8 Things You Need to Know About De Novo Metastatic Breast Cancer

The diagnosis sounds frightening: De novo metastatic breast cancer, or breast cancer that, when detected, is stage 4 and has already spread to another part of the body — most likely the bones, lungs, liver, or brain. Approximately 6 to 10 percent of women will get this news upon their breast cancer diagnosis.e60dc2a1-f33c-4a05-9b50-8e3e8e59762989318d32-76af-4bbe-b1ad-fd153839cd59 While it may sound terrifying, however, there is hope. “This isn’t an immediate death sentence,” says Stephen Malamud, MD, a medical oncologist and regional director of medical oncology at Nuvance Health Systems in Poughkeepsie, New York. “You’re not terminal. We’re going to be treating you — for years, in many cases.” The development of new therapies that target a cancer’s specific characteristics has particularly improved the outlook for people diagnosed with de novo metastatic breast cancer (MBC), said Tiffany Onger, MD, a breast medical oncologist at Cleveland Clinic. According to a study looking at changes in survival over time in women with de novo MBC, the five-year overall survival rate improved from 33 percent for people diagnosed between 1995 and 1999 to 43 percent in women diagnosed between 2015 and 2017.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ee27365c-13b6-4d9d-bb56-f22d59d751ec Some studies, in fact, have found that de novo MBC has a better prognosis than recurrent metastatic breast cancer (breast cancer that is diagnosed at an early stage and later spreads, or becomes metastatic), possibly because a higher proportion of cases of de novo MBC is HER2-positive (HER2+), a subtype for which there are many very effective treatments.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fd61ea53-c7fd-49a5-8cb7-e1e3a3f22850 “So with the bad news,” Dr. Onger says, “there’s good news — and empowering information.” Here is what else you need to know if you’ve been diagnosed with de novo metastatic breast cancer. 1. Wherever Breast Cancer Metastasizes, It’s Still Breast Cancer and Will Be Treated as Such Breast cancer, if it travels to and lodges in another organ or part of the body, doesn’t transform into a different type of cancer. It’s still breast cancer. 2. The Cancer Cells That Have Spread May Differ From Those in the Original Tumor “Cancer is devious,” Dr. Malamud says. The cells are known to mutate and adapt, often to evade treatment. “It can camouflage itself to hide from an immune system’s attack and it can mutate when it migrates in order to survive,” says Malamud. That’s why you may hear your doctor talking about checking the biology of both the primary tumor (where the breast cancer started) and cells that have metastasized from it to see if the metastatic cells require a different approach to eradicate and control them. 3. Chemotherapy Isn’t Everyone’s Go-to-First Treatment Option The word “chemotherapy” tends to scare people because of its reputation for harsh side effects. But in fact, Onger says, because this type of cancer is often sensitive to hormones, the “gold standard” in some cases is endocrine therapy (also known as hormone or anti-estrogen therapy), such as an aromatase inhibitor (AI), combined with ribociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, which disrupts the function of enzymes in the cancer cell. 4. De Novo MBC Can’t Be Cured, but It Can Be Well Managed “Think of this as a kind of chronic condition that you can live with for years,” Malamud says. A growing array of treatments and approaches — “systemic” body-wide therapies and more narrow-gauged “local” therapies — can slow cancer’s growth and relieve symptoms and side effects, enabling people with de novo MBC to feel as healthy as they can for as long as possible. The surprise for many, Malamud says, is that treatment plans themselves must be managed. “If we exhaust one therapy — it stops working — then we want to find another one that works, and another after that,” he explains. “And by ‘we’ I mean doctors and patients in ongoing dialogue and consultation.” 5. You Need a Doctor Who’s a Breast Cancer Specialist In some hospitals, a single doctor may treat a variety of cancers. For de novo metastatic breast cancer, you’ll want a doctor who specializes in breast cancer. Speak with primary care physicians, cancer care centers, local and regional medical centers and hospitals about recommendations. Also try the Find an Oncologist database of the American Society of Clinical Oncologists (ASCO). “Look for a breast oncologist who will spend time answering your questions,” Onger says, “someone who repeatedly asks how you feel and really listens to what you say.” 6. Clinical Trials Are a Good Idea “That’s how to access state-of-the-art care,” Onger says. While in a clinical trial, Malamud notes, “You won’t be given a placebo — that’s a powerful misconception. Everyone in a clinical trial receives the standard of care, what we know works. Some participants then receive extra — whatever is being tested — to see whether it works better or, perhaps, with fewer side effects.” Though eligibility requirements, inconvenient locations, and other barriers can make enrolling difficult, there are workarounds and ways in which people with de novo MBC can kickstart the process . Good places to start include ClinicalTrials.gov (U.S. National Library of Medicine), BreastCancerTrials.org , and the Susan G. Komen Metastatic Trial Search tool. 7. Genetic Counseling and Testing Is a Good Idea “Understanding the tumor’s genetics can open up all sorts of targeted treatment options,” Malamud says. “And tests that indicate whether there’s an inherited genetic predisposition to breast cancer can help family members better understand and potentially reduce their own risk.” 8. Palliative Care for Pain and Symptom Management Is a Good Idea “Palliative care isn’t hospice care,” Onger says. “We’re not talking about making people comfortable at the end of life .” Palliative care is designed to make people comfortable while undergoing treatment and coping with side effects of their disease and treatment. “We’re talking about extending and enhancing life,” Onger says. Palliative care will vary with the location of the metastases and may include surgery or radiation to reduce tumor size and discomfort; medication, such as bone-strengthening drugs to lower the risk of fractures and stave off bone pain; nutritional and dietary changes; relaxation and stress-relieving techniques, such as meditation , journaling , and mindfulness practices; guided imagery and breath work ; massages; acupuncture and other nondrug treatments for pain, and appropriate forms of exercise.
Resources We Trust Cleveland Clinic: How Palliative Care Can Help if You’re Living With Metastatic Breast Cancer American Cancer Society: Treatment of Stage IV (Metastatic) Breast Cancer Beth Israel Deaconess Medical Center: De Novo Metastatic Breast Cancer: Does Local Therapy Help? Dana-Farber Cancer Institute: Metastatic Breast Cancer Clinical Trials and ResearchAmerican Society of Clinical Oncology: What to Expect When Meeting With a Genetic Counselor

Are you and your partner neglecting sex play? Learn how to add it back into your routine to boost your bond in and out of the bedroom. While "quickies" can be fun and spontaneous, skipping foreplay means missing out on a great way to connect emotionally and physically. According to Pepper Schwartz, PhD, a sexual health expert and researcher at the University of Minnesota in Minneapolis, foreplay is critical, elemental, and necessary. Foreplay, also known as "outercourse," is any sexual activity that occurs before intercourse. There is no single way to engage in foreplay, as it can mean different things to different people. It can involve kissing, caressing, cuddling, flirty texting or talking, massage, and oral sex. If you like it a little rough, biting, pinching, scratching, and spanking can be a turn-on. The goal is to increase sexual excitement, which can help prepare the body for intercourse. Foreplay is sometimes thought of as a warm-up for sex, but it doesn't necessarily have to lead to intercourse. Some couples find foreplay itself to be sexually fulfilling as a main event. The benefits of foreplay include lubrication of the vagina, an extended erection, and the prevention of premature ejaculation for people with penises. The female body pulls the uterus up when aroused, lengthening the vagina. This process, called uterine tenting, creates a pool area for semen, which is part of the reproductive sophistication of our machinery, according to Dr. Schwartz. As those muscles relax, the nerve endings start to get stimulated, paving the way for a more pleasurable experience. Research involving married couples has found that 1 to 10 minutes of foreplay was associated with 40% of women achieving orgasm during sex. That percentage rose to 50 with 12 to 20 minutes of foreplay and 60 with more than 20 minutes of foreplay. If you want more action in bed, you have to let your partner know what you want. But talking about sex can be easier said than done for some. Dr. Lyndsey Harper, a clinical assistant professor of obstetrics and gynecology at Texas A&M School of Medicine in Bryan, Texas, recommends two sentence starters to try when expressing sexual desire to your partner: "I want you to..." and "It feels so good when you...". If it makes you more comfortable, you can bring up your sexual needs outside of the bedroom. If you don't know how to bring it up, she suggests starting the conversation with something like, "Our sex life is really important, and I'd love for us to feel open talking about things. Would it be okay for me to share with you some things I like?" Communication comfort is closely linked to trust. To experience true intimacy and fun foreplay, trusting each other is essential, especially since our needs constantly change. Couples who find it difficult to communicate about their desires should consider seeing a couple's counselor or sex therapist who can help them navigate these discussions.
  • Foreplay is just play. Couples can engage in it however they want. According to Dr. Harper, it generally takes about 20 minutes of arousal for women to become fully lubricated and ready for penetrative sex. However, it is best to abolish the idea of "foreplay" and the "main event" of penetrative sex and work together with your partner to create a fun and intimate sexual life where everyone's needs are met.

https://www.everydayhealth.com/sexual-health/sexual-foreplay.aspx