Targeted biological therapies

Approximately 20% of breast cancers are known as HER2 positive. This means that a gene mutation has caused the cells to have an over expression of HER2 receptors and this protein signals the cancer cells to grow and divide.

The HER2 receptor can be tested for by:

  1. Immunohistochemistry (IHC)- which shows how much of the protein is on the cell surface
  2. In-situ hybridisation (ISH)- which tests the number of copies of the gene inside the cell..

HER2 positive breast cancers tend to be more aggressive than HER2 negative cancers.

Trastuzamab (Herceptin) is a biological therapy that has been designed to specifically target the HER2 receptor in HER@ positive breast cancer. It reduces the risk of recurrence and death in women with HER2 positive breast cancer and prolongs survival in women with HER2 positive metastatic breast cancer.

Lapatinib (Tykerb) is another “HER receptor blocker” that is sometimes used in combination with Herceptin

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Side effects:

Although Herceptin has been shown to have greatest benefit when used in combination with chemotherapy, it is not in itself a chemotherapy treatment. Chemotherapy treatments affect all rapidly dividing cells whether they are cancer cells or healthy cells.

Herceptin, however, targets only those abnormal cells with increased display of the HER2 receptor and it spares the healthy cells.

For this reason the side effect profile is substantially less.

Its main possible side effect is on the heart and the use of Herceptin in some patients may require baseline and periodic cardiac function tests. This side effect is usually reversible. In some cases hypersensitivity or allergic reactions can occur and for this reason it should be given in an appropriately equipped facility by staff who are trained to manage a possible reaction. Other less common and mild side effects may include fever, throat irritation and runny nose.

It is an intravenous therapy administered via a peripheral drip into a vein ideally every 3 weeks for one year.

However, it is unfortunately extremely expensive, not yet available in State hospitals and not covered by many Medical Aid schemes.

For those who can afford it, or those whose medical aids will cover it, Herceptin has significantly improved the prognosis and survival of patients with HER2 positive breast cancers to the extent that the outcomes are even better than some patients with HER2 negative breast cancers!

This blog was kindly supplied by Ronelle de Villiers at http://www.capebreastcare.org

 

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The Breast Course for Nurses: who we are and what we do

Regular readers of this blog will know that the Cancer Alliance is a collective initiative by South Africa’s main breast cancer organisations. We will be introducing each of our partners over the next few months. Today, meet Breast Course for Nurses. This blog was written by Dr Jenny Edge, Founder and director of Breast Course for Nurses.

     

It is an indisputable fact that women who are diagnosed with breast cancer at an earlier stage have a much better outcome than those diagnosed at a later stage.  Breast cancer screening programmes are well established in high income countries.

The modality of screening used is generally mammographic screening.

There has been a lot of debate about why women are diagnosed late in low income settings.  Do they present late because they are scared or cannot afford to access the health facility?  Do they present with symptoms that are not recognized as cancer by the health care worker (generally a nurse in a primary clinic)?  Do they get lost in the journey of diagnostic tests?

We don’t have the answer to these questions.  The Breast Course for Nurses aims to educate nurses working in primary clinics and equip them with the skills to recognise normal changes to the breast and differentiate them from changes associated with breast cancer.  We teach clinical breast examination with an aim to identifying breast cancers at an earlier stage.

Does clinical breast examination work as a means of breast screening?

Clinical breast examination, as a screening modality, has been studied with mixed results.   A recent study carried out in Sudan showed that clinical examination does pick up breast cancer at an earlier stage than in the control population.1    In Canada, where clinical breast examination was compared to mammographic examination, the mortality from breast cancer, 20 years later, was similar in both groups although more cancers were diagnosed in the mammographically screened population2.

The Breast Course for Nurses is a combination of a self-learning program (PEP educations series) and a residential program that contextualizes the theory in the book, encourages networking amongst the participants and stimulates debate as to how to improve access to care.  The courses are taught by local faculty and no course is the same.

Does our method of transferring understanding work?  We will be doing various projects to look at the impact of running our course.

In the next blog, we will give details of the courses we have run over the last 12 months.

References

  1. Abuidris DO1, Elsheikh A, Ali M, Musa H, Elgaili E, Ahmed AO, Sulieman I, Mohammed SI. Breast-cancer screening with trained volunteers in a rural area of Sudan: a pilot study. Lancet Oncol. 2013 Apr;14(4):363-70. doi: 10.1016/S1470-2045(12)70583-1. Epub 2013 Jan 31.
  1. Anthony B Miller, Claus Wall, Cornelia J Baines, Ping Sun, Teresa To, Steven A Narod.. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast. Screening Study: randomised screening trial. BMJ: g366 doi:10.1136/bmj g 366

Facebook: http://www.facebook.com/breastcourse4nurses

Blog: www.jennyedge.co.za

Email: lieskewegelin@gmail.com

ABC - Advocates for Breast Cancer - Breast Course 4 Nurses

Before cancer I didn’t realise just how much I was loved

Tanya Keevy says when your back is against the wall you can either fall apart or you can give it your best. I chose to give it my best!

I decided to live!

Thobeka Dadisaid that chaemotherapy was very difficult: “I thought I would rather die” but support from her family, colleagues and community pulled her through.

 

 

Never give up!

Nontobeko Sikiti, who was diagnosed in 2012, says that after treatment, there are good results, so she advises other survivors to never give up!

(we apologise for the bad sound quality on this video)

What do you want to know about your surgery?

What are the implications of losing a breast or both breasts? Will it be painful? How long will I take to recover? When I get back to my normal day to day activities? Will I have scars? These are the questions that follow once a patient knows that they will need a mastectomy. People respond to the news of needing a mastectomy in many various ways. Some people want it as soon as possible, others delay as they are not sure that it is the right thing to do or they may be anxious or nervous about it. Everyone is different.

What are the implications of losing a breast or both breasts?

When you research a mastectomy it is very easy to become anxious. Whether about the operation, recovery or what you will look like after the surgery. Many people, organisations, doctors and surgeons will write about the topic but unfortunately what you read is not always accurate and can cause mixed emotions. The best way to understand the process is to listen to your options from your surgeon and to meet and talk with a person that has been through a similar experience or had a similar operation.

Will it be painful?

Very often there is more emotional than physical pain after a mastectomy. It is something new that one has to get used to. It takes time and everyone will go through their own recovery at their own rate. You may be happy, sad, teary or relieved. A whole wave of emotions may follow after having a mastectomy.

How long will I take to recover?

This will depend on the person, the type of operation and the circumstances that surround the patient. It takes a good few weeks to recover from a breast operation but again the emotional side may take longer than the physical side. Getting back to day to day activities will gradually increase and become easier with time. It is important to take time to recover and to not do too much too soon. If you rest in the beginning your recovery tends to be quicker. If you are very busy straight after your surgery and do not give yourself time to recover, the patient will tend to have a lot more aches and pains that may continue for a lot longer than usual.

Will I have scars? The answer is yes. If you have an operation, you will have a scar. Scars however, do not have to be associated with something bad. There are ways to minimise scars and each surgeon will have their own way of looking after wounds and scars. The emotional scars on the other hand may remain for quite some time. As we are all different, we will all heal in different ways. It is very important to ask for help if you need it. Whether speaking to a fellow patient, a psychologist, your GP or your medical team, it is important to communicate. It is a natural feeling to be anxious regarding a pending operation and even after the operation it remains important to communicate. Therefore speak to someone before your operation and have that person as a support during your operation and after your operation as you recover. Recovering mentally is a process that starts from the time that you are diagnosed.

Most importantly, try to stay positive! Surround yourself with positive, happy and supportive people that make you feel good. Do not be afraid to ask for help when you need it! A little bit of support goes a long way when needed.

Sr Lieske Wegelin

ABC - Advocates for Breast Cancer - Breast Course 4 Nurses

I look up every morning and I say ‘thank you’

“My colleague at work urged me to go for a mammogram, and she saved my life,” says Suzette Laubscher. “The worst part of it was the waiting, the waiting to find out what the diagnosis is. Its like being in limbo – you hear the words but they don’t sink in,” says Suzette Laubscher.

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