Genomic profiling of male breast cancer. summary

Burki, T.K. (2016). Genomic profiling of male breast cancer. The Lancet Oncology.

This brief article added to robust research in the area of the biological differences between male and female breast cancers.

Subjects were 59 male breast cancer patients, all were ER+ and 57 were HER2-. All exons (parts of the gene) of the 241 genes that commonly mutate in female breast cancer or are involved in DNA repair were the focus of the sequencing.

Analysis showed similar mutation patterns in males and females when compared with The Cancer Genome Atlas (TCGA) study.

Exceptions were:

• 1.    In male breast cancer, genes involved in DNA repair were more frequently mutated than in female breast cancer.
• 2.    Both male and female breast cancer had mutations in “genes such as PIK3CA, GATA3, MAP3K1, and TP53.” The main differences were that these mutations were more common in female breast cancer. (E.g., PIK3CA: 42% in female to 18% in ER+, HER2- male breast cancers. This is important because this mutation is the second most common mutation in female breast cancer and has been identified as a target for treatment.) Consequently, this finding emphasized the care needed in applying trials from female breast cancer to male breast cancer cautions Reis-Filho from Memorial Sloan Kettering.

Valerie Spiers from Leeds University sees the differences at the biological level of male and female breast cancer as support for treating male and female breast cancer as different diseases that may indicate the need for “male-focused breast cancer clinics.”

Finally, Reis-Filho notes that the number of sequenced genes was incomplete and consequently did not identify specific mutations found only in male and not female breast cancers.

My final comment: If this is not new, why has so little been done?

My final final comment: Did anyone else to a double take when reading the part about 241 genes. I checked. It’s not a typo.

Am I still me?

The sicker I get, the more of a stranger to myself I become. 

Time used to be measured by teaching days and holidays. Now time is measured by weekly infusions, daily neupogen injections, monthly xgeva injections, teaching days, and recovery days. 

I used to stride at full speed down the corridors of academia and now I walk slowly. I’d like to say I walk thoughtfully but that is what I’m pretending to do. I’m actually just concentrating on not making it obvious that I’m completely out of breath.

I stand at the bottom of a flight of maybe a dozen stairs and I wonder who this person is who is drawing on every last energy cell to climb them. This is not the person who, six months ago, could run up seven flights of stairs chatting and laughing. Now all flights of stairs are my Rocky stairs. Climbing them feels like a mile sprint even as I know that I will never sprint a mile again, or even jog one. 

I am does not abruptly become she was when we die. I am is chipped away by the disease and treatment.

I walk past a window and inadvertently catch my reflection in the glass. I don’t recognize the ashen face. My pace slows down with each stop and rest but my reflection is a time-lapse played at 100 frames a second.

The pallor from yesterday has given way to the waxen bloodlessness of today. This illness has robbed me of the normality of adapting to my slowly aging body. The morphing of childhood to adult to middle age is abruptly set to fast-forward.

I still go to work and pretend that I can do it all. I’m lucky to still be on the same treatment for 8 months. However, even as the carbo/gemzar combo keeps the cancer in check, it weakens my body. My oncologist keeps saying there are many more treatments. However, the unspoken words are that my body will break down before the treatments end.

In less than two months, it will be three years since my diagnosis of metastatic breast cancer. I have reached the median survival time.  This is my 13^th treatment.

I am and she was edge closer together. 

We don’t need more treatments. We need better ones.