Elizabeth Edwards, wife of former senator and presidential candidate John Edwards, knows her breast cancer is not going away.
Edwards' breast cancer, first diagnosed in 2004, has recurred. It's in her bones, and, as Edwards writes in her new memoir, Resilience, "it wasn’t leaving. Not ever."
That knowledge -- that she will one day die from breast cancer or die with it -- is at the heart of some hard-won lessons about dealing with breast cancer -- and getting aggressive about its early detection...
In general, surgical and radiation treatments are similar for these different types of breast cancer. But drug treatments -- such as chemotherapy, endocrine therapies, and other medications -- are usually different. These treatments are targeted to the specific type of cancer.
Hormone Receptor-Positive Breast Cancer
About 75% of all breast cancers are “ER positive.” They grow in response to the hormone estrogen. About 65% of these are also “PR positive.” They grow in response to another hormone, progesterone.
If your breast cancer’s cells have a significant number of receptors for either estrogen or progesterone, your cancer is considered hormone-receptor positive and likely to respond to endocrine therapies.
Breast cancer tumors that are ER/PR-positive are 60% likely to respond to endocrine therapy. Tumors that are ER/PR negative are only 5% to 10% likely to respond to endocrine therapy.
Endocrine therapies for breast cancer are treatments usually taken after surgery, chemotherapy, and/or radiation are finished. They are designed to help prevent recurrence of the disease by blocking the effects of estrogen. They do this in one of several ways.
The drug tamoxifen, taken by some women for up to five years after initial treatment for breast cancer, helps prevent recurrence by blocking the estrogen receptors on breast cancer cells and preventing estrogen from binding to them.
A class of drugs called aromatase inhibitors actually stops estrogen production in post-menopausal women. These drugs cannot be taken by women who have not yet gone through menopause.
HER2-Positive Breast Cancer
In about 20% to 25% of breast cancers, the cancer cells make too much of a protein known as HER2/neu. These breast cancers tend to be much more aggressive and fast-growing.
For women with HER2-positive breast cancers, the drug Herceptin has been shown to dramatically reduce the risk of recurrence. It has now become standard treatment to give Herceptin along with adjuvant (after-surgery) chemotherapy in those with metastatic breast cancer. Another drug, Tykerb, is often given for metastatic cancer if Herceptin fails. Kadcyla is another drug that can be given after Herceptin and a class of chemotherapy drugs called taxanes, which are commonly used to treat breast cancer.
Herceptin has far fewer immediate side effects than chemotherapy -- for example, there is usually no nausea or hair loss. However, there is a small but real risk of heart damage and possible lung damage. Scientists are still studying how long women should take Herceptin for the greatest benefit.
An intravenous treatment called Perjeta is also approved for late-stage HER2-positive breast cancer. In one study, Perjeta was shown to extend life when given in combination with Herceptin.