fertility and breast cancer

Fertility and breast cancer – a new link discovered

An American research team has conducted a study of anti-Mullerian hormone (AMH) – which indicates the size of a woman’s ovarian reserve – and have concluded that women with high levels of it can be up to 60%  more likely to develop breast cancer, compared to women with low levels of the hormone.

The hormone – which can be detected with a simple blood test – is naturally secreted in cells which develop egg sacs, and its level is usually checked and monitored during fertility tests, as an indicator of a woman’s ovarian reserve – in other words, it’s a good indicator of a woman’s fertility, or otherwise.

It’s also used as a marker of time to menopause: those with higher AMH levels for their age tend to reach menopause later in life, but for most of us our AMH levels peak in our early twenties and then tail off. But the results of these new findings have alerted to the medical community to the possibility of keeping tabs on it during cancer testing.

A ‘possible biomarker’

The study – conducted by researchers at the New York University School of Medicine – involved an analysis of blood samples from almost 6,000 premenopausal women across the United States of America, Italy, Sweden and the UK. This valuable data had been collected from ten separate studies (including one from the Breast Cancer Now Generations Study at The Institute of Cancer Research, London), and the goal was to conduct the most intensive examination yet of the association of AMH levels with breast cancer risk.

Their findings, published in the International Journal of Cancer, concluded that women with the highest levels of the hormone were more likely to develop breast cancer – leading them to state that AMH is a ‘possible biomarker’ for breast cancer.

“The link we found between anti-Mullerian hormone and breast cancer risk is interesting because few markers of risk in the blood have been identified for premenopausal women,” said Professor Anne Zeleniuch-Jacquotte, the lead author of the study.

“Our study found a moderate risk increase, and we hope additional markers can now be found to help substantially improve individual risk prediction.”

A key to earlier breast cancer detection?

Co-author Anthony Swerdlow, professor of epidemiology at The Institute of Cancer Research, London, who leads the Breast Cancer Now Generations Study – a landmark prospective study of the causes of breast cancer that is following over 113,000 UK women for 40 years – added; “In future, anti-Mullerian hormone could be factored into new ways of predicting individual women’s risk of developing the disease. The causes of breast cancer are highly complex and not yet fully understood. Pooling together large datasets is key to understanding how the many different causes interact and affect breast cancer risk.’

In an era where more women are being diagnosed with breast cancer than ever before – thanks to a vast improvement in detection technology – this study could open up another avenue on the journey towards understanding cancer.

breast cancer detection

New research points the way to earlier breast cancer detection

Another month, another vital discovery in the fight against cancer: a collaboration between the Washington University School of Medicine in St Louis, the Baylor College of Medicine Waco, Texas and Canada’s University of British Columbia has detected a link between certain DNA mutations and a high risk of relapse in oestrogen receptor positive breast cancer, as well as other mutations which are associated with better outcomes.

Their study, which was published this month, could really help the medical community when they attempt to predict which patients are most likely to have their cancer return and spread – which would be a huge help when it comes to mapping out a plan of treatment. Furthermore, it also opens the door to the development of more aggressive treatments for patients with the newly identified high-risk mutations.

The researchers analysed tumour samples from more than 2,500 patients with oestrogen receptor positive breast cancer – which is one of the most common forms of the disease, where the cancer cells have receptors which bind to the hormone oestrogen in the nucleus of the cell and drive tumour growth.

Why detecting ER positive cancer cells are vital

Women who suffer from ER positive breast cancer have a number of treatment options that can block the oestrogen receptor to stop tumour growth, which are more effective and less toxic than traditional chemotherapy and radiation, but certain tumours have the ability to develop a resistance to these treatments and can mutate without the presence of oestrogen. And it is these types of mutations which cause the majority of deaths due to breast cancer.

This new study not only confirmed previous studies which proved that relatively common mutations in patients with a gene called MAP3K1 responded well to treatment, while those with a gene known as TP53 were more likely to have a recurrence. But it also picked out three other genes – DDR1, PIK3R1 and NF1 – which are comparatively rare mutations that are also linked to cancer recurrence and spreading and recommended that they should be also be targeted in future cancer screenings.

“Although mutations in DDR1 and NF1 are considered rare, they are associated with early relapse, which makes them much more common in patients who unfortunately die from the disease and, thus, could be critical therapeutic targets,” said Matthew J. Ellis, MB, BChir, PhD, of the Baylor College of Medicine. “Their identification also gives us very important molecular clues into the nature of aggressive tumour behaviour.”

Earlier breast cancer detection = a better chance of beating cancer

The upshot of studies like this is to help the medical community sharpen its focus on what they should be looking for in screenings in order to detect the occurrence of cancer as early as possible, in order to give patients the best possible chance against cancer.

“We would like to help doctors identify patients who are likely to do well versus those who are likely to have a recurrence,” said first author Obi L. Griffith, PhD, an assistant professor of medicine and an assistant director of The McDonnell Genome Institute at Washington University School of Medicine.

“Those with mutations that are associated with a good prognosis may need less intensive therapy than they might otherwise receive. But if a patient’s tumour has mutations linked to high risk of relapse, it’s useful to know that early so they can be treated with more aggressive therapies or even potential investigational therapies that could be targeted to their specific mutations.”

breast cancer terminology

Breast cancer terminology: is it time to stop the fight?

We all know the language that gets used about cancer. It’s an ‘enemy’. We ‘fight’ it. Hopefully we can ‘defeat’ it and become a ‘survivor’. And those who don’t ‘lose their battle’.

A lot of people are happy to use this language – or at least don’t question the logic of it – but a lot of people aren’t. Articles like this, in the wake of the death of broadcaster Rachel Bland, make the case that framing cancer treatment in aggressive, militaristic terms is a worn-out and strangely macho cliché that reduces everyone who undergoes breast cancer as a grizzled survivor at best or not strong enough at worst.

A recent medical study examined the language of cancer and came to the conclusions that treating cancer as a ‘fight’ can have long-term implications for those with cancer – and also can stop people without cancer from doing what they can to avoid it.

In one study, the research team split a group of volunteers with no history of cancer into two groups. One group was asked: “What things would you do to fight against developing cancer?”, while the other group was asked: “What things would you do to reduce your risk of developing cancer?” Then, they were asked to list the things they could do – or stop doing – to reduce the risks of developing cancer.

Breast cancer terminology: defence is the best attack

The researchers collated the responses and discovered that the group that was exposed to combat-related metaphors listed significantly less self-control preventative behaviours. Why would this happen? Because according to the researchers, framing cancer in combative terms means that we see it as an unavoidable thing that can only be attacked when it’s there. “When we’re at war,” said the study’s authors, “we have no choice but to engage a hostile force that must be attacked in order to be stopped. Self-limitation is not part of that equation.”

Another study claimed that people who see themselves ‘at war’ with cancer are more likely to frame their treatment plan in more aggressive terms – such as pushing to undergo a severe course of chemotherapy rather than early palliative care, which can provide a better quality of life and sometimes even extend lifespan.

Breast cancer terminology: words matter

The study, conducted by Lancaster University, analysed one and a half million word’s worth of interviews and online cancer discussions, and discovered that ‘fight’ and ‘battle’ were two of the most commonly-used words, and that framing the discussion in combative terms foists the blame onto the people who have developed it. “Blame is being put on the patient, and there’s almost a sense that, if you are dying, you must have given up and not fought hard enough” claimed the study author, Professor Elena Semino.

Not only that, but the cancer-as-war analogy can also affect people who have successfully undergone cancer treatment – the guilt of ‘surviving’ while others didn’t, for example – and those who have successfully undergone treatment only for the cancer to return can experience an additional sense of failure – that their previous ‘victory’ is now fraudulent.

Naturally, the language you choose to use is a completely personal thing: if seeing cancer as an enemy that needs to be fought helps you make sense of your situation, that’s absolutely fine. But just as there are many different treatments, there are also many different ways to look at it – and you’re free to pick your words you like.

breast cancer risk and diet

More fruit and veg may reduce the risk of breast cancer

The Five-A-Day campaign is probably the most well-known of our government’s health campaigns so, in that respect, the most successful. However, since its introduction in 2003, we’re still only eating only three and a half portions of fruit and vegetables a day on average. But, now there’s even more reason to up your fruit and veg intake, particularly if you want to ward off breast cancer.

According to a recently-published study in the International Journal of Cancer, getting your five-a-day – and more – could mean you’re getting a sizable chunk of extra protection from aggressive forms of breast cancer, and the medical community is sitting up and taking notice.

The study, conducted by Harvard University’s T.H. Chan School of Public Health, utilised the data of 182,145 female nurses from 1980 to 2013, and concluded that those who’d eaten 5.5 servings of fruit and veg a day or more, were significantly less likely to develop breast cancer than those who ate fewer than 2.5 servings. In fact, they had an 11% lower risk.

Antitoxidants and nutrients can help

 So what kinds of fruit and veg should you be looking for? According to the study, the anti-cancer properties of greens and fruits have nothing to do with the fibre they contain, which doesn’t seem to have a substantial effect on fending off cancer (although it keeps you regular).

According to the study, the real benefits of a five-a-day routine come from the increased levels of antioxidants and micronutrients – particularly in the following…

Cruciferous vegetables

Otherwise known as ‘brassicas’, cruciferous vegetables are mainly leafy greens – things like broccoli, sprouts, cress, cabbage, bok choy, kale and caulis (but also turnips and radishes). The reason for this is that they’re loaded with glucosinulates (which can reduce hormone-related cancers and deactivate carcinogens). They work especially well when eaten raw – as part of a smoothie, for example – but also do a job when they’re lightly cooked – in a stir fry, for example.


Low in natural sugar, that are packed with anthocyanins – which reduce inflammation and fend off oxidation in the brain – and ellagic acid, which can neutralise carcinogens and have anti-tumour benefits.

Capisicums and other yellow-orange veg

If you like spicy food, keep it up: there’s been a barrage of scientific evidence which claims that capsaicin – the active ingredient of chilli peppers – has the ability to kill cancer cells while leaving healthy cells undamaged. But other veg such as pumpkin and corn can help, too.

Know your portions

If you’re not portion-savvy but you’d like to begin a healthy-eating regime, it’s worth remembering the following: one portion equals to or three small items (like plums, apricots etc), one medium-sized fruit (like apples or pears), one portion of a large fruit (slice of pineapple, melon etc), four tablespoons of greens, three tablespoons of cooked veg, and three heaped tablespoons of pulses or beans. Oh, and potatoes don’t count, alas: they’re counted as a starchy food.

chemotherapy and hair loss

FAQ: Chemotherapy and hair loss

You might not be aware of the importance of your hair to your self image and state of mind until you face the prospect of losing it and, in fact, both men and women note that hair loss is one of the side effects that they worry about most when they are diagnosed with cancer.

Here we have answered some of the most common questions we get asked about chemotherapy and hair loss, as we have found that talking through any concerns and fears is the best way to prepare patients for their breast cancer care journey.

Does chemo automatically cause hair loss?

It depends on the kind of treatment you get because hair loss occurs with some – but not all – chemotherapy drugs.

Why do certain treatments cause hair loss?

Because certain chemo procedures use cytostatic drugs – which are designed to quickly detect and destroy any rapidly-dividing cells, such as cancer cells. Unfortunately, they can also wipe out other rapidly-dividing cells, such as the cells in hair follicles that make hair grow. However, because chemo is a bespoke treatment involving a cocktail of specific drugs depending on the circumstances of the cancer you have, it’s not a given that your treatment will result in hair loss.

If hair loss occurs, when will it start to happen?

Usually two to three weeks after the first course of treatment. With some people, hair loss will happen gradually, while with others it’ll be more sudden – again, it depends on the treatment. The amount of hair loss varies from a slight thinning to complete baldness, and affects the scalp, eyelashes, eyebrows, legs, armpits and pubic area. By the second course of treatment, the hair loss will be more pronounced.

Is there any pain during hair loss?

Some people will experience a pain in the scalp area, while others could experience itching.

Will my hair ever grow back?

Yes. Hair will grow back when the course of treatment has ended. Some people will notice immediate growth, while others will experience it a month or two afterwards.

Will my regrown hair look or feel different?

Hair that grows back after chemo often looks different at first: there may be a different tint to it – usually darker. Sometimes the texture changes as well, with straight hair going curlier, and vice versa. Sometimes this is a temporary effect which lasts for a few months. Sometimes it isn’t. Sometimes it comes back thicker: sometimes it feels finer.

What should I do to prepare for chemotherapy and hair loss?

This is a very personal thing, and it depends on two main factors – the treatment you are about to receive, and your personality. If you have been advised that your treatment will result in hair loss, you could get the jump on it and cut your hair shorter beforehand: a gradual experience of losing hair can help people cope better than a sudden loss.

If you really can’t handle changing your looks and intend to wear a hairpiece as you recover from chemo, make sure you shop around for one that suits your current look well in advance – or maybe it’s an opportunity to try out another look altogether.

And, of course, more and more women are choosing not to hide their hair loss at all. If you’re one of those people, remember that your exposed scalp will feel very sensitive – and not always in a negative way – at first. A huge amount of body heat is lost through the top of the head, so stock up on headscarves and hats. And an exposed scalp can be extremely sensitive to UV rays, so keep the sun cream handy.

If you have any other questions, one of the cancer care team at Thames Breast Clinic is always on hand to discuss every aspect of your treatment.

breast cancer screening importance

Breast cancer screening: the pros and cons

Breast cancer screening aims to identify signs that breast cancer is developing, spotting breast cancers early when they are often too small to see or feel but are usually easier to treat. One in eight women in the UK will be diagnosed with breast cancer at some point in their life and the UK breast cancer screening programme finds cancer in about eight of every 1,000 women tested. The NHS states that early screening saves approximately 1,300 lives per year.

However, researchers at University College London have found that women who fall into the low-risk category when it comes to breast cancer – estimated to be a third of the population – would actually be better off not being screened at all.

Their findings showed that a screening programme based on the level of risk of developing cancer over a lifetime will not substantially increase the number of women who are missed but will reduce the number of women who go through unnecessary breast cancer screening tests.

Overdiagnosis and breast cancer

On first evaluation of breast cancer screening, it might seem to patients that there are no downsides to tests that could pick up early signs of breast cancer and potentially save your life. Yet, breast cancer screening can deliver an abnormal result that means women are called back for further and more invasive tests, often experiencing great distress, and eventually they are found to be cancer-free.

A more sophisticated approach to breast cancer

The researchers at UCL propound the view that genetic testing could inform women of their individual risk and the sector of the population that are most at risk could be entered into the screening programme. Genetic screening brings with it its own set of concerns, though, and at the Thames Breast Clinic we can discuss all the possible implications before you decide to go ahead.

childbirth after cancer

Childbirth after cancer: a new breakthrough?

Deciding to start or build upon a family after cancer is a difficult decision, for many reasons – especially if you’ve gone through certain treatments.

In the main, pregnancy after cancer treatment is safe for both mother and baby: the medical community is in agreement that pregnancy does not seem to raise the odds of cancer returning. However, when it comes to exactly when a cancer survivor should embark on pregnancy, the waters become a little muddy, depending on the cancer type and stage, your age, and – especially – the type of treatment you’ve undergone. Let’s start with those:

  • Radiation therapy can affect the support cells and blood supply of the uterus, which can also increase the chances of miscarriage, early birth, low birth weight, and other complications.
  • Cervical surgery – whether partial or complete –  may increase the risks of miscarriage or early birth.
  • Chemotherapy is loaded with chemicals which can may damage heart cells and weaken the heart, which will cause it to have to work harder during pregnancy and labour. When chemo is combined with radiation therapy to the upper abdomen or chest, the risks of heart problems increase.

Consequently, there is no one-size-fits-all advice to dispense when it comes to post-cancer pregnancy. Some medical experts advise chemo patients to put off pregnancy for six months after the end of treatment, to give any eggs damaged by the treatment the time to leave the body. Others advise that you put off pregnancy for anything from two to five years, as the chance of cancer returning is always higher in the earlier years.

Another major worry that potential parents who have survived cancer wrestle with are the chances of their child contracting cancer too. In actual fact, research demonstrates that children of cancer survivors are not at higher risk. As we know, however, a few cancers are hereditary, and can be passed on through genes. It also goes without saying that a brush with cancer forces people to contemplate their own mortality a litter sooner than everyone else, and the idea of bringing a child into the world and then not being around for them can be a sobering thought.

A new breakthrough in post-cancer motherhood?

For those willing to pursue motherhood after a cancer diagnosis, the usual procedure involves having ovarian tissue removed and frozen before fertility-harming treatments commence. If all goes to plan and the cancer is eradicated, the tissue is put back. It’s mostly a safe procedure – but there are certain cancers which invade the ovarian tissue, meaning that when restored, there is a risk that the cancer will return.

However, science continues to find a way. The latest breakthrough comes from the Rigshospitalet in Copenhagen, where doctors have created an ‘artificial ovary’ from human tissue and eggs, in an attempt to help women have children after cancer treatment.

A recent demonstration showed that a lab-made ovary could keep human embryos alive, which could then be implanted in the future. This is created by stripping donated ovarian tissue of all of its cells (including any potential cancer cells) in order to leave a bare framework of collagen – which is then pitted with scores of human follicles, which can host early-stage eggs.

Returning you to normal life after successful cancer treatment is the goal of the breast cancer specialists at Thames Breast Clinic.

breast cancer chemotherapy

Your chances of undergoing breast cancer chemotherapy just got smaller

Data presented at the world’s biggest meeting of cancer doctors and scientists at the annual meeting of the American Society of Clinical Oncology in Chicago has caused a stir amongst the worldwide cancer treatment community, and for good reason: its findings on trials of a genetic test that analyses the danger of a tumour have concluded that as many as 70% of women with the most common form of early-stage breast cancer can safely avoid the challenges inherent in chemotherapy treatment.

We know that chemotherapy – the course of treatment designed to reduce the chance of breast cancer spreading or coming back, can (and has) saved lives across the world, but the side-effects of the toxic drugs deployed in the treatment are manifold. In ‘mild’ cases, these range from vomiting, fatigue and infertility to permanent nerve pain – and in extremely rare cases, it can lead to heart failure and leukaemia.

However, the trial – which involved the studying of cancer in 10,273 women using a genetic test that is already widely available, including on our NHS – is set to change practices across the world immediately, meaning that many women with breast cancer can be treated safely with surgery and hormone therapy.

An end to uncertainty?

The genetic test has been used for a while now, and women who get a low score on the test are told they do not need chemotherapy, while those with a high score are told they definitely do. But the problem has been that the vast majority of test results fall into an intermediate range, with an unclear result – which results in them undergoing chemo as a precautionary measure.

The data presented in Chicago by the Albert Einstein Cancer Center in New York, however, has demonstrated that women in the intermediate range have practically the same survival rates with or without chemo: the nine-year-survival-rate was 93.9% without chemotherapy and 93.8% with chemotherapy. This is a doubly important development: not only will fewer women have to undergo chemo, but it will also save a lot of money for a cash-strapped health service and instantly change the way the medical community deals with cancer.

According to experts, this means that an estimated 3,000 women a year in the UK will no longer need chemotherapy because of this trial.

A ‘life-changing breakthrough’

The test focuses specifically upon early-stage breast cancers – specifically those that can still be treated with hormone therapy, have not spread to the lymph nodes and do not have the HER2 mutation, which makes them develop faster. The test is performed on a sample of the tumour when it is removed during surgery, and examines the activity levels of 21 genes, which are markers of how aggressive the cancer is.

As Rachel Rawson, from the charity Breast Cancer Care, pointed out: “Every day, women with certain types of breast cancer face the terrible dilemma of whether or not to have the treatment, without hard facts about the benefit for them.

“This life-changing breakthrough is absolutely wonderful news as it could liberate thousands of women from the agony of chemotherapy.”

breast screening error

The breast screening computer error: what you need to know

If you’ve been worried about the recent news about an IT error which meant that 450,000 women in England aged 70 to 79 were not informed about crucial breast cancer screenings, you’re not alone: there are fears that as many as 270 women may have died because of a computer error. And according to a letter published in the Lancet recently, there may be even more women who should have been screened than first thought.

While no-one likes being reminded about being tested, not being reminded at all is a far more troubling experience. So how do you know if you missed a breast screening, and what can you do about it? Here are the main points…

How will I know if I’ve missed a breast screening appointment?

Of all the women who weren’t informed about screenings, over 309,000 are still alive and have been sent a letter, which should have arrived before the end of May. The letters invited women under 72 for a catch-up screening and directed women over the age of 72 towards a helpline to discuss whether a screening is appropriate.

According to Public Health England (PHE), women aged between 70-79 who are currently registered with a GP and have not received a letter are not affected, and do not need a catch-up screening. They advise that if you not currently registered with a GP and you believe they have been affected, you should call their helpline on 0800 169 2692.

What should I do now?

The PHE have advised – as always – that women should be aware of any changes to their breasts, while the Ministry of Health advised that if women had any concerns about their breasts, they should visit their GP at the first opportunity. They also re-stressed that everyone registered with a family doctor who did not receive a letter by the end of May should be reassured they had not missed a screening.

What about women currently under 70 and over 80?

The Ministry of Health has stated that no-one under 70 has been affected, and only a small proportion of women at the upper age limit of the NHS programme who were aged between 70 and 71 were affected. People over 80 are not affected.

What is being done to ensure this doesn’t happen again?

The government claims that urgent work is being carried out on the computerised invitation system, and an additional failsafe procedure has been introduced to ensure that the problem does not reoccur.

What if I have noticed a change in my breasts?

As always, if you have noticed any changes in your breasts or had any breast cancer symptoms, then you should go to see your GP. The symptoms of breast cancer include:

  • A lump in the breast
  • Dimpling of the skin or thickening in the breast tissue
  • A nipple that has turned inward
  • Pain or discomfort in the breast that has not gone away

For more advice, call us on 0800 612 9490 or email us on info@thamesbreastclinic.com to arrange an immediate consultation.

chemotherapy risks

Breast cancer treatment and heart damage: is it worth worrying about?

It’s a sad fact that many of the breast cancer therapies currently available can cause heart damage, but a new study conducted by the German Cancer Research Centre in Heidelberg has provided some good news. According to their report, the risk of death from heart disease in breast cancer patients following radiotherapy or chemotherapy is no higher than it is among the average population.

We know that many of the breast cancer treatments – especially chemotherapy and radiotherapy – have done a lot to give women an excellent chance in their fight against breast cancer, but the fact remains that a number of clinical trials point to a correlation between chemotherapy and radiotherapy treatment and an increased risk of developing heart disease.

In certain cases, patients who underwent either treatment may be at higher risk from death by heart disease than succumbing to breast cancer. So, when we undergo such treatment, are we just eliminating one risk in exchange for developing another? This was the conundrum that the DKFZ sought to investigate.

Getting to the heart of the matter

The study, headed up by Dr Hermann Brenner of the DKFZ, analysed data from almost 350,000 patients in America who were diagnosed with breast cancer in the years 2000-2011 and underwent radiotherapy or chemotherapy. Comparing that data like-for-like with the female average population in the United States, the researchers concluded that the long-term risk of mortality from heart disease is not higher following breast cancer treatment than in the average female population, be it chemotherapy or radiation therapy.

Why is this? Well, experts are deducing that hospitals have caught up to the idea of good risk management, where the potential dangers are flagged up well in advance and by avoiding a one-size-fits-all approach to patient care. When a new patient checks in, their potential risk of suffering heart disease due to breast cancer treatment will be immediately taken into account when it’s time to select the choosing the best possible method of treatment.

Not only that, but testing for any side-effects on the heart are being conducted at certain points during the course of treatment, meaning that doctors can make the necessary ‘tweaks’ to the treatment quickly and effectively, in an attempt to nip any potential heart problems in the bud as soon as possible.

No need for heart-related stress

“We consider the result of our study to be very positive for the treatment of breast cancer,” says Dr Brenner, and he claims that the benefit-risk ratio in modern-day breast cancer treatment is of a high standard. “It is particularly good news for the large number of affected patients that if they are in good medical care and have survived breast cancer, they do not need to be more worried about deadly heart diseases than women at the same age without breast cancer.”

So, in short: while the risk of side-effects is still prevalent in today’s breast cancer treatment, the chances of developing heart disease whilst eliminating the risk of breast cancer should be one less thing to worry about.