diabetes-drug

Inexpensive Diabetes Drug May Be New Weapon in War on Cancer

Researchers are a step closer to figuring out how metformin may help prevent cancer.

Metformin is generally used to treat type 2 diabetes. The drug helps the body use insulin more effectively.

It also helps lower glucose production in the liver. And it’s relatively inexpensive.

Observational studies have suggested that people who take it may have a lower risk of certain types of cancer.

Researchers at the University of California, San Diego, wanted to know why. The answer could lead to better prevention and more effective cancer treatment.

Details of their research are published in the journal eLife.

What the research says

All cells possess cell polarity. It’s what allows them to perform specific tasks.

Polarity lets epithelial cells form protective walls in cavities and organs. The walls protect against toxins, pathogens, and inflammatory triggers.

Any crack in the wall can open the door to cancer.

The research team identified the mechanism that helps keep the wall strong.

Researchers already knew about something called the stress-polarity pathway.

As stated in the researchers’ press release, it’s “a specialized pathway mobilized only during periods of stress. It is orchestrated by a protein kinase called AMPK that protects cellular polarity when epithelial cells are under energetic stress and an activator of AMPK called LBK1.”

LBK1 is a tumor suppressor. LBK1 mutations are associated with loss of cell polarity and cancer.

The mystery was in how the LKB1-AMPK pathway preserves cell polarity during stress.

The new research found that the stress-polarity pathway relies on a protein called GIV/Girdin. Metformin affects this protein.

“In summary, by identifying GIV/Girdin as a key layer within the stress-polarity pathway we’ve peeled another layer of the proverbial onion,” Dr. Pradipta Ghosh, the study’s senior author, said in the press release.

Ghosh explained that the research provided new insights into the epithelium-protecting and tumor-suppressive actions of metformin.

Cancer fighting properties

Dr. Timothy Byun is a medical oncologist with the Center for Cancer Prevention and Treatment at St. Joseph Hospital in Southern California.

He told Healthline that metformin has several mechanisms that may contribute to its anticancer property.

Byun said multiple epidemiologic studies show an association between metformin use and reduced cancer incidence and mortality.

“It’s also well-known that individuals with diabetes or metabolic syndromes have increased insulin production or insulin-resistance state. Hyperinsulin state is associated with increased risk of certain cancers,” said Byun.

He explained that metformin has insulin-lowering activity. This may slow cancer in hyperinsulinemic patients.

It also suppresses production of adenosine triphosphate (ATP). ATP transports energy within cells.

By suppressing it, cancer cells have less energy available. This makes it harder for cancer cells to spread or survive.

“Population studies suggest cancer incidence reduction of 14 to 40 percent. And mortality reduction. The main sites appear to be in breast, colon, liver, pancreas, endometrium, and lung,” said Byun.

The cancer-nutrition connection

“It’s exciting, if you think about it,” said medical oncologist Dr. Jack Jacoub in an interview with Healthline.

“There’s an increasingly loud voice about how important nutrition might be in cancer. In fact, it could become one of the tools we use to treat it,” explained Jacoub, director of thoracic oncology at MemorialCare Cancer Institute at Orange Coast Memorial Medical Center in California.

“There’s been some skepticism in the field,” he added. “This is part of a new area of looking at prevention and treatment related to glucose and insulin. Also, cholesterol, triglycerides, and other pathways that affect cancer cells.”

Jacoub said nutrition, weight control, and level of activity all matter. All affect development, progression, and response to therapy.

“Metformin is part of a growing story. It would be irresponsible to say metformin is the standard of care at this point. It’s early in the research. But if you’re already on it for diabetes, there may be a lot of benefits to you beyond controlling sugar,” advised Jacoub.

Next steps

Will metformin eventually help prevent or treat cancer?

It’s too soon to say.

“Researchers have been looking at metformin for several years,” said Jacoub. “There are unique features in terms of risk factors of specific cancers. Maybe a drug like metformin could impact cancer cells of that group. There are ongoing trials involving women with a history of breast cancer to learn if it could reduce the risk of recurrence. It’s a well-established concept in breast cancer. There’s a very large trial going on specifically asking that question.”

Byun suggested that phase III studies may be able to determine if metformin is effective in prevention or decreasing recurrence. Or if it could make chemotherapy or radiation therapy more effective.

There’s no immediate role for metformin in treating cancer, according to Byun. He would like to see positive phase III study data before changing his pattern of practice.

“There is a phase III study in France looking at hepatocellular cancer risk in patients with viral hepatitis C cirrhosis. [Cirrhotic patients are at high risk of developing liver cancer due to underlying liver damage.] This study randomizes patients on metformin vs. placebo for three years,” he said. “Another phase III study is in prostate cancer [and patients with] localized disease who are undergoing active surveillance, rather than definitive surgery or radiation therapy. It is looking at time to disease progression.”

“These efforts are underway. But it will take some time for us to know,” said Byun.

testicular-cancer

Why Cancer Symptoms Can Sometimes Seem Like The Flu

Rapper Taboo is talking about his tough battle with testicular cancer. The Black Eyed Peas member (real name: Jaime Luis Gomez) revealed in a new interview that he actually thought his cancer symptoms were the flu. “It all started with a pain in my back and abdomen,” he told People. “I was so busy working that I wasn’t worried about it, but I went to the emergency room to get checked out.” After undergoing a slew of tests, Gomez was diagnosed with Stage 2 testicular cancer.

“The very next day I went into surgery to have the ‘mother ship’ removed. But my fight had just begun,” he says. “My family and the group were all in shock, but Will.i.am instantly reached out to a great doctor who helped me figure out a treatment plan. I was racing against the clock.” Following his surgery, Gomez went through 12 weeks of “intense, aggressive” chemotherapy and is now cancer-free.

“There were times that I wanted to give up, but I became inspired by sports figures who have gone through similar battles,” he says. “I wanted to share my story and inspire others like those who had inspired me.”

About 8,720 new cases of testicular cancer will be diagnosed by the end of 2016, and 380 men will die from the disease, according to American Cancer Society estimates. Testicular cancer is not common, the organization says, but rates of the disease have been increasing for several decades. Testicular cancer largely impacts young and middle-aged men, the society reports.

Lower back pain like Gomez experienced is a sign of advanced testicular cancer, along with shortness of breath, chest pain, stomach pain, and headaches or confusion, per the American Cancer Society. However, a lump or swelling in the testicle is the most common symptom.

Flu-like symptoms—joint aches and pains, fatigue, and occasionally a fever—aren’t rare for cancers, Jack Jacoub, M.D., medical oncologist and director of thoracic oncology at MemorialCare Cancer Institute at Orange Coast Memorial Medical Center in Fountain Valley, California, tells SELF. Cancers secrete various hormones that make you feel run-down and achy, cause general weakness, and give you a fever, he explains. However, these symptoms are pretty nonspecific. “A lot of things can present that way,” Jacoub says.

Wade Sexton, M.D., senior member in the Department of Genitourinary Oncology at Moffitt Cancer Center, tells SELF that a lot of this really depends on the type of cancer and how advanced it is. A man with testicular cancer who has fatigue and back pain likely had the cancer spread to the lymph nodes in his abdomen, Sexton says. (However, that typically also comes with a lump in a man’s testicles, he says, so men shouldn’t freak out and assume any back pain is cancer.) “It’s also not uncommon for us to see a patient with advanced kidney cancer to present with general malaise, fatigue, and even a low-grade fever,” Sexton says.

Jacoub says back or abdominal pain can also present in people suffering from ovarian, uterine, stomach, colon, and bladder cancers. Fatigue is also a big symptom, which can be mistaken for the flu, he says.

If you think you have the flu or are generally feeling ill, no need to worry that it’s a sure sign of something worse. Sexton says time is a big factor in distinguishing the flu from a more serious issue like cancer. “The flu tends to be transient—the majority of us get better over a few days,” he says. With cancer, however, your symptoms would continue for a longer period of time and typically get worse. “That would be the tip-off that maybe you’re not dealing with a run-of-the-mill flu,” Jacoub says.

If you find that you’re having flu-like symptoms that don’t get better, talk to your doctor, especially if pain is involved. While there’s a small chance it could be cancer, it could also be a sign of one of a host of other issues that can be easily fixed. Either way, it’s a good idea to get it checked out.

david-bowie-liver-cancer

What We Can Learn From How David Bowie Coped With Terminal Illness

David Bowie received a terminal cancer diagnosis more than 18 months before he died, but reportedly kept it hidden from many, including some close friends.

The 69-year-old music icon suffered from liver cancer, Ivo van Hove, the director of a musical based on Bowie’s songs, told Dutch radio station NOS.nl. “He told me more than one year and three months ago that he had liver cancer, just after he had been told himself,” van Hove said, per the U.K.’s Daily Mail. “He said that because he knew that he may not always be able to be around.”

Bowie reportedly wrote thank you notes to friends before his death, who weren’t aware of his diagnosis until Monday’s announcement of his death. He also released his final album Blackstar on Jan. 8, as well as a video for the song Lazarus, which begins with the lyrics, “Look up here, I’m in heaven.”

Tony Visconti, a producer who worked on Blackstar, said in a Facebook post that the album was deliberately created as a “parting gift” for Bowie’s fans. “He always did what he wanted to do,” Visconti said. “And he wanted to do it his way and he wanted to do it the best way.“

Unfortunately, liver cancer rates are growing in the U.S., the American Cancer Society reports, and it often affects men more than women. According to Society estimates, more than 35,000 news cases were diagnosed in 2015, and more than 24,500 people died of the disease last year.

“It almost always is terminal,” Lewis Roberts, MD, a gastrointestinal cancer expert at Mayo Clinic, tells Yahoo Health. Liver cancer can be treated if it’s caught early, Roberts says, but in most industrialized countries like the U.S., only 15 to 20 percent of liver cancer patients are still alive five years after their diagnosis.

People who are diagnosed early enough can be treated with a liver transplant, surgery, or a procedure in which a needle-like probe is inserted into the liver, which “cooks” the area around the cancer. “Those treatments can be extremely successful,” says Roberts.

Liver cancer can be caused by hepatitis, alcohol, or fatty liver disease, Roberts says, the latter of which is tied to obesity, which may explain the growing incidence of the disease in the U.S.

But Jack Jacoub, MD, an oncologist at California’s Orange Coast Memorial Medical Center tells Yahoo Health that liver cancer “only develops in individuals who have a diseased liver.” If a liver disease is caught, patients must have regular liver cancer screenings to try to catch liver cancer at an early point. “You don’t want to come in with advanced liver cancer,” Jacoub says. “That’s a situation where the prognosis is not good.”

Unfortunately, Roberts and other clinicians like him have to give terminal diagnoses, which he calls “challenging.”

“It’s very stressful for people to hear about having a diagnosis like that, especially if it’s an advanced diagnosis where a lot can’t be done,” Roberts says.

Not everyone turns their grief into art, like Bowie. Some patients may become depressed by the news and will be referred to a psychologist or psychiatrist who can help them come to terms with the diagnosis. They also can receive support from terminal care and hospice programs, Roberts says.

There are several stages that a person goes through once they’re diagnosed with a terminal illness, Joseph Nowinski, PhD, co-author of Saying Goodbye: A Guide to Coping with a Loved One’s Terminal Illness, tells Yahoo Health.

“The first thing that happens is a state of crisis for the individual and loved ones,” he says. “There’s a lot of anxiety, needless to say, and sometimes panic.”

The second stage involves loved ones pulling together after getting through the shock to help comfort each other, figure out next steps, and what needs to be done. This is typically when someone would make a will, if they haven’t already, and try to figure out what they can do to take care of their loved ones, says Nowinski.

The third stage is the final and most difficult one. “This is where it begins to wear on the terminally ill person and their loved ones,” Nowinski says. “The strain begins to show as time wears on.” During this time, Nowinski says it’s incredibly important to support a terminally ill patient, emotionally and physically.

It’s also often during this time that people think about their legacy, he notes, and often work to be remembered in a certain way.

There are some treatment options available to people with a terminal diagnosis but it depends on how advanced their cancer is. Some may extend a person’s life by several months, but others may make things worse if the cancer is advanced. “Most drugs or chemotherapies have to be processed by the liver,” Roberts says. “For people with very advanced liver disease, there is nothing we can recommend.”

While Roberts stresses the importance of early detection, he also wants people to know about the severity of liver cancer: “This is one of the fastest growing cancers in the U.S. It’s important for people to be aware.”

CML Monitoring Guidelines

CML Monitoring Guidelines Not Consistently Followed in Community Setting (Online First)

Patients with chronic myeloid leukemia (CML) who are receiving care in a community setting may not be undergoing the proper amount of cytogenetic and molecular monitoring to assess their response to tyrosine kinase inhibitors (TKIs). That is the conclusion of a study published in Clinical Lymphoma, Myeloma & Leukemia.

The results showed that molecular and cytogenetic response assessments were conducted less frequently than recommended by the National Comprehensive Cancer Network in patients with chronic-phase CML–“which was surprising,” said the study’s lead author, Nicholas J. Di Bella, MD, a hematologist at Rocky Mountain Cancer Centers in Aurora, Colorado and the McKesson Specialty Health/US Oncology Network in The Woodlands, Texas.

“This was an eye opener for us, and a matter of concern. The main reason for reporting these data was that we felt that community physicians need to be following these guidelines more closely.”

‘Amazingly Low Compliance Rate to Medication’

While the researchers found that the overall effectiveness of TKIs in patients treated in the community reflected that found in previous clinical trials, patients had “an amazingly low compliance rate” to medication, Di Bella said.

Still, despite the troubling findings of this report, TKI therapy for newly diagnosed CML patients in actual clinical practice remained highly successful, which was reassuring, commented Eunice Wang, MD, Chief of the Leukemia Service and Associate Professor of Oncology and Assistant Member of the Tumor Immunology Program at Roswell Park Cancer Institute in Buffalo.

Also asked for her perspective for this article, Maen Hussein, MD, a medical oncologist at Florida Cancer Specialists and a member of the Advisory Committee for the Association of Community Cancer Centers’ 2010-2011 project on CML, said: “Overall, I don’t think community oncologists are lacking. As the study demonstrated, patients were experiencing good response rates, regardless of monitoring.

Study Details

Using electronic medical records and medical charts, the researchers conducted a retrospective, observational cohort study of 300 chronic-phase CML patients who received first-line imatinib, dasatinib, or nilotinib in community clinical practices at the McKesson Specialty Health/US Oncology Network from July 2007 to March 2011.

Patients were followed for at least 18 months. Overall, 222 received imatinib, 34 had dasatinib, and 44 had nilotinib.

During the time period observed, 40 percent of patients did not receive genetic or molecular monitoring. Seventy-six percent did not receive both a cytogenetic and molecular response assessment. Molecular monitoring frequency fluctuated, with 18 percent of individuals assessed at 13 to 18 months, ranging from 30 percent of patients tested at seven to 12 months and 18 percent tested at 13 to 18 months.

Eighty-nine percent of CML patients treated with first-generation imatinib and 94 percent of patients treated with either second-generation dasatinib or nilotinib achieved a complete hematologic response at four to six months; at seven to 12 months, these rates were 84 and 82 percent, respectively.

For individuals who did undergo cytogenetic or molecular testing, the cumulative response rates as indicated by these tests increased for both imatinib and second-generation TKIs. However, the rates were higher in patients who took dasatinib or nilotinib versus imatinib at six, 12, and 18 months.

For example, 61 percent of individuals taking a second-generation TKI achieved a cytogenetic or molecular response by 12 months versus 38 percent of those taking imatinib. Time to a major molecular response was significantly faster in patients treated with a second-generation TKI compared with those receiving imatinib.

Dasatinib and nilotinib were more effective than imatinib as first-line therapy for CML in a community setting, as observed in prior clinical trials, which was to be expected, since dasatinib and nilotinib are more potent TKIs, Di Bella noted.

The time to discontinuation was significantly longer for patients treated with second-generation TKIs than for those receiving imatinib.

Adherence was estimated as the actual days of TKI therapy divided by the total days of recommended treatment, converted to a percentage. The researchers considered 90 percent or higher as adherent. Adherence rates were 56 percent in the imatinib group and 55 percent in the second-generation TKI group.

Time Factor

Hussein noted that while the findings may motivate community oncologists to look at the issue of guideline adherence more closely, the timing of the study may not reflect how physicians are currently practicing.

“In 2007, not many of us had an EMR. When these systems were first introduced, doctors may not have been routinely documenting how they were practicing. Moreover, documents from other care providers may not have been regularly scanned into the EMR.”

In 2007, oncologists also had less of an understanding of how to best monitor CML because of the relative newness of TKIs, whether it was with complete blood counts or polymerase chain reaction (PCR), which was not easy to order at the time, Hussein added. “It takes time to adapt guidelines into clinical practice.”

Challenges

Wang said that the study results clearly demonstrated that the importance of performing monitoring tests has not been conveyed to the majority of community practitioners.

Di Bella said several challenges can interfere with adherence to monitoring guidelines. For example, in some practices, one physician may be managing many different types of cancer and may not be particularly interested in following the specifics for hematologic malignancies: “It’s becoming increasingly challenging for oncologists to keep up with all the advances in treatment and monitoring.”

In practices with at least four to five oncologists, having one physician dedicated to treating hematologic malignancies would be ideal, but is not always feasible, Di Bella said.

Also asked for his perspective, Jack Jacoub, MD, Medical Director of Orange Coast Blood & Cancer Care and Director of Thoracic Oncology at MemorialCare Cancer Institute at Orange Coast Memorial Medical Center in Fountain Valley, California, said that physicians also need to recognize that while sharing information with patients about the efficacy of CML medications, “this assurance can be a double edged sword. Patients assume that they will do well, regardless of whether or not they are monitored and attend appointments.”

In addition, Jacoub said, in some cases, patients who do well for many years and over decades may stop receiving care at a specialty center and then see a primary care physician, who may not be aware of monitoring guidelines. Because CML is a long-term disease, the intensity of follow-up may thus wane over time.

Physician and Patient Education

Physicians need to be aware that adhering to guidelines of monitoring and adjusting therapy accordingly may improve overall outcomes, Jacoub said.

Di Bella noted that there is still a debate about whether to start patients on imatinib or second-generation TKIs. “However, if you’re monitoring patients on imatinib at appropriate intervals and the CML is not responding, it’s easy to switch to another TKI.” The critical factor is to be monitoring serial measurements to make an informed decision.

He noted that he and his colleagues have added reminders in their EMR system to alert physicians about the need to conduct molecular and cytogenetic monitoring tests in newly diagnosed CML patients at three, six, nine, and 12 months. The researchers are considering conducting a prospective analysis of their centers’ monitoring activities now that they have EMR reminders in place.

Oncologists also need to ensure that their patients and caregivers understand the significance of testing and the milestones in the treatment of chronic phase CML, said Pamela Crilley, DO, Chair of the Department of Medical Oncology at Cancer Treatment Centers of America and Chief of Medical Oncology at the Eastern Regional Medical Center in Philadelphia.

In addition to being aware that laboratory testing needs to occur at three-month intervals, patients need to understand that the treatment goal is to achieve a complete hematologic response first, followed by a complete cytogenetic response, ideally within the first 12-month period. Following that, the goal is to achieve a major molecular response, which can be assessed by PCR testing, she said.

Addressing the Problem

Adherence and its impact on outcomes needs to be addressed with any chronic illness in which patients are asked to take daily medications indefinitely, Jacoub emphasized.

And, Di Bella noted, many patients have difficulty following a routine and taking drugs regularly. However, if patients know that the success of treatment depends on adherence, they will be more likely to comply.

Oncologists may be able to improve the TKI compliance rate by taking a more active role in educating patients, both verbally and in writing, at each clinic visit, Wang concluded. Providing patient diaries and enlisting the help of a nurse educator, pharmacist, or family member to reinforce instructions may also be beneficial.

Surprising-Signs-Of-Lung-Cancer

Should You Be Really Worried That Hormonal Birth Control Will Give You Breast Cancer?

A new study links the Pill and hormonal IUDs to cancer. But we asked a doc to weigh in.

If you want to avoid an unintended pregnancy, taking birth control is usually a no-brainer. But what if that same birth control upped your risk of breast cancer?

According to research published in The New England Journal of Medicine, women who take hormonal birth control pills or use hormonal IUDs for years experience a small yet significant increase in their risk of breast cancer compared to those who don’t.

The study followed 1.8 million Danish women for more than 10 years and found that, for every 100,000 women, hormonal birth control caused an extra 13 cases of breast cancer a year. Specifically, there were 55 breast cancer cases each year among the 100,000 women who didn’t use hormonal birth control, and 68 cases of breast cancer among those who did.

The study didn’t find any big distinctions between the hormonal method women used—those who used combined oral contraceptives (which use estrogen and progestin) and those who used progestin-only methods each had a higher risk. Ditto for whether women used a hormonal IUD or took a pill. A woman’s risk went up the longer she used hormonal birth control, the study found. So, obviously, hormones are to blame for the increased risk, but the exact mechanisms aren’t yet known.

But before you panic, know this: The birth control-breast cancer link actually isn’t news to your doctor. Previous research has found a link between ongoing hormonal contraceptive use and breast cancer, points out Jack Jacoub, M.D., a medical oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, California. For instance, a large-scale 2010 study found that birth control pills came with a “marginally significant higher risk” of breast cancer.

However, older versions of hormonal birth control had more estrogen than current versions, and many medical professionals have assumed that the risk has been lowered with the newer versions. Still, “we’ve known this for a long time,” Jacoub says.

Jacoub says that women “definitely should not freak out about this,” but notes that it’s good to be aware of the risks. Given that being on hormonal birth control for a long period of time raises your risk, he says it’s a good idea to try to cut back on how long you use it or, at least, try to swap in some non-hormonal methods after you’ve been on a hormonal method for years. If you have a strong family history of breast cancer, Jacoub says it’s a good idea to talk to your doctor about potentially switching to a non-hormonal birth control method. So, for example, you might switch from a hormonal IUD to the copper version. (And it’s always a good idea to keep condoms on hand—these LELO Hex condoms from the Women’s Health Boutique ship in discreet packaging.)

Ultimately, though, you shouldn’t stress about this. Just be aware and informed about the pros and cons of any birth control method you use. Breast cancer development depends on a whole slew of factors, Jacoub says, and taking hormonal birth control alone is unlikely to cause you to develop breast cancer.

Surprising-Signs-Of-Lung-Cancer

6 Symptoms of Breast Cancer That Aren’t a Lump

Lumps get most of the attention when you think about the symptoms of breast cancer. You’ve probably heard that you should check your breasts regularly and be on the lookout for new or unusual bumps you can’t remember being there before. If you do find one, don’t panic—some women’s breasts happen to be lumpy without it being a sign of cancer. But if it’s a new lump, feels different from other lumps, or you just want some reassurance, it’s a good idea to get it looked at by a doctor.

But there are other breast cancer signs you should know, too. “It’s not uncommon for breast cancer to present itself as something other than a lump,” Jack Jacoub, M.D., a medical oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, Calif., tells SELF, estimating that anywhere from 10 to 20 percent of breast cancers he’s seen don’t involve one. While the most common symptom of breast cancer is still a new bump or mass, according to the American Cancer Society, here are a few others that should be on your radar, too.

1. Skin dimpling

Tumors can be deep in your breast and cause inflammation around them that tethers to the ligaments and skin, Dennis Holmes, M.D., a breast cancer surgeon and researcher and interim director of the Margie Petersen Breast Center at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif., tells SELF. When this happens, part of your skin can be pulled in, creating a dimpled effect. This tends to be more obvious when your arms are raised, Dr. Holmes says, so make sure you also elevate your arms when you’re inspecting your breasts and bring this change up with your doctor.

2. Nipple retraction

Most women’s nipples stick out, but it’s possible to have inverted nipples, where your nipple is pulled into the breast. That’s no biggie from a medical standpoint. What is concerning, though, is if your nipple used to stick out and starts to get pulled inward. Nipple retraction can be caused by a tumor that’s located in the center of your breast, says Dr. Holmes. “It involves the milk ducts and causes them to shorten, pulling in the nipple, ” he explains. Like dimpling, this is more obvious when your arms are raised and is more than enough reason to check in with your doctor.

3. Nipple discharge

It’s important to take a few things into account with this one, says Dr. Jacoub. If you’re pregnant or breastfeeding, it’s normal to have some nipple discharge. But if you’re not and you have bloody or clear discharge from your nipples, even when you’re not squeezing them, it’s important to get it checked out, John Kiluk, M.D., F.A.C.S., a breast cancer surgeon at Moffitt Cancer Center, tells SELF. Keep in mind, though, that nipple discharge isn’t automatically a sign that you have cancer. Noncancerous tumors in the breast, called papillomas, can cause a bloody discharge, according to the Mayo Clinic, and birth control, breast infections, and having fibrocystic (i.e., lumpy) breasts can also cause discharge. In any case, a medical professional can help you determine the cause and figure out the best course of treatment if necessary.

4. Breast asymmetry

It’s pretty likely that your boobs aren’t a perfectly-matched set, but if you start to see that one is suddenly becoming bigger than the other or its shape is changing somehow, it’s time to call your doctor. “The most important thing is noticing a change,” Dr. Kiluk says. A ductal or lobular breast cancer can cause asymmetry in your breasts, although weight gain and loss can as well. Bottom line: You won’t know what’s going on until you get it checked out.

5. Redness or a rash

Your boobs are regularly subjected to things that can irritate them, like your bra, lotions, and soaps. But if you notice a redness or freckle-like rash on your breast that feels warm to the touch and isn’t going away, you should get it checked out. Again, it could just be the soap you found in your partner’s shower or the new detergent you switched to. However, in rare cases, it could be a sign of inflammatory breast cancer, a rare and aggressive form of breast cancer, Dr. Holmes says. Worth noting: People with nipple piercings can develop the skin infection cellulitis, which has similar symptoms, Dr. Jacoubs says. Cellulitis requires a doctor’s care, too, so if you’re dealing with strange nipple symptoms, you might as well make an appointment.

6. Breast or nipple pain

This is an unusual symptom of breast cancer, but it can happen, especially as a sign of inflammatory breast cancer. “It could be an infection, but you might need a mammogram or ultrasound to be sure,” Dr. Jacoub says. If you get an ultrasound or mammogram and it’s inconclusive or negative for breast cancer but doctors can’t find another cause for your symptoms that makes sense, don’t let it go. “Don’t lose sight of it and keep pushing for answers,” Dr. Jacoubs says.

If you find something off with your boobs, the odds are pretty high that it’s something that’s completely unrelated to cancer. “It’s important to put everything into context,” Dr. Jacoub says. Still, it’s a good idea to get new and unusual breast symptoms checked out, just in case.

8-Reasons-Your-Boobs-Are-So-Damn-Itchy

8 Reasons Your Boobs Are So Damn Itchy

Itchy boobs can be such a predicament. Of course, one of the universal truths of having skin is that it’s going to get itchy at some point. And that’s usually no big deal—if you have an itch on your arm, you scratch it. Ditto for your leg. But when it comes to itchy boobs? Sure, you could scratch them, but you might get a side eye or two in the process depending on your surroundings.

Boob itchiness is normal, and being itchy to the point where you’d see a doctor about it also isn’t unheard of. “I see a few patients every month with this complaint,” Gary Goldenberg, M.D., assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City, tells SELF. Women will usually mention itching around their nipples or under their breasts, he says, and they often have skin irritation and a burning sensation along with it.

While regularly scratching your breasts (or, well, itching to) is probably nothing to worry about, it could be a sign that something is up. These are the top eight reasons why your boobs might be itchy, plus when you need to discuss the issue with your doctor.

1. You last washed your bra…uh…you actually can’t quite remember.

You probably have a go-to bra or two that you wear more often than you’d care to admit, and you probably wash them close to never. Unfortunately, this can cause issues with your boobs. “Dirty clothes, including underclothes, often have bacteria that can infect and irritate the skin,” Dr. Goldenberg says. Your chest in general tends to be a place where bacteria may grow thanks to the sweatiness that can happen in the area, so you really should wash your bra at least once a week, Dr. Goldenberg says. (That number goes up if you sweat a lot or if it’s a sports bra—you should wash those after every wear.) If you think your itchy boobs are due to a dirty bra, using a topical antibiotic like Neosporin can help with the irritation, but you should really just do a load of laundry.
2. You got a sunburn.

Topless sunbathing on your weekend trip to Miami may have sounded like a good idea at the time, and you hopefully slathered on sunscreen with an SPF of 50 or higher before you whipped off your swimsuit top. Still, your breast skin is sensitive and can easily get burned, especially since it’s not typically exposed to sunlight. Along with delightful side effects like peeling, sunburns can cause intense itching thanks to skin irritation. You can help soothe your itching with a moisturizer like Aquaphor, Dr. Goldenberg says. The American Academy of Dermatology recommends cool baths or showers and aloe vera-based moisturizers, too.
3. Your soap, laundry detergent, or dryer sheets aren’t agreeing with you.

Contact dermatitis is an allergic reaction that can happen when your skin is exposed to something it doesn’t like, and itchiness is one of its major giveaways. If you wash your bras with regular detergent or dry them with dryer sheets, it’s possible your boobs will riot and become itchy. (Same goes for towels, sheets if you sleep in the nude, and basically anything else that can come into contact with your chest, including your body wash.) Fragrances in particular are suspect, which is why Dr. Goldenberg recommends switching to fragrance-free products if you notice any reactions.
4. You have eczema.

Eczema is a chronic skin condition that causes dry, itchy inflammation that can show up as a red rash. If you’ve had breast itchiness for a while and you can’t pinpoint why, eczema could be the cause, Jack Jacoub, M.D., a medical oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, Calif., tells SELF. An over-the-counter topical steroid cream should help, Dr. Goldenberg says (as should avoiding potentially irritating fragrances in your products). If not, call your doctor to ask about something stronger.
5. You have psoriasis.

Psoriasis is a condition that causes skin cells to build up and form scales as well as dry, itchy patches. Unfortunately, much like eczema, it can show up on or under your boobs. You can also treat this itchiness with a topical steroid, Dr. Goldenberg says, as well as avoiding fragrances, which can exacerbate psoriasis flare-ups.
6. Your boobs hate your bra.

Bras are made with all different types of fabric, and some cheaper versions can be seriously irritating to your breasts. “Synthetic fabrics are the biggest problem,” Dr. Goldenberg says, calling out polyester and latex as some of the top potential irritants. If you recently tried out a new bra and developed itching, Dr. Goldenberg recommends switching to something that uses a natural fabric like cotton.
7. You have a yeast infection under your boobs.

You probably associate yeast infections with your vagina, but they’re actually pretty common under the breasts, too, Dr. Goldenberg says. Moisture can get trapped under there, creating an environment that’s perfect for yeast to grow, which can make your skin all itchy. To treat it, you’ll need to keep the area dry and use a topical anti-yeast medication.
8. And, in extremely rare cases, itchy boobs can be a symptom of cancer.

If you have breast itchiness, it’s much more likely that it’s due to one of the above reasons and not breast cancer. With that said, there’s a small chance it could be inflammatory breast cancer, a rare but aggressive form of the disease that invades your skin’s dermis (the layer of skin that lies beneath your epidermis, the outer layer of skin), creating an inflammatory response, Dr. Jacoub explains. Inflammatory breast cancer also usually has other symptoms like a rash, orange-peel skin, and red, inflamed skin that’s hot to the touch, Dennis Holmes, M.D., a breast cancer surgeon and researcher and interim director of the Margie Petersen Breast Center at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif., tells SELF.

It could also be Paget disease of the breast, another rare form of breast cancer where cancer cells go through the milk ducts and collect in or around the nipple, Dr. Holmes says. With Paget’s disease, you may also have flaky or scaly skin around your nipple, bloody nipple discharge, or a newly inverted nipple, per the Mayo Clinic.)

Again, if you have itchiness and it’s new, it’s probably due to something pretty harmless like a bad detergent. But if it persists, comes with other symptoms, or you can’t think of a reason why you’re so itchy, call your doctor just in case.

Type 2 Diabetes

Type 2 Diabetes May Increase Breast Cancer Risk in African-American Women

Findings from an observational study show type 2 diabetes increased the risk for an aggressive form of breast cancer in African-American women by more than 40 percent (Cancer Res 2017;77(22):6462-6469).

African-American women are disproportionately diagnosed with ER-negative breast cancer, with double the incidence of white women, according to researchers.

“Our results showed statistically significant evidence of an increased risk of ER-negative breast cancer in black women who had type 2 diabetes before they ever had breast cancer, primarily in the women who had diabetes for at least 5 years,” said Julie R. Palmer, ScD, Associate Director of Boston University’s Slone Epidemiology Center, Professor of Epidemiology at Boston University School of Public Health, and Associate Director of Population Sciences at the BU-BMC Cancer Center.

“If these results are confirmed, type 2 diabetes would be a modifiable risk factor for ER-negative breast cancer.”

The study did not show diabetes increased incidence of estrogen receptor (ER)-positive breast cancer, which is the most common subtype (75%) and has a very high survival rate, Palmer noted.

Also garnering attention from oncologists and cancer researchers around the country is that the association Palmer and colleagues made between type 2 diabetes and ER-negative breast cancer was only observed in non-obese black women.

“This study’s findings are both surprising and compelling,” commented Dennis Holmes, MD, Breast Cancer Surgeon and Researcher, and Interim Director of the Margie Petersen Breast Center, John Wayne Cancer Institute, at Providence Saint John’s Health Center, Santa Monica, Calif.

“Obesity has long been recognized as a cause of both diabetes and breast cancer. However, this study demonstrates a convincing direct relationship between type 2 diabetes and ER-negative breast cancer, even among non-obese women. This insight is critically important, because [ER]-negative breast cancer is particularly challenging to treat,” Holmes told Oncology Times.

Troubling Epidemiology

Although black women and white women get breast cancer at about the same rate, black women have a 40 percent higher mortality rate, according to the CDC. About 20 percent of white women in the U.S. are diagnosed with the ER-positive subtype, which is typically treated very successfully with hormone therapies (MMWR 2016;65(40):1093-1098).

The far more aggressive ER-negative breast cancer subtype typically is treated with chemotherapy, radiation, or surgery. It also is prone to returning, according to the CDC (MMWR 2016;65(40):1093-1098).

“A troubling aspect of breast cancer epidemiology is the higher risk of ER-negative breast cancer in African-Americans, which accounts significantly for the higher risk of breast cancer-related deaths among African-American women,” Holmes said.

Yet, little is known about associations by breast cancer subtype in African-American women, Palmer revealed. “We are still trying to understand the basic biological processes that lead to ER-negative breast cancer. One way to do this is to study factors that are more common in an African-American population.”

For the study, Palmer and colleagues analyzed data from the Black Women’s Health Study (BWHS) to assess for an association between type 2 diabetes and breast cancer. The nationwide prospective cohort study utilizes questionnaires to collect self-reported medical histories from 59,000 enrollees on a biennial basis. Palmer was instrumental in creating the BWHS, which began in 1995.

From this massive dataset, the researchers identified 1,851 cases of invasive breast cancers, including 914 ER-positive diagnoses, and 468 women with ER-negative breast cancer. Among the latter group of women, the researchers found a 43 percent greater risk. Among non-obese black women, type 2 diabetes was associated with increased risk for ER-negative cancer 92 percent of the time.

“Our findings may account for some of the racial disparity in breast cancer, and could partly explain why mortality from breast cancer is so much higher in black women than white women,” Palmer stated.

Metabolic Derangement

African-American women also are twice as likely as white women to be diagnosed with diabetes, according to the CDC. The federal agency estimates more than 50 percent of black women will develop type 2 diabetes due to a high prevalence of obesity, high blood pressure, high cholesterol, and a lack of exercise.

“Researchers now believe triple-negative cancers have an inflammatory component, and patients with diabetes are in a perpetual inflammatory state,” noted Nisha Unni, MD, Assistant Professor and Breast Cancer Oncologist, University of Texas Southwestern Medical Center, Dallas.

About 20-25 percent of all breast cancers are the so-called “triple-negative” subtypes, which include ER-negative, progesterone-negative, and HER2-negative breast cancers; hence, the name (MMWR 2016;65(40):1093-1098).

But while the observational study led by Palmer showed incidence of ER-negative breast cancer is higher in black women with type 2 diabetes, “it does not prove a causal association, which means it does not prove that diabetes led to the development of breast cancer,” Unni pointed out. “Since the prevalence of both triple-negative breast cancer, as well as type 2 diabetes, is higher in African-American women, the association could just be a reflection of that,” she told Oncology Times.

Jack Jacoub, MD, Medical Oncologist and Medical Director, MemorialCare Cancer Institute at Orange Coast Medical Center, Fountain Valley, Calif., agreed the study by Palmer, et al. “is a hypothesis-generating dataset, as we have long known African-American women have worse prognostic breast cancer, higher mortality rates from breast cancer, and high rates of triple-negative breast cancer than their white counterparts.”

However, the study’s findings helped reinforce Jacoub’s position that women at risk “be counseled about metabolic health, diabetic control, and the possible link to increased breast cancer risk due to chronic inflammation.

“Cancer-screening should be emphasized,” Jacoub told Oncology Times. “Frankly, I also look for reasons to put female patients at risk on metformin, given the recently accumulating data on its efficacy (Curr Oncol 2017;24(2):e85-e91).”

The study by Palmer, et al. “also informs physicians that diabetic and metabolic derangement control should be emphasized, and perhaps that more metformin and other hypoglycemic agents should be used in treating this patient population,” he commented.

Targeted Clinical Strategies

Several studies have suggested diabetes is a risk factor for breast cancer. One recent study also found an association between type 2 diabetes and breast cancer in African-American women, for example; however, the researchers did not report results separately for ER-negative and ER-positive disease.

Tomi Akinyemiju, PhD, MS, Associate Professor of Epidemiology and Assistant Dean for Inclusive Excellence, College of Public Health and Markey Cancer Center, University of Kentucky, Lexington, said the findings in the Palmer-led study “are in line with recently published work by our group (Obesity 2017; doi:10.1002/oby.22067).”

The research led by Akinyemiju showed a significant association between lack of metabolic health—defined as a patient with any combination of the following three conditions: high blood pressure, dyslipidemia, high triglycerides, diabetes or high fasting blood glucose, high waist circumference and cancer mortality—but only among normal-weight individuals, she explained.

Speaking to the clinical implications of the results from the Palmer-led study, Akinyemiju told Oncology Times: “If type 2 diabetes is found to increase the risk of the more aggressive ER-negative breast cancer subtype, then targeted interventions focused on patients with diabetes may help reduce breast cancer incidence among African-American women, and reduce racial disparity in breast cancer outcomes that have remained intractable over the past few decades.”

Akinyemiju further noted the study led by Palmer also shows women with diabetes and using medication to treat it had a 30 percent increased risk of ER-negative breast cancer, compared with more than a two-fold increased risk among those not using medications.

“This suggests strongly that clinical strategies to ensure that type 2 diabetes is well-controlled using either medication, or lifestyle changes, such as weight loss and exercise, may be a promising approach to reducing the risk and mortality of breast cancer in African-American women,” she concluded.

If borne out with additional research, the findings of Palmer, et al. could lead to new treatment approaches “to reduce risk or even prevent triple-negative breast cancer in a population that is at higher risk,” said Melissa D. Fana, MD, FACS, Chief of Breast Surgery, Southside Hospital at Northwell Health System, Bay Shore, N.Y.

The results of the study “also support the recent understanding that it is the biology of breast cancer which is key in understanding how to better treat patients with individualized treatment regimens, and perhaps one day soon prevent breast cancer with targeted strategies,” she concluded.

Chuck Holt is a contributing writer.

Breast Implants

FDA Links Breast Implants with Rare Form of Cancer

A rare form of cancer tied to breast implants has been linked with nine deaths, the Food and Drug Administration announced on Tuesday.

Anaplastic large-cell lymphoma (ALCL), a rare type of non-Hodgkin’s lymphoma, was first associated with breast implants in 2011, and the FDA has been investigating the link ever since.

The FDA has received 359 reports of the cancer associated with breast implants as of Feb. 1. However, the organization says, the number of cases could be underreported. The administration also found a stronger link between textured breast implants and this particular form of cancer. Of 359 cases the FDA uncovered, 231 had information on the surface of the implant — 203 were textured and 28 were smooth.

There does not seem to be a significant link between what’s in the implants and cancer — 312 of the 359 reports included information on implant contents, with 186 filled with silicone gel and 126 filled with saline.

It’s worth noting that anaplastic large-cell lymphoma is not a form of breast cancer. Rather, it’s a cancer of the immune system. Only about 1 percent of non-Hodgkin’s lymphomas are ALCLs, according to the Lymphoma Research Foundation, and symptoms typically include fever, backache, painless swelling of lymph nodes, loss of appetite, and tiredness. ALCL can appear in the skin via raised red skin lesions that don’t go away, in the lymph nodes, or in organs throughout the body, the Lymphoma Research Foundation says.

More than 290,000 women received breast augmentation in 2016, according to the American Society of Plastic Surgeons — a 4 percent increase over 2015 — making this a concern for a lot of women.

The FDA is not the only organization to link this form of cancer with breast implants: The World Health Organization also recognized it in 2016, and the Plastic Surgery Foundation and the National Comprehensive Cancer Network published information to help doctors understand more about the disease, its diagnosis, and treatment.

Brian Czerniecki, MD, chair of the Moffitt Cancer Center department of breast oncology, tells Yahoo Beauty that breast implants may cause cancer because they can create bodily inflammation. “Your body wants to create a wall around the implants,” he explains. “You get some inflammation — your immune system is attracted to that — and you can get lymphoma from your immune system being overstimulated.”

Textured implants may be particularly suspect because more of the implant goes into bodily tissue, causing more of an inflammatory response, Jack Jacoub, MD, medical oncologist and director of thoracic oncology at MemorialCare Cancer Institute at Orange Coast Memorial Medical Center in Fountain Valley, Calif., tells Yahoo Beauty.

Why use the textured implants? Surgeons do so if they want the implant to stay in place. Smooth implants are more likely to flip or shift.

Lymphoma is typically treated with chemotherapy and radiation therapy, Jacoub says, and patients who develop ALCL would also need to have their implants removed. But, he adds, “This type of lymphoma has a good prognosis if one does develop it.”

If you have breast implants, don’t panic and remove them out of an abundance of caution. Czerniecki points out that this is a pretty rare thing that can happen and you don’t want to have unnecessary surgery.

Roberto N. Miranda, MD, a professor of hematopathology at MD Anderson Cancer Center, tells Yahoo Beauty that women who have been diagnosed with this form of cancer present with some symptoms first, including a seroma — a pocket of fluid. “It’s not like any person who has an implant and no symptoms should be concerned,” Miranda says.

However, Jacoub notes it’s a good idea to do regular breast checks — typically, ALCL manifests as a lump — and be aware of the symptoms. If you notice something off, talk to your doctor right away.

When Your Immunotherapy Stops Working

When Your Immunotherapy Stops Working

Immunotherapy is a new and different treatment option for people living with advanced lung cancer. It helps your body’s immune system better find and destroy cancer cells, even when they try to hide. The breakthrough therapy is helping some people with hard-to-treat cancer feel better and live longer.

But it doesn’t work for everyone. Currently approved drugs for lung cancer only help 1 out of 5 people. Scientists are hard at work to find new treatments to help more.

If you or a loved one is scheduled to have lung cancer immunotherapy, you need to know the key warning signs of treatment failure and what to do if they occur.

How Do You Know It Isn’t Working?

Three immunotherapy medicines, called checkpoint inhibitors, are FDA-approved for lung cancer: atezolizumab (Tecentriq), nivolumab (Opdivo), and pembrolizumab (Keytruda).

No one can tell you how well these treatments will work for you. There’s no blood test or other method to predict if the drug will shrink your tumor or make you feel better. However, there are some signs that it isn’t helping.

Tell your doctor if you have:

  • Cough
  • Pain
  • Trouble breathing
  • Any other symptoms that concern you

They may be a sign that your cancer is getting worse, or they may be side effects of treatment. Only a doctor can tell the difference. However, pain is rarely a side effect of lung cancer immunotherapy treatment.

Side effects don’t mean the medicine isn’t fighting your cancer — but a severe reaction can be life threatening and may require you to stop treatment. Serious side effects are rare, but include inflammation of the lungs (pneumonitis), liver, kidneys, intestines, and other parts of the body.

When the Cancer Looks Worse but Isn’t

Your doctor will order CT scans of your tumor to keep track of it and make sure your treatment is working.

Your cancer might look worse on the first CT scan after your start immunotherapy. But it may really be getting better. Doctors call this “pseudoprogression.“ It doesn’t mean the drug isn’t working. Immunotherapy causes your immune system to attack cancer cells. The rush of helper immune cells can cause your tumor to swell and look bigger. The report may say your cancer has progressed, when it really hasn’t.

Your doctor will review your scans and discuss your symptoms. She’ll decide if your treatment is really working and your cancer is stable.

  • If the scan shows a larger tumor but there are no new areas of cancer and you feel OK, it may be pseudoprogression. Doctors usually suggest you wait two or three more treatment cycles (about 2 months) then get another scan.
  • If you feel worse and the scan shows a larger tumor and new lesions, immunotherapy likely isn’t working. The doctor will recommend you stop it and try something else.

Other Treatment Options

If immunotherapy doesn’t work, you and your doctor will discuss other ways to treat your cancer. These include:

  • Chemotherapy
  • Targeted drug treatments

If these options also fail, your doctor may suggest you to take part in a clinical trial. They provide access to cutting-edge immunotherapy treatments that aren’t yet approved for lung cancer. These include other checkpoint inhibitors, therapeutic vaccines, and adoptive T-cell transfer.

If nothing helps at all, it may be time to ask your doctor if it’s time to stop treatment and start hospice and palliative care to ease your symptoms and make you feel better. An honest discussion will help you and your family make the most of every day.