Breast Cancer Anticancer Treatment And Shingles
Department of Breast Cancer Surgery, Jyoban Hospital, Iwaki, Fukushima
Editor: Yudai Kaneda
School of Medicine, Hokkaido University, Sapporo, Hokkaido
Proposed administration of shingles vaccine.
Starting in late 2021, we propose administering the dry recombinant shingles vaccine Shingrix® to breast cancer patients who will receive anticancer agents over 50 years old because we often experience cases of shingles during anticancer treatment.
Shingles is a skin infection caused by the varicella-zoster virus. The trigger is said to be a weakening of the immune system due to aging, stress, or overwork. Naturally, the administration of anticancer drugs is a powerful trigger.
One million people in the United States are reported to develop shingles annually, and approximately 30% of people will develop shingles during their lifetime.
Breast cancer surgery forced to be postponed.
For example, a breast cancer patient in her 70s developed shingles after completing five months of preoperative anticancer drugs. Numerous blisters appeared on the inner side of the left lower extremity, which was typical of herpes zoster.
It was also when peripheral neuropathy, a side effect of the paclitaxel, was strongly affecting her lower limbs. She had a high degree of pain combined with numbness and could not walk.
Surgery should be avoided for about a month after the onset of shingles.
Effectiveness of vaccine against shingles.
Cost is also an issue for the shingles vaccine.
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Summary Of Main Findings
This is the largest study of this nature to date, and the first to show a clear association between zoster and a subsequent diagnosis of cancer. Following analysis of the primary care records of 13248 patients with a diagnosis of zoster, this study shows that the risk of a cancer diagnosis in adults is significantly increased . The magnitude of the risk varied between cancers, and was highest in younger patients. The median time from zoster to cancer was over 2 years. There were proportionally more cancers in the patients with a history of zoster compared with those without zoster for all age groups and both male and female patients. This was more marked in the first 90 days following diagnosis and in patients over the age of 65 years. A diagnosis of zoster before cancer did not affect survival, although the study was not powered to detect this. Prior immunosuppression was not associated with a change in the risk of cancer ours being the first study to control for this.
Cancer Patients Face Higher Risk For Shingles New Vaccines Hold Promise For Prevention
People newly diagnosed with cancer, particularly blood cancers, and those treated with chemotherapy have a greater risk of developing shingles, according to a new study in The Journal of Infectious Diseases. The findings may help guide efforts to prevent the often painful skin condition in cancer patients through the use of new vaccines. The large prospective study expands on previous research by examining the risk of shingles before and after a new cancer diagnosis and across a range of cancer types among approximately 240,000 adults in Australia from 2006 to 2015.
Shingles, or herpes zoster, is caused by the varicella zoster virus, the same virus that causes chickenpox. Shingles develops when the virus, which remains dormant in the body, reactivates later in life. Nearly one in three people in the U.S. will develop shingles in their lifetime, and there are an estimated 1 million cases in the country each year, according to the U.S. Centers for Disease Control and Prevention.
These findings have important implications in view of recent advances in development of zoster vaccines, wrote Kosuke Kawai, ScD, of Boston Childrens Hospital and Harvard Medical School and Barbara P. Yawn, MD, MsC, of the University of Minnesota, in a related that appears with the new study in The Journal of Infectious Diseases. The commentary authors were not involved in the research.
Fast Facts
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Should You Get A Covid
Some experts recommend that it can be a good idea for people with autoimmune diseases to get the COVID-19 vaccine. This is because people who have autoimmune diseases may have weakened immune systems due to taking immunosuppressant medications to treat their conditions.
People with weakened immune systems may be more likely to get severe COVID-19, according to the . Experts say that the vaccine may be effective against the illness severity. Speak with your doctor to learn more about the COVID-19 vaccine to see if its right for you.
Medicines And Food To Avoid When Taking Palbociclib
When taking palbociclib:
- Do not take anything that contains St Johns Wort
- Do not eat grapefruit or drink grapefruit juice
Some drugs should not be taken with palbociclib. These include some commonly prescribed antibiotics, antifungal and anti-epileptic drugs.
Tell your specialist about any prescribed or over-the-counter medicines you are taking.
If a healthcare professional, such as your GP or dentist, prescribes you a new drug, tell them youre taking palbociclib.
Always ask your treatment team before taking any herbal medicines or supplements.
Palbociclib contains lactose. If you know you are lactose intolerant discuss this with your treatment team.
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Breast Cancer Treatment And Rashes
People who are having treatment for breast cancer may develop rashes as a result of their treatment. Some forms of breast cancer medication, chemotherapy, hormone therapy, and radiation can cause rashes, but they are unlikely to affect only the breast.
Before starting any treatment, a person should talk with a doctor about possible side effects, including breast rashes.
The skin on the breast is prone to many common and relatively harmless rashes. Some common, noncancerous causes of rashes on the breast and other areas of the body include:
Increased Risk Of Varicella
- Yo-Liang Lai,
Roles Conceptualization, Data curation, Formal analysis, Validation, Visualization, Writing original draft, Writing review & editing
Affiliations Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan, Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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Roles Data curation, Formal analysis, Investigation, Methodology, Software, Validation, Visualization, Writing original draft, Writing review & editing
Affiliation Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Chia-Hung Kao,
Roles Conceptualization, Formal analysis, Resources, Validation, Visualization, Writing original draft, Writing review & editing
Affiliations Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan, Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan, Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Discussion Of Findings Within Context Of Literature
The studies to which ours are most comparable are those by Sørensen et al , Buntinx et al , and Ho et al . Buntinx et al , in a smaller primary care study from Belgium, demonstrated an increased risk of cancer after zoster, but only in females over the age of 65 years . Our findings may be a reflection of a much larger sample size . Sørensen et al had a similar sized sample to ours , but these were patients hospitalised with zoster , who were compared with the expected rate derived from the Danish Cancer Registry. They found an overall relative risk for cancer of 1.2 with a cumulative cancer risk of 1.8% in the first year. Similarly to our findings, they found no difference in cancer survival for all cancers but were able to demonstrate a poorer survival for zoster patients with subsequent haematological cancers. Our reported risk is lower than that reported by in the Taiwanese study by Ho et al . Their sample was much smaller and only included patients with herpes zoster ophthalmicus. Our findings differ from those from the large population-based study of Wang et al . This may be explained by study design ours being a retrospective cohort with matched controls and the Taiwanese study being an unmatched cohort with expected incidence of cancer being the comparator.
Prevention Of Armpit Pain
Theres no proven way to prevent breast cancer or lymphatic disorders. But getting annual exams can help you get diagnosed early.
Other causes of underarm pain may be avoidable with a few precautions. For instance, you can prevent a pulled muscle by stretching and not pushing yourself beyond your abilities in the weight room.
Other less serious skin problems, like contact dermatitis, can be prevented by switching deodorants, antiperspirant products, or detergents that might be bothering your skin.
In general, you want to practice good skin hygiene in areas that can trap oil, sweat, and dirt. Keep your armpits clean and dont wait to see a doctor if you notice a rash or other problem.
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Can Shingles Cause Breast Cancer
The shingles virus has never been connected to cancer, but it has the potential to be confused with rashes that are linked with cancer cells. Shingles can develop on or near the breast. Interestingly, shingles favors the torso. When presented on the breast, symptoms typically follow this progression:
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Very sensitive skin, often accompanied by pain or numbness
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Within a week a red rash develops
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With this rash blisters develop
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Blisters break to form scabs
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After several weeks the blisters heal
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Unfortunately nerve pain can continue for up to one year
Palbociclib And Hormone Therapy
In the UK palbociclib is always given alongside a hormone therapy drug.
You may have palbociclib with:
- An aromatase inhibitor if you have not already had hormone therapy for locally advanced or secondary breast cancer
- Fulvestrant if you have had hormone therapy for locally advanced or secondary breast cancer
Some people who had hormone therapy for primary breast cancer, and who now have locally advanced or secondary breast cancer, may be offered palbociclib with an aromatase inhibitor or fulvestrant. This will depend on their circumstances.
Taking palbociclib and an aromatase inhibitor
Palbociclib is taken as a capsule once a day for 21 days followed by a seven-day break. This is known as a cycle.
The cycle is then repeated.
An aromatase inhibitor drug is taken once a day continually throughout the cycle.
Taking palbociclib and fulvestrant
Palbociclib is taken as a capsule once a day for 21 days followed by a seven-day break. This is known as a cycle.
The cycle is then repeated.
Fulvestrant is given in two injections, one into the muscle of each buttock. They are usually given every 14 days for the first three doses, then every 28 days for as long as you are having palbociclib.
If you have not been through the menopause
Aromatase inhibitors and fulvestrant are suitable for women who have been through the menopause .
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How Do Vaccines Including The Covid
Mullen says, Lymph nodes under the arm where a person has gotten a vaccine can become enlarged as part of the normal immune response to the vaccine.
Not all vaccines cause swollen lymph nodes, but ones that cause a more intense immune response, such as the COVID-19 vaccine, some shingles vaccines, and others, are more likely to affect them. The COVID-19 vaccine is a new type of vaccine, and people are reacting strongly to it, Mullen says. That heightened immune response is normal and expected.
She adds that even the yearly flu shot can affect the lymph nodes. Every year, flu vaccine season corresponds with breast cancer awareness month, so some patients are getting mammograms when they have enlarged nodes due to the flu shot.
That being said, the Society of Breast Imaging and the Johns Hopkins breast imaging division do not recommend a delay between receiving the vaccine and scheduling your screening mammogram.
Shingles Risk Increased For Cancer Patients
A new vaccine is safe for cancer patients but hard to find.
by Nancy Averett
Cancer patients face an approximately 40 percent higher risk of contracting shingles than those without cancer, according to a study by Australian researchers. The investigation, which was published Dec. 13 in The Journal of Infectious Diseases, found that the risk was far greater for patients with blood and bone marrow cancers, also called hematological malignancies, than those with solid organ tumors.
Theres been a reasonable amount of research that has shown if you have a cancer diagnosis, youre at increased risk of having shingles, says Bette Liu, senior author of the paper and an epidemiologist at the University of New South Wales, Sydney. Liu and her colleagues hoped to better understand which cancer types make a patient more vulnerable to shingles and whether the risk comes more from chemotherapy-related immune suppression or the cancer itself.
Liu and her colleagues analyzed the medical records of 241,497 adults, comparing cancer and shingles diagnoses over time and looking for where they overlapped. They found the risk of contracting shingles was 41 percent higher overall for cancer patients in the cohort compared to in patients without cancer. Broken down by cancer type, patients with hematological cancers faced a 374 percent higher risk, while patients with solid organ cancers faced a 30 percent higher risk.
Nancy Averett is a science journalist living in Cincinnati.
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Viruses That Can Lead To Cancer
Viruses are very small organisms most cant even be seen with an ordinary microscope. They are made up of a small number of genes in the form of DNA or RNA surrounded by a protein coating. A virus must enter a living cell and take over the cells machinery in order to reproduce and make more viruses. Some viruses do this by inserting their own DNA into that of the host cell. When the DNA or RNA affects the host cells genes, it can push the cell toward becoming cancer.
In general, each type of virus tends to infect only a certain type of cell in the body.
Several viruses are linked with cancer in humans. Our growing knowledge of the role of viruses as a cause of cancer has led to the development of vaccines to help prevent certain human cancers. But these vaccines can only protect against infections if they are given before the person is exposed to the cancer-promoting virus.
Should A Mother With Shingles Continue To Breastfeed
Maybe. If a mother has active shingles infection, she can continue to breastfeed if she does not have skin lesions on her breast. If a lesion develops on or near the areola, where the infants mouth would touch the lesion while nursing, then the mother needs to express her milk on that side to maintain her milk supply and prevent mastitis. She can discard that milk until the infant can resume nursing directly at that breast. She may need access to a hospital-grade pump and additional lactation support to maintain her milk supply and reduce the possibility of developing a breast infection.
Before expressing breast milk, mothers should wash their hands well with soap and water and, if using a pump, follow recommendations for proper cleaning. Breastfeeding can continue on the unaffected breast during this time. All lesions should be covered with clean, dry bandages until they are healed to avoid direct contact with an infant. Mothers need to be vigilant about hand washing until all lesions are fully crusted over.
Immunocompromised mothers who develop an active shingles infection can seek consultation from a specialist on how or if to proceed with breastfeeding. If the infant comes into direct contact with the shingles lesions, consultation with a pediatric specialist is recommended and Varicella-Zoster Immune Globulin may be considered.
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Outlook For Armpit Pain
Armpit pain thats related to a muscle strain might be able to heal on its own after resting your muscles for a few days. If you have other symptoms, like swelling or the presence of a lump, you should see your doctor.
Doctors may refer you to a hematologist who specializes in lymph node disorders or a breast cancer specialist if cancer is suspected.
If you see a rash or other signs of skin problems under your arm, talk with a doctor about treatment or for a possible referral to a dermatologist.
If you suspect a lymph node disorder and have symptoms like fever or congestion, you may have a respiratory infection related to your lymph nodes.
In most cases, early treatment of any condition will lead to better outcomes. If the pain is a temporary muscle-related problem, getting a diagnosis can ease some anxiety too.
If you have armpit pain that lasts for more than a few days or there are other symptoms, like swelling or a rash, see a doctor right away.
Why Does Shingles Appear On Only One Side Of The Body
The varicella-zoster virus is active in specific nerves, so shingles often appears where these nerves are located, mainly in a band along one side of the body. This band corresponds to the area where the nerves transmit signals. The shingles rash stays somewhat localized to an area, and it does not spread over your whole body.
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from ©DermNet NZ www.dermnetnz.org 2022
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The Great Mimicker: Zona Zoster At The Mastectomy Site Causing Contralateral Intramammary Lymph Node Enlargement
Umit Aksoy OzcanAcademic Editor: Received
Abstract
Zona zoster is rarely observed in patients with malignancy when present, it follows a dermatomal fashion. Involvement of widely separated regions is very rare. Hereby, zona zoster causing enlarged intramammary lymph nodes in the opposite breast is reported for the first time in literature. The masses were hypoechoic on US with no hilum and hypervascular on color Doppler US. MRI showed hypointense masses with type 3 time-intensity curve and adjacent vessel sign. The complete regression of the nodes after the antiviral therapy confirmed the diagnosis. In breast cancer patients, IMLN enlargements may mimic breast cancer metastasis, and zona zoster infection of the mastectomy site may present with contralateral IMLN enlargement due to altered lymphatic drainage. When breast US is not sufficient for the differential diagnosis, breast MRI may warrant proper diagnosis, and prevent unnecessary biopsies. Antiviral treatment with followup would be sufficient for management.
1. Introduction
2. Case Report
A 70-year-old breast carcinoma patient was referred for her routine radiological followup. Within the follow-up period the patient had developed painful skin lesions on the mastectomy side in a dermatomal distribution of two-week duration with multiple erythematous firm papulo-nodular lesions arranged along the T-4 segment dermatome, extending from left mammary region to the left scapular region.
3. Discussion