That's why Dr. Saranya Chumsri, a Mayo Clinic oncologist, says she often recommends her patients with breast cancer participate in clinical trials, which research innovative therapies and accelerate critical advances in patient care.

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Therapies for people with breast cancer have advanced, thanks to clinical trials and the people who volunteer to participate in them. But the need for research continues.

"Our treatment for breast cancer has improved significantly in the past few decades," says Dr. Chumsri.

She says she encourages breast cancer patients to consider clinical trials.

"First of all, it will help us advance science … the patient herself will also benefit from being able to have the access to these new drugs."

But a lack of diversity in clinical trials could mean a lack of data for different groups of people.

So it’s important for people from diverse communities to participate in clinical trials to promote health equity and reduce health disparities.

"Enrolling these patients into the clinical trial, first of all, they actually might benefit from these novel treatments, like immunotherapy," says Dr. Chumsri.

And research findings from clinical trials benefit everyone by advancing health care and improving community health.

"This is the only way we can learn whether the treatment would be better than what we currently have as a standard of care," she says.

Related stories:

• Mayo Clinic Q&A podcast: Surgical options for breast cancer treatment.
• Consumer Health: Breast cancer types and what your type means.
• Dancing through complex care during COVID-19.

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DEAR MAYO CLINIC: I was recently diagnosed with breast cancer. The doctor mentioned using immunotherapy. What is immunotherapy, and how does it differ from chemotherapy, which I've traditionally heard about for treating cancer?

ANSWER: Immunotherapy is a newer therapy in the current treatment landscape for breast cancer. It also has been used in treating other cancers, including lung cancer, melanoma and kidney cancer. While chemotherapy directly targets cells that grow and divide quickly, such as cancer cells, immunotherapy harnesses the body's immune system to help fight cancer.

To understand how immunotherapy works, you must understand the role of the immune system. The immune system is designed to protect the body against any perceived threats, including cancer cells. The immune system is a complex network of cells that is trained to recognize proteins on the surface of other cells as "self," or a part of your body, or as "nonself," or not a part of your body and possibly harmful.

This mechanism is designed to prevent neoplastic cells — cells that have abnormal tissue growth — from developing into tumors by destroying them. However, cancer cells can outsmart these immune cells. One way they do this is by manipulating the immune mechanism to turn off the body's response. Essentially, cancer cells disable the immune checkpoints, thereby preventing attack and hindering destruction of cancer cells.

A specific type of immunotherapy was developed to prevent this. Known as checkpoint inhibitors, or PD-1/PD-L1 pathway inhibitors, this treatment aims to prevent the deactivation and increase the body's anti-tumor immune response.

At this time, immunotherapy is approved primarily for patients with metastatic or locally advanced triple-negative breast cancer, which is an aggressive subtype of breast cancer, representing 10%–15% of breast cancer, with limited treatment options other than chemotherapy.

Two immunotherapy agents have been approved by the Food and Drug Administration for this subtype of breast cancer: atezolizumab (PD-L1 inhibitor) and pembrolizumab (PD-1 inhibitor), in combination with chemotherapy. To receive immunotherapy at this time, the patient’s cancer tissue must express PD-L1, which is detected by a test, or have a high tumor mutation burden, which means a high number of gene mutations in cancer tissue.

My patients often ask about side effects of immunotherapy. Immune-related side effects often occur due to the immune system being "incited." Typical side effects can include fatigue, chills, body aches, injection site pain, infusion-related reaction, headache, flu-like symptoms and gastrointestinal symptoms. Immunotherapy also can affect liver function tests; cause respiratory symptoms, such as shortness of breath, cough and fever; cause symptoms of overactive or underactive thyroid gland, or adrenal gland; and rash. Most of these side effects are mild to moderate and reversible, if detected early and treated in a timely manner.

When patients develop side effects, depending on the severity of the side effects, the immunotherapy drug may need to be withheld, and sometimes oral steroids may need to be given to reduce the immune response and counteract side effects. In severe cases, other immunosuppressant medications may be used.

Researchers also are exploring the benefits of immunotherapy in early stage breast cancer, such as in the preoperative setting in combination with chemotherapy for triple-negative breast cancer. The use of immunotherapy for other subtypes of breast cancer, including hormone-receptor-positive and HER2-positive breast cancer, also is being evaluated. Several clinical trials are underway to investigate the combination of immunotherapy with targeted agents across breast cancer subtypes.

A cancer vaccine is another type of immunotherapy that is being developed and tested for breast cancer. Cancer vaccines help train the immune system to see and "memorize" antigens, or proteins, found on the surface of cancer cells, so that the immune system can fight these antigens if encountered in the future. These vaccines are being studied in different breast cancer settings: treatment of current cancer; prevention of cancer recurrence; or to decrease the risk of cancer spreading to another part of the body, or metastasis.

The use of immunotherapy to treat patients with certain breast cancers is promising. Immunotherapy can be a valuable tool for many patients, but I encourage you to speak with your health care provider about the pros and cons for your situation. You also can learn more about clinical trials using immunotherapy from Mayo Clinic's website. — Dr. Pooja Advani, Hematology/Oncology, Mayo Clinic, Jacksonville, Florida

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Related Articles 

• Mayo Clinic Minute: Why breast cancer screening is important published 10/5/21
• Consumer Health: Metastatic breast cancer published 10/4/21
• Mayo Clinic researchers advocate new approach to breast cancer prevention published 9/27/21
• Mayo Clinic Minute: Using targeted therapy to treat breast cancer published 6/29/21
• Consumer Health: Breast cancer in men published 6/10/21
• Consumer Health: Reducing your risk of breast cancer published 5/14/21
• Preventive screening during COVID-19 pandemic leads to early diagnosis of treatable breast cancer published 5/7/21
• Mayo Clinic Q&A podcast: Breast cancer radiotherapy and treatment innovations published 4/30/21

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DEAR MAYO CLINIC: I recently was diagnosed with breast cancer, and I will have surgery followed by chemotherapy. A friend told me that turmeric has anti-cancer properties. I have taken turmeric supplements in the past for osteoarthritis. Can you tell me more about turmeric and if I can safely take it as a supplement along with conventional breast cancer treatment.

ANSWER: Turmeric, a bright yellow spice powder made from the root of a plant in the ginger family, is grown in many Asian countries and other tropical areas. It's a major ingredient in curry powders common in many Indian and Asian dishes, and it is used as a coloring for foods, fabrics and cosmetics. The root can be dried and made into capsules, tablets, extracts, powders or teas. Or it can be made into a paste to apply to the skin.

Turmeric's main active component — curcumin — is what gives the spice its yellow color. Curcumin has anti-inflammatory properties, making it a potential treatment for a number of health conditions, including reduced pain and increased ease of movement in people with osteoarthritis. One study found that taking turmeric extract three times daily was comparable to taking a 1,200-milligram dose of ibuprofen daily for arthritis pain. However, more research is necessary to confirm these effects.

In addition to its anti-inflammatory properties, research suggests that curcumin has many other health benefits. Among them are antioxidant, metabolic-regulating, antimicrobial, immune-modulating, mood-enhancing, neuroprotective and anti-cancer effects.

Preclinical studies demonstrate curcumin stops the growth of breast cancer cells in the laboratory, but it's not known if this happens in humans since the body quickly breaks down curcumin, making it difficult to study. High-quality human studies are needed to confirm these findings, and guide effective and safe use of turmeric as a supplement.

When ingested as a superfood or when turmeric is used as a spice in culinary cuisine, the curcumin it contains appears to be generally safe among cancer patients. But dietary food sources are different than turmeric supplements or when it is taken as a pill. There is little research to ensure turmeric supplements are safe when used in combination with cancer treatments, including surgery, radiation and chemotherapy.

The use of supplements, like turmeric, among cancer patients undergoing cancer treatment can be a concern. Supplements are not standardized like prescription medications, meaning the dose is not regulated and purity cannot be guaranteed. What you get may differ from bottle to bottle and among brands, and there can be variables depending on what specific part of the plant is used. Many supplements that have powerful anti-inflammatory effects, like turmeric, have blood-thinning properties, which can increase the risk of bleeding and cause complications around the time of surgery.

In combination with chemotherapy, using supplements is worrisome because of potential drug-herb interactions. Laboratory studies have shown that two common chemotherapy drugs used to treat breast cancer ― doxorubicin and cyclophosphamide ― may have reduced effectiveness when used alongside turmeric, but the clinical significance is not yet known. Another commonly used chemotherapy drug for breast cancer, paclitaxel, when combined with turmeric may result in liver toxicity. The bottom line is that it's not known how turmeric affects chemotherapy and further research should be a guide. To reduce the risk of harm, clinician-guided supplement use is recommended.

It is best to talk with your cancer care team about the supplements you take to ensure they are safe, especially in combination with your cancer treatment. Oftentimes, marketing of supplements appears promising. However, high-quality research supporting these claims may be lacking and could pose harm. As a rule of thumb, there is no magic bullet. The best option ― one proven in studies time and time again ― is to get all the antioxidants, phytonutrients, vitamins and minerals your body needs by eating a whole food plant-based diet rich in colorful vegetables and fruits, whole grains, beans, nuts and seeds. — Dr. Dawn Mussallem, Hematology/Oncology, Mayo Clinic, Jacksonville, Florida

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Related Articles 

• Are there health benefits to taking turmeric: Mayo Clinic Radio Health Minute published 10/2/20
• Mayo Clinic Q and A: Turmeric’s anti-inflammatory properties may relieve arthritis pain published 1/24/20
• Home Remedies: Are there health benefits of turmeric? published 3/20/19

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"Breast cancer is an entire spectrum of disease, from very-low grade ductal carcinoma in situ, which is almost similar to just an atypical finding that is considered benign, all the way up to the other end of the spectrum, which is a very high-grade, invasive tumor," says Dr. Degnim.

Treatment depends on several factors, including what the cancer looks like under a microscope.

"Some tumors have strong estrogen receptors on the outside of their tumor cells, and some tumors do not. Some tumors have HER2 receptors," says Dr. Degnim.

Cell receptors determine treatment options, which can be targeted to specific types of tumors.

"So in terms of creating treatment plans, it is quite complex. We recommend that that be done often through a multidisciplinary team," says Dr. Degnim.

Treatment plans may include surgery, chemotherapy, radiation and medication depending on type, size, stage, location and grade of tumor. 

The encouraging news is that treatment for breast cancer keeps getting better.

"We have come a long way in the last few decades," says Dr. Degnum. She goes on to say that most women survive breast cancer.

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Pancreatic cancer
Pancreatic cancer begins in the pancreas, an organ that secretes enzymes that aid digestion and hormones that regulate the metabolism of sugars. Pancreatic cancer, which typically spreads rapidly to nearby organs, seldom is detected in its early stages. One sign of pancreatic cancer is diabetes, especially when it occurs with weight loss, jaundice or pain in the upper abdomen that spreads to the back. Treatment may include surgery, chemotherapy, radiation therapy or a combination of these. Learn more about the symptoms and risk factors of pancreatic cancer, and when you should see your health care provider.

Cancer survivors: Taking care of yourself after treatment
After your cancer treatment, you likely will be eager to return to good health. And beyond your initial recovery, there are ways to improve your long-term health and quality of life so that you can enjoy the years ahead as a cancer survivor. Here's what you can do to take care of yourself after cancer treatment.

Breast cancer radiation: Can it cause dry skin?
Dry skin after breast cancer radiation treatment is fairly common. In addition to dry, flaky, itchy skin, you may experience sunburnlike skin changes to the treated area. Your radiation oncologist can determine whether any underlying conditions are contributing to your symptoms or decide if you need to see a dermatologist. There also are a number of self-care strategies that may relieve your symptoms. Learn more from Dr. Sandhya Pruthi, a Mayo Clinic general internal medicine physician and past director of the Mayo Clinic Breast Diagnostic Clinic.

The post Living With Cancer: What do you know about pancreatic cancer? appeared first on Mayo Clinic News Network.

Prostate cancer brachytherapy: Can radiation pass to others?
Prostate brachytherapy is a form of radiation therapy used to treat prostate cancer. The radioactive "seeds" are implanted into the prostate gland, so that radiation is delivered directly to the prostate, minimizing radiation to the surrounding tissue. Depending on the type of prostate cancer brachytherapy you receive, your health care provider may recommend some precautions in the weeks after the procedure to protect others. Learn more from Dr. Erik Castle, a Mayo Clinic urologist.

Pap test: Can it detect ovarian cancer?
A Pap test, also called a Pap smear, is a procedure to test for cervical cancer in women. A Pap smear also can detect changes in cervical cells that suggest cancer may develop in the future. If ovarian cancer cells travel away from your ovaries through your fallopian tubes and uterus to the area around your cervix, the ovarian cancer cells could be collected during a Pap test. But this is rare, so the Pap test isn't a reliable test for ovarian cancer. Learn more from Dr. Shannon Laughlin-Tommaso, a Mayo Clinic OB-GYN.

Treatment for breast cancer  
Following a breast cancer diagnosis, your health care provider will establish the extent, or stage, of your cancer. Your treatment options will depend on your type of breast cancer; its stage, grade and size; whether the cancer cells are sensitive to hormones; and your overall health and preferences. Most women undergo surgery for breast cancer and many also receive additional treatment after surgery, such as chemotherapy, hormone therapy or radiation. Chemotherapy also might be used before surgery in certain situations. And men can have breast cancer, too. Tests and treatments for men are similar to those for women, including the use of mammography to investigate changes in breast tissue. Learn more about the treatment options for breast cancer and what you can expect with each.

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On the next Mayo Clinic Radio program, Dr. Karthik Ghosh, former director of the Breast Diagnostic Clinic at Mayo Clinic, will discuss the latest in breast cancer screening and treatments. Also on the program, Dr. Ralph Gay, a physiatrist at Mayo Clinic, will explain what can be done about low back pain. And Terri Wheeldon, a well-being specialist at Mayo Clinic's Dan Abraham Healthy Living Center, will share why strength training is especially important for women.

Here's your Mayo Clinic Radio podcast.

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When breast cancer patients face surgery to remove the cancer and associated lymph nodes, many worry about the risk of lymphedema.

Dr.  Boughey says, “Lymph nodes in your armpit drain both the cancer cells from the breast, but they also drain your arm. And, so, when you’re removing those lymph nodes, it can decrease the lymphatic drainage from the arm. That lymph fluid then builds up in the arm, resulting in lymphedema.”

A study by Dr. Judy Boughey and colleagues shows surgery is not the only treatment that puts patients at risk of lymphedema. Radiation and chemotherapy may be culprits, too.

“It’s a multi-step insult that leads to this lymphedema risk. So it’s not just surgery alone. What this tells us is that lymphedema is an important aspect that patients need to discuss not only with their surgeons, but also with their radiation therapist and also with their medical oncologist.”

If a patient does develop lymphedema, addressing it early is key, because there are treatments that can help.

“We, nowadays, have many more opportunities to treat lymphedema than what we had 10 years ago and even 5 years ago. There are procedures that can be done to reconnect the lymphatics to different veins to get them to drain. We can do lymph node transfers, all kinds of procedures.”

“And, so, early recognition, early treatment, early intervention, I think, is critical to try to make this collateral damage as minimally impactful on the patient as possible.”

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Many women who are going through treatment are advised not to exercise, because movement could trigger or make lymphedema worse. However, Mayo Clinic experts say exercise may help prevent lymphedema and lessen its symptoms.

In this Mayo Clinic Minute, reporter Vivien Williams talks to Mayo Clinic surgeon Dr. Sarah McLaughlin about lymphedema and exercise.

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