HER2-Positive Breast Cancer—Reduce Your Risk of Recurrence | Access Health

HER2-Positive Breast Cancer—Reduce Your Risk of Recurrence | Access Health

(upbeat chiming music)
– Every two minutes, one woman is diagnosed
with breast cancer somewhere in the United States,
and in every five women diagnosed,
about one will have HER2-positive breast cancer,
a more aggressive form of the disease
known for putting its patients at a higher risk of recurrence. Today, living with
HER2-positive breast cancer, understanding that
there are options to reduce your
risk of recurrence, and the empowering
stories of the women who are leaving no stone
unturned in their fight. Join us for a very special
program this morning. I’m Ereka Vetrini,
Access Health starts now. (upbeat chiming music)
(soft music) There are currently over 3.3
million breast cancer survivors today in the United States,
and approximately 20% of these women have
HER2-positive breast cancer. (soft music)
– They found a lump in my left breast
through my annual mammogram. I went through the
biopsy, and the MRI, and went to the breast surgeon,
who gave me my official diagnosis
of ER/PR-positive HER2-positive early stage breast cancer. I had never heard of
HER2-positive breast cancer before I was diagnosed with it. I didn’t know that there were
all these different kinds of breast cancer
that were out there. When I got the diagnosis,
that changed a little bit of the conversation
because HER2-positive is a little more aggressive. I wasn’t highly emotional,
I think it had to do with having my mom
dying of ovarian cancer and kind of having in
the back of my mind at some point that
I might have to deal with something like this,
and I knew all of the money that has gone into
breast cancer research and the survivability of it. I just thought, hey, you know,
tell me what I need to do, what the best treatment
options are for me. People would always say,
you have the best attitude, and I said, you know what? I find the alternative
unappealing. I’m gonna do
whatever’s available to help me get through
this and survive. (upbeat music)
– In 2015, I found a lump myself in my right breast. I went to my doctor,
she immediately sent me for a mammogram and a biopsy. I got the phone call
that I had cancer. I knew a little
bit about stages, but I was stage three and
I thought, oh my gosh, that’s so close to stage four. What’s going to happen to me? From that point on, I
had to plan my treatments and my life around cancer. Before I got the phone
call, everybody was saying, it’s not going to be cancer,
you have no family history, you’re not gonna have cancer. The phone rang and the
doctor said, it’s cancer. My heart just sunk. I chose a lumpectomy and
ended up having to go back and do a mastectomy anyhow. That was another
emotional roller coaster because you’re having
your breasts removed, but you’re also wanting
to do everything possible to get rid of all the cancer
and keep it from coming back. Halfway through my radiation
is when I found out that I was HER2-positive,
and that I would need to do additional treatments. When you find out
that you have cancer, there’s nothing like
finding that out to realize you really
do want to live and be there for your
family and your children. Do everything possible
to stay alive. – If you’ve been diagnosed with
HER2-positive breast cancer, things can likely be
very overwhelming, but the more informed
you are as a patient, the more you can
actively participate in your care decisions. Thankfully, we have
Dr. Reshma Mahtani, a breast medical oncologist
from the Sylvester Cancer Center at the University of
Miami here with us today for this extremely
important conversation. Doctor, thank you so
much for joining us. – Thank you for having me. – So, we’ve so much
to cover today. Let’s start with
the very basics. What does HER2-positive mean
for a breast cancer patient? – So, first off, I’d
just like to emphasize that breast cancer
is not one disease. There are several
characteristics that we look at in the tumor that help
dictate how these cancers are going to behave and
those same characteristics also help us identify
potential treatment options. So for example, one thing
that we look at quite often is whether the tumor grew under
the influence of estrogen, progesterone, normal
female hormones, and those are potential
targets for treatment, and we also look
to see if the tumor is what we call HER2-positive. Now, what that means
is that in the tumor there are too many copies
of this gene, the HER2 gene, that makes a protein, and
that protein helps the cell usually divide, repair itself,
but when there are too many copies of this protein,
it causes the cell to divide uncontrollably
and be a more aggressive type of cancer. So approximately
one in five cases or about 20% of all
cases of breast cancer are HER2-positive
or HER2-amplified. It’s important because we
have targeted treatments against that type
of breast cancer. – As you’re going
through your treatment, at what point do you learn
that you are HER2-positive? – Very early on,
because usually, when a breast cancer
diagnosis is made, the pathologist is looking
to characterize that cancer for the medical
oncologist like myself, who will be then
tailoring treatments against that specific
type of cancer, so in addition to identifying
if the tumor is estrogen and progesterone-driven,
we get information about whether the tumor
is HER2-positive or not, and it’s very important
to accurately make that characterization
because it dictates the treatments that
we’re going to give. – Cause HER2-positive means,
it’s more likely to recur. – Correct, and not only does
it impact the recurrence risk, it also impacts what
treatment we’re able to offer. – So, talk a line about
treatment, fortunately enough, year after year, we are
learning so much more about breast cancer, thankfully,
so, what do we know now about, well, breast
cancer in general, but HER2-positive now
versus 20 years ago? – So this is one of the
greatest success stories in breast cancer and we’re
proud of the research that’s been done in the
field, especially in this area because the natural history
of HER2-positive breast cancer has changed dramatically
with the incorporation of targeted anti-HER2 therapies,
so taking us back many years ago,
a diagnosis of HER2-positive breast cancer
was a pretty dismal prognosis, and despite receiving treatments
in the early stage setting, including surgery, local
therapies like radiation, and even standard chemotherapy,
which was meant to prevent the cancer from recurring,
approximately up to about 40% of women
were still developing recurrences,
and that’s changed dramatically with the incorporation
of targeted treatments against the HER2 amplification. – Can you explain the difference
between targeted therapy and then I guess what we’d
call standard therapy? – Right, so standard therapy
including chemotherapy for example are drugs
that are not able to discriminate between a
rapidly dividing blood cell as opposed to a rapidly
dividing cancer cell. There is a lot of
collateral damage with chemotherapy, whereas
a targeted treatment looks to exploit a certain
aspect of the cancer, a protein that’s expressed,
a gene that’s over-amplified. We have something that we
can target in the cancer cell to provide a treatment that
is hopefully less toxic. – Doctor Mahtani,
such good information. We have so much more to cover,
so stick around, we’ll be right back. (upbeat chiming music) (upbeat chiming music)
Welcome back to this special edition of Access Health. I’m here with breast
oncologist Dr. Reshma Mahtani. Today, we’re taking
a closer look at HER2-positive breast cancer. Doctor, tell me, is the
goal of treatment similar for all early-stage
breast cancer patients? – Well, our goal of therapy
for early stage breast cancer is to reduce the
risk of recurrence, and by recurrence, I mean
the cancer coming back in the breast, or
in a distant site, for example, the bone,
the liver, the lung. It’s important to recognize
that tumors that are found at an earlier stage and
treated at an earlier stage have a better prognosis. – So explain to me what does
a treatment plan look like? – So when we’re thinking about
how we treat these cancers, there are different
modalities of treatment, so we have surgery, and
we have radiation therapy, we have chemotherapy,
hormonal treatments, and targeted treatments, and
the order that we utilize those treatment
modalities can differ based on the characteristics
of the tumor, on the patient’s preference,
on the physician’s recommendations,
mainly based on things like the size of the tumor,
the lymph node involvement, and most importantly,
the HER2 status of the tumor. – So then Doctor, how do
you determine in what order to administer these therapies? – So there are three time points
that we need to recognize in the treatment
of an early stage breast cancer patient. There is the
neo-adjuvant setting, so neo meaning before surgery,
and in certain instances we offer women treatment
before surgery, then surgery, then at the
completion of surgery and review of the
pathology report, we then offer what we
call adjuvant therapy, and that therapy is typically
for a HER2-positive breast cancer patient, a year,
and then the third time point is extended adjuvant therapy
where we consider giving additional treatment
beyond that year. Now, how do we decide who
gets neo-adjuvant therapy, who gets adjuvant therapy,
well, here’s where we look at the biology of the tumor,
whether it’s HER2-positive or not, where it, is
it just in the breast or is it also in
the lymph nodes? How big is the
tumor in the breast? All these things
factor into the order that we do these things. – Such great information,
knowledge truly is power. You’re sticking around, we
have much more to talk about. But right now, let’s check
in with Christine and Mary Jo for more on their stories. (soft music)
– When the pathology report came back
saying that it was HER2-positive, and I discovered
that my path was gonna be a little bit different
than most of the people who have breast cancer,
it was gonna be a little bit longer,
I just kind of had to wrap my head around that,
I was gonna be going to treatment for more weeks
than most people, I knew going in
that even though I had a longer path,
the path at the end was gonna be much easier
than at the beginning. I wanted to do
everything possible to make sure that my
cancer would not come back. I just want to live life. (soft upbeat music)
– I was really surprised to find out
that I was HER2-positive after my mastectomy. I didn’t know a lot
about HER2 at that time. My doctor explained
it all to me, let me know that there were
different treatment options. I really thought my
treatment was over, other than the radiation
I needed to do, and so, the thought of
doing another treatment was really scary and emotional. I got really upset about it. My treatment plan was
to do chemotherapy for five and a half months,
and once the chemotherapy was over,
then I had to continue the Herceptin
for the rest of the year. – I knew from the get-go I
wanted to get both breasts taken off because of
my family history. When you have a loved one
that dies at a younger age, you kind of have this
clock in your head, and you think, okay, am I
gonna make it past there? My mom died at 54, I
was diagnosed at 50. I wanted to surpass her. I wanted to be able
to have those things that my mom didn’t have. – I love my family and my
children and husband very much, so I had to fight, but I was
able to come to terms with that and know that this drug
would block the HER2 cells and reduce my risk of
recurrence greatly. (optimistic music) (upbeat chiming music)
– Welcome back. Significant advances
have been made over the last 20
years towards the goal of reducing recurrence
for HER2-positive disease and improving outcomes. Dr. Mahtani is still with us
as we continue our conversation about HER2-positive
breast cancer. Doctor, thank you so
much for being here. So before the break,
we were talking about how targeted
therapies come into play in the overall treatment plan. What are these
targeted therapies? – We’re really fortunate to
have three targeted therapies approved for early stage
HER2-positive breast cancer and these treatments
again have really changed the natural history of what
was considered previously one of the most aggressive
subtypes of breast cancer, so we’ve made
considerable progress. The treatments that
we have currently, IV trastuzumab
and IV pertuzumab, are both therapies that
work outside the cell, and block the chemical
signals that are transmitted to the cell to divide
uncontrollably, and they actually also
flag the immune system to take care of
these cancer cells. More recently, an oral
therapy, neratinib, was also approved and
this is a different type of treatment in that it
works inside the cell and is a smaller molecule. – So when do patients require
these additional therapies? – Well, first off, it’s
important to realize that there are a lot of data now
that point to the importance of adding targeted therapies
to chemotherapy, in the adjuvant setting,
so after surgery, we know that the addition
of HER2-targeted therapy improves outcomes. Unfortunately, we still have
patients that are recurring, and so, we heard stories of
women that were concerned, and understandably concerned,
because some of them still have a considerable risk
of recurrence that’s high enough to warrant additional therapies,
and here is where we have to balance the risks
and benefits associated with these treatments,
because the risk of recurrence has to be high enough
to warrant the toxic side effects of the drugs. – But if there is,
then there are options, which is wonderful to know. – Absolutely. – So it is so amazing
that we have come so far with understanding
of breast cancer, and such great advice
today, thank you. We’ll be back with more. (upbeat chiming music) (upbeat chiming music)
For those with a higher-risk disease
such as HER2-positive breast cancer,
recurrence is a real concern, but patients need to know
there are options to help reduce your risk of recurrence. (soft upbeat music)
– At first, after all my treatment,
when I heard about Nerlynx, I didn’t want to
do more treatment. I thought I was over,
I thought that was it, and then I had to
actually sit down and think through it with
my doctor, with my family, and say, hey, I have
to turn this around to a positive thing,
it can reduce the risk of recurrence
significantly for me, especially since I
was estrogen-positive. I just have to do, as much
as I didn’t want to do it, I just had to do it,
it was only a year. I can get through
anything for a year. – So just as I was finishing
up with my year of Herceptin, and thought that
that would be the end of my kind of formal treatment,
I went to a breast cancer symposium
and learned that there was a new treatment
that was being tested and in the approval process
for the FDA, called Nerlynx that was specifically
for early stage HER2-positive breast cancer,
which is the type that I have. At that point, I thought, okay,
I was pretty much done with any kind of formal treatment,
but I went and talked to my oncologist
and he was aware of the trials that were going on
and we didn’t find any trials open at that time,
but I just kept my eye on the research
along with my oncologist, and we waited
until the FDA approval came out, and I went back and saw him and
he had my prescription ready and we went through
the year together, and everything worked
out pretty well, and a lot of the side effects,
we were able to control with antidiarrheals
and things like that. – My doctor told me about
the side effects of Nerlynx, with the biggest
concern being diarrhea, but I had a plan after
speaking with my doctor to take antidiarrheal medicine,
and I really didn’t have many issues at all,
maybe four or five throughout the entire year
that was managed by taking the antidiarrheal medicine. I’d like to really encourage
women to take the medication because you may be one
of the lucky people that don’t have side effects. I had some minor fatigue,
but other than that, I did great, I sailed right
through the entire year. Well, I want women
to educate themselves and advocate for themselves
because if you don’t advocate for yourself, you go along
with whatever’s presented to you and it’s not a
collaborative process. You don’t have a say in
how you’re being treated, and it may not be the best
treatment option for you, you know, you can
get a second opinion, you can find another doctor,
other health care professionals but do what’s best for
you, whatever that is. I really encourage
other women to fight and do everything possible,
don’t let losing your breasts
discourage you from fighting. You want to do
everything possible so you can live your
life to the fullest and be there for your
family and friends. (soft upbeat music)
– There’s a lot of treatments out there. The risk of recurrence
has been diminished Your mind is a great
tool that makes you kind of forget the bad
days and just remember the really, really great
things that happened while you were in treatment. Makes me a little sad
because I had so many great people around me, but,
but what I would say now is, after three years, it,
I feel like I felt before I had breast cancer. – Such powerful stories. Dr. Mahtani, before we
leave, do you have any advice for women out there who are
worried about breast cancer? – Well, again, the good news is,
mortality rates from breast cancer are dropping
and some of that has to do with the improvements
in treatments we’ve discussed today,
but also a lot of it has to do with finding cancers earlier
and the importance of screening and early detection,
leading to a better prognosis, so any changes in
your breast exam, it’s important to bring
that to the attention of your health care provider. It’s also important
of course to adhere to a healthy lifestyle,
staying active, diet, exercise,
limiting alcohol intake, and then if you find
yourself in the situation where you are diagnosed
with breast cancer, it’s crucial to
recognize the importance of your part in the
treatment plan as a patient. Recognize that it’s
important that you understand what are the benefits,
what are the side effects of these drugs, what type
of cancer do you have, and what is the
overall treatment plan? And being a partner in that. – We have truly come so far
in having you here today, thank you, first of all. – Most welcome. – So much advice. I hope you come and
join us again soon. – [Reshma] Thank
your for having me. – We want to thank
everyone who helped us tell this story today, so
revealing and so inspirational. For more information on the
important topic discussed today, please visit our website
at accesshealth.tv and don’t forget to follow
us on Facebook and Twitter. We’ll see you next time. (perky electronic music)
� Access Health �

About the author


  1. My cancer is ER+, PR+, HER2- 8.5 cm and 3.5 cm invasive lobular carcinoma of the left breast. After 3 months taking Lexotrole, had a bilateral mastectomy with 16 lymph nodes removed due to positive nodes in breast and under the armpit. Had expanders and having those removed and implants put in in 5 weeks🤗. Did 8 weeks of radiation 6 weeks after mastectomy. Still on Lexotrole. So my risk of reoccurrence is high based on size of tumor and lymph node involvement but I am HER2- so that’s good news. Anyone HER2- reading this? I’m wondering about reoccurrence chances… it’s like I’m waiting for the other shoe to hit the ground…

  2. My cancer in 2017 was Her2 with no stage. I'm on my 11th surgery to my breast. Now, Fat grafting July 12th. But implant are too big, but doctor is not going to remove them. They are in my armpits. I Pray this new doctor helps me.

  3. I have stage 1 HER2+. I have 3 kids. Most days I’m positive. My insurance won’t pay for a second pet scan, my chemotherapy is finished I just get herceptin and perjeta every 21 days.I’m scared guys😭 I see the breast surgeon on 9/20, I will have a double mastectomy soon

  4. “Dairy cheese contains reproductive hormones that increase breast cancer mortality risk.”
    Eating meat and dairy causes cancer.
    Eat a healthy superior plant based diet for you and your family.

  5. does this mean cancer? to be exact heres the mammogram result

    The breast are heterogeneously dense, which may obscure small masses

    Nodular breast parenchyma w/ no particular suspicious mammographic focus

    There is interval increase in number of the previously seen cluster of microcalcification in the mid to outer upper quadrant of the right breast. This

    is highly suggestive of malignancy. Tissue correlation is suggested.

    Other benign type of calcifications are seen bilaterally.

    Skin line and nipples are unremarkable.

    Axillary areas show no abnormality>

    Birads category 5

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