BEWARE OF THE BREAST CANCER SURVIVAL FLIP FLOP....WHAT YOU CAN DO ABOUT IT

The newly recognized delayed breast cancer recurrence several years after therapy (10-25 years) is just coming to the forefront of discussion among medical oncologists. Here I demonstrate the problem and discuss some solutions you can discuss with your own physicians.

More about prolonged hormonal therapy for breast cancer.

Dr. Tisman's Cancer Letter #4

Charts modified from: JCO March 20, 2016 vol. 34 no. 9 927-935

I HAVE BREAST CANCER…HOW LONG CAN I EXPECT TO SURVIVE?

Simple review of a surgical pathology report reveals important information that will help the patient evaluate the answer to "How Long Can I Expect To Survive?" However remember we are all individuals and not numbers and every few months a new medication with breakthrough efficacy has become available offering cure for many.

Glenn Tisman, M.D.

Prostate and Breast Cancer Patients Have Abnormally High Vitamin B12 and Folic Acid Blood Levels

We have for years been sounding the alert that ingestion of large doses of vitamin B12 and or folic acid lead to abnormally high blood levels of the vitamins. There is important scientific data revealing that patients with  breast and prostate cancer (among others) generally have higher than normal blood levels of vitamin B12 and folic acid. Other researchers (Sydney Farber, Victor Herbert, Ralph Green, R W Heinle) had previously reported that patients with various cancers of the blood such as chronic myelogenous leukemia and acute leukemia experienced a disappointing rapid progression of their leukemia in response to high doses of folic acid and or vitamin B12.

In our clinic,  we observed and reported that megadoses of B12 alone and large doses of B12 plus folic acid stimulated prostate cancer to rapidly grow in two different patients (see panel below).

Tomaszewski’s group (Tomaszewski et al, 2011) revealed a direct correlation of Gleason’s grade and rapid cellular proliferation with both high serum and prostate tumor tissue folic acid levels. Suggesting that folic acid was actually feeding prostate tumor tissue. Tisman (doi:  10.1186/1752-1947-3-9295) had demonstrated that large doses of B12 stimulated while withdrawal of folic acid (doi:  10.1186/1752-1947-5-413) and vitamin B12 inhibited the clinical growth of their prostate cancer.

The charts below display information from our clinic and laboratory revealing results from two groups of our patients (Breast cancer and Prostate cancer). Notice that they have higher than normal blood vitamin B12 levels. We feel that such findings are suggestive that these two vitamins, in higher-than-normal levels, may be stimulating normally occult and indolent pre-malignant tissue into overtly malignant tumors or quiescent malignant tumors as has been reported previously for patients with prostate cancer by JC Figueiredo at USC (doi: 10.1093/jnci/djp019).

Studies by Young-In Kim's group of Toronto indicate that folic acid, by affecting epigenetic/gene expression may have a dual modulatory role in colorectal as well as in breast cancer carcinogenesis depending on the dose and the stage of cell transformation at the time of folate exposure. His murine studies conducted in colorectal cancer models confirm that folic acid supplementation may prevent as well as promote the progression of established pre-malignant abnormalities (similar to the work of Figueriredo in prostate cancer). Animal studies  suggested that megadoses of supplemental  folic acid  may promote, rather than prevent cancer development. (DOI: 10.1002/9780470015902.a0002268.pub2).

Because of the above, BD Maintenance Plus++ was formulated to deliver just enough and not too much B12 to prevent deficiency and contains no folic acid. It also delivers normal levels of B2 and B6 to maintain normal epigenetic relationships by providing normal blood levels of the important complement of B vitamins. Unfortunately, the US government has already added too much  folic acid into the American diet, federally mandated since 1998. You can read an in depth discussion of the fortification of the American diet with large doses of folic acid at doi:  10.3390/nu3030370.

Glenn Tisman, M.D.

Does B6 Really Protect Against Breast Cancer?

Who Says Vitamin B6 May Protect Against Breast Cancer? Kasperzyk et al. Am J Clin Nutr, 90, pp. 561-9, 2009 and Key et al. Cancer Epidemiol Biomarkers Prev, 18, pp. 1538-43 1997. In our own laboratory and clinical practice we confirmed that several patients with various cancers had low levels of vitamin B6. This is not an uncommon issue. Too much B6 may be toxic however "Just Enough and Not Too Much" as delivered by BD Maintenance Plus++ was able to correct patients blood levels of B6. Both abnormally low and abnormally high doses of B and D vitamins adversely affect the expression of genes some of which are tumor promoting. That is why we developed BD Maintenance Plus++.

Glenn Tisman, M.D.

Breast Cancer-Benefits of Prolonged Endocrine (Hormonal) Therapy >5 Years

Because breast tumors of all stripes have a propensity to continually recur over several years, a study of the duration of treatment (MA.17R trial) of breast tumors containing (Estrogen and or Progesterone Receptors) was undertaken. Usual hormone therapy for breast cancer includes one or two of the following drugs (anti-estrogen drugs such as Tamoxifen, Toremifene (Fareston) and Faslodex (Fulvestrant) or an aromatase inhibitor such as Femara (Letrozole, non-streoidal inhibitor), Arimidex (Anastrozole, non-steroidal inhibitor) or Aromasin (Exemestane, a steroidal inhibitor) as adjuvant therapy. These medications are given to prevent distant tumor spread and or a new tumor of the other breast (contralateral breast). These medications were generally administered for 5 years. However, the MA.17R trial results proved that patients will experience added benefit in terms of decreased recurrence rate of the original tumor (metastases) and decreased incidence of the other breast from developing a new, second tumor if therapy is extended for 10-years. Data from the MA.17R trial (which used Letrozole (Femara) as adjuvant therapy revealed a significant and important difference in the annual incidence rate of contralateral breast cancer (other breast)  0.21% in the Letrozole treated group and 0.49% in the placebo group (P = 0.007), with a hazard ratio of 0.42. See the following Figure 2.

The above table reveals the differences in tumor recurrence between those extending taking Letrozole for extended periods longer than 5-years vs. the placebo group that stopped Letrozole therapy at 5-years (the initially recommended duration of therapy). N Engl J Med 2016;375:209-19. DOI: 10.1056/NEJMoa1604700

This trial comes on the heels of the ATLAS extended Tamoxifen trial (10-years vs. 5-years) of adjuvant therapy revealing the superiority of extending therapy with Tamoxifen for 10 years. Below Figure 3. Lancet 2013; 381: 805--16 Published Online December 5, 2012 http://dx.doi.org/10.1016/ S0140-6736(12)61963-1 

Who is at high risk of recurrence after stopping only 5-years of endocrine therapy? See below:

Glenn Tisman, MD.