The CRBCM has grown to a larger Oncology Clinic
but its interest with Breast Cancer has sharpened.
It is clear that Breast cancer in the young women is clearly associated with not only to obesity as claimed by Pundit but to undefined, undiagnosed autoimmune syndromes. The link to autoimmune syndrome appears to be stronger despite the fact that it is also the more difficult to ascertain. There appear to be no consensus among Immunologist as what should constitute a basic work-up for autoimmune syndromes.
There are many autoimmune syndromes and all seem to lead to cancer predisposition. Autoimmune disease detection remains the biggest challenge and mostly not completed at the time of diagnosis of cancer in a young individual. Therefore it remains ignored. In our practice, the basic screening include :
1.ANCA
2.Anti-Saccharomyces Cerevicea for detection of early Colitis and related colon cancer
3.Anti CCP
4.Rheumatoid factor
5.and ANA
(rarely anti-Smith)
rarely we add the anti-RNP for possible connective tissue disorder.
It is clear that a full Lupus panel would be advised but cost could be prohibitive and, in these days in age, the insurance companies limit our exploration.
Quickly one will note that some tests are "confirmation" test while other are "screening" tests. In our hands, experience show that many times these so called confirmation test could be positive while the screening test is in the "high normal". In these instances, suspected diagnosis is made. It belongs to the Rheumatologist to actually treat accordingly.
With this approach, countless of Lupus positive young women are found among our Breast cancer patients. We will publish our findings soon. The interest is also in the frequency of Bilateral findings of Breast cancer among these patients. Care should be exercised while following these young patients.
The patient with Antisaccharomyces calls for attention to early colonoscopy. Countless young women approached this way are found with Polyps and at least one patient was found with a non invasive colorectal cancer. Certainly this antibody will be talk about in the future as we discuss increasingly about early colonoscopy. (As we speak, I have a 49 year old found with stage IV colorectal cancer who is Rheumatoid Factor Positive and anti-Saccharomyces positive).
In the absence of clear autoimmune syndrome by lab, suspicion is kept in patient with sudden profound fatigue that remains explained, anxiety or Depression, insomnia, and low Vitamin D
arthritic pains and sometime Hypothyroidism. Those will colitis will report bouts of unexplained diarrhea, or constipation, or hx of Gallbladder disease including history of cholecystestomy (and ITP). These are present in autoimmune syndromes.
The reason for the association of autoimmune disease correlation with early cancer remains a mistery and is an area of intensive research. We are on it. From "proximity of genes" and something to do with "check points". We will update you as the thing unfolds.
