Doc: ‘Triple negative’ breast cancer more aggressive
Dear Dr. Roach: One of my relatives has been diagnosed with stage 2 or 3 triple-negative breast cancer. Her death sentence is chemotherapy every two weeks for eight weeks, and then every week for 20 weeks! What is your opinion on this kind of chemotherapy? Isn’t there some therapy safer than this?
Dear R.I.: Before I answer your question about chemotherapy risks, let me explain “triple-negative” breast cancer. Breast cancer cells often have receptors on their surface, which regulate growth in normal breast cells. Three of these are estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2. If they don’t express these in high numbers, they are called “triple negative.” These kinds tend to behave more aggressively than other cancers.
Any diagnosis of breast cancer must be taken seriously. It must be evaluated, ideally by an expert team including an oncologist, breast surgeon, pathologist and radiation oncologist, in order to decide the optimal treatment. There is hope for every breast cancer patient. What often is done in triple-negative breast cancer is chemotherapy followed by surgery (this is called neoadjuvant chemotherapy), but sometimes the surgery comes first, followed by chemotherapy (called adjuvant chemotherapy).
Chemotherapy improves that hope, particularly in triple-negative breast cancer, where there are no options to block the hormone receptors. Yes, chemotherapy can be difficult, but an oncologist chooses a chemotherapy regimen that is designed to best treat the cancer while minimizing toxicity. It is unfair (and possibly harmful to your relative) to call a chemotherapy regimen a “death sentence.” There may certainly be safer therapies, but neither you nor I have enough information to evaluate her regimen. Regimens using weekly chemotherapy are well-tolerated and improve the chances for a cure.
Dear Dr. Roach: Is a vegan diet the healthiest option?
Dear W.H.: A vegan diet — that is, one with no animal products — can be a very healthy option. There is little doubt among experts that less red meat and more vegetables, fruits, whole grains and nuts will reduce risk of coronary artery disease and many malignancies. However, experts believe that adding, for example, two servings of fatty fish weekly to a vegan diet will further reduce a person’s net risk. Adding modest amounts of skinless poultry also may have benefit, or at least have no harm compared with a strict vegan diet.
A vegan diet is a serious lifestyle change, and I don’t recommend it in general, but I certainly support it for my few patients who have made that choice, based on health, moral or ecological reasons. However, I do recommend increasing plants, fish, nuts and whole grains to most. Almost everybody would benefit from eating less meat, especially less red and processed meat. You don’t need to be strictly vegan to gain benefit. Even on a vegan diet, it still is necessary to limit refined sugar. Vegans also need a source of vitamin B-12, whether it’s B-12 fortified foods or a supplement.
Email questions to ToYourGoodHealth@med.cornell.edu.