Managing Menopause Symptoms in Breast Cancer Patients
Tori Hudson, ND
The primary focus of this presentation was evidence-based nutritional and botanical therapies for menopause symptoms in breast cancer patients/survivors—whether those symptoms are medication-induced or a result of physiologic menopause.
Secondarily, we also covered conventional medication options for vasomotor symptoms and genitourinary syndrome as well as reviewing the benefits and risks of vulvovaginal estrogen strategies.
- Attendees gained an understanding of the evidence-based nutritional, nutraceutical and botanical interventions for menopause symptoms and implications for breast cancer patients.
- Attendees also gained a review of implications of therapeutic options for breast cancer patients who have had surgical menopause.
- Attendees gained an understanding of the current nonhormonal prescription medications used for vasomotor symptoms.
- Attendees learned the nonhormonal and hormonal prescription options for genitourinary syndrome, and risks and benefits to breast cancer patients.
Conveying Realistic Risks and Benefits for Standard of Care Treatments for Early Breast Cancer
Ian Bier, ND, PhD, LAC, FABNO
This lecture focused on simple tools to understand and use to inform patients of the true benefits versus risks of some of the standard of care (SOC) chemotherapy and radiation treatments for early-stage breast cancer so that they can make the most informed decisions.
Some topics included:
- Radiation after mastectomy. For node-negative women, radiation post-mastectomy does not improve disease specific mortality; however, for node-positive women there is a significant improvement.
- Tamoxifen for prevention and early breast cancer. Tamoxifen is used for both prevention in high-risk patients and for treatment in ER+ breast cancer. In prevention trials, the tamoxifen group had fewer cases of breast cancer but actually had more breast cancer deaths. In treating early stage ER+ breast cancer, tamoxifen has been shown to reduce breast cancer recurrence and deaths. The NNT-to prevent 1 death over 5 years is 22, while the NNH (number needed to harm) for endomentrial cancer in the same period is 97.
- Lymph node dissection (sentinel vs axillary). Although more extensive, axillary lymph node dissection is often recommended. It has been shown to not be superior to sentinel lymph node dissection in women with certain breast cancers and results in significant impact to quality of life.
Maintaining the Remission and Connections of Toxic Metals to Cancer
Davis Lamson, ND
The presentation covered an important but neglected concept in mainstream oncology: strategy to maintain remission from cancer once obtained. The case of an 85-year-old engineer diagnosed with colon cancer is used to illustrate patient education about naturopathic oncology and strategy.
The second section surveyed six different mechanisms occurring with accumulation of toxic metals to foster carcinogenesis and progression. This included the changing role of transforming growth factor-beta from normal to malignant cells and the ability to lessen that influence.
- To be able to explain the strategies for prolonging remission from cancer to oncology patients.
- To be able to assess risk factors involved in cancer recurrence and direct the offsetting of these.
- To employ appropriate methods of testing toxic metal accumulation.
- To be able to offset the five mechanisms by which toxic metal accumulation can damage cells and foster cancer.
- To use TGF-beta level as one assessment for likely cancer invasion and metastasis.
Key Clinical Applications
- See the rationale for the idea of prolonging remission from cancer.
- Be able to employ this idea in patient education.
- Be able to utilize the agents to assist this goal.
- Understand the toxic metal mechanisms fostering cancer growth.
- Be able to administer procedures to offset the mechanisms.
- Use testing for TGF-beta.
New Diagnostic and Therapeutic Approaches to Prostate Cancer
Eric Yarnell, ND
The prostate cancer field has been changing and evolving rapidly since the US Preventive Services Task Force weighed in against routine prostate-specific antigen (PSA) screening. Preventing overtreatment of low-grade prostate cancer patients remains a high priority, and conventional tools besides active surveillance continue to be lacking in this important area. A naturopathic approach to screening for prostate cancer, including discussion of the PCA3, MiPS, 4K, and other new diagnostic tools, was provided. Tools for assessing aggressiveness of prostate cancer including prostatic acid phosphatase, circulating tumor cells, prostate biopsy (including how these have been mishandled for decades), and imaging were reviewed. Naturopathic approaches to helping patients with low-grade, localized disease were presented, as well as naturopathic adjuncts to conventional therapies for high-grade disease. The naturopathic application of intermittent maximal androgen blockade as a viable life-extending strategy for patients with aggressive metastatic disease were presented.
Why Don’t We Get More Cancer: The Critical Role of Extracellular Matrix and Microenvironment in Malignancy and Dormancy
Mina Bissell, PhD
This session had three key objectives. Attendees left with an understanding of:
- How we assay drugs with relevance to humans.
- How we can avoid excessive toxicity.
- Where we are in our understanding pf drug resistance.
The Macrophage in Cancer: Mighty or Malicious?
Lise Alschuler, ND, FABNO
True, inflammation underlies cancer. The molecular impact of inflammation can be linked to the pathophysiology underlying cancer and the macrophage is central to the inflammatory response. However, macrophage-induced inflammation is also necessary for immune activation, regulation of epithelial mesenchymal transition (EMT), and tissue repair. Gaining a nuanced appreciation for how low-grade inflammation and macrophage polarity influence carcinogenesis will guide our “anti-inflammatory” approach over the spectrum of cancer, from prevention to metastatic disease.
- Review the nature of the inflammatory response with particular emphasis on the macrophage.
- Understand the diverse interactions between the local environment, malignant cells, and macrophage polarization into M1, M2, and Tumor Associated Macrophages (TAMs).
- Address the Cause: identify common triggers of repetitive, or chronic, low-grade inflammation, characterized by M1 macrophage activation.
- Discuss strategies to avoid constitutive macrophage activation in order to reinstate homeostasis in the M1/M2 macrophage pool and to downregulate TAMs.
- Use the understanding of the dynamics of low-grade, chronic inflammation as a guide in the prevention of cancer and its recurrence.
Additional Questions & Answers
Relevance? Chronic low-grade inflammation is well-recognized as associated with increased incidence of chronic disease, including cancer. As such, an anti-inflammatory strategy would seem imperative to comprehensive cancer prevention. However, simply suppressing inflammation ignores the dynamic nature of inflammation in tumorigenesis as well as tumor-associated, or tumor-originated, inflammation. With greater insight into the nature of the inflammatory response, one can: 1) understand how diverse physiological conditions upregulate M1 macrophages, and are therefore justifiable targets in cancer prevention; 2) gain an appreciation for the central role of the macrophage and specific strategies to alter macrophage polarization; and 3) appreciate the importance of assessing the impact of various therapies on the local environment, in turn a source of macrophage activation and TAMs.
Proton Pump Inhibitors in Cancer Care
Jacob Schor, ND, FABNO
Proton pump inhibitors (PPIs) may be useful adjuncts in cancer therapy. Reviewing PPIs mechanisms of action in particular in regard to cancer cells and their surrounding microenvironment provides insight into how we might make standard chemotherapy more effective and limit tumor growth potential.
PPIs are in general frowned upon by our profession, for good reason, but because of this judgment we may be omitting a simple, accessible and valuable tool that may in some situations be helpful to our patients.