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Q&A With Kevin Kalinsky, MD

By Kevin Kalinsky, MD, director of breast medical oncology at the Winship Cancer Institute of Emory University, as told to Alexandra Benisek 

In the WebMD webinar “Triple Negative Breast Cancer: How We Are Learning to Treat it More Effectively,Kevin Kalinsky, MD, director of breast medical oncology at the Winship Cancer Institute of Emory University, answered viewer questions about TNBC and its treatments.

We don’t have clear data from any of the tumor subtypes about stress and how it affects the development of cancer. There’s some preclinical data, meaning data in the lab, that’s looked at stress hormones and the risk of cancer coming back. But again, those are preclinical data. And that hasn’t necessarily been translated into how we can care for people with TNBC.

When I speak to people about stress management, it’s important for us to think about the impacts stress can have, period — on our overall well-being and mindfulness. 

There’s data suggesting this link between mind-body connection and the outcomes of someone with TNBC. However, there haven’t been clear data about relationships between stress hormones and risk of recurrence — and whether that can help lessen the risk of cancer coming back.

When we treat people who have triple-negative breast cancer, and if we give them systemic therapy, it’s to lessen the likelihood that the cancer comes back. This includes lowering their risk of a metastatic recurrence of triple-negative breast cancer (when the cancer has spread to other parts of your body). 

We think more of the risk of other cancers happening if someone carries a genetic predisposition like the BRCA gene. With BRCA, there’s a risk of breast cancer, including with BRCA1 and the link with triple-negative breast cancer and, for instance, ovarian cancer.

So if people have a genetic predisposition, depending upon what that is, there may be a risk for other cancers as well.

There’s data that looked at people who took supplements during chemotherapy. We saw that the more supplements people take, the worse their outcome. And it may be that these are interfering with some of the treatments that we’re giving.

There’s certainly been interest in turmeric. But I would say that, in general, whenever you’re taking supplements to make sure that you’re talking with your doctor.

It comes down to a case-by-case basis. For example, there was a study that looked at giving a supplement, L-carnitine, to see whether it lowered the risk of neuropathy. We actually saw that it made the risk of neuropathy go up. 

This is the most common question we get in breast cancer. There are ongoing studies that look at nutrition and exercise and whether this can help with better outcomes, including in triple-negative breast cancer.

We’re waiting for the results to help us answer this question. 

I would say that it’s always helpful to speak with your nutritionist, even outside of breast cancer recurrence, just to have a healthy lifestyle. And I’d say, in general, everything in moderation.

Yes, it’s an excellent question and something that’s important for us to continue to evaluate.

I think it’s been one consistent finding over the years, and also just puts emphasis on the importance that people — in particular young women who are non-Hispanic Black — maintain getting their screening mammography and stay up to date with those images. Especially if they have a strong family history.

I don’t know if inequities are related to prevalence. But for outcome differences, this remains an important question in terms of social determinants of health. 

That’s not just for triple-negative breast cancer, and not just for non-Hispanic Blacks versus non-Hispanic Whites. The differences can also be seen with urban versus rural communities. 

This is an extremely important question in terms of access to care. And even when somebody has care, whether there’s a difference in their level of care. We know there can also be differences in communities in terms of the rate of mammographic screening.

Watch an online replay of  “Triple Negative Breast Cancer: How We Are Learning to Treat it More Effectively.”

Watch other free WebMD webinars by leading experts on a variety of health topics. 

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