Breast Cancer – Page 7 – Frantic Shanti

Nothing to Fear but Fear…Sort of

About five years ago around this time of the year, I had an uneasy feeling.

So, let me back up. The previous August 2016 I had felt a small lump in my left breast. It wasn’t all that different from another lump that I had gone to see my Nurse Practitioner about in late June 2016, and she had put my fears to rest.

Still, she noted that I hadn’t had a mammogram since 2013, so she wrote me an order for one so that I could keep on track with my screenings.

But I dragged my feet on the mammogram. And when the August lump appeared, I decided to wait until it disappeared–you know, like they always did–before setting up the appointment. Because going into a screening knowing that I had a lump seemed terrifying.

You can’t hide from your fears, but that didn’t stop me from trying.

It didn’t disappear. I kept feeling it, pressing it to see how squishy it was, did it move about, was it getting bigger. And all the time, wondering how long it would last. It was hanging around longer than I expected.

But I still waited because I was afraid. I didn’t want to go to the mammogram and have the technician look concerned. Maybe she’d call the doctor in and the doctor would look concerned. Maybe they’d suggest more tests.

I *knew* it was nothing because it had to be nothing, but I didn’t want to risk having the medical professionals think it was something because that would be terrifying to me when I really knew that it was nothing. I didn’t want to experience that fear needlessly. I was afraid of being afraid.

So I waited until around this time of the year in 2017, when, after talking with my mom, we both agreed that getting the lump checked out would relieve my building anxiety. I imagined a pleasant conversation with the Nurse Practitioner as she would say, “Don’t worry, it’s nothing.”

Except that’s not what my NP said. Her expression went from friendly-smiley to concern, and she told me that I needed to get that mammogram done as soon as possible. All that fear that I’d tried to avoid by not getting the screening suddenly hit me at once. As the NP left the examination room, she admonished me to not put the mammogram off.

The order that I got read, “Mammography and Diagnostic Screening”. The left breast on the picture on the sheet was circled. I think. To be honest, I don’t remember much more than that. To an outsider, I was just going to have a suspicious lump checked out. But inside me, there was a tornado of anxiety whipping around unchecked.

I know I know I know…but at that time, the fear of what might be overpowered common sense. So I waited.

I had waited six months simply to avoid fear. I was so afraid of the fear that I was willing to risk my life–even though I hadn’t see it that way. The overwhelming need to not experience fear trumped everything else because it was so horrible that I couldn’t seen past it. Nothing else mattered.

Believe it or not, I didn’t realize that I had been suffering from severe anxiety for a number of years. It was always bubbling right by the surface, occasionally boiling over, but never sufficiently dealt with. It had built up throughout my life through an unfortunate series of events and I had become worse and worse at shaking it, but the two years prior to my diagnosis brought some of the longest bouts of chronic anxiety and feelings of worthlessness.

And all that fear that I had, that reason for not getting the lump checked out, that fear that almost cost me my life? Cancer was what forced me to face it. The most feared disease that I could have imagined ironically put me on the path to finally dealing with one of the most crippling issues of my adult life.

No, I’m not going to say that I’m thankful for cancer. Because that would be ridiculous. But I can now step back and see the worth of fearful experiences and understand that sometimes it’s the horrible things that push you into the most meaningful personal growth.

No More Sticky Fingers!

Running late with this post as I’m furiously cleaning our apartment in advance of the Christmas holiday!

I noticed a few mornings ago that when I made a fist and then straightened the fingers of my right hand, the joints didn’t stick at all.

It took over 300 days…but I’m happy to celebrate the end of the side effects!

While this may seem like an odd thing to celebrate, it marked a milestone for me. This was the last side effect attributable to letrozole that I had been experiencing, and it was finally gone. Letrozole is an aromatase inhibitor that blocks production of estrogen and is used as endocrine therapy for breast cancer patients who have estrogen receptor-positive tumors. I’d been on it for about 14 months after switching to it from tamoxifen.

For reference, as of today, I am at Day 307 since stopping the medication, so it’s taken quite a while for this joint side effect to subside. Yes, there are other things still plaguing me, such as memory issues, low libido and difficulty maintaining muscle (even with strength training), but those are more difficult to separate out from the garden-variety effects of menopause.

The sticking fingers began in August 2020 (about 8 months after starting letrozole) and were getting progressively worse. By March 2021, when I called it quits with the endocrine therapy, a number of finger joints were sticking and painful, particularly in the morning.

At that point, I was having trouble getting up off the floor, as I was having issues with joints throughout my entire body. The medication was affecting various aspects of my life, making it difficult to exercise and, as I like to put it, lowering the quality of my existence. Following discussions with my oncologist, we both agreed that my risk of breast cancer recurrence was low enough to stop the meds.

It’s been quite a journey to get to the point where I am now.

Shaking this last side effect of letrozole reminded me how far on this cancer journey I’ve traveled. There have been so many ups and downs, friends made and friends lost to the disease, that it was easy to forget that nothing in life is permanent. Time passes and situations change, sometimes for better, sometimes for worse.

The concept of “CANCER” used to terrify me, and after I was diagnosed, I hit a low so deep I thought I’d never be able to crawl out of it.

Gradually, as my experience with the disease played itself out, I came to accept the uncertainty about the future. As the end of 2021 draws near, I inch closer to the 5-year survival mark. The fact that I can straighten my fingers in the morning without any pain or sticking is a perfect example of how while I cannot know what the future will bring, I can deal with the “now”. And this “now” is not so bad.

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Best wishes to everyone for a very Joyous Holiday Season and much promise for 2022!

Targeted Therapy? Yes, Please!

You cannot say that there is a “good” cancer to have. Because the only thing that would make the cancer that you have “good” is not having it in the first place.

But if that’s not the case, the next best thing is having a cancer with characteristics that serve as targets for drugs, enabling the use of “targeted therapy”. As described by the American Cancer Society, “Targeted therapy is a type of cancer treatment that uses drugs designed to ‘target’ cancer cells without affecting normal cells. …Targeted drugs can block or turn off signals that make cancer cells grow, or can signal the cancer cells to destroy themselves.”

Cancer treatment often means chemotherapy, but there are some targeted therapies available that are highly effective.

When talking about breast cancer, currently there are several targets possible: estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (or HER2 [also HER-2/neu or ErbB2]). These three are the ones that your oncologist will use to characterize your tumor.

The estrogen and progesterone receptor positive (ER+ and PR+, respectively) tumors are the most common ones. According to WebMD, about 80% of breast cancer tumors are ER+ and 65% are PR+, and these tumors are treated with hormone therapy, generally tamoxifen and aromatase inhibitors (depending on the patient’s menopausal status).

HER2+ is an interesting case. HER2+ tumors contain extra copies of the gene that makes the HER2, which is thought to make cancer cells grow faster. Historically, the prognosis for HER2+ tumors has been worse than for HER2- tumors, with a greater chance of recurrence and metastasis.

At least, that was the case before the development of targeted drugs specifically for HER2, such as trastuzumab (Herceptin), pertuzumab (Perjeta) and others. These drugs don’t come without risks and are known for being potentially cardiotoxic, but they are very effective.

This is the irony. Triple-positive breast cancer went from being one of the more aggressive breast cancers to being almost “curable”. All due to targets.

This is also what makes triple-negative breast cancer (TNBC) more complex. Without specific targets to aim for, treatment of TNBC relies on aggressive chemotherapy, which can be quite effective. But without targeted therapies, TNBC still has the highest rate of recurrence and worst prognosis of all breast cancers. Researchers are furiously searching for new ways to characterize TNBC tumors for this very reason.

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We are all looking forward to the day when we can say there is a definitive cure for cancer.

But what brought on this post? I was searching on the internet for breast cancer info on HER2+ tumors and came across a provocative headline from MedicineNet.com that read, “Can HER2-Positive Breast Cancer Be Cured?” The answer to this, I assumed, would be “no” because we’re not at the point where we can say that we’re definitively “curing” breast cancer.

In addition, I’d been conditioned by my oncologist to think of cancer in terms of years of survival rather than cure.

But according to this MedicineNet article, “With recent advances in medicine, it is considered that HER2-positive breast cancer is curable.” A bold statement indeed. And one that I hope we will be making more and more.

For an article from the American Cancer Society describing available targeted therapies for breast cancer, go here.

Working Out to Avoid Freaking Out

It’s hard to imagine a cancer diagnosis that doesn’t provoke some level of anxiety.

When I was told that I had breast cancer, it didn’t take long before I got a prescription for Xanax because my anxiety was going through the roof — I clearly couldn’t handle everything I was feeling. It wasn’t until my radiation oncologist suggested that I try meditation that my view of the best way to handle my anxious feelings changed, and eventually I dropped the Xanax altogether.

But one thing that I kept on doing was exercising, at least as much as I could manage on a given day. So after reading a recent study about exercise, I had to wonder how much worse my experience might have been if I hadn’t kept to my workouts.

Henriksson et al. (2022, Journal of Affective Disorders; see link below) found that engaging in moderate or strenuous exercise was very effective in relieving the symptoms of anxiety. What I found so interesting was that half of the study participants had actually lived with anxiety for at least a decade, and they still got relief!

The subjects in the exercise groups did a combination of both strength and cardio training.

The subjects in the experimental groups were assigned to one of two groups: low-to-moderate intensity group exercise or high intensity group exercise. The exercise was timed circuit training that combined both cardiovascular and strength moves and subjects maintained heartrates at levels appropriate for their assigned intensity levels. At the end of the 12-week program, everyone’s anxiety had significantly decreased, as compared to a control group that was not participating in group exercise.

What is striking is that there was a tendency for the improvement to follow the level of intensity; the harder the subjects exercised, the more anxiety relief they experienced. Talk about motivation!

My own experience echoes this, but in a subtractive sense. At times of intense stress, my anxiety skyrockets when I’m prevented from engaging in my regular workouts. This may happen, for example, when I’m dealing with an unreasonable workload that ties me to my desk and preempts my exercise sessions.

I used to wonder why I felt so much worse when I was getting more work done. This study answers that question for me.

Couple these results with what we’ve learned about the beneficial effects of exercise in decreasing the risk of recurrence of breast cancer and it is incredible why physicians don’t write exercise prescriptions for their patients, and why personal trainer sessions are not covered by health insurance.

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There are several things that I feel are important to underscore here if you’re interested in trying this out yourself.

The social aspect of the exercise sessions may have also played a role in alleviating the anxiety that the study participants had initially complained of, and there was the added benefit of a pre-planned, supervised program.

First, this was a group session. That means that there was also social support involved as no one was exercising alone. The subjects were supervised by a physiotherapist; they didn’t have to come up with their own program, as it had been created for them.

Also, the exercise included both cardio and strength exercises and included warm-up, cool-down and stretching, so it covered all the bases, so to speak. And the subjects got fitter as the study progressed, so there was also a sense of self-efficacy at work here.

Does this mean that the exercise didn’t matter? Not at all! The emotional benefits of exercise have been documented in previous studies. If you consider the mind-body as a single system, as your physical fitness improves, your mental health will generally follow.

If you’d like to see the original article, it is available free online:
Malin Henriksson, Alexander Wall, Jenny Nyberg, Martin Adiels, Karin Lundin, Ylva Bergh, Robert Eggertsen, Louise Danielsson, H. Georg Kuhn, Maria Westerlund, N. David Åberg, Margda Waern, Maria Åberg. Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trial. Journal of Affective Disorders, 2022; 297: 26 DOI: 10.1016/j.jad.2021.10.006

For a reader-friendly version, see the write-up in Science Daily:
University of Gothenburg. “Anxiety effectively treated with exercise.” ScienceDaily. ScienceDaily, 9 November 2021. www.sciencedaily.com/releases/2021/11/211109095348.htm

Don’t Call It a Boob Job…

I remember telling people that I had breast cancer. Most tried to be as supportive as they could, some weren’t quite sure what to say. But regardless of how they reacted, there was a general expectation that breast cancer surgery meant that I had lost both breasts to the disease.

A few people went as far as trying to get me to “look on the bright side” that I had gotten a “nice rack” out of the deal. For the record, I had opted for a lumpectomy, otherwise known as breast-conserving surgery, which removes only the tumor and some surrounding healthy tissue to ensure that the entire diseased part is removed. There was no “nice pair” to be had.

So maybe this is a good place to clarify a few things.

A mastectomy is performed to remove all breast tissue, usually (but not always) along with nipples, areolae and lymph nodes, of one or both breasts. It’s done to treat breast cancer or, in the case of prophylactic mastectomy, prevent development of cancer in the breasts.

There are alternatives to reconstructive surgery that may be very meaningful to the breast cancer survivor, including creating something beautiful out of what she might otherwise consider an ugly experience.

Whether or not a woman chooses to have a mastectomy vs. a lumpectomy is a very personal decision and based on a number of physiological and even emotional considerations. No one should ever be judged for their decision regarding this.

Similarly, well-intentioned folks should not assume that breast cancer means a bouncing new set of perky breasts. Not everyone who gets a mastectomy will opt for reconstructive surgery. In fact, there are tattoo artists who specialize in using mastectomy scars and the newly-flat chest as a canvas to create meaningful and beautiful artwork.

It’s also important to note, total removal of the breast does not come without its downsides. Surgical complications are more likely with mastectomies, and because so much breast tissue and skin is removed, there may be loss of sensation in the chest area that in some cases is permanent.

A newly published study in JAMA Surgery (Dominici et al., 2021; note, the free PMC version of this article does not appear until Sept 2022) with a reader-friendly version appearing in the NCI blog Cancer Currents) compares quality-of-life scores between a variety of breast cancer surgery types, including lumpectomy, unilateral mastectomy (one breast) or bilateral mastectomy (both breasts). All subjects were young (under age 40 at time of diagnosis) cancer patients with early stage breast cancer who gave scores to their perceptions of items such as breast statisfaction following surgery and both psychosocial and sexual well-being. Having a bilateral mastectomy with radiation treatments resulted in the poorest quality-of-life scores out of all surgery options.

Important: while the sample size of this study was ample, with 560 subjects filling out the questionnaire, the women were predominantly white, married and financially stable. A more diverse subject pool might affect the scores and the study must be replicated with inclusivity in mind in order to extrapolate the findings to the general female population. It should also be noted that no surgical groups’ quality-of-life scores were particularly stellar – such is the way with cancer surgery – but those of bilateral mastectomy patients were worse.

All women, regardless of age, have the right to have their questions answered before making a decision about breast cancer surgery.

Given the notable difference between these scores, and the fact that all the different surgical options were open to these young women due to their early-stage tumor status, it stands to reason that women should be informed by their oncologists and surgeons of the possible outcomes of their decisions and second opinions should be encouraged.

That doesn’t mean that a bilateral mastectomy isn’t the right choice for a younger woman with early-stage breast cancer, only that she should be aware of the possibilities of complications and persistent quality of life issues. She should not be pressured in either direction because there is a lot to consider and it’s not an easy choice, nor does it come at an easy time in her life.

So please, don’t call it a free boob job.

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If you are contemplating a prophylactic mastectomy in the absence of a genetic predisposition (BRCA+) and have early-stage breast cancer, please read this article from breastcancer.org and discuss your options with your medical team.

Perspective: The Broom that Sweeps the Mind

Last week, I had a good reminder about the importance of maintaining perspective.

It had been a stressful few days at work. At the height of it I found myself in a problematic situation, trying to “fix” an issue that wasn’t my responsibility by sending a quick email. I would have done better to pause, but I was in “go-go-go” mode, driven by anxiety that the situation was causing.

Afterwards, I found myself obsessing about what had happened and how I had reacted. So even though I had initially felt that my email response was the best course of action, by evening I was convinced that it was the worst. This opened the door to allow in unrelated doubts about myself. That frustration carried into my nightly meditation, and ultimately, into fitful dreams.

In a few seconds, a perspective shift changes your entire view of things.

The next morning, I felt marginally better. But it wasn’t until I checked my text messages that my perspective shifted. I received photos of my father, leg in a cast, at the local hospital’s emergency room. Reason? Cracked tibia bone and deep vein thrombosis.

In an eyeblink, I forgot about what had happened with work. I needed to get more information about my father’s predicament.

As news of exactly what had happened filtered down to me (it was a much more controlled situation than I had initially understood it to be), I went into the office with a different mindset. The work stress that had been top-of-mind and in-my-face was now way over there in the back of the room.

FYI, my father is fine and the trip to the ER was actually a follow up from the previous day’s visit to his doctor where they discovered the fracture and the blood clot. The doc had encouraged the ER trip to get quicker access to an orthopedist. My dad is in good spirits and my mother (a former nurse) has been tasked with administering the clot-dissolving injections.

But the shift in perspective that morning reminded me so much of a similar shift several years ago: prior to my cancer diagnosis I had been experiencing a lot of anxiety at work…but once I learned that the lump in my breast was cancer, everything else fell away. It was as if the roar of work stress suddenly became muffled and all I heard was my beating heart, my health, the important stuff.

When I had cancer, the things that used to bother me, stopped. I knew then what was really important.

I distinctly remember that as I was going through my cancer treatments, in all the concern about what was happening in my body, I experienced the least amount of anxiety about anything going on at work that I’d ever had at that job. It felt like I could handle anything that they threw at me.

Perspective. That’s what I had as I sat in the infusion room. And that’s what I regained last week.

How curious that the shift in perspective was so simple to achieve. All I needed was to remember what was really and truly important and everything changed within a few seconds.

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“Simple” is not necessarily “easy”. We have so many things coming at us in the course of the day and we try to triage them as quickly as we can. It’s expected that we will make “little mistakes” and give more weight to the problem right in front of us–those things that are immediate. But with practice, we can realize that most of those are transient and the important stuff is what deserves our deepest attention and appreciation.

And even the “important stuff” needs to be swept out once in a while.

Don’t Overpink It

If you have been living under a rock or have pink color blindness, it probably hasn’t escaped your notice that October is Breast Cancer Awareness month.

I know I shouldn’t disparage the color pink (after all, my hair is currently pink), but there is a downside to all of this “pinking.” Actually there are two.

Awareness is important, but has the inundation of pink made the month lose it’s meaning?

First, after some point, there’s so much pink that it starts becoming meaningless. Whereas it used to be loads of fun for pre-adolescent boys to go around with “save the boobies” t-shirts in the name of cancer awareness, and then make a social media stink about it when their school sends them home to change, I’m not really seeing that kind of enthusiasm anymore. Kind of like when something that was cool and forbidden becomes legal…it loses its luster.

Which is not to say that breast-saving have gone out of style. A quick search of local events in my area does result in a number of fund-raising events. After all, we are still being diagnosed with breast cancer and in ever-greater numbers. But maybe it’s because of the pandemic, maybe it’s because of my current state of mind, I’m not hearing much about spreading the word of breast cancer prevention (not simply screenings) anymore.

But there’s another part of the pinkness that I’ve struggled with. And that’s the pink everything around this time of the year. I mean, if we want people to be aware, I guess they’re aware. But those of us who have lived the diagnosis may need to turn our awareness elsewhere.

That may sound ungrateful of me because all that awareness has translated into dollars for research, potentially at the expense of other cancers. And even though I will tout breast cancer awareness at this time of the year, it also stings.

I’ve lost friends to breast cancer. And I lost a year to breast cancer treatment, not to mention a good amount of my direction in life. Yes, I’m recalibrating, but no, things are not back to “normal”. Cancer still means people and things that are gone and will not return.

Consider taking your breast cancer friend out for coffee…with no pink in sight.

At times all this pink feels like loud cheerleaders shaking pink pom-poms in my face. And for many cancer patients and survivors, being constantly reminded that it’s BREAST CANCER AWARENESS MONTH can be overwhelming. We may need to ground ourselves in where we are right now, being present and grateful for each minute and away from all the pink noise.

So I agree that with 1 in 8 women being diagnosed with breast cancer at some point in their lives, and the mortality rate still unacceptably high, it’s definitely important to spread the word about risk factors and urge that women do the oh-so-critical self-exams and not forgo screenings.

But it’s also a great opportunity to reach out to a friend or relative who’s a patient or survivor and offer to take them out for coffee or a walk…and let them forget what month it is.

Working Out the Brain Fog

So if you needed yet another reason to exercise before, during and after your breast cancer treatments, I’ve got one for you.

A recent study in the Journal of Clinical Oncology (Salerno et al., 2021) found that early stage (I-III) breast cancer patients who were meeting the US minimum physical activity guidelines both before and during their chemotherapy displayed better cognitive function then did those patients who did not, and the effects were apparent both at the time of chemo and also six months after its completion.

Cognitive impairment is a relatively common complaint of breast cancer survivors–and can be improved with exercise.

This follows along the lines of other things we already know about exercise and cancer, such as increased survival rates and reduced rates of recurrence. It’s not a big stretch to say that exercise (and for the purposes of this post, I’m referring to the US national guidelines) is possibly one of the best things you can do for yourself, whether you are already a cancer patient or don’t want to become one (again).

What are these guidelines?

It’s suggested that adults do (1) at least 150-300 minutes per week of moderate-intensity or 75-150 minutes per week of vigorous-intensity aerobic physical activity, or some combination of the two intensities, the more the better; and (2) strength training activity involving all the major muscle groups at least two days a week at moderate or greater intensity (see specifics at Physical Activity Guidelines for Americans, 2nd edition).

Notably, similar guidelines hold across age groups and health conditions, with some modifications, although what exactly constitutes moderate to high intensity for different people will vary according to their conditioning and abilities. Take home message: If you can’t meet the guidelines, do what you can. It will still benefit you. The worst thing you can do is nothing.

The benefits of exercise for cancer survivors have been well-documented.

While there’s been a considerable amount of research done on the benefits of exercise as a whole, we’re only now beginning to focus on cancer patients and survivors as the test subjects. And new research is being conducted on different aspects of exercise to learn what effects they might have on cognition.

I’m going to be watching for the results of two clinical studies regarding exercise and cognition of cancer survivors. Both are currently recruiting participants.

The first, being conducted by the University of California, San Diego, is entitled “I Can! Improving Cognition After Cancer” and will be a randomized trial that examines whether physical activity improves cognitive function. You can read about it here: A randomized trial of physical activity for cognitive functioning in breast cancer survivors: Rationale and study design of I Can! Improving Cognition After Cancer, funded by the National Cancer Institute. Want to learn more? Go to https://clinicaltrials.gov/ct2/show/NCT04049695.

The second, conducted by the University of Pittsburgh and entitled, “Aerobic Exercise in Improving Cognitive Function in Patients with Stage 0-IIIA Breast Cancer”, will explore the effects of aerobic exercise specifically and will involve neuroimaging and the examination of pro-inflammatory biomarkers. You can read about it here: https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/v?id=NCT02793921&r=1. Again this is funded by the National Cancer Institute. Interested in learning more? Go to https://clinicaltrials.gov/ct2/show/NCT02793921.

If you’re not exercising yet, the important thing is not what physical activity to choose, it’s to make the decision to begin.

If you have any interest in participating in either of these studies, contact info for the research project is available above in the posted clinical trial links.

So you might be thinking, “I can barely deal with the diagnosis…and you want me to EXERCISE???” I promise you, physical movement will only make you feel better. However, if you don’t have an established exercise routine and don’t particularly enjoy the experience, consider what you can manage.

We’re not talking about training for a marathon or a powerlifting competition. But if you can do something, ANYTHING, you will still see greater improvements in your cognition–and quite frankly, many other aspects of your physical and mental state–than if you hadn’t done any activity at all.

It is worth it and you are worth it. So lace up your shoes and give it a go.

Surviving Another Ride in the Tube

During my last oncologist appointment, I was told it was time for a chest MRI.

The last time I had one of those, I was barely holding it together–it had been a couple of weeks since my breast cancer diagnosis an dI was in an emotionally fragile state.

But that was four and a half years ago. This time, I was fine. I thought.

In case you’re never experienced one, the bilateral chest MRI is not particularly comfy. You lie face-down, your breasts hang between two open slots beneath you and your arms are outstretched in a “superman” pose.

I was a bit taller than they expected…things didn’t completely fit.

And you hold that for a specified length of time. I seem to recall almost an hour last time in 2017, but this time it was only a half hour. Which is good, since I had a hard time getting comfortable–based on how the MRI bed was set up, they hadn’t expected me to be quite so tall.

And since I needed “contrast” in my MRI, I was hooked up to an IV for infusing gadolinium. But the veins on my right arm (which is the only one I’m supposed to use) have seen a lot of wear and tear. Yes, they bulge and look nice and juicy. But it’s a lie. Only after some false starts–the first vein the nurse tried was a bust–did we get the IV going.

The MRI machine looked shiny and competently high-tech. I got to listen to spa music through headphones, which is kind of funny, since it’s like being at a spa where they also bang pots and jackhammer while you’re getting your treatment. In case you’re not aware: MRIs are LOUD.

Ironically, there’s something quite positive about that: the percussive nature of the noise has an almost lulling effect–if you let it. This worked quite well with my strategy of meditating throughout the procedure. Breathing was not particularly comfortable because of pressure on my ribcage (again, due to my height and positioning on the bed), so I chose not to focus on it.

The dressing room was cute, but I couldn’t help feeling so alone in it.

Instead, there were many other bodily sensations that I could pay attention to. At times, I could “feel” the MRI in my hips and spine. I focused on the weight of my body on that bed and on releasing tension whereever I sensed it. Compared to the previous chest MRI, I felt a sense of grounding.

But there were little cracks in my composure. I took a picture of the cute little dressing room where I changed and left my clothing. It was lightly decorated with homey touches. At the same time, it looked so empty: my gown on one chair, my belongings on another. Briefly, I felt small and alone.

After unsuccessful attempts, the IV was connected, and I remembered the feeling of expecting that things were just gonna hurt.

After I got home I removed my bandages from the IV arm and looked at the crook of my elbow, and it reminded me of all the pokes that I’ve endured. All the discomfort that I learned to expect and not question if it was necessary, because it always was. And I fought back feelings of helplessness.

It’s not all bad. This time, I had a better grip on things. I wasn’t even thinking about the MRI the next morning when I went grocery shopping, until…

…I saw a call come through from my oncologist’s office. And suddenly my heart started racing. It was a pure knee-jerk reaction. The voice on the other end told me that the MRI looked normal and my oncologist would see me at my next scheduled appointment next year.

It took a bit for my heart to calm down. I hadn’t been worrying about the results, certainly hadn’t expected anything bad, but wow, when that phone rang, it was as if my brain yelled at me, “Time to PANIC!”

This ride in the tube had a happy ending. But there’s no mistaking all the anxiety bubbling under the surface. Try as I might, I am always going to associate these procedures with fear and possible death. Memories of what happened a few years ago are not going anywhere.

And that’s okay. Because even though my reactions to those memories may still be stressful, I can accept that this will be the case and not expect them to be otherwise. And that acceptance is one of the most valuable skills that I’ve learned.

Melatonin As Cancer Fighter? Maaaaybe…

The last time I was researching the link between cancer and sleep, noting the myriad benefits gained from solid nighttime rest, I was surprised to see mention of melatonin’s role in decreasing the risk of cancer.

For anyone who might not be familiar with it, melatonin (a tryptophan derivative) is a naturally-occuring hormone secreted by the pineal gland that signals when it’s time to sleep and wake. It’s mediated by light levels, with the amount of melatonin in your body increasing as the sun goes down. You’ve probably seen melatonin on the vitamin shelves at your local store, as in recent years it’s been popularized as a non-addictive sleep aid. What I hadn’t realized was that its effect on cancer cells has become an active area of study.

I dug into the PubMed database to find there was quite a bit on this topic. However, note that not all the journals in which these results were published were familiar to me, so I cannot vouch for the rigor of the peer review, however, there was a general consensus that melatonin showed promise.

Melatonin shows a lot of promise as a cancer fighting hormone.

It’s well-established that women who work night shifts experience disruption of their circadian cycle and have an increased risk of breast cancer risk, purported to result from extra circulating estrogen (Cohen et al., 1978, Lancet). Researchers are now linking that disruption with a decrease in melatonin production.

Amin et al. (2019, J Cell Biochem) describe the action of melatonin as it relates to cancer: “Melatonin via its receptors and various second messenger pathways decrease[s] cell duplication and increase[s] cell differentiation.” Since cancer tumors are composed of a proliferation of poorly differentiated cells, this means that the action of melatonin works against the process by which cancer develops and progresses.

Amin et al. continue by noting that melatonin “regulates estrogen-dependent pathways (by nonreceptor-dependent means) and reduces the production of oxidants; as a result, melatonin inhibits cell toxicity and mutations….Melatonin interrupts estrogen-dependent cell signaling and also causes reduced estrogen-stimulated cells in breast cancer. [It] is a mammary tumor inhibitor…[as relates to the] development, progression, and metastasis of breast cancer via a number of molecular mechanisms.”

A randomized, double-blind, placebo-controlled research study showed that melatonin has a neuroprotective effect that can counteract the effects of chemotherapy on “cognitive function, sleep quality and depressive symptoms” (Palmer et al., 2020, PLOS One). These are significant side effects that have a profound impact on the patient’s quality of life, and anything that may relieve these will improve the entire treatment experience.

Griffin & Marignol (2018, Int J Radiat Biol) noted that melatonin administered to subjects before they were exposed to ionizing radiation resulted in the breast cancer cells being more sensitized to the radiation therapy, rendering it more effective. And melatonin seemed to reduce the radiation-induced side effects exhibited by both human and rodent subjects.

No matter how many drug treatments are available for cancer, they do no good if the cancer cells develop a resistance to them. In a study published this year, Sang et al. (2021, Cancer Lett) found that melatonin increased the effectivess of drug lapatinib in HER2 receptor-positive breast cancer cells that were originally resistant to the drug, suggesting that melatonin could be a promising adjuvant therapy for treating advanced HER2+ tumors.

So, melatonin may reduce breast cancer risk, make existing treatments more effective and help protect patients against negative effects of these therapies. Does that mean you should run out and gobble melatonin every night?

Many studies are first run on animal subjects, but to truly determine whether a treatment will be effective for cancer patients, it must be tested on humans.

No! As tempting as it sounds, that’s not an advisable course of action. Many more studies still have to be run to evaluate the exact mechanisms by which melatonin acts on physiological processes. Some of the results in the cited studies were based on small sample sizes; good for proof of concept, but following up with larger scale studies is critical. Some studies were run on animal models which are not the best human analogues. In addition, there’s little direction regarding proper therapeutic dosages. Establishing those will take additional research.

Keep in mind: a naturally-occurring hormone like melatonin likely has a “sweet spot” in terms of dosing, and determining the ideal amount may be tricky. Just because you can buy melatonin gummies in 10mg doses does not mean you should be taking that much.

Furthermore, melatonin may elicit negative side effects in some people, including headaches, nightmares and nausea. Side effects tend to be short-lived with short-term usage but there’s still not enough information available about long-term safety, so taking it for longer periods of time is strongly discouraged.

Note also, the articles I’ve mentioned above were selected because they describe recent research, although some of these are review articles that espouse the authors’ opinion, backed up by research selected for the purpose. If you’d like to read the above studies yourself and the links I’ve posted do not provide you full access, please consult your local university library for copies (copyright laws prohibit me from providing access to pay-only articles, regrettably).

Finally, it may be that some of melatonin’s benefits might be its undoing. Reiter et al. (2017, Int J Mol Sci) note that melatonin is inexpensive and readily available, and therefore there might not be the same level of interest in researching and developing it for cancer use as there might be with a novel drug with the potential to be more lucrative.

Where does this leave us?

I would urge you to:
1) Ask your oncologist about what they would recommend, given the research that’s coming out. They are still your best source for information. FranticShanti.com is only a blog and can be used as food-for-thought but definitely not for determining your course of treatment.
2) Learn how to read scientific studies. There are free courses on educational site such as Coursera.com that explain research design and interpretation in layperson terms. They can offer instruction on reading research with a critical eye.
3) Keep an eye on emerging research. Databases such as PubMed are excellent sources for health research. Even if you’re not well-versed in research design, you can look up articles to bring to your next visit with a health provider.
4) Do not take megadoses of melatonin! There is still so much we have to learn about this hormone as it relates to cancer, and self-medicating with melatonin in the hopes that “maybe it’ll help” is dangerous. Again, your oncologist remains your best source of information.

I do encourage you to respect your circadian rhythm by establishing good sleep hygiene practices to improve the conditions for your body to create and release its own melatonin. Proper and adequate sleep will always benefit you!

And so we get back to the idea that launched this post: sleep remains the ultimate good.

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It bears repeating: ALWAYS ask your cancer team about starting any new medication or supplement, regardless of how well-supported it is by research.