by Mary Kremer, CN-Bi, R.T. (R)(T) Certified Breast Cancer Navigator

Newer approach to breast cancer treatment for Her2 positive cancer

In the last several years there has been new management in the treatment of breast cancers that are Her2-neu positive. While examining the sample obtained during a breast biopsy, the pathologist evaluates for expression of a certain protein called Her2-neu, if the diagnosis is a breast cancer. Her2 or “human epidermal growth factor receptor 2” is a gene that helps control the growth and repair of cells.

This is a protein that appears on the surface of some breast cancer cells. Breast cancers that are Her2 positive have over-expression of the gene indicating that the gene is making too many copies of itself. Extra copies of Her2 genes tell breast cancer cells to grow and multiply. For most breast cancers, surgery is the first line of treatment. After healing of the surgical wound in about 4 – 6 weeks, then other forms of treatment tend to follow.

However, for Her2-neu positive cancers, the oncologists and surgeons may consider certain medications before surgery which is called neoadjuvant therapy. Two agents that have been used in neoadjuvant regiments are Herceptin and Perjeta. Treatment recommended after surgery is called adjuvant therapy.

A benefit of neoadjuvant treatment is that it prevents delay of administering chemotherapy to treat and prevent breast cancer spread beyond the breast, as it is given in these cases, before surgery. In patients who tend to heal slowly after having a lumpectomy or mastectomy, their treatments could be delayed, as doctors typically wait for the surgical wound to heal before administering chemotherapy.

Additionally, since neoadjuvant chemotherapy could shrink the size of cancer, the patient may now be able to have a lumpectomy with radiation, instead of a mastectomy, hence allowing breast conservation. Not every woman who has been diagnosed with a Her2 positive breast cancer may require neoadjuvant treatment.

There are many factors that the medical team considers before deciding on a course of treatment. Doctors will take into consideration multiple different factors to decide on the appropriate regiment for treatment. Some of the factors may include age, overall performance status and other medical issues which could make some patients unable to tolerate potential side effects of certain treatments.

In summary, neoadjuvant chemotherapy is available in treating specific cases of breast cancer which are Her2-neu positive which allows shrinkage of the breast cancer and treatment of cancer beyond the breast, prior to surgery. This has additional benefits of changing surgical management from mastectomy to lumpectomy, which allows breast conservation. Recent advances in research have led to a patient-centered approach where treatment is tailored to each patient based on multiple relevant patient factors. 

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by Marina Steffner,

I was 34 years old when I was diagnosed. My kids were ages 1, 4, 6 and 9. My daughter Roni had turned 1 in November, and I was just finishing up breast feeding in December or January. In February, I found a lump by accident. I thought nothing of it. I just thought I was still drying up from nursing, but I decided to have my doctor take a look at it just in case. My doctor suggested I get an ultrasound. The ultrasound doctor said it was not filled with fluid but it was a mass and suggested I go to a surgeon. I literally had no idea what anything meant because no one gets cancer at 34….right?

I was oblivious. But I just went from one appointment to the next. Nothing really hit me until the oncologist (literally the cancer doctor) told me I was going to get chemo. I said to her, “Ummm…I’m just here for radiation.” As it turned out, I wasn’t just there for radiation. Over the next 12 months, I was scheduled for a surgery to implant a port for the chemo, then endured 6 rounds of chemo and 32 radiation treatments. My breast cancer was Stage 2. One standard test during cancer treatment is a bone scan. My bone scan showed several tumors throughout my body, so they started to check for bone cancer. They were looking for Stage 4 bone cancer…that was very scary. They did hideous bone biopsies but thankfully they turned out to be benign tumors.

I write about this, not to bore you with my medical history, but to give you a general feel for where my head was at during that time. It also speaks to how I feel about the Pink Ribbon Run. Through the first six months, I never thought a thing about my cancer. I kept saying I was totally fine. I was just thankful my kids didn’t have cancer. I was in complete denial. So, I completed four rounds of chemo, worked 40 hours per week and raised four kids, like everything was totally normal. I was so sick and really tired. After I completed four rounds of chemo and all the radiation treatments, I was supposed to go to back for two more rounds of chemo, Taxol. I had heard that Taxol was the worst. My hair was just starting to grow back. I was feeling normal, rocking my short hair; I had even stopped wearing a bandana. I was preparing to go in for my weekly doctor appointment with the oncologist and I was feeling strong. Super confident. I had convinced myself that I did not need to finish my treatments, I was still “fine” and I was going to tell her I wasn’t going to do it. I prayed, out loud, all the way to the doctor appointment. It was a super strong conversation with God, praying for strength and guidance to get through this appointment, a “help me through this” kind of prayer. It was a good conversation. I walked into the office, confident and strong, ready to go. I sat in the waiting room of her office…..it was also the waiting room for the “chemo room.”

This is the turning point in my story. A woman came out of the chemo room and sat down right next to me and started a conversation with me. I know she was an angel. I can’t tell you word for word what she said to me but she was younger, in her 40’s and she had had a relapse. She was talking to me about fighting and never giving up, and how no matter what you are faced with you have to be strong and know you can do it. I never told her what I was planning to say to my doctor, but every word she said was exactly what I had asked God for…I had wanted to quit, and the message back was: I needed to fight. The woman went back in the chemo room and I just sat there with tears just streaming down my face, I wasn’t crying out loud, just silent tears. I went into my appointment with my doctor and started bawling… a lot. She rubbed my back and called a counselor and set up an appointment for me. She said, with her Indian accent, “You go to counseling, it’s ok.” So, I went to counseling, and it was amazing.  But, I never went to a young cancer survivor group. I never had anyone to talk to about what I was going through. I never connected to another person going through what I was going through. That was 11 years ago.

My first Pink Ribbon Run was in 2013. We have gone for the past three years. This is the time of year I celebrate how thankful I am for my life, and every year I am so amazed at how happy I am. I cannot believe how many people are in my life now and how thankful I am that I fought through the tough times. The Pink Ribbon Run 5K is very special because I am surrounded by women who have gone through the same thing I have gone through, even though we don’t talk in depth about our stories. It is seriously the first time I have been around survivors. Not reaching out to a survivor group is my biggest regret, I feel like I missed out on a sisterhood of support.

When we are all together for the big picture, sometimes we make funny comments that would only be funny to someone who has had cancer. For example, the year of the spray painted sign someone said, “we survived chemo, a little paint fumes aren’t going to kill us.” With other survivors it is okay to say cancer. People get so afraid to talk about it, and I get it, no one knows what to say, and certainly does not want to offend or make us feel bad. But it’s nice to be with survivors, to be a little sarcastic and funny. I love the survivor picture, it makes me feel a part of the sisterhood. I feel like I belong to something bigger than cancer. I love my pink shirt that says Survivor, and I love the pink beads, I feel fancy…and special. ☺

At the Pink Ribbon Run, we celebrate our lives and the time we have as a family. The kids and I run together as a family; as a celebration. We all get dressed up in pink, crazy socks, make tutu’s, have fun with it. I love the memorial signs that are along the course, too. I cry every time I walk by one. I am thankful every day. I am still here, watching my kids grow, and the first weekend in October is when I remember and celebrate all these things. I will be there every year to celebrate my life and be an inspiration to the women who are still fighting. And to the survivors who are attending their first race? Come join us.