplatin, and cytosine arabinoside have been found to be
more toxic for the progenitor cells of the central nervous system and cells that help
myelinate the nervous system than they are for multiple cancer cells lines.
(See Dietrich J, CNS Progenitor Cells and Oligodendrocytes are Targets of
Chemotherapeutic Agents In Vitro and In Vivo, Journal of Biology 2006.)
I’ve just finished chemotherapy and my tumor markers are back to normal. Is
there anything more I can do?
Congratulations on getting through your treatment. No matter what treatment we
started out with, we are all trying to prevent recurrence. You may want to join Amazon
to explore the ways our members try to boost their immunity by cleaning up toxins
from their households as well as their bodies. Chlorine,fluoride, benzenes and a host
of other chemicals are all around us. Part of our clean up strategy is to reduce the
toxic load on our immune systems.
This website is intended as information only. The editors of this site are not medically-trained.
Please consult your licensed health care practitioner before implementing any health strategy.
The information provided on this site is designed to support, not replace, the relationship that
exists between a patient/site visitor and his/her existing physician. This site accepts no
advertising. The contents of this site are copyrighted 2006 by Breast Cancer Choices, Inc.
Contact us for reprint permission.
Web page updated January 4, 2008.
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