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Pamelas Big Heart Foundation Inc.
Barriers
- Representation
Commitments
- Pamelas Big Heart Foundation Inc. commits to improving life and advocating for all women especially women of color on all levels.
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“Be the change you wish to see”-Ghandi
“If you haven’t hired a team of people who are of color, female, and/or LGBT to actively turn over every stone, to scope out every nook and cranny, to pop out of every bush, to find every qualified underrepresented founder in this country, you’re going to miss out on a lot of money when the rest of the investment world gets it.”~ Arlan Hamilton
Castor EDC
Barriers
- Representation
Commitments
- Castor commits to collaborate with Tigerlily Foundation to host Town Hall with internal leadership and staff.
- Castor commits to highlighting its commitment through a social media campaign.
- Castor commits to issue a press release for call to action with partners, suppliers, and customers.
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Coming soon
Chris Venezia
Barriers
- Representation
Commitments
- Informa commits to continue to find and give exposure to more partners like Tigerlily who are focused on such important D&I initiatives in clinical trials.
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Coming soon
Speak Up for Your Bones
Author: Virginia Leach
To conclude the Amgen Bone Health Series, the Tigerlily Foundation has connected with one of our ANGEL Advocates to learn about the effects of breast cancer on bones.
Unfortunately, being diagnosed with breast cancer can lead to a ripple effect of health issues that patients are not always aware of. Although the primary concern is reducing and removing cancer from the body, patients put their bodies through extreme processes when exposed to chemotherapy, radiation, and intensive drug medications. Exposure to harsh treatments forces the body to change rapidly. One of the potential changes is the drastic loss of bone mass in the body, leading to osteoporosis.
The story of Kiana Wooten demonstrates just one example of breast cancer treatment leading to unintended health consequences needing to be addressed.
Kiana Wooten’s Story
Kiana Wooten was very young when she was diagnosed with breast cancer. At 34 years old, she was informed that she had Stage 2A Invasive Ductal Carcinoma (IDC).
This type of cancer is labeled as one of the most common types of breast cancer due to its prevalence in diagnosis. Almost 80% of all breast cancer diagnoses are labeled as IDC. What does this type of breast cancer mean exactly: “Invasive” means that cancer has spread or invaded throughout the surrounding breast tissues; “Ductal” means that cancer has started in the milk ducts, which are tubes that carry milk to the nipple; and “Carcinoma” is cancer that begins in the skin or any tissue that cover internal organs. Therefore, this type of cancer has moved from the wall of the milk duct to move throughout the breast; from there, it can spread to the lymph nodes then to the rest of the body. Over 180,000 women are diagnosed with this cancer yearly.
Just three years after Kiana’s breast cancer diagnosis and completing several cycles of chemotherapy, she was told that she had full-blown osteoporosis after completing a bone density scan. She has lost almost 15% of bone mass due to the side effects of chemotherapy on her bones. You might be thinking 15% loss of bone mass does not sound like a lot, but in just one year, that is a significant amount of bone loss.
To address osteoporosis in Kiana’s bones, she recently started receiving Zoledronic acid infusions to strengthen her bones at her local cancer institute twice a year. These infusions take several hours to complete, in addition to getting blood drawn. Depending on time and point in the osteoporosis treatment cycle, Kiana may have to get two infusions of Zoledronic acid in one day, which takes a lot of energy to complete.
In her own words, this is what Kiana had to say about dealing with the side effects of chemotherapy: “People look at me, and they say I look great and that I don’t look sick. I’m not sick, technically, but having to do injections monthly and taking oral chemo and now having other ailments from chemotherapy really stresses me. It would stress anybody in that situation. I’m sure other cancer patients could attest and agree with what I’m saying. This is what we go through. This is the aftermath. This is my aftermath of chemotherapy.”
Breast Cancer, Bone Health, and Patient Self-Advocacy
Conversations around breast cancer and bone health are rarely discussed with patients until the issue has grown severe, like in Kiana’s case. There is an urgent need for primary care physicians and oncologists to speak with their patients about bone health before starting cancer treatment. Everyone recognizes the seriousness of detecting breast cancer early and beginning a holistic treatment plan right away. However, bone health should not be left off the table for discussion.
Research from one study demonstrated that, “Overall, breast cancer survivors had a 68% higher risk of osteopenia and osteoporosis than [individuals without cancer].” The study also showed, “The risk for women receiving chemotherapy plus hormone therapy was 2.7 times higher than [individuals without cancer]. The risk was greatest for women receiving chemotherapy plus aromatase inhibitors—3.83 times higher.”
Breast cancer patients and survivors should be well-informed of the short and long-term effects of cancer treatment. When patients are armed with this knowledge, they can bring it to the attention of their medical providers and prepare a proactive plan to protect and love their bones.
Kiana said it best: “The frustration I feel when it comes to the aftermath of cancer. We, breast cancer patients and survivors, honestly, just exchange one ailment for another! If people only knew…”
Sources
Amgen. “Know Your Bones.” Amgen, 8 October 2018. https://www.amgen.com/stories/2018/10/know-your-bones.
Bath, Charlotte. “Increased Risk of Bone Loss Extends to Younger Women Treated for Breast Cancer.” The ASCO Post, 25 February 2019. https://ascopost.com/issues/february-25-2019/increased-risk-of-bone-loss-extends-to-younger-women-treated-for-breast-cancer/.
Tigerlily Foundation. “My Life Glossary.” Tigerlily Foundation, n.d. https://oldtlf.iedev.net/breast-cancer-toolkit/my-life-glossary/
Facing the Facts About Bone Health
Author: Virginia Leach
Which Bone Loss Prevention Therapies Are Available?
Several medications or forms of therapies are available to prevent further bone loss. Although there are more options than what’s included on the list below, this is a start to begin thinking about what you can integrate to help with bone loss as you get older. The following four medicines and therapies can be incorporated into one’s daily regimen.
- Bisphosphonates – A constant cycle of bone cell creation and breakdown forms bone cells. Bisphosphonates are used to strengthen bone density by reducing the speed of the breakdown process. This type of medicine can have long-lasting effects, but studies have shown that its benefits may be contained in the first five to seven years of taking it.
- Denosumab – This type of therapy is an under the skin injection received twice a year. It slows the breakdown of bones and can be used as a short-term intervention.
- Menopausal Hormone Therapy (MHT, previously known as HRT) – Women lose estrogen as they age. MHT boosts estrogen levels and reduces the chance of getting osteoporosis after menopause is experienced. Although this therapy indirectly helps prevent bone loss by increasing estrogen, it is associated with an increased risk of other conditions.
- Selective Estrogen Receptor Modulators (SERMs) – The role of SERMs is to perform just like estrogen in the body. By behaving in this way, SERMs can reduce bone loss.
What Are the Health Risks of Bone Loss?
The health risks of bone loss should be understood from two perspectives: short and long-term effects. In the short-term, bones with low density can put you at risk for experiencing fractures. When we are younger, our bones are strong and have a lesser chance of breaking when we fall or get hurt. As we age, the strength of our bones gets weaker. The long-term effects of bone loss can be seen when bone density levels are so low that individuals are diagnosed with osteoporosis. The condition of osteoporosis for postmenopausal women can be an issue if one falls. There is a good chance that falls after menopause are not because you are clumsy. According to Amgen, women can lose up 20% of their bone density after menopause, which can lead to bone fracture. Once severe bone density is lost, lifestyle changes that focus on diet and exercise may no longer improve bone health.
Additional Suggestions to Improve Quality of Life and Bone Loss Prevention
In previous articles in the bone health series, Tigerlily Foundation shared several ways to prevent bone loss through food choices, vitamin supplements, and lifestyle changes. Below is a list of additional suggestions that can improve bone health while addressing other key areas in life.
- Gentle exercise – Participating in physical activity that focuses on posture helps train the mind to slow down and pay close attention to your body movements.
- Improving balance – Connect with a physiotherapist or exercise physiologist to learn and practice influential exercises.
- Wearing glasses – In many cases, we are our own obstacle to improving our quality of life. For those prescribed glasses or who have considered getting glasses, wearing them can prevent falls that can cause fractures.
- ‘Trip proof’ your home – Things like removing loose rugs, installing handrails in bathrooms and along stairs, and keeping all rooms well-lit can improve safety in the home.
- Shoe type and quality – Wearing shoes that offer support and fit properly can improve your balance and posture over time.
How Can We Support Our Bones Through Their Natural Journey?
Since bone breakdown occurs faster later in life, it is vital to build up bone mass early in life. Individuals in their teens and 20s have a slight advantage in giving their bones some love. Taking specific steps like eating the right foods and exercising early in life can build bone mass. Later in life, when estrogen levels drop, bone care continues to be essential to reduce the risk of too much bone breakdown and developing osteoporosis. Always consult a medical provider to inquire about ways to strengthen your bone health.
Sources
Amgen. “Know Your Bones.” Amgen, 8 October 2018. https://www.amgen.com/stories/2018/10/know-your-bones.
Better Health Channel. “Osteoporosis.” Better Health Channel, 3 April 2019. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis.
Tigerlily Foundation. “Bone Health and You.” Tigerlily Foundation, n.d. https://oldtlf.iedev.net/bone-health-and-you/.
Tigerlily Foundation. “Pure Cat Initiative.” Tigerlily Foundation, n.d. https://oldtlf.iedev.net/programs/pure-cat-initiative/
Did You Know Your Breast Cancer Treatment Could Affect Your Bones?
Author: Virginia Leach
Is There a Link Between Bone Health and Breast Cancer?
Osteoporosis is a condition in which bones become weak and brittle. Those who have osteoporosis are at a higher risk of developing bone fractures. Many factors affect osteoporosis risk, including diet, exercise, and genetics.
Hormone levels play a role in osteoporosis risk as well. Estrogen is one such hormone, and higher levels have reduced bone breakdown. Conversely, when estrogen levels decrease, bone breakdown can increase. While some bone breakdown is normal and natural, too much breakdown with insufficient rebuilding can result in osteoporosis and put you at a higher risk of bone fractures.
The breasts and the bones are both estrogen-sensitive organs. Therefore, more estrogen exposure means less risk for osteoporosis. However, more estrogen in the blood may also indicate an increased risk of breast cancer, specifically in women after menopause. Additionally, higher lifetime exposure to estrogen may increase breast cancer risk.
Due to the estrogen link, higher bone mineral density (BMD) is associated with a higher risk of breast cancer.
Hormone Positive (HR+) Breast Cancer and Bone Loss
According to the University of Pennsylvania’s Abramson Cancer Center, HR+ breast cancer can be determined when breast cancer cells have receptors for either progesterone or estrogen. From their research, almost 80% of all HR+ breast cancers are positive for estrogen receptors (ER+) or form a combination of positive progesterone receptors (PR+) and estrogen receptors (ER+).
HR+ breast cancer operates differently from other types of breast cancer on bone loss. As a result, oncologists will often include hormone therapy in treatment care plans to block or lower the number of hormones in the body. This treatment, in particular, can increase the risk of bone loss.
Antiestrogen Therapies: Aromatase Inhibitors and Tamoxifen
Antiestrogen therapies block hormone actions or lower hormone levels in the body. Two such therapies, aromatase inhibitors and tamoxifen, have been shown to negatively affect bone health in women.
Aromatase inhibitors (such as anastrozole, letrozole and exemestane) reduce the amount of estrogen in the body, which can help with breast cancer outcomes. Unfortunately, it can also reduce bone density. Since these drugs block the conversion of androgen to estrogen, estrogen levels in the body are decreased. As mentioned previously, lower estrogen levels often mean reduced bone mineral density. In the case of aromatase inhibitor use, it has been reported that bone fracture risk is increased, and bone loss is accelerated.
Tamoxifen is another antiestrogen therapy that blocks estrogen from attaching to hormone receptors. Since breast cancer cells need estrogen hormones to grow, this obstruction helps slow or stop cancer growth in some instances. Tamoxifen’s effects on bone health depend on whether a woman is premenopausal or postmenopausal. Data suggests this drug has an opposite effect depending on the stage of life. The effects tamoxifen has on bone health depends on whether a woman is premenopausal or postmenopausal, as data suggests this drug has an opposite effect depending on the stage of life. In postmenopausal women, tamoxifen appears to protect against bone loss. In contrast, it seems to decrease bone mineral density in premenopausal women.
What You Can Do to Love Your Bones When Undergoing Breast Cancer Treatment
While specific common breast cancer treatments have been shown to result in positive outcomes, unfortunately, many come with the side-effect of taking a toll on bone health.
It is wise to support bone health before and during treatment (if possible) to maximize bone density when possible. This includes steps like:
- Limit or avoid alcohol
- Participating in weight-bearing exercise
- Avoiding cigarette smoking
- Reducing caffeine intake
- Healthy diet and exercise lifestyle choices
- Good wellness habits such as adequate sleep and stress-reducing activities
- Consuming sufficient calcium, magnesium, phosphorus, and other bone-building nutrients
Bone health can be compromised when treating breast cancer, depending on the care plan. Supporting bone health before, during, and after treatment is a wise step to reduce your risk of struggling with bone health issues later in life, like fractures or an osteoporosis diagnosis. Simple steps can have an enormous impact when it comes to bone health.
Sources
The American Cancer Society medical and editorial content team. “Hormone Therapy for Breast Cancer.” The American Cancer Society, 27 October 2021. https://www.cancer.org/cancer/breast-cancer/treatment/hormone-therapy-for-breast-cancer.html.
Cancer Research UK. “Osteoporosis Risk and Hormone Therapy.” Cancer Research UK, 27 January 2021. https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/hormone-therapy/osteoporosis.
Tigerlily Foundation. “Bone Health and You.” Tigerlily Foundation, n.d. https://oldtlf.iedev.net/bone-health-and-you/.
Tigerlily Foundation. “Pure Cat Initiative.” Tigerlily Foundation, n.d. https://oldtlf.iedev.net/programs/pure-cat-initiative/.
University of Pennsylvania Abramson Cancer Center. “Hormone Positive Breast Cancer.” University of Pennsylvania Abramson Cancer Center, n.d. https://www.pennmedicine.org/cancer/types-of-cancer/breast-cancer/types-of-breast-cancer/hormone-positive-breast-cancer#:~:text=Breast%20cancer%20cells%20that%20have,are%20ER%2B%20or%20ER%2FPR%2B.
Zlatopolsky, Ashley. “Antiestrogen Therapy for Breast Cancer.” Healthline, 12 August 2021. https://www.healthline.com/health/breast-cancer/anti-estrogen-therapy
Bone Health and Why It Matters to You
Author: Virginia Leach
Several things can impact how our bone health may deteriorate over time. First, you might be taking steps to be proactive about your bone health, including taking vitamin C and D supplements, stretching daily, and incorporating non-traditional wellness habits such as red-light therapy. All of these activities can support healthy bones. Still, other things outside of our control may impact and contribute to bone loss.
What You Should Know About Bone Health When It Comes to Breast Cancer
When young women are diagnosed with breast cancer, they can experience early menopause, osteoporosis, and loss of estrogen due to treatment.
Many factors need to be managed while undergoing breast cancer treatment. Even though certain items may be obvious, others may not be as straightforward. Bone health is an element that should be top-of-mind when undergoing your breast cancer treatment journey.
Chemotherapy
Chemotherapy is a standard treatment for breast cancer. While many women succeed with this treatment, they may find a lower bone mineral density (BMD) once treatment is complete. This is likely due to chemotherapy’s effects on the ovaries and organs that produce estrogen. Chemotherapy is associated with ovarian dysfunction. Thus, the onset of menopause can begin and arrive earlier in premenopausal women who received chemotherapy treatments. Earlier menopause means estrogen levels are reduced, which leads to an increase in bone breakdown that results in the loss of bone density.
Ovarian Suppression
Ovarian suppression, also known as Ovarian Ablation, is a controversial therapy for breast cancer treatment. It has been used for many years and involves removing or temporarily stopping the ovaries from working. When ovaries are not working efficiently, estrogen is not being secreted. Thus, with reduced estrogen, bones may break down faster resulting in a higher risk of bone loss or fracture.
Radiation
Radiation therapy is a cancer treatment that utilizes high doses of radiation directly onto the tumor. Undergoing radiation therapy can take a toll on bone health by damaging soft-tissue components of the bone, including blood vessels. As a result, radiation may lead to bone loss in the area where radiation therapy was given, as well as an increased risk of fracture over time.
Osteoporosis
A study conducted by Dr. Cody Ramin and colleagues (2018) found that osteoporosis can occur in women under 50 years old at a higher risk than those of the same age who do not have cancer. From their research, breast cancer survivors had a 68% higher risk of developing osteopenia and osteoporosis than cancer-free women. The reason for developing osteoporosis earlier stems from undergoing cancer treatment. Bone health should be monitored during and after the cancer treatment process.
Bone Loss Prevention Therapies
Bone loss prevention therapies have proven almost universally effective for limiting bone loss in cancer patients. Some examples of bone loss prevention therapies are as follows:
- Resistance and weight-bearing exercises are popular bone loss treatments. Bone is a living tissue that becomes stronger with exercise. Participating in resistance exercises like weight-lifting or weight-bearing exercises like walking can be an excellent part of bone loss prevention therapy.
- Immunotherapy helps the immune system identify and more effectively eliminate cancer cells.
- Denosumab (Prolia/Xgeva) is a group of drugs used to prevent or treat bone problems. It has been shown to increase bone mass in some instances.
- Bisphosphonates are drugs that prevent the loss of bone density. They are the most prescribed drugs used to treat osteoporosis. Zoledronic acid (Reclast/Zometa) is a bisphosphonate that reduces the amount of calcium released from bones into the bloodstream. It also works by slowing the breakdown of your bones by cancer to prevent bone fractures.
Note that specific side effects may occur, such as osteonecrosis of the jaw (when the jaw bone is exposed and begins to starve from a lack of blood) and hypocalcemia (low blood calcium levels). Therefore, always consult a medical provider before starting any therapies mentioned above.
Bone health can, unfortunately, be compromised when treating breast cancer, depending on the plan of care. Supporting bone health before, during, and after treatment is a wise step to reduce your risk of struggling with bone health issues later in life, like fractures or an osteoporosis diagnosis. Simple steps can have a large impact when it comes to bone health.
Sources
Johns Hopkins Medicine. “Bone Densitometry.” Johns Hopkins Medicine, n.d. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bone-densitometry.
Johns Hopkins Bloomberg School of Public Health. “Osteoporosis Risk Rises Sharply Even For Younger Breast Cancer Survivors.” Johns Hopkins Bloomberg School of Public Health, 28 November 2018. https://publichealth.jhu.edu/2018/osteoporosis-risk-rises-sharply-even-for-younger-breast-cancer-survivors#:~:text=Study%20results%20suggest%20that%20common,who%20do%20not%20have%20cancer.
Tigerlily Foundation. “My Life Glossary.” Tigerlily Foundation, n.d. https://oldtlf.iedev.net/breast-cancer-toolkit/my-life-glossary/.
Tigerlily Foundation. “Treatments.” Tigerlily Foundation, n.d. https://oldtlf.iedev.net/breast-cancer-toolkit/treatments/.