Breast cancer is the most common cancer found in women in the United States, with more than 300,000 new cases being diagnosed each year. While approximately half of diagnoses are middle aged women (50-70 years old), about 10% are women under the age of 45 and 20% are women over the age of 70. Current forms of treatment range from surgery such as lumpectomy (removal of a tumor from the breast) and mastectomy (removal of all breast tissue from the breast) to radiation therapy to chemotherapy, as well as multimodal approaches involving two or more treatments.
In an interview with The News-Letter, Dr. Jenni Sheng, an Assistant Professor in the Department of Oncology at the Hopkins School of Medicine, discussed her journey in treating breast cancer patients as well as her clinical outcomes research, specifically in how to improve cardiometabolic health in breast cancer survivors by leveraging diet and activity.
Sheng described her experience as an internal medicine resident at the Lewis Katz School of Medicine at Temple University as formative in shaping her decision to pursue oncology.
“What gravitated me the most towards the field of oncology was the potential for compassionate and longitudinal care, as well as advancement in research and therapies. It is a privilege to help an individual and their family through a terrifying diagnosis, and finding effective treatments that ensure a good quality of life.”
Sheng is currently the principal investigator in clinical trials involving patients who have been diagnosed with early stage and metastatic breast cancer. Her research goals focus on reducing side effects from treatments and improving the overall health and wellness of patients. One of her current studies includes a feasibility study of 24-hour water-only fasting during chemotherapy in breast cancer patients. Previous literature has indicated that short-term fasting can potentially reduce the intensity of common side effects from chemotherapy along with a better tumor response. Such common side effects from chemotherapy include fatigue, nausea and lower blood clots.
“Fasting during chemotherapy reduces side effects by forcing healthy cells into a protective, slow-growth mode while leaving cancer cells vulnerable to treatment, a concept known as differential stress resistance. By lowering insulin and IGF-1 levels, fasting triggers nutrient-sensing pathways that cause normal cells to focus on repair and maintenance rather than proliferation, decreasing toxicity, fatigue and gastrointestinal issues,” Sheng explained.
Differing from an efficacy study that investigates the impact, a feasibility study is a preliminary trial conducted to determine the viability, risks and potential for success of such a protocol. The fasting intervention will be deemed feasible if the majority of participants complete the 24-hour water-only fast for at least three or four out of four cycles of chemotherapy. Symptoms of chemotherapy will be measured through standardized questionnaires. Blood counts will be monitored through routine blood work before each dose of chemotherapy.
Another area of interest for Sheng is addressing the management of obesity in breast cancer patients and their individual struggles with weight loss, which is highly prevalent and impacts cancer and non-cancer outcomes. Obesity increases the risk of breast cancer but also associates with a higher mortality rate. Her Adaptive Nutrition and Exercise Weight Loss (A-NEW) Study evaluated newer strategies to manage excess weight.
“Lifestyle interventions alone, like diet and exercise, may not be sufficient for the majority of patients… [In the A-NEW study], we identified a threshold for weight loss (at least 5% at 8 weeks) that is indicative of longer term weight loss with behavioral intervention alone, and then integrated FDA-approved weight-loss pharmacotherapy (Contrave, which is a combination of naltrexone and bupropion) for individuals who were not attaining sufficient weight loss after two months period of time,” Sheng said.
The results of the A-NEW study also indicate that about half of the breast cancer patients who were slow to respond to behavioral interventions were able to start to losing weight with the addition of anti-obesity medication, validating pharmacotherapy as a potential method of weight loss.
Sheng also discussed several misconceptions around breast cancer. She outlined the multifactorial causes behind breast cancer: only around 5% to 10% of breast cancers are hereditary, while the rest can be a result of environmental factors such as alcohol use and obesity, and emphasized the safety and importance of mammograms.
“While social media and other digital platforms have the power to spread knowledge, they also have the ability to propagate misinformation. For example, there are individuals and sites that state that mammograms are not safe and should be avoided because of radiation; I disagree with that recommendation. Mammograms are standard of care, and help to diagnose breast cancers as early as possible. This helps to not only improve survival outcomes but also reduce the change of needing more intensive treatments for higher stage breast cancer. The radiation that one would receive from a mammogram is very small, [less than] a year of natural background radiation.”
There have been multiple advancements in the field of breast cancer research within the past decades especially in tumor detection and diagnosis, such as 3D mammography, abbreviated breast MRIs and artificial intelligence in analyzing mammograms. Amid the rapid growth, Sheng spoke of the consistent responsibility to provide equitable care to all patient populations regardless of socioeconomic status.
“We have all these wonderful diagnostics, and we need to make sure that everyone has access to regular primary and gynecologic care to ensure that routine breast cancer screening is completed,” she said.
Lastly, Sheng underscored the importance of collaboration between physicians across different specialities, characterizing it as a unique feature of oncology.
“Cancer care is multidisciplinary and we convene on a weekly basis to discuss new and complex cases. We work closely with a breast surgeon, radiation oncologist, pathologist and radiologist to give our patients comprehensive care, and the best possible treatment experience and outcome.”