This October, BC Faculty Discuss Breast Cancer Awareness

In her homey office on the fifth floor of Higgins Hall, biology professor Danielle Taghian effortlessly juggles grading the first Molecules & Cells midterm of the semester, advising students of all years and in various stages of existential crisis, and checking in on her daughters.

After a long day, she ushers the last student out of her office, closes the door, and composes herself at her desk in the few precious moments of silence.

Her carefully calculated preamble is spoken with assured confidence. “The month of October for Breast Cancer Awareness Month commemorates all the women who’ve had breast cancer and are cured from it, those who are currently fighting it, and those who’ve died from it,” she begins, pulling facts and figures from outside research and her Cancer Biology course—one of the first to fill up during the registration period—for an interview on breast cancer.

Down one floor and on the other side of Higgins, bookshelves lining the walls of biology professor Thomas Seyfried’s office bear the weight of well-thumbed textbooks and stacks of research articles collected throughout the years. Though his corner office is quietly tucked away from the hustle and bustle of the rest of the building, a palpable electricity hangs in the air in anticipation of the Next Big Thing in science.

Seyfried’s first words on the subject? “There’s no such thing as breast cancer.” And we’re off to the races.

The Cancer Code

Almost 300,000 new cases of breast cancer were reported in 2015, according to a study conducted by the American Cancer Society (ACS).

The ACS classifies breast cancer into two main categories: ductal carcinoma in situ (DCIS), a noninvasive cancer that affects the epithelial cells that line breast tissue, and invasive, which infiltrates into the breast tissue and affects mammary glands and ducts.

On average, women have a 12 percent risk over the course of their lifetimes of developing breast cancer, with additional family history, the surrounding environment, and lifestyle choices influencing this risk.

Approximately 90 to 95 percent of breast cancers are thought to be caused by the failure of cellular machinery to function properly. An accumulation of mutations in a cell results in the development of malignant tumors, the first signs of cancer.

“As you age, these mutations can accumulate due to faulty DNA repair enzymes,” Taghian said.

DNA repair enzymes are vital in repairing genetic wear and tear that occurs throughout a cell’s life cycle. When the enzymes themselves become damaged over time, genetic mutations accumulate in the cell and are inherited by future cell generations. Breast cancer incidence and mortality rates increase with age, according to the ACS study. But the men and women who are eventually diagnosed with breast cancer may have had their fate already written in their genes.

While researchers don’t know all the molecular mechanisms underlying a tumor’s abnormally high metabolism that allows it to escape detection by the immune system, those that researchers do know of are used to develop a new generation of drug treatments that induce cancer cells to die in a process called apoptosis. Breast cancer patients can use the Oncotype DX test to see if the tumor’s genetic makeup would require chemotherapy. A well-known example of targeted chemotherapy that revolutionized breast cancer treatment is the drug combination of Herceptin and Pertuzumab, which arrests cell growth by preventing the tumor protein marker HER2 from binding to its receptor in rapidly dividing breast cells. Tamoxifen, another well-known chemotherapy drug, binds to estrogen receptors in breast cells to stop their development.

Mutations in the BRCA gene family—an abbreviation of BReast CAncer—were recently discovered to dramatically increase one’s risk of developing breast cancer to 85 percent.

The well-studied BRCA1 and BRCA2 mutations are inherited through the father’s line and can occur in both men and women. A variety of mutations in other BRCA genes are still under further study.

Other environmental risk factors that contribute to the development of breast cancer include hormone therapy, early onset of menstruation, poor diet, high alcohol consumption, and lack of exercise.

“Overall, survival has improved over the last three decades, thanks to screening and more efficient drugs,” Taghian said. “The actual diagnostics for mammography has made breast cancer detection very sensitive.”

In addition, improved surgery techniques are able to excise tumors and preserve healthy breast tissue. According to the ACS, mortality rates due to breast cancer have dropped 36 percent since 1989.

While all of these detection methods and therapies have reduced mortality rates and improved overall quality of life for breast cancer patients, they come at a steep psychological cost.

Silent Suffering

A world away, in the dimly lit halls of McGuinn Hall, sociology professor Sharlene Hesse-Biber welcomes students into a bohemian oasis of colorful couches and an array of houseplants. Underneath the whimsical nature of her office, however, is a mournful backstory.

Hesse-Biber first became involved in breast cancer research after losing her sister to the disease. Her research, however, was not confined to a lab bench. Over the course of interviewing breast cancer patients about their journeys with the disease, she discovered that all of the women she interviewed used genetic testing to assess their risks of having the hereditary BRCA mutation. She has since spent years studying the psychosocial effects of genetic testing.

“It breaks up families, it saves lives, it creates havoc, and it creates nightmares,” she said of her research.

Her results culminated in her book, Waiting for Cancer to Come: Women’s Experiences with Genetic Testing and Medical Decision Making for Breast and Ovarian Cancer, which won the 2015 Alpha Sigma Nu Book Award and has since been turned into a podcast series. In addition, she has also written about her work in an article entitled “Opening Up Pandora’s Genetic Testing Box” for The Huffington Post.

Genetic testing gained popularity in the ’90s, with unregulated genetic testing companies attempting to patent genes and use fear tactics in their marketing in order to lure clients. By the time the Supreme Court stepped in to enforce federal regulations, the testing bug had bit the nation, and genetic testing became a ritual for a generation reaching adulthood in the new millennium.

“Half of the women who are BRCA-positive have no history of cancer because it comes through the father’s line,” Hesse-Biber said. “Their fathers may have a family history and were never tested for the mutation, so their daughters never knew.”

The development of more sensitive mammography technology has also led to early detection of small tumors and identifying breast tissue that is at risk for developing cancer. Following a mammography, most women undergo risk-reducing surgeries such as mastectomies—removal of one or both breasts—and hysterectomies—removal of the ovaries.

“Losing your breasts or your ovaries goes to the heart of losing your femininity,” Hesse-Biber said, recounting the stories of various women who have suffered permanent nerve damage to their breasts, have needed reconstructive surgery to fix their appearances post-mastectomy, have either failed to attain or fallen out of relationships, and have sacrificed plans of becoming mothers.

“They’re in touch with their mortality at a young age,” she said.

Focus has now shifted to the small demographic of men who have been diagnosed with breast cancer. Incidence among men is lower—however, the mortality rate among men due to breast cancer is much higher than it is in women. Hesse-Biber attributes much of this to genetic testing.

On average, men get screened for breast cancer 10 years later than women, but may have already developed late-stage breast cancer by the time their testing results come back BRCA-positive.

For men who test positive for breast cancer, they face the additional social perception and stigma of breast cancer as an exclusively feminine disease. They also struggle with the guilt of having passed the hereditary BRCA mutation to their children.

This cycle of fear encourages an increasing number of young men and women in the prime of life to get caught up in what Hesse-Biber terms the “testing net” without knowing the unintended negative consequences of genetic testing until it’s too late.

“The minute people find out they’re BRCA-positive, they think they’re going to die—they’re fearful, they feel they have to do something,” she said. “Testing tells you if you’ll get cancer, not that you’re going to die. People don’t understand that you can get treatment and live with a similar quality of life.”

Hesse-Biber stressed that taking a family history is the best way to assess one’s risk for breast cancer and is worth spending time discussing with your physician.

Her intent is not to entirely condemn the genetic testing industry—instead, she wants people to thoroughly consider why they want to undergo genetic testing and be ready to face the consequences.

“Just because you’re positive doesn’t mean you’re going to die tomorrow,” she said. “But just because you’re negative doesn’t mean you stop doing surveillance.”

How to “Starve” Cancer

Unlike most physicians, geneticists, and medical researchers who are pulling out their hair over the genetic cause of cancer and developing intense chemotherapies, Seyfried offers a simple solution.

To Seyfried, cancer is all one disease caused by the same thing: damage to the mitochondria, the powerhouse of the cell, in the process of cellular respiration, hence his previous assertion that there is no such thing as breast cancer. Seyfried eliminates tumor cells by depriving them of the fuels they need to produce the energy they need to function—namely, glucose and glutamine.

“The reason that we have so many deaths is because people think it’s a genetic disease,” Seyfried said. “Mutations are the effect, not the cause.”

Seyfried developed the “press-pulse” regime, which entails a press of a zero-carb, high-fat, high-protein, ketogenic diet with an exercise regimen, and a pulse of drugs to supplement vitamin deficiencies and support a weakened immune system.

In a lecture given at the Florida Institute for Human and Machine Cognition (IHMC), as well as in his best-selling book Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer, he dismantles the widely accepted “gene theory” of cancer and explains why the medical field is still adamant about teaching the flawed theory, leading to a general misunderstanding of the true nature of the disease and development of ineffective therapies.

“It’s very hard to change the minds of people who’ve been indoctrinated into the dogma of thinking that cancer is a genetic disease,” he said.

Alternatively, the “metabolic theory” shows promise and could drastically reduce health care costs, but threatens the lucrative pharmaceutical industry that depends on the use of chemotherapy regimens.

Seyfried laments that thousands of cancer patients who are treated with chemotherapy must unnecessarily suffer at the hands of physicians who don’t know what they’re doing. He doesn’t put all the blame on today’s physicians, though—after all, they’re indoctrinated into the faulty gene theory of cancer the second they set foot into medical school.

“They’re not getting training in using food as medicine,” Seyfried said. “[Regarding chemotherapy as the default treatment], if you really know what you’re doing, why are all these people dying?”

Currently, cancer patients turn to the ketogenic diet as a last resort when radiation and chemotherapy fail, but by that point their bodies are too weak to withstand the new pressures of metabolic therapy.

Seyfried noted that physicians are willing to adopt the metabolic theory and implement his “press-pulse” regime once they learn about them—in fact, doctors in small local clinics, not large city hospitals, were the first to try the ketogenic diet with cancer patients to rousing success.

Success stories with the ketogenic diet have made headlines around the world, such as those of Pablo Kelly and Andrew Scarborough, who had personally reached out to Seyfried inquiring about the metabolic theory. These individual success stories are not enough to convince skeptics to trust the ketogenic diet, and they would be hard-pressed to find clinical trials proving that the therapy works—metabolic therapy is personalized medicine to the core, requiring a team of physicians and dieticians cooperating with the patient to create a unique therapy plan.

Consequently, these individualized reports can’t be used in a traditional clinical trial format to be published in medical journals, which necessitates that a population-wide experimental group adheres to the exact same treatment regime.

This bottom-up revolution, then, requires significant participation on the part of the patients who must be willing to make major lifestyle changes and quite literally battle their cancer instead of leaving their medical decisions up to a faceless institution.

“Will the ketogenic diet ever be embraced by top medical schools? It’s highly unlikely,” Seyfried said of the future direction of metabolic therapy. “Change is going to be patient-driven, not institution-driven. Remember, [patients are] the consumers—if their wants change, the field will change to follow.” 

Photo Courtesy of AP Exchange

October 23, 2016