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New research shows that people undergoing treatment for breast
cancer have a greater mountain to climb when also infected with
Hepatitis C. Breast cancer affects both men and women. Note: October is
designated as both Breast Cancer Awareness Month and Liver Awareness
Month.
by Nicole Cutler, L.Ac.
Considering how many people are diagnosed with chronic Hepatitis C,
along with the likelihood of someone developing breast cancer,
treatment for these two illnesses must be compatible. Because Texan
researchers have discovered that Hepatitis C infection may impair
breast cancer treatment and increase the complications of chemotherapy,
improved communication between hepatologists and oncologists is crucial.
Gender and Breast Cancer
Although predominantly occurring in women, breast cancer can also
affect men. Many do not realize that just like women, men have breast
tissue. At puberty, a girl's ovaries make female hormones (estrogen),
causing breast ducts to grow, lobules to form at the ends of ducts and
the amount of stroma to increase. During a boy’s puberty, male hormones
(testosterone) made by the testicles typically prevent further growth
of breast tissue. Although men's breast tissue is mostly composed of
ducts, these cells can undergo cancerous changes. In addition, each
individual produces varying amounts of hormones that can encourage
breast cancer development; women produce varying amounts of
testosterone and men produce varying amounts of estrogen.
Breast Cancer Prevalence
Excluding cancers of the skin, breast cancer is the most common type of
cancer in women in the United States, accounting for one of every three
cancers diagnosed. The chance of developing invasive breast cancer at
some time in a woman’s life is about one in seven. It is one of the
leading causes of cancer mortality among women in the United States.
One in every 100 people with breast cancer is a man. Unfortunately,
breast cancer’s gender preference typically leads to dangerously late
detection in men.
Aside from the gap between men and women in initial diagnosis, early
detection, intervention and postoperative treatment have decreased
breast cancer mortality. The use of mammography for screening has
largely contributed to early detection, and aggressive treatments have
allowed many people to survive breast cancer.
Hepatitis C Prevalence
Most Hepatitis C diagnoses come as a surprise because of how long a
person can live without any indication of this illness. A study by the
Centers for Disease Control and Prevention suggests that 4.1 million
individuals in the United States are infected with Hepatitis C, and
most have chronic infections. However, most academics agree that the
current Hepatitis C statistics are underestimated due to the number of
new diagnoses that occur each day.
University of Texas Research
Assistant Professor at the University of Texas department of breast
medical oncology, P. K. Morrow, MD is a medical oncologist specializing
in the treatment of breast cancer patients. As the lead researcher in a
study presented at the 2007 American Society of Clinical Oncology
Breast Cancer Symposium, Morrow warned, “Hepatitis has wide-ranging
effects on treatment of breast cancer.” The researchers indicated in
their presentation that poor outcomes of breast cancer treatment are
endemic to those also infected with Hepatitis C.
In the small retrospective study of breast cancer patients, Texan
researchers found chemotherapy dose delays or required dose reductions
in those with Hepatitis C:
· Neoadjuvant Chemotherapy – Given prior to a surgical
procedure to shrink the cancer, neoadjuvant chemotherapy effectiveness
was reduced by 27 percent in the study’s participants with Hepatitis C.
· Adjuvant Chemotherapy – Given to destroy leftover
(microscopic) cells that may be present after the known tumor is
removed by surgery, adjuvant chemotherapy effectiveness was reduced by
30 percent in the study’s participants with Hepatitis C.
Although the reason for this effect is not fully understood, Morrow
postulated two reasons for a poorer outcome in breast cancer treatment
in those dually affected by chronic Hepatitis C:
1. Poor drug metabolism – A person with chronic Hepatitis C
is likely to have decreased liver function, thereby making it more
difficult to metabolize the toxic chemotherapy drugs used in breast
cancer treatment.
2. Myelosuppression – A common side effect of chemotherapy,
myelosuppression occurs when bone marrow activity is decreased,
resulting in fewer red blood cells, white blood cells, and platelets.
The current treatment standard for Hepatitis C, interferon and
ribavirin combination therapy is also known to initiate
myelosuppression. With a decrease in bone marrow activity, recovery
becomes an immense challenge.
In addition, participants with Hepatitis C undergoing chemotherapy
for breast cancer had a drastically increased likelihood of treatment
complications.
Study Analysis
It makes sense that chemotherapy would be the ultimate challenge for a
person with chronic liver disease. Essentially, chemotherapy is the
administration of toxic medications to kill cancerous cells. Of course,
a person with chronic Hepatitis C must do all they can to protect their
liver from any additional toxic burdens. This is likely to explain why
a prior study demonstrated that breast cancer treatment for patients
with Hepatitis B increased the chance of viral reactivation, early
discontinuation of chemotherapy, and treatment delay.
Dr. Morrow urged doctors who treat breast cancer to closely monitor
their patients living with Hepatitis C. She even suggests that
oncologists do a full hepatitis panel on their patients with elevated
liver enzymes. It is important to note that there is hope for those
dually diagnosed with breast cancer and Hepatitis C. When extra
cautionary measures are taken, these individuals have the potential for
regaining their health.
With so many people being diagnosed with breast cancer and Hepatitis
C, the primary item needing attention in such cases is the integration
between the fields of hepatology and oncology. According to Morrow, “I
think what we need to do is to cooperate with hepatologists to see if
we can act at the onset and see if we can reduce the type of risks that
we're seeing in these patients’ therapy.” Although modern medicine is
often fragmented into specialties, this research urges healthcare
workers to work together in search of their common goal – patient
wellness.
References:
P.K.H. Morrow, et al., Clinical outcomes of breast cancer patients with hepatitis C: A case series, Journal of Clinical Oncology, June 2005.
http://jama.ama-assn.org, Hepatitis C Prevalence, Tracy Hampton, PhD, Journal of the American Medical Association, June 2006.
www.cancer.org, What is Breast Cancer in Men?, American Cancer Society, Inc., 2007.
www.chemocare.com, Chemotherapy Terms, The Cleveland Clinic Foundation, 2007.
www.docguide.com, Breast Cancer Patients With Hepatitis C Require
Surveillance to Avoid Poor Outcomes, P/S/L Consulting Group Inc.,
September 2007.
www.emedicine.com, Breast Cancer, Mammography, Nagwa Dongola, MD, FRCR, WebMD, 2007.
www.mdanderson.org, Who We Are, The University of Texas M. D. Anderson Cancer Center, 2007.
www.medpagetoday.com, ASCO Breast: Hepatitis C Impacts Breast Cancer
Treatment, Crystal Phend, MedPage Today, LLC, September 2007.
www.websters-online-dictionary.org, Myelosuppression, Philip M. Parker, INSEAD, 2007.
www.menstuff.org, Breast Cancer in Men, Gordon Clay, 2007.
http://www.hepatitis-central.com/mt/archives/2007/10/hepatitis_c_com.html?eml=hepcen40
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