BREAST CANCER

Gene May Influence Tamoxifen's Effectiveness-(Reuters Health-05/11/2002)

Breast cancer patients who have inherited a "slow version" of a certain gene may not fare as well on tamoxifen as other patients, the results of a new study suggest. Assuming that the results are confirmed, doctors may one day be able to "make treatment decisions based on who is likely to respond well to tamoxifen treatment," said Susan Nowell, of the National Center for Toxicological Research in Jefferson, Arkansas. Once researchers understand the mechanism of how the genetic variation affects a person's response, "this could lead to the design of individualized dosing strategies that could enhance the response to this drug."

Tamoxifen, which has been shown to prevent and treat breast cancer that is sensitive to the effects of estrogen, attaches to the same receptor as the hormone estrogen. In the breast, tamoxifen acts as an "anti-estrogen" to fight cancer. The cancer drug can prolong survival and prevent breast cancer from recurring, but some women on the drug do experience recurrences of cancer. A gene called SULT1A1 is involved in processing tamoxifen, so a team led by Nowell, who is also at the University of Arkansas for Medical Sciences in Little Rock, analyzed the activity of this gene in women with breast cancer.

The study included 160 women who had received tamoxifen and another 177 women with breast cancer who had not. Among women who did not receive the drug, the survival rate was similar regardless of whether a woman inherited a less-active version of SULT1A1. But the gene did seem to have an effect on the survival of women taking tamoxifen, according to a report in the Journal of the National Cancer Institute. Women who inherited two low-activity copies of the SULT1A1 gene--one from each parent--were three times less likely to survive as women who had two normal SULT1A1 genes or one low-activity and one normal activity gene. The lower survival odds persisted even when the researchers took into account factors that could influence survival, such as age, race and stage of tumor at diagnosis. "Although this study needs to be replicated, our results suggest that there may be decreased efficacy of tamoxifen among approximately 13% of the population, based on SULT1A1 genotype," the authors state in the report.

The 5-year survival was 88% in patients with the high-activity form of the gene, compared to only 64% in patients with the low-activity form, Nowell told Reuters Health. Roughly 13% of women had two copies of the slow version of the gene, 43% had two copies of the normal gene, and 44% had one of each. The findings suggest that "genetic variation in a common drug-metabolizing enzyme can have an influence on how well a patient responds to tamoxifen therapy," she said. Nowell and her colleagues are in the process of confirming the findings in a larger study.

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Benefits of Mammogram for Some Women Questioned-(Reuters-06/11/2002)

Having frequent mammogram could be risky for women who have a genetic mutation that increases their chances of developing breast cancer, according to research by German scientists. They said women with defects of the BRCA1 or BRCA2 genes should have a different screening method because the low-energy X-rays used in mammograms can cause more genetic damage than normal X-rays and could raise their susceptibility to the disease. "It is a big risk for these women," Marlis Frankenberg-Schwager, of the University of Gsttingen, told New Scientist magazine.

But other scientists say any risk to women with mutations in the breast cancer genes would be minuscule. "I don't see good cause for reconsidering mammography screening," said Roger Cox of Britain's National Radiological Protection Board. He pointed out that the International Commission on Radiological Protection in Stockholm estimated that the additional risk to the women would be just a fraction of one percent. But Dieter Frankenburg, who worked on the German research, said the risk of frequent mammograms for young women with a genetic mutation would be greater. Faults in the breast cancer genes BRCA1 and BRCA2 account for between two and five percent of all breast cancer cases. The disease is the most common cancer in women. A family history of the illness, early puberty, late menopause and delaying or not having children are factors which increase the chances of a woman developing the disease.

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Alcohol, HRT May Increase Breast Cancer Risk-(Reuters Health-19/11/2002)

Previous research has suggested that postmenopausal women who either drink alcohol or use hormone replacement therapy (HRT) have a higher than average risk of breast cancer, and new evidence suggests that the combination of both could up the risk more than either alone. Based on results from a group of more than 44,000 women, the investigators discovered that those who drank at least 1-1/2 drinks each day and used HRT for at least 5 years were almost twice as likely to develop breast cancer as women who neither drank alcohol nor took HRT. The authors also demonstrated that women who either drank at least 1-1/2 alcoholic drinks each day or took HRT for at least 5 years appeared to have a 30% increased risk in breast cancer, relative to their teetotaler counterparts who opted out of HRT.

Study author Dr. Wendy Y. Chen of Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston, Massachusetts told Reuters Health that she realizes that women who go through menopause have a lot of medical information to sift through, especially lately. "There are a lot of women who are now facing difficult decisions," she said. However, when women are faced with the decision of whether or not to take HRT, she said that she hopes they also consider how drinking alcohol every day may affect their breast cancer risk. The decision is not an easy one, Chen admitted; while her study suggests that alcohol can increase the risk of breast cancer, a wealth of previous research indicates that regular drinking can improve a woman's cardiovascular health. To make sense of this confusion, Chen pointed out that women who drank an average of less than one drink each day--for example a couple of drinks per week--showed no increased risk of breast cancer. There is no established minimum amount of alcohol that women need to receive its heart healthy benefits, Chen noted, so cutting consumption to less than a glass each day could help the heart without sacrificing the breast.

Chen and her colleagues base their findings on a group of 44,187 postmenopausal women who were followed for 14 years. Every two years, the women checked in and indicated whether they were using HRT or had developed breast cancer. At four points during the study, the researchers queried the women about how much alcohol they drank. The researchers published their findings in the Annals of Internal Medicine. A total of 1,722 women developed breast cancer, and the authors discovered that the risk of doing so increased if the women either drank 1-1/2 servings of alcohol--wine, beer or spirits--or took HRT, or did both. In an interview with Reuters Health, Chen explained that the current study did not investigate how alcohol consumption or HRT could influence the risk of breast cancer, but said that previous research has suggested that both can up the risk by increasing levels of estrogen in the body. However, Chen emphasized that the current findings do not suggest that women need to abandon alcohol all together. "I think it means you should limit it to less than a glass and a half per day," she noted.

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New Compounds May Block Cancer Spread to Bone-(Reuters Health-19/11/2002)

Blocking the production of a molecule that promotes bone destruction may keep cancer from spreading to the bone, according to the results of a new animal study. Dr. Wolfgang E. Gallwitz of OsteoScreen Ltd. in San Antonio, Texas, and colleagues identified compounds that prevented breast cancer cells from spreading into bone in mice. Gallwitz told Reuters Health that "one of the worst characteristics of cancer is its capacity to spread or metastasize." He noted that breast cancer is particularly prone to spreading to the bone and bone marrow. The Texas researcher explained that the spread of cancer into bone can be very painful, and can make bones fragile and more likely to fracture. Metastasis to bone may also lead to high levels of calcium in the blood, a condition called hypercalcemia.

Based on recent research, a peptide called parathyroid hormone-related peptide (PTHrP) seems to play a crucial role in a "vicious cycle" of metastasis to the bone. PTHrP promotes the breakdown of bone, and then cells called osteoclasts communicate with tumor cells, which leads to further bone loss and spread of the tumor. Laboratory experiments have shown that neutralizing PTHrP can block the growth of cancerous lesions in bone as well as reduce hypercalcemia.

Gallwitz and his colleagues were able to identify two compounds that neutralize PTHrP. In studies in mice, these compounds were able to "block the capacity of tumors to metastasize to bone and cause bone destruction," Gallwitz said. The compounds also reduced tumor formation in bone, he said, and they reduced calcium levels. A report on the findings is published in the Journal of Clinical Investigation. Gallwitz added that "an old anti-cancer drug called 6-thioguanine has the unique capability of inhibiting PTHrP production by breast cancer cells, and we plan to examine its potential as a therapy for patients at risk from breast cancer metastasis to bone in a clinical trial." If the drug proves effective, it may be possible to use it in combination with drugs currently used to prevent cancer from spreading to bone. These drugs, known as bisphosphonates, were designed to counter the bone destruction of the brittle-bone disease osteoporosis, but they also can reduce the spread of cancer to bone. Bisphosphonates act in a completely different way than the compounds tested in the study, however.

PTHrP is often present in breast cancer, and it promotes bone destruction, so it is possible that the "reduction of PTHrP production or action could be of benefit in late stages of cancer," Dr. T. John Martin of St. Vincent's Institute of Medical Research in Melbourne, Australia, writes in an editorial that accompanies the study. However, he points out that one study found that women with breast cancer whose tumors contained PTHrP were more likely to survive than women whose tumors lacked the peptide, so it is possible that the presence of PTHrP early in cancer might be linked to a less invasive type of cancer.

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Protein May Predict Breast Cancer Prognosis-(Reuters Health-14/11/2002)

High levels of a particular protein in breast tumors may help pinpoint those women who face a poorer chance of survival, preliminary research suggests. Investigators found that having a high level of the protein, called cyclin E, was a stronger predictor of a woman's prognosis than were traditional markers, such as whether the breast cancer had spread to the lymph nodes. A test for the protein level could be especially useful in identifying the small percentage of women with early, stage 1 cancer who have a poor prognosis, the study's lead author told Reuters Health. However, Dr. Khandan Keyomarsi stressed in an interview, any use of a cyclin E test awaits the results of the more-stringently designed research now under way. "The hope is that we have a marker that can potentially identify women with a better or poorer prognosis," said Keyomarsi, a researcher at the University of Texas M.D. Anderson Cancer Center in Houston. She and her colleagues report their findings in the New England Journal of Medicine.

Past research has shown that cyclin E is overexpressed in breast cancer cells. The protein normally helps regulate the cell division that goes on continually in the body, but when cyclin E is overexpressed, cells are not allowed to stop dividing--an effect Keyomarsi likened to a "car with no brakes." It's the uncontrolled division and spread of abnormal cells that underlies all cancer. Whether cyclin E levels in breast tumors have any prognostic value, however, has been unclear.

In their study, Keyomarsi and her colleagues analyzed stored tumor samples from 395 women who had been diagnosed with breast cancer between 1990 and 1995. They found that compared with women with low cyclin E levels, those with high levels were more than 13 times more likely to die over roughly 6 years. Among the 114 women with stage 1 cancer, the 12 who had high levels of low-molecular-weight cyclin E--shortened, "hyperactive" forms of the protein--had all died within 5 years of diagnosis. All of the other stage 1 patients were still alive. Overall, high levels of cyclin E predicted a poorer prognosis for women with stage 1, 2 or 3 breast cancer; by stage 3, the breast tumor is large and the cancer has spread to nearby lymph nodes. But cyclin E levels may prove particularly useful in spotting the roughly 10% of stage 1 patients who do not do well after treatment, according to Keyomarsi. By definition, these early-stage tumors have not spread to the lymph nodes, so the traditional measure of lymph-node involvement does not apply in patients' prognoses.

If further research confirms the prognostic value of cyclin E levels, Keyomarsi said, cyclin E tests could be used in deciding which women need more aggressive treatment--and which patients can be spared "grueling chemotherapy." Cyclin E is also highly expressed in other tumors. Whether the protein is tied to prognosis in these cancers is unknown, Keyomarsi said, but research will begin to find out.

According to an editorial published with the report, the breast cancer death risk tied to a high cyclin E level is "significantly greater" than that linked to any other prognostic factor identified to date. "Undoubtedly," this study will spur new interest in cyclin E and similar molecules and their role in breast cancer, write Drs. Robert L. Sutherland and Elizabeth A. Musgrove of Garvan Institute of Medical Research in Sydney, Australia.

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Progestin, not estrogen, linked to breast cancer in Swedish study-Associated Press-25/11/2002)

New research indicates that women who take hormone replacement therapy containing estrogen alone may have less chance of developing breast cancer than those who take a combination pill. Scientists at Lund University in Sweden said that their study suggests that progestin, not estrogen, is the cancer-causing substance in the hormone therapies. However, experts warned the study was small and didn't provide definite answers. Sales of hormone replacement drugs have plunged since last summer, when a major U.S. study linked pills containing a combination of estrogen and progestin to breast cancer and heart disease. Scientists have debated whether the increased risks outweigh the benefits of the medications and whether estrogen-only drugs also increase the risk of cancer. Large studies comparing the therapies are under way. Using estrogen alone is recommended only for women who have had hysterectomies, because the use of estrogen increases the risk of womb cancer and progestin protects against it.

Women take the hormone replacement drugs primarily for relief from menopause symptoms, including hot flashes, trouble sleeping, irritability and vaginal dryness. The Swedish study, to be presented at the annual meeting of the Swedish Society of Medicine in Goteborg, in southwestern Sweden, involved 30,000 women, including about 3,500 who were taking hormone replacement therapies to ease symptoms of menopause. It showed that women who took pills containing progestin had triple the normal risk of breast cancer, lead researcher Haakan Olsson said. Women taking drugs with only estrogen had normal rates of breast cancer.

Olsson's study showed that among 395 women taking drugs with progestin for more than four years, 25, or 6.3 percent, developed breast cancer. Among women taking estrogen-only drugs, the corresponding number was nine of 322, or 2.8 percent, a rate similar to that of the women in the study who were not taking hormone treatment. "The risk (of breast cancer) is about three times higher after more than four years' use of progestin and 1.8 times higher after less than four years' use," he told The Associated Press.

Experts, however, said the number of women studied was too small to provide any answers. "You can't use a study like that to draw definite conclusions," said Valerie Beral, head of the Oxford University epidemiology unit in Britain. William Creasman, an expert on hormone replacement therapy at the Medical University of South Carolina, was also skeptical because of the scope of the study. He said even the large U.S. study on combination treatment was flawed and raised "more questions than answers."

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Leptin May Play Role in Obesity-Breast Cancer Link-(Reuters Health-20/11/2002)

Elevated levels of the obesity hormone leptin may be the "missing link" between obesity and increased breast cancer risk, new study findings suggest. "It has been well established that obesity and/or weight gain are risk factors for postmenopausal breast cancer," said lead investigator Dr. Margot P. Cleary. "However, the mechanism of action of linking obesity to this increased risk is not clear." So far, experts have speculated that the elevated blood estrogen and insulin levels that occur in obese individuals may be possible links, explained Cleary, who is with The Hormel Institute at the University of Minnesota in Austin. Now, Cleary and colleagues propose that leptin, a protein synthesized and released by fat tissue in proportion to the amount of body fat, may provide a more direct link from obesity and weight gain to an increased postmenopausal breast cancer risk. The findings of their experiments with both cancerous and normal breast cells appear in the Journal the National Cancer Institute.

"In this paper we show that addition of leptin increased proliferation of both a breast cancer cell line and a normal mammary tissue cell line," Cleary told Reuters Health. "However, leptin stimulates cell proliferation to a much greater extent in the breast cancer cell line, 150% above the number of cells without leptin, than in the normal cells where a 50% increase was found." In addition, Cleary and her team identified the presence of the leptin receptor--a tiny "docking site" for the protein--in these cell lines and showed that specific signaling pathways known to be activated by leptin in other tissues were activated in both the healthy breast cells and the breast cancer cell lines, she explained. "We feel that these preliminary studies provide evidence that leptin may play an important role in...normal breast tissue development, and elevated serum leptin levels may promote breast tumor growth and development," Cleary concluded.

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Contraceptive Said a Risk for Some Women-(AP-03/12/2002)

Women with certain gene mutations have more than a 60 percent lifetime risk of developing breast cancer. Now a new study suggests the risk is even greater for these women if they used oral contraceptives at an early age or before 1975. The study, in the Journal of the National Cancer Institute, found that among women with the BRCA1 gene mutation, taking the pill years ago increased the chances of developing breast cancer by 33 to 42 percent when compared to mutation carriers who did not take it. Dr. Steven A. Narod, chairman of breast cancer research at the Centre for Research on Women's Health at the University of Toronto, said the study does not mean that modern birth control pills are dangerous for women with the breast cancer gene, but it does add a note of caution about how they should use the pill.

"In this data, the only women who had an increased risk started taking the pill before 1975. Also, they had to take it when they were young, under the age of 25," said Narod. He said the increased risk for the gene mutation carriers is "mostly women who took the pill when they were young a long time ago." Modern birth control pills have only a fraction of the hormones that were present in birth control pills routinely used before 1975, he said. Narod said the study also showed the risk increased if women started the pills before the age of 25 or if they took the oral contraceptives for longer than five years. The study is based on an analysis of the health histories of more than 2,600 women in 11 countries, all of whom have mutations of the BRCA1 or BRCA2 genes. Half of the women studied had taken birth control pills and half did not. The study compared the breast cancer histories of the two groups and found there was an increased risk for the pill takers.

Earlier studies have shown that mutations of the BRCA1 or BRCA2 genes increase the lifetime risk of breast cancer by about 60 percent, and even higher in some cases. The mutations are relatively rare, occurring in one of 250 women in the general population, and account for less than 10 percent of all breast cancer cases. Narod said the new study shows that early birth control pill use increases the lifetime breast cancer risk up to about 85 percent for women with the BRCA1 mutation when compared to women without the mutation. Oral contraceptive use was not found to increase the risk among BRCA2 mutation carriers. Why there is a difference in risk between the two mutations, he said, is not known.

Debbie Saslow, director of breast and gynecological cancer control for the American Cancer Society said the study suggests that women with the BRCA mutations should approach oral contraceptive use with caution, but that the research need to be verified by other studies before the findings can be generally applied. "We don't make broad policy decisions based on just one paper," she said. Saslow said decisions about oral contraceptive use among mutation carriers is complex because the pill is protective, to some degree, against ovarian cancer, a much more difficult to detect type of deadly cancer. 'I think women who have this BRCA1 mutations need to talk to their doctors because there is a trade-off," she said.

Narod said researchers are gathering data to determine if mutation carriers were placed at even greater risk of breast cancer after menopause if they took hormone replacement therapy. "Based on what I see for birth control pills, I am certainly concerned that giving hormones to women with these mutations might increase the risk," he said. The results from that study will not be ready for about a year, said Narod.

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HRT Raises Risk of Lobular Breast Cancer-(HealthScoutNews-03/12/2002)

The National Institutes of Health pulled the plug on a massive study earlier this year after women taking combined hormone therapy were found to have an increased incidence of breast cancer. Now a new study has identified which type of breast cancer may be associated with the combined hormone replacement therapy, or that which includes estrogen and progestin. Research appearing in the journal Cancer finds that women on combined hormone therapy are at an increased risk for lobular breast cancer. Lobular and ductal breast cancer are two of the more common forms of breast cancer. Although lobular carcinoma is less aggressive than ductal, it has been on the rise since the 1980s. The use of combined hormone replacement therapy increased during the same time period, leading some to speculate that it might be responsible for the increase.

"It's kind of a bad news/good news thing," says Janet Daling, lead author of the study and a professor of epidemiology at Fred Hutchinson Cancer Research Center in Seattle. "[Lobular carcinoma] is a little more difficult to diagnose because you don't pick it up as often on mammograms, but it has a good prognosis. It appears to be highly related to the continuous combined hormone therapy."

Hormone replacement therapy (HRT) is taken by women to relieve symptoms of menopause. While the hormone estrogen is actually responsible for ameliorating hot flashes and vaginal dryness, it also increases the risk of cancer of the uterine lining. Adding progestin to the mix effectively eliminates that risk. HRT is given one of two ways: continuous (meaning every day or almost every day of every month) or sequential (less often than every day).

This study, called the Women's Contraceptive and Reproductive Experiences (CARE) Study, looked at about 4,500 postmenopausal women aged 35 to 64 who had been diagnosed with their first incidence of breast cancer. They were compared to a control group of postmenopausal women who had no history of breast cancer. In interviews, all the women were asked to recall information on various aspects of their medical history, including type of hormone therapy used, pattern of use, dose and total duration. Women who used combined hormone replacement therapy for six months to five years were 1.6 times more likely to get lobular carcinoma. Women who used it for more than five years were twice as likely to be diagnosed with the cancer, compared with women who never used it. The risk was also greater with continuous hormone therapy, or that which is delivered daily for 25 or more days each month. Women on this type of hormone replacement therapy for five years or more had a 2.5 times greater risk of lobular breast cancer. After adjusting for the age at which menopause began, the increase rose to 3.2 times. Sequential combined hormone replacement therapy was associated with a 1.5 times greater risk for lobular cancer."There was very little risk with sequential HRT," Daling says.

Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York City, cautions against giving too much weight to the findings. This latest research was a case-control study in which women were asked to remember details of their history, and there was no actual control over the dispensing of the medication. The gold standard in medical research remains the prospective randomized trial. "This is the highest standard because presumably bias doesn't influence who takes or doesn't take the medicine," Hudis says. The results of this study apply only to women under the age of 65. Daling has just finished another study looking at women aged 65 to 79 and, in this group, sequential HRT seemed to play a larger role. Estrogen alone did not appear to affect the risk of breast cancer.

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Breast and Womb Cancer Have No Genetic Link-Study-(Reuters-05/11/2002)

Women with a family history of breast cancer do not have a higher risk of developing cancer of the lining of the womb, American scientists said. Although several risk factors for both illnesses are the same, there is no genetic link between breast and endometrial cancer, they concluded. "A family history of breast cancer does not seem to be an important endometrial cancer risk factor, although a personal history of breast cancer does increase the risk," said Dr Neely Kazerouni of the US Centers for Disease Control in Atlanta, Georgia.

According to research published in the Journal of Medical Genetics, a woman who has suffered from breast cancer has about a 30% increased risk of developing endometrial cancer. But having a close family relative with breast cancer does not have an impact on a woman's susceptibility to endometrial cancer. Kazerouni and his colleagues studied the medical histories of 37,500 women who participated in a US national breast screening program that started in 1979. During a 14-year follow-up period, 648 women in the study developed cancer of the lining of the womb but the scientists said there was no evidence that having a close relative with breast cancer predisposed them to the disease. Endometrial cancer usually occurs in older women. Obesity, diabetes, early puberty and late menopause and having few or no children are risk factors for the illness.

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More Breast Screening Benefits (HealthScoutNews-16/10/2002)

Approximately one in every 1,300 mammograms will result in a diagnosis of ductal carcinoma in situ (DCIS), a type of non-invasive tumor that makes up roughly 20 percent of breast cancers detected by screening, says new research. A study in the Journal of the National Cancer Institute found that as the use of screening mammography has increased, the detection of DCIS -- which usually cannot be felt by a clinical exam -- has also risen. But because the lesions are removed when detected, doctors are uncertain what percentage of such lesions, if untreated, would progress to invasive breast cancer.

Studies have shown that only a fraction of DCIS treated by lumpectomy (removal of the lump) alone later progress to invasive cancer. Thus, there is a concern that diagnosis and treatment of many DCIS cases may not be beneficial. Non-invasive tumors are those that have not spread into the breast tissue and are contained within the cells lining the milk ducts. The researchers, Virginia L. Ernster, of the University of California, San Francisco, and Rachel Ballard-Barbash, of the National Cancer Institute, found that the percentage of screen-detected breast cancers that were DCIS decreased with age. For example, in women between the ages of 40 and 49, 28.2 percent of screen-detected breast cancers were DCIS; in women 70 to 84, 16 percent of screen-detected breast cancers were DCIS. However, the rate of DCIS diagnoses per 1,000 mammograms increased with age, from 0.56 per 1,000 for women ages 40 to 49 to 1.07 per 1,000 for women ages 70 to 84.

Further analysis revealed that mammograms were more sensitive at detecting DCIS than they were for detecting invasive breast cancer or tumors that have spread into the breast tissue. The authors point out that the likelihood of benefit from treatment of DCIS is probably greater for women with larger, higher-grade lesions than for those with very small, low-grade lesions.

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Mastectomy, Lump Removal Seen Equal (AP-16/10/2002)

Twenty years of follow-up research on women with breast cancer has offered powerfully reassuring confirmation that cutting out just the lumps can save as many lives as mastectomies. Dr. Monica Morrow, a Northwestern University breast-cancer specialist, said the findings should convince "even the most determined skeptics." "It is time to declare the case against breast-conserving therapy closed," she proclaimed. Her editorial was published with two studies in The New England Journal of Medicine.

The studies - one Italian and one American - showed similar death rates after 20 years for large groups of women who underwent either mastectomies or breast-saving surgery. Mastectomy, or removal of the breast, was the surgery of choice for most of the 20th century. Then, in the 1980s, largely on the strength of early data from these two studies, many doctors began to suspect that in women whose tumors have not spread, mastectomy works no better than cutting out only the diseased tissue. The two landmark studies changed the way many surgeons treated breast cancer. By the end of the 1980s, the less-disfiguring procedure, often called a lumpectomy, was widely accepted on an equal footing with mastectomy for cancer that has not yet spread. Still, breast-saving surgery is not always offered to women who are potential candidates for the operation. The researchers behind the latest findings hope to change that.

The researchers at the European Institute of Oncology in Milan split 701 women into two groups: one got mastectomies, the other got lumpectomies with radiation treatments. In the end, about a quarter of each group died of breast cancer over 20 years. The American study of 1,851 women, backed by the government and run at the University of Pittsburgh, also found little survival differences between two similar groups. A third group of women who underwent lumpectomy without radiation also survived as well as others, though they developed recurrent cancer on the same side more often than women who got radiation.

Researchers say survival remains unaffected by the kind of surgery because it turned out that breast cancer is fundamentally a systemic disease, not one that simply spreads from an initial site. Systemic treatments, like chemotherapy, have increasingly been used in recent years. In a 1999 survey by the American College of Surgeons, 57 percent of 145,681 operations for breast cancer were lumpectomies, and the rest were mastectomies. The sample included 1,480 hospitals. About 90 percent of women with stage I disease - the earliest stage - are reasonable candidates for lumpectomy, according to Morrow. Yet only 68 percent chose it, according to the American College of Surgeons. Only 37 percent with stage II disease get lumpectomies, but only 75 percent are potential candidates.

The lead author at Pittsburgh, Dr. Bernard Fisher, said many women who could have undergone more narrow surgery have chosen mastectomies on the theory that you "get it out, and you're not going to have any trouble." But he said the evidence clearly shows no survival advantage for them. A shadow spread over the American study in 1994 when a small fraction of data provided by a researcher in Canada was exposed as fake. However, the National Cancer Institute later cleared Fisher of misconduct and determined that the bad data did not change the overall findings.

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Deodorant Not Linked to Breast Cancer: Study (Reuters Health-15/10/2002)

Contrary to Internet lore, women who use antiperspirant or deodorant are not at increased risk for breast cancer, researchers report. Their study of more than 1,500 women is the first clinical trial to investigate the widely circulating rumor. While several cancer organizations have issued statements that there is no reason to suspect personal hygiene products as a risk factor for breast cancer, many women remain afraid. In particular, some women believe that products contain harmful substances that can be absorbed, particularly by skin that has become cut or irritated by shaving. The current report, published in the Journal of the National Cancer Institute, may ease these fears, Dana Mirick of the Fred Hutchinson Cancer Research Center in Seattle, the study's lead author, told Reuters Health.

"Hopefully, upon hearing reports of these results, the public will become less concerned that the use of these products could increase one's risk for breast cancer," Mirick said. She added that the widespread use of underarm products might explain why such a rumor spread in the first place. "I suspect that it frightened so many women because such a high percentage of people use one of these products," Mirick said.

The investigators interviewed 813 women with breast cancer and 793 healthy women aged 20 to 74 about their personal habits when it came to shaving under their arms and applying deodorant or antiperspirant. The use of deodorant or antiperspirant did not raise the risk of breast cancer, according to an analysis of the findings. Similarly, there was no relationship between underarm shaving and using products within 1 hour of shaving. "These findings do not support the hypothesis that antiperspirant use increases the risk for breast cancer," the study concludes.

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Gene Therapy May One Day Halt Breast Cancer Spread (Reuters Health-09/10/2002)

The British charity Cancer Research UK has patented a new form of gene therapy it says has the potential to block the spread of breast cancer cells through the body. In the laboratory, the approach blocks the movement of cancer cells with a fragment of DNA, or "minigene," carried by a modified virus, the charity said. More research is needed to determine if the technique will work in patients. "One of the most distinctive features of a cancer cell is its ability to respond to chemical signals and begin to move through the tissues surrounding it," said lead researcher Dr. Tony Ng, of the Richard Dimbleby/Cancer Research UK Department of Cancer Research at St. Thomas's Hospital in London. "Blocking the ability of cancer cells to follow instructions to move may be an effective way of preventing the disease from spreading," Ng explained.

The patented strategy targets a molecule called protein kinase C alpha, which plays a key role in tumor cell migration. Blocking protein kinase C alpha (PKC-alpha) with a virally delivered minigene reduced the ability of cancer cells to move in response to a growth factor. The study, conducted in a laboratory culture dish, showed the movement of the treated cells was inhibited by 90%, researchers from the charity reported in a recent issue of Molecular and Cellular Biology. Cancer Research UK believes the approach has particular potential against tumors in which PKC-alpha is highly active. Dr. Peter J. Parker, of the charity's London Research Institute, said: "In the laboratory the new system has been extremely successful at preventing cancer cells from moving around. We now need to find the best way of getting the virus into tumors, so women with breast cancer could benefit. "The treatment might be particularly useful around the time of surgery to remove a tumor, since this is a time when cancer cells may break away from a tumor and spread around the body."

Sir Paul Nurse, chief executive of Cancer Research UK, said: "Over the last few years, there's been an explosion in our knowledge of the genes involved in cancer's development and we're starting to see that translated into treatments that target very specific molecular mechanisms. "There's still work to do to find the best possible way of getting therapeutic genes into cancer cells, but over the coming decade we should see gene therapy playing an increasing role in cancer treatment."

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Mixed messages continue on breast cancer (AP Medical Writer-07/10/2002)

Call it the year of mixed messages: First came debate about mammography's value, then the news that long-term use of the hormones estrogen and progestin raise the risk of breast cancer and heart attacks after all. Now more headlines, declaring that checking breasts for cancerous lumps once a month doesn't do much good, have some cancer patients and health care providers irate - and telling women to ignore the news and keep on checking. "I'm on a rampage about the whole thing," says Sherry Goldman, a nurse practitioner who teaches breast self-examination at the University of California, Los Angeles, and who last year found a tiny cancerous lump in her own breast that a mammogram had missed.

"Women are very confused," adds Dr. Gale Sisney of Georgetown University Hospital, who still advises self-exams. "We feel like we're getting pingponged around by these different messages." Yet contrary to popular belief, the value of breast self-exams has long been in question. U.S. government cancer guidelines don't recommend them. National Cancer Institute patient guides downplay them. So does the American Cancer Society. Then a study of 260,000 women in China reignited the controversy last week. It concluded that women taught to carefully check their own breasts were no less likely to die of breast cancer than those who didn't, but that they did find more noncancerous breast lumps. The bottom line: "Women should not feel guilty about not doing breast self-exam," says American Cancer Society epidemiologist Robert Smith. In fact, women often discover breast lumps while dressing, showering or making love, not on that one day a month some set aside for a breast check, he says. Hence the real key is for a woman to be familiar with what's normal for her breasts, whether that requires a regimented monthly self-check or not, so that she can recognize an abnormal spot, Smith explains. After all, some breasts are naturally lumpier than others, and a change is the key symptom.

Goldman counters that without regular self-exams, women won't be familiar enough with their breasts to notice a new lump. With the medical profession itself in disagreement, what's a woman to do? For all of this year's breast-cancer controversies, it comes down to weighing the evidence to decide what's best for a woman's unique circumstances, says Dr. Helen Meissner, chief of the NCI's cancer screening research.

Take mammograms, which came under attack as critics argued that studies suggesting the X-rays cut the risk of dying from breast cancer were too flawed to believe. The government and most cancer groups call the criticisms overblown and still recommend that women 40 and older get mammograms every year or two. Certainly mammograms aren't perfect: They miss some cancers; cause many false alarms by flagging benign lumps; and diagnose very early tumors called "ductal carcinoma in situ" that some experts say are overtreated because doctors can't tell in advance which ones will prove life-threatening. "Like all medical tests, you have to weigh the risks and benefits" in deciding when and how often to have mammograms, Meissner says. Be sure to pick a radiologist who reads many mammograms, because more experience means more accuracy, Smith stresses.

Some radiologists advise women with very dense breasts to ask for ultrasound scans with their mammograms. Mammograms are less reliable for dense breasts than fatty ones; the cancer society is debating what to advise such women. These controversies should spur women to insist that scientists focus on finding better ways to detect breast cancer - and test them appropriately so such confusion doesn't happen again, says Fran Visco of the National Breast Cancer Coalition.

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Location of Breast Tumor May Influence Prognosis-(Reuters Health-30/09/2002)

An analysis of more than 35,000 breast cancer patients enrolled in a Danish breast cancer registry suggests that women may be more likely to survive depending on where the tumor is located in the breast. Dr. Mads Melbye of the department of epidemiology research at Statens Serum Institute in Copenhagen, Denmark found that women who have breast tumors located on the upper lateral quadrant of the breast have a 15% to 20% better survival rate than women who have medial or central lesions.

Melbye presented the study results last week at the Department of Defense Breast Cancer Research meeting here. He said that tumor location was an independent marker for survival regardless of how advanced the tumor was or whether or not it had metastasized, or spread to other parts of the body."We don't really know how to explain this difference. Except that we can say this: these findings tell us that for many women we should be able to do better," Melbye said in an interview with Reuters Health.

Dr. Dennis Slamon, chief of the division of hematology-oncology at UCLA Medical Center and director of the Revlon/UCLA Women's Cancer Research Program, said this is the first time that he has seen compelling data that suggest location is a factor in survival. "But here are the numbers. They are undeniable. This is a population study with huge numbers, so this is real." Slamon cautioned that the study "needs to be replicated in another large population study --perhaps another study from one of the Scandinavian countries--before we can start guessing at the biology behind it." It's possible that tumors in certain locations of the breast have a better prognosis due to differences in the circulation of lymph or tumor biology, Slamon said. Women included in the registry are less than 70 years of age and the median follow-up is 5.3 years, but 25% of the women had more than 10 years of follow-up.

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Lifelong Exercise May Cut Breast Cancer Risk (Reuters Health-30/09/2002)

Even moderate physical activity--for example brisk walking for at least 2 miles three times a week--over the course of a lifetime can reduce a young woman's risk of developing breast cancer 33%, and the risk of breast cancer after menopause by 26%, according to results of a study of women living in the San Francisco Bay area. The results were presented at the Department of Defense Breast Cancer Research Program. Dr. Esther M. John, an epidemiologist at the Northern California Cancer Center in Union City, California, told Reuters Health that the study confirms earlier reports that "exercise can reduce the risk for breast cancer." But, she added, "this study also points out two important factors: it is total physical activity over the course of a lifetime that confers a benefit, and this activity is not limited to vigorous exercise. Even moderate activity has real benefits."

John and colleagues based their findings on interviews with 1,249 women aged 35 to 79 who were newly diagnosed with breast cancer between 1995 and 1998, and 1,547 similar women who were cancer-free. Of the women with breast cancer, 402 were diagnosed before menopause and 847 were diagnosed after menopause. The risk of breast cancer increases with age, John noted. The women agreed to detailed interviews that assessed total physical activity "beginning in the teen years and then continuing through every decade thereafter.

We asked about all types of activity including traditional exercise like biking, running, walking and weight lifting and so on, as well as nontraditional exercise such as housework and yard work," she said. The women were asked, for example, if they walked to school as teens or if they rode bikes for pleasure or to run errands. Women were also asked to rate their jobs for exercise content. The researchers then divided the women into three groups based on their activity level. Those premenopausal women in the most active group had a 26% lower risk of breast cancer compared with the least active women. Postmenopausal women in the most active group had a 19% lower risk than the least active women. Breast cancer risk was cut by 33% in premenopausal women who were moderately active and 26% in postmenopausal women who were moderately active compared with the least active women. The benefits were greater for women with a lower body mass index (BMI), which "probably indicated greater overall fitness," said John.

Women with a BMI of 25 or less who were in the most active group were 47% less likely to develop premenopausal breast cancer and 31% less likely to develop breast cancer after menopause than the most sedentary women. Anyone with a BMI 25 or more is considered overweight, while a BMI of 30 or more is considered to be obese. In the San Francisco Bay area, the incidence of breast cancer is lowest among Latinas (90 cases per 100,000 population aged 35-49) followed by African Americans (105 per 100,000 aged 35-49), and highest among white women (135 per 100,000 aged 35-49). John said lifetime physical activity was highest among Latinas followed by African Americans and whites. She estimated that physical activity explained "13% of the difference observed between Latinas and whites but does not explain the difference between African Americans and whites."

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Fatty Acid in Milk May Ward Off Breast Cancer-(HealthScoutNews-27/09/2002)

A fatty acid in milk and meat appears to muzzle budding breast cancer by shutting off its ability to summon blood vessels, a new study shows. The substance, conjugated linoleic acid (CLA), clamps down on the formation of new blood vessels -- a process called angiogenesis -- that tumors need to support their lust for nutrients. "It appears to be an anti-angiogenic compound and a nontoxic one," said Margot Ip of the Roswell Park Cancer Institute in Buffalo, N.Y., who led the work. Ip presented her findings today at a meeting in Orlando of the U.S. Department of Defense Breast Cancer Research Program.

Ip's group first dosed rat mammary cells in a dish with CLA, and saw that in the presence of the chemical they produced far fewer tiny blood vessels. They then fed the substance to live rats, and saw in tissue samples that the growth of new vessels was cut by up to 80 percent. Ip said CLA seems to prevent one class of flexible mammary cells, called stromal cells, from becoming vessels that can feed tumors that form in the milk ducts. Instead, it encourages these cells to convert into harmless fatty tissue.

CLA has anti-cancer properties in a wide range of cells, from the breast to the colon. But its effects are overwhelmed by the harmful impact of other fats that are more prevalent in food, said Jack Vanden Heuvel, a molecular toxicologist at Penn State University who studies the chemical. "CLA is just one type of fatty acid that's in all those foods that are high in fats, and on balance they're bad," Vanden Heuvel said. Scientists are trying to increase the concentration of CLA in dairy products by manipulating what cows eat. The substance is also available as a dietary supplement, and evidence suggests that it can lower body fat while increasing lean muscle mass.

However, it hasn't been around as a diet aid long enough to know if it indeed prevents cancer in people, Vanden Heuvel said. Vanden Heuvel said the latest study agrees with his own research, which has found that CLA binds to and activates a protein called PPAR-gamma. This protein helps cells become a variety of tissues, whereas tumors are cells that have already committed to a single function and are more prone to cancerous mutations. His group has found that CLA acts much like a novel class of diabetes drugs called the glitazones, which make fat cells better able to handle blood sugar. Research suggests that these medications not only block angiogenesis but also may prevent colon, breast and prostate tumors. "There's solid evidence that CLA has the ability to inhibit cancer," said Mark McGuire, a lactation biologist at the University of Idaho in Moscow who studies the chemical.

Humans get about 95 percent of their CLA in beef and milk. Yet because it's a fatty acid, people who drink skim milk aren't getting any in their glass. Rat data and human studies from Finland suggest that bumping up CLA intake by only 20 percent can slice the risk of breast cancer in half, McGuire said. One way to do that is to swap whole milk for skim and to cook with butter instead of vegetable oil or margarine. Of course, making those changes increases saturated fat consumption, which can hike the risk of heart disease. But McGuire said he and his colleagues have found that women who drink whole milk in moderation don't develop unhealthy blood fat levels that might put them at risk of heart and vessel problems.

In another study presented at today's meeting, Alabama scientist found that when you eat a cancer-preventing food may be as important as simply eating it at all. The researchers showed that rats fed the soy protein genistein, which may prevent breast cancer, had fewer tumors later on if they ate the substance before entering puberty. The findings suggest that adolescent and pre-adolescent girls who eat a soy-rich diet may ward off breast cancer later in life. That agrees with a 2001 study, which found that Chinese women who ate high-soy foods when they were teenagers had half the incidence of breast cancer as those who ate less of the nutrient. Coral Lamartiniere, a toxicologist at the University of Alabama, Birmingham, who led the latest work, said genistein helps immature mammary cells become "differentiated"-- that is, it prompts them to choose a specific function in the breast. "It's undifferentiated cells that are susceptible to carcinogens," he said.

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Test May Reduce Node Biopsy Need in Breast Cancer-(Reuters Health-27/09/2002)

Researchers at the University of Sydney report they have developed a special program that can be used along with magnetic resonance spectroscopy (MRS), a type of scan, to identify breast cancer that is more likely to spread to the lymph nodes. They hope the technique might one day provide a diagnosis and prognosis before a woman goes into surgery. Patients with early breast cancer might avoid having numerous armpit lymph nodes removed for testing and women with truly benign lesions may be able to avoid surgery to rule out cancer, the Australian researchers said. The program is a type of mathematical pattern recognition or statistical classification strategy (SCS) that organizes thousands of pieces of information to gauge whether or not breast tissue is malignant, and if so whether it is likely to spread to the lymph nodes. Dr. Cynthia Lean, scientific director of the Institute for Magnetic Resonance Research, presented results of her research at the Department of Defense Breast Cancer Research meeting.

In an interview with Reuters Health, lead investigator Lean said the ultimate goal of her team is to develop "a total program of breast cancer screening and diagnosis that is completely noninvasive." Currently, she and her colleagues have collected cell samples from 400 breast cancer patients who participated in three separate breast cancer trials. The samples were from fine needle biopsies, in which cells are collected with a needle to test for cancer after a suspicious mammogram. Initially they used MRS to look at the specimens, and determine if malignant samples had "a different array on the spectrum" than benign specimens. Spectroscopy uses light to identify the chemical components of a substance, each of which absorbs different wavelengths of light. "And the specimens did appear very different," Lean explained.

The next step involved identifying approximately 4,000 pieces of chemical information in each sample. "With those 4,000 pieces of information, we were able to develop the statistical classification strategy program." She said that she and her colleagues are developing similar recognition programs for "10 or 12 other cancers, but we have achieved the greatest success with breast cancer." MRS analysis using the statistical classification strategy identified 94% of the cancerous samples, with 2% false positives. It is also useful in determining which tumors were likely to spread to lymph nodes. Lean said MRS may be most useful as an adjunctive test for women "who have inconclusive mammography and fine needle biopsy. As an additional piece of information, MRS could be used to confirm malignancy without the need for an open biopsy."

Moreover, she added, it could be used to confirm that the cancer had spread, or metastasized, to the lymph nodes. While Lean and colleagues are currently using MRS to analyze biopsy samples, they hope to use MRS for diagnosing and determining prognosis in patients. Dr. Kenneth A. Bertram, colonel in the US Army Medical Corps and director of the Congressionally Directed Medical Research Programs, said that MRS is appealing because it "has the potential to reduce the need for open biopsy." Asked if it was likely that MRS could someday be used as a completely non-invasive technique for diagnosis, he said "the physics folks tell us this is possible. And although it is likely to be expensive, remember CT (CAT scanning) was very expensive in the beginning."

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Drug Helps Prevent Breast Cancer Spread to Bone-(Reuters Health-23/09/2002)

Women with early-stage breast cancer were half as likely to see their cancer spread, or metastasize, to their bones when treated with an oral drug called clodronate, researchers report. Clodronate is a member of a class of drugs called bisphosphonates, which are used to treat the bone-thinning disease osteoporosis. Since tumor-induced breakdown of bone can promote the development of metastases, Dr. Eugene McCloskey, Sr., clinical research fellow at the University of Sheffield, England, and colleagues decided to investigate whether giving breast cancer patients the drug might prevent their cancer from spreading to the bone.

The researchers assigned patients to take 1,600 milligrams of clodronate or an inactive placebo daily for 2 years. All of the women had operable, early-stage cancers. Treatment was initiated within 6 months of women undergoing primary therapy, which included surgery, radiotherapy, chemotherapy and tamoxifen as required. During the total follow-up period, which lasted about 5 years, 63 patients in the clodronate group and 80 patients in the placebo group developed bone metastases, a difference that was not significant between the two treatment groups. In contrast, during the 2-year treatment interval, only 12 women developed bone metastases in the clodronate group compared with 28 women in the placebo group. The difference between the two groups was significant, McCloskey reported.

He presented his results during the 24th annual meeting of the American Society for Bone and Mineral Research. Over the post-medication period, there was again no difference in the number of women developing bone metastases at 51 in the clodronate group and 52 placebo patients. The incidence of metastases that developed outside of bone was also similar between the two treatment groups, at 112 patients in the clodronate arm, and 128 women in the placebo arm. Most importantly, McCloskey noted, only 98 women in the clodronate group died over the follow-up period compared with 129 in the placebo group, a 23% reduction in mortality risk in favor of active therapy.

"We know there is a conversation between tumor cells and bone marrow, and this conversation is basically a vicious circle whereby tumor cells stimulate bone cells to resorb bone and the resorption of bone feeds backs and stimulates tumor cells," McCloskey told Reuters Health in an interview during the meeting. The metastases that attack bone "depend on this vicious cycle and by interfering with this cycle, you decrease the number of women who get clinically significant bone metastases, and if they don't get bone metastases, they don't get metastases at other sites and you improve survival," McCloskey commented.

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Ultrasound May Help ID Breast Cancer Early-(Reuters Health-19/09/2002)

Stating that mammography does not effectively catch cancerous tumors in as many as two thirds of premenopausal women, a researcher suggested that perhaps ultrasound tests should be added as a screen for that group. These women--and as many as 25% of postmenopausal women, along with half of postmenopausal women taking hormone replacement therapy--have dense tissue in their breasts that blocks detection of tumors on mammogram films, said Dr. Thomas M. Kolb, a radiologist in private practice in New York. Kolb spoke here at a science reporters' conference sponsored by the American Medical Association. His research will be published in the journal Radiology.

Kolb just completed a study of 11,130 women, comparing how well mammography, physical breast exams and ultrasound detected cancers. These women had 27,825 consecutive screening sessions. Kolb found that "density is the most significant predictor of mammography sensitivity." Dense tissue--which is mostly glandular, not fatty--appears solid white on film. Tumors appear black, so the dense white often hides the cancerous tissue. Kolb found that mammography could only detect 48% of cancers in the densest tissue, and only slightly more in less-dense tissue. Mammography detected only 9% of the most aggressive, invasive cancers, he said. Adding ultrasound after a mammogram greatly improved detection in his study. The two tests together found 98% to 100% of tumors in less-dense breasts and 94% in the densest tissue.

"This is clearly a more acceptable state of affairs," said Kolb. "The importance of ultrasound cannot be overstated right now." However, ultrasound screening is largely viewed as unproven and is rarely performed by physicians, Kolb said. And it is almost never paid for by insurance. There are other downsides. In his study, 2.5% of women were sent for biopsies of suspicious masses that later turned out to be negative. But he said that is a fairly low false positive rate, and one that may be acceptable when traded off with increased detection rates. Kolb said more study is needed before ultrasound will be accepted and added to current screening. There are no other ongoing US studies of ultrasound, though several are planned, he said. Ultrasound testing could also help answer the question on whether mammograms do cut death rates, he added. Kolb suggested that women ask their doctors to tell them their breast density after a mammogram. If they have dense tissue, they could seek an ultrasound test at a clinic that performs them often, he explained. But women will have to absorb the average $100 cost, he said.

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Tamoxifen Prevents Breast Cancer, but Has Own Risks-(Reuters Health-13/09/2002)

Findings from a large international study confirm that the breast cancer drug tamoxifen can prevent the disease in some high-risk women, but researchers say it is still unclear whether that benefit outweighs the drug's risks. Preliminary findings from the International Breast Cancer Intervention Study (IBIS) show that, among women at high risk of breast cancer, tamoxifen cuts the odds of developing the disease by nearly one-third over 5 years. But the study also confirmed the down side of using tamoxifen as a preventive drug--potentially serious side effects, particularly blood clots. "We cannot recommend tamoxifen to be given to high-risk women for the prevention of breast cancer," said the study's lead author, Dr. Jack Cuzick, of Cancer Research UK in London.

He told Reuters Health that it will take another 5 years' worth of data to conclude whether tamoxifen's benefits outweigh its risks for these women. The preliminary findings appear in The Lancet. The investigators stress that these findings do not detract from tamoxifen's proven benefit in treating breast cancer. The drug, produced under the name Nolvadex by AstraZeneca, is the most widely prescribed drug for breast cancer treatment. Its role in prevention got a huge boost several years ago when a large US trial showed that tamoxifen halved the incidence of breast cancer among high-risk women over 5 years. That trial was cut short so that women in the comparison group, who were receiving an inactive placebo, would be allowed to take tamoxifen. At the time, British researchers criticized the decision to halt the US trial, saying long-term studies were needed to confirm the drug's effectiveness in cancer prevention. In addition, two European studies had failed to show tamoxifen has such benefits.

Cuzick said that his team's findings, based on more than 7,100 women in Europe, Australia and New Zealand, give "weak support" to the US study. That's because the risk reduction they found was smaller, while the potential risks of the drug itself were as clear as they were in the US trial, he explained. "This shifts the risk-benefit ratio," Cuzick said. Specifically, Cuzick's team found that while women given tamoxifen were 32% less likely to develop breast cancer, they also had more than double the rate of blood-clotting complications, such as potentially dangerous clots in the legs. They also had a higher rate of death overall, and fatal blood clots could account for only a portion of this difference, according to Cuzick. For now, he said, "we think it's a chance, freak finding."

Another documented risk of tamoxifen is an increase in cancer of the uterine lining, or endometrium. In the current study, more tamoxifen patients than placebo patients developed endometrial cancer, but the difference was not statistically significant, according to the researchers. In addition, the risk of blood clots in this study was highest shortly after women had had surgery or were otherwise immobile over a long period of time. The researchers suggest that women taking tamoxifen for cancer prevention be taken off the drug before surgery and be put back on only after they're moving around again. Cuzick said his team will also study a newer class of drugs called aromatase inhibitors for the prevention of breast cancer. Early research suggests one such drug, anastrozole (sold as Arimidex by AstraZeneca), bests tamoxifen in preventing breast cancer recurrence. It also does not appear to cause blood clots or endometrial cancer, although other side effects such as bone loss are a concern. Cuzick and other investigators on the IBIS study have served as advisors to AstraZeneca.

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Study says radiologists give false positive mammogram readings at 2.6-15.9 percent rate-(Associated Press-13/09/2002)

Radiologists examining mammogram X-rays gave false-positive cancer readings up to 15.9 percent of the time, with the youngest and most recently trained doctors having two to four times the false-positive rate of older radiologists, a study has found. The study, in the Journal of the National Cancer Institute, found that the rate of false positives in the United States could be reduced significantly if radiologists could compare films from previous mammogram screenings. Dr. Joann Elmore of the University of Washington School of Medicine in Seattle said the rate of false positives - breast cancer mammogram screenings that require follow up tests - are becoming increasingly common in the United States, but it should not discourage women from having annual screenings. "Mammography is not a perfect test (for breast cancer), but it is the best test we have," said Elmore, first author of the study in the Journal of the National Cancer Institute. "Women should realize that they have a 10 percent chance of being called back for additional tests."

The results of the study, she said, carry this message: women should continue to have mammograms, but they should try to return to the same testing facility each time so radiologists can compare past test films. False positives are reduced by about 70 percent when radiologists compare current films with images from past tests, Elmore said.

The study involved an evaluation of mammogram readings from 2,169 women by 24 radiologists in a community clinic practice from the years 1985 to 1993, which gave time for follow-up studies of the patients. The study analyzed the rate of false positive interpretations by the doctors, then related that to the experience and training of the radiologists and to the age and other characteristics of the women patients. It found that the false positive rate ranged from 2.6 percent to 15.9 percent. But when this rate was adjusted for the effect of patient characteristics, such as age, the false positive rate dropped to 3.5 percent to 7.9 percent. Age affects the false positive rate because breast tissue is denser in younger women, their mammograms more difficult to interpret.

The study found that doctors who graduated from medical school in the last 15 years had false-positive rates two to four times higher than more experienced doctors. Elmore suggested the young doctors may have had training that concentrated on finding cancer without emphasizing that false positives "can cause a lot of women who don't have breast cancer to be called back" for additional tests. Older doctors also have more experience, she said, and "experience matters." "Radiologists who have been reading mammograms for 20 to 30 years have seen a lot of cases and hopefully learned," she said. The threat of malpractice lawsuits also may affect mammogram interpretations by causing doctors to err on the side of caution, said Elmore. "Mammograms are very challenging to interpret.," she said. "There is a definite art to reading them." But, Elmore said, mammography "is one of the top causes of medical malpractice allegations." That probably does influence radiologists' behavior, she said.

Although the study determined which of the doctors had the most false positives, it could not determine which of the doctors was most accurate in detecting cancer. Out of the 2,169 mammogram readings, there were 45 verified cases of breast cancer. False positives usually result in women being called back for added tests, which can be limited to examination by a specialist or to additional X-ray exams. For some women, the callback results in a biopsy, removal of a small bit of breast tissue for microscopic examination. This is the "gold standard" for evaluating suspicious lesions detected with mammograms, Elmore said. Elmore said even with the rising number of false-positive readings, a women still has only a 50 percent chance of having a single false positive in 10 annual mammography tests. Among those called back for more tests, only a small percentage will be diagnosed with cancer, she said.

In the United States, the average woman has a one-chance-in-eight lifetime risk of cancer, she said. In an editorial in the journal, Dr. Larry Kessler, Dr. Robyn Andersen and Dr. Ruth Etzioni, all of the Fred Hutchinson Cancer Research Center in Seattle, said the Elmore study found a variability in false negative rates among practicing radiologists and "raises the fundamental issue of the source of this variability." They suggest that the solution may lie in a focus on training of doctors and on a system where each mammogram film is interpreted by two radiologists. "It has been shown repeatedly that double reading can improve" both the detection of cancer and the proper interpretation of images on the film, the doctors said.

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Hair Dye Use Doesn't Up Breast Cancer Risk: Study-(Reuters Health-17/09/2002)

Women who color their hair do not appear to increase their breast cancer risk, according to the results of a new study. "We found no overall association between hair dye use and breast cancer risk based on detailed information regarding lifetime use of hair dye products," write Tongzhang Zheng of Yale University in New Haven, Connecticut, and colleagues.

Hair-coloring products are known to contain both mutagenic--meaning they can induce mutations in a cell's DNA--and carcinogenic compounds. But studies searching for a link between hair dye use and breast cancer have had mixed results, the researchers note in the European Journal of Cancer.

To investigate, Zheng's team evaluated the hair coloring practices of 608 women who had been diagnosed and treated for breast cancer and compared them with a group of 609 similarly aged healthy women. The researchers found no association between use of permanent or temporary hair-coloring products and breast cancer. While there was a slightly increased breast cancer risk among women who used semi-permanent hair-coloring products, this finding could have been due to chance because it did not reach statistical significance. And risk did not increase if a woman used such products more frequently or for a longer time, or had started using them earlier in life.

"We also did not find an association between hair dye use and risk of breast cancer based on an individual's reason for using a hair-coloring product as suggested by (other research findings)," the investigators add. For example, whether a woman colored her hair to change her natural color or to cover up gray did not have an impact on risk. "These observations, together with the majority of the earlier studies, suggest that personal hair-coloring product use is unlikely to be a major cause of human breast cancer," Zheng and colleagues conclude.

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Breast Tissue Density May Be Inherited: Study-(Reuters Health-18/09/2002)

New research suggests that dense breast tissue, believed to be a risk factor for breast cancer may run in families. Patterns of fat, connective tissue and glandular tissue in the breast as seen by mammography vary greatly from woman to woman. Past studies have shown that women with denser breast tissue--meaning their breasts contain less fat--have up to six times the breast cancer risk of women whose breasts are less dense. The reason why is not clear. The new study, which involves groups of identical and fraternal twins, suggests that breast density, and its influence on breast cancer risk, may be inherited.

Dr. Norman F. Boyd of the Ontario Cancer Institute in Toronto, Canada, and colleagues reviewed the results of routine mammograms to determine the physical distribution of types of breast tissue in 353 sets of identical twins and 246 fraternal twin pairs from Australia, and 218 sets of identical twins and 134 sets of fraternal twins from the US and Canada. Identical twins share the same genetic make-up, whereas fraternal twins (like non-twin siblings) share about half their genes. The investigators found that genetic factors could account for 60% of the variation in breast density in Australian twins, 67% in North American twins and 63% in all twins studied, according to the report in The New England Journal of Medicine.

"These results show that the population variation in the percentage of dense tissue on mammography at a given age has high heritability," the authors write. "Because mammographic density is associated with an increased risk of breast cancer, finding the genes responsible for this (physical characteristic) could be important for understanding the causes of the disease," they add. In spite of the current findings, women with dense breast tissue shouldn't approach their regular mammographic screening examinations any differently than women with less dense breast tissue, according to Dr. Erik Thurfjell, who wrote an editorial accompanying the study.

Women should continue to follow the recommendations for their age group, notes Thurfjell, who is with Uppsala University in Sweden. "When there is a palpable lump in a dense breast and mammographic examination is inconclusive, ultrasonography should be used," Thurfjell writes. "I would not inform a woman that the mammographic density of her breast increases her risk of breast cancer, since the absolute increase in risk is small. The provision of such information might lead only to unnecessary anxiety."

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Study Looks at Hormone-Cancer Link (AP-12/09/2002)

A new study suggests that while long-term hormone therapy may raise the risk of breast cancer, users who develop the disease may survive longer than those who never took supplements. The reason may be that hormone users' tumors are less aggressive, said Dr. Rodney Pommier, who led the study at the Oregon Health and Science University. Among participants whose tumors were detected by mammogram, all hormone users survived at least six years after diagnosis, compared with 87 percent of nonusers. The research, published in Archives of Surgery, comes two months after a big hormone-replacement therapy study was abruptly halted because it found that women who took estrogen and progestin for about five years had a 26 percent higher risk of developing breast cancer. Some doctors said the Oregon study is flawed and does not let hormones off the hook.

"The results should be interpreted very cautiously," said Dr. JoAnn Manson, who is chief of preventive medicine at Harvard's Brigham and Women's Hospital and took part in the halted research. Rather than showing that hormone treatment overall is beneficial, the study "shows that if you have breast cancer, you are better off if you've had a long history of hormone replacement therapy," said Dr. John Butler, an Orange, Calif., physician who was not involved in the research.

The Oregon researchers reviewed medical records of 292 postmenopausal women diagnosed with breast cancer at the Oregon center. On average, hormone users had taken supplements for 16 years before diagnosis and developed breast cancer at age 66. However, the researchers did not randomly assign women to receive hormones or a placebo and follow them to learn the consequences — the method considered the gold standard of medical research. They also did not differentiate between women who had used estrogen plus progestin and those who took estrogen alone. Manson said there is mounting evidence that the combination raises the risk of breast cancer more than estrogen alone. Users of hormone supplements were no more likely than nonusers to get mammograms. Hormone supplements have been found to make breast tissue denser and potentially more likely to hide tumors on mammograms. But the hormone users in the Oregon study were actually more likely than nonusers to have their tumors detected by mammograms.

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How Faulty Gene Raises Breast Cancer Risk (Reuters-03/09/2002)

Women with a faulty BRCA1 gene have an increased risk of developing breast cancer because the defect disarms the immune system and allows tumors to develop, scientists said. Researchers already knew the gene was vital for repairing gene damage that can lead to cancer, but scientists at Queen's University in Belfast have discovered that it also helps to detect cancerous cells. "Now we can see that the faulty gene also impairs the body's ability to spot cells that are becoming cancerous. This combination of problems may explain the gene's devastating effects," Professor Patrick Johnston, director of the Cancer Research Center at the Northern Ireland university, said in a statement.

Using microarray technology, Johnston and his colleagues looked at thousands of genes at once to determine which were switched on or off in different situations and compared normal cells with cells containing an overactive BRCA1 gene. Their research is reported in the Journal of Biological Chemistry. Women with a faulty BRCA1 gene have between a 65% to 85% increased risk of developing breast cancer sometime during their life. "Our results showed that BRCA1 interacts with a specific part of the body's immune system--a chemical called interferon gamma," said researcher Heather Andrews. The chemical searches for diseased cells and forces them to self-destruct. In cancerous breast cancer cells, interferon gamma does not work properly and the system breaks down. But when the researchers inserted a good copy of the gene into cells during laboratory studies the immune system surveillance system was restored. "These results are beginning to shed light on why some women have such a high risk of developing breast cancer," Johnston added.

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Mammograms Don't Help Women Under 50, Study Says (Reuters-03/09/2002)

Undergoing an annual mammogram before the age of 50 does not reduce a woman's risk of dying from breast cancer, according to a new study reported by the Globe and Mail. The Canadian study involved 50,430 women in their 40s, who were recruited from 1980 to 1985 as part of the Canadian National Breast Cancer Study. Half the participants had annual mammograms while the other half underwent annual physical examinations by a nurse or physician, the national daily stated. By 1996, 592 women in the mammogram group were diagnosed with invasive breast cancer and 105 had died. In the group that received physical exams, 552 women were diagnosed and 108 died. "The data from this research is quite striking and quite clear," said Dr. Cornelia Baines, a professor of public health sciences at the University of Toronto and co-author of the study. "The difference between annual screening compared with the control group is not statistically significant. Breast cancer mortality was not reduced."

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Immune Factors May Influence Post-Cancer Fatigue (Reuters Health-02/09/2002)

New research suggests that immune system molecules that promote inflammation may play a role in the fatigue that plagues many women years after being treated for breast cancer. "Enduring fatigue seen in some breast cancer survivors may be related, at least in part, to chronic, low-level changes in the immune system," the study's lead author, Dr. Julienne E. Bower of the University of California, Los Angeles (UCLA), told Reuters Health.

As many as one third of breast cancer survivors continue to have moderate to severe fatigue 2 or more years after treatment. In the study of 40 breast cancer survivors, the 20 women who continued to suffer fatigue an average of 5 years after treatment tended to have higher blood levels of several markers linked to immune molecules called proinflammatory cytokines. These molecules are released by the immune system after an injury, trauma or infection to help orchestrate the immune response. Despite the apparent link between cancer-related fatigue and proinflammatory cytokines, Bower cautioned that the results come from a small sample and must be confirmed in a larger study.

She added that many other factors may affect fatigue, including depression, pain, menopausal symptoms and socioeconomic factors. For example, the study found that women with fatigue were more likely to be depressed than non-fatigued women. It is a bit like the old question about the chicken and the egg--researchers do not know which came first, depression or fatigue. Though depression can bring on fatigue, feeling tired all the time can make a person feel depressed.

The researchers also are not sure what caused the spike in cytokine activity in fatigued women. One cause that is "plausible," according to a report in the journal Psychosomatic Medicine, is that immune disturbance and the accompanying fatigue may be long-lasting effects of cancer treatment. But Bower's team did not find any link between particular therapies and fatigue or cytokine levels, although they note that the small size of the study meant that only a few women received each type of treatment. Despite the several unanswered questions about the relationship between fatigue and the immune system, the results do suggest a new approach for treating fatigue in cancer survivors, Bower noted. "If fatigue is related to proinflammatory cytokine activity, as we found here, there are medications designed to block these cytokines that could be tested as potential treatments for this symptom," she said. The UCLA researcher and her colleagues are now studying whether elevated levels of these proinflammatory cytokines may be associated with other symptoms experienced by cancer patients, including sleep disturbances and problems with mental function and mood.

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FDA Approves Labeling Addition for Herceptin (Reuters Health-30/08/2002)

US regulators have approved an addition to the labeling of Genentech Inc.'s Herceptin (trastuzumab) to include data that support the use of Vysis' PathVysion fluorescence in situ hybridization (FISH) test in diagnosing HER2-related breast cancer, the firm said. Herceptin is a targeted therapeutic antibody used for treatment of HER2 (human epidermal growth factor receptor2)-positive metastatic breast cancer in women. The drug is indicated as a first-line therapy when given in combination with paclitaxel, as well as a second- and third-line therapy when given alone.

Beyond suggesting FISH as a method for identifying women with the disease who might benefit from Herceptin therapy, the drug's updated label indicates that patients in Genentech's pivotal trials whose tumors showed HER2 gene amplification benefited from Herceptin treatment, the firm said. A retrospective analysis showed that its trial patients selected using FISH testing and treated with Herceptin combined with standard chemotherapy had a 30% decrease in the risk of death and a 56% decrease in the risk of disease progression compared with patients treated with chemotherapy alone, Genentech said.

Previous to the additional labeling claims approved by the FDA, Herceptin's label only included data recommending immunohistochemistry as an appropriate way to identify HER2-positive patients, South San Francisco-based Genentech said. In December, members of a US Food and Drug Administration (FDA) advisory committee unanimously recommended the additional inclusion of data on the FISH assay in the Herceptin package insert, the firm noted.

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Long Pack-A-Day Habit May Up Breast Cancer Risk (Reuters Health-30/08/2002)

While smoking is not traditionally associated with an increased risk of breast cancer, an international team of scientists say that women who are heavy smokers for many years may be at greater risk of developing the disease. There is some scientific evidence that tobacco smoke contains potential human breast cancer-causing agents. However, studies have often failed to demonstrate a clear link between breast cancer and smoking. One possible explanation for this may be that tobacco's potential breast cancer-inducing effects, if they exist, take decades to cause harm, according to the study's lead author Paul D. Terry of the Albert Einstein College of Medicine, Bronx, New York, and colleagues.

To investigate, Terry's team evaluated the smoking habits of nearly 90,000 women between the ages of 40 and 59 years. After nearly 11 years of follow-up, 2,552 were diagnosed with breast cancer. Relative to women who never smoked, those who smoked a pack of cigarettes a day for 40 years or more had an 83% increase in their risk of developing breast cancer, according to the report published in the International Journal of Cancer. For women smoking a similar number of cigarettes, but who had quit before 40 years, their risk of breast cancer was increased by 22%.

"Our findings suggest that smoking of very long duration and high intensity may be associated with increased risk of breast cancer," Terry and colleagues write. Because studies of groups of women smokers that have examined breast cancer incidence in relation to smoking duration of 30 to 40 years or more are scarce, more data are needed, the authors conclude.

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Non-Mutated Breast Cancer Gene Finds, Fixes DNA (Reuters Health-26/08/2002)

Stanford researchers have discovered the normal function of the BRCA1 gene, the gene that--when mutated--leads to a high risk of breast cancer. According to the new study, the BRCA1 gene normally has the job of finding and repairing damaged DNA. To test their theory that BRCA1 helps to repair damaged DNA, the researchers tweaked cells to make them overproduce the BRCA1 gene, according to the study, which was published in the advance online edition of Nature Genetics. The cells also were deficient in a protein called p-53, which is known to play an important role in repairing DNA, Dr. James M. Ford, an assistant professor of medicine and genetics, and director of the Program for Applied Cancer Genetics and the Stanford Cancer Genetics Clinic, said in an interview with Reuters Health. Women who inherit mutant versions of BRCA1 have a 50% to 80% lifetime risk of developing breast cancer, Ford pointed out. "There is strong evidence that these cancers develop along a different genetic pathway than breast cancers that contain a functioning BRCA1 gene," he said.

In the new study, Ford and his colleagues looked at the role of BRCA1 in tidying up damage from ultraviolet (UV) radiation. Even without p-53, the cells with extra copies of BRCA1 were still able to repair the damage from the UV light, the report indicates. "BRCA1 seems to regulate the genes that find and recognize the damage," Ford said. "And we think it induces the expression of downstream repair genes that work to snip out the damage and help the DNA replicate normal base pairs." Interestingly, Ford said, there's often a genetic double whammy. "Women with a mutated copy of BRCA1 who develop breast cancer often also have a mutated form of p-53." The new research may help direct doctors to better chemotherapy agents for women with mutated copies of BRCA1 who develop breast cancer, Ford said. "This pathway is also very important in repairing damage from certain chemotherapeutic drugs and this suggests that these drugs might be particularly effective in treating breast cancers that arise in women with BRCA1 mutations," he added. And, if doctors figure out what proteins BRCA1 releases, they may be able to find a way to correct for its mutation. "These results have implications both for the prevention and treatment of breast cancer," Ford explained. "And hopefully, one day, women with a high risk of breast cancer won't have to choose between less than perfect screening and a radical mastectomy."

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Mastectomies: More Is Not Better (HealthScoutNews-21/08/2002)

When it comes to mastectomies, new research shows that more is not better. A 25-year update of the first randomized clinical trial to ever look at this issue finds that a radical mastectomy is not more effective than a simple mastectomy, in which lymph nodes and muscles are left in place. In this latest follow-up, both procedures produced essentially the same survival rates. The findings appear in The New England Journal of Medicine. The "B-04" trial, as it is called, launched the trend towards less surgery to treat breast cancer. "This was one of the most important trials ever in breast cancer," says Dr. Alan J. Stolier, medical director of the Lieselotte Tansey Breast Center at the Ochsner Clinic Foundation in New Orleans. "It told us that what we thought might be true intuitively was not true, that more was not better. The cure was the same whether we did a more simple procedure versus a more radical procedure. This trial was one that was given credit for doing away with most radical breast surgery."

"This opened the door for what we are now doing," says Dr. Bernard Fisher, the study's author and scientific director of the National Surgical Adjuvant Breast and Bowel Project (NSABP), which conducted the trial. "This was the turning point in the story of the surgical management of breast cancer, plus it led to the understanding that you weren't going to cure more people by bigger operations, and that you needed systemic therapy in order to do that. And that opened the door for chemotherapy."

In 1971, when the study first started enrolling women, radical mastectomy -- in which the entire breast, muscles of the chest wall and nearby lymph nodes are all removed -- was the norm. However, not all doctors agreed and they pushed for less invasive procedures. To resolve the controversy, the NSABP started the B-04 trial. The study involved 1,765 women who were randomly assigned to one of three groups. The first group received a radical mastectomy. The second got a simple mastectomy, plus radiation. The third received a simple mastectomy without radiation. "There was no difference in the outcome by any of the three methods," Fisher says. Twenty-five years later, the survival rate for all three groups was 14 percent if their lymph nodes tested positive for cancer at the time of surgery. The survival rate for all three groups was 23 percent, on average, if the lymph nodes tested negative for cancer at the time of surgery.

At the time the trial started, biopsies and mastectomies were done at the same time, while the woman was under general anesthesia. Stolier, then a resident, operated on some of the women in the trial and remembers waiting in the operating room with the whole surgical team for the biopsy results to come back. If the diagnosis was cancer, Stolier was handed a white envelope that contained which of the three procedures he was to perform on the woman, still asleep on the operating table. Part of the significance of the trial is its sheer length. "I don't know of anything else that long," Fisher says. "It provides the first real solid natural-history information to what happens to these women."

A substantial proportion of women had recurrences of breast cancer after the watershed five-year mark, indicating the need for long-term follow-up, even when the patient has a good prognosis. Because none of the women in the study received chemotherapy, the trial also serves as a good baseline for what is accomplished with the addition of chemotherapy, Fisher says. "I don't know of any other studies that really have that information," he adds.

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Breast Cancer Gene Risk May Be Overstated (HealthScoutNews-20/08/2002)

The risk of breast cancer associated with two inherited gene mutations is probably much lower than previously believed, new research now says. The reasons involve highly technical epidemiology, but the bottom line is this: Earlier studies probably overestimated the contribution to cancer risk of the two mutations, while downplaying the importance of other, yet undiscovered genetic factors.

Ever since the discovery in the mid-1990s of the BRCA1 and BRCA2 breast and ovarian cancer mutations, women have lived in fear of inheriting the errant genes. Cancer geneticists had previously estimated the risk of breast cancer associated with these mutations at between 70 percent and 85 percent by age 70 for women who have close relatives with the disease. As a result, those who test positive for the flaws, which are particularly common in Jewish women of Eastern European heritage, often opt for breast removal surgery or preventive drug treatment to reduce their risk. According to the new research, the risk is still "considerably elevated, but it's not a life sentence," says Colin Begg, an epidemiologist at Memorial Sloan-Kettering Cancer Center in New York City and author of the study. "The evidence suggests that there's considerable variability in risk even among individuals who have the BRCA mutations."

Begg's study hinges on a phenomenon called penetrance. When expressed as a percentage, this term refers to the likelihood that a carrier of a disease mutation will develop the condition. Knowing the penetrance of a particular cancer gene, for example, can help genetic counselors advise carriers of that mutation how best to protect themselves against illness. Although Begg didn't calculate a figure for the true penetrance of BRCA mutations for breast cancer, research shows it could be as low as 26 percent for some women, or perhaps even lower. While that's about three times the average woman's lifetime risk of the disease, estimated at 8 percent, it may not warrant radical medical procedures, he says.

Begg, whose research appears in the Journal of the National Cancer Institute, says the implications of the findings will become weightier as more women seek genetic testing. Now, most of those getting tested for BRCA errors have family members with breast or ovarian tumors, and thus are at high risk for the diseases. "But we're moving into an era when testing is likely to be commonplace, and a lot of people are going to get it. Preventive options like prophylactic mastectomy make much less sense" for women whose risk of breast cancer isn't soaring, he says. Instead, he adds, they may do well with regular mammograms, self-exams and other prudent monitoring.

Karolynn Siegel, a Columbia University public health researcher who specializes in coping with chronic illnesses, says people "cling to anything that gives them more hope." So revising the risk of inherited breast cancer downward might help some women breathe easier, she adds. "There are other factors that come into play, so women don't have to feel that genetics is destiny," Siegel says. The difficulty, however, is that scientists aren't certain what these factors are, though they seem to include lifestyle habits such as diet, exercise and smoking. Ruby Senie, a Columbia University cancer epidemiologist, says several recent studies have hinted that the risk of breast cancer from BRCA1 and BRCA2 errors might be lower than previously suspected. Also, studies of women with strong family histories of breast cancer but who test negative for these mutations are powerful evidence that other gene flaws almost certainly are involved in the disease, she adds. Ultimately, Senie says, women simply want to know what it means when they're told they carry a cancer mutation -- and right now science can't say.

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Broccoli 'Pill' Eyed in Cancer Fight (HealthScoutNews-19/08/2002)

Broccoli pills may be in our future. Researchers have developed a new synthetic compound, derived from a known anti-cancer agent found in broccoli, that they say could become a pill to prevent breast cancer, and, possibly, other forms as well. Finding compounds to prevent cancer is a Holy Grail of medical research. Right now, Tamoxifen is the only drug approved by the FDA to prevent breast cancer, but it is effective only in women whose cancers are estrogen-dependent. The new compound, called oxomate, could have a much wider application. In a test study, female rats who had been given carcinogens and who were fed oxomate had up to a 50 percent reduction in the number of breast tumors compared with similarly treated rats given a regular diet. "It definitely has a lot of potential," says Jerome Kosmeder, lead author of the study, which was presented last night at the annual meeting of the American Chemical Society in Boston. "The public knows that prevention is better than trying to treat something. Right now the government is trying to do what it can, but I think private industry needs to step in and take charge."

Other experts are not so sure about this new finding. "You never know when something might be really great. The problem is it has never been tried in a human," says Dr. Alan J. Stolier, medical director of the Lieselotte Tansey Breast Center at the Ochsner Clinic Foundation in New Orleans. "There has not been one human test on it. I'm amazed at how much press something can get that was given to rats." Kosmeder, who is also a research assistant professor at the College of Pharmacy at the University of Illinois at Chicago, estimates that a pill could be ready for human trials in seven to 10 years.

Researchers at Johns Hopkins University in Baltimore had already identified sulforaphane as a natural cancer-preventing agent found in broccoli and other cruciferous vegetables such as cabbage and Brussels sprouts. Sulforaphane, however, is toxic in high doses and is difficult and expensive to produce. The new compound, oxomate, acts the same way as its natural counterpart sulforaphane, but has been engineered to be less toxic. In tests on cultured liver cells, oxomate was seven times less toxic than sulforaphane. Oxomate can also be produced synthetically in large quantities. Like sulforaphane, oxomate increases the number of Phase II (detoxification) enzymes needed to protect cells from damage by carcinogens. "Phase II enzymes are sort of our body's protection against internal and external compounds that can damage DNA," Kosmeder says. "This compound and that in broccoli work by elevating these enzyme levels beyond what would abnormally be there. They're boosting your own body's defense against carcinogens." Basically, oxomate prevents normal cells from becoming cancer cells by blocking the action of carcinogens.

Though the researchers so far only have results in breast cancer, they think oxomate may have a role to play with colon, skin and lung cancer. The idea would be to give oxomate in pill form to people who have been exposed to carcinogens or who, for whatever reason, have a predisposition to the disease. "You take a vitamin every day, and this is the same idea," Kosmeder says. "You want to keep up your natural enzyme levels to keep protecting your body." Even though prevention is a huge area of medical research, it is also a time-consuming expensive one. Trials for drugs to treat diseases may take one to two years, whereas trials to test preventives can take five to 10 years to complete. Kosmeder and his colleagues are trying to find ways to shorten that time by locating biochemical markers to measure the action of oxomate. "It is very, very difficult to prove that something prevents something from happening," Stolier says. And he knows from experience. "Many years ago when I had a lab, I learned that you could take a mouse or rat, inject the solution of destroyed cancer cells into the mouse and then in a few weeks that mouse wouldn't get that kind of cancer. You can immunize the mouse against cancer, but we haven't done that to humans. We've tried. It just doesn't seem to work."

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Diet, Weight May Affect Breast Cancer Prognosis (Reuters Health-14/08/2002)

Women with breast cancer who control their weight and eat enough fruit and vegetables may live longer after their diagnosis than those who are not as health conscious, US researchers report. Drs. Cheryl L. Rock of the University of California, San Diego in La Jolla and Wendy Demark-Wahnefried of Duke University in Durham, North Carolina base their findings on a review of recent studies that investigated the effect of nutrition on survival and cancer recurrence. Although the authors admit more research is needed, they say current evidence suggests that breast cancer patients would benefit from eating healthy and getting enough exercise.

Women who are diagnosed with breast cancer should "achieve and maintain a healthy weight and eat a plant-based diet with plenty of vegetables, fruits and whole grains," Demark-Wahnefried told Reuters Health. Furthermore, the authors note that many women newly diagnosed with breast cancer become motivated to change their diet to improve their health, and doctors may wish to take advantage of this so-called "teachable moment." By doing so, the researchers add, doctors can also help reduce patients' risks of other conditions influenced by nutrition, such as diabetes or cardiovascular disease.

"A diagnosis of breast cancer is often a wake-up call that can't be ignored," Demark-Wahnefried said. "Both Dr. Rock and myself have witnessed many women turn their lives around after diagnosis--they begin to exercise and eat better and they become healthier than they ever have before." Reporting in the Journal of Clinical Oncology, Rock and Demark-Wahnefried reviewed scientific papers on nutrition and breast cancer published between 1985 and February 2002. In regard to body weight, the investigators report that most studies focused on that issue found that breast cancer patients who are either overweight or obese survived for less time than slimmer patients.Women can also gain weight as a result of cancer treatment, which some studies noted can reduce patients' quality of life and the amount of time they live without cancer, or may increase their risk of other conditions.

Turning to vegetables, the authors report that studies examining the link between fruit and vegetable intake and breast cancer prognosis found these foods to have somewhat of a protective effect, "although the strength of the association is modest." Previous research has suggested that drinking alcohol can increase the risk of developing breast cancer. Interestingly, Rock and Demark-Wahnefried found that most studies found no link between alcohol consumption and survival.

In an interview with Reuters Health, Demark-Wahnefried said that although alcohol may help initiate cancer, that does not mean it will also influence the cancer's progression. "Liken it to lighting a fire," she said. "The initial match may start the process, but once the fire is racing, the match becomes unimportant." None of the results presented in the paper surprised her, the researcher added, since the material had already been published. But putting it all together made a difference, she said. "In assimilating the literature, you develop an appreciation for study results that are durable and that stand the test of time versus results that might be chance findings," Demark-Wahnefried said.

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Little Evidence of Breast Cancer, Pesticide Link (Reuters Health-06/08/2002)

There appears to be little or no link between breast cancer and exposure to certain pesticides and air pollutants, and these environmental factors don't seem to explain the high breast cancer rate seen on Long Island, New York, researchers reported. "Starting with more than 3000 women in this federally mandated research, we looked at blood samples taken from hundreds of new breast cancer patients and comparable women without breast cancer who served as controls," Dr. Marilie D. Gammon from the University of North Carolina School of Public Health, Chapel Hill, said in a prepared statement.

In their first study, Gammon and colleagues tested blood samples for polycyclic aromatic hydrocarbons (PAH) from 575 women with breast cancer and 424 "control" women who were cancer-free. PAHs are known to cause breast cancer in rats and are found in cigarette smoke, car and airplane exhaust and in grilled and smoked food. Overall, the researchers found no link between PAH level in the body and breast cancer risk. When they looked at women with the highest amount of PAH exposure, those women did have a slightly higher risk--about 1.5 times higher--than women with the lowest level. However, there was no consistent increased risk with increasing exposure. And the researchers found no link between DNA damage associated with PAH and smoking or passive smoke exposure or the consumption of grilled or smoked foods, the researchers note.

In their second study, Gammon's team looked at blood samples from 646 women with breast cancer and 429 controls. They tested for environmental pollutants such as DDE (a breakdown product of the now-banned pesticide DDT), chlordane (an insecticide used to combat termites), dieldrin (a pesticide) and several types of PCBs, a now-banned group of synthetic chemicals once widely used in industry and in products from plastics to pigments. Among these women there was no increased breast cancer risk associated with the compounds, known collectively as organochlorines. The two reports are published in Cancer Epidemiology, Biomarkers and Prevention.

However, the studies are not the final word on a possible link between pollution, pesticides and breast cancer, according to the researchers. "Our findings with polycyclic aromatic hydrocarbons suggest that women's individual response to similar PAH exposures might be more relevant to breast cancer development than the absolute amount of PAH exposure," Gammon said. "A lot more work needs to be done to sort out exactly what and how environmental exposures may promote breast cancer."

The Long Island Breast Cancer Study Project was started in 1993 by the National Cancer Institute and the National Institute of Environmental Health Sciences to determine, among other things, whether the rate of breast cancer seen on Long Island, which is higher than the national average, has an environmental cause.

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Study Backs Short, Intense Radiation for Breast Cancer (HealthScoutNews Reporter-06/08/2002)

When it comes to radiation therapy for breast cancer, slow and steady doesn't always win the race. New research finds a shorter, more intense course of radiation after a lumpectomy seems to be equally effective as the standard course, which is longer but with less radiation each time. Although experts agree that radiation therapy after surgery to remove a malignant tumor reduces the risk of a recurrence, there's no consensus on how long that treatment should last. Currently, most treatments last for four to six weeks.

In the new study, appearing in the Journal of the National Cancer Institute, researchers gave patients modestly higher bursts of radiation for only three weeks. "This shorter treatment is going to be a lot more convenient for women," says Dr. Timothy Whelan, study author and an assistant professor of medicine at McMaster University in Hamilton, Ontario. "The other thing from the health-care perspective is that you can reduce the cost by half almost, so the ramifications are really huge."

This is not a new treatment for breast cancer, experts say. Cutting-edge research these days involves localized radiation, such as brachytherapy, which targets the tumor rather than the whole breast. On the other hand, shortening conventional radiation therapy has the advantage of being something many women can take advantage of now.

In this study, Whelan and his colleagues randomized 1,234 women who had undergone lumpectomies for their breast cancer into two different treatment arms. One received the more intensive radiation (30 percent more) over 22 days, and the other received the conventional, less intensive radiation over 35 days. None of the cancers had spread to the lymph node. After six years of follow-up, there appeared to be no difference in recurrence of the breast cancer or in cosmetic outcome. Local recurrence-free survival was 97.2 percent in the "short" group and 96.8 percent in the "long" group. The authors counsel, however, that the shorter therapy is not recommended for women with very large breasts.

Should this new course of radiation therapy become the new standard? The authors of an editorial in the same issue of the journal give a qualified "yes." Women who have small tumors that have been successfully removed might benefit. At the very least, the findings expand the range of options.

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Grouchy? Type A? It Won't Affect Breast Cancer Risk (Reuters Health-02/08/2002)

Personality has no effect on breast cancer risk, according to a large study of twins published in the International Journal of Cancer. While it has been suggested that there may be a cancer-prone personality, study authors report that being extroverted, neurotic or hostile or having a type A personality do not, individually or in combination, increase a woman's risk of developing the disease, which should help ease women's concerns. "This study is quite consistent with the majority opinion among behavioral scientists at this time, and should be seen as reassuring related to someone's personality 'causing' cancer," Michael Stefanek of the National Cancer Institute told Reuters Health.

Kirsi Lillberg of the Department of Public Health, University of Helsinki, Finland and colleagues studied 12,499 Finnish twins aged 18 and older from 1976 to 1996. The women answered health questionnaires in 1975 and 1981, which included questions about personality traits. Other potential breast cancer risk factors, including age, weight, social class, age at birth of first child, number of children, physical activity and alcohol or tobacco use, were also reported. A total of 253 cases of breast cancer were identified between 1975 and 1996. No discernible difference was found in breast cancer between women considered to be moderately or highly extroverted and those who did not have an outgoing personality. Similarly, having a type A personality (characterized by ambitiousness, competitiveness and aggressiveness) and having a hostile personality (marked by irritability, ease of getting angry and argumentativeness) were not related to breast cancer risk.The researchers also studied combinations of personality traits, such as extroversion plus hostility and extroversion combined with neuroticism. Again, there was no difference in breast cancer risk for women with these combinations of traits.

Within twin pairs in which one twin had breast cancer and the other did not, personality was not found to be related to risk. Previous research has tended to support these findings, including a Dutch study that found no substantial link, with the exception of a very small risk increase for women with anti-emotionality (a lack of trust in one's true feelings).

An analysis of 46 studies reported between 1970 and 1996, conducted at Roswell Park Cancer Institute, Buffalo, New York, also failed to find a connection between variables such as stress and depression and breast cancer. The possible connection of personality to the development of cancer has a long history, dating back to ancient Rome, according to Stefanek. "It's a complex issue given the multitude of cancer sites and different risk factors involved in each," he said.

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Study Looks at Breast Cancer in Young Black Women (Reuters Health-31/07/2002)

Young African-American women who develop breast cancer appear to be more likely to die from the disease than their white counterparts, according to the results of a new study. But the investigators also found a bit of good news--the percentage of African-American women who have their breast cancer detected while it is still in an early stage, and therefore more treatable, has nearly doubled during the 1990s. This finding suggests that education campaigns targeting African-American women may be working. However, detection rates in blacks still lag behind detection rates in whites, the researchers point out.

In their investigation, Dr. Lisa A. Newman of Wayne State University in Detroit, Michigan and colleagues evaluated the outcomes of 507 African-American and 1,378 white women diagnosed with breast cancer before age 40. All of the women lived in Detroit. Although most study patients with localized breast cancer survived, Newman's team found that black women were nearly twice as likely to die as white women."Young African-American women are clearly facing increased risks for breast cancer mortality, and this public health issue warrants further investigation and research," Newman and colleagues write.

With regard to detection of breast cancer among women with disease that has yet to spread, African-American women jumped up from a rate of 6.4% in the early 1990s to 11.3% in the later part of that decade. White women actually saw a slight decrease in their rates of early detection--from 16.4% to 15.7%. The study authors are calling for more education campaigns to be targeted at African-American women, and that this group be included in more clinical research.

"These are not new findings," said Dr. Vilma Cokkinides, a spokesperson for the American Cancer Society. "Racial disparities for young women with breast cancer have been reported over and over." With regard to the current study, Cokkinides notes that socioeconomic factors including level of education and access to healthcare "have not been properly accounted for," and if they were, the death rate differences may be "somewhat reduced." Regardless, what remains controversial is the cause for the differences in cancer rates and death rates attributed to the disease, according to Cokkinides. There is currently a "big debate" as to whether the differences are related to socioeconomic factors or cancer tumor biology, Cokkinides noted. In other words, experts are not sure if African-American women are more likely to develop more aggressive forms of breast cancer or if other, society-related factors play a role. Researchers continue to investigate the issue, Cokkinides said.

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Clue Found to Breast Cancer Drug Resistance (Reuters-25/07/2002)

Scientists have discovered why some breast cancer patients do not respond to the drug tamoxifen, in a finding that could improve treatment and save lives from the disease that afflicts a million women worldwide each year. Tamoxifen is the most widely prescribed drug for breast cancer and has been credited with improving survival of women with the illness. Breast cancer patients with tumors that use estrogen to grow are routinely given the drug, but it does not work in all women. Researchers at Cancer Research UK said they have found a change in a molecule that explains why, and they are developing a standard test to detect which patients will not respond to the drug and would benefit from alternative treatments. "When you give patients tamoxifen the only way of measuring response is by seeing whether the tumor continues to grow or not. If you can determine how the patient will respond you could put them on tamoxifen or a more appropriate treatment. So it (the finding) will likely save lives," said Dr. Simak Ali of Imperial College in London.

Tamoxifen works by neutralizing the action of the hormone oestrogen, which stimulates breast tumor growth. It blocks the function of the oestrogen receptor (ER), which around half of breast tumors rely on for their growth. Studies have shown that it is effective in treating early and advanced breast cancer, particularly in women older than 50 who are most likely to develop the disease. But the drug can also increase the risk of a rare form of cancer of the uterus. After studying the ER, Ali and his team noticed that part of the molecule is altered in some women and instead of being blocked by tamoxifen, it becomes more active. Their research is published in the journal Oncogene.

"Chemical alteration seems to switch the ER molecule into a completely different state, in which it becomes immune to the inhibitory effects of tamoxifen," said Ali. "It's important that we learn to identify women who are not going to respond to the drug." In addition to pinpointing the change in the molecule, Ali and his team have developed antibodies that home in on the altered ER molecule, allowing doctors to detect it. They are developing a diagnostic test that will identify the altered ER receptor during a standard biopsy so treatment can be customized to suit the patient, and precious time will not be wasted by prescribing inappropriate drugs. "You are essentially ending up with customized treatments," said Ali. Breast cancer is the most common cancer in women, usually striking after 50. Postponing childbirth or not having children, early puberty, late menopause and a family history of the illness are risk factors.

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Strong Identical Twin Breast Cancer Link Identified (Reuters-23/07/2002)

Women who have an identical twin with breast cancer have four times the normal chance of developing the disease themselves, American scientists said. The risk is higher than researchers had previously thought and highlights the role of genetics in the development of the disease that kills more than 370,000 women worldwide each year. "Doctors could use this information to identify women who are particularly susceptible to breast cancer and advise them accordingly," said Professor Thomas Mack of the University of Southern California in Los Angeles, who headed the research team.

Having a close family member, a mother or sister, with breast cancer is known to increase a woman's chances of getting the disease but Mack and his team were surprised by how strong the link was with identical twins. Not only does the risk increase significantly, it continues after the menopause and women are more likely to develop the disease earlier -- within five years of their identical twin. "The fact that non-identical twins have the same risk as a mother or sister despite having a more similar upbringing can show us to what extent genetics plays a part in the development of breast cancer," Mack added in a statement.

His research is published in the British Journal of Cancer. Scientists have identified genetic mutations which are linked to breast cancer, but they account for only about 10 percent of cases. Mack and his colleagues compared the rate of breast cancer among the general population and 2,562 pairs of identical twins and non-identical twins with either one or two cases of the illness. Breast cancer is the most common cancer in women. One million women develop the disease each year with most cases occurring past the age of 50. Postponing childbirth or not having children, early puberty, late menopause and obesity are also risk factors.

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Breast-Feeding May Protect Vs. Cancer (Associated Press-18/07/2002)

The number of children women have and the length of time they breast-feed them are the most important factors influencing their chance of developing breast cancer even more important than genetic factors, major new research shows. The landmark study, published in The Lancet medical journal, found that if women in the industrialized world breast-fed each of their children six months longer, they could reduce their chance of breast cancer by 5 percent, even if they have a strong family history of the disease. Experts said the findings help explain the mysterious rise in breast cancer rates over the last century.

"In the developed world there have been enormous changes over the last 100 years in childbearing patterns and this illustrates that those changes can explain a great deal of the increase in breast cancer rates," said Eugina Calle, director of analytic epidemiology at the American Cancer Society. The study involved 200 researchers across the globe examining more than 47 studies that investigated a total of 150,000 women worldwide. The analysis of the pooled information was conducted by epidemiologists at Oxford University in England. The idea that childbearing is linked to breast cancer dates to 1743, when an Italian researcher called the disease an occupational hazard of nuns, attributing their relatively high rate of breast cancer to their childlessness. Breast cancer rates really started to climb at the end of the 19th century, and by the 1950s, it was well established that the number of children a woman had was a major factor in breast cancer.

In 1970, a study found that the age at which a woman had her first child was key, but that neither the number of children she had nor her breast-feeding habits mattered. "Since that time, almost every study on breast cancer has confirmed that finding on age at first birth, but there's been a lot of confusion about whether the number of children and breast-feeding had an effect on breast cancer," said the new study's leader, Valerie Beral, head of the Oxford epidemiology unit. Confusion has remained, particularly about the role of breast-feeding, because individual studies have been too small to provide answers, she said. The Oxford group started by looking at 20,000 women who had only one child and who had never breast-fed, and compared them with women who did not breast-feed but continued to have children.

"The risks go down the more children you have. Even if they'd never breast-fed, the risk of breast cancer went down by 7 percent for every additional child," Beral said. The researchers also found that, regardless of the number of children, the risk of breast cancer dropped by 4.3 percent for every year the women breast-fed. The magnitude of protection was the same in all women, regardless of other characteristics, such as ethnic origin, drinking habits and age at menopause. In the developed world, women have on average two or three children and breast-feed each for about two or three months.

A century ago - before oral contraception, infant formula, improved infant survival and career opportunities for women - Western women used to have six or seven children and breast-feed each for about two years - a pattern still dominant in many parts of the developing world. Today, women in the industrialized world have a 6.3 percent chance of getting breast cancer by age 70, compared with a 2.7 percent chance for their counterparts in poor countries. Part of the reason is that women in poor countries have children earlier, at about 18 or 19, compared with 23 or 24 in the developed world. But that couldn't explain all the difference in the breast cancer rates.

"People have been struggling to fill that gap. Things like diet, alcohol ... all these things have come up in an attempt to explain the difference," Beral said. "But, it's prolonging breast-feeding and having lots of children that really pushes breast cancer rates down. "There are obviously other determinants, but they are much smaller. Those two factors account for much of the difference in breast cancer rates between developed and developing countries," Beral said. The study found that if women in developed countries had six or seven children instead of two or three, their risk of breast cancer would decrease from 6.3 percent to 4.7 percent.

"If you add to that two years of breast-feeding per child - which is typical for women in rural areas of the developing world - you get a further 40 percent reduction down to 2.7 percent," Beral said. Changing those two factors alone would more than halve the risk of breast cancer in the developed world, the study found. The researchers also calculated what would happen to breast cancer risk if women still had only two or three children but breast-fed each for six months longer than the norm of two or three months. That would translate to a maximum breast-feeding time of nine months per baby. They found that the chances of breast cancer would decrease from 6.3 percent to 6 percent, a 5 percent drop.

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Study Shows Hormone Therapy Raises Risk of Cancer (Reuters-09/07/2002)

Women wondering whether to take hormone replacement therapy got a clear answer: Don't do it if the goal is to lower the risk of heart disease and other chronic illness. Women who take combined hormone replacement therapy after menopause increase their risk of breast cancer, stroke and heart disease, researchers said. The risks are so high that the federal government stopped a trial of women taking hormone replacement therapy, or HRT, and issued a warning to doctors and patients.

The study, published in the Journal of the American Medical Association, is the second blow this month to HRT, which is taken by more than 6 million American women. Doctors reported last week that the combination of estrogen and progestin does not protect women from heart disease after menopause. "Women with a uterus who are currently taking estrogen plus progestin should have a serious talk with their doctor to see if they should continue it," Dr. Jacques Rossouw of the National Heart, Lung, and Blood Institute, who led the study, said in a statement. "The cardiovascular and cancer risks of estrogen plus progestin outweigh any benefits and a 26 percent increase in breast cancer risk is too high a price to pay, even if there were a heart benefit," added the institute's director, Dr. Claude Lenfant.

An estimated 38 percent of women past menopause take HRT for a range of reasons, including immediate relief of symptoms including hot flashes and sexual problems, as well as to prevent osteoporosis and heart disease. The study of 16,600 women nationwide found that HRT does lower the risk of hip fracture, a measure of osteoporosis, but it raised the number of strokes by 41 percent, heart attacks by 29 percent and breast cancer cases by 26 percent.

The study did not find that women taking HRT were more likely to die than the women who took placebos, but the study was stopped after the women had taken the drugs for just over five years. The overall higher risk of cancer, heart disease or stroke was low, the researchers pointed out. For every 10,000 women who take the hormones for a year, seven extra have coronary heart disease "events" such as a heart attack, eight more develop breast cancer and eight more suffer a stroke, as compared to women not taking hormones. Women taking the hormones for the short-term may not have a higher risk of disease, Rossouw said."Menopausal women who might have been candidates for estrogen plus progestin should now focus on well-proven treatments to reduce the risk of cardiovascular disease, including measures to prevent and control high blood pressure, high blood cholesterol, and obesity," Lenfant said.

Dr. Lori Mosca of Columbia University in New York, one of the earliest critics of using HRT to prevent heart disease, said women can take osteoporosis drugs to prevent thinning bones, or use diet and exercise. "We do need more research on other types of hormone replacement for the menopausal years," she added in a telephone interview. The estrogen-progestin combination was formulated because taking estrogen alone was shown to increase the risk of ovarian cancer.

For women who have had hysterectomies and who need HRT, estrogen alone may be safer, Dr. Suzanne Fletcher and Dr. Graham Colditz, both of Harvard Medical School, said in a commentary. "The (study) provides an important answer for generations of healthy postmenopausal women to come -- do not use estrogen/progestin to prevent chronic disease," they wrote. The women in the study took Premarin, the best-selling HRT drug made by Wyeth . According to the Kaiser Family Foundation, a nonprofit research group, 46 million prescriptions worth $1 billion were written for Premarin in 2000, making it the second most prescribed drug in the country after cholesterol-lowering Lipitor, made by Pfizer Inc. .

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More Evidence Soy Guards Against Breast Cancer (Reuters Health-08/07/2002)

Women eating a diet rich in soya products are 60% less likely to have "high-risk" breast tissue than women with the least soya in their diet, scientists said. "Our findings considerably strengthen the hypothesis that soy consumption protects against breast cancer development," said researchers at the National University of Singapore, Cancer Research UK and the US National Cancer Institute.

Scientists have previously suggested that soya intake might contribute to the low rates of breast cancer in countries like China and Japan but research has proved inconclusive. The latest research-reported in the journal Cancer Epidemiology, Biomarkers and Prevention-combined data from two studies of Chinese women in Singapore. The first study focused on women's eating habits, including their intake of soya, while the second used mammograms to classify women according to the density of their breast tissue.

After identifying 406 women who took part in both studies and adjusting for energy intake and other potential confounding factors, the scientists found that soy protein intake was inversely related to high-risk tissue. Other research has shown that dense tissue is associated with an increased risk of breast cancer. "This research shows for the first time how the amount of soya a woman eats may have an effect on breast tissue and in turn may potentially reduce her risk of breast cancer," Dr. Stephen Duffy of Cancer Research UK said in a statement. Soy is a rich source of plant oestrogens, which are known to protect against breast cancer in animals.

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Stress Not Linked to Breast Cancer Recurrence-Study-(Reuters-14/06/2002)

Stressful events such as divorce or the death or illness of a loved one do not lead to a recurrence of breast cancer, British psychologists said. It is a widely held belief that stress contributes to the disease and women diagnosed with illness or those whose cancer returns often blame terrible events in their lives for triggering the illness. But researchers at the charity Cancer Research UK said a study of 222 breast cancer patients did not find any evidence of a link between stress and a return of the cancer.

A team of scientists questioned the women about stressful events in their lives in the year before they were diagnosed with breast cancer and five years afterwards. They were not concerned about the usual trials and tribulations they experienced daily but focused on major events including serious financial problems, the collapse of a marriage, discovery of an infidelity or the loss of a child or husband. Rather than contributing to a relapse they found the opposite occurred. The results contradict the findings of an earlier study that showed stress could increase the risk of a recurrence.

Graham said her prospective study was larger, had a long follow-up up period and used different research methods that could explain the conflicting results. Fifty-four women in the study experienced a recurrence. Up to a third of women with operable breast cancer will have a recurrence of their disease within five years of it being diagnosed, according to Graham. The size and grade of the tumour and whether or not it has spread beyond the breast to the lymph nodes are factors that influence recurrence. Breast cancer is the most common cancer in women. One million women develop the disease worldwide each year. Early detection and treatment increase the chances of surviving the illness. Women are advised to check their breasts to detect changes or lumps that could be indications of the disease. Most breast lumps are not cancerous.

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Effect of Family on Breast Cancer Survival Varies-(Reuters Health13/06/2002)

Women with a mother, sister or other relative with breast cancer are known to have an increased risk of developing the disease themselves, but a family history of breast cancer does not seem to have much of an effect on the odds of surviving the disease, results of a new study suggest. In a study of more than 1,200 women with breast cancer, women with a family history of breast cancer were, for the most part, neither more nor less likely to survive as long as women with breast cancer who did not have any relatives with the disease.

The 5-year survival rates of women with breast cancer, regardless of whether or not they had a close or distant relative with the disease, hovered around 80%, according to a report in a recent issue of the International Journal of Cancer. "Our study suggests that family history did not modify the survival" of women with breast cancer, according to the study's lead author, Dr. Antonio Russo, of the Local Health Authority of Milan in Italy. However, he told Reuters Health that there were suggestions of an effect of family history on survival in some groups of women. Among women diagnosed with breast cancer before age 45, women with a family history of the disease had a lower 5-year survival rate than women without a family history, although the difference was not statistically significant.

A possible explanation, according to Russo, is that these younger women may be more likely to carry gene mutations called BRCA1 and BRCA2, which have been linked to early breast cancer. But the relationship between family history and survival was the opposite in women who were diagnosed at age 45 or older, Russo said. He explained that in this age group, women with a family history tended to have better, or at least not worse, survival odds than women without a family history. The results of the study suggest that the effects of family history on breast cancer vary widely, according to Russo. Whether family history improves or worsens survival odds may depend on the type of breast cancer genes a woman has, he said. Previous research on the effects of family history on breast cancer survival has been mixed. About 20% of women with breast cancer have a family history of the disease, but only 4% to 10% are thought to have a hereditary form of cancer, such as those caused by the BRCA1 and BRCA2 mutations.

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Mammography Gets a Helping Hand-(HealthScoutNews-04/07/2002)

A portable device that peers into the biochemical machinery of cells can help identify breast cancers that conventional scanning can't find. A new study has found the machine, called a high-resolution breast-specific gamma camera (HRBGC), gives doctors a view into an organ's biochemical percolation. Cancer cells are busier than normal tissue, and the scanning device is able to detect this activity. Experts say the tool, which has already been approved by the U.S. Food and Drug Administration, isn't meant to replace mammography. Rather, it will supplement that technology in women with dense breasts and other tissue traits that cloud a clean mammogram."Because it's small, you can bring it much closer to the patient with any angle you want," says Dr. Cahid Civelek, a Johns Hopkins University nuclear medicine specialist and co-author of the study, which appears this month in the Journal of Nuclear Medicine. "The way it's built, it can see smaller objects more clearly."

More than 180,000 American women will be diagnosed with breast cancer this year, according to the National Cancer Institute. Routine mammography is recommended for women over 40. Conventional X-ray mammography works very well for most women. However, for the quarter of women with dense breasts, the scan's ability to find tumors drops markedly, and as many as 30 percent to 35 percent of tumors go undetected. While mammography can identify lesions, it's poor at discerning benign masses from cancers. As a result, only about 20 percent to 25 percent of lumps found during mammograms are malignant. Scientists have been working on a variety of ways to improve the eyesight and accuracy of mammography.

One promising approach has been the gamma camera. This device, which has been around in various forms for decades, offers doctors an inside look at an organ's biology by detecting a radioactive contrast agent that's absorbed more readily by tumor cells than healthy tissue. However, this technique, called scintimammography, has limitations. The machines are bulky, resolution is sometimes poor, and they have trouble catching lumps of a centimeter or less in diameter. The new device, made by Dilon Technologies, is a modified gamma camera designed specifically to scan breast tissue. For an imaging agent it uses a radioactive molecule attached to a breast cancer drug that migrates to tumors and gets taken up by the cells. Civelek and his colleagues tested the machine on 50 women with 55 breast lesions that had already been discovered by a manual exam or during mammography or ultrasound scanning. Subsequent cell samples showed that 52 percent of the lesions were benign and 48 percent were cancerous. Both machines were able to identify the benign lesions 93 percent of the time.

However, the high-resolution device identified nearly 79 percent of the cancerous tumors, compared with 64 percent for the conventional gamma camera. The new device was also more effective at diagnosing tumors that couldn't be felt, and at finding lumps a centimeter or smaller in diameter. It also detected four masses, with an average size of just 8.5 millimeters, which the other gamma camera missed. The high-resolution gamma camera ideally will supplement mammograms and ultrasound scans with vague results. The most likely candidates for the additional test are women with dense breasts -- who include the young and those taking hormone replacement therapy -- as well as those with scars from previous biopsies. Another advantage of the machine is that the test, which takes 20 minutes to perform, is painless. "During the imaging procedure, the breast is not compressed as in mammography, and therefore there is no discomfort to the patient," he says.

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Pounds Added Over Years Raise Breast Cancer Risk-(Reuters Health-06/06/2002)

Women who gain the most weight over their lifetime are most likely to develop breast cancer after menopause, new study findings from Canada suggest. "Gaining weight over a lifetime increases breast cancer risk," Dr. Christine M. Friedenreich of the Alberta Cancer Board in Calgary told Reuters Health. "Being overweight after menopause is also a risk factor," she said. Extra pounds seem to be particularly risky when they are carried around the abdomen, the Canadian researcher noted. A woman's shape and weight have been thought to influence her risk of breast cancer, but the evidence has not been conclusive.

To evaluate the possible connection, Friedenreich and her colleagues compared 1,233 women with breast cancer and a "control" group of 1,237 women who did not have the disease. Among premenopausal women, none of the so-called anthropometric factors--waist circumference, waist-to-hip ratio and weight gain during adulthood--affected the risk of cancer, according to a report in the International Journal of Cancer. But a woman's shape and weight did affect the risk of breast cancer after menopause. Women with the highest waist-to-hip ratio, meaning that they carried more weight around the abdomen, were 43% more likely to have breast cancer than women with the lowest ratio.

Gaining weight as an adult also seemed to make women more susceptible to breast cancer, the report indicates. Women who gained the most weight since age 20 (25 kilograms, or about 55 pounds, or more) were 35% more likely to develop breast cancer than those who had gained the least (less than 7.8 kg, or about 17 pounds). The effects of hormone replacement therapy on the risk of breast cancer are controversial, but the present study suggests that hormone therapy may diminish some of the increased risk brought about by weight gain or extra pounds around the waist. The link between all measures of body weight and size and the risk of cancer was stronger in women who had never used hormone replacement therapy, according to the report. Although Friedenreich and her colleagues call for additional research, they conclude, "Our results corroborate and strengthen the evidence from previous research that avoiding weight gain throughout life is a means of reducing postmenopausal breast cancer risk," especially among women who have never taken hormone replacement therapy.

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States Sue Bristol-Myers Over Taxol Monopoly-(Health Scout News-28/05/2002)

Pharmaceutical giant Bristol-Myers is being sued by more than half of U.S. states, who accuse the company of monopolizing the market on the popular cancer drug Taxol, reports the Wall Street Journal. By illegally stalling competitors for years, Bristol-Myers has deprived consumers access to less expensive versions of the potentially lifesaving drug, says the suit, filed today. What's worse, attorneys general say in the lawsuit, is that the drug, generically known as paclitaxel, was discovered by the National Cancer Institute and taxpayers themselves footed the bill for its development and testing. "I find it particularly distasteful that Bristol is illegally profiting from a drug which only exists because taxpayers paid for its development in the first place," Jennifer Granholm, Michigan's attorney general, said in a prepared statement. "That's double-dipping at its worst." Taxol is commonly used in the treatment of ovarian, breast, and various other cancers.

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Gene Implicated in Cancer's Spread (HealthScoutNews-26/06/2002)

Many cancers spread, striking off from the main tumor to take up in distant organs. However, the mechanics behind this migration aren't well understood. Now, a new study has found a gene in breast cancer cells that might help explain the phenomenon. The gene, called NFAT, regulates a variety of body functions, from the immune system to vessel formation. And it may give breast cancer cells a compass with which they can navigate their migration. A report on the findings appears in Nature Cell Biology. NFAT (short for nuclear factor of activated T-cells) is an umbrella acronym for a group of genes that turn on other genes. Discovered about two decades ago as a puppeteer in the immune system -- and subsequently, in many other systems -- NFAT is the target of the transplant drug cyclosporine, which suppresses the immune response against grafted organs.

More recently, scientists found chemicals that block NFAT have anti-tumor properties, hinting at a role for the regulatory molecule in the spread of cancer. In the new work, researchers led by Sebastien Jauliac, a postdoctoral fellow at Harvard University's Beth Israel Deaconess Medical Center in Boston, looked for NFAT activity in invasive breast and colorectal cancer carcinoma cells growing in lab dishes. Both NFAT1 and a newly identified form of the protein, NFAT5, were present in the tumor cells and appeared to help promote invasiveness. Jauliac's team then looked for and found strong NFAT signals in tissue samples taken from five women with aggressive breast cancer that had spread to their lymph glands. They showed that NFAT activity was linked to that of another gene, alpha 6 beta 4 integrin, known to be involved in cancer cell migration.

Integrin may activate NFAT, which in turn triggers gene changes that send tumor cells wandering, explains Alex Toker, a Harvard pathologist who headed the research effort. Once activated, carcinoma cells can move away from the main tumor, burrow through nearby blood vessel membranes, and break out into the circulatory system, where they have open access to the rest of the body. Although the researchers looked only at breast and colon carcinomas, Toker says he has a "strong feeling" that NFAT activity will be present in virtually all other carcinomas. It's still unclear how NFAT might trigger metastasis. Jauliac says the gene might switch on instructions within tumors that lead them to behave like immune cells. "Immune cells have the property of migrating when there's an infection," he explains.

However, Dr. Gerald Crabtree, the Stanford University biochemist who discovered NFAT, says it's "a bit early" to draw any conclusions from the latest findings. "What is lacking is the evidence in patients with cancer of mutations" in NFAT that might alter its normal functioning, says Crabtree, who reviewed the paper for the journal. If NFAT errors ultimately prove to have metastatic powers, Crabtree says, they're not likely to stem from its role in the immune system. Rather, the gene's influence over blood vessel formation is a more probable prospect. Whatever the case, NFAT may make a promising target for new tumor drugs. However, these might be long in coming. Cyclosporine, which is known to inhibit NFAT in normal cells, has no sway over it in cancerous tissue, Jauliac says.

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The Pill Not Tied to Future Breast Cancer (HealthScoutNews-26/06/2002)

Birth control pills will not increase a woman's risk of getting breast cancer later in life, and they never have. That's the comforting conclusion of a new study showing that the estrogen in oral contraceptives doesn't take a toll on the breasts once women stop using them. Birth control pills may slightly elevate a woman's likelihood of developing breast cancer while she's taking them. However, these women are typically young and at very low risk for the disease to begin with, and the effect fades once they are stopped. "This study provides strong evidence that past use of oral contraceptives does not increase the risk of breast cancer," said Polly Marchbanks, an epidemiologist at the Centers for Disease Control and Prevention and a co-author of the paper.

Birth control pills were introduced in the early 1960s, and eight in 10 American women born since 1945 have taken them at some point in their lives. Currently, more than 10 million women between the age of 15 and 44 use the contraceptive method. The Pill loosely mimics the hormonal environment of pregnancy and prevents ovulation. It initially contained high doses of estrogen and another hormone-like substance called progestin. Now, birth control pills have sharply lower doses of estrogen to mute the hormone's side effects, and some forms contain the progestin only. Long-term use of estrogen by itself is known to cause uterine cancer. And since estrogen can spur abnormal growth of breast tissue, some scientists were concerned it might also be linked to breast tumors.

A review of 54 much earlier studies found that current or recent birth control pill users had a slightly higher risk of breast cancer than women who'd never used the birth control method. However, those studies found no consistent evidence of such an effect in past users. Still, Robert Spirtas, a contraceptive expert at the National Institute of Child Health and Human Development, says the previous reports hadn't included older women, in whom the disease is more common, because they didn't have access to the Pill when they were in their reproductive prime. The new study looked at 4,575 women, aged 35 to 64, with breast cancer and 4,682 similarly aged women without the disease. Roughly a quarter of women in each group had never been on the Pill. Reassuringly, the researchers found no changes in breast cancer risk from the various formulations or doses, or in longer use of the contraceptives.

Only 372 women in the study were currently taking the Pill, too small a number to draw conclusions from, says Spirtas, whose agency helped fund the research. Even so, there didn't seem to be an elevated risk of breast cancer among these women, either. A previous study found Pill users with a close female relative with breast cancer had triple the risk of developing the disease as those who didn't use the contraceptives. However, the latest study found no such association. Spirtas says the new study is just the first to come from this group of women. He and his colleagues have other questions to answer, including, for example, whether the combination of oral contraceptives and hormone replacement therapy leads to an increased risk of breast cancer over time.

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Spotting Breast Cancer: Doctors Are Weak Link -(The New York Times-27/06/2002)

Ten years after the federal government set out to clean up a mammography industry awash in scandal, many women are still getting inaccurate examinations at clinics bearing the federal seal of approval. The federal mammography standards have eliminated many of the most egregious abuses and have made the breast X-rays much easier to read. But an examination by The New York Times has found that they have largely failed to remedy what many experts say is the biggest problem of all: the skill of the doctors who interpret those X-ray films.

For the last year or so, scientists have been engaged in a highly technical, and high-profile, debate about how many lives mammography screening can save. But The Times found that many doctors, and their clinics, are compromising whatever precise value mammography has. New and little-noticed research is revealing that radiologists miss far more tumors than previously assumed. Many of them simply lack the ability to discern the elusive signs of breast cancer in the shadows and swirls of a mammogram, widely regarded as the hardest task in all of radiology. Yet the government, by its own admission, holds the doctors to only minimum standards. Little specialized training is required. While studies indicate that doctors need to read at least 2,500 films each year to stay sharp, the government mandates a mere 480, a number many experts say is so low as to be virtually meaningless.

Most important, the government does not monitor the doctors' performance. Even those who miss far more than their share of cancers tend to remain unidentified and beyond regulatory reach. In fact, the doctors themselves rarely know with any precision whether they are doing a good job or not. And the women are often left to fend for themselves. In a sense, that is simply the way most of medicine works. Except for the clearest cases of criminality or gross incompetence, doctors have always pretty much policed themselves. But mammography was supposed to be different; it was, after all, the great public-health hope of the politically charged war on breast cancer.

So, in the early 90's, the government embarked on an extraordinary experiment: a system of national standards to ensure accurate screening for the more than 30 million women who had mammograms each year. At a time of rising furor about doctor competency and medical errors, many people believed that the experiment might become a template for other precincts of medicine as well. Today, at government-certified clinics all over the country, women can pick up official pamphlets assuring them that "your mammogram will be safe and of high quality." But the inside story of that regulatory experiment based on hundreds of interviews with doctors, experts and regulators over the course of a year is a chronicle of opportunities lost. Far from ensuring high-quality mammography for all, many experts acknowledge, the system has promoted mediocre care for all but an elite, or just plain lucky, few.

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Doctors, Women Urged to Discuss Breast Cancer Drugs (HealthScoutNews-01/07/2002)

A group of experts recommended today that clinicians start discussing the pros and cons of tamoxifen and other prescription drugs to reduce the risk of breast cancer in women who have a high likelihood of developing the disease. At the same time, the U.S. Preventive Services Task Force, an independent panel of experts sponsored by the Agency for Healthcare Research and Quality (AHRQ), recommended that women at low or average risk for breast cancer refrain from taking the drugs. The recommendations were based on a study concluding that tamoxifen and raloxifene appear to reduce the risk of developing breast cancer in women at high risk. Both the study, conducted by researchers at the University of North Carolina and RTI International, and the recommendations appear in the July 2 issue of the Annals of Internal Medicine. "Most of us in the breast cancer field have already been discussing tamoxifen with our high-risk patients," says Dr. Bert Petersen, a surgical oncologist and director of the family risk program at Beth Israel Medical Center in New York City.

Tamoxifen is the only medication approved by the Food and Drug Administration for prevention of breast cancer in women at high risk. So far, raloxifene is approved only for the prevention and treatment of osteoporosis, although an effect on breast cancer risk was noted in the osteoporosis trial. "We're waiting to see the results of the STAR trial [the Study of Tamoxifen and Raloxifene, an ongoing trial by the National Cancer Institute]," Petersen says. "Pending results of the STAR trial, ralixofene may prove to be yet another drug we have in our armamentarium to reduce breast cancer risk but at this time, it's premature to start discussing it as a breast cancer reduction drug. One has to keep in mind that while it did show a reduction, that finding came out of a study that was not designed to look at breast cancer. We need to keep an open mind that it might not pan out to be that way." The task force is also emphasizing that the drug be recommended on a case-by-case basis.

"We're making population-based recommendations, so we're saying these recommendations are good for this group of women that are at high risk for breast cancer and low risk for complications," says Janet Allan, vice chair of the task force and dean of the School of Nursing at the University of Texas Health Science Center in San Antonio. "It doesn't mean that it necessarily fits the individual woman. That's why we are recommending not that women take this drug, but that they talk to their clinician about it." The authors reviewed four studies, three involving tamoxifen and one involving raloxifene. The largest of the tamoxifen studies, conducted in the United States and involving 13,000 women, found a 47 percent reduction in the risk of breast cancer in women with a greater-than-average chance of developing the disease. "It was really clear from the large [tamoxifen] study that it had a tremendous impact on reduction of breast cancer risk, and that was the largest study and probably the highest quality of the three," Allan says. "It was so impressive we certainly felt the evidence was strong enough to make recommendations, which we did."

Both drugs also have potentially dangerous side effects: They can increase the risk of blood clots in the legs and lungs as well as cause hot flashes. Tamoxifen may contribute slightly to the risk of stroke and of endometrial cancer. In fact, the FDA last week announced that it would be adding a "black box" warning to the labeling of tamoxifen alerting patients about the possibility of developing uterine sarcoma, a rare but dangerous cancer of the uterus. "There's enough harm to it and benefit that a woman who is at high risk or who considers herself at high risk needs to go over the evidence to make a decision," Allan says.

Women with previous blood clots, hypertension, or diabetes should avoid the drugs, as should women who are not at high risk for breast cancer. "We're saying that this is a drug based on a very good study that looks like for certain women it's going to make a big difference," Allan says. "We haven't had much to offer women who are at risk. This is another piece. But what we don't know is if women take this for five years, is that enough or will they have to take it longer or will they have to go off it for a while and go back on? We still need future studies."

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Breast Cancer on Rise Among Asian-American Women (HealthScoutNews-10/06/2002)

Breast cancer rates among Asian-American women are on the rise, and Japanese-American women have been hardest hit in that group, says new research. The study by epidemiologists at the Keck School of Medicine and Norris Comprehensive Cancer Center at the University of Southern California looked at cancer cases reported in the mid-to-late 1990s to the Los Angeles Cancer Surveillance Program.

They found that among Asian women 50 years of age or older, diagnosed breast cancer cases increased about 6.3 percent a year from 1993 to 1997. Among non-Hispanic white women 50 years or older, diagnosed breast cancer cases increased about 1.5 percent a year over the same time, they say. In 1997, Asian-American women had 78 breast cancer cases per 100,000 women. Non-Hispanic whites had about 129 per 100,000, African-Americans had about 98 per 100,000, and Hispanics about 64 per 100,000, the study says. When the researchers broke down the Asian-American numbers by national origins, they found that in 1997, Japanese-American women had about 114 breast cancer cases per 100,000 women, Filipinas had about 98 per 100,000, Chinese women had about 51 per 100,000 and Korean women had about 45 per 100,000. The authors say the trend points out the need to increase awareness among Asian-American women that breast cancer is a serious health hazard for them. While Asian-American women have traditionally had lower-than-average breast cancer risk, that's no longer the case, the authors say.

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Vibrations Hold Promise for Detecting Breast Cancer-(Reuters Health-25/06/2002)

Breast cancer screening could someday be conducted without x-rays by using a new technique, which enables doctors to detect suspect lumps according to their hardness. The new procedure sends waves of vibrations through the breast and measures where the waves are unusually distorted, indicating a less elastic piece of tissue. The data is then turned into a three-dimensional image for doctors to analyze before deciding whether there is anything wrong. Electronics giant Philips says it is confident that its MR-elastography could be put into widespread use in about 2 years.

Dr. Ralph Sinkus, from the company's Hamburg research base, said the new method should make earlier and more accurate diagnosis possible. "The examination is absolutely pain-free and can be compared with the vibrations of an electric razor," he said in a statement. "The advantages are many--the result is on the one hand objective in comparison to manual testing, and on top of that is visible. On the other hand, it can also pick up lumps that are very small and deep, or close to the ribs which can easily be missed by routine medical checks." And he claimed the technique could even pick up tumors as small as 4 millimeters in diameter. The machine includes a vibrating part that is set onto the breast to be examined while the movement of the vibrations through the tissues is recorded and turned into images.

The Philips researchers explain that measuring elasticity is more complicated than measuring the absorption coefficient shown by x-rays. The darkness of the x-ray film is directly linked to the local levels of absorption within the tissue. With elastography, the hardness of tissue is measured indirectly--through the linkage of the machine's vibrator which sends waves through the tissue, and the measurement of these waves as they move and are broken up by harder material. Measuring the waves is done with a magnetic resonance imager. Sinkus said there was also hope that the machine might not only detect very early tumors, but might also be able to differentiate between benign and malignant tumors, based on their elasticity or density. A 2-year clinical trial is now being planned at the University hospitals at Bonn and Hamburg-Eppendorf. Sinkus said he expected the system to be put on the market once the trial has been completed, if successful.

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Stem cell cancer cure aid-(Cancer Info-02/06/2002)

A world-first stem cell therapy developed by scientists has the potential to deliver a cure for many types of cancer. Doctors at the Peter MacCallum Cancer Institute are growing human stem cells and successfully transplanting them back to patients to quickly replace bone marrow destroyed by high dose chemotherapy. Professor Miles Prince, who helped pioneer the therapy, says it is potentially medicine's "Holy Grail" - a cure for many types of cancer.

Five women suffering an aggressive form of breast cancer have been on a clinical trial of this treatment for the past year and the results have been startling. So successful has the trial been that Professor Prince said the treatment might be ready for public use within 18 months. Stem cells are the body's building blocks and have unlimited capacity to grow and replace all the cells within a particular tissue or organ. The stem cell transplant success comes as the Federal Government announced last week that Melbourne will become home to a multi-million dollar bio-technology centre for excellence. The Centre for Stem Cells and Tissue Repair will be the world's first dedicated research facility to study stem cell therapies, using adult and embryonic stem cells. The team at the Peter MacCallum are part of the new centre. Professor Prince is the head of haematology at the cancer institute and, together with Dr David Haylock, has devoted much of the past decade to human stem cell research. The institute has the only licensed cell therapy centre, a $2.5 million laboratory where human stem cells can be safely grown.

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Cancer drug gets Scottish approval-(Cancer info-07/05/2002)

Women suffering from breast cancer are to benefit from a powerful new drug approved today for use across Scotland. Herceptin, which can prolong the lives of women diagnosed with aggressive tumours for almost a year, has been made available on the NHS by the body that approves new medicines. But campaigners last night criticised the delay of almost two months between the drug being made available to patients in England and gaining approval in Scotland. They added that even though the drug has been approved, some health boards may find its high cost prohibitive and continue to restrict access.

The National Institute for Clinical Excellence (NICE), the Westminster government's medicines watchdog, gave Herceptin the go-ahead for cancer sufferers in England on 15 March. But the Scottish Executive's system means all guidance given by NICE for medicines approved for English patients must then be re-examined by the Health Technology Board for Scotland. Breast cancer affects about 3,000 Scots women a year. Up to 600 women are expected to benefit from Herceptin. The drug is already widely used in 40 countries in Europe and North America and offers the best hope for women with an aggressive form of the disease. Although it does not provide a cure, it can buy women vital time. However, at £20,000, it is expensive for a course of treatment.

Herceptin can be used on its own or in combination with another drug, Taxol, to treat women with the advanced form of HER2 positive metastatic breast cancer, an aggressive form of the disease. Sufferers with this type of illness have a protein on the surface of their cancer cells which means the tumours are particularly fast-growing. The drug has been subject to a postcode prescribing lottery. Breast cancer patients in some parts of Scotland, particularly the west coast, have been denied the treatment, while those in the east received it on a case-by-case basis.

Nicola Sturgeon, the SNP's health spokesperson, welcomed the drug's approval, adding: "I think we have fallen behind other places and many patients in Scotland who would have benefited from this drug have been denied it, which is incredibly unjust. "I would now call on health boards in every part of Scotland to adhere to the recommendation that this drug should be prescribed where appropriate because it is still down to them whether to prescribe it." The cost of making Herceptin available in England and Wales has been estimated at £17 million annually, with the Scottish estimate at somewhere around £2 million. The drug itself will only help one in five women diagnosed with breast cancer. National screening has cut deaths from the disease by 35 per cent. Dr Chris Twelves, a Cancer Research UK specialist from the Beatson Oncology Centre, in Glasgow, said: "It is clear that Herceptin can make a real difference to these women. It can prolong their survival, meaning they can spend more time with their family and friends."

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More Cancer Screening Linked to Earlier Detection-(Reuters Health-08/05/2002)

Earlier detection of breast cancer in the United States has been thought to be the result of women's increased use of mammography screening. Now new research, performed in Vermont, provides evidence to support this belief. "Our study shows that when invasive breast tumors are detected by screening mammography they are more likely to be small in size and less likely to have spread to the lymph nodes than tumors detected some other way," Dr. Pamela M. Vacek, of the University of Vermont in Burlington, told Reuters Health. "As a result, there has been a shift toward earlier breast cancer detection in Vermont as more women receive screening mammograms," she added.

In an analysis of 1975-1984, 1989-1990, and 1995-1999 data from nearly 3,500 Vermont women with breast cancer, Vacek and her colleagues investigated the impact of increased mammography use on earlier detection of breast cancer. Their results are published in the April 15th issue of the journal Cancer. Overall, there was a 34% increase in the proportion of breast tumors detected via mammography screening, from 2% in 1974-1984 to 36% in 1995-1999, the investigators report. Further, tumors detected through mammography were smaller than those detected via alternative methods, the report indicates. This was particularly true among women aged 50 years and older. They were reportedly 4.5 times more likely to have smaller tumors detected than their peers who used a different type of screening. The size of the tumor is important because smaller tumors do not typically require as aggressive treatment as larger tumors, according to Vacek.

Also, "small tumors that have not spread to the lymph nodes have historically been associated with a lower chance of recurrence and hence a better chance of survival," she said. In addition, 1995-1999 data revealed that women who had multiple mammograms were less likely to experience cancer spreading to surrounding areas, the researchers report. "We don't currently know whether recent decreases in the numbers of women dying from breast cancer are due to earlier detection or better treatment," Vacek said. Despite this, "having regular mammograms is still a good idea," she added. "Given the current uncertainty about the relative merits of improved treatment and earlier detection, it makes good sense to take advantage of both," the researcher concluded.

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Test Predicts Response to Breast Cancer Therapy -(ET-30/04/2002)

Researchers have found a way to quickly figure out which patients will respond to a powerful anti-breast cancer drug, according to study findings presented at this month's meeting of the American Association for Cancer Research, held in San Francisco, California. The method can predict the response of breast cancer patients to trastuzumab (Herceptin) within a week of initiating therapy, Austrian researchers report. Herceptin targets a mutation in the HER-2/neu gene, of which at least a quarter of breast cancer patients have high levels.

Currently available prediction methods, such as MRI and CT scans, are not effective until 6 to 8 weeks after treatment starts, according to Dr. Wolfgang Koestler of Vienna's University Hospital, one of the researchers. Koestler and colleagues assessed whether a test made by Bayer Diagnostics' Oncogene Science unit, which is approved by the US Food and Drug Administration for other monitoring, could predict response to trastuzumab-based treatment. Identifying patients most likely to respond to trastuzumab with or without chemotherapy could allow for a more targeted use of trastuzumab-based treatment, Koestler said, since only between 20% and 40% of patients with breast cancer that has spread respond to trastuzumab alone. This could restrict the toxicity of combined treatment with chemotherapy to patients unlikely to respond to single agent trastuzumab, as well as allowing for early initiation of alternate treatment in patients unlikely to benefit from any kind of trastuzumab-based treatment.

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Panel Backs Tamoxifen Over Newer Drugs-(Reuters Health-20/05/2002)

Doctors should continue to recommend the widely used drug tamoxifen for women with early-stage breast cancer, even though newer medications show promise for better preventing tumor recurrence, according to a panel of cancer experts. Tamoxifen has proven its worth time and again over the last two decades, and more data are needed before it should be replaced as a standard treatment following surgery in postmenopausal women, concluded an 18-member panel convened by the American Society of Clinical Oncology (ASCO). For example, research has documented that tamoxifen can reduce deaths in these patients, but there is no information on whether a newer class of drugs known as aromatase inhibitors also does so, said the panel, whose report was released at ASCO's annual meeting. "Certainly survival data would have been extraordinarily persuasive," said panel chair Dr. Eric Winer, director of the breast oncology center at the Dana-Farber Cancer Institute in Boston, Massachusetts. Three aromatase inhibitors are already on the market but have been studied primarily for patients with advanced breast cancer.

The panel was convened after a study presented at a breast cancer symposium last December found that the aromatase inhibitor Arimidex (anastrozole) was slightly more effective than tamoxifen in preventing breast cancer recurrence in postmenopausal women with early-stage disease. But the women were only followed for a median of 33 months, not long enough to determine whether that benefit will translate into longer lives, speakers said. "There has not been a survival advantage demonstrated with the use of anastrozole over tamoxifen," Winer said. It also is unclear just how long the effects of Arimidex last, said ASCO president Dr. Larry Norton of Memorial Sloan-Kettering Cancer Center in New York. "One important thing we know about tamoxifen is that it continues to work after (the standard 5-year treatment) is stopped," he said. "We're not sure if that's the case with aromatase inhibitors." In addition, the panel expressed concern that aromatase inhibitors may cause unknown side effects down the line.

In the study of 9,366 patients that stirred debate on this issue and led to the new panel report, 90% of women taking Arimidex remained cancer-free, compared with 88% of the women taking tamoxifen. Arimidex was shown to have fewer of the side effects associated with tamoxifen, such as hot flashes, vaginal bleeding and blood clots, but the newer drug was linked to weaker bones. The panel members said they encourage doctors and patients to discuss the data when deciding about treatment. Winer noted that tamoxifen may not be appropriate for all patients, including those who have had blood clots or a recent stroke. In these patients, aromatase inhibitors may be warranted, he said. Both tamoxifen and aromatase inhibitors only work in patients who have breast tumors that are hormone-receptor positive, meaning that estrogen fuels the cancer growth. Tamoxifen works by blocking the effects of estrogen on tumor cells, whereas aromatase inhibitors decrease the overall amount of estrogen in the body. The two other aromatase inhibitors on the market are Femara and Aromasin

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SignalGene Lead Anti-Cancer Compound Blocks Growth of Human Breast Cancer Tumors in Animal Models-(29/05/2002)

SignalGene today announced that it has achieved positive results in the first tests in animals of its proprietary, small molecule anti-cancer compound, SG292, designed under the Company's anti-angiogenesis program. The test results show that this compound inhibits the growth of human breast cancer tumors when administered orally and has no acute toxicity at high doses. "The positive results achieved in this round of animal testing provide clear evidence that SG292, the most advanced designed compound from our anti-angiogenic program, has significant therapeutic potential as an inhibitor of tumor growth", said Dr. Michael Dennis, President and CEO of SignalGene. "These results should advance our ongoing discussions with potential partners for this program in the field of oncology, and we are pursuing additional partnering opportunities based on other therapeutic indications for anti-angiogenic compounds".

The recently completed study, conducted by a leading contract research laboratory, demonstrated the ability of orally administered SG292 to inhibit tumor growth in xenograft models of aggressive human breast cancer in nude mice. Over a treatment period of 20 days, mean tumor growth in mice receiving SG292 was significantly reduced compared to controls. The SignalGene compound showed no obvious toxic effects over the period of treatment, and produced no adverse behavioral effects or changes in body weight. Angiogenesis, the formation of new blood vessels, plays a major role in several diseases, especially the growth and metastasis of cancer. Angiogenesis inhibitors are currently under investigation by numerous groups as novel therapeutics for the treatment of diseases caused or supported by inappropriate growth of blood vessels, including growth of solid and metastatic tumors, diabetic retinopathy, age-related macular degeneration and psoriasis. The control of this process is expected to have important therapeutic applications for the treatment of such diseases.

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UK Breast Cancer Referral Programme 'Not Working'- (Reuters Health-24/05/2002)

Some women with breast cancer are waiting six times longer than they should be for diagnosis and treatment, according to a new report. The UK government announced a 2-week directive for breast cancer referral in 1999. Under the initiative, women with suspected breast cancer can see a specialist within 2 weeks of an urgent referral from their general practitioner (GP). Dr. Jonathan Roberts, consultant surgeon from King's College Hospital in London, and colleagues analysed information on nearly 3,600 GP referrals to King's College Breast Clinic between April 1999 and December 2000. Of these, 665 (18.5%) were marked as urgent and the remainder non-urgent, according to a letter in the May 25th edition of the British Medical Journal.

The researchers found that 62 urgent patients and 49 non-urgent patients were eventually found to have breast cancer, suggesting that the distinction had little bearing on clinical outcome. "It is clear that the 2-week wait initiative is not working. We are artificially creating a two-tier system when there is no need for one," Roberts explained in an interview. "Our earlier work has shown anxiety was the same regardless of whether patients were referred urgently or non-urgently," he added. While he held back from saying that patients could die as a result of a delay in seeing a specialist, Roberts said there is growing recognition that delay may have a role to play in breast cancer outcomes. "No patient wants to wait 12 weeks. They want to be seen promptly, efficiently and without anxiety. "Whilst the government initiative should be applauded, its basis on the use of urgency in referral means unacceptable delays to those with breast cancer as well as those without," he added. Roberts noted that his unit was part of a government initiative called the Cancer Collaborative, which applies business management principles to cancer care. "As much improvement can be brought about by better organisation as by increasing resources," he said. "The solutions will vary from hospital to hospital but we found that the biggest improvement was brought about by simplifying the referral process," he said. "Through a fax-back system, we make sure that within 10 minutes of the GP's request an appointment is given to the patient before she leaves the surgery. In other hospitals there may be up to five stages before an appointment is made," he added. Additional clinics on bank holidays and other procedures mean fewer patients miss appointments, he noted. "Doctors and managers need to work together to match capacity with demand, so all suspected breast cancer patients are seen within 2 weeks," Roberts said.

According to Dr. John Toy, Cancer Research UK's medical director, "Even best intentioned approaches to improving cancer patient outcomes will fail if they are too simplistic or flawed in design. The King's group is to be loudly applauded for finding ways of rapidly managing all women with the worry of suspected breast cancer, which are not dependent on finding extra money."

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Timing of Breast Cancer Treatment Is Key: Study (Reuters Health-20/05/2002)

While many women with early-stage breast cancer are simultaneously treated with chemotherapy and tamoxifen after surgery, new research shows that the disease is less likely to recur if the tamoxifen is given after the chemotherapy is completed. "These results support a new practice standard of starting tamoxifen after chemotherapy," said Dr. Kathy Albain, a cancer specialist at Loyola University in Chicago, Illinois. The findings apply to as many as half of the roughly 200,000 American women diagnosed with breast cancer each year, Albain said at a meeting of the American Society of Clinical Oncology (ASCO). ASCO president Dr. Larry Norton, of Memorial Sloan-Kettering Cancer Center in New York, said the findings should help settle the debate among doctors about the best way to time these treatments.

The study involved 1,477 postmenopausal women with early-stage breast cancer that had spread to the lymph nodes. All of the breast cancers were hormone-receptor positive, making the women candidates for tamoxifen. The drug works by blocking the hormone estrogen from fueling breast tumor growth. Patients were treated with either chemotherapy and tamoxifen simultaneously, chemotherapy followed by tamoxifen or tamoxifen alone. Eight years later, 67% of 566 patients who received chemotherapy followed by tamoxifen remained free of breast cancer, compared with 62% of the 550 who received the simultaneous treatment, and 55% of the 361 patients given tamoxifen alone. Albain concluded that women who received chemotherapy followed by tamoxifen were 18% more likely to remain disease-free than those who received both treatments at once. While the exact explanation for the results is unclear, it appears that tamoxifen may interfere with the effectiveness of chemotherapy, she suggested

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Aspirin a Possible Therapy for Chemo Side Effects (Reuters Health-24/05/2002)

Adding to the list of potential benefits of aspirin, new animal research suggests that the traditional painkiller may help combat some of the toxic effects of the cancer drug cisplatin. In research with rats, scientists found that treatment with salicylate reduced hearing and kidney damage in animals given cisplatin. In humans, salicylate is usually given in the form of aspirin, which is rapidly converted to salicylate in the blood. Both hearing and kidney damage are among the harsh side effects seen in cancer patients treated with cisplatin. And if the current findings can be extended to humans, it might be possible to minimize these toxic effects by giving patients aspirin or a similar drug, according to researchers led by Dr. Geming Li of Albert Einstein College of Medicine, Bronx, New York.

Li's team studied rats implanted with breast cancer cells, assessing whether giving salicylate along with cisplatin prevented certain side effects of the cancer drug. They found that the tactic did appear to reduce damage to the animals' auditory cells and hearing, as well as to their kidneys. This apparent protection against cisplatin side effects "is a new and potentially powerful application of this remarkable drug," the researchers conclude. As for why salicylate may carry such benefits, Li's team notes that it appears to have powers other than its well-known painkilling, blood-thinning and inflammation-fighting abilities. For one, salicylate has been shown to "mop up" free radicals, cell-damaging forms of oxygen that naturally circulate in the body. Li's team speculates that this ability may the key to the drug's success in this study, since the formation of free radicals caused by cisplatin treatment may help explain its toxic side effects

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Prognosis Can Be Better Than Thought When Breast Cancer Returns (HealthScoutNews-22/05/2002)

Women who have a local recurrence of breast cancer have a better prognosis and more treatment options than they might think, a new study says. However, the outlook depends on their age at first diagnosis, how aggressive the initial tumor was, and how long they were cancer-free. The small study, appearing in the journal Cancer, says the prognosis was better for women whose initial cancer came before they reached age 60 and for those whose cancer hadn't returned for at least eight years.

Recurrences are a very real risk for women who have had breast cancer. Local recurrences occur in or near the site of the original tumor, and are generally thought to be a re-growth of the first tumor. Recurrences in other parts of the body, or distant metastases, mean the cancer has spread. In this study, women who had had a local recurrence had a 10-year survival rate of 56 percent versus just 9 percent for women who had had distant metastases. The median survival length for women with a local recurrence was 12.9 years, and only 2.2 years for women with cancer that had reappeared elsewhere. The study authors also found the risk of death was not affected by whether the woman had initially had a mastectomy or breast-conserving surgery (a lumpectomy followed by radiation). "It's a small study, but an important one," says Dr. Clifford Hudis, chief of the breast cancer service at Memorial Sloan-Kettering Cancer Center in New York City. He was not involved in the research. Local recurrences of breast cancer are the subject of much discussion among doctors because it's not always clear when the tumor is indeed a recurrence of the original cancer and when it's a completely new one. "We struggle all the time with the clinical meaning of local recurrence," Hudis says. "If the tumors are new, you would expect a better prognosis and that's what they see here."

The authors analyzed data from 105 patients who had experienced a local recurrence of breast cancer. Fifty-five of these patients had had a lumpectomy followed by radiation, and 50 had undergone a mastectomy. A second group of 335 patients had had a recurrence, but in sites far removed from the original tumor. The authors then identified seven factors that might have an impact on survival: the initial size of the first tumor; the tumor grade (how abnormal the cells appear under a microscope); whether the cancer had spread to the lymph nodes; the date of the initial diagnosis; the age at the time of the initial diagnosis; the time elapsed between tumors; and the type of treatment for both the initial cancer and the recurrence. Only tumor grade, age at the time of diagnosis of the first tumor, and the time elapsed between tumors seemed to affect the risk of death. Women with a grade 3 tumor (a grade 1 tumor is the least dangerous) had a threefold increased risk of death; patients more than 60 years old at the time their first cancer was diagnosed had twice the risk of death; and patients who went more than eight years without a recurrent tumor had a threefold decreased risk of death.

How the local recurrence was treated did affect the risk of death in women who were pre-menopausal. In this group, women who had ovarian suppression either by surgical removal or radiation and chemotherapy had better survival rates. Ovarian suppression is used to stop the functioning of the ovaries and, thereby, stop the production of estrogen, which can fuel some breast-cancer growth. "The study tells us that a careful pathological review would be the next step," Hudis says, referring to the finding that tumor grade affected risk of death. It may also mean more treatment options for women faced with a local recurrence. Women who have already had breast-conserving surgery may not need a mastectomy for the recurrence. Also, women who have already had a mastectomy could receive local radiation therapy. In pre-menopausal patients, chemotherapy could be effective.

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New Breast Cancer Treatment Available Here-(Yahoo News-21/05/2002)

Women who have a cancerous lump removed from a breast now have a new -- and quicker -- option for follow-up treatment. The Food and Drug Administration approved a way to radiate just the tumor site -- instead of the whole breast. With the approval of MammoSite, produced by Proxima Therapeutics of Alpharetta, Ga., doctors can send radiation through a spaghetti-thin catheter implanted at the tumor site. The procedure takes just five days instead of the seven weeks that external radiation can require. The device is intended to be used primarily to treat breast cancer in its early stages when there is no need to remove the whole breast. Doctors at the Cancer Therapy and Research Center in San Antonio are the first physicians in the United States to use the MammoSite. The method, which does not replace whole breast irradiation in women who need that treatment, has long been available to men suffering from prostate cancer. But some doctors worry the therapy doesn't hit cancer cells lurking elsewhere, like external radiation does.

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Ovary removal may prevent breast cancer in women with gene defect-(AP Medical-20/05/2002)

Women likely to get breast cancer because of a genetic defect may lower their risk substantially by having their ovaries removed, two studies show. The genes, called BRCA, increase the risk of both breast and ovarian cancer. Doctors often recommend that women with the genes have their ovaries taken out when they reach their 40s, and many also opt to have their breasts removed, too. The new research raises the possibility that ovary removal alone may be a reasonable option for avoiding both kinds of cancer. However, while taking out the ovaries lowers a woman's high chance of breast cancer, the operation does not eliminate it, and the decision will depend on how much risk she is willing to live with. "Prophylactic mastectomy is still the gold standard," said Dr. Kenneth Offit of Memorial Sloan-Kettering Cancer Center in New York City. "Ultimately, these decisions are highly individualized."

Women with the BRCA genes are estimated to have between a 50 percent and 85 percent lifetime risk of breast cancer and between a 10 percent and 40 percent risk of ovarian cancer. Offit presented his findings at a meeting in Orlando of the American Society of Clinical Oncology. His and a similar study by Dr. Timothy Rebbeck of the University of Pennsylvania are being published in the New England Journal of Medicine. The new studies suggest that besides eliminating the risk of ovarian cancer, taking out the ovaries reduces the risk of breast cancer by eliminating the hormones made by the ovaries. Rebbeck's study estimates that women with BRCA who have their ovaries removed lower their breast cancer risk between 25 percent and 50 percent. Dr. Olufunmilayo Olopade of the University of Chicago said that by also taking the drug tamoxifen, these women may be able to bring their risk down to the normal level without having a mastectomy.

Patients say having their ovaries taken out is more acceptable than a double mastectomy, she said. "It may be that women will no longer have to make a choice about having their breast removed." However, a journal editorial by Dr. Daniel Haber of Massachusetts General Hospital said whether this much protection will be enough for women "is likely to remain a highly personal choice." BRCA genes are rare in the general population. However, they occur in about one in 40 Jewish women of Eastern European origins. In Offit's study, 98 women chose to have their ovaries removed, and three of them developed breast cancer during the next six years. Another 72 women decided not to have their ovaries taken out, and eight of them got breast cancer.

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Certain PCBs May Increase Breast Cancer Risk (Reuters Health-01/04/2002)

Although most studies have failed to detect a link between overall exposure to pollutants called PCBs and an increased risk of breast cancer, the results of a new study suggest that high levels of specific PCBs may be linked to the disease. "Our results suggest that some persistent environmental contaminants that accumulate in the body of women with age and are similar in structure to dioxin may be a risk factor for breast cancer," Dr. Pierre Ayotte, of Laval University in Beauport, Quebec, Canada, told Reuters Health.

But Ayotte, who is a co-author of a report on the findings in the American Journal of Epidemiology, cautioned, "The final word is not in, and these results need to be confirmed." Ayotte added that the findings also highlight the importance of additional research "on the possible link between environmental contaminants that can mimic hormones or alter hormone metabolism and the risk of breast cancer."

PCBs, or polychlorinated biphenyls, are a class of chemicals with a variety of industrial and commercial applications. Because of concerns about the health effects of the chemicals, PCBs were banned in the US and Canada two decades ago. The chemicals still linger in the environment and are present in the food chain, particularly in fatty foods. During the past decade, there have been many studies of the possible link between exposure to PCBs and an increased risk of breast cancer. Most studies did not detect a link between high levels of the chemicals and breast cancer, but most of the studies looked at overall levels of PCBs, not individual chemicals.

Ayotte and his colleagues examined the relationship between breast cancer risk and 14 individual PCBs in 314 women with breast cancer and a "control" group of 523 healthy women. Levels of two PCBs--PCB 118 and PCB 156--were linked to a 60% to 80% greater risk of breast cancer, the researchers report. This relationship was more pronounced in premenopausal women. The study also found that women with high levels of a combination of three PCBs that mimic the cancer-causing chemical dioxin--PCBs 105, 118 and 156--were about twice as likely to have breast cancer. These chemicals are known as mono-ortho PCBs. This risk was also greater in premenopausal women.

"Our results may indicate a relation between dioxin-like compounds and breast cancer risk," the authors state in their report. They note that the study is the second large study to suggest a link between mono-ortho PCBs and breast cancer. Although the study only analyzed three of this type of PCB, Ayotte and colleagues point out that PCBs 105, 118 and 156 composed a "major fraction" of dioxin-like chemicals in a study of breast milk in southern Quebec.

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Doctor-Patient Talks May Impact Breast Cancer Care- (Reuters Health-29/03/2002)

Doctors who spend some extra time talking with their elderly breast cancer patients about treatment options and concerns regarding surgery can improve care and boost patient satisfaction too, a study finds. Compassion appeared to be the key determinant of whether the patients, all of whom had early-stage breast cancer that had not spread, were satisfied with their care, results indicate. Patients who said their doctors initiated a lot of communication about the women's worries and opinions about the disease were more than twice as likely to say they were satisfied with their care than patients whose doctors asked fewer such questions.

"There are two components of communication here--one is for the technical information and one is more about caring, talking about patients' concerns," said study author Dr. Wenchi Liang, a cancer researcher at Georgetown University Medical Center in Washington, DC. "A caring attitude is a strong factor for satisfaction."

The study, published in a recent issue of the Journal of Clinical Oncology, involved 613 mostly white women aged 67 and older who had been treated for early-stage breast cancer 3 to 6 months prior to being interviewed about their care. Liang noted that while most doctors are pretty good at discussing treatment options, they may fall short when it comes to addressing the emotional issues surrounding surgery, either because they don't have good skills in this area or they are too pressed for time.

But thorough treatment discussions have their merits, too. In the study, women who said their doctors discussed the most treatment options with them were one-third more likely than other women to receive breast-conserving surgery, such as lumpectomy, followed by radiation, rather than undergoing a complete breast removal (mastectomy) or breast-conserving surgery without radiation. Survival rates are similar for mastectomy and breast-conserving surgery plus radiation, Liang said, though many doctors recommend--and women often prefer--the latter because it preserves more breast tissue. However, some elderly women do not opt for breast-conserving surgery because they don't want to keep going back to the hospital for the recommended follow-up radiation treatment. And older women who have breast-conserving surgery are less likely to undergo the radiation therapy than younger women, according to Liang. But the new study found that women who had detailed treatment discussions with their doctors were most likely to complete the radiation as advised.

Research has indicated that older breast cancer patients tend to seek less medical information than their younger counterparts, perhaps because they are uncomfortable asking questions, or they don't know how to raise questions, Liang said. But informed choices are better choices, she stressed. "If they feel they can't ask questions then they should have a friend or relative ask for them," she advised.

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Protein May Explain Two Faces of Tamoxifen (Reuters Health-28/03/2002)

The split personality of the drug tamoxifen, which fights cancer in the breast but increases the risk of cancer in the uterus, may depend on the presence of a gene-activating protein, new research suggests. Tamoxifen, which has been shown to prevent and treat breast cancer that is sensitive to the effects of estrogen, is known as a selective estrogen receptor modulator (SERM) because it attaches to the same receptor as the hormone estrogen.

In the breast, tamoxifen acts as an "anti-estrogen" to fight cancer. But in the uterus, the drug mimics estrogen, which leads to an increased risk of cancer in the endometrium, the lining of the uterus. In contrast, the drug raloxifene, a SERM used to prevent and treat the brittle-bone disease osteoporosis, acts as an anti-estrogen in breast tissue but does not mimic estrogen in uterine cells. Why tamoxifen's effects vary from tissue to tissue has been a mystery.

Now Drs. Yongfeng Shang and Myles Brown of Harvard Medical School in Boston, Massachusetts, have found that tamoxifen's effects in the uterus may depend, at least in part, on the presence of a protein called steroid receptor coactivator 1 (SRC-1). In experiments with breast cancer cells, the researchers found that both tamoxifen and raloxifene "recruit" so-called coregulator molecules that repress genes that promote tumor growth. But in uterine cancer cells, tamoxifen, but not raloxifene, recruits molecules that help to promote rather than suppress cancer. This estrogen-like activity relies on SRC-1, which is more abundant in the uterus than in the breast, according to a report in the journal Science.

"Our studies help explain how tamoxifen mimics estrogen effects in the uterus while at the same time blocks estrogen action in the breast," Brown said. The research should speed the development of safer and more effective SERMs. "These new medicines are likely to find important uses not only in breast cancer, but also in osteoporosis, cardiovascular disease and in the treatment of menopausal symptoms."

There are still several unanswered questions about the effects of SERMs such as whether the drugs behave the same way in normal cells as they do in cancer cells, according to Drs. Benita S. Katzenellenbogen and John A. Katzenellenbogen of the University of Illinois at Urbana-Champaign. Still, they state in a related editorial that the understanding of the "molecular partners" involved in the activity of tamoxifen and raloxifene "provides a foundation for the development of SERMs that are optimized for breast cancer prevention and treatment, and menopausal hormone replacement."

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Birth Control Pill Can Increase Breast Cancer Risk (HealthScoutNews-23/03/2002)

For women who use oral contraceptives comes a new word of caution today: using the Pill marginally increases your risk of breast cancer, and the longer you use it, the higher your risk of disease. The finding, which echoes the much-debated historical link between the Pill and breast cancer, was reported on the final day of the week-long Third Annual European Breast Cancer Conference in Barcelona. The conference also heard compelling new research on why some women with breast cancer can safely avoid chemotherapy, on how high-tech gene scanners can determine who is really at risk for this disease, and on a standard surgical tool that is being redeployed to possibly diagnose breast cancer 10 years before symptoms normally appear.

The study on Pill use was a collaboration among Norwegian, Swedish and French doctors. They analyzed data from the large Norwegian-Swedish "Women's Lifestyle and Health Study," which began in 1991 and tracked lifestyles, including Pill use, of women between the ages of 30 and 49. The researchers followed the women for almost 10 years, during which time 1,008 cases of breast cancer were diagnosed.

For those women who reported any Pill use, the risk of breast cancer was about 26 percent higher than for those who didn't use oral contraceptives. But for women who used the pill throughout the 10-year study, the risk shot up to 58 percent higher than non-Pill users, the doctors report. The group at highest risk appeared to be those still using the Pill after age 45. Their risk was almost one and half times -- or 144 percent - that of non-Pill users. On the other hand, the study also showed that women who used the Pill before age 20 and then stopped, or who used it only before their first full-term pregnancy and then stopped, had no increased risk.

The study's author, Dr Merethe Kumle, an epidemiologist from the Institute of Community Medicine in Tromso, Norway, cautioned conference participants that the research should not dissuade most women from using the Pill. "The total number of deaths from any cause amongst women who use oral contraceptives is likely to be lower than women who have never used the Pill, just as we have seen with hormone replacement therapy," Kumle reported to the conference.

Dr. Loren Wissner Greene, an endocrinologist at New York University School of Medicine, is quick to agree. "Even if women who use the Pill do get breast cancer, they are far more likely to survive than those who don't use the Pill and get breast cancer," Wissner Greene says, pointing to studies that have shown women who take birth control pills generally get a less-virulent form of breast cancer.

In other conference news, doctors from Guys Hospital in London announced a new breast-cancer detection technique that will soon undergo its first clinical trial. The procedure could help detect changes in breast cells up to 10 years before any cancer would appear through a mammogram or other diagnostic tool. The process involves the use of a tiny endoscope, a probe no thicker than a few strands of hair, which is passed through the nipple into the center of the breast to search the entire area for signs of tissue abnormalities. If abnormalities are found, the suspect cells can be removed, and that could help keep the cancer from ever developing.

Belgium researchers have developed high-tech methods of scanning thousands of genes at once, which they say enabled them to identify groups of markers associated with specific types of breast cancer, as well as the stages of those cancers. Identification of certain genes, they say, can even help predict breast cancer survival. In a collaborative effort with doctors from England and the U.S. National Cancer Institute the researchers from the Free University of Brussels used a microchip coded with data on 7,600 genes to analyze the genetic material from 99 breast cancer patients. By running comparisons, the researchers say they could identify patterns of activity that might one day help doctors more accurately identify and stage tumors, as well as predict cancer outcomes.

Finally, a group of American researchers from the University of Chicago revealed how biochemical markers found in breast cancer patients can help predict which women may need chemotherapy after surgery and which may not. Professor Ruth Heimann told conference participants her team discovered four such markers in breast cancer tissue samples -- factors that can adequately predict whether a woman's cancer may spread. "If we have more accurate knowledge of the risk of metastasis in an individual patient, based on these biomarkers, we could tailor treatments and give chemotherapy only to the women who really need it," Heimann reported at the proceedings. Although the American researchers say they can now accurately predict women at lowest and highest risk for cancer spreading, they remain unsure about those in the middle. More study is needed, they say, before the finding can benefit all breast cancer patients.

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Breast cancer likelier to kill in new mothers: Hutch research shows the risk is twice as high-(Yahoo News-22/03/2002)

Surviving breast cancer can be much more difficult if a woman has recently had a baby; she is twice as likely to die from the disease, Seattle researchers say.

In the largest study ever of young women with breast cancer, scientists at the Fred Hutchinson Cancer Research Center and the University of Washington found that women are more likely to die of the disease if they have given birth within two years of their diagnosis.

"It is a very difficult thing," said Hutchinson scientist Dr. Janet Daling, director of the study. "You don't know how sad it is."

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New Breast Cancer Vaccine Being Tested in Europe (HealthScoutNews-21/03/2002)

A new breast cancer vaccine is now being tested in a small group of women in Great Britain and Denmark, European researchers disclosed. That announcement came amidst a flurry of other promising developments presented this week at the Third European Breast Cancer Conference in Barcelona, Spain.

Highlights of the meeting included an "optical detection" system for early diagnosis of breast tumors; a novel way to predict which breast abnormalities will become malignant; a microchip that may help doctors stop invasive breast cancer from developing; a new way of delivering radiation therapy; smart drugs that stop cancer before it starts, and new data on how HRT may affect breast cancer diagnosis.

The potential vaccine -- known as Auto-Vac -- targets the tumor growth factor known as HER-2, present in excessive amounts in almost a quarter of all breast cancer patients. Because HER-2 is also found in small amounts in normal tissue, the immune system doesn't recognize the excess as something to be destroyed. This, researchers said, is where the vaccine may help. "The objective of our vaccine is to stimulate the patient's own immune system, and to see whether we can induce it to launch specific killer cells, as well as producing HER-2 specific antibodies," said Denmark's Dr. Dana Leech, who addressed the international press group.

The new study, which involves 27 women with advanced breast cancer, will involve three injections of the vaccine, with results expected before the end of the year. There was more good news at the conference.

Researchers from University College in London introduced a new way to tell the difference between malignant and non-malignant tissue without surgery. The system, known as "optical detection," involves shining tiny pulses of harmless white light onto breast tissue. The scattered light patterns are sent back to a meter that records the wavelengths, which are later analyzed on a computer. The result is an "optical signature" of the tissue that is then compared with "signatures" of both normal and malignant tissue. By comparing patterns, doctors can tell whether the tissue being examined is likely to be normal or malignant. So far, the system has made an accurate diagnosis in 93 percent of breast tissue examined, and 85 percent of lymph nodes, the researchers said.

Doctors from Royal Liverpool University Hospital in Great Britain offered a new diagnostic test capable of predicting if a breast abnormality known as hyperplasia of unusual type (HUT) could be a red flag for breast cancer. Although the condition itself is normally benign, women with HUT have up to twice the risk of developing breast cancer. Using the new system of tissue analysis, doctors can determine which women with HUT will go on to develop breast cancer.

Preliminary results of British studies of the breast cancer drug tamoxifen show it may help prevent breast cancer in women at high risk. Speaking at the conference, researcher Jack Cuzick from Cancer Research UK said early results are promising, but doctors still don't know if the benefits outweigh the risks. Those include up to a threefold-increased chance of endometrial cancer, as well as blood clots. Cuzick said extensive follow-up is necessary to know who is most likely to be helped by tamoxifen.

From Norway came news that women who use HRT are more likely to discover they have breast cancer between mammography screenings than non-users. Researchers said this may be because HRT causes an increase in breast tissue density, making it more difficult to image via mammography. While links between HRT and breast density are not new, doctors said this study puts the number of women affected at a much higher rate than previously thought. That, in turn, points up the need for continued self-exams and professional manual exams between screenings for women who use HRT.

Three independent studies conducted in England, Spain and Italy offered evidence of the effectiveness of "interoperative radio therapy," a new way of administering radiation to breast cancer patients. In the past, those patients required at least 25 treatments over a period of weeks or months. Doctors said delivering a single, concentrated beam of radiation directly into breast tissue at the time of the cancer surgery may do the job faster and easier. It could also reduce much of the cosmetic scarring that can occur with the extended treatments. While results were promising, doctors warned the procedure is still experimental, with a possible increased risk of new cancer growth, scar tissue formation and tissue death.

American doctors made an important contribution with data that identified a group of genes that play a role in turning non-aggressive breast cancer into the much more deadly aggressive type. Craig Allred, a professor at Baylor College of Medicine in Houston, explained how a technique called "microarray" uses a sophisticated microchip to unravel which genes may cause ductal carcinoma in situ -- a less aggressive form of breast cancer -- to develop into the more deadly invasive breast cancer. The ultimate goal, he said, is to develop drugs targeted to correct or prevent defects in the suspect genes which, in turn, may help prevent invasive breast cancer from occurring.

Elsewhere, doctors are working on "smart drugs" -- medications designed to interfere with the process that leads to malignancy. Dr. Stephen Johnston, of the Royal Marsden Hospital in London, announced the results of the world's first phase II trail of R115777 (Zarnestra), one "smart drug" showing great promise. Smart drugs work, Johnston explained, by targeting essential enzymes involved in many stages of tumor growth. Although it may be a while before they are available, "smart drugs" are considered a major hope for breast cancer victims in the near future.

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New Drug Tops Gold Standard in Breast Cancer Trial (Reuters-21/03/2002)

A new breast cancer drug is better than the best currently available treatment in preventing postmenopausal women with early disease from developing a new tumor in the other breast, researchers said. The drug, called anastrozole, is produced by AstraZeneca PLC under the brand name Arimidex. In research presented at the 3rd European Breast Cancer Conference, scientists said the drug outperformed tamoxifen, currently the gold standard for treatment, in a trial of women with early breast cancer. Women who were given anastrozole for two and a half years had a 58% lower risk of developing a new tumor in the other breast than those taking tamoxifen, which is also made by AstraZeneca.

"It is an important finding. The reduction in the development of contralateral (other) breast cancer was very much greater than we had anticipated," Dr. Jeffrey Tobias of University College Hospital London, one of the researchers on the study, told Reuters. Tamoxifen cuts the risk of a new cancer in the other breast by 50% and anastrozole slashes it in half again.

The study, one of the largest breast cancer trials ever conducted, involved more than 9,000 women who were given either anastrozole, tamoxifen or a combination of both. The combination therapy was no better than tamoxifen alone.

Anastrozole works by inhibiting production of the female hormone estrogen in postmenopausal women. Estrogen is linked to the development of cancer, and most cases of breast cancer are in postmenopausal women. But the drug does not work in younger women and it may increase the risk of fractures or osteoporosis. Tobias said women given anastrozole had fewer side effects such as blood clots, hot flushes and cancer of the uterus than the tamoxifen group.

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Radiation During Surgery May Aid Breast Cancer Care- (Reuters-21/03/2002)

Breast cancer patients may one day have the option of having one blast of radiotherapy during surgery instead of a series of up to 25 sessions afterwards, researchers said. They believe the new intra-operative radiotherapy could be cheaper and easier for women and may improve the treatment of breast cancer for patients living in remote areas or in the developing world. Dr. Emiel Rutgers, of the Netherlands Cancer Institute in Amsterdam, told the Third European Breast Cancer Conference that early tests of the new technique were promising but more research was needed. "In addition to its ability to target the tissue that is most at risk of relapse, patients would not need long radiotherapy courses--one treatment and it's over," Rutgers told the conference.

Radiotherapy is usually given in daily sessions for 6 weeks to kill any leftover cancer cells after the tumor has been removed during breast conservation surgery. With the new technique, a portable radiotherapy machine delivers one beam to the site of the tumor during surgery. Researchers in Milan, Madrid and London are currently testing variations of the technique in patient trials.

"It could save time, money and breasts," Dr. Jayant Vaidya of University College London, who is involved in the British study, said in an interview. "We believe that it may be better than the conventional treatment because we are giving the radiotherapy to the correct place," he added.

Women in poor countries often do not have the option of breast conservation surgery because they cannot be away from home for the 6 weeks of radiotherapy that is part of the treatment. Instead their entire breast is removed. But Vaidya said the new technique could change that and save money because it is cheaper than conventional radiotherapy. "With (this) technique, more women in the developing world will be able to have breast conservation surgery," he explained.

But Rutgers said there are potential drawbacks. Not all the breast tissue receives the radiotherapy, so there could be an increase in the relapse rate and of cancer developing in another area of the breast. There may also be a risk of scar tissue formation, so the cosmetic result may not be as good.

Vaidya and his colleagues are conducting a randomized controlled trial of the technique that they hope will answer these questions. They expect to have the first results by 2006. "It could become a standard treatment," he said.

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New Light Shines on Breast Cancer-(Reuters-20/03/2002)

Scientists have developed a new high-speed technique to determine if breast cancer has spread by looking at how light is scattered by cancerous tissue, a cancer researcher said. Instead of patients waiting for tissue to be examined following surgery, an "optical biopsy" would determine almost immediately if it contained cancerous cells, Andrew Lee of University College London (UCL) said in an interview. "The potential application for our system is that it will detect cancer at the time of the initial surgery, so that it saves the patient the necessity of coming back for a second operation and the anxiety of waiting a few days for the analysis," Lee explained. The optical biopsy would detect the spread of cancer to the lymph nodes as well as any residual cancer in the breast that had not been removed during surgery, said Lee, one of the developers of the new technique. He was speaking at the 3rd European Breast Cancer Conference, a five-day event attended by 4,000 scientists, doctors and patient advocates.

Currently, during removal of a cancerous tumor, surgeons also take a sample of one or more lymph nodes to determine if the cancer has spread beyond the breast, requiring further treatment. The tissue is examined for cancer but a result can take hours or longer. The optical biopsy, however, produces an almost instant result by analyzing how light is scattered by the tissue sample.

Light is fed down an optical fiber on the lymph node sample, and as it is scattered it is picked up by a second fiber and fed into a portable computer. It compares the optical signatures to samples of healthy and cancerous tissues. "The whole process including the analysis takes about a second. Hopefully the end product will be a system that will tell the surgeon whether there is cancer or not," Lee said. So far, tests on 200 patients have provided promising results. "The number of patients is still relatively low, but the preliminary results indicate that the same diagnostic information could be obtained 93% of the time for breast tissues and in 85% of lymph glands examined, but in a fraction of a second," said Lee.

The new technique, which has won US army funding, has also been tested on skin cancer. More research and patient trials are needed but Lee said a clinically useful could be available within a few years. Although it may not replace traditional biopsies it could be used with existing techniques to improve the treatment of breast cancer, which kills 500,000 women worldwide each year.

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Tamoxifen Shown to Prevent Breast Cancer-(Reuters-20/03/2002)

The drug tamoxifen can prevent breast cancer in healthy women who have a high risk of developing the disease, cancer experts said. Preliminary results of the International Breast Cancer Intervention Study (IBIS) presented at the 3rd European Breast Cancer Conference showed that the drug, produced by AstraZeneca under the name Nolvadex, reduced the incidence of breast cancer by a third. Professor Gordon McVie of Cancer Research UK, which funded the trial, said the results confirmed that tamoxifen could prevent cancer. "The results so far show that incidence was reduced by one-third, compared to women taking a placebo," he said in a statement. But the study also showed that the drug could increase the risk of blood clots before and immediately after surgery.

Professor Jack Cuzick, the lead investigator of the trial, said the benefits of using tamoxifen to treat breast cancer were indisputable, but there was still no conclusive evidence that the benefits of taking the drug outweighed the risks. "I stress that these results are preliminary and it is essential to continue to follow the participants to see if a particular high risk group of healthy women can be identified for whom the benefits of tamoxifen clearly outweigh any risks," Cuzick told the conference. He stressed that the drug only reduced breast cancers that were sensitive to the female hormone estrogen and the benefits were the same for women of all age groups, regardless of whether they were taking hormone replacement therapy (HRT).

Tamoxifen works by neutralizing the action of estrogen, which stimulates breast cancer growth. Studies have shown that it is effective in treating early and advanced breast cancer, particularly in women over 50 who are most likely to develop the disease. But the drug can also increase the risk of a rare form of cancer of the uterus. Tamoxifen's role in preventing cancer has been controversial. US scientists hailed it as a wonder drug several years ago after researchers reported it reduced breast cancer cases by 45% in a US trial that was cut short to allow women on the placebo to take tamoxifen instead.

At the time British researchers criticized the US decision to halt the trial, saying long-term studies were needed to confirm the drug's effectiveness in cancer prevention. "For high-risk women, we calculate that deaths from breast cancer within 10 years of diagnosis would be reduced by 18%," Cuzick said. But he stressed that doctors and women should be aware of the risks and suggested women should not take the drug before or after surgery because of the increased risk of blood clots.

Tamoxifen, launched in 1973, is the most widely prescribed drug for breast cancer.

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WHO Concludes Mammograms Save Lives-(AP Medical-18/03/2002)

The World Health Organization has concluded that mammograms can prevent breast cancer deaths in one in 500 women aged 50 to 69. The findings, the latest word in a debate over whether mammograms save lives, were being hailed as definitive. The report, produced by 24 independent experts for the International Agency for Research on Cancer, an agency of the WHO, said many of the doubts raised recently were unsubstantiated. World breast cancer experts are meeting this week in Barcelona for the European Breast Cancer Conference and plan to devote a day to discussing the mammogram controversy.

Recommendations that women have regular mammograms have been based on seven landmark studies conducted in the 1970s and 1980s that concluded d mammograms can cut deaths from breast cancer significantly. However, confidence in breast screening has been hit by damning conclusions reached last fall by scientists from the Nordic Cochrane Center in Copenhagen. They reanalyzed the seven landmark trials and concluded that five of them were so flawed that it was not possible to tell if routine mammograms save lives. Since the Danish research, several other expert panels, including the WHO group, have taken a fresh look at the old studies to see if the findings were indeed flawed. They have each concluded that mammograms save lives, although their opinions vary as to by how much regular mammograms reduce the chance of breast cancer death.

"This is the definitive answer," said Julietta Patnick, who coordinates Britain's national breast cancer screening program. The WHO group found there was sufficient evidence in the old trials that death rates for women aged 50 to 69 can be reduced by 35 percent if they have regular mammograms. They said that many of the criticisms that the Danes had of the old trials were unfounded.

"What we can say to women is if you go and take up the offer of the screening and are screened regularly then the risk of dying of breast cancer goes down by 35 percent," said the group's chairman, Bruce Armstrong of the International Agency for Research on Cancer."That's the promise we can make to women."

There was only limited evidence of reduction for women aged between 40 and 49, the WHO evaluation found.

Breast Cancer Drug Gets Go-Ahead in UK- (Reuters-15/03/2002)

A breast cancer drug that experts say could help thousands of women has finally won the backing of the government's drug cost watchdog. So far only a few NHS hospitals have made the therapy, Herceptin, available because they have been waiting for guidance from the National Institute of Clinical Excellence, which decides which drugs the hard-pressed health service can buy. Critics say the delay has cost lives.

Herceptin, made by Swiss company Roche and US biotechnology firm Genentech, costs up to £13,000 per course of treatment. It has been licensed for the treatment of women with advanced breast cancer in the United States since 1998 and since 2000 in the European Union. The treatment is thought to hold up the progress of cancer in women who have too much of a certain gene and to improve quality of life. "Today's guidance represents a major step forward for women with this type of breast cancer," a NICE spokesman said.

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Second Opinion Often Shifts Breast Cancer Care-(Reuters Health-12/03/2002)

A second opinion can in many cases change the course of care for women in the earlier stages of breast cancer, a study at one US hospital suggests. Researchers found that among 231 breast cancer patients who sought second opinions at their center, 20% changed their treatment decisions. Moreover, fewer than half of the women said they had all of their surgical options presented to them at their original consultation. Most commonly, women who were eligible for breast-sparing procedures were offered only mastectomy, according to findings published in a recent issue of Cancer.

Dr. Monica Morrow and colleagues at Northwestern University in Chicago, Illinois, looked at women with up to stage II breast cancer--when tumors are in the breast tissue and sometimes nearby lymph nodes. All of the patients had come to their program for a second opinion on their surgical options, which, for many women in these stages of the disease, include mastectomy alone, mastectomy plus immediate breast reconstruction and breast-conserving surgery. In breast-sparing procedures, surgeons remove tumors while taking as little surrounding tissue as possible.

Morrow's team found that only 46% of the women had been given information on all three options from their original doctors. Thirty-one women who were eligible for breast-sparing surgery were offered only mastectomy, while 23 patients with contraindications to breast-conserving treatment were nevertheless offered it. Reasons that women should not get this conservative measure include multiple tumors in separate areas of the breast and prior radiation treatment to the affected breast region, Morrow noted. She said this amounts to roughly 10% of women with stage I breast cancer and 30% of women with stage II. Still, Morrow said that women should have all three surgical options presented to them, even though in some cases it will center on the reasons they should not have a particular procedure. "If patients do not have all three treatment options discussed, then they should consider a second opinion...or if they feel they are being pushed into a treatment they don't want," she said.

According to Morrow and her colleagues, research suggests that most women with stage I or II breast cancer are eligible for breast-sparing surgery, based on US guidelines. Yet, they note, national data have suggested far fewer women actually receive the treatment. This study, they write, suggests that one reason is the "failure to inform patients adequately" about the option--although medical reasons and patient preferences are also involved. Morrow noted that her center has a program designed specifically for giving second opinions on breast cancer treatment--"as do most major cancer centers." Centers with particular expertise in breast cancer, she said, are generally the best place to go for a second opinion.

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Late marriages increase the risk of breast cancer-(Times of India Online-09/03/2002)

Late marriage is one of the factors increasing the risk of breast cancer. Late child bearing which follows late marriage together with the inability or unwillingness to breast feed the infant, imbalance in diet and obesity are some of the likely causes. Women with a history of cancer in the family run a higher risk. Breast cancer is the second most common cancer seen in the Indian women. Urban women are more frequently affected than their rural counterparts.

During the public forum organised for the benefit of the public, certain queries regarding the causes, detection, prevention and treatment of breast cancer were clarified by the eminent panel of specialists present.

Dr Shekhar Salkar, chairman of the organising committee said that the doctor has to be a friend, philosopher and a guide to the patient since a positive attitude by the patient will help her to accept the diagnosis and lead to her longer life span. The medicos disagree on how much of information to reveal to the patient of her sickness. But it is very relevant to judge the patient's mental condition and the financial status of the family before revealing the nature of the malady. A breast is the self-image of women and if breast cancer is detected at an early stage through self-examination there is a possibility of saving the vital organ. Social obligations and pressures play an important role in the therapy of the patient, said Dr Salkar. There is a wrong impression here in Goa that counselling by a psychiatrist means the patient is mentally unsound. Likewise comments based on half-truths regarding hair loss leads the patient to a state of depression.

Hair loss is dependent upon the type of treatment involved. Deliberate neglect by the patient (even educated women) due to social obligations like a marriage in the family causes delay in the treatment. Unfortunately 80% of the patients visit the specialists in the late stages thereby the patients die earlier.

Public awareness campaigns, self-examination of the breast followed by an early diagnosis by the experts can help in improving the survival and saving the organ, said president of BCF, Dr Sanyal. Mammogram or Sonogram (special kinds of X-rays) are recommended for the high risk group, he added. Due to high literacy levels of education, women in Goa get married late and delay the process of child birth. Working women are also less likely to breastfeed their infants. Change of life style in urban women and regular screening may reduce the risk of cancer in these category of women. Menstrual status of women like early menarche and late menopause increases the chances of breast cancer in women. Genetic predisposition, where the family history of the women's grandmother, mother, aunt or sister have developed breast cancer are at an increased risk.

Dr Rajendra Badwe of Tata Memorial hospital, Mumbai remarked that the acceptance of the diagnosis by the patient is very strong in India and no single test can give 100% diagnosis, so a series of regular examinations by the doctor of the subtle changes will help to detect and diagnose breast cancer.

Dr Baruah comments that more than 90% ladies discover themselves of the presence of the fibroid lump by self-examination of their breasts. The self-examination of the breasts done every month preferably seven days after the start of her menses is the most cost effective method of detection of breast cancer.

The BCF has on its agenda awareness programmes of self-examination of the breasts to prevent breast cancer at various women colleges.

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Breast Cancer- prevention and early detection-(Times of India Online-09/03/2002)

Cancer of the breast, considered as the 'Foremost cancer in women', causes about 20 per cent of cancer deaths among females. The incidence of breast cancer has been rising steadily and it has been estimated that one out of every eleven women will develop breast cancer. A third of these women will succumb to the disease. Understandably, then, breast cancer has received a great deal of publicity and has been the focus of intensive study.

It is both ironic and tragic that a cancer arising in an exposed organ, readily accessible to self-examination and clinical diagnosis continues to take such a heavy toll. In Goa, breast cancer is the commonest cancer in women. The primary aim of breast cancer detection is to diagnose these cancers early, ie in Stage 0 or Stage I. In this stage, the breast cancer is totally curable.

Common age group: Breast cancer is rare below the age of 30. It may occur at any age thereafter, with a peak incidence at or near menopause (in most women menopause occurs at around 45 years). In Goa, we are now encountering young patients in the age group 30-40 years. The youngest patient who was diagnosed with breast cancer was an 18 year old girl. She had a family history of breast cancer and her mother had died of breast cancer soon after her delivery.

Genetic factors: A family history of breast cancer is a risk factor for development of breast cancer. The risk is increased in the following situations: a) if a maternal first degree relative is affected b) If the relative has bilateral breast cancer (ie cancer of both the breasts) c) If the relative has pre-menopausal breast cancer (ie cancer occurring before 45 years) or d) If multiple relatives are affected.

Length of reproductive life: Risk increases with early menarche and late menopause.

Parity: It is more frequent in nulliparous women (ie those who have no children).

Age at first child: Increased risk when over 30 years, at the time of the first child.

Obesity: Increased risk, because of synthesis of estrogens in fat depots.

Oral contraceptives and hormone replacement therapy: increased risk

Diet: High fatty diet and intake of alcohol has an increased risk.

Proliferative breast disease: It is associated with an increased risk.

Cancer of the contralateral breast (ie the other breast) or cancer of the endometrium: Increased risk.

Exposure to radiations: increased risk.

Types of breast cancers

In Situ Carcinoma: Ductal Carcinoma in Situ and Lobular Carcinoma in Situ.

Invasive: Ductal, lobular, tubular, cribriform, colloid, medullary, papillary, apocrine, Paget's disease, metaplastic, squamous and inflammatory carcinomas.

Breast cancer during pregnancy and lactation: It has a very bad prognosis because the hormones help the cancer cells to grow and spread.

Screening for breast cancer

Breast self-examination should be done by every woman who is 35 years and above. It involves self-examination of both the breasts. It should be done once a month. In the self-examination the woman should look for or feel for any nodule, lump, thickening, granularity in the breast or discharge from the nipple. If they notice any of the these they should report immediately to the surgeon or surgical pathologist for an FNAC, clinical examination of the breast by the physician or surgeon once a year, mammography, ultrasound and FNAC.

Screening for breast cancer is recommended for women 35 years and above, except in high risk groups and those having family history of breast or ovarian cancer, in whom screening should begin at an earlier age. By regular screening methods breast cancer can be detected early, treated and cured. It should also be noted that all lumps in the breast are not cancers. In fact, the majority is benign. But the message is never neglect a breast lump. Always get it biopsied or removed.

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PET Scans Give Breast Cancer Victims Peace of Mind-(Health Scout News-07/03/2002)

One of the most devastating aspects of having breast cancer is never knowing if or when it will return. Now, a new study says there is a way to reduce that trepidation and know with some degree of certainty that you really are disease-free. A report published in the Journal of Nuclear Medicine found a particular type of nuclear imaging known as an FDG PET scan (positron emission tomography) can detect disease recurrence much more accurately than conventional forms of imaging, including X-rays, magnetic resonance imaging (MRIs), CT scans and sonography.

"When you have treatment for breast cancer, the treatment itself can cause a number of problems, such as inflammation or even scar tissue that, upon conventional imaging, can appear as a mass," says study author Dr. Johannes Czernin, of the department of nuclear medicine at the UCLA School of Medicine. What conventional imaging can't tell you, Czernin says, is whether that mass is malignant. However, the PET system of imaging can make that important distinction, and it can detect some masses that conventional imaging can't, experts say.

"Rather than just taking a picture of a tumor or mass, the PET scan is actually able to measure the 'living chemistry' of that mass, and tell us with some degree of certainty if a malignancy is at work or not," says Dr. Steven M. Larson, chief of the Nuclear Medicine Service at Memorial Sloan-Kettering Cancer Center in New York City.

To view that " living chemistry," patients are given an injection of a harmless radioactive substance that acts as a kind of homing device, traveling through the body and collecting in areas where a mass exists. If that tumor is malignant, PET scanning causes the image on a computer screen to light up, indicating a metabolic "hot spot" -- a mass that is burning energy at a faster rate than normal tissue. This, doctors say, is often a sure sign a tumor is malignant.

For the women in the study, the PET scan effectively showed which women were harboring "hot spots" -- indicating recurrence of disease -- and which ones were cancer-free. "This is a well-done study that concurs with our own findings about the PET scan. It is highly consistent with the work we have done in this area, and I believe represents an important finding about the usefulness of PET scans in breast cancer patients," Larson says. However, he cautions that "we also need more studies to back up these findings, so we can know with much more certainty which subgroups of patients will benefit most from this technology."

The new research involved 61 women, all of whom underwent breast cancer surgery. In addition, 46 of the women got chemotherapy, and 34 received radiation therapy. Each woman also had some form of conventional imaging -- MRI, X-ray or CT scan -- to check for disease recurrence. Soon after that, they all received whole body PET scans. Forty-two women were evaluated for residual or recurrent disease, 10 were tested because of increased blood levels of tumor markers, and nine had suspicious findings from the conventional imaging. After the PET scans, the women were followed for a minimum of six months, to check for disease recurrence.

The result: Six of the 61 women in the study who had positive conventional imaging tests but negative PET scans were found to be cancer-free. Six of nine women who had a negative finding with conventional imaging but a positive PET scan were found to have recurrent disease. Overall, the study found a difference between PET scan findings and conventional imaging existed for about 25 percent of the women, with PET correctly predicting disease outcome 80 percent of the time. Conventional imaging was right in only 20 percent of the cases.

The PET scans were also better at determining the length of disease-free survival, accurate 90 percent of the time, compared to 75 percent for conventional imaging. PET was also almost 15 percent more sensitive in finding tumors, and approximately 16 percent more specific in identifying what was found.

There was, however, one caveat: all six women who were identified as positive for disease by the PET scan, and who received follow-up chemotherapy, radiation or surgery, remained positive for disease, a strong indication that the screening did not impact remission.

However, the authors believe it may have significantly delayed disease progression. "What is of equal significance is that, for the women who were given a clean bill of health with a negative PET scan, this was information they could be very sure of. It gave them an important sense of security knowing that they were really healthy and did not have to worry," Czernin says.

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Search on for alternatives to mammograms-(Associated Press-06/03/2002)

Scientists are testing blood from more than 1,000 women for a protein that might signal breast cancer, hoping to create for women the kind of blood test men have for prostate disease. It is too soon to know if the experiment will work. But the quest for new ways to catch early tumors or even precancerous cells - from blood testing to analysing nipple fluid - is heating up amid controversy over mammograms. Proponents foresee a day when the X-ray routinely comes with a backup test.

"Mammography is not the end-all," says Dr. Alan Hollingsworth of Oklahoma City's Mercy Health Center, one of seven US hospitals participating in Matritech's blood-test research. With a hint from another test that a tumor might be forming, "you could look harder. There are ways to look harder than just with mammography."

Mammograms can detect tumors when they are tiny, often meaning the difference between surgery that severs or spares the breast. Whether they also save lives is under hot debate. The US government thinks so, and strongly urges women over age 40 to get one at least every other year. Regardless, an estimated third of women do not get regular mammograms.

Other scientists argue that studies backing mammograms are too flawed to determine if the procedure reduces death. Mammograms are certainly not perfect. They can miss tumors or flag suspicious spots that turn out to be benign. More powerful imaging techniques, like ultrasound or MRI, can better pinpoint tumors but are too complex and expensive to use on everybody. The presence of prostate-specific antigen (PSA) protein in men's blood suggests they may have either an enlarged or cancerous prostate. So why not a blood test for breast cancer?

Nuclear matrix proteins, or NMPs, help form the skeleton of cell nuclei as cells reproduce. Changes in nuclei size or shape can signal cancer. The theory: Different cells use different NMPs, so changes in the type or amount of a certain NMP in the blood could signal cell changes that mean cancer. Matritech, which licensed rights to NMP research from the Massachusetts Institute of Technology, already sells a test that helps diagnose bladder cancer by finding NMP-22 in urine.

Now Matritech says a related protein, NMP-66, appears specific to breast cancer. In a preliminary study of blood samples from 78 women, NMP-66 was found in everyone with invasive cancer; four of five who had a noninvasive tumor of the milk ducts; and no one with a normal mammogram. The downside: It also was found in two of 24 women with benign breast conditions. Matritech is looking for NMP-66 in 700 women who will receive biopsies to check for breast cancer, and another 400 women whose regular mammograms show nothing suspicious. Results are expected later this year. Even if this first clinical trial of NMP-66 is promising, it will take much more research to prove the test works, Hollingsworth cautioned.

Researchers are concerned about those false positives - positive tests that turn out to be benign. It is not too hard to tell when a mammogram causes a scare, but it will probably take longer to tell if a blood test result is wrong, says Robert Smith of the American Cancer Society. Ultimately, Matritech hopes to sell NMP-66 as a routine mammogram backup.

There is another breast test, called ductal lavage, that some women are clamoring to get. Doctors put an anesthetic on the nipple and insert a threadlike catheter to flush milk ducts with fluid that dislodges and draws out cells. Ductal lavage is still experimental. It does not hunt for actual tumors but can detect abnormal cells that may signal precancerous changes. It is recommended only for women at high risk of getting breast cancer, to help them decide such things as how often to get mammograms or whether to try the drug tamoxifen in hopes of preventing tumors.

"We need to be responsible about how we integrate this into our practice," cautions Dr. Freya Schnabel of New York's Columbia-Presbyterian Medical Center. "The people for whom this technique is most helpful are people where the information is going to make a difference in terms of what they do." Until these experimental tests are better understood, the best advice is to get a regular mammogram from a radiologist who does lots of them - because more experience means more accuracy, says the cancer society's Smith.

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Cancer charity backs gene check-(The Guardian-04/03/2002)

Britain's biggest cancer research charity has thrown its weight behind mass genetic screening for predisposition to the disease after research suggested that many individually minor gene variations, inherited together, can multiply cancer risk. The approach, which initially focuses on breast cancer, would prove controversial because it would divide healthy women into "cancer-prone" and "less cancer-prone" bands. Critics argue that it would encourage fatalism in the former and irresponsibility in the latter.

The charity, Cancer Research UK, said lives would be saved by enabling those most at risk to be monitored more intensively and nipping early stage cancers in the bud. Paul Pharoah, the lead researcher in the new study - funded by the charity - said he would support putting healthy but genetically at risk women on powerful anti-cancer drugs like tamoxifen. Details of the research are published in the journal Nature Genetics.

"Our results showed that many common genes seem to add together to raise the risk of breast cancer. In the future, we should be able to test for a selection of these, accurately identifying those women who have a high chance of getting the disease. Rather than spending lots of money on a one-size-fits-all breast screening programme that examines some women too often and others not often enough, we could plan screening according to a woman's risk. And for women with a very high risk of the disease, drugs like tamoxifen may be useful preventative agents."

The study, carried out at the Strangeways Research Laboratories in Cambridge, is a statistical analysis of breast cancer rates among relatives of 1,484 women with the disease. It concluded that the main hereditary risk of breast cancer came from many different genes, which were cumulatively dangerous. Mutations in two genes - BRCA1 and BRCA2 - give a very high risk of breast cancer, but are present only in a few people. The Cambridge team's results suggest that there is a much larger group of genes which could be used to identify a high risk group, comprising 12% of the female population, which gives rise to half of all breast cancer cases.

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Study links hormone therapy to elusive tumors-(Times of India Online-13/02/2002)

The suspected breast cancer risk associated with post-menopausal hormone replacement therapy may involve a type of tumor that can be hard to detect, researchers reported. The report from the Fred Hutchinson Cancer Research Center, Group Health Cooperative and the University of Washington, Seattle, looked at 705 women between the ages of 50 and 74. It found the incidence of all types of breast cancer in the group was increased by 60 to 85 percent by replacement therapy and that long-term users had a higher risk for lobular breast cancer.

"We found an elevated risk of invasive breast cancer among post-menopausal women who were long-term, recent users of oral estrogen, either alone or in combination with progestin," said the study published in this week's Journal of the American Medical Association. "These results are generally consistent with the results from other case-control and cohort studies and (a) recent collaborative analysis," it added. "Two prior studies have observed a two to three-fold increase risk of lobular breast cancer associated with current combination therapy, and we found similarly large risks of lobular cancer associated with current combination therapy and longer duration of all formulations of hormone replacement therapy," it said.

If there really is an increased risk for lobular breast cancer, it added, that "could have implications for screening, because lobular carcinomas are relatively more difficult to palpate (feel) and more difficult to diagnose by mammography. However, until more is known about the costs and benefits of different screening modalities for women using hormone replacement therapy, it would be premature to use our results as a basis for modifying early detection activity in them."

About 38 percent of U.S. women between the ages of 50 and 74 are on hormone replacement therapy, according to medical literature. The therapy replaces estrogen which the ovaries cease to produce at menopause -- a change that can cause mood swings, vaginal dryness, lowered libido, hot flashes and insomnia. The replacement therapy also is believed to have the potential to prevent heart disease and ward off osteoporosis. Risks associated with the treatment include breast cancer and blood clots.

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The Cutting Edge of Cancer Treatment-(Cancer Info-11/02/2002)

The cutting edge of cancer treatment surgery, radiation and chemotherapy are still the first line of defense against breast cancer. But exciting new techniques are entering clinical trials and, if they work, may eventually replace the old standards with kinder, gentler treatments.

Tumor Ablation: Cancers can be frozen or vaporized with lasers or high-energy radiowaves delivered by a probe through a tiny incision. In one technique, the probe opens like an umbrella inside the breast. The technique is already used for liver tumors. Clinical trials for breast cancer are under way, but could take five years to complete.

Endoscopy: Tumors can be examined with a miniature fiber-optic camera that is inserted through the nipple and into a milk duct. Eventually surgeons may be able to treat tumors through the same tiny probe. The fiber-optic scope was okayed by the FDA last summer. Using it for treatment may be less than five years away.

Targeted Radiation: After a lumpectomy, a tiny radioactive bead is delivered directly into the tumor site through a small balloon-tipped catheter. Treatment takes a matter of days, not weeks. Clinical trials on 70 patients nationwide have been completed. The procedure is awaiting FDA approval.

Molecular Forecasting: With microarrays, scientists can study patterns of gene activity using strands of cancer DNA and predict which tumors are likely to spread. The technique may someday be used to design customized treatments. Clinical trials for breast cancer are starting this year; treatment may be widely available within the decade.

Smart Drugs: As scientists come to understand at the molecular level precisely how tumors form, they are designing a new generation of smart drugs that bind to specific receptors or block particular proteins. Herceptin, the first of these smart drugs for breast cancer, is available for certain advanced cancers.

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Researchers identify breast cancer gene-(Cancer Info-11/02/2002)

Australian researchers have identified a gene, which may cause up to 20 per cent of familial breast cancers. The scientists have found that 60 per cent of women who carry a mutation in the ATM gene will develop breast cancer by the age of 70 years.

Dr Georgia Chenevix-Trench, head of the cancer genetics laboratory at the Queensland Institute of Medical Research (QIMR), said the link was just as strong as for carriers of the so-called breast cancer genes, BRCA1 and BRCA2. "Our study indicates that the ATM gene could be thought as BRCA3," she said.

The ATM - ataxia telangiectasia mutated - gene causes a rare recessive degenerative disease in people with two copies. Those with one copy have been known to have an increased cancer risk, and previous QIMR research has found that products of the ATM gene can activate the BRCA1 gene. Dr Chenevix-Trench said previous research had focused on huge samples of cancer cases to find out whether those carrying the gene had a higher risk. The QIMR approach, conducted in collaboration with the national Kathleen Cunningham Foundation for Research into Familial Breast Cancer (kConFab), has been to find out whether the risk is sufficiently strong to cause multiple-case families. Dr Chenevix-Trench said the study of Australian families, published in the US Journal of the National Cancer Institute, shed light on the strength of the effect of the ATM gene.

One family in the study had five cases of breast cancer, all of whom carried the mutation. Another family had three sisters with the mutation, who all developed breast cancer, and a third family had five cases, of whom four were carriers and the fifth was unavailable for study.

Dr Chenevix-Trench said the research indicated the ATM gene might be responsible for one per cent of all breast cancers in the community. This figure is based on the assumption that the ATM gene causes 20 per cent of familial breast cancer, and five per cent of all breast cancers are familial.

The important finding was the extremely high risk conferred by carrying at least two specific mutations in the ATM gene. "There is clear data from studying our own particular families that 60 per cent of women who carry one of the ATM mutations will develop breast cancer by the age of 70 years," Dr Chenevix-Trench told AAP. "This is similar to the risk of carrying BRCA1 or 2: it may not occur to quite as many families but it could be something close." The research will now be expanded to examine the ATM gene in a new panel of 150 families from the kConFab database.

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Breast cancer treatment uses seeds-(Times of India Online-04/02/2002)

Learning she had breast cancer was not bad enough for the 40-year-old Miriam Norton after she learnt about Brachytherapy, a radiation alternative which works with radioactive seeds injected into the breast at the site of the tumour. Brachytherapy, an alternative more commonly associated with prostate cancer treatment. A few breast cancer doctors have been using it as a follow-up to lumpectomy - removal of only the tumor - and recent studies show it's effective. Best of all, breast brachytherapy requires about four or five days of treatment instead of six weeks or more with traditional radiotherapy. And Norton, like about 70 percent of U.S. women diagnosed with breast cancer, was eligible because her tumor was small and caught early. She had the procedure last May. "I was in, I was out, it was one week - and then I got on with my life," said Norton, now 42. "It was wonderful."

Brachytherapy - brachy means "short" in Greek - refers to the short distance between the radiation source and the targeted tissue. Dr. Robert Kuske, who treated Norton at the University of Wisconsin in Madison, says that in 1991 he was the first doctor to perform breast brachytherapy in this country. He does the procedure on about 100 patients a year, but it is not widely available. Many patients have never heard of it and some doctors consider it experimental. Proponents think that's about to change. Two recent studies involving at least five years of data on more than 200 women suggest breast brachytherapy is as effective as standard radiation at preventing cancer recurrence. In addition, the U.S. Food and Drug Administration has been asked to approve a new device called MammoSite. That would make brachytherapy easier, said Dr. Krystyna Kiel, a Northwestern University radiation oncologist with a waiting list of patients who want the procedure. Kiel has only used brachytherapy a few times in the past five years but says she'd likely do a treatment each week if the new device is approved.

The American Cancer Society estimates that 203,500 U.S. women will be diagnosed with breast cancer this year. About 70 percent will be potential candidates for lumpectomies, and thus brachytherapy, because their tumors are early stage and small, said Dr. LaMar McGinnis, the society's senior medical consultant. Many, however, will choose disfiguring mastectomies - which generally don't require radiation - simply because they can't afford or fear the time required for standard radiation, McGinnis said.

He said brachytherapy holds great promise "because of the convenience for patients and the hopes of getting more patients to choose breast conservation therapy." McGinnis noted that some doctors worry that patients who undergo the procedure might also have undetected tumors elsewhere in their breast that would be treated with standard radiation but not with brachytherapy.

Dr. Beryl McCormick, a breast cancer specialist at Memorial Sloan-Kettering Cancer Center, said brachytherapy probably will prove to be best for patients 55 and older whose cancer is less likely to recur. McGinnis said more long-term data is needed to show brachytherapy's effectiveness. Occasional side effects, including tissue hardening or reddening, probably will be avoided as more doctors become skilled at the technique, he said.

More than 100 doctors attended the first annual breast brachytherapy "school" for three days a few weeks ago in New Orleans. Kuske was on hand to teach the procedure.

The high-dose method Kuske uses involves temporarily inserting an average of 19 spaghetti-thin plastic catheters into the cavity where the tumor was removed. During twice-daily treatments, radioactive metal seeds about the size of rice grains are injected, then retracted through the catheters, which are attached by a cable to a radiation machine. Women can return home between treatments and the catheters are removed at week's end. Medicine numbs the breast during the procedure, which takes about an hour including preparation time, Kuske said.

The MammoSite device awaiting FDA approval involves inserting a single catheter into the breast, attached to a tiny balloon that is inflated and filled with radiation. Manufacturer Proxima Therapeutics Inc. says eight months of data show the device is safe; though whether patients remain cancer-free long-term is unknown.

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Researcher says mammography saves lives-(Times of India Online-04/02/2002)

A team from Cornell Medical Center has taken a fresh look at data that caused some investigators to doubt that mammography saves lives, and has concluded that there is a significant benefit over the long term. "Screening does not have an immediate effect; the deaths that get to be prevented by screening are in the future, years away," said Claudia Henschke of Weill Cornell Medical Center, whose team published its findings in the British medical journal, The Lancet.

The report is the latest contribution to a heated debate on the value of mammography in preventing breast cancer deaths - and the efficacy of cancer detection in general. Ten U.S. medical groups, including the American Cancer Society and the American Medical Association, placed a full-page ad in The New York Times, supporting mammography while conceding the limitations "and even some flaws" in existing studies.

"Early breast cancer detection means a greater chance for successful treatment and a greater range of treatment options," the advertisement said. "We have grave concerns that these public debates have already begun to erode the confidence in mammography that has been built up over the past two decades."

Henschke's team reviewed data from a study published in the British Medical Journal in 1988, based on data from Malmoe, Sweden. The authors of that study concluded that mammography led to a significant reduction in deaths from breast cancer after six years. Those conclusions have been attacked by Ole Olsen and Peter C. Goetzsche of the Nordic Cochrane Center in Copenhagen, who reported their findings in The Lancet two years ago. They concluded that "screening for breast cancer with mammography is unjustified," and in a follow-up report declared "there is no reliable evidence that screening for breast cancer reduces mortality." Olsen and Goetzsche looked at seven studies but rejected five as flawed. They accepted two as valid, the Malmoe study and another from Canada, published in 1992 in the Canadian Medical Association Journal. Henschke's team looked only at the Swedish data.

"The Canadian follow-up stopped at the point at which the Malmoe follow-up started to show fewer breast-cancer deaths among the screened, the Canadian screening having been continued for only three to four years after study entry," Henschke's team said. They criticized Olsen and Goetzsche for initially looking only at total breast cancer deaths over 11 years, 63 among those screened and 66 among those not screened, without analyzing when the deaths occurred. In a subsequent review, Henschke's team said, Olsen and Goetzsche based their conclusions on deaths from all causes rather than isolating deaths from breast cancer.

The Henschke team's report added that early detection and treatment may be associated with "somewhat increased mortality" in earlier years because of possible complications from surgery and other treatments. Dr. Robert Smith, head of cancer screening at the American Cancer Society, commented that the latest report in The Lancet would not end the debate. "But I think it should highlight what most experts who have a track record in the field have said, that the Goetzsche and Olsen analysis was severely flawed."

Smith, who was not involved in the Henschke analysis, said it was expected that the benefits would appear after some years. "Usually between year three and year six to seven, the difference in deaths should begin to separate as the advantages of treating tumors when they are smaller ... becomes evident. If your screening has been very good, that will come a little bit earlier," he said.

The Lancet also published an exchange of letters between Goetzsche and members of the Cochrane Breast Cancer group debating technical issues of methodology and publication. Goetzsche said he had published his earlier reports "because we believe it is important for women to know that screening increases their risk of losing a breast. This finding contrasts with the information they get from screening advocates who generally say the opposite, but without reliable data to support their claims." He also argued that data on deaths from breast cancer "are biased in favor of screening."

Lancet editor Richard Horton added a comment that the exchange highlighted the intensity of a debate which has now drawn wide public attention. "I cannot imagine anybody wishing that screening mammography does not succeed in reducing both breast cancer and overall mortality among women," Horton wrote. "But the public believes mammography to be far more effective than it really is. Women deserve an accurate assessment of the benefits or harm from screening mammography. That means encouraging an open debate about the issue."

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Gene screening can help cancer victims-(Times of India Online-30/01/2002)

A tell-tale genetic "signature" could one day spare millions of victims of breast cancer from having to face unnecessary follow-up treatment that often causes toxic side-effects. Breast cancer in the United States and Britain strikes around one women in 10, about half of whom die because the disease is detected too late. Women whose tumours are spotted before the cancer has spread to the lymph nodes are usually given surgery and radiotherapy. Eighty per cent of them will be free of the cancer five years later, a yardstick for measuring the success of treament in the medium term.

But the other 20 per cent develop cancer again within this time. The reason: Microscopic deposits of cancer cells have spread from the primary tumour and lodge elsewhere in the body, where they multiply again. To destroy these lingering foes, doctors often prescribe powerful drugs which kill the cells but often have painful and nauseous side-effects. At present, diagnostic tools are not smart enough to say which of the 20 per cent of patients are at risk from the secondary cancer, and which are not. As a result, many patients, between 70 and 91 per cent according to which diagnostic criteria are applied, are given the follow up therapy as a precaution, even though they do not in fact need it.

Researchers led by Stephen Friend of Rosetta Inpharmatics in Kirkland, Washington, and Laura van't Veer of the Netherlands Cancer Institute believe they have spotted a genetic "signature" that could help pinpoint which patients need the extra treatment.

They used a gadget, widely employed in laboratories, which is called a gene chip, a sort of glass slide that carries DNA from thousands of genes. RNA genetic material isolated from cancer cells taken from breast-cancer victims was placed on the slide. Wherever this material paired up with a piece of DNA on the slide pointed the finger to a gene implicated in the cancer.

By analysing 78 primary breast tumours from young women, the researchers were able to pinpoint 70 genes that gave a strong indication as to whether the patient is at risk from developing a secondary tumour. In 65 of the 78 cases, the presence or absence of the "signature" accurately told whether the patient would develop a secondary tumour or not.

The study, which is published in the British weekly journal Nature, is only a pilot research with a small sample size. But if further trials prove its worth, it means that the proportion of women who unnecessarily get the follow-up therapy could be slashed from 70-91 per cent to just 20 per cent.

Cancer, which just a few decades ago was feared as a monolithic, inevitably fatal disease, is fast being fragmented into a mosaic of conditions with varying causes and treatment options. As this latest breakthrough shows, headway is being made in understanding why some individuals are more susceptible to cancer and respond better to specific therapy than others.

In a commentary, University of Cambridge cancer specialists Carlos Caldas and Samuel Aparicio likened the combat to the use of antibiotics in the 20th century, which gradually became more refined and sensitive to specific conditions. "If findings such as those by Friend and colleagues can be generalised, we can likewise hope that cancer treatment will be vastly improved by better predicting the response of individual tumours to therapy."

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Two-drug therapy for breast cancer set for trial-(Times of India Online-24/01/2002)

A "one-two" punch? No, this has nothing to do with boxing bouts but something more serious. It is a strategy against breast cancer in cells. The modus operandi lies in using two targetted therapies which interfere with a key growth signal pathway. And this has been reportedly successful.

The findings by the scientists at the Vanderbilt-Ingram Cancer Center, USA, have been reported in the Cancer Research journal, according to Science Daily. They provide the doctors with a foundation for a clinical trial in patients with metastatic breast cancer which produces too much of a protein called HER2/neu. This protein is the target for the antibody Herceptin. In the trial, Herceptin will be combined with another drug called ZD1839, or Iressa. The latter targets the epidermal growth factor receptor (EGFR), also known as HER1. The HER network transmits signals that lead to an overgrowth of cells that characterize cancer.

In the laboratory, the researchers found that they could indirectly inhibit the activity of HER2 by directly arresting HER1. It was also observed that a mixed dose of Herceptin and Iressa has the ability to kill and reduce tumor cells much more than when either of them is used individually. Both the inhibitors have minimal side-effects. Dr. Stacy L Moulder, assistant professor of Medicine (Hematology/Oncology), lead author of the journal paper and principal investigator of the clinical trial, has expressed the hope that they'll be able to use these drugs together to shrink tumors with fewer side-effects.

Clinicians, scientists and patients are pretty excited about the therapies specifically targetting steps in the cancer development process. The Food and Drug Administration has approved two such treatments so far - Herceptin for a portion of breast cancer eukemia. However, many more, including Iressa, are being investigated against various types of cancer.

But questions still remain. Will the body develop resistance to such treatment even if the drugs are target-specific and much better than traditional chemotherapy? Many researchers, including Moulder and her colleagues, point out that cancer is a complex disease and war on it launched from multiple fronts may be required for long-term success. This study is the first demonstration of a combined molecular approach to inhibit the HER network in breast tumor cells that overexpress HER2. (HER2 is overexpressed in about a third of human breast cancers).

The clinical trial will ultimately enroll 150 patients with HER2-overexpressing metastatic breast cancer. Some of the participants will be women whose disease has progressed after treatment with chemotherapy. Others will be women who have the disease at an advanced stage and have refused standard treatment, preferring to go in straight for the investigational therapy.

The trial is what's known as a Phase I/Phase II investigation. The Phase I portion will examine two dose levels, in three patients each, to determine what, if any, side-effects result from combining the drugs. If the combination is found to be safe, the trial will be expanded into a Phase II study to test effectiveness.

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Insulin levels are linked to cancer -(Cancer Info-29/12/2001)

Breast cancer patients with high insulin levels from being overweight may have double the risk of the cancer recurring and triple the risk of death, says a study by Toronto doctors. Blood insulin levels appear to be a reliable predictor of whether a woman with breast cancer will survive over the long term, the study suggests.

If the study's findings prove correct, it may mean that low-tech ways of lowering blood insulin levels will become vital weapons in the arsenal used to battle breast cancer. Those means? Weight loss and exercise.

"It will never replace chemotherapy or hormone therapy or radiation or surgery, but it might provide an added benefit to all of those treatments," said the study's lead author Dr. Pamela Goodwin.

Insulin controls blood sugar. It enables muscles and tissues that require sugar to take it from the blood. Insulin is also a growth factor that can influence the progression and development of breast cancer.

"So what we think we have identified is a physiologic factor that is related to obesity that increases risk of breast cancer recurrence in women who have just been diagnosed with breast cancer," said Goodwin, a medical oncologist at Mount Sinai Hospital. "We found that overweight women had higher insulin levels and that was associated with a doubled risk of breast cancer recurrence and a tripled risk of death, even after considering stage of (tumour) and treatment." The 10-year study was conducted on 512 women aged 30 to 70 from 1990 to 2000.

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Coffee Does Not Cause Breast Cancer-(Times of India Online-27/12/2001)

Drinking coffee does not increase the risk of incurring breast cancer, Swedish physicians said. Nearly four million women around the world die of breast cancer every year, according to World Health Organisation statistics. Some scientists have suspected that high coffee consumption increases the risk of contracting breast cancer after research 20 years ago indicated that women with breast cancer experienced a regression of the disease if they stopped drinking coffee. But a 13-year-long study of 60,000 Swedish women found no link suggesting coffee would be a culprit.

"We found no association between self-reported coffee, black tea, and caffeine consumption and subsequent breast cancer incidence," said the research report made at the Karolinska Institute medical university, most famous for choosing the annual winner of the Nobel prize for medicine. Swedes are the world's second biggest coffee consumers per capita, drinking three cups or more per day, a tradition dating to the 17th century. In Sweden 6,188 women - and 29 men - died from breast cancer in 1998, according to the national cancer foundation's data.

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What has hair to do with cancer?-(Times of India Online-14/12/2001)

The international Trichologists association was in the process of developing a technique for detection of breast cancer by examining the hair of a woman, a top official of the association said. "The research in this direction is in an advanced stage and we are hopeful of a breakthrough by next year" Dr Apoorva Shah, executive director of the association's Indian chapter told newspersons while announcing the opening of a Trichology centre here, claimed to be the first of its kind in south India.

Trichology is the science of hair and scalp in health and disease and the International Association of Trichologists. He said the research on the relationship between hair and breast cancer was the second major research project undertaken by the association. Dr Shah said it had been found that there was a definite relationship between the health of the human hair and that of the rest of the body parts and many of the astrogens present in other parts of the human body and the hair were one and the same.

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New medicine for breast cancer -(Cancer Info-12/12/2001)

Initial results from the largest study of a breast cancer drug ever show that the drug anastrozole is significantly more effective at treating early-stage cancer in postmenopausal women than the current "gold standard", tamoxifen. The risk of an old breast cancer recurring was up to 22 per cent lower with anastrozole, and there were indications that the chances of developing a new could be reduced by 80 per cent.

However, cancer experts sounded a note of caution since it would be a while before the full results could be evaluated, and questions were raised over some of the drug's side effects. At present the drug is only licensed for the treatment of a limited number of women with advanced breast cancer in the UK.

Anastrozole, which has the brand name Arimidex, generally caused fewer side effects than tamoxifen, the study found. Blood clots in the legs were twice as likely and cancer of the womb five times more common for tamoxifen treated women. But there were suggestions of higher rates of osteoporosis in women given anastrozole. Fractures occurred in 5.8 per cent given the drug compared with 3.7 per cent treated with tamoxifen, and musculo-skeletal disorders were more common in the anastrozole group.

The results emerged from an international trial called ATAC (Arimidex, Tamoxifen, Alone or in Combination) which involved more than 9300 postmenopausal women with early breast cancer. Launched in 1996, the largest contingent of patients, numbering more than 3000, came from the UK.

Researchers found that when the treatments were given on their own, anastrozole was more effective than tamoxifen at enhancing disease-free survival. Combination treatment produced results on a par with tamoxifen alone.

Principal investigator Professor Michael Baum, from University College Hospital, London, presented the findings today at a breast cancer conference in San Antonio, Texas. He said: "This advance is as important for women fighting early breast cancer as the advent of tamoxifen was 20 years ago. "We already know that anastrozole can give better results than tamoxifen in patients with advanced breast cancer. The results of the ATAC study show that these advantages are also seen in women with early-stage disease." He said anastrozole may take over from tamoxifen as the preferred "adjuvant" treatment aimed at preventing breast cancer returning after surgery, and chemotherapy or radiotherapy. Both drugs work by preventing the cancer-triggering effects of the female hormone oestrogen.

After a follow up, 317 women out of 3125 women given anastrozole on its own had relapsed or died compared with 379 out of 3116 in the tamoxifen-only group. Professor Gordon McVie, director general of the Cancer Research Campaign, which funded part of the trial, said: "We are pleased that yet another drug has proved to be a viable alternative to tamoxifen. "The side effects seem to be different from other comparable breast cancer treatments and that may be an advantage. But he urged caution calling for more research.

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Cells in breast fluid could predict cancer -(Times of India Online-07/12/2001)

Women with abnormal cells in breast fluid are twice as likely to develop breast cancer, says a study that evaluated the disease risk in more than 7,600 women. The study, appearing in the Journal of the National Cancer Institute, classified thousands of women by the types of cells found in fluids that had been drawn from their breasts using a mild suction device. None of the women in the study were pregnant or lactating.

After following the women for up to three decades, the researchers found those whose breast fluid contained abnormal cells were twice as likely to develop breast cancer later in life. Women from whom no fluid could be drawn were the least likely to have breast cancer, while those with normal cells in the fluid were at about 60 per cent greater risk.

"Our study shows that if you can get fluid from a woman and there are abnormal cells in that fluid, then it is an indication of increased risk of breast cancer," said Margaret R. Wrensch, an epidemiologist at the University of California, San Francisco, School of Medicine and first author of the study. She said the study suggests, but does not prove, that for a woman who is not pregnant or nursing to produce any fluid at all may be an indication of increased risk. Wrench said the results of the study suggest that an analysis of the breast fluid should be considered for considered for inclusion on the list of factors that doctors now evaluate when predicting a woman's breast cancer risk. Other risk factors include close family members with breast cancer, age and the results of physical examinations and biopsies.

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Study details new breast cancer treatment-(Times of India Online-27/11/2001)

A new technique may allow women in the early stages of breast cancer to complete treatment in one session, without the six weeks or more of daily radiation therapy now required, researchers reported. The technique involves surgical removal of the tumor, a procedure called a lumpectomy, followed by temporary insertion of a metal sphere into the cavity to provide 25 minutes of radiation therapy for the breast tissue from the inside out. The technique, being developed at University College London Medical School, was outlined in a report delivered at the annual meeting of the Radiological Society of North America.

"Approximately three-quarters of women with breast cancer are candidates for lumpectomy, rather than mastectomy, which is total removal of the breast," said Jayaant Vaidya, a surgeon at the British school. "But because lumpectomy typically involves daily radiation treatment for an extended period of time, and mastectomy typically does not require radiation therapy, women sometimes choose mastectomy," he said. "If this new technique is proved effective, it should make lumpectomy available to many more patients. Early tests are promising."

Jeffrey Tobias, a tumor specialist at the school, said: "We believe this is going to work. Most cancer recurrences occur immediately adjacent to the tumor, an area which receives radiation with this method."

An electron generator charges the metal ball that is lowered into the area where the tumor was removed. It then emits a dose of ionizing radiation lasting from 21 to 28 minutes. The report said the technique is not sufficient for a form of breast cancer called lobular carcinoma, which accounts for up to 15 percent of all breast cancers. Vaidya said victims of such cancer still need an extended period of radiation but the radiating sphere can be used initially.

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Tamoxifen may reduce cancer risk-(Times of India Online-14/11/2001)

The drug tamoxifen may help prevent breast cancer in healthy women with BRCA2 genetic mutations but not in women with BRCA1 defects, new research suggests. The abbreviations stand for defects involving Breast Cancer Gene 1 and Breast Cancer Gene 2 that are strongly linked with breast and ovarian cancers. The new findings show tamoxifen can reduce breast cancer risk by 62 percent in women with the BRCA2 mutations. They also underscore how rare the mutations are, present in only about 7 percent of women studied, and help clarify conflicting results in previous studies on tamoxifen's effectiveness.

Tamoxifen inhibits growth of cancer cells that are sensitive to the hormone estrogen. Evidence suggests that most BRCA2-linked tumors are estrogen-positive and that most BRCA1 tumors are estrogen-negative, or not fueled by the hormone. This explains the new findings, said University of Washington geneticist Mary-Claire King, the lead researcher. She emphasized that the study did not address treatment of existing breast cancer with tamoxifen, which has been shown to help reduce a recurrence in women with estrogen-positive tumors who have BRCA1 or BRCA2 mutations. The findings appear in Journal of the American Medical Association.

King and colleagues analyzed blood samples from 288 women aged 35 or older who took tamoxifen or a placebo for five years in a national breast cancer prevention study that started in April 1992. Only 19 women had BRCA1 or BRCA2 mutations. Three women with BRCA2 mutations who used tamoxifen developed breast cancer during the study, compared with eight taking the dummy drug. Among BRCA1 women, breast cancer developed in five tamoxifen patients and in three placebo patients. King said the results would help high-risk women who decide to undergo genetic testing ``make an informed decision about what kind of preventive medicine they ought to follow.''

The study is important because it helps solidify previous evidence that tamoxifen is preventive and a ``viable option'' for some women, said Dr. Lynn Hartmann, a Mayo Clinic breast cancer researcher. Some women who learn they have the BRCA mutations decide to have their breasts removed in hopes of preventing the disease. Hartmann was lead author of a study published last week that showed removing both breasts can help high-risk women reduce their chances to near zero. But she said the new study does not answer whether tamoxifen, which increases the risk for endometrial cancer and blood clots, is a better choice than radical surgery.

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Double mastectomy lowers cancer risk –(Times of India Online-12/11/2001)

Surgically removing both breasts before disease strikes lowers the risk of breast cancer to almost zero for a rare group of women who have a combination of gene mutations and family members with the disease, a study found. The study, appearing in the Journal of the National Cancer Institute, involved women who had close female relatives with breast cancer and who had a mutation in one of two genes, BRCA1 or BRCA2, that have been linked to breast cancer.

Researchers said that the average woman has about a 10 per cent lifetime risk of breast cancer. For the women in the study, the lifetime risk was 55 per cent to 85 per cent. For such women, said Dr. Lynn C. Hartmann of the Mayo Clinic, a double mastectomy may be considered a reasonable option. "Those of us outside and looking in may feel very different than the women who must confront this issue," said Hartmann, the first author of the study.

Most experts said that double mastectomy is not expected to become a major choice of preventive therapy, even for the rare women who are at such exceptional risk. "It is a valuable observation," Dr. Patrick Borgen, a breast surgeon at Memorial Sloan-Kettering Cancer Center in New York, said of the study. "But nobody has been willing to build the future of breast cancer prevention" on a procedure that removes both breasts. In the study, Hartmann and her colleagues analysed data from 214 high-risk women who had chosen double mastectomies to prevent breast cancer. From this group, the researchers identified 26 who had both a strong family history of breast cancer and a mutation in the BRCA1 or BRCA2 gene.

The researchers found that, at an average of about 13 years after undergoing double mastectomies, none of the 26 women had developed breast cancer. Without the surgery, the researchers estimated, six to nine of the 26 women would have breast cancer. They translated this result into an estimated breast cancer risk reduction of 89.5 per cent to 100 per cent.

Hartmann said the study was conducted because even a careful mastectomy does not remove all the cells that can lead to breast cancer in high-risk women. "The ductal system of the breast does not conform to a defined area," she said. "Ductal cells can exist up near the collarbone or down in the armpit or even on the abdominal wall." The concern was that if the surgery left behind a nest of these cells, women with gene mutations "might not be protected at all" by double mastectomies. But the new study, she said, shows that "if a surgeon removes the vast majority of the tissue at risk, then it removes the chance of breast cancer."

Hartmann said that most women who choose double mastectomies also undergo breast reconstruction. She said a survey of women who have undergone the procedure found that most were satisfied they had chosen to have their breasts removed because it substantially reduced their high risk of cancer.

Debbie Saslow, head of breast and gynecological cancer care at the American Cancer Society, said the study "may be a big advance" for some high-risk women. Saslow said that most cancer counselors do not recommend double mastectomies, but the procedure is usually mentioned as an option. "This study will help women who do choose it to be more confident about their decision."

Dr. Deborah K. Armstrong, a breast cancer specialist at Johns Hopkins University Medical Center in Baltimore, said the option of a double mastectomy applies "only to a very select group of people." She said only 5 per cent to 10 per cent of breast cancer patients are in a group identified as "high risk" and only about half of this group would have one of the BRCA mutations. "Only an extremely small percentage of patients will choose this option," said Armstrong. Instead, she said, many choose to take five-year courses of Tamoxifen, a drug that studies suggest can reduce breast cancer risk by about 50 per cent.

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'The View' sets sights on breast cancer-(Cancer Info-30/10/01)

Every week on ABC's talk show The View, Barbara Walters, Meredith Vieira, Lisa Ling, Star Jones, and Joy Behar discuss hot topics spiced with lively opinions. But this October, they've all been in agreement: Women should broadcast the dangers of breast cancer loud and clear.

"The View provides an excellent forum for discussion," says Vieira, an Emmy Award-winning journalist. "We reach a lot of people and we all have big mouths, so the American Cancer Society's (ACS) Tell a Friend program is what we already do." "We're very excited about promoting breast cancer awareness," chimes in Ling, the youngest co-host. "Breast cancer is something each and every woman should take seriously. We should talk about it and spread the word."

And in an effort to help women consume more information during this October's Breast Cancer Awareness month, The View — which will tape its 1,000th show Nov. 28 — has been giving away a special edition pink coffee mug for every donation of $25 or more. "Our commitment to this issue is obvious. We probably have more breasts on this show than any other on television," kids Bill Geddie, executive producer of The View and The Barbara Walters Specials. "What is nice is when the mug is filled with coffee it serves as a daily morning reminder about breast cancer awareness. This is a special mug with a special message."

So far, donations have exceeded expectations, with more than 7,000 mug pledges generating over $175,000 for the ACS. The mug promotion runs through Oct. 31 or until all the mugs have been given away.

Despite a 2% annual decline in breast cancers deaths over the past decade, over 40,000 women will die from the disease this year. "I've had a number of people in my life pass away from breast cancer," says Ling. "Allison Fisher was only 30. She was a brilliant young woman that this disease stole from us. Her experience is a wake-up call to all of us. I know they recommend mammograms for women over 40, but I think young women have to be diligent too."

And a mammogram is the most effective diagnostic tool to catch breast cancer before it spreads. Unfortunately, only about 60 -65% of American women get a mammogram on a regular basis. Whether women avoid mammograms out of fear or denial, ACS reports that 70% of all women listen to their friends' and peers' opinions on health issues. The View is using that fact to everyone's advantage.

"We want everyone to be proactive no matter what their age," says Vieira. "I'm nearly 48. I've gotten mammograms before so I was fine getting a mammogram done for a segment on our show. OK, it hurts a little, but no big deal — cancer is a lot worse. But I did it and thank God mine was clear."

"The biggest problem with mammograms is that women don't get them," says Dr. John Glaspy, director of the UCLA Oncology Center at the Jonsson Cancer Center. In many cases, women simply forget to schedule their yearly mammogram.

"I realized while doing this mammogram that I'd missed a year," admits Vieira. "I'd been so concerned with my husband going through his cancer treatment that I forgot. I was shocked, because I would have thought I'd have been more on top of an issue like this. One of the tips I've heard is make a tradition out of getting your mammogram," she adds. "Get one every daylight savings time in the fall when you change the smoke detector batteries, or do it every year on your birthday."

One aspect of the process is all too easy to remember: Mammograms can cause some temporary discomfort. "The vice-like compression doesn't feel good. Sure it hurts, but it goes away immediately. It's not like you're limping afterwards," says Vieira. "I hope they find a better way, but until then, you have to get them done."

"Right now I'm not aware of anything that is going to supersede mammograms," says Glaspy. "Mammograms are continuing to improve. They are more sensitive, using less radiation, using digital film, but we are years away from replacing mammograms with some other screening technique."

A good screening test has to detect most of the abnormalities and do so early in the cancer's development. And it needs good science behind it to warrant its use. "Studies have shown that if mammograms were performed on all women 50 and older, their risk of breast cancer would be lowered by 30%. None of the other procedures — ultrasounds, MRI's, thermography, or PET scans — can make that claim," says Glaspy.

"Actually the worst part about mine was they place your breast on this plate and they told me I need a smaller one — a dessert plate instead of like a pasta plate," jokes Vieira.

In addition to getting annual regular checkups, including breast examination with a doctor, monthly self-exams and a mammogram, there may be lifestyle changes that American women can make to prevent a higher incidence of breast cancer. While there is a proven genetic component to breast cancer, only 24% of women who get breast cancer have a family history of the disease. That means in the vast majority of cases some other factor is creating the cancer.

"There is a clear environmental risk to breast cancer," says Glaspy. "When women migrate from one area to another they develop the risk of the place they move to so that means it's environmental, not genetic. Most of these studies have been with Japanese women who when they immigrate to Hawaii their incidence of breast cancer rises. The question has been what is that environmental factor. The short answer is, it isn't known. There are lots of theories and some data, which points to the diet. There is evidence that fat intake in the diet changes estrogen levels."

The ASC strongly suggests that a good diet, getting exercise, stopping smoking, and drinking less alcohol can promote health and reduce the risk of getting cancer.

"I think diversity in your diet is important. We're evolved enough to know what is good for us," says Ling. "Excessive quantities of anything can't be good for you. I try to keep my red meat consumption down and eat more fish and vegetables."

"Nonetheless, if you add up alcohol, smoking and everything else, it doesn't explain a fivefold difference in breast cancer between a low-risk country and a high-risk country," says Glaspy. "That difference is an active area of research. Theoretically, we could lower the risk of breast cancer fivefold." For today, women must do what they can.

"The most important thing you can do is to tell a friend," advises Ling. "Remind them about breast health and taking care of their body. Don't think you're immune just because you're young. Be smart and be cautious."

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New cancer test can help avoid chemotherapy –(Times of India Online-25/10/2001)

A new genetic test on breast tumours could spare thousands of women every year from post-operative chemotherapy and its side effects, and help tailor treatment for those who need it. Doctors know that 20 or 30 per cent of women with early breast cancer will have a recurrence within five years, but because they can't identify those most at risk, they give chemotherapy in nearly every case. Early research presented at a conference of the European Federation of Cancer Societies indicated the new method could cut the proportion of women given chemotherapy unnecessarily from 90 per cent today in the United States and 70 per cent in Europe to 27 per cent overall by better categorizing tumours.

Dr Bruce Ponder, a world leader in breast cancer genetics and professor at Cambridge University in England, said the approach holds promise. Experts say the test should be available in about five years. "If you take 100 women who have got breast cancer and ... they have very similar tumours, we know that some of them will do well and some of them will do badly and we don't know which they are and so at the moment we tend to treat all of them on the basis that they might do badly," Ponder said. "It's almost certain that some breast cancers respond to some treatments and some respond to other treatments and that's because of the molecular makeup of the tumour," Ponder said. "What these sorts of analyses will do in the first instance is they will allow us to use the treatment that we have already more effectively - to tailor treatments to individual patients."

Chemotherapy reduces the risk of recurrence by about 35 per cent, but many women suffer unpleasant side effects, including nausea, hair loss, diarrhea and fatigue. "You are sparing a lot of women unnecessary toxicity and you're saving time too because if you can pick up what is the optimum treatment for them, you won't necessarily cure them but at least you've got the best chance of success with minimum distress and toxicity to the patient," Ponder said.

The approach is one example of how the recent unraveling of the human genetic code is starting to pay off. Breast cancer recurs if undetectable cancer cells derived from the main tumour are already elsewhere in the body at the time of surgery. Some tumours send microscopic outposts, while others don't. Doctors cannot currently tell which ones do, so chemotherapy, which kills cancer cells lurking anywhere in the body, is given after surgery to most women just in case their tumours are the type that do.

In the United States, drugs are given whenever the breast tumour is bigger than 1 cm (half an inch) in diameter, which is the case in 90 per cent of patients.

In Europe the drugs are administered either when the tumour is larger than 2 cms (1 inch) or when the woman is over 35, the tumour is not fuelled by the female hormone estrogen, or when the tumour is classed as aggressive, which together includes 70 per cent of cases. However, cancer will not have spread to a distant site in 70 to 80 per cent of those women.

The new test is designed to tell scientists whether the tumour has sent satellites to other areas of the body, giving them a better way to determine who should get chemotherapy.

In the study, Laura van 't Veer, a pathologist at the Netherlands Cancer Institute in Amsterdam, studied the activity of 25,000 genes in breast tumours of 78 patients who were treated for early breast cancer between 1983 and 1995, before women were being treated with chemotherapy after surgery. The disease later recurred in 34 of those women and the other 44 remained cancer free. She examined how active each of the genes was in every tumour in both groups. A pattern emerged, giving her a signature unique to the tumours that had spread to other parts of the body. The new test worked just as well as the current method at allocating chemotherapy to the women who needed it.

"In the group that remained disease free - 44 women - the (US classification) would have treated 40 out of 44. Those 40 would all have been treated without any use. We would have selected only 12 out of the 44. If normally 92 per cent would get chemotherapy, with our profiling, only 55 per cent would get it," Van 't Veer said.

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New techniques to make breast cancer surgery less traumatic-(Times of India Online-23/10/2001)

New surgical techniques could save the lymph nodes and avoid radiotherapy after breast cancer surgery, a leading expert said. Traditional breast surgery involves removing all the lymph glands in the armpit to determine if the tumor has spread. Most of the time in early breast cancer, it has not. However, about 20 percent of women then suffer the rest of their lives from swelling in their arms, which can painfully balloon to twice the normal size and leave them disabled and prone to infections.

Dr. Umberto Veronesi, a pioneer of breast conserving surgery in the 1970s and now a leader toward less radical treatment of the lymph nodes, presented new evidence at a meeting of the Federation of European Cancer Societies that indicated that first removing only one key node for testing was as accurate a predictor as cutting them all out right away.

The technique, known as sentinel node biopsy, is rapidly gaining recognition and is used quite widely in top cancer centers, but has not been embraced by all cancer doctors.

"It's a little controversial. Certain opinion leaders feel it's not totally established yet," said Dr. Larry Norton, chief of medical oncology at Memorial Sloan-Kettering Cancer Center in New York. Although he follows Veronesi's approach with his own patients, Norton said more research is still needed before the technique becomes universally accepted.

Dr. Harry Bartelink, head of radiotherapy at the Netherlands Cancer Institute, also took a cautious view. "Breast cancer is a slow recurrent disease, so I would really like to see 10 years of follow-up to say it's safe," he said. "Also, it's complicated, people have to be trained well. It would be better to remove all the nodes than the wrong one."

The status of the lymph glands is considered one of the most important indicators of prognosis and which treatment is best. "But we are convinced that if you remove healthy lymph nodes, first of all it's an unnecessary operation which has side effects and perhaps as these lymph nodes are immunologically active cells, it might even be dangerous," Veronesi said.

There are between 25 and 40 lymph nodes under each armpit and the location of the sentinel node - the first node to be invaded by cancer - varies from woman to woman.
To find the right node, a radioactive probe is injected into the breast, close to the tumor, and is carried by the lymphatic system into the sentinel node. The glow of the tracer guides surgeons to the correct node. Doctors then remove the tagged node and tests establish whether cancer is present, and therefore whether removal of the rest of the lymph nodes and further treatment are necessary.

Veronesi said his institute now offers the technique to all its breast cancer patients. So far 2,500 women have undergone the procedure since it was first performed six years ago.

In his new study, 516 breast cancer patients got either a lumpectomy and total lymph node removal, or the tumor cut out of their breast and only the sentinel node extracted. There were 257 women in each group. In cases where the sentinel node showed cancer, the rest of the nodes in the armpit were cut out.

The cancer had spread to the lymph nodes in 35 percent of the women who had all their lymph nodes removed, and in the same proportion of those who had only the sentinel node cut out. In the four years since the surgery, the lymph nodes of all the 167 women whose sentinel nodes were clear have remained cancer free.

As well as minimizing the lymph node surgery, Veronesi is also researching whether the trauma of radiotherapy after surgery can be avoided by delivering a single radiation dose during surgery directly into the area where the tumor has just been removed. About 90 percent of breast cancer recurrences happen at the site of the original tumor, he said. The single dose is equivalent to that of a full course of standard external radiation therapy to the whole breast.

"I think that's an extremely exciting approach that needs to be evaluated," Norton said. "Veronesi has always been ahead of the rest of the world in terms of innovative ideas and if this turns out to be true, it would make a huge difference to patients' quality of life."

Veronesi envisions one day treating breast cancer definitively in a single operation. "In one hour, or two hours, the patient will have removal of the tumor, the sentinel node biopsy ... and a single full-dose of radiation to the breast," he told doctors. "I think it might be considered a breakthrough. If these two new procedures prove effective then we can present breast cancer to women with a more optimistic view."

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Night shift linked to breast cancer-(Times of India Online-17/10/2001)

Women who work nights may increase their breast cancer risk by up to 60 percent, according to two studies that suggest bright light in the dark hours decreases melatonin secretion and increases estrogen levels. Two independent studies, using different methods, found increased risk of breast cancer among women who worked night shifts for many years. The studies, both appearing in the Journal of the National Cancer Institute, suggested a ``dose effect,'' meaning that the more time spent working nights, the greater the risk of breast cancer.

``We are just beginning to see evidence emerge on the health effects of shift work,'' said Scott Davis, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle and first author of one of the studies. He said more research was needed, however, before a compelling case could be made to change night work schedules.

``The numbers in our study are small, but they are statistically significant,'' said Francine Laden, a researcher at Brigham and Women's Hospital in Boston and co-author of the second study.

``These studies are fascinating and provocative,'' said Larry Norton of the Memorial Sloan-Kettering Cancer Center in New York. ``Both studies have to be respected.''
But Norton said the findings only hint at an effect and raise ``questions that must be addressed with more research.''

In Davis' study, researchers explored the work history of 763 women with breast cancer and 741 women without the disease. They found that women who regularly worked night shifts for three years or less were about 40 percent more likely to have breast cancer than women who did not work such shifts. Women who worked at night for more than three years were 60 percent more likely.

The Brigham and Women's study, by Laden and her colleagues, found only a ``moderately increased risk of breast cancer after extended periods of working rotating night shifts.'' The study was based on the medical and work histories of more than 78,000 nurses from 1988 through May 1998. It found that nurses who worked rotating night shifts at least three times a month for one to 29 years were about 8 percent more likely to develop breast cancer. For those who worked the shifts for more than 30 years, the relative risk of breast cancer went up by 36 percent.

The studies relate to working hours between 7 pm and 9 am on shifts that include the peak melatonin secretion time of about 1:30 am, the researchers said.

American women have a 12.5 per cent lifetime risk of developing breast cancer, according to the American Cancer Society. Laden said her study means that the lifetime risk of breast cancer for longtime shift workers could rise above 16 percent. There are about 175,000 new cases of breast cancer diagnosed annually in the United States and about 43,700 deaths. Breast cancer is the second only to lung cancer in causing cancer deaths among women.

Both of the Journal studies suggested that the increased breast cancer risk among shift workers is caused by changes in the body's natural melatonin cycle because of exposure to bright lights during the dark hours. Melatonin is produced by the pineal gland during the night. Studies have shown that bright light reduces the secretion of melatonin. In women, this may lead to an increase in estrogen production; increased estrogen levels have been linked to breast cancer.

``If you exposed someone to bright light at night, the normal rise in melatonin will diminish or disappear altogether,'' said Davis. ``There is evidence that this can increase the production of reproductive hormones, including estrogen.'' Davis said changes in melatonin levels in men doing nighttime shift work may increase the risk of some types of male cancer, such as prostate cancer, but he knows of no study that has addressed this specifically. Both Laden and Davis said the melatonin-estrogen-breast cancer connection is still a theory that will require more research to prove or disprove.

Dr. S. Eva Singletary, a breast cancer specialist at M.D. Anderson Cancer Center in Houston, said the two studies show ``a small relative increase in breast cancer risk, but nothing to become alarmed about.'' More study is needed to precisely define the risk of shift work and how that compares to other known breast cancer risk factors, such as family history, smoking and obesity, said Singletary. But she said the finding does suggest the need for women who work night shifts to be particularly prudent in getting regular mammograms and medical exams.

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Working Women more Prone to Breast Cancer-(Indian Express-09/10/2001)

On the occasion of International Breast Cancer Day doctors in the city say they have observed that contrary to the trend in the rest of the country, the incidence of breast cancer is higher than that of cervical cancer which is higher elsewhere in India. In Mumbai 27 out of every lakh women have breast cancer and the rate has been rising roughly 1% every year.

While incidence of cervical cancer has decreased due to better personal hygiene, the more emancipated lifestyle of women could be one of the reasons for increase in breast cancer incidence. With an increase in the numbers of working women, doctors have observed an increase in occurrence since a working lifestyle results in late marriage and late childbirth. Studies show that women who have children before the age of 18 have three times fewer chances of suffering from breast cancer than those who have children after the age of 30.

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Activity could lower cancer risk –(Times of India Online-03/10/2001)

Women who are active on the job or doing housework have a lower risk of breast cancer, researchers say. The busiest women had 31 percent less risk than those who did the least, their study found. But although the women did have to stay active, they didn't have to work hard, said Christine M. Friedenreich, a research scientist at the Alberta Cancer Board in Calgary. "Moderate activity was related to the greatest risk reduction," she said.

Friedenreich and her colleagues looked at data on breast cancer cases in the province of Alberta from 1995 to 1997. In Canada's health care system, all cancer cases have to be reported to government agencies. Their study looked at 1,233 women with breast cancer and 1,237 women who were healthy and who served as a comparison group. The researchers found the healthy study participants by doing telephone solicitations. Study results were reported in the September issue of the American College of Sports Medicine journal, Medicine and Science in Sports and Exercise.

The researchers asked the women to recall their physical activity over their lifetimes. To freshen the subjects' memories, the researchers also asked them to recall events from those times — among them, school experiences and major life events such as weddings.

Women who put in more than about 43 hours a week of physical activity throughout their lives had a 31 percent lower risk of breast cancer than did women who put in about 29 hours or less, the study found. The study found women benefited from activity in housework or on the job, but that work carried a slightly greater benefit. There was no significant benefit from exercise, but Friedenreich said there were too few exercisers among the women in her study to ascribe much meaning to that. Women who don't get much activity cleaning house or at work probably would get as much benefit from an equivalent amount of energy-using exercise, Friedenreich said. ``The take-home message is that it's important to be physically active in all aspects of your life,'' Friedenreich said. A brisk walk of 30 to 40 minutes on most days of the week is ``probably the level that people should be trying to achieve,'' she said.

When intensity of the activity was considered separately, women who were moderately active had a 41 percent lower risk of breast cancer. The study defined moderate activity as increasing the heart rate slightly and possibly creating some light perspiration.

Earlier research also has found signs that activity reduces the risk of breast cancer, but this is the first to show a benefit can be gained from housework, said Louise Brinton, chief of the environmental epidemiology branch at the U.S. National Cancer Institute.

Exercise might have caused an improvement directly or by reducing the impact of some other risk factor, such as overweight, Friedenreich said. However, while the study found that women who did more had a lower risk of breast cancer, it does not prove that their activity caused the reduction. The possibility remains that some other, unknown factor was at work in the lives of the more active women.

"It's too early to make a firm conclusion," said Brinton, who was not affiliated with the Canadian project. "We are hopeful that the studies will emerge that this is a protective factor because we have so few modifiable factors for breast cancer." Exercise may also affect hormones that can raise the risk of breast cancer, Brinton said. Obesity and alcohol use are among modifiable factors. But genetics plays a strong role, and much of the cause of breast cancer simply is not known.

Friedenreich's paper has several weaknesses, said Leslie Bernstein, a researcher at the University of Southern California. For instance, the project did not properly account for the effect of exercise, she said. Bernstein's research found a dramatic drop in breast cancer risk among women who exercised. But the idea that activity can reduce the risk of breast cancer sits well with Bernstein. Reducing risk factors can't prevent the disease, but studies have indicated the odds can be cut, she said. "I'm a firm believer that physical activity is one means of reducing breast cancer risk," Bernstein said.

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