Egg freezing may not delay chemo for breast cancer patients

Women diagnosed with breast cancer who want to freeze their eggs and embryos before tumor treatment leads to infertility can do this without delaying the start of chemotherapy, a U.S. study suggests.

Researchers focused on 89 women newly diagnosed with breast cancer who received counseling at a fertility clinic about a relatively new technique known as random-start ovarian stimulation. This process doesn’t wait for a woman’s natural menstrual cycle to stimulate the ovaries to release eggs and can be done in about two weeks, compared with four to six weeks with older ovarian stimulation techniques timed to coincide with menstruation.

Overall, 67 of the women proceeded with random-start ovarian stimulation before beginning cancer treatment. With fertility treatment, women started chemotherapy an average of 38 days after their breast cancer diagnosis, compared with 39 days when patients decided against fertility preservation. “What this tells us is these women can still go on to build a family,” said senior study author Dr. Mitchell Rosen, a reproductive health researcher at the University of California San Francisco. “It only takes two weeks, and it isn’t going to cause any delay in their cancer treatment,” Rosen said in a telephone interview. When chemotherapy is needed soon after a breast cancer diagnosis, doctors generally advise that it begin within four to six weeks to avoid hurting women’s survival odds. Chemotherapy can cause infertility by damaging the ovaries and by triggering an early menopause in women of childbearing age.

For the study, researchers examined data from medical records for breast cancer patients between the ages of 18 and 45 who were referred to the UCSF Center for Reproductive Health between 2011 and 2017 before starting chemotherapy. Women started chemotherapy at roughly the same time whether or not they decided to first harvest eggs and freeze eggs or embryos, researchers report in Human Reproduction. One limitation of the study is that it didn’t look at other reasons beyond fertility preservation that might influence how long it takes for women to start chemotherapy, such as tests to pinpoint the type of tumors imaging to find out how far cancer has spread or patients making arrangements to take time off of work or prepare their lives for chemo.

The study also wasn’t a controlled experiment designed to prove how fertility preservation directly influences the time it takes to start chemotherapy, and the results from one fertility center might not represent what all women would experience. Even so, the findings suggest that random-start ovarian stimulation may be a viable option for women with breast cancer or other types of malignancies who don’t want to lose their ability to have children after tumors are in remission, said Dr. Kutluk Oktay, director of the Innovation Institute for Fertility Preservation and IVF in New York and a researcher at Yale University School of Medicine in New Haven, Connecticut.

“With this approach, a patient can be started on ovarian stimulation even on the day of the initial consultation and can be done with embryo or egg freezing in two weeks,” Oktay, who wasn’t involved in the study, said by email. “And if she has more time, she can even do multiple cycles of freezing without risking a delay in chemotherapy,” Oktay said. “Random start extends all women who are considering embryo or egg freezing before chemotherapy for any type of cancer more flexibility and ability to preserve fertility with the least delay before initiating ovary damaging cancer treatments.”

Signs of Lymphedema

Lymphedema is somewhat unpredictable and doctors do not fully understand why some people develop lymphedema and others do not. People who have had several lymph nodes removed and/or radiation treatment in the axillary area (underarms) during cancer treatment are at higher risk of developing lymphedema. Lymphedema can occur after treatment for any type of cancer, but it is most commonly associated with breast cancer, prostate cancer, lymphoma, melanoma and cancers in the pelvic area such as bladder, testicular or gynecological cancers. Obesity, lack of exercise and infections after surgery are also risk factors.

Signs and symptoms of lymphedema:
-Swelling in the arm or leg (clothes or jewelry feel tighter)
-Arm or leg feeling heavy or tight
-Weakness, decreased flexibility, difficulty moving
-The skin thickens (hyperkeratosis) or hardens
-Pain and redness in the arm, hand, leg or foot

Women with Alopecia Share Powerful Photos and Stories

When Brittany Myers was just a little girl, her mother noticed that her hair was falling out while she was brushing it. After several test screenings and by the process of elimination, doctors diagnosed her with alopecia at just 7 years old. Alopecia is a type of hair loss that occurs when your immune system mistakenly attacks hair follicles.

Now at 33, Myers is raising awareness during Alopecia Awareness Month, when many people with the condition take to social media to share their stories. “[Alopecia is] not a sickness. It’s not caused by stress. It’s simply a function of the body that we have no control over,” Myers tells Yahoo Beauty. “Throughout my childhood and into early adulthood, I would only have a missing patch of hair here or there — sometimes more and sometimes less,” she says. “When things were good, I didn’t think about it much. When things were bad, I worried a lot about one day losing all my hair.”

Myers overcame her fear of becoming bald when she was 26. One missing patch of hair grew bigger, so with the help of a stylist friend, she saw this as a sign that it was time to reinvent herself and her look. “Back then, I never imagined it wouldn’t grow back,” she says, “but I’ve been bald ever since.”

Myers says meeting other women with alopecia has been “hugely beneficial.” She explains, “It helped me begin to see the complex beauty in the baldness, in the challenge of it all, and finding that comfort over time helped me to shift focus away from alopecia and baldness.” Other women like Myers are sharing their inspiring journey with alopecia on Instagram, including powerful photos that illustrate how they’ve handled hair loss.

When discussing her resilience, Myers says, “Part of being strong is coming to terms with the fact that these are the cards I’ve been dealt. We’ve all been dealt something. I realized not too long ago that once you stop caring so much, once you stop focusing on it all the time, the rest of the world does too.” She continues, “So much freedom comes from acceptance and letting it go.”

Apple-shaped women are at risk of a deadlier form of breast cancer (and those who store fat on their thighs, hips and buttocks are prone to a more treatable form of the disease)

Apple-shaped women are at risk of developing a deadlier form of breast cancer, a new study suggests. But those who have a pear-shaped figure, with fat stored on their thighs, hips and buttocks, are prone to a more treatable form of the disease.

For years, scientists have warned of the dangers of obesity due to evidence of its role in triggering breast cancer among other health risks. But the Chinese study shows the link between obesity and this form of the disease to be more complex than previously thought.

They discovered women with a higher BMI, which measured subcutaneous fat, were more likely to have ER+ (oestrogen-receptor positive) breast cancer. This form of the disease can be influenced by oestrogen, as the hormone can attach to proteins in cancerous cells to stimulate growth. Patients are often given Tamoxifen, a drug that costs 6p a day and which work by blocking oestrogen, which is known to stimulate the formation of tumour cells.

In contrast, those with a high waist-to-hip ratio, showing belly fat, were more likely to have ER- (oestrogen-receptor negative) breast cancer. This form of the disease can't be tackled with hormone blocking drugs, and have to go down traditional chemotherapy routes. The greater risk of developing ER- breast cancer for women with a high waist-to-hip ratio existed even if they weren't obese, Shandong University scientists noted.

Lead researcher Dr Zhigang Yu said: 'A possible reason is that subcutaneous fat is involved in estrogen production, which may promote ER+ breast cancer. 'Visceral fat is more closely related to insulin resistance and may be more likely to promote ER- breast cancer.' The researchers said that clinicians should assess ER- risk by assessing a woman's body shape before prescribing Tamoxifen, which is often given to those at high risk.

Experts stressed the findings, published in The Oncologist, were important as breast cancer is becoming a 'pandemic'. Around one in eight women will develop breast cancer in their lifetime and the illness is becoming increasingly prevalent as the population ages. There were 55,222 new cases recorded in the UK in 2014 and 11,433 deaths. In the US, 252,710 are expected to receive a diagnosis this year. Around 40,000 will die.

Researchers recruited 1,316 women who were newly diagnosed with breast cancer for the study. They were compared to a control group. Body measurements were taken, alongside details of their form of cancer - whether it was ER+ or ER- breast cancer.

Why does chemotherapy cause hair loss?

Because many chemotherapy drugs are designed to effectively kill all rapidly dividing cells, hair is the unfortunate bystander that takes the fall along with the cancer cells. While some find the thought of losing their hair so distressing that they refuse chemotherapy, most people will see their locks grow back after the treatment has finished.

The level of hair loss, or chemotherapy-induced alopecia (CIA), depends on the type of cancer, the specific drug, and the dose and pattern of the treatment. Many patients experience the first wave of CIA within 1 to 2 weeks of starting their treatment. Areas that experience high friction during sleep, such as the top of the head and the sides above the ears, are often the first to see hair loss. Yet the precise pattern depends on the individual's hair. Those hairs that are actively growing will be most affected, but because growing hair follicles can be arranged in patches or evenly distributed all over the scalp, it is unfortunately impossible to predict the pattern of hair loss for any given individual.

Hair regrowth after chemotherapy usually starts within 1 to 3 months after the therapy has finished. Up to 60 percent of patients report a change in hair color or structure during the first wave of hair regrowth, with many experiencing curlier hair. However, these changes are mostly temporary, and hair returns to normal eventually.

Hair has important functions in culture and communication, and so CIA is consistently ranked top of the list of traumatic events for many patients that undergo chemotherapy. Some patients even consider refusing chemotherapy as a result of the impending threat of CIA. Treatments for CIA are, at best, experimental. Cooling the scalp with ice packs or special caps was first introduced in the 1970s. The theory underlying this treatment is that cooling will narrow the blood vessels leading to the hair follicles. Some studies have reported success rates of up to 50 percent with this technique, but there is clearly a need for more effective therapies.

Very little is known about how chemotherapy drugs cause CIA. Most information stems from studies using mouse models. Here, research has shown that programmed cell suicide, or apoptosis, is the most likely cause of cell death in the hair follicle, causing the hair to fall out. Researchers in the Department of Medicine at the University of Chicago, IL, used genome-wide association studies to compare the genetic signature of breast cancer patients who had experienced CIA with that of those who had not. They found several candidate genes that might be implicated in the loss of functional hair follicles. One of these, CACNB4, is part of a calcium channel that plays an important role in cell growth and apoptosis. Another gene, BCL9, was active in a subset of CIA patients and is known to play a role in hair follicle development. Armed with this knowledge, scientists are continuing their quest to develop effective inhibitors of chemotherapy-induced hair loss, hoping to reduce the burden that this unwanted side effect has on cancer patients.

How one app is helping to tighten the link between cancer patients and their doctors

When chemotherapy patient Allison Hailey meets with Dr. Angela Kueck at Texas Oncology in Austin, she comes prepared. That is because Hailey's phone displays graphs, charts and logs of her medications, mood changes and physical health — courtesy of an app called ChemoWave. Since its launch on June 29, ChemoWave is giving chemotherapy patients and their doctors more insight on treatment plans, side effects and mental health. The app arrives on the scene at a time when health care is becoming a major focus for tech giants like Amazon and Apple, and joins an increasingly crowded field of biometric tech that helps people track vital health information.

ChemoWave is designed to help track a wide variety of vital data like symptoms, exercise, water intake and medications. It then compiles those figures into a health compliance database, then graphs the information so patients — and their doctors — can connect what symptoms are related to what medication or activity. Patients can also send daily updates to their doctors, which can be critical when treating cancer. A recent study by the Journal of the American Medicine Association found a 21 percent increase in survival time for patients who tracked and reported their symptoms. Thirty-one percent were more likely to report better quality of life and physical functions, the study said. "I have a better understanding as opposed to when I see [Hailey] every couple weeks in the office with her trying to remember what side effects she had on what day," Kueck told CNBC. "You can see trends over time, so we can plan for her next cycle" of chemo, she added. "It improved communication and we're connected more."


Matt Lashey, the developer of the app and co-founder of Treatment Technologies & Insights, came up with ChemoWave when his partner Richard Grenell was diagnosed with cancer in 2013. Each morning, Lashey would administer Grenell a survey about how he was feeling emotionally and physically, along with any side effects. Lashey's background in data analysis propelled him to do some correlation analysis from the surveys to track Grenell's symptoms. "I started doing some simple correlation analysis to see what things were related to his highs and lows, and our doctor loved (the charts)," the former research consultant for Discovery Communications and Nationwide Insurance told CNBC. "We could point to very specific days when something had occurred, and having those graphs and data really led to a lot more efficient collaboration with him." ChemoWave features an added benefit, according to Kueck: helping to improve communication between patient and doctor. "I might see a patient every three weeks, and when trying to recount what happened on day two or four, it's hard for them to remember so it does take a lot of time of the visit," Kueck said. Using the app, she now gets daily updates.

Kueck said there haven't been any widely used apps among her patients, and ChemoWave is fulfilling a large need among those involved in chemotherapy. "I'm already in the loop. We can just talk about today and the future. It's definitely streamlined the visits in the office," she said. ChemoWave is free to download, in order to get it as widely disseminated as possible, according to Lashey. He's also meeting with care organizations, doctors and pharmaceutical companies to explore future partnerships and possible financing. "There could be a lot of money to be made if we were to charge money for this app, but we decided that the real value is in the data," Lashey said. "The hope is that getting it into the hands of patients will start to add value to their life on an immediate basis, and that if we can stick with this and we can get the app with funding that we need, there's going to be money to be made in the future," he added. Grenell is now healthy and sees his doctor regularly, while Hailey said she plans on using the app throughout her treatment. "It does exactly what it's supposed to do, and it provides even more information for a patient to have some control over what what's going on with us," she said.

Large diet study suggests it's carbs, not fats, that are bad for your health

A large, 18-country study may turn current nutritional thinking on its head. The new research suggests that it's not the fat in your diet that's raising your risk of premature death, it's too many carbohydrates -- especially the refined, processed kinds of carbs -- that may be the real killer. The research also found that eating fruits, vegetables and legumes can lower your risk of dying prematurely. But three or four servings a day seemed to be plenty. Any additional servings didn't appear to provide more benefit. What does all this mean to you? Well, a cheeseburger may be OK to eat, and adding lettuce and tomato to the burger is still good for you, but an excess of white flour burger buns may boost your risk of dying early. People with a high fat intake -- about 35 percent of their daily diet -- had a 23 percent lower risk of early death and 18 percent lower risk of stroke compared to people who ate less fat, said lead author Mahshid Dehghan. She's an investigator with the Population Health Research Institute at McMaster University in Ontario. The researchers also noted that a very low intake of saturated fats (below 3 percent of daily diet) was associated with a higher risk of death in the study, compared to diets containing up to 13 percent daily.

At the same time, high-carb diets -- containing an average 77 percent carbohydrates -- were associated with a 28 percent increased risk of death versus low-carb diets, Dehghan said. "The study showed that contrary to popular belief, increased consumption of dietary fats is associated with a lower risk of death," Dehghan said. "We found no evidence that below 10 percent of energy by saturated fat is beneficial, and going below 7 percent may even be harmful. Moderate amounts, particularly when accompanied with lower carbohydrate intake, are probably optimal," she said. These results suggest that leading health organizations might need to reconsider their dietary guidelines, Dehghan noted. But not everyone is ready to throw out current dietary guidelines. Dr. Christopher Ramsden is a clinical investigator with the U.S. National Institute on Aging. "There's a lot more information that's needed. They did a great job and they're going to have a lot more coming out of it for years to come, but it's hard to get it down to recommendations regarding food at this point," he said. "It really highlights the need for well-designed randomized controlled trials to answer some of these questions," Ramsden added.

The researchers noted that their study did not look at the specific types of food from which nutrients were derived. And, that, said Bethany O'Dea, constitutes a "major flaw from a nutrition standpoint." O'Dea is a cardiothoracic dietitian with Lenox Hill Hospital in New York City. "For example, eating a healthy carb like an apple is more nutrient dense and better for you than eating a bag of processed potato chips," O'Dea said. "Furthermore, the study did not take trans fats into account, which hold heavy evidence of being unhealthy and contributing to cardiovascular disease," she pointed out. Current global guidelines recommend that 50 percent to 65 percent of a person's daily calories come from carbohydrates, and less than 10 percent from saturated fats, the researchers said. Dehghan suggested that "the best diets will include a balance of carbohydrates and fats, approximately 50 to 55 percent carbohydrates and around 35 percent total fat, including both saturated and unsaturated fats." All foods contain three major macronutrients essential for life -- fat, carbohydrate and protein. The optimum amounts a person should eat has been the focus of debate for decades, with the pendulum swinging from low-fat to low-carb diets over time.

For this study, Dehghan and her colleagues tracked the diet and health of more than 135,000 people, aged 35 to 70, from 18 countries around the world, to gain a global perspective on the health effects of diet. Participants provided detailed information on their social and economic status, lifestyle, medical history and current health. They also completed a questionnaire on their regular diet, which researchers used to calculate their average daily calories from fats, carbohydrates and proteins. The research team then tracked the participants' health for about seven years on average, with follow-up visits at least every three years. The investigators found that high-carbohydrate diets are common, with more than half of the people deriving 70 percent of their daily calories from carbs. High-carbohydrate diets have been linked with increases in both blood cholesterol and in the chemical building blocks of cholesterol, Dehghan said. While the experts continue debating what's the best diet, what should you be eating? O'Dea said, "Your diet should consist of healthy carbs, lean protein, and plenty of fruits and vegetables. Remember to avoid processed snacks that contain trans and saturated fats, and opt for a healthy carb source." The study was scheduled to be presented Tuesday at the European Society of Cardiology annual meeting in Barcelona, Spain. The research was being published online as two studies on Aug. 29 in The Lancet.