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HER2-Positive Breast Cancer Survivorship: Moving Forward and Staying Healthy

Posted on September 30, 2022
Medically reviewed by
Todd Gersten, M.D.
Article written by
Joan Grossman

  • Advances in treatment for human epidermal growth factor receptor 2 (HER2)-positive breast cancer have improved survival rates considerably.
  • Healthy lifestyle changes have been shown to increase survival time and reduce the chance of breast cancer recurrence.
  • Emotional support is also an important part of overall health and well-being.

Advances in treatment have increased survival for those diagnosed with HER2-positive breast cancer, and more people are staying healthy for longer without cancer coming back (also called recurrence). Surviving breast cancer and staying healthy is a topic many MyBCTeam members discuss. “No more oncology, no more medicine, and the results of my physical were great. Now just to maintain and stay healthy!” a member wrote.

Staying healthy after treatment — or with maintenance treatment — is an important part of survivorship for people with HER2-positive breast cancer. With improved treatment options and lifestyle changes, you can take effective steps to protect your health and quality of life.

Read on to find ways to get the support you need for both your physical and mental well-being as you live as an HER2-positive breast cancer survivor.

Improved Survival With Current Treatments

In the past, an HER2-positive breast cancer diagnosis meant a poor prognosis (outcome) — a high rate of recurrence and a shorter survival time. Better treatments have changed outcomes for people with this subtype of breast cancer. These days, after six years of treatment following current standards of care — that is, treatments generally accepted in the medical community — more than 90 percent of people with early-stage HER2-positive breast cancers don’t experience recurrence.

Advances in Treatment Options

Current treatment options for HER2-positive breast cancer include targeted therapies that have dramatically improved survival. Trastuzumab (sold as Herceptin) was the first drug used to target HER2-positive phenotypes and showed significant improvement when added to standard chemotherapy regimens. Trastuzumab is a monoclonal antibody (human-made antibody made in a laboratory) treatment that has improved HER2-positive breast cancer survival by as much as 58 percent. An antibody is a protein produced by the body’s immune system when it detects harmful substances.

Since the release of trastuzumab, more treatments have been developed. Other monoclonal antibodies, such as pertuzumab (Perjeta) — as well as kinase inhibitors — have extended life expectancy for both nonmetastatic (cancer that hasn’t spread beyond the breast) and metastatic (cancer that has spread) HER2-positive breast cancer, including cases with brain metastasis.

New treatment options, including targeted therapy and immunotherapy treatments, are currently in clinical trials — research studies to determine the effectiveness of treatments on people. These new treatments are showing promising outcomes for longer progression-free survival for people with HER2-positive breast cancer. Progression-free survival is the length of time during and after the treatment that a patient lives with the disease but it does not get worse.

What You Can Do to Stay Healthy

There are many steps you can take to stay healthy after HER2-positive breast cancer treatment is complete, or while taking maintenance treatment. Positive lifestyle changes can help you live longer and give you a sense of control over your health.

Maintain a Healthy Weight

Studies show that a weight gain of more than 10 percent during or after breast cancer treatment increases the risk of cancer recurrence and decreases survival time. People with obesity at the time of HER2-positive breast cancer diagnosis also have a higher risk of recurrence and mortality (likely to die). Higher weight and obesity are also associated with a greater risk of lymphedema, a buildup of lymph fluid that causes swelling after cancer treatment.

Maintaining a healthy weight is not only associated with increasing the rate of progression-free survival. It can also improve overall health and reduce the risk of other diseases, including lowering the risk of developing other types of cancer.

Eat a Well-Balanced Diet

A healthy diet has also been shown to increase breast cancer survival. Research shows that a diet high in vegetables and fiber, and low in fruit juices, is linked to longer survival rate for people living with breast cancer. Breast cancer survivors who ate a daily serving of cruciferous vegetables such as broccoli and cauliflower had a 13 percent lower risk of mortality, while those who ate two servings per day of leafy green vegetables had a 20 percent lower risk of mortality. Whole fruits, rather than juices, were not found to raise the risk.

Eating large amounts of carbohydrates was found to decrease survival from breast cancer. Likewise, saturated fat, which is found in red meat and high-fat dairy products, has been linked to metastatic breast cancer.

MyBCTeam members frequently discuss healthy eating. “I’m so glad my entire palate changed after chemo. I can’t eat junk food or fast food anymore. I’ve actually lost 17 pounds instead of gaining the ‘tamoxifen 20,’” said one member.

Some research has indicated that a Mediterranean diet of vegetables, fruit, unsaturated fat, fish, and whole grains is associated with a higher survival rate from breast cancer. You can find more guidelines for a healthy diet for breast cancer here.

Your health care team can provide a referral for a nutritionist or dietitian to help you make meaningful changes in your diet.

Stay Active

Per an article in Cancer Research, regular physical activity and exercise can improve survival and reduce the risk of recurrence in people with breast cancer, particularly in those with HER2-positive breast cancer. Regular exercise reduces the risk of breast cancer recurrence by as much as 55 percent and decreases the risk of death by as much as 68 percent, according to the National Cancer Institute. In people with HER2-positive breast cancer, exercise has also been shown to minimize heart-related side effects from trastuzumab (cardiotoxicity).

“I started working out after six months of chemo and steroids. Not only am I feeling better, but I have lost weight. I am just now hearing that weight training slows estrogen and helps in slowing down or stopping recurrence,” a MyBCTeam member with stage 4 HER2-positive breast cancer shared.

Physical activity and exercise can also benefit mental health in people with cancer and reduce depression, anxiety, and grief that often occur with breast cancer. Exercise can also help reduce side effects from chemotherapy and other treatments.

Exercise can feel empowering, too. As one member wrote, “Movement and exercise almost seem like magic sometimes. For me, gaining strength helps me to feel powerful to fight this disease. I’m always amazed how it elevates my mood, confidence, and perspective on the world.”

If you’re concerned about physical limitations, you can ask your oncologist for a referral for physical therapy to guide you in an exercise program that is right for you.

Get the Emotional Support You Need

Living with HER2-positive breast cancer can be an emotionally grueling experience that brings up many difficult feelings about your health, your future, and your body. Relationships and daily activities can be affected. “I’m very overwhelmed and emotional,” a MyBCTeam member wrote. “I’m crying at everything and very angry. I feel like no one understands what I’m going through.”

Taking care of your mental well-being is an essential part of staying healthy as a breast cancer survivor. In fact, emotional stress is linked to cancer recurrence. You can take the following steps to improve your mood and mental health:

  • Share your feelings with family and friends, and let people know what kind of support you need.
  • Let yourself be cared for by a partner or loved one, rather than avoiding help.
  • Talk to your partner about intimacy. You may have new limits or need to find new approaches together.
  • Learn more about HER2-positive breast cancer to help ease the anxiety that may come with follow-up examinations.

Communicate openly with your health care team about your emotional and mental health. Ask for a referral for mental health counseling if anxiety or depression are affecting you. You can also join support groups either in person or online, such as MyBCTeam. Your doctor can help you determine whether you might benefit from an antidepressant or anti-anxiety medication.

“The fear that this will come back is with all of us, and it takes a while (and practice!) to learn how not to let it take up too much space in our minds and lives,” wrote one member. “We don’t fight this hard for life, not to enjoy it. Many of us have found that either medication, counseling, or a combo approach has helped in coping with how our lives are turned upside down by this diagnosis.”

Some people find that practicing yoga, tai chi, mindfulness, or other relaxation techniques can help reduce stress and ease the mental anguish that breast cancer survivors sometimes feel. Mindfulness training (meditation, focusing on the present moment), among other techniques, has been found to have lasting benefits for people with breast cancer.

“The best thing to remember is that difficult feelings will pass, and we just need to breathe,” encouraged another member. “Concentrate on your breath and realize that you need some time to relax. I have found deep breathing exercises and yoga to be my best method for relaxation.”

For some people living with HER2-positive breast cancer, it’s helpful to recognize the strength that comes from surviving it. As one member wrote, “No one wants it. No one asks for it. But sometimes, we have to look around at what has been put in our path,” they said. “I found there were gifts with it, if I just looked. I’m a much better person for dealing with it.”

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

What have you learned as an HER2-positive breast cancer survivor? How do you stay healthy, and what would you tell those entering survivorship today? Share your tips and experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Prediction of HER2-Positive Breast Cancer Recurrence and Metastasis Risk From Histopathological Images and Clinical Information via Multimodal Deep Learning — Computational and Structural Biotechnology Journal
  2. Understanding Your Pathology Report: HER2 Status — Breastcancer.org
  3. More Tolerable Cures for Patients With Early-Stage HER2-Positive Breast Cancer: Halfway to Precision — ASCO Daily News
  4. The Changing Paradigm for the Treatment of HER2-Positive Breast Cancer — Cancers
  5. Lifestyle Modifications for Patients With Breast Cancer to Improve Prognosis and Optimize Overall Health — CMAJ
  6. Can I Lower My Risk of Breast Cancer Progressing or Coming Back? — American Cancer Society
  7. Two New Studies Suggest Diet Can Help Breast Cancer Survivors Live Longer — American Institute for Cancer Research
  8. Nutrition & Breast Cancer — UCSF Medical Center
  9. Exercise and Prognosis on the Basis of Clinicopathologic and Molecular Features in Early Stage Breast Cancer: The LACE and Pathways Studies — Cancer Research
  10. For Women With Breast Cancer, Regular Exercise May Improve Survival — National Cancer Institute
  11. A Phase 2 Randomized Trial To Evaluate the Impact of a Supervised Exercise Program on Cardiotoxicity at 3 Months in Patients With Her2 Overexpressing Breast Cancer Undergoing Adjuvant Treatment by Trastuzumab: Design of the CARDAPAC Study — BMC Cancer
  12. Physiotherapy and Physical Activity as Factors Improving the Psychological State of Patients With Cancer — Frontiers in Psychiatry
  13. Study Suggests a Link Between Stress and Cancer Coming Back — National Cancer Institute
  14. Breast Cancer: Coping With Your Changing Feelings — Cancer Care
  15. Benefits of Mindfulness Meditation for Survivors of Breast Cancer — UCLA Health

All updates must be accompanied by text or a picture.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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