Saturday, September 21, 2024

RECURRRENCE EXPLAINED

ADVOCACY & JOINING HANDS TO MAKE A DIFFERENCE
By: Geri Barish -  Hewlett House (Cancer Resource)

Getting the word out is vital when it comes to supporting our community in the fight against cancer.  Part of the search for answers is learning how to assess your own life - including your history, the area where you live, what you eat, what you breathe and your genetic blueprint. This may lead to identifying any kind of cancer in the family.  

Staying vigilant in understanding how cancer happens and how it affects us and our families is the key to awareness. Advocacy is also about supporting one another. As we wait for the cure, we also need to live a full life- this includes staying proactive with our health and staying in touch with the latest solutions. There's a lot more work to be done- and because we are fighters, we have to keep asking questions. Look at your environment- get genetic testing for gene mutation in your lineage, don't ignore checkups- find out if you have any risk factors. That's where education and research comes together. And if you've had cancer already, please don't think it won't come back. Recurrence (or re-occurrence) is a real term- and when it happens, it can come back with a vengeance. 







There is a constant debate in the cancer community about the term "CANCER FREE". Cancer recurrence continues to be a major concern as reported in annual medical reports- identifying its tendency to “return with a vengeance". [1, 2]

Medical research has identified the major reasons why cancer recurs.  A widely reported cause for this is attributed to a deficiency in treatment performance. [2] This means the therapy induced did not successfully remove or kill all of the cancer cells, possibly due to the patient's level of drug resistance.  During treatment, Cancer cells can enter a dormant state to protect themselves from treatment and other stimuli. Over time, these dormant cells can reactivate. The cause of this may be a spike in chronic stress or the release of toxins from oxidative stress from environmental factors like smoking or repeat exposure to reactive chemicals. [3]

Inflammation has also been linked to the activation of immune cells called neutrophils. [4] Cancer cells that have spread to other areas of the body after successful treatment of the original tumor can remain dormant for years or decades before recurring as metastatic cancer. Further activators of these dormant cells have also been linked to one's personal Epigenetics. [5] This determines how your environment and lifestyle affects your cell function- including the dormancy state of your cancer cells. 

Another known cause for recurrence are Cancer stem cells or CSC's.  These are a small group of cells in tumors that have the ability to self-renew, differentiate, and give rise to all cell types in a tumor. [6] Most stages of tumor progression, including tumorigenesis, promotion, progression, and recurrence are accompanied by epigenetic alterations, some of which can be reversed by epigenetic drugs. [6]

DETECTION MONITORING
After cancer surgery, there are many preventive measures to support a safe and healthy recovery and to reduce the risk of recurrence.  A logical and preventive strategy as part of postop maintenance is called RECURRENCE PREVENTION SCANS. Through the use of affordable, real-time medical imaging such as the 3D Doppler Ultrasound, post-cancer surgery patients can subscribe to a personal monitoring regimen to scan for any potential lesions and micro-tumors that may have fallen under the radar.  Proactive monitoring can also address complications such as post-surgical Infections, recurring pain, swelling, neuropathy from nerve damage, scarring, fluid buildup or blood clots. In less than 20 minutes per visit, you earn peace of mind from a comprehensive scan by seasoned specialists trained to support postop patient management.



1. Butow P, Sharpe L, Thewes B, et al. Fear of Cancer Recurrence: A Practical Guide for Clinicians. Oncology (Williston Park). 2018 Jan 15;32(1):32-8. 
2. Mahvi DA, Liu R, Grinstaff MW, et al. (2018). Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies. CA: A Cancer Journal for Clinicians, 68(6), 488. https://doi.org/10.3322/caac.21498
3. Payne KK. Cellular stress responses and metabolic reprogramming in cancer progression and dormancy. Seminars in cancer biology 2022 Jan Vol. 78, pp. 45-48.
4. He X-Y, Gao Y, Ng D et al. Chronic stress increases metastasis via neutrophil-mediated changes to the microenvironment. Cancer Cell 2024:42(3);474-486. DOI: https://doi.org/10.1016/j.ccell.2024.01.013 
5. Costa S, Alves Sales SL, Pinheiro DP, et al. (2023). Epigenetic reprogramming in cancer: From diagnosis to treatment. Frontiers in Cell and Developmental Biology, 11. https://doi.org/10.3389/fcell.2023.1116805
6. Yu X, Zhao H, Wang R, et al. (2024). Cancer epigenetics: From laboratory studies and clinical trials to precision medicine. Cell Death Discovery, 10(1), 1-12. https://doi.org/10.1038/s41420-024-01803-z



DR. ROBERTA KLINE is an ObGyn physician, an award-winning author, an educational advocate, and an inspirational speaker for the professional and women’s communities. She holds a combined mission to upgrade how we approach health and deliver healthcare for women through education, globalized communication, research, and advocacy.  Dr. Kline develops and teaches CME programs, consults on gene expression project designs, and leads collaborative projects designed to advance the direction of women’s health. She is also a clinical advisor in integrative medicine and functional genomics to many health organizations including the Integrative Health Research Center.  In addition to her mentorship programs for women physicians, Dr. Kline is Director of Educational Programs for the Women's Health Collaborative, Editor of the Women’s Health Digest, and on faculty at the University of Western States. 






FOR IMMEDIATE RELEASE:

8/6/2024- Dr. Robert Bard (Bard Diagnostic Imaging) and Cheri Ambrose (President of the MBCGA / Male Breast Cancer Global Alliance) officially launched the RECURRENCE DETECTION SCANS program- a life-saving diagnostic program in support of recurrence prevention.  

Program developer Dr. Lennard Goetze spearheaded this plan in 2019 during the launch of the "FIGHT RECURRENCE" educational program with the NY Cancer Resource Alliance. Under a collaboration with the AngioInstitute, Dr. Goetze aligned with national breast cancer organizations who adopted the Fight Recurrence campaign.  In the summer of 2024, a partnership with Ms. Ambrose was officially forged with a clinical blueprint for a postop diagnostic scanning program to monitor possibilities of cancer recurrence. "Getting checked for breast cancer has been an uphill battle for anyone- but it's equally important to not get complacent after surgery... saying 'cancer free' is an ideal that does not apply to everyone." 

Since the inception of his practice in 1972, Dr. Bard has been a staunch supporter of the use of the 3D Doppler Ultrasound to provide safe and quantitative scans of postop cancer cases. "Due to a significant number of cancer recurrence cases (estimated 40%) either before or after the 5 year 'cancer free' mark, we established a comprehensive and personalized diagnostic strategy for tracking potential RECURRENCE. We also wanted to send a message to maintain proactive vigilance after surgery."

One of the recognized voices for Male Breast Cancer awareness was Mark Futterweit, whose interview in the 2019 WBAB episode "Men DO Get Breast Cancer!" emphasized that he got breast cancer TWICE. This became the launch pad for the Male Breast Cancer Global Alliance and for Cheri Ambrose to be one of the first organizational partners to go national with Dr. Bard's message about proactive monitoring. 

Nancy Novack, founder of  NancysList.org, a major online cancer resource is a supportive backer of both Dr. Bard's cancer imaging practice and the MBCGA. She is an ovarian cancer survivor as well as a primary voice for the "Fight Recurrence" project. "Living with cancer is about ADVOCACY and AWARENESS ... and  maintaining regular checkups, both before treatment and after. We must be informed and wisely active regarding the tools of recurrence detection and survivorship."

Talks with the American Breast Cancer Foundation and other national cancer organizations are underway to join the FIGHT RECURRENCE educational campaign in underserved communities.  AngioInstitute outreach coordinator and research director Dr. Noelle Cutter says “In the cancer world, we see recurrence to be so prevalent and often arises with a vengeance – this detection program needs to be a default solution after every cancer procedure… I echo Dr. Bard who instills continued monitoring as a preventive measure!” 










RECURRENCE PREVENTION FROM A 3-TIME CANCER SURVIVOR: VANESSA SILVA

My name is Vanessa Silva. I was diagnosed with breast cancer in 2007 after my father was first diagnosed with breast cancer where he was identified as BRCA2 positive.   I found out in a very roundabout way. I only went for a check-up because my doctor wanted to be proactive, and she just wanted to confirm that I was healthy.  More importantly, she wanted to check to see that I wasn't carrying the gene. But during the mammogram, they told me to go upstairs to see my doctor.  Right then and there I knew they were going to tell me I had cancer. I spoke to my doctor and she confirmed it.

I can remember crying- then saying, "Okay, you need to get yourself together. There's options. They said it was at stage zero. It's not a death sentence. We're going to do what we have to do... but you're probably going to be BRCA2 positive, as well."  The battle for me started with chemotherapy- but not radiation. In a matter of weeks, they realized the cancer was more aggressive than they thought, and it wasn't at stage zero after all because it already had gone to the lymph nodes.


RECURRENCE: PART 1

During the treatment process, I pushed to do my part and changed the way I lived starting with the way I ate. I exercised, I stopped eating meat and I did everything by the book ... and sure enough, I was told I was cancer free!.  So after five years, I felt it was safe to go back to old habits and eat the things I missed the most – including meats. I was still working out, but admittedly, junk food managed to creep its way into my system.

My cancer came back after roughly eight years. 

One day, while taking a shower, I decided to check and feel for any lumps- just to make sure everything's okay.  Surprisingly, I felt a lump. It was small but experience says to keep an eye on it.  By September, it grew to the size of a pea and it was getting bigger.  My doctor elected a sonogram then an MRI just to confirm that my cancer came back.

This time, I was angry, because I felt like I did everything I needed to do. I did the chemo. I honestly didn't believe my eating would have brought my cancer back.  They recommended four treatments of chemo, but this time it was stronger. For the first time, I had to take Taxotere, and then, this time, I had to do the AC.

I looked at my husband and said, "This is a joke. I feel like I'm being punked… we're going to do this again!" I started the first chemo treatment and became really, really sick. I was hospitalized for a week. I could not tolerate the chemo's side effects; it was way too strong. And I told them, "What are my options, because I can't do four treatments with the way I was feeling."  It really hit my body hard- so they redirected me to 6 weeks of radiation treatments.

So again, I stopped eating meat, stopped sugar, went back to the juicing, I did my daily routine of walking (I live by Central Park, so I would walk the reservoir).  I was religious with my health especially during and even after I was done with the treatments.

But a year later, I kept up with my self exams to make sure there were no lumps, and then ended up finding another one - this time on the right side! Very small again, underneath my breast - and just like the last one, it started to grow.

For the third time, the cancer had come back.

Once again, I underwent surgery to remove the cancer. It did not go to the lymph nodes, so they didn't recommend chemo this time around, but I had to do radiation again for six weeks. This was my reality. I had cancer in 2007- then again in 2014, and then the cancer came back in 2016.

What was confusing to me was that this time, I was so diligent about prevention- not having any meat, and constant juicing and exercising.  I feel as if my body produces cancer cells much faster than a regular person. I just have to be more vigilant with checking myself.

I try to make sure that I'm stress-free, that I don't put myself in situations that would make my immune system just crash.  My doctor and I are both very diligent about checkups and often do sonograms at the slightest concern. I see my breast surgeon every six months. And now, she's finally pushed it to a year, so I'm so happy with that.


FOOD 101: GOING 'CLEAN' AND ORGANIC

I think, meat plays a huge part in all of this because of the hormones that are being injected into them.  I do my best to buy products that say Non-Hormones, No Antibiotics, etc., however, how much of that is true.  I was convinced that I needed to stop eating meats all together and to stop putting all of these processed products into my body and start eating a much healthier diet.

Eventually, I would like to become a vegan, but I know there's so many things that I really enjoy eating, like eggs and cheese. But slowly, I've been pulling away from eating eggs. It's been a year since the last time I’ve eaten eggs, but cheese is a hard one to quit. I'm just trying to eat a more "clean" foods-- a lot more vegetables, a lot more fruits, and making sure that I wash them, and they're organic.

Organic and gluten-free was the way to go for me! I don't drink dairy milk anymore only almond milk. I'm really trying NOT to introduce the bad stuff to my children. Two of them are already grown, I really try to give my youngest one ZERO red meat except maybe once a month.  Sometimes, it's turkey or chicken, but even that, we've really pulled away from. I try not to be as restrictive with them because they're young, and they should make their own decisions later, however, I want them to be knowledgeable of what they put into their bodies.  Zero sugar is hard to do but we try to stay away from candy, donuts and pastries.


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