When you’re battling breast cancer, it can be easy to forget about your bones. But what many Black breasties don’t realize is that their fight against cancer can take a huge toll on their bone health.
As Howard University Cancer Center oncologist Dr. Sara Horton put it: “We know that some breast cancer treatments may cause weakening of the bones. Luckily, there are treatments and lifestyle changes that can help prevent this. Part of your breast cancer management plan needs to include taking care of your bones.”
Bones are dynamic living structures made up of a hard, thick outer layer and a spongy, honeycomb interior. Healthy, young bone constantly breaks down and rebuilds, but eventually your bones break down faster than they build back up. This imbalance creates weaknesses in your bones—thin areas on the outer layer and larger, gaping openings in the honeycomb—that can make your bones brittle and increase your chance of fracture (Westmead Breast Cancer Institute).
For women, estrogen plays a key role in protecting and helping to build bone. When estrogen levels drop, either naturally from menopause or due to some cancer medications, women begin to lose bone strength and density.
You May Also Like
Some common breast cancer treatments that impact or target estrogen, like tamoxifen and certain chemotherapies, speed up bone breakdown and depletion. As a result, breast cancer survivors are at higher risk for bone loss leading to osteoporosis, a condition where the bones become so fragile that they are more prone to breaks or fractures (NIH).
Meet Our Breastie Bone Warrior
Angela (Jersi) Baker is a three-time survivor of ER/PR+ HER2- breast cancer. She was first diagnosed at age 32 with stage 0 non-invasive breast cancer (also called ductal carcinoma in situ or DCIS), which was discovered during her regular yearly physical. Angela decided to undergo a unilateral mastectomy paired with reconstruction. Her doctor also prescribed five years of the drug Tamoxifen to prevent recurrence.
But Angela experienced two recurrences: a local recurrence in 2010 that was surgically removed and then, in 2011, a metastatic stage IV diagnosis. What had felt like a stubborn cold turned out to be metastatic spread of the cancer to her chest wall, spine, and head.
Angela completed 24 rounds of radiation and a regimen of drug treatments. Because of the correlation between estrogen and her cancer, Angela also opted for an oophorectomy—the removal of one or both ovaries—to decrease her estrogen levels and minimize the chances of her cancer spreading further. Angela explanted in 2016.
You May Also Like
Ten years later, Angela runs Angel in Disguise, her own non-profit that provides free transportation to and from doctor’s appointments for cancer patients. Beyond transportation, Angel in Disguise also offers emotional and moral support that includes helping patients to understand diagnoses as well as sitting through treatments with them. Through Angel in Disguise, Angela has currently driven 1,689 patients for 21,369 miles and spent a cumulative 422 waiting hours in doctors’ offices and treatment centers. In her free time, Angela makes beautiful shirts with her catchphrase “Live Life Now” emblazoned on the front.
What Is Bone Mets?
Bone metastasis (known as bone mets) occurs when breast cancer cells break away from the breast and travel to the bones using the bloodstream or lymph system. Once settled in the bones, the cancer cells multiply and grow new tumors.
Bone is the most frequent site of initial metastasis in breast cancer patients and well over 50% of women with stage IV breast cancer develop bone metastasis (Annals of Oncology). In Angela’s case, her breast cancer first metastasized to her breastbone.
In addition to the negative effects of breast cancer treatments and estrogen loss on bone, breasties with bone mets also have to deal with calcium loss. When malignant cancer cells enter bone, those cells draw calcium out of the bone and dump it into the bloodstream instead. Without enough calcium, the bones become weaker.
With so much impacting their bones, 60% of women with bone metastasis will face a serious bone event, such as spinal cord compression, bone fracture, or necessary bone surgery (Supportive Care in Cancer).
What Does Bone Mets Feel Like?
The most common symptom of bone mets is pain, ranging from aching to sharp, closely followed by generalized muscle weakness. Other prominent symptoms of bone mets include constipation (from increased blood calcium), dehydration, sleepiness and fatigue, bone fractures (breaks), spinal cord compression, and high blood calcium levels (American Cancer Society).
Angela experiences joint and bone pain as well as fatigue. “I feel like I’m an 80-year old lady,” she explains. “It tires you out; you need to rest. I feel like I need more help with daily chores. Sometimes I try to keep going, but when your body says sit down you have to sit down, take a break, and re-energize.”
Naps have become Angela’s number one tool for tackling fatigue. As for the pain, Angela tries different remedies including epsom salt baths, a heated massager, acupuncture, and stretching. The most significant management of bone mets symptoms, though, comes from the many ways that Angela cares for her bones every day.
Angela’s Five Ways to Love Your Bones
First and foremost: Listen to your body!
For a longtime single mom who wakes up at 4am to run her nonprofit, Angela has had to learn how to pace herself and how to listen to her body. “I have to take breaks and that’s okay,” Angela says. “You have to listen to your body and not overdo it.”
Anything to keep moving.
“If you sit down too long your bones are gonna get stiff,” Angela often reminds her friends and family, “so you gotta keep moving!”
Since walking has become difficult for Angela, she’s taken to dancing instead. “Even if you don’t feel like it, just move in a chair. You know, you can dance sitting down!” One of her favorite dance tracks is “Ain’t No Stopping Us Now” and she loves to put it on so that she can dance with her dog, Northe. “I’ll just grab her two paws and she’ll dance with me. We’ll dance around the kitchen.”
Angela just finished physical therapy and is in the market for a stationary bike to help her keep moving, too. “I feel like if I’m sitting, at least I can keep my legs moving and build up my stamina.”
Keep your calcium, vitamin D, and vitamin C up.
Women should be getting 1,000 to 1,300 milligrams of calcium per day. You can do this by consuming calcium rich foods like milk, collard greens, and baked beans (Harvard T.H. Chan School of Public Health).
Vitamin D allows your body to effectively absorb calcium, but most Black women don’t get enough of it (National Osteoporosis Foundation). You should be getting at least 1000 international units per day. Vitamin D comes from the sun as well as foods like tuna, egg yolks, and mushrooms (NIH). Also look for cereal, orange juice, and milk fortified with vitamin D. If you take a supplement, make sure it is Vitamin D3.
Women should be getting between 250mg and 1,000mg of vitamin C per day. For reference, a small orange contains 50mg of vitamin C, a medium red pepper contains 152mg, and a cup of cooked broccoli contains 101 mg.
Protect your bones with medicine.
“Xgeva is going to be a part of my treatment plan for the rest of my life,” Angela says. “It’s been with me since 2011 and I’ve changed treatment plans a few times, but Xgeva has always been a part of it. I’m grateful for that. I feel like it gives me peace of mind. I gotta worry about all the other areas, but I feel like the bones are okay. The medicine is taking care of my bones.”
Not only does Xgeva decrease bone breakdown, but it also increases bone density and overall bone strength. Angela gets the Xgeva shot once a month to help protect her bones. “It’s not like other shots I used to get that were thick and would burn,” Angela reassures breasties. “It’s an easy shot.”
Advocate for yourself!
When Angela’s doctors first laid out her metastatic treatment plan, they automatically included Xgeva without Angela having to ask. While she was lucky to have a proactive team, Angela wants all breasties to ask “Am I on all the medicines that I can be on? Is there anything else that can help with my bone health? Really research all the things that you can do to help yourself.”
If you want to know more about how you can love your bones, reach out to us at [email protected] or 443-758-1924. And join us for our Love Your Bones dance party every Friday at 3pm on facebook.com/TouchBBCA/!
Don’t forget to check out Angela’s amazing work through Angel in Disguise at www.angelindisguiseinc.org.
