New research suggests that exercise can turn white fat into brown fat—which is not heart-unhealthy, is stabler, increases metabolism and decreases insulin resistance. Who knows if brown fat also secretes less androstenedione than white fat? Is the change at the cellular level (walls, nuclei) or just the fat stored in them? Worth looking into.

And since the fat in the cells is metabolically inert—it’s the cells themselves that function as a sort of organ system insofar as estrogen synthesis is concerned, would surgical excision, liposuction or cool-sculpting (the only ways to remove fat cells themselves) reduce estrogen production? Would those of us with large fatty breasts be advised to have them bilaterally reduced along with or after lumpectomy?

Artista thank you so much for this article. I am right at the point of deciding whether to go on with Letrozole. Already have Aortic Stenosis. Apparently extention helps a small few. I wonder if they would have done well anyways. It's been a month since stopping and this morning I woke up stiff and in pain all over. I hope that goes away with time. The pain was way worse a month ago.

Bummer on the cool scupting I was really thinking about it.

It didn't work for me either, I went to Medscape, clicked on Breast Cancer and scrolled through today's news. It's called:

Extended AI Use Linked to CV Events and Bone Fractures

Roxanne Nelson, BSN, RN

August 29, 2017

I was just reading General Surgery News:

New Edition of Cancer Staging Manual Includes Tumor Biology

http://www.generalsurgerynews.com/In-the-News/Arti...

...Another important inclusion in the new edition is the use of genomic profiling based on level 1 evidence. As the manual was being printed in early 2016, only the 21-gene recurrence score (Oncotype DX) had level 1 evidence from the TAILORx trial showing excellent outcomes for patients with a recurrence score of less than 11.

"This means that all patients who have a T1 or 2 tumor, N0, M0, ER-positive, HER2-negative and a recurrence score less than 11 are staged as a stage IA cancer because they have a recurrence-free survival of 99%-plus," Dr. Edge said.

The AJCC will issue rolling updates, "carefully defined and carefully constructed so as not to overwhelm the registry community," as level 1 evidence emerges on other genomic profiling assays, he added.

The prognostic staging system will rank many patients into groups different from what they would have been using the seventh edition. "For example, a T1, N0, M0, grade I triple-negative cancer would have been staged as stage IA in the seventh edition, but it's a IIA in the eighth edition, reflecting a worse outcome for these patients," Dr. Edge said.

By contrast, a patient with a T3 tumor, N1 or 2, M0, grade I, HER2-positive, ER-positive and PR-positive whose cancer was classified as a stage III cancer in the seventh edition, will be a stage IB cancer in the latest edition.

"In fact, there will be an increase in the number of patients who will be classified as stage I and a decrease in the number of stage II and stage III patients who receive the appropriate therapy," Dr. Edge said.

I have an oncotype DX score of 11. Not sure what "T1 or 2 tumor, N0, M0" are but I'm astounded by the "recurrence-free survival of 99%-plus".

If the recurrence rate is less than 1 percent and AIs lower it by 50 percent, wouldn't that mean the rate before AIs was 2 percent. I plan to discuss this with my MO next month to make sure I am understanding this correctly. Makes me much more comfortable with my decision not to do anti-hormone therapy.

Now after re-reading it, I'm not sure if the Oncotype score of 11 is the same as the "a recurrence score".

It has down graded most as I can see it but upgraded triple negative. I'm wondering if they're finding the als or tamoxafin work well enough to forgo chemo

T: the size of the tumor. Tn—microscopic to 1mm; T1–1mm to 1.5cm. T1a—1-5mm; T1b—5-10mm; T1c—1-2cm. T0 is an “occult primary tumor,” which was seen by imaging but could not be found upon surgical exploration.

N: the number of nodes involved, i.e., in which cancer cells are found. N0—no nodes involved. N1, one node, and so on…

M: the number of metastases (“mets”), i.e., evidence of cancer cells that traveled past the axillary nodes, in distant parts of the body. M0—no metastases.

So as a node-negative 1.3cm tumor without evidence of mets, my tumor is classified as T1cN0M0.

I read that article too, and it was not about initial AI therapy but rather extension past 5 years. Yes, there was a higher incidence of fractures & heart disease. But most women about to get AI therapy are given DEXA bone density scans (if they haven’t had a recent one already); and if the scan shows osteopenia (weakening bones) or osteoporosis (weak or brittle bones), we are given bone-strengthening treatment (oral or I.V. bisphosphonate or Prolia injection). If the scan shows normal bone density, common-sense measures to maintain bone health (calcium supplementation, avoidance of steroids or PPI drugs for GERD if possible, and weight-bearing exercise) are advised; another DEXA is done at 2 years.

As to cardiovascular risk, Tamoxifen is riskier for those already at risk or have a family history of ischemic (blood flow interrupted by a clot) heart disease or stroke, because it can cause blood clots. At this point, there is no causal relationship or anything more than a statistical relationship between AIs and heart disease, only a mathematical correlation. The difference between the AI and no-AI groups was small. The mechanism by which AIs increase CV disease risk is not known, other than decrease in systemic estrogen accelerates aging, and aging raises CVD risk. It’s not the AIs themselves, but their effect in lowering estrogen below levels in women who have had no estrogen-lowering treatments.

The takeaway from the study is that overall survival (time till death from all causes) is the same for both groups. And both ER+ breast cancer and CVD can have decades-long courses of progression. (My mom was diagnosed with heart failure at 65; she lived till 85). The longest period studied was 82 months, less than 7 years—definitely too short a time to come to definite conclusions for diseases that can take decades to kill. The #1 cause of death in early-stage ER+ breast cancer patients is heart disease—but not because the cancer or its treatment causes it but because patients live to be old enough to die of heart disease.

The uncomfortable truth is that we all will die sometime, of something. "No one here gets out alive,” as the Doors sang. But some of us get to stay longer and more pleasantly, and leave through different doors.

The more I read and hear the more confused I get. It sounds like this breast cancer is a crap shoot, and we take whatever the hell they give us and hope for the best. I have been on Anastrozole for 4 1/2 years and am so done. I am not sure if I will make it the 5 years that was first suggested by my onco and who is now saying 10 because that is what whoever said it should be..I am tired of the hot flashes that attack me every 20 minutes, I am tired of walking like a duck in the morning or whenever I get up off a chair. . I am tired of not having my sense of humor anymore, I am tired of my libido being completely at a zero. I am tired of feeling so not myself. So what do we do, go off of and pray for the best. I wish I knew...

BB I have made my decision, I choose not to speed up the aging process. It's been a month, I feel better today than yesterday. Going natural, healthy food and exercise, supplements. My kids are supporting me in this choice (DIL is a nurse). You can always go off, see how you feel, and go back on again. But it has to be your decision. Not sure how old you are? Have faith.

Don't be sorry MariH, that was a very nice rant. Good to see someone else has woken up. I feel like I've been sleep walking thinking I was getting help from the AI when all I was getting was old and creaky. My calculator shows I would get another 140 days survival maybe. Meanwhile my eyes were getting blurry with serious issues. The pain started to feel like I had crushed glass in my muscles and joints. Off it now and starting to feel better. One doctor said it takes a year for hormones to balance. I'm reading a good book, What Doctors Won't Tell You About Breast Cancer. I'm sure someone will come along and call it propaganda. Oh well, I did about 28 months, it's my choice.

Thank you chef, what nice thoughts to start the day with. You are very kind. I have another eye exam in January, until then I'm hoping my body is doing secret repair! Last night I watched a show on TLC channel about a little boy born with only 2% of his brain, the rest was empty space. Since then his brain has grown to 80%, there is a shunt in his head to remove excess fluid. He can talk, think, see (no glasses). He's a little developmentally delayed but they say in a few years he might be like a regular 8 year old, he's a three year when the show was made. He has spinal bifida, but who knows maybe someday he will walk. Cutest little guy ever, a medical celebrity. Anyways the body can do marvelous things if we allow it and help it. I feel better today than yesterday. Out for a walk now.

A glass of wine raises your risk a percentage of a percentage and is not the biggest factor by far, obesity is. I posted a chart here at bco a long time back, if I find it I'll post it again.

BB with that logic everyone should be on AIs to avoid BC, because we don't know which people with high risks have yet to discover they have a slow growing, ten to 20 years in the making, tumor. Oh but I never had a primary tumor. Just a pop-up in my lymph node. How much is the higher than normal chance as you recall? Do you think you are up to another three years of AI? Because there's a new study that says they found no difference between 2.5 years extended after five years (7.5) or an additional 5 years (10). Do you have any serious issues? I can't remember. Just think 175,000 (.70 x 250000)women per year are dx'd with hormone positive. That doesn't count the ones that don't get checked

I've forgotten the difference between luminal A and B?

Yeah, Chisandy posted it somewhere.....

OG if I get a recurrence can we get together and throw a tantrum together, because I can relate.

Yes, OG you won the Recurrance Lottery good going