Flashback Friday

Twenty years ago, in August of 1996, I was a 17-year-old girl about to start college. I had just flown across the country from Seattle to Baltimore, Maryland, by myself. My parents and I had said our tearful good-byes at the gate at SeaTac (back when you could still walk people to their gates at airports). I'd get picked up at BWI by upperclassmen on the welcoming committee. There were about four of us who rode nervously in the university-issued van to campus, our new home.

I moved into an un-air-conditioned, stifling dorm room at Johns Hopkins University, all of my worldly possessions in a large suitcase, plus a box or two I'd receive from home in the next couple of weeks. I had my rolls of quarters for laundry and phone calls home, my shower tote for carting my toiletries to and from the shared bathroom, and the weird extra-long twin sheets made specifically to fit those narrow dorm room beds. I just needed to go buy a box fan to deal with those last few weeks of swampy mid-Atlantic summer.

That first week is kind of a blur of freshman orientation activities like figuring out who has your same area code, if anyone, and things like finding the financial aid office for a check so I could buy books. And then I started a work-study job at the campus bookstore, so I got to see what classes everyone else was taking, too. The bookstore was mercifully air-conditioned, and in a basement, so I was happy to spend time there, even if I was only making $5.25 an hour.

At some formal my freshman year. LOOK HOW YOUNG!

***
Fifteen years ago, I was a college graduate living on Capitol Hill in Washington, DC, and working as a lobbyist. It was late summer 2001.

I was also training for my first marathon. My marathon training team would meet early on Saturday mornings to run along the historic C&O canal path past Georgetown, into the shaded woods in Maryland, through old tunnels, for miles and miles. It was muggy, but the conversation was good and the cause was worthy. I had joined the AIDS Marathon Training Program to raise money for DC's Whitman Walker Clinic, at the time the largest service provider for AIDS patients in the District. My marathon would be at the end of October in Dublin, Ireland.

Prior to security barricades and guards everywhere, ca. 2001

Then September 11th happened. I was at a client office in Northern Virginia that brisk, beautiful morning, listening to a presentation on systems security when everyone's phones and Blackberries started buzzing. How rude, I thought. But then the whispers made their way to the podium and the speaker stopped speaking. "A plane hit the World Trade Center," a colleague said to me, quietly. I had been in the World Trade Center the weekend before. We all gathered around a TV in the conference room to watch the news coverage, wondering what the hell had just happened in New York. It looked like footage out of a movie. This can't possibly be real, I remember thinking. And then the Pentagon was hit. 9:37 a.m. It suddenly became crystal clear we were under attack.

I was able to reach my boss, who said they were closing the city. She asked whether I had a place to stay. I called a college friend who lived in Gaithersburg, Maryland, outside the beltway. I could crash with her until the city opened again and I could get back to my apartment. We drank cheap wine and cried about the new world we were living in.

Two days later was my twenty-third birthday. I didn't much feel like celebrating.

But I did get on a mostly empty plane the next month and I ran that marathon in Ireland.

Proof.

***
Ten years ago, I was just returning from studying abroad in South America. I had finished my first year of law school and had taken the opportunity to spend six weeks in Santiago, Chile (where I spent much of the time sick with what was probably a bronchial infection) and Buenos Aires (where, recovered from my mystery illness, I ate my weight in grass-fed beef and red wine).

Chris and I had been dating about a year by then. Our schedules were equally crazy. I'd taken leave from work to go to South America, but was back at my job and school that August. He was frantically trying to finish his dissertation and typing away in his office at the Smithsonian most nights until the last bus came by, sometime around 1:30 in the morning. We saw each other on the weekends, where we'd rehash our weeks over runs through the zoo or beers in Adams Morgan. Or both, if we were feeling ambitious.

I was exhausted, but who cares when you're twenty-seven and in love?

In 2008, I graduated law school, followed Chris to Arizona, took and passed the bar here, and planned our wedding. We got married that fall, so broke it felt like we were in college again, but we had each other. And at least one of us (not me) had a job.

***
A little more than five years ago, Quinn was born. I'd settled into a job with a great team, Chris and I had purchased our first home (a tiny thing built in the 1950s), and Arizona was even growing on me. Life was so good.

Then on August 19, 2011, I went in for an exam with a breast surgeon who asked me to go to radiology right away. I still remember what I was wearing, a cute belted smock, navy with white flowers. I later threw it away. The radiologist took one look at my ultrasound pictures and told me she was 99% sure this was cancer.

Time seems to stand still at moments like this. I'll never forget where I was for 9/11, or what it felt like those first few days away from home at college. I'll always remember the prickly tentacles of fear that crept up the back of my neck when I was told I had cancer that Friday afternoon five years ago.

I wouldn't learn until later how aggressive or extensive it was, but I knew my lump was large. I'd thought it was an infection from breast-feeding. I was shattered to learn how wrong I was.

Five years later, I'm still here. A woman in my workout class this morning said, "Oh, congratulations! Five years is when your risk for recurrence goes way, way down, isn't it?" She was so excited, I hated to burst her bubble. But I chose honesty.

"No, it's just when they stop tracking us," I said.

She looked crestfallen. "Oh," she said.

"But it still feels like a milestone," I added, throwing her a bone. But also because it's true. It does feel like a milestone some days, like a rock in my throat on others.

Quinn is finishing his second week of kindergarten today. Chris just started teaching a new semester at ASU. I don't often know how to celebrate this day, or whether it's appropriate for a cancerversary. I mean, it was a terrible day of our lives, but then, look how far we've come. A lot of times I give the day a moment of silence and move on, but I think five years deserves something. Ice cream and a movie is sounding spot-on.

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To all of my friends and family who've stepped in the last couple of weeks, the last few years to help me out and entertain my son and feed our family (sometimes all three things at once), I'm not sure I say it often enough: from the bottom of my heart, thank you. You are exactly why our family has been able to make this chemo thing work while also raising a baby/toddler/preschooler and having a spouse who routinely travels for weeks at a time for work.

Yesterday was a chemo day for me, but also a holiday, which meant Quinn's school was closed. And it's one of those times that Chris is out of town while I need my infusion. I didn't exactly know how I was going to pull it off, and came close to rescheduling my appointment til later in the week. But it turns out I just had to ask. My friend Julee could step in to take Quinn for a few hours. "No problem!" she said. Quinn could play with her son, one of Quinn's best friends, while I went to my infusion center and received treatment.

Then, in the afternoon, Quinn's friend Sydney's dad brought her over for a playdate that relieved me of my obligation to sit hunched over on our hardwood floor, crashing cars with my boy. They even brought popsicles! Sorry, rest of the country where you currently feel like a popsicle.

Thank you, friends, for keeping me afloat.

Again, I've been a little remiss in posting this little series, but that's what single parenting has done to me. But hey, our laundry is folded and our teeth are brushed and I even sent my manuscript to my agent last week. So some things are getting accomplished.

To Wit: The FDA Approves Another Treatment for Metastatic Breast Cancer

"The drug’s efficacy was demonstrated in 165 postmenopausal women with ER-positive, HER2-negative advanced breast cancer who had not received previous treatment for advanced disease. Clinical study participants were randomly assigned to receive Ibrance in combination with letrozole or letrozole alone. Participants treated with Ibrance plus letrozole lived about 20.2 months without their disease progressing (progression-free survival), compared to about 10.2 months seen in participants receiving only letrozole. Information on overall survival is not available at this time."

And the Mayo Clinic is Planning Trials on a Vaccine for Triple Negative B.C.

Oh, how my fingers are crossed on this one.

"Donna Deegan, a WTLV- and WJXX-TV news anchor, is a three-time breast cancer survivor. She was diagnosed with the cancer at age 38.

"For women with triple negative breast cancer, if this works, it could be a game changer," Deegan said.

Perez said that in the past, she was not optimistic about the chances for success of a breast cancer vaccine. However, that has now changed."

Harnessing the Immune System to Fight Cancer

"But scientists recently discovered that cancer takes a page from Harry Potter: It puts on a kind of invisibility cloak.

"Cancer can keep the immune system from recognizing that it's bad and keep it from attacking itself," Brahmer says.

Now scientists have found a way around this.

"The breakthrough is in therapies called 'checkpoint inhibitors,' " Brahmer says."

New Delivery System for Chemo Drugs Shows Promise

"A new device that delivers cancer drugs directly into tumors without relying on perfusion via the bloodstream, could increase life expectancy for patients with pancreatic, breast and other solid cancers, say researchers."

3D Printed 'Phantom' Tumors Could Help Deliver Radiation More Precisely

"Scientists in London are using 3D printed replicas of tumors and organs, called 'phantoms', to show how drugs will pass through tumors and give them a better understanding of how that will be replicated in individual patients."

Certain Her-2+ Tumors May Only Need Chemotherapy (sans Herceptin)

"A study suggests that HER2-positive breast cancer tumors with high levels of tumor-infiltrating lymphocytes had a lower risk of the cancer coming back (recurrence) when treated with chemotherapy alone compared to HER-positive tumors with low levels of tumor-infiltrating lymphocytes treated with only chemotherapy.

This means that HER2-positive breast cancers with high levels of tumor-infiltrating lymphocytes might be able to be treated with chemotherapy alone and avoid Herceptin (chemical name: trastuzumab)."

I had ZERO side effects from Herceptin, so I was happy to take the kitchen sink approach. But I know what a pain it is to continue on infusions for a year (or longer for those with metastatic disease). Would you skip Herceptin if you could?

A Promising Drug Target for Certain Breast and Ovarian Cancers

"The Food and Drug Administration's recent approval of the drug olaparib for ovarian cancer patients with inherited mutations in the genes BRCA1 or BRCA2 came as welcome news to the thousands of women now eligible to receive it. A new study by Dana-Farber Cancer Institute scientists indicates that the pool of patients who can benefit from the drug is potentially much wider -- and offers a ready means of identifying them.

The study, published in the journal Nature, found that an enzyme called polymerase q (or POLQ) is the active agent in the protein "pathway" that olaparib targets within tumor cells. The finding suggests that breast and ovarian cancer patients whose tumor cells carry abnormally high levels of POLQ are likely to respond to the drug -- and that POLQ itself is an inviting target for future therapies."

Lastly, This is Making the Rounds in My Circles: Would You Try It?

One naturopath's take: "Although it is clearly uncomfortable not eating for a total of 72 hours, the research is indicating that this is a worthwhile sacrifice. The discomfort from hunger will actually decrease the severity of the side effects from the chemotherapy. It is also important to keep in mind that this starvation state is triggering a powerful metabolic shift in your cells that protects your cells while making the cancer cells more vulnerable to the chemotherapy."

I am fairly strong-willed, but I don't think I could voluntarily go without food for three days. What about you? Would you try this? Have you? Or is this guy a total coconut?

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We had a busy weekend here at the Campisano household. Besides Quinn making a mud pit in our back yard (see photo, below), my mom moved back to town after a two-year stint in Denver.

My younger brother flew down from Alaska to help her make the drive here, and he and I were both close to tears when they arrived Saturday night. Chris would say this is because us Akres are criers. The truth is we might be, but also that I hadn't seen my little brother (who's 6'4") in nearly eighteen months. He was deployed to Afghanistan for nearly half of that time, and the other half it was -38 degrees Fahrenheit where he lives.

So even if us Washingtonians were disappointed by the end of Sunday night's Super Bowl, all was okay in the world for a little bit because I got to watch the game over some chili and queso with my brother (and some other friends and family, including my mom).

(I realize this is not the best picture, but Quinn literally never stops moving and I should probably know by now to shoot everything in "sports" mode. Still, look at that smile. Clearly, this was taken before the Seahawks' last play call.)

With all that's been going on, I've slacked a bit on the "Around the Web" series. But here's what I've seen on the Internet over the past couple of weeks. Have anything to add? Email me at jen dot campisano at gmail. I like hearing from you guys.

The Emperor of All Maladies: A Biography of Cancer Becomes a Movie

Perhaps I'll do better watching this on screen than I did in book form? I picked up the book (some of the best prose I've read) shortly after my diagnosis. It hit too close to home, and I stopped reading. I haven't had the guts to try again. Maybe this will be my impetus.

"So she turned to PBS's premiere filmmaker, Ken Burns — whose mother died of breast cancer when he was eleven — to shepherd the project. The result is a three part, six-hours series arriving on March 30 narrated by Edward Herrmann, who died of brain cancer shortly after completing work on the film."

Or maybe not...

This Is Important: The Pressure to Stay Positive

"I understand the impetus from well-meaning friends who interrupt with "don’t say that, just stay positive!" when you talk about fears of what may come to pass in your cancer treatment, but they don't seem to understand that speaking about these anxieties is a means of release. The patient ends up feeling like she has to act happy and fine all the time, and stifles the desperate need to talk through all of this."

A New Strategy to Fight Cancer Actually Starts by Making Cancer Tougher

"'We think that being relatively soft lets invading cancer cells slip through the body and colonize new areas,' Surcel says. 'You can envision an octopus having a much easier time getting through a small opening than would a lobster. 4-HAP seems to make the cancer cells more like the lobster.'

The team is now testing 4-HAP in mice. The drug is already in use in some countries as a treatment for jaundice, so if it shows success against pancreatic cancer, it could potentially make it to market relatively quickly, Robinson says. But even if that doesn't happen, the study demonstrates that the new drug screen has great potential, he says."

And Yet Another Might Look to Create a Tumor Within a Tumor

"A tumor, as strange as it may sound, is a little society. The cancer cells that make it up cooperate with one another, and together they thrive.

Scientists are only starting to decipher the rules of these communities. But if they can understand how these cells work together, then they may be able to stop the tumor. “You can drive it to collapse,” said Marco Archetti, a biologist at the University of East Anglia and at the Icahn School of Medicine at Mount Sinai."

Why Breast Cancer Education (Rather than Awareness) Remains So Important

"Women with breast cancer often don’t know what kind of tumors they have, a new study found.

Not knowing one’s tumor features isn’t necessarily tied to worse outcomes, but better knowledge might help women understand treatment decisions and take medications as directed, said Dr. Rachel Freedman, the study’s lead author from the Dana-Farber Cancer Institute in Boston.

Based on their medical records, only 56 percent of women reported the correct estrogen status, 58 percent reported the correct HER2 status and 57 percent reported the correct stage. Only about one in five women reported the correct grade.

Overall, only 8 percent of women correctly answered all four questions, but the lack of knowledge was more pronounced among minority women, the researchers report." (emphasis mine)

Scientists Find New Target for Triple Negative Breast Cancer

Triple negative breast cancer (TNBC, for short) is what I lost my friend Renee to late last year. If targeted treatments could be developed for these patients, that is an absolute game-changer. It's not a cure, but — like the treatment I'm on — it's getting closer. 

"The team concludes that increasing expression of beclin 1 could be a promising therapy for breast cancer, especially for patients with the triple-negative type.

Beclin 1 is already a target of four classes of drug approved to treat other types of cancer, and the team suggests more research should now be done to see whether these could also save lives of breast cancer patients."

. . . And Then Boom

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As you probably heard, sports anchor Stuart Scott died of cancer over the weekend. The immensity of Scott's love for his daughters is palpable in this ESPY award speech. He calls his girls his "heartbeat." Like almost every parent, I can relate. And watching this (just fair warning), I cried big, ugly tears. A reminder that even though cancer research has come so far, we still have miles to go before we sleep.

 

Here is some of the research I've seen over the past few weeks. If I've missed anything over the holidays that you think should be included, please send me an email and I'll add it next week. Now that I'm done stuffing myself with gingerbread and dark chocolate candy cane bark, I have time again for sifting through articles online. Because, ahem, THAT CANDY CANE BARK WASN'T GOING TO EAT ITSELF.

Zinc Test for Early Breast Cancer Looks Promising

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"For the first time, a study shows that breast cancer cells process zinc isotopes differently to normal cells - leading researchers to suggest this might be a way to detect the cancer early."

No Surprise: Herceptin Improves Long-Term Survival for Her-2+ Patients

"The results show that the 10-year survival for HER2-positive breast cancer patients who received chemotherapy without Herceptin was 75%, whereas for those who also had Herceptin, it was 84%."

Two Pre-Surgical Drugs Improve Survival for Triple-Negative Breast Cancer Patients

"We found that adding either carboplatin or bevacizumab to standard preoperative chemotherapy increased pathologic complete response rates for women with basal-like cancers -- that is, it increased the proportion of women who had no residual cancer detected at surgery."

Disease Progression Delayed by a New Drug Combination in Some Advanced Patients

"A new combination of cancer drugs delayed disease progression for patients with hormone-receptor-positive metastatic breast cancer, according to a multi-center phase II trial.

'Because the study showed a statistically significant benefit among patients whose disease progressed on an aromatase inhibitor, a larger phase III study comparing this combination to other approved therapies used after initial therapies fail, like exemestane and everolimus, should be done.'"

Updated Results of MARIANNE Study for Advanced Her-2+ Patients

"The study assessed the feasibility of three different regimens targetting HER2 in people with previously untreated (first-line) advanced HER2-positive breast cancer. Patients enrolled in the study received one of the three composites: Kadcyla (ado-trastuzumab emtansine) plus Perjeta (pertuzumab), Kadcyla alone, and Herceptin (trastuzumab) plus either docetaxel or paclitaxel chemotherapy.

Results from MARIANNE trial showed that all the three regimens were feasible in progression-free survival (PFS) for a similar amount of time."

Development of Most Cancers Is Beyond Our Control, Study Finds

Notably, breast and prostate cancer were NOT included in this particular study. So the jury's still out as to whether those might be controlled by environmental factors.

"In a groundbreaking paper published in Science, the duo describe a new factor, a tissue’s stem cells, that may explain as much as two-thirds of the difference in cancer risk among different tissues."

What's Blowing Up the Breast Cancer Blogosphere This Week

In case it's not obvious, I'm in total agreement with Ms. Schattner on this one. No amount of whisky could ease the pain I would feel if treatment wasn't an option for me. There were other great articles countering Mr. Smith's blog post -- if you're interested, here are a couple that resonated with me.

"The image of a person retching or in pain, afraid to ask questions of his doctor and not being offered palliative care is outdated by several decades.

Today, cancer surgery and medicines can extend and improve the lives of people who live for years and decades after treatment. Malignancies that were notoriously hard-to-treat just a few years ago, like some forms of lung cancer, melanoma, T-cell lymphomas, Her2+ breast cancer and other conditions have become, in many cases, manageable." (emphasis mine)

Miracles Do Happen (What I Was Thinking About Over the Holidays)

We know very little about spontaneous remission except that it's extremely rare. Most doctors refrain from mentioning it to avoid giving false hope to patients. But the allure is undeniable.

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I had a CT scan this morning, so now I wait. The official line that the technician gave me (and all the patients he sees, I suspect) is that it'll take two to three days to hear from my doctor's office. If I'm lucky, my oncologist will call earlier than that (if I'm luckier still, with good results). I'm meeting with him Wednesday morning, so in any case, I'll know by then.

As my friend Joanna reminded me, as a wise man named Tom Petty said about waiting...

A Device for Watching Metastases IN REAL TIME

This both fascinates me and terrifies me at the same time (knowing it is what happened in my body). But kudos to the scientists who are making it possible to better understand this process--and, ultimately, how to stop it.

"This close-up view allowed the pair to see that the tissue attempted to surround and contain the cancer cells. Unfortunately, some of those cells escaped and began to burrow in to a vulnerable point along the vessel. After a while the force from the artificial bloodstream was great enough to pull the cell into the vessel completely and flush it along."

Whatever Your Thoughts on Mammography, There's No Denying Its Cost

"Medicare-funded breast cancer screenings jumped 44 percent from $666 million to $962 million from 2001 to 2009, yet those added costs did not improve early detection rates among the 65 and older Medicare population, according to a Yale School of Medicine study published recently in the Journal of the National Cancer Institute."

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Potential Postpartum Breast Cancer Therapy (This One Hits Close to Home)

"Nearly 25 percent of all breast cancers among premenopausal women occur within two to five years following a pregnancy. These postpartum tumors are more likely to spread or metastasize to other parts of the body, leading to an increased risk of death.

"Unfortunately, these are young women who have just had children. All breast cancer deaths are tragic but the loss of a young woman who is also a mother is so devastating for families and has a profoundly negative societal impact," said Rebecca Cook, Ph.D., assistant professor of Cancer Biology at Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.

While more research is needed, Cook said the results suggest that using a MerTK inhibitor in conjunction with other therapies could be helpful.

In the meantime, Cook said women who have recently given birth need to be vigilant about breast health."

No Surprise Here: Cancer's Costs Run Deep

"What’s clear is that employment and money concerns haunt many people with all kinds of cancer, nation-wide, during and after treatment. A malignant diagnosis can lead individuals to experience disappointment at work, earn less, retire early and, as a consequence of medical bills, reduce their home and leisure spending."

Predicting When Cancers Will Spread to the Brain

"Up to 30 per cent of breast cancers will eventually spread to the brain, often many years after the first tumour was treated. Tackling secondary brain tumours with radiotherapy and surgery has limited success, with most women surviving just seven months after the brain metastasis has been diagnosed."

Surprise Discovery Makes Way for Possible New Treatment for Breast Cancers

"Researchers at Sydney’s Garvan Institute of Medical Research have found that calcium-binding drugs commonly used to treat people with osteoporosis, or with late-stage cancers that have metastasised, may also benefit patients with tumours outside the skeleton, including in the breast."