ENCORE # 95! – Breast Cancer: Nigeria

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in November of 2016.

Most people don’t know that for most of 1984, I was in the West African countries of Nigeria, Cameroon, and Liberia.

I got to thinking this morning when I noticed that some of my blog entries have taken a new direction, that I can pretty much talk about whatever I want to talk about.

So, it got me to wondering: what are the breast cancer facts, figures, and treatment in these three developing countries and what does it have to do with me – or you? Two of them have recent histories rife with coup d’etat, civil war, and mass exodus. One of them has had the same president for 34 years.

What have they accomplished for women’s health in relation to breast cancer – and why would it matter to us in the US?

Nigeria: Well…here was study conducted in 1992. That’s almost a quarter century old… (https://www.ncbi.nlm.nih.gov/pubmed/1393468). There DOES seem to be a current drive to help the women in Nigeria and that is what you’ll find below.

“BACKGROUND: In most resource-constrained settings like Nigeria, breast self-examination self-breast examination (BSE) is culturally acceptable, religious friendly and attracts no cost. Women's knowledge and beliefs about breast cancer and its management may contribute significantly to medical help-seeking behaviours. This study aimed to assess knowledge and beliefs of BSE among market women.

METHODS: A descriptive cross-sectional study was conducted among 603 market women in Ibadan, Nigeria (Ibadan is a major city with a heavy Western influence. This is not necessarily representative of MOST women in Nigeria). Data was collected using semi-structured interviews and analyzed using descriptive and analytic statistical methods.

RESULTS: The mean age of the respondents was 34.6±9.3 years with 40% of the women aged between 30-39years. The proportion of married women was 339 (68.5%) with 425 (70.8%) respondents reporting that they do not know how to perform BSE. However, 372 (61.7%) women strongly agreed that BSE is a method of screening for breast cancer. Highest proportion 219 (36.3%) reported that the best time for a woman to perform BSE was 'anytime'. Most of the respondents believed breast cancer is a dangerous disease that kills fast and requires a lot of money for treatment. (Emphasis mine)

CONCLUSION: More efforts are needed in creating awareness and advocacy campaigns in the grassroots in order to detect early breast cancer and enhance prevention strategies that would reduce the burden of breast cancer in Nigeria. - See more at: http://www.cancerindex.org/Nigeria#sthash.vxdUxdCI.dpuf”

The conclusion: “The vast majority of deaths from malignancies occur in sub-Saharan Africa primarily as a result of lack of public awareness of cancer and how it is diagnosed and treated in the setting of a severe lack of resources (physical and personnel) to actually diagnose tumors. To correct this massive health disparity, a plan of action is required across the continent of Africa to bring diagnostic medicine into the modern era and connect patients with the care they desperately need.” http://www.cancerindex.org/Nigeria#sthash.vxdUxdCI.dpuf

Why should this matter to you? Why should the matter to me?

I COULD wallow in guilt. That would be both easy and satisfying! Instead, I’ve decided I’m going to take a character I’ve created in a science fiction short story, and send him on a few adventures. Most likely, he’ll be travelling with a hard-thinking woman who will become his perfect match. They’ve already started out rebuilding the educational infrastructure of Liberia in the future middle of this century. I’m thinking the two of them need to make a trip to Nigeria. Separately – where they’ll meet and butt heads.

The driving issue will be breast cancer education, diagnosis, and treatment in these three West African countries that hold a special place in my heart. From the sale of the stories, I’ll donate the money to breast cancer research in those places…

UPDATE: The story I wrote shifted to Liberia and at this time, I have been unable to sell it…

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

GUY’S GOTTA TALK ABOUT…Alzheimer’s #18 – “In 1960, about a half-million teens took a test. Now it could predict the risk of Alzheimer’s disease.”

Dad’s diagnosis of Alzheimer’s stayed hidden from everyone until I took over the medical administration of my parents in 2015. Once I found out, there was a deafening silence from most of the people I know even though virtually all of them would add, “My _____ had Alzheimer’s…” But there was little help, little beyond people sadly shaking heads. Or horror stories. Lots of those. Even the ones who knew about the disease seemed to have received a gag order from some Central Alzheimer’s Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this part of my blog…

Start today’s blog by following the link and reading this article…https://www.washingtonpost.com/local/social-issues/in-1960-about-half-a-million-teens-took-a-test-now-it-could-predict-whether-they-get-alzheimers/2018/09/20/fcbabebe-b864-11e8-a7b5-adaaa5b2a57f_story.html?noredirect=on&utm_term=.e218caa362c9

Read it. Fascinating…

The gist of it is that the largest test ever given to adolescents was done in 1960, when most of the 500,000 teens were 15 years old.

The data sat around then for sixty years and no one did much with it until researchers thought they’d look into how the test correlated to the students, who were now entering their seventies, to Medicare and Medicaid claims.

They also followed up with them as many were celebrating 50 years since their high school graduations, so they were able to gather data much more easily by targeting their questionnaires at the class reunion venues.

The study found that about a quarter of them had died since taking the test. They also found numbers correlating to kidney disease and heart disease. But these newly savvy seniors wanted to know something that was WAY more important than kidney and heart health. They wanted to know if the data correlated the possibility of being diagnosed with Alzheimer’s.

And there WAS a correlation.

Note:

CORRELATION does not mean PREDICTION!

Just because you were a dufus at fifteen, did NOT mean that you were automatically destined to be an Alzheimer’s victim.

However, there was a correlation between language use and a few other indicators in that men and women who had become Alzheimer’s victims had gotten lower scores than their peers. Researchers then took the stance that if there IS a correlation, maybe we could use those types of scores to begin a bit of early intervention!

What does this have to do with us in 2018? Perhaps we could continue the research using another kind of test given to a large number of teenagers? There would have to be a massive overhaul of the test. One of the questions asked you to identify the type of FISHING LURE that was illustrated. We can’t possibly give the same test today that they gave in 1960.

However, it’s still possible that we could do this today, perhaps with the ACT.

In the state I live in, the ACT is given as a matter of course for all juniors (sixteen-going-on-seventeen-year-olds). The same kind of statistical analysis might be applied to it as well.

In fact, since it’s inception in 1959, some sixty MILLION ACT tests have been administered (1959 = 75,460; 2017 = 2,030,000; average = approx. 1,010,000 over 58 years). The ACT is now given in fifteen other countries (one acting as the testing site for ten other countries) and all fifty US states, the District of Columbia and the fourteen US territories.

That data would be interesting to work with. Even MORE data than a measly half-million American teenagers…

Image:  http://az616578.vo.msecnd.net/files/2016/06/25/6360242025150255191939281878_Alzheimer-disease-patients.jpg

ENCORE #94! – Computer Targeting Cancer Cells

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in June of 2016…

Targeting breast cancer cells seems to be a major new thrust in the fight against breast cancer. I talked about it a couple of months ago here as well as some years ago: http://breastcancerreaper.blogspot.com/2012/09/breast-cancer-research-right-now-2.html and here: http://breastcancerreaper.blogspot.com/2016/04/breast-cancer-research-right-now.html

But how do you get from the IDEA of targeting cancer cells to trying drugs to do it? Apparently, you can do computer models.

Now don’t get me wrong, I am NOT a fan of computer models. The model is only as good as the person who inputs the raw data and the person who writes the program. Computer models are notorious for spitting out inaccurate predictions and drawing false conclusions – not the machine’s fault, of course. Like I said, programmers and data entry folks. Also, the assumptions of the researcher can find their way into the model as well; but that’s happened since forever, so it’s not a new factor.

Here we have the following: “Researchers have built a model to investigate the metastasis of cancer by examining the metabolism of breast epithelial cells and look at the role of signaling. This research may contribute to the development of cell specific anti-cancer interventions.”

In English, then: researchers are looking at how the cells that typically erupt into breast cancer cells use the nutrients they get from the body and the waste materials they give off. With that kind of a trail, scientists can design drugs to follow the trail and destroy the cancer cells.

Sounds simple enough – sort of like the old story of Hansel and Gretel: going out into the forest, the smart little girl leaves an easily followed trail that her and her brother can follow back home.

In this case, the cancer cell leaves a trail that well-designed cancer drugs can follow. Then they can destroy the cancer cell. The way it’s done now, is that drugs like Taxotere (which interferes with cell division), Adriamycin (which inserts itself into the cancer cell’s DNA so the cells can’t make new cancer cells), and Cytoxan (which sneaks in as a harmless drug, then is converted by the cancer cell into a toxin) – but they aren’t perfectly targeted. They kill hair cells and T-cells that protect the body from infections.

The researchers, programmers, and data entry people are working to reduce the amount of damage current cancer drugs do while still maintaining the attack on cells.

So, while I won’t CHEER this new model on, I will certainly watch to see what kinds of effective results it produces!

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

BREAST CANCER RESEARCH RIGHT NOW! #63: Blocking the Hippo Pathway!

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Every month, I’ll be highlighting breast cancer research that is going on RIGHT NOW! Harvested from different websites, journals and podcasts, I’ll translate them into understandable English and share them with you. Today: Researchers discover a way to break cancer’s vicious cycle.

“…the so-called Hippo pathway, a network of proteins that are important for normal cell and tissue growth but which often goes haywire in cancer, (named after its role in controlling organ size so that organs grow abnormally large, or ‘hippo-like,’ when the pathway breaks down)…normally keeps cell proliferation in check, is inactivated in many cancers, so far there was no good way to target it with drugs...”

Reading this as someone who loves a breast cancer victim or survivor, you know that the most horrific aspect of cancer is that it takes the cells of a normal person, which grow to keep us healthy, and sends them on an ever accelerating spiral of uncontrolled growth. Bits of the “crazy cells” break off, drift through the blood and set up housekeeping elsewhere in the healthy body (metastasizing) and soon become impossible to control.

While researchers and doctors KNOW this, there hasn’t been an effective way of reaching into cells and turning off the gene that cancers turn on. They may have found a protein that will do that. Thus far, they’ve only worked with breast cancer cells in a test tube (in vitro) and in lab mice, and bladder cancer cells in the same situations.

However, “University of Toronto researchers have…identified a protein called NUAK2, which is produced by cancer cells to boost their proliferation [make them grow faster] and whose presence in tumours is associated with poor disease prognosis [it’s bad news]…the researchers show that blocking NUAK2 slows down cancer cell growth...”

Please note that this research is BRAND NEW, published just a few days ago as I write this, so we’re not talking about a rush to volunteer for a drug test program, but with some $5.2 BILLION dollars spent on cancer research (https://www.cancer.gov/about-nci/budget/fact-book/data/research-funding) in 2016 alone, ($519,000,000 for breast cancer – half a billion dollars), we can trust (as much as anyone can!) that the motivation of researchers will be to bring as many therapies and treatments to bear against cancer as possible.

Long live the Hippo research!

Resources: https://www.sciencedaily.com/releases/2018/08/180829081336.htm

Image: (Personal photo) Hippo at the Seoul (South Korea) Grand Park Zoo, August 2018

ENCORE #93! – Vascularized Lymph Node Transfer (VLNTx) and Lymphaticovenous Anastomosis (LVA)!

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in August of 2016.

 “One procedure is a lymph-to-vein bypass surgery that involves connecting tiny lymph channels in the affected limbs to tiny veins, so blocked up lymph fluids have an outlet to flow into the circulatory system. These connections may be made in multiple locations on the affected limbs during outpatient procedure.

“Another option is lymph node transfer. It involves cutting a wedge of skin tissue containing lymph nodes from one area of the body, often the groin, and transplanting into the affected arm or leg. The transplanted lymph nodes are often able to clear lymph fluid from the affected arm or leg, resulting in partial or full reduction in limb swelling. The procedure requires several days in the hospital.”

“A new approach to treating lymphedema involves transplanting lymph nodes from elsewhere in the body to replace those removed as part of treatment…pioneer a method for selecting lymph nodes for transplant that could minimize this risk…Removing lymph nodes that drain the trunk does not generally cause lymphedema.”

In our area both VLNTx and LVA are being performed by at least one plastic surgeon. He notes however, “Surgery is a treatment option for a very small, selected percentage of the patients who have lymphedema…”

The next question is then, would my wife be one of that small, selected percentage? How is it paid for (ie: does health insurance recognize it as something important or as something cosmetic, that is, “unimportant”)?

To clarify, I should mention that there are TWO systems of fluid transfer in the Human body. The first one we are intimately familiar with called the cardiovascular system – that’s the one that’s connected to our heart and we see every time we cut a finger or scrape a knee. It transfers blood from one part of the body to the other, connects up with the lungs, and general keeps us from dropping dead in sixty seconds!

The lymphatic system is both hidden and for most of us, virtually undetectable. Our Medieval ancestors however, became acutely aware of the lymph system during the Black Death – the plague virus infects the lymphatic system and causes an horrific swelling of the lymph nodes. The nodes were also called “buboes” and the other name for the disease is the Bubonic Plague. Since then, we haven’t paid much attention to it.

It is the nodes, found at the joints – neck, armpits, hips, abdomen, and a few other places – that are removed when there is a suspicion of breast cancer. The nodes, when compressed by our movements, push the lymph from one place to another in the body.

Damage to the lymphatic system does NOT cause death in moments, rather the death from diseases of the lymph nodes and system cause death in terms of months, years, or even decades. The most significant disease to affect the lymphatic system – which also carries white blood cells to injured or infected parts of the body – was the Human Immunodeficiency Virus, more commonly known as HIV. This of course led to the scourge of the 20^th Century, Acquired Immune Deficiency Syndrome or AIDS.

It is this parallel system that, when the nodes are removed, causes the buildup of lymph in the extremities. It causes lymphedema.

So there you have it. There is now SOME hope for treating lymphedema; there is now hope for patients whose doctors said, “Oh, don’t worry about injuring the arm we took the lymph nodes from. It’ll be fine…”

It wasn’t fine, and if I could, I would mention to that doctor exactly where he could PUT such saccharine, ineffective, unintelligent, gobbledygook…

UPDATE: 9/1/2018

There seems to be movement and study at the forefront of this surgical practice. The following from a recent article found at https://www.ncbi.nlm.nih.gov/pubmed/29355987: “CONCLUSION:

VLNT followed by SAL can allow patients with late Stage II lymphedema achieve near normal limb size and eradication of infectious episodes. At follow-up, these desirable outcomes were maintained well after discontinuation of compression therapy.” (J Surg Oncol. 2018 May;117(6):1148-1156. doi: 10.1002/jso.24969. Epub 2018 Jan 22.)

I will say that this looks GOOD! I’ll probably do a new article soon!

Resources: http://www.cancercenter.com/video/treatments-technology/vascularized-lymph-node-transfer/, http://www.advancedreconstruction.com/breast-reconstruction/lymphedema/?gclid=CIr0mNawvs4CFQYOaQodgKYPEQ

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg