Tuesday, November 23, 2010

Positives vs Negatives

Recently a good review of Triple Negative Breast Cancer was published http://forum.tnbcfoundation.org/new-england-journal-of-medicine-article-on-tnbc_topic7460.html It summarizes all that is known about the disease and where treatment stands. Somewhere between 12 to 17% of BC is characterized as TNBC. Patients are generally much younger (less than 40) and more likely to be African-American or Hispanic. Women with BRAC1 or BRAC2 gene mutations are also more likely to have TNBC. As I am not under 40, African-American or have a history of BRAC mutations, I am an outlier.

In this paper, they distinguish between TNBC with so called basal markers and TNBC without these markers. In which category I fit is unknown because if they tested me for this, it wasn't shared with me. Unfortunately the yellow line for TNBC negative markers didn't show up well here but you have to take my word that overall survival at ten years is 75% vs 70%. I have yet to get hard numbers on 'old' TNBC patients but I feel and hope that survival is higher, in part as young patients aren't even looking for BC so it is found at a later stage. Also for all my her2+ friends, even though this is a very recent publication, the data does not reflect that now early stage her2+ BC is treated with Herceptin so survival  should be much better than the 55-60% shown here.

If you compare the survival curves of TNBC vs ER+ above, you'll see at about 5 years  or so, it flattens out for TNBC but keeps on dropping for ER+. Another way of looking at this is the hazard ratio for distal recurrences.
(sorry about the crookedness). At I year, the chances of having a distal recurrence for TNBC is .125 vs .025 for ER+ or 5 times as high. At ten years though, the risk remains the same for ER+ but is none for TNBC.

Where do distal recurrences occur first?
          TNBC                    ER+
Brain  30%                       10%
Lung  40%                       20%
Liver  20%                       30%
Bone  10%                       40%

So the most common site for recurrences to happen for ER+ is in the bones. This is rarely deadly in itself (though painful and awful). From there though, it will spread elsewhere though it takes time.
TNBC spreads to the deadly spots first, thus the quicker time to death.

With all the new treatments on the horizon, I am hoping that graphs in the future don't look so dismal.

So much for BC.

Shanna and her family will begin the long drive here tonight for Thanksgiving. Think good thoughts to ensure that the ride goes smoothly. They do the drive at night as the boys are more likely to be asleep.If she becomes too tired, they will stop. I look forward to seeing them.
Tomorrow Maya goes in to check out what her hip 'pops'.

There was a high wind advisory this morning with a note that they mean it this time (so many warnings failed to materialize). I got out as soon as I could to face the wind, which was not bad. It had completely died down by the time I stopped but now I see it has returned.

No comments:


Blog Archive