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Breast Cancer Explained As Sarah Ferguson Diagnosed - Symptoms, Treatment And Risk Factor
The Duchess of York, 63, underwent a single mastectomy and is now urging for a nationwide rigorous breast cancer screening programme
Currently, women between 50 and 70 are invited by the NHS to have mammograms, a special type of X-ray, every three years to check for breast cancer(Getty Images)
Sarah Ferguson, the Duchess of York, revealed this week that she is recovering from surgery to treat breast cancer.
The 63-year-old former wife of Prince Andrew had a single mastectomy, and is thankful to have been diagnosed early during a routine mammogram.
She believes her experience underlines the importance of the regular scans, explaining on her latest Tea Talks With the Duchess & Sarah podcast: "I'm telling people to go get screened."
The Duchess is far from alone.
Dr Liz O'Riordan, a former breast cancer surgeon and the co-author of The Complete Guide to Breast Cancer, says: "Breast cancer is now the most common form of cancer in the UK, with around 55,000 women diagnosed each year.
"The good news is that these days, thanks to huge medical advances, it's highly treatable, with over 80% of those diagnosed still alive 10 years later."
So what do women over 50 need to know about breast cancer? Here, we find out
Sarah Ferguson has mastectomy after sister urged her to go to routine cancer check
Sarah Ferguson believes her experience underlines the importance of the regular scans(Getty Images)
Sarah said she will use her platform to talk about breast cancer and the importance of screening(S Meddle/ITV/REX/Shutterstock)
SymptomsLimiting alcohol intake can help reduce breast cancer risk(Getty Images/iStockphoto)
Although factors such as age and family history can't be changed, research shows these lifestyle changes can help lower your risk of breast cancer…
Drinking less alcohol
If you want to decrease your risk of breast cancer occurring, or a previous cancer coming back, research shows you should cut down on drinking. "When alcohol is broken down in the body, a cancer-causing chemical called acetaldehyde is released. Consistent, regular drinking means it builds up in the body. Plus alcohol consumption also increases the level of oestrogen, which drives some types of breast cancer," says Dr O'Riordan. Just one glass of wine daily increases your risk by 15%.
Losing weight
Obesity has been shown to increase breast cancer risk by 30% – particularly in post-menopausal women - and to increase recurrence rates. Fat cells produce an enzyme called aromatase which raises oestrogen levels and encourages the growth of some breast cancers. Losing just 5% of your body weight can bring your risk down to normal levels.
Exercising more
Being physically active reduces your risk of breast cancer by up to 30%. Exercise also reduces the risk of recurrence and boosts survival rates. Exercising for the recommended 150 minutes per week helps balance hormone levels and reduce inflammation, reducing the likelihood of cancer developing.
Chance of diagnosisCurrently, women between 50 and 70 are invited by the NHS to have mammograms, a special type of X-ray, every three years to check for breast cancer(Getty Images)
Most Read {{#articles}} {{/articles}}About one in eight women will develop breast cancer, and the biggest risk factor is age, with 82% of those diagnosed over 50.
Genetics play a role, too, and up to 20% of women with breast cancer will have a family history of the disease. The earlier breast cancer is found, the more treatable it is, so regular screening is vital.
Currently, women between 50 and 70 are invited by the NHS to have mammograms, a special type of X-ray, every three years to check for breast cancer.
Although uncomfortable – it involves each breast being pressed between the machine and a plastic plate – the screening programme is estimated to save 1,300 lives per year.
Mammograms stop being routinely offered over the age of 70 because as women age over-diagnosis of cancers that wouldn't ever be a problem becomes more common. So it's more likely that women aged 71 could have treatment they don't need.
But one in three cases of breast cancer still occur in women over 71 and you have the right to free screening every three years. Just ask your local NHS screening unit.
Self-checkingCheck your whole breast area, including up to your collarbone and armpits(Getty Images)
Self-checks can help find signs early, but a YouGov survey commissioned for the Breast Cancer Now charity found around 40% of women don't bother.
Half of these simply forgot and the other half failed to check because they were unsure how. But the charity says there is no special way to check your breasts and you do not need any training .
The key is to get used to feeling and looking regularly so you can be aware of anything that's new or feels different.
You can check in the shower, lying down in bed or in the mirror before getting dressed. Check your whole breast area, including up to your collarbone and armpits. Most breast changes or lumps aren't cancer, but if you spot any signs mentioned below you should get checked by a GP.
What tests to expectJulia Bradbury shared images during her own breast cancer journey(Instagram)
Samantha Womack now lending her support to a campaign enabling greater access to a new AI breast cancer diagnostic tool called Digistain(Ken McKay/ITV/REX/Shutterstock)
If your GP isn't sure what's causing a lump in your breast they will refer you to a hospital breast clinic, usually within two weeks.
Dr O'Riordan says: "They're one-stop shops where a mammogram, and sometimes an ultrasound can be given, as well as a biopsy – where a needle is used to remove a small piece of tissue for testing – all during one appointment." If breast cancer is confirmed, then specialists will determine the cancer size and if it has spread.
Stage 1 is the earliest stage and stage 4 means the cancer has spread to another part of the body. Cancer cells are also graded from low, which means slow growth, to high, which is fast-growing. Support is on hand to help people through testing.
TreatmentOnly a third of women with breast cancer now need chemotherapy(Getty Images)
Don't miss {{#articles}} {{/articles}}Treatment options are now both effective and varied and can include any combination of surgery, chemotherapy, hormone therapy and radiation.
Dr O'Riordan says: "These days the majority of women don't need a full mastectomy to remove the entire breast. Surgeons can often perform a lumpectomy, removing a smaller part of breast and reshaping it."
For women who do need a mastectomy, breast reconstruction is possible with implants or your own tissue.
Only a third of women with breast cancer now need chemotherapy.
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Dr O'Riordan says: "It's normally only given if you're young, your cancer is large or has spread to your lymph nodes. Most women only need an operation to remove the tumour and radiotherapy."
After initial treatment, Tamoxifen is given to women with oestrogen-sensitive breast cancer, about 70% of cases, as it cuts recurrence risk by up to 50%. But side effects include hot flushes, weight gain, mood swings, and loss of libido.
Is HRT safe?Latest research has shown that HRT is only linked to a small increased risk – less than having one alcoholic drink a day or being overweight(Getty Images/Collection Mix: Subjects RF)
The controversial Million Women Study in 2003 suggested taking HRT could greatly increase risk.
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But the latest research has shown that HRT is only linked to a small increased risk – less than having one alcoholic drink a day or being overweight.
"However, if a woman has had breast cancer before, she should not be given HRT – except in 'exceptional cases', where symptoms are severe and all other approaches have failed," saysDr O'Riordan.
"This is because HRT works by topping up oestrogen – and as three-quarters of all breast cancers are fuelled by oestrogen, taking it could increase the risk of breast cancer coming back."
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Finding New Hope With An Innovative Immunotherapy For Blood Cancer
Sponsored by and provided by Genentech, a member of the Roche Group
Each year in the United States, approximately 16,000 people are diagnosed with follicular lymphoma (FL) [1], the most common slow-growing form of non-Hodgkin's lymphoma (NHL). [2] People with this blood cancer often experience periods of remission and relapse, and the disease can become more difficult to treat each time it relapses. [3]
Juan Yee and family Juan Yee Juan Yee, a married father of three and a postal worker in San Diego, knows first-hand what it is like to be diagnosed with FL and experience relapses. He was living an active life, going to professional baseball games and enjoying jet skiing and other activities with his sons, but began experiencing swollen lymph nodes and fatigue. He brushed the symptoms off, explaining, "I was trying to be strong and kept working a lot, but then my appetite disappeared, I felt weak, and I was having night sweats."
Lab tests revealed that Yee had FL. While not everyone responds to treatment, Yee is in remission today because of multiple treatments including one innovative cancer therapy.
Experiencing his third bout of blood cancer
At the time of Yee's initial diagnosis, he was treated with chemotherapy, which caused many side effects, including constipation, heartburn and hair loss. "I was 38 years old. My three sons were still young, so it was scary. But I tried to be positive, and my whole family really supported me," says Yee.
Several years later, Yee again noticed swollen lymph nodes and fatigue, as well as weight loss and night sweats that wouldn't go away. With this first relapse, he was again treated with chemotherapy.
Just two years later, Yee's cancer returned yet again. For this third bout of blood cancer, his doctor recommended a stem cell transplant that would require preparation with chemotherapy. Feeling like he was at the end of his rope, Yee decided not to undergo any treatment. "I couldn't go through chemo again. I was done. I didn't want to put my family through all that," he explains.
Deciding to participate in a clinical trial
Yee's sister told him about a celebrity she had seen on television who was celebrating being cancer-free five years after battling the same cancer Yee had, though this person received a different treatment. That inspired renewed hope for Yee, and he went back to see his oncologist, who had read about an experimental medicine being evaluated in a clinical trial and recommended Yee meet with Dr. Elizabeth Budde. An associate professor in the Division of Lymphoma at City of Hope, Dr. Budde was leading a clinical trial of an investigational medicine – mosunetuzumab-axgb.
"She explained to me how the medication is designed to work and that it would not require chemotherapy," says Yee.
Mosunetuzumab is a T-cell engaging bispecific antibody, a unique type of cancer immunotherapy for FL patients who have received two lines of previous therapy. This T-cell engaging bispecific antibody is designed to bind to proteins on T cells, immune cells that help detect foreign and abnormal cells, and B cells, which can be healthy or malignant. Once bound, the medicine redirects the T cells to engage and destroy B cells.
As Dr. Budde explains it, "The cells are pulled together, with mosunetuzumab serving as a kind of bridge. The idea is that being in such close proximity allows the now activated T immune cells to recognize the cancerous B cells and release cancer-killing proteins to eliminate them."
Yee decided to participate in the study because having the option of a different type of medicine – a therapeutic approach unlike ones he'd tried before that uses the patient's own immune system to fight cancer – was important to him.
Mosunetuzumab received accelerated approval from the U.S. Food and Drug Administration under the name Lunsumio® (mosunetuzumab-axgb) to treat adults with FL whose cancer has come back or did not respond to previous treatment and who have already received two or more treatments for their cancer. The conditional approval of Lunsumio is based on response rate. There are ongoing studies to establish how well the medicine works. Individual treatment experiences may vary.
The approval was based on findings from the clinical trial. Results showed that 80% of patients who received at least two previous therapies achieved either a disappearance of all signs and symptoms of cancer (complete remission) or a decrease in the amount of cancer in their body (partial remission). Among all study participants, 60% went into complete remission. The median duration of response to the medicine was 22.8 months. All medicines have side effects. In the study, the most common side effect with Lunsumio was cytokine release syndrome, a type of inflammation throughout the body that can be severe and life-threatening. Fatigue, rash, fever and headache were among other common side effects. [4]
"Thanks to the participation of Juan and other patients in the study, we now have a bispecific antibody treatment option to offer patients with follicular lymphoma whose disease has already relapsed twice," explains Dr. Budde. "This treatment offers patients who have received two prior treatments realistic hope for achieving a durable remission."
Sharing his experience
Patients continue to benefit from people like Yee who participate in clinical trials because these studies provide critical information for doctors and researchers. He is glad he participated in the study and now focuses on the activities he loves, such as volunteering at his church and spending time with his family, including his first grandson.
"When I was going through all those rounds of treatment, remission, relapse and more treatment, I kept asking God why this was happening to me," says Yee. "Now I think it was so I could help other people by sharing my experience and telling others to never give up."
For more information, visit Lunsumio.Com.
[1] American Cancer Society: Cancer Facts and Figures 2023. American Cancer Society, 2023. Https://www.Cancer.Org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2023/2023-cancer-facts-and-figures.Pdf. Accessed May 11, 2023.
[2] American Cancer Society. Types of B-cell lymphoma. Https://www.Cancer.Org/cancer/non-hodgkin-lymphoma/about/b-cell-lymphoma.Html. Accessed February 22, 2023.
[3] Cahill KE, Smith SM. Follicular lymphoma: a focus on current and emerging therapies. Oncology. 2022;36(2):97-106.
[4] Genentech, Inc. 2022. Lunsumio (mosunetuzumab-axgb) Prescribing Information. Https://www.Gene.Com/download/pdf/lunsumio_prescribing.Pdf
Lunsumio U.S. Indication
LUNSUMIO (mosunetuzumab-axgb) is a prescription medicine used to treat adults with follicular lymphoma whose cancer has come back or did not respond to previous treatment, and who have already received two or more treatments for their cancer.
It is not known if LUNSUMIO is safe and effective in children.
The conditional approval of LUNSUMIO is based on response rate. There are ongoing studies to establish how well the drug works.
What is the most important information I should know about LUNSUMIO?
LUNSUMIO may cause Cytokine Release Syndrome (CRS), a serious side effect that is common during treatment with LUNSUMIO and can also be severe or life-threatening.
Get medical help right away if you develop any signs or symptoms of CRS at any time, including:
Due to the risk of CRS, you will receive LUNSUMIO on a "step-up dosing schedule."
Your healthcare provider will check you for CRS during treatment with LUNSUMIO and may treat you in a hospital if you develop signs and symptoms of CRS. Your healthcare provider may temporarily stop or completely stop your treatment with LUNSUMIO, if you have severe side effects.
What are the possible side effects of LUNSUMIO?
LUNSUMIO may cause serious side effects, including:
Your healthcare provider may temporarily stop or permanently stop treatment with LUNSUMIO if you develop severe side effects.
The most common side effects of LUNSUMIO include: tiredness, rash, fever, and headache.
The most common severe abnormal lab test results with LUNSUMIO include: decreased phosphate, increased glucose, and increased uric acid levels.
Before receiving LUNSUMIO, tell your healthcare provider about all of your medical conditions, including if you:
Females who are able to become pregnant:
Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
What should I avoid while receiving LUNSUMIO?
Do not drive, operate heavy machinery, or do other dangerous activities if you develop dizziness, confusion, tremors, sleepiness, or any other symptoms that impair consciousness until your signs and symptoms go away. These may be signs and symptoms of CRS or neurologic problems.
These are not all the possible side effects of LUNSUMIO. Talk to your health care provider for more information about the benefits and risks of LUNSUMIO.
You may report side effects to the FDA at (800) FDA-1088 or www.Fda.Gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.
Please see Important Safety Information, including Serious Side Effects, as well as the LUNSUMIO full Prescribing Information and Medication Guide.
Children Of Cancer Patients Have Increased Risk Of Unmet Economic Needs
Children who have a parent with cancer are more likely than other children to experience unmet economic needs, according to research published in JAMA Network Open.
These children are at greater risk of food, housing, and transportation insecurity, researchers reported.
The researchers examined data for 22,941 children aged 5-17 years from the 2013-2018 US National Health Interview Survey. The primary objective was to determine associations between parental cancer and the economic needs of the affected children.
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Parental cancer was present in 3.4% of the cohort (n=812). Children of cancer patients were more likely to be older and non-Hispanic White, and to have a single parent. The parents with a cancer history were more likely to be older, female, and non-Hispanic White, to have comorbidities, and to be on public health insurance. The majority of parents with cancer (81.2%) had received their diagnosis 2 or more years prior to the study.
Adjusted analyses showed that families in which a parent had cancer were more likely than cancer-free families to have food insecurity. The proportion of families who "often or sometimes" worried about food running out was 30.1% for families with parental cancer and 20.1% for cancer-free families (odds ratio [OR], 1.97; 95% CI, 1.56-2.49; P <.001).
The proportion of families who said it was often or sometimes true that food did not last was 26.0% for families with parental cancer and 16.7% for families without cancer (OR, 2.01; 95% CI, 1.56-2.58; P <.001). In addition, 16.9% of families with parental cancer and 13.3% of those without cancer were often or sometimes unable to afford balanced meals (OR, 1.38; 95% CI, 1.06-1.79; P =.02).
The proportion of families who said they were "very or moderately" worried about paying monthly bills was 44.8% for families with parental cancer and 37.9% for cancer-free families (OR, 1.41; 95% CI, 1.15-1.74; P =.001). The proportion of families who were very or moderately worried about housing-related costs was 35.7% and 30.7%, respectively (OR, 1.31; 95% CI, 1.07-1.60; P =.009).
Delayed access to child medical care due to lack of transportation was more likely in families with parental cancer than in cancer-free families — 3.6% and 1.6%, respectively (OR, 2.31; 95% CI, 1.49-3.59; P <.001).
Of families with unmet economic needs, the greatest odds of food insecurity were present among female children (OR, 1.61; 95% CI, 1.03-2.51; P =.04) and children who were non-Hispanic Black (OR, 2.28; 95% CI, 1.04-4.99; P =.04). The risk of food insecurity was also greater for children whose parents had public health insurance rather than private insurance (OR, 1.89, 95% CI, 1.04-3.43; P =.04) and multiple comorbidities rather than none (OR, 2.83; 95% CI, 1.39-5.73; P =.004).
Food insecurity was also dependent upon family income. When compared to families with income at least 400% of the federal poverty level, food insecurity was higher for families with incomes 200% to less than 400% of the federal poverty level (OR, 5.32; 95% CI, 2.31-12.27; P <.001) and for families with incomes below 200% of the federal poverty level (OR, 20.88; 95% CI, 8.70-50.11; P <.001).
"These findings suggest that strategies to identify children with a parental cancer history and address their unmet economic needs are warranted," the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
ReferenceZheng Z, Han X, Zhao J, Fan Q, Yabroff R. Parental cancer history and its association with minor children's unmet food, housing, and transportation economic needs. JAMA Netw Open. Published online June 22, 2023. Doi:10.1001/jamanetworkopen.2023.19359
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