The District has the highest breast cancer mortality rate in the nation and, like all sufferers, there’s a fear of “chemo brain.”
HealthDay News has now reported that many older breast cancer patients might worry that they will be struck by “chemo brain” after their treatments, but a new study suggests that only those who carry a gene linked to Alzheimer’s face that risk.
Researchers found that breast cancer survivors carrying the APOE4 gene who underwent chemotherapy were more likely to experience long-term impairment in brain function.
But the study did not prove that the gene caused the cognitive problems known as chemo brain. And the declines observed were small, the study authors added.
“It was only a small group who had cognitive problems after chemotherapy treatment, and those women were distinct in having that APOE4 gene,” said Dr. Jeanne Mandelblatt, the lead researcher, according to HealthDay News.
Mandelblatt, a professor of oncology at Georgetown Lombardi Comprehensive Cancer Center in northwest D.C., said the results are good news for the large majority of breast cancer survivors.
Most women who received chemotherapy or hormone therapy didn’t experience long-term thinking or memory declines related to either their cancer or their treatment, the findings showed.
“Our study suggests that, for most older breast cancer patients, chemotherapy and hormonal treatments do not have major adverse effects on cognitive function, at least as measured by our current tests,” Mandelblatt said.
Experts have long been concerned that older people might be at increased risk for thinking and memory problems related to cancer treatment, Mandelblatt said.
Aging is already related to dementia and Alzheimer’s disease, she noted, and seniors also face a number of other health problems that affect their ability to think.
For the study, researchers recruited 344 breast cancer patients between the ages of 60 and 98.
These women were compared with 347 healthy women of similar ages, to see whether breast cancer or its treatments spurred any sort of intellectual decline.
Both groups of women were given a battery of 13 cognitive tests at the beginning of the study, before cancer patients received any treatment. They were retested one and two years later.
Tests showed that women treated with hormone therapy suffered no long-term cognitive problems, whether or not they carried the APOE4 gene.
But breast cancer patients with the APOE4 gene did experience a notable decline in thinking and memory if they received chemotherapy, the researchers reported.
“The APOE4 gene is a very strong genetic risk factor for Alzheimer’s disease,” Mandelblatt said. “There’s probably some interaction between chemotherapy and something this gene controls, but we’re very careful to say this finding needs to be replicated. We also need to take this into the laboratory so we can understand better the mechanisms and pathways.”
Only 20 percent to 25 percent of people are APOE4-positive, Mandelblatt said, and fewer than 30 percent of older breast cancer patients receive chemotherapy.
And she emphasized that the mental declines observed were not large.
“The types of cognitive changes we observed even in this group who were at genetic risk, these changes were reasonably mild and not of the magnitude you see in Alzheimer’s disease,” Mandelblatt said. “We don’t want women to worry that they’re going to have severe memory problems. These were mild declines in cognitive abilities.”
So, it’s too soon to include the APOE4 gene in discussions about breast cancer treatment, Mandelblatt stressed.
“It needs more research before we can make a recommendation like that,” she said. “The primary consideration for women in choosing their treatment is to survive their cancer. If their cancer is more advanced, they’re going to want to choose the most aggressive treatment so they survive their disease.”
Though more research is needed, survivors in the District said it remains important to know your own body and to regularly get checkups.
At 39 years old, District resident Allison Fisher was in the prime of her life. Her focus was on raising her four children.
Little did she know that in February of this year, her life would change forever.
Fisher was in the shower, reaching to wash her armpit when her hand grazed against something. She felt around and immediately knew something was wrong.
That lump on her breast had not been there before and she immediately made an appointment to see her doctor. Her mind was racing with so many “what ifs” in the week that followed.
After a biopsy and several tests, she got the news in early March. It was breast cancer. She had stage 2b Invasive Ductal Carcinoma. It was not estrogen receptive, which is what doctors call double negative.
“You just think you’re going to die and you’re going to leave your kids,” Fisher told WUSA-TV (Channel 9).
The hardest part after learning of her diagnosis was sitting down and telling her children.
“We were just about to start a movie and my dad said my mommy has cancer and we need to take really good care of her,” Allison’s son told WUSA.
After the tears, Allison and her husband Justin went into fight mode. They searched for the best doctors and put a team together that would get them through this. She went through a mastectomy and a clinical trial at Johns Hopkins.
“My hair fell out, my eyebrows, my eyelashes, and trying to be a mom to four kids laying on the couch doesn’t really work,” Fisher said in a televised interview.
It was her husband and children that kept her going through her treatment. Seven months after her initial diagnosis, Fisher is now cancer-free. Her family is now ready for a new chapter and a new year.
“This year, 2018 is just a blur at those point, 2019 is going to be a lot better,” Fisher said.
Fisher’s cancer is aggressive, so there is a high risk of recurrence. She is still undergoing chemotherapy as a precaution and will continue with radiation. That will follow with regular visits to the doctor. They are visits she says she will not take lightly.
Fisher was not old enough to get a mammogram and is thankful she discovered the lump in the shower that day. As a survivor, she said she shares her story because she wants “both men and women to be vigilant about their health.”