BREAST CANCER

M. D. Anderson nurse addresses lymphedema in breast cancer patients and survivors (Yahoo News-17/04/2008)

Nurse-administered prevention and management strategies can decrease incidence of lymphedema and improve quality of life in patients
PHILADELPHIA - A poster session presented today by The University of Texas M. D. Anderson Cancer Center at the Oncology Nurses Society 33rd Annual Congress, found that early nursing intervention and implementation of effective strategies can lead to a decrease in the incidence of lymphedema, better management of chronic lymphedema and improved quality of life in breast cancer patients. The literature review, led by Mattie J. Sennett McDowell, RN, BSN, a research nurse in the Department of Breast Medical Oncology at M. D. Anderson, examined 20 years of data about the prevention, management and care of upper extremity lymphedema (ULE), or lymphedema that occurs in the arms, in breast cancer patients. The goal of the review was to identify a comprehensive list of current evidenced-based strategies that nurses and hospitals can use in caring for their patients. "Women are living longer as breast cancer treatments get better, but at the same time, they face more devastating side effects like lymphedema," McDowell said. "So many women present with the symptoms, yet it is understudied and not well understood. More can to be done to proactively recognize and address lymphedema in breast cancer patients." 

ULE is an often a distressing and debilitating side effect of breast cancer treatment in which protein-rich fluid in the tissue of the arms accumulates and obstructs the lymph vessels. According to the National Lymphedema Network, approximately 15 to 20 percent of all breast cancer patients are affected by ULE. Its development can be triggered by breast cancer diagnostic procedures, radiation, surgery or environmental factors. It also can can occur immediately after treatment or many years down the road. ULE, which can make simple tasks such as picking up children, getting dressed or exercising painful, has a detrimental impact on the patient's quality of life. According to the literature, effective strategies to address lymphedema included early identification of at-risk patients through enhanced assessment techniques, monitoring, standardizing at-risk assessment tools and increased awareness of lymphedema through educational efforts of the health care team. The studies noted that increased awareness through educational forums, patient-nurse learning modules, and increasing the number of research studies focusing on ULE are vital in addressing this problem. McDowell, who is dedicated to the study, prevention and management of ULE after a breast cancer patient died from significant disease progression, complicated by advanced, unmanageable lymphedema, said, "This research is centered on what is important to the patient and their quality of life after treatment. Nurses are on the frontline and may hold the key in proactively preventing lymphedema in many patients by educating them about triggers and symptoms, continual and specific lymphedema assessments during each visit and pursuing research in this area." 

At M. D. Anderson, nurses and patient care teams have implemented several strategies to educate breast cancer patients about lymphedema and treat it aggressively. One such strategy is having a nurse and physician present information via discussion and prepared handouts before women undergo surgery. Additionally, all women are assessed for lymphedema during treatment and at follow-up visits. M. D. Anderson's multidisciplinary care team also offers comprehensive support and collaboration from prevention of the sequelae to advanced physical therapy for those with lymphedema. McDowell plans to develop further research studies examining the evidenced-based practices for ULE identified in this study, with the end-goal of developing a standard set of recommendations. More information on the causes and symptoms of lymphedema, risk reduction strategies and recommended treatment are provided online at M. D. Anderson's Rehabilitation Services Lymphedema homepage or by logging onto the National Lymphedema Network Web site.

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Circulating Tumor Cells Are A Reliable Predictor Of Treatment Response In Metastatic Breast Cancer (Yahoo News-18/04/2008)

With the goal of tailoring cancer treatment for each individual, researchers at Georgetown University Medical Center have presented a study suggesting a simple blood test can help doctors more reliably assess treatment efficacy for patients with metastatic breast cancer. "It can take several weeks and sometimes months to determine if a particular cancer treatment is working because it can take that long to observe any significant radiographic changes in tumor size or appearance," says Minetta Liu, M.D., of Georgetown's Lombardi Comprehensive Cancer Center. "Right now, we have to rely on radiology studies such as CT scans, ultrasound, and the like to determine whether or not there is disease progression. With this new blood test, we have another reliable tool that may allow us to determine much sooner if a therapy is ineffective so that we can change therapy earlier and potentially make more significant improvements in survival." Using the FDA-approved CellSearch™ technology, researchers measured the number of circulating tumor cells (CTC) in blood collected from women with metastatic breast cancer. About one tablespoon of blood was collected every three to four weeks. The number of CTCs was correlated with disease response or progression as determined by standard radiology studies performed every 9-12 weeks. The women in the study received various treatments including chemotherapy, endocrine therapy, and combination therapy with a biologic agent. 

A CTC count of five was used as the threshold, based on previous studies. There was a highly significant difference in the distribution of progression between two groups of patients defined by their CTC result. Seventy-one percent of patients who had a CTC greater than or equal to five had disease progression, and 66 percent of patients with a CTC count of less than five did not. "A CTC count of five or greater at the time of restaging was associated with a 5.32 fold increase in a patient's chance of having disease progression compared to CTC counts of less than five," explains Liu. "CTC assessments should be used as a surrogate marker for treatment efficacy and disease responsiveness. Changes in CTC results from less than five to greater than or equal to five over time may herald disease progression." Liu adds that the CTC assay is a more reliable means of assessing treatment response than the traditional tumor markers currently in use. "We have a follow-up study underway that evaluates CTC results within the framework of a randomized clinical trial to eliminate potential variability from the treatment administered, "says Liu, the national principal investigator of the new trial. Liu and her colleagues believe a study with the same therapies would offer even stronger evidence for routine use of CTC in patients with metastatic breast cancer. "We have many treatment options for advanced breast cancer. The key is to find the most effective therapy for each patient. It shouldn't take months to figure that out," she concludes. 

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Exercise may protect girls from future breast cancer (Yahoo News-13/05/2008) 

Get your daughters off the couch: New research shows exercise during the teen years — starting as young as age 12 — can help protect girls from breast cancer when they're grown. Middle-aged women have long been advised to get active to lower their risk of breast cancer after menopause. 
What's new: That starting so young pays off, too. "This really points to the benefit of sustained physical activity from adolescence through the adult years, to get the maximum benefit," said Dr. Graham Colditz of Washington University School of Medicine in St. Louis, the study's lead author. Researchers tracked nearly 65,000 nurses ages 24 to 42 who enrolled in a major health study. They answered detailed questionnaires about their physical activity dating back to age 12. Within six years of enrolling, 550 were diagnosed with breast cancer before menopause. A quarter of all breast cancer is diagnosed at these younger ages, when it's typically more aggressive. Women who were physically active as teens and young adults were 23 percent less likely to develop premenopausal breast cancer than women who grew up sedentary, researchers report Wednesday in the Journal of the National Cancer Institute. The biggest impact was regular exercise from ages 12 to 22.

"This is not the extreme athlete," Colditz cautioned. The women at lowest risk reported doing 3 hours and 15 minutes of running or other vigorous activity a week — or, for the less athletic, 13 hours a week of walking. Typically, the teens reported more strenuous exercise while during adulthood, walking was most common. Why would it help? A big point of exercise in middle age and beyond is to keep off the pounds. After menopause, fat tissue is a chief source of estrogen. In youth, however, the theory is that physical activity itself lowers estrogen levels. Studies of teen athletes show that very intense exercise can delay onset of menstrual cycles and cause irregular periods. The moderate exercise reported in this study was nowhere near enough for those big changes. But it probably was enough to cause slight yet still helpful hormone changes, said Dr. Alpa Patel, a cancer prevention specialist at the American Cancer Society, who praised the new research. And while the study examined only premenopausal breast cancer, "it's certainly likely and possible" that the protection from youthful exercise will last long enough to affect more common postmenopausal breast cancer, too, Colditz added. If you were a bookworm as a teen, it's not too late, Patel said. Other research on the middle-age benefits of exercise shows mom should join her daughters for that bike ride or game of tennis or at least a daily walk around the block. Many breast cancer risks a woman can't change: How early she starts menstruating, how late menopause hits, family history of the disease.

Even though the exercise benefit is modest, physical activity and body weight are risk factors that women can control, Patel stressed. "I'd say you and your daughter are getting off the couch," she said. "Women who engage in physical activity not only during adolescence but during adulthood lower their risk."

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Surgeon offers answers on metastatic breast cancer (Yahoo News-22/03/2007)

In light of Elizabeth Edwards' recurrent breast cancer, CNN Medical News producer Shahreen Abedin spoke with Dr. Rache Simmons, breast surgeon at the New York-Presbyterian Weill-Cornell Medical Center's Breast Cancer Center. Dr. Simmons has never treated Elizabeth Edwards, so the answers she gives are mainly about metastatic breast cancer in general, unless otherwise specified.

CNN: What are survival rates for Stage IV metastatic breast cancer? 
Dr. Rache Simmons: It depends on where the cancer is located. Patients can do very well for years if it's isolated just to the bone. If there is a speck on the lungs or other organ that turns out to be cancer, that could mean a much worse prognosis, a much shorter life expectancy. The bone is often the first place to spread to with breast cancer. Most breast cancer systemic recurrences (meaning the kinds that spread to the rest of the body) happen in the next two years after the first time the cancer is diagnosed. The next plateau is within five years. After that, it's very rare to have recurrences. However, recurrences do still happen, even as late as 10 years later. But that's very unusual. For patients with small cancers and negative lymph nodes with no evidence of disease spread at the time of diagnosis, still about five to 10 percent of women end up developing metastatic disease. If the recurrence happens later in the five-year period after diagnosis, rather than earlier, that's a good sign; the patient will probably have a better response to the treatments. If the recurrence happens very soon after diagnosis, like six months, a year, or 18 months, then patients tend to do worse.

CNN: What would the standard treatment be once recurrence is diagnosed? Simmons: Probably hormonal therapy. Mainly anti-estrogen types of treatments -- like Tamoxifen or aromatase inhibitors. Sometimes chemo is an option, either in addition to or instead of hormone therapy. Sometimes radiation therapy to localized area, especially if the patient is in pain. To find it accidentally, when the person is having no pain, is a very lucky thing. Usually what happens is a patient develops a pain and then gets X-rays -- and then they find it.

CNN: What does it mean when it's "low-volume" amounts of cancer in the bone? 
Simmons: It means the patient probably will respond to treatment better. If it's found at the stage where it's spread throughout the body, it's less optimistic.

CNN: How does this affect quality of life? 
Simmons: Usually people respond to medications with bone cancer. They can have a very decent quality of life for years.

CNN: Why is surgery usually not an option in metastatic breast cancer? 
Simmons: There wouldn't be any benefit in going in and taking out that area. Many cells with cancer are probably located throughout her system. If you remove cells from one area, chances are, another cell will grow elsewhere. It's much more effective to treat systemically. Plus, it's hard to go in and remove cells from the bone.

CNN: Why is metastatic breast cancer considered incurable? 
Simmons: With patients with Stage IV disease, they will always have breast cancer. But you could live 10 years with it. And if the treatment medications improve, the outcomes may be even better.

CNN: What is the likelihood of the metastatic cancer spreading to the lungs or other organs? 
Simmons: Typically it spreads to bone, lungs, liver, and brain. If it's contained within the bone -- which is the case with the majority of patients -- they can do very well. When it goes to other organs, patients usually don't do as well for long, generally speaking. But the likelihood of spreading is very individualized, so we can't say what the likelihood of it spreading for Elizabeth Edwards would be.

CNN: What other tests are usually done to decide which treatment to try? 
Simmons: Doctors will probably want test to see whether the cancer cells in the bone are estrogen-receptor positive, to see whether anti-estrogen medications would work much better. And they will probably test for other tumor markers to let them know what medications would be beneficial.

CNN: Elizabeth Edwards had a pain in her left side -- a fracture -- could that have something to do with the cancer? 
Simmons: The two could be totally unrelated. Or it could be that there's a cancer that they can't yet see there.

CNN: What is the likelihood that some of the medications she takes will make her tired? 
Simmons: It depends on what meds. If a patient takes mainly hormonal drugs -- patients usually feel good with those drugs. If they are taking chemo drugs -- that depends on how it's tolerated.

CNN: Does late-life pregnancy increase risk of this type of cancer?
Simmons: No.

CNN: How much can Elizabeth Edwards be expected to campaign while receiving treatment? 
Simmons: For patients who become metastatic, the prognosis depends on where it presents. Eventually, most likely, they will die from the breast cancer. So it's a matter of how long they live, and how good is their quality of life.

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Breast Cancer Tends to Grow Faster in Younger Women By Steven Reinberg (HealthDay News-8/05/2008)

While the rate at which breast cancer tumors grow varies among patients, that growth tends to be faster among younger women, Norwegian researchers report. These findings may help in planning and evaluating screening programs, clinical trials and other studies, the researchers say. Using a new mathematical model, the scientists were also able to estimate the numbers of breast cancers detectable by mammography. This is a new approach to estimating the growth rate of tumors and the ability of mammograms to find them. "There are enormous implications for the sensitivity of breast cancer screening programs," lead researcher Harald Weedon-Fekjr, of the Department of Etiological Research, Cancer Registry of Norway, said in a statement. "We found that mammography screen test sensitivity increases sharply with increased tumor size, as one might expect. Detection rates are just 26 percent for a 5 millimeter tumor but increase to 91 percent once a tumor is 10 millimeter in size," he added. The report was published in the May 8 issue of the online journal Breast Cancer Research.

In the study, Weedon-Fekjr, and colleagues tested their model using mammography results from 395,188 women aged 50 to 69. The researchers found that the growth rate of tumors varied significantly between patients. About one in 20 tumors doubled in size, from 10 to 20 millimeters in just over a month. However, a similar number of tumors took more than six years to double in size. Based on this finding, Weedon-Fekjr's team estimated that it takes an average of 1.7 years for tumors to double in size. Moreover, tumor growth appeared to be faster among younger women and slowed as women aged, the researchers noted. "Tumor growth and test sensitivity estimates can be directly linked to tumor size in a full population study, resulting in very useful growth estimates directly connected to a biologically relevant measure," the researchers wrote. "Tumor growth seems to vary greatly between tumors, with higher growth rates among younger women. Most tumors become visible at screening when they reach a diameter of 5 millimeters to 10 millimeters," they concluded. One expert thinks this study again confirms the need for women to have a mammogram every year. "This study continues to prove why we need to screen women every year, starting at age 40," said Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society. This is another study that shows that tumors grow faster in younger women, Saslow said. "It just doesn't make sense to have guidelines that say younger women should be screened every one to two years and every year as they get older," she said.

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Previously unseen switch regulates breast cancer response to estrogen (Yahoo News-8/05/2008)

A tiny modification called methylation on estrogen receptors prolongs the life of these growth-driving molecules in breast cancer cells, according to research by scientists at Emory University's Winship Cancer Institute. The results are published in the May 9, 2008 issue of the journal Molecular Cell. Most breast cancers contain estrogen receptors, which enable them to grow in the presence of the hormone estrogen. Their presence can determine whether tumors will respond to the estrogen-blocking drug tamoxifen. The finding will help researchers sort out how mutations change the estrogen receptor's function and allow some breast cancers to resist tamoxifen, says Paula Vertino, PhD, associate professor of radiation oncology at Emory University School of Medicine. "The problem is that a significant fraction of estrogen receptor positive tumors don't respond to tamoxifen," Vertino says. "Development of new drugs that interfere with the methylation of the estrogen receptor may be an alternative way to treat those tumors." Until recently, scientists thought methylation enzymes acted only on DNA molecules or on histones, proteins that bundle DNA into spool-like packages. Methylation enzymes add tags called methyl groups to other molecules, influencing their ability to turn genes on or off.

Vertino and her colleagues found that one of the modification enzymes, called SET7, methylates a flexible part of the estrogen receptor. When they created breast cancer cells with reduced levels of SET7, the estrogen receptor molecules lasted only half as long and were less effective in turning on genes. Vertino's team showed that a mutation in the estrogen receptor found in more aggressive breast tumors interferes with methylation in cells. Also, the methylation appears in exactly the same spot where another protein called BRCA1 adds a different kind of regulatory marking, and may block BRCA1's restrictive effects on the estrogen receptor. Women who inherit a mutation in the gene that encodes BRCA1 have up to an 80 percent lifetime risk of developing breast cancer, several times the risk of those who don't have it, according to the National Cancer Institute. BRCA1 mutations are estimated to account for about a third of all inherited breast cancers and roughly 2-3 percent of all breast cancers. Scientists are beginning to look for drugs that could modulate methylation enzymes. Vertino says that methylation probably affects several other proteins similar to the estrogen receptor. "I expect this will be just the tip of the iceberg," she says. "Methylation may be just as common as other protein modifications, and even more complicated."

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Fewer Breast Cancer Patients Get Chemo Genetic Test Spares Thousands of Women From Misery and Cost of Chemotherapy (Yahoo NEws-02/05/2008)

Women with breast cancer are increasingly being spared the misery and cost of chemotherapy, thanks to a test that characterizes each tumor by its genetic thumbprint. Two new studies show that the test, known as Oncotype DX, significantly cut the number of women who got chemo. "It works and it works great. It has really changed the way we manage a substantial proportion of our breast cancer patients," says Susan K. Boolbol, MD, chief of breast surgery at Beth Israel Medical Center in New York City. Boolbol tells WebMD that after the diagnosis itself, "getting chemotherapy and losing their hair is the biggest concern" of women with breast cancer. The findings were presented at the American Society of Breast Surgeons (ASBS) Ninth Annual Meeting.

Moving Away From One-Size Fits All
The test is used to help guide the treatment of estrogen-fueled breast cancers that have not spread to the lymph nodes. Nearly half of the 182,000 invasive breast tumors that will be diagnosed in the U.S. this year fall into that category. In the past, about 90% of women with so-called estrogen-dependent, lymph-node negative breast cancer were given chemotherapy to reduce the odds of the cancer returning, says Nashville Breast Center's Pat Whitworth, MD, chairman of the board at the ASBS. "We couldn't identify who would benefit from treatment, so we had to treat everyone," he tells WebMD. Enter OncoType DX, which measures the activity of 21 genes that can raise breast cancer risk. Based on their activity, women are assigned a recurrence score: low, medium, or high risk of recurrence. Studies have shown that women who fall into the low-risk category gain little, if any, benefit from chemotherapy. Based on those studies, recently updated guidelines recommend that the test be incorporated into the care of some women with breast cancer. "It's really helping to individualize therapy," Whitworth says.

Studies Show Test Spares Women From Chemo
One study presented at the meeting involved 18 premenopausal and 60 postmenopausal women with estrogen-dependent, node-negative breast cancer. "Prior to Oncotype DX, 39 of the 78 women, or 50%, would have been given chemotherapy," says Leila C. Thanasoulis, MD, a fellow in surgical oncology at Bryn Mawr Hospital in Pennsylvania. With Oncotype DX, chemotherapy was recommended for only nine of the 78, or 12% of the women. The cost savings: nearly $7,000 per woman, Thanasoulis tells WebMD. The second study involved 66 women with estrogen-fueled tumors that hadn't spread to the lymph nodes. "The recurrence score influenced our treatment decision in 44% of them," says Juhi Asad, MD, a fellow in the department of surgery at St. Luke's-Roosevelt Hospital in New York City.

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Second breast cancer may be greater than thought for high-risk women without BRCA mutations (Yahoo News-4/05/2008)

Finding also raises questions about the use of sentinel node biopsy with prophylactic mastectomies in high-risk .A preliminary analysis of ongoing research suggests that high-risk women with breast cancer who do not have a BRCA1/2 mutation may face a greater chance for developing a second breast cancer than previously thought. With the increased risk of cancer in these women, should sentinel node biopsy be considered at the time of prophylactic mastectomy, and how can women best be counseled after these findings? The increased risk of developing breast cancer is already understood for women with the disease who test positive for a BRCA1 or 2 mutation. Many of these women choose to have their breast(s) surgically removed (prophylactic mastectomy) to reduce their risk of developing breast cancer or developing a second breast cancer The role of sentinel node biopsy remains controversial in this group. "We know more about counseling women regarding prophylactic mastectomy if they have a BRCA mutation," says Shawna C. Willey, MD, FACS, a member of the Breast Cancer Program at the Lombardi Comprehensive Cancer Center and director of the Betty Lou Ourisman Breast Health Center at Georgetown University Hospital. "In high-risk women who have cancer but don’t have a known mutation, we generally advise that the risk of developing a second cancer in the same or opposite breast is lower than it is for women who test positive for a mutation. This latest analysis has us re-thinking our approach."

Willey, the incoming president of the American Society of Breast Surgeons, is the lead author of the study presented today at the society’s annual meeting in New York City.  The study included women in a familial cancer registry at Lombardi who were enrolled between 1998 and 2007. The registry participants had a least a 10 percent probability of carrying a BRCA1/2 mutation based on personal or family history of cancer. The cohort for the study included 119 women. 74 women had a BRCA mutation (group 1) and 45 did not test positive for the mutation (group 2). The women in group 2 already had known malignancies and had preoperative genetic testing. All the women opted to have a mastectomy to remove their affected breast (group 2) or surgery to remove both breasts (both groups). They all had both breasts removed, but in Group 2 they all had a unilateral prophylactic mastectomy. "We examined the rate of occult malignancies in both these groups of women in the prophylactic mastectomy specimens," Willey explains. "What we found was interesting. There was a higher than expected presence of disease in the women who did not test positive for a BRCA mutation. "The higher rate of occult cancers in group 2 may be because they all had contralateral known malignancies, but this study supports the use of prophylactic mastectomy as an option for these women as it is for those who have a BRCA mutation," says Willey. 

Willey notes that additional studies should address the role of sentinel node biopsy for high-risk women who are receiving prophylactic mastectomy. "We need a better understanding of the incidence of cancer in these women to help determine the need for sentinel lymph node biopsy at the time of mastectomy, even in patients in which mastectomy is entirely prophylactic," says Willey. "There are risks and serious side effects involved with sentinel node biopsy. We will need to find a balance between offering appropriate care and over-treating these women. "The trend in this study highlights the importance of counseling all high-risk women about their risk of developing another cancer when considering surgical options including sentinel node biopsy."

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Breast Cancer: Magnetic Resonance Imaging Improves Breast Cancer Diagnosis (Yahoo News-01/04/2007)

Women who have been diagnosed with breast cancer in one breast have a higher risk of contracting the disease in their opposite breast as well. A thorough examination of the opposite breast using mammography and ultrasound is therefore common practice. However, many tumours still remain undetected when using mammography. Magnetic resonance imaging (MRI) promises better results, as is shown in an inter-national study involving the University of Bonn. In almost 1,000 women with a recent diagnosis of breast cancer in one breast, MRI helped identify 30 cancers in the seemingly normal opposite breast . In women with a normal (negative) MRI of the opposite breast, there was a 99.6% confidence that in fact no breast cancer was present which means that if the MRI study is normal, preventive mastectomy of the opposite breast, which some women want, is definitely unnecessary . These findings have now been published in the prestigious journal "New England Journal of Medicine."

About two dozen sites in North America participated in the study, as well as one sole site outside the USA, the University of Bonn. Bonn was selected as a team member due to its internationally leading position in breast cancer diagnostics. A total of 968 patients were examined, almost 200 of them at the University of Bonn alone. 'Therefore, proportionally, most patients came from our Department, which means that the data from Bonn had a substantial impact on the results of the entire study,' explains Professor Christiane Kuhl from the Department of Radiology of the University of Bonn. All the women had previously been diagnosed with tumours in one breast. A mammography as well as a clinical examination of the opposite breast had remained normal and without evidence of breast cancer . The patients then underwent breast MRI .Using MRI, the doctors found tumours in the other breast in as many as 30 women, yielding a contralateral cancer yield of over 3% - which is a high rate given the fact that regular breast cancer screening yields a detection rate of around 1 per million.. 'It is already well established that an MRI is essential before breast cancer surgery in order to delineate the extent of the disease and provide a road map for the surgeon. Now we know that it is also important for discovering further tumours in the opposite breast which was presumed to be healthy,' Professor Kuhl says.

What is particularly reassuring for women with a recent diagnosis of breast cancer is that if the doctors did not discover a tumour on MRI, there was a 99.6% certainty that the breast indeed was free of cancer. 'A prophylactic mastectomy of the opposite breast, which some patients want, is definitely unnecessary if an MRI shows no evidence of cancer,' she emphasises. Although the MRT is comparatively expensive, 'it is definitely the most reliable method that is currently available for diagnosing breast cancer. Breast MRI should be considered the standard of care for screening women who carry an increased risk of breast cancer be it due to a strong family history, or, as our results show, due to a recent diagnosis of supposedly unilateral breast cancer,' she says. 'And women themselves should be aware of this.'

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By using radio waves and magnetic fields to produce richly detailed images of soft tissue, magnetic resonance imaging can uncover breast abnormalities that cannot be seen with an ordinary mammogram. (Yahoo News-3/04/2007)

A mammography image from the more-sensitive M.R.I. scan, which sometimes detects anomalies that turn out to be false positives. 
So after reviewing data published in the last few years on the effectiveness of this technology as a screening tool, the American Cancer Society last week issued new guidelines recommending an annual M.R.I. scan starting at age 30 for women at high risk for breast cancer. “We have got to change the way we look at these patients and to start treating them differently,” said Dr. D. David Dershaw, director of breast imaging at Memorial Sloan-Kettering Cancer Center. But for many women, the new standards raise difficult questions. For one thing, they apply mainly to the estimated 1.4 million women at high risk of developing breast cancer. Many women have no idea which risk category they belong to, researchers note. Several studies have found that women tend to overestimate their chances of breast cancer, and the risk models used by clinicians can produce widely varying results. And it is far from certain that there are enough qualified facilities to handle an influx of high-risk women who may now seek regular M.R.I. screenings. 

“From an individual woman’s point of view, I think these guidelines are useless,” said Barbara Brenner, executive director of Breast Cancer Action, an advocacy group in San Francisco. “We don’t have a medical system that can do this. It’s just not the real world.” Because M.R.I.’s are more sensitive than mammograms or ultrasound, they are more likely to reveal suspicious anomalies that turn out to be benign. Every false positive generates expense, anxiety and treatment that may not be necessary.  “M.R.I. scans send up a lot of red flags,” said Dr. Carl D’Orsi, co-chairman of the American College of Radiology’s breast imaging commission. “Unless there’s a dramatic change in technology or in the cost of the exam, it won’t be appropriate for screening the general public.” Along with the troublesome false positives, the scans do pinpoint cancer missed by other methods. After Adrienne Evans of Terlingua, Tex., learned from a biopsy that a lump in her left breast was cancer, she had a mammogram and an ultrasound scan. They revealed no other tumors, so Ms. Evans and her doctor agreed that the best treatment would be a simple procedure to remove the lump. Still, because her breast tissue was unusually dense, the doctor ordered an M.R.I. It revealed a second tumor buried deep in the same breast, a menace that had been invisible on the previous scans. 

She opted for an immediate mastectomy, followed by reconstructive breast surgery. “I think that M.R.I. saved my life,” said Ms. Evans, who is 50. “Without it, my cancer would have gone undetected, and it would have advanced.” By recommending M.R.I. screenings only for highest-risk women, the scientists writing the new guidelines hope to raise the odds that what is discovered is actually cancer. Women at high risk include those with mutations of the cancer susceptibility genes BRCA1 and BRCA2, first-degree relatives who have not yet been tested, and those who have undergone radiation therapy to the chest for treatment of conditions like Hodgkin’s disease. By most estimates, women with strong family histories of breast and ovarian cancer also are at high risk, even if they are not known to have a particular gene mutation. For example, a 35-year-old woman whose father’s sister contracted breast cancer at 29 and whose grandmother contracted it at 35 has an estimated lifetime risk of 31 percent, according to one risk model. She would qualify for regular M.R.I. screenings under the new guidelines.

Not all women at increased risk are being advised to get M.R.I. scans. The new guidelines take an equivocal approach to the evaluation of women at only moderate risk of developing breast cancer — including, surprisingly, those who have survived it. The risk of a second diagnosis is just 10 percent over their lifetimes, not enough to justify regular magnetic resonance screenings. And though women found to have such precancerous conditions as lobular carcinoma in situ or atypical ductal hyperplasia are also more likely to develop breast cancer, the increased risk is not sufficient to recommend regular M.R.I. screenings, according to the cancer society. Women who have been told repeatedly that early detection is crucial to surviving breast cancer may find this advice confounding. But it stems partly from the limitations of the current health-care system. “M.R.I. generates a high number of biopsies for every cancer that you find,” Dr. Dershaw said. “If we did screening with M.R.I. for everyone, we would raise the price of screening 10 times over.” Since that cost may not be reimbursed by insurers or government programs, indiscriminate use of M.R.I. could create a disincentive for screening, compared with less expensive mammography. In addition, the quality of scans can vary significantly from clinic to clinic, according to some researchers. 

The best facilities have dedicated breast coils, which are required for the most accurate screening, and they are able to perform the guided biopsies necessary for diagnosis. Experienced facilities are uncommon outside metropolitan areas, noted Dr. D’Orsi of the radiology society, so putting the new screening guidelines into effect for high-risk women is likely to prove challenging. Simply reading an M.R.I. scan of the breast is a relatively new skill, as much an art as a science. “The real issue is what kind of M.R.I. patients will get and how it will be interpreted,” Dr. D’Orsi added. “Now it’s like a perfect storm coming together.”

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Aspirin Use May Protect Against Breast Cancer (Yahoo News-1/05/2008)

Might an aspirin a day keep breast cancer away? A new study finds that the same pill that doctors sometimes recommend to prevent heart attacks and strokes may also reduce the risk of developing the most common type of breast cancer, according to Reuters. Researchers found that those who took daily aspirin reduced their risk of developing estrogen-receptor positive breast cancer by 16 percent. The study was published in Breast Cancer Research. Previous research reached conflicting conclusions on whether taking aspirin, which carries a risk of side effects such as stomach bleeding, helps prevent breast cancer. Learn what prior studies have shown about painkillers' effect on the risk of developing breast cancer. And U.S. News's Deborah Kotz explains what you need to know about hormones and breast cancer, and she ticks off three ways to lower your risk of recurrence of the disease.

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More aggressive breast cancer in Hispanics independent of health care utilization (Yahoo News-9/04/2007)

A new study provides evidence that racial differences in the clinical presentation of breast cancer may be due more to biological factors rather than differences in access to healthcare alone. Published in the May 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, an analysis of breast cancer cases diagnosed in a managed health care system found that in patients with equal access to healthcare, Hispanic women were at significantly higher risk for being diagnosed with more advanced and more aggressive tumors and at a younger age than non-Hispanic women. Previous studies have shown that the incidence of breast cancer, the most common cancer in women, varies according to race and ethnicity. For example, breast cancer is more common among Caucasian women compared to other races. However, Hispanic women present with more advanced disease and with cancers that have a worse outcome compared to other races. A growing body of evidence suggests that biological or genetic factors may explain these racial differences. Few studies, however, have fully controlled for healthcare access between Hispanic and non-Hispanic women with breast cancer.

To study this question, investigators in Denver, from the University of Colorado Health Sciences Center and Kaiser Permanente Colorado, compared demographic and clinical characteristics of 139 Hispanic and 2118 non-Hispanic women diagnosed with breast cancer in an equal access healthcare system. The researchers found that even in the situation where utilization of healthcare services such as mammography and regular primary care physician visits was similar, Hispanic women presented with more aggressive disease and at younger ages than did non-Hispanic women. These differences persisted even with adjustments for socioeconomic status and the length of time enrolled in the system. Hispanic women on average were diagnosed at a significantly younger age than were non-Hispanic women (56 years old versus 61 years old). After accounting for differences in age, Hispanic women were almost three times more likely to have been diagnosed with stage IV disease; and about two times more likely to have larger tumors with cellular characteristics that predict poorer clinical outcomes. In this population of women with similar healthcare access and use, the authors conclude that “the persistent findings of earlier mean age at diagnosis, advanced state, poorer grade, larger tumor size and fewer cases with estrogen receptors may suggest that true biological differences exist in breast cancer by ethnicity”.

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Gene test 'targets cancer drug' (Yahoo News-9/04/2007)

Testing for a gene called ESR1 can show which women with breast cancer would benefit most from oestrogen-blocking drugs, Nature Genetics work suggests. 
Women with extra copies of the gene, which carries DNA code for an oestrogen receptor, had tumours that were more likely to respond to tamoxifen.  An estimated 31,000 post-menopausal women are diagnosed with breast cancer in the UK each year. In 80% to 85% of these cases, the disease is fuelled by oestrogen. Testing women for extra copies of ESR1 could also provide a way of identifying people with a higher risk of developing breast cancer.  In these women, anti-oestrogen drugs such as tamoxifen, can slow tumour growth and cut the risk of the cancer returning.  Doctors can already check whether breast tumours are "hormone sensitive".  Now experts from Switzerland and Germany say a test for one specific type of oestrogen receptor gene - ESR1 - could help doctors identify cancers that would be particularly likely to respond to anti-oestrogen therapy.  They analysed 2,000 breast cancer samples and found a fifth of the tumours had extra copies of ESR1 gene. 

Guiding therapy 
In a small follow-up study of 175 women with breast cancer who were being treated with tamoxifen, they found that women with extra copies of ESR1 survived longer than those who did not, even though the tumours in both groups of women had at least one copy of ESR1. Dr Emma Pennery of Breast Cancer Care said: "This research adds to our growing knowledge about the complexity of breast cancer, including the many variations of how breast cancer cells originate and what stimulates them to grow.  "We talk to patients on a daily basis who are encouraged by studies that add to this. "Our increasing understanding means treatments can be increasingly tailored to the individual, helping to ensure people with oestrogen-receptor positive breast cancer benefit from improved outcomes." Cancer Research UK's Dr Simak Ali, who is based in the department of oncology at Hammersmith Hospital, said: "If confirmed, this result should help us to identify people with breast cancer who are most likely to benefit from drugs like tamoxifen. "Testing women for extra copies of ESR1 could also provide a way of identifying people with a higher risk of developing breast cancer." 

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Genentech Tests Stronger Cancer Drug, May Boost Sales (Bloomberg News13/04/2007)

Genentech Inc., the world's second- largest biotechnology company, is testing a breast-cancer treatment that may add $1.5 billion in annual sales to its Herceptin drug business. The experimental therapy increased the effectiveness of Herceptin against drug-resistant cancer cells by linking the drug with chemical toxins, according to a study by the South San Francisco, California-based drugmaker. The treatment binds tumor- killing chemicals to Herceptin, causing fewer side effects by attacking cancer cells and mostly avoiding normal tissue. The research may give Genentech a way to sell its standard Herceptin for early forms of breast cancer, and then provide the more-potent therapy after the disease progresses. The strategy may increase market share and spur new treatment practices for a disease diagnosed in more than 78,000 U.S. women a year, analysts and doctors say. ``It's unlikely this will cure breast cancer, but it's got a good chance of being a really helpful weapon,'' said Ian Krop, an oncologist at Dana Farber Cancer Institute in Boston who is studying the combination. ``We're about as excited about this one as we can get this early in the game.''  Herceptin had $1.2 billion in sales in 2006, making it Genentech's third-biggest drug, behind cancer therapies Rituxan and Avastin. The drug also adds revenue for Basel, Switzerland- based drugmaker Roche AG, Genentech's largest shareholder. 

`Supercharged' 
``A supercharged Herceptin could one day allow Genentech to basically double-dip with breast cancer patients,'' said Geoffrey Porges, an analyst with Sanford Bernstein & Co. in New York, in an interview. He estimated a new, more-potent form of the drug would generate as much as 25 percent more in sales yearly than the original medicine. The more-potent version could also help Genentech fend off competition from GlaxoSmithKline Plc.'s Tykerb, analysts said. The U.S. Food and Drug Administration approved the rival drug, which also targets HER-2 proteins, last month. 

`Positive Data' 
Emerging data on the combination therapy has been positive, said Marc Tessier-Lavigne, head of drug discovery for Genentech.  In a study involving 18 patients, the souped-up Herceptin was linked to a toxin made by ImmunoGen. The combination produced ``sustained anti-tumor activity'' at low doses in multiple patients who stopped responding to Herceptin and other drugs, Tessier-Lavigne said. The drug has also showed minimal side effects, the company said.  ``If the empowered Herceptin works, it's going to attract a huge amount of interest in this technology,'' said Peter Senter, vice president of chemistry at Seattle Genetics Inc., a Bothell, Washington-based company that collaborates with Genentech on antibody-drug linking technology.  Senter said he will give a presentation on the new technology April 14 at the American Association for Cancer Research conference in Los Angeles. Breast tumors are the second most common cancer among women in the U.S. behind skin cancer, with 40,910 patients expected to die from the disease this year, according to the U.S. National Cancer Institute, based in Bethesda, Maryland. 

HER-2 Protein 
About one-fourth of breast cancer patients have tumors that carry excess amounts of HER-2 protein, the protein that Herceptin, an antibody drug, is designed to target, Genentech says. The drug works by blocking HER-2 positive cancer cells from dividing and growing. The new technology offers a different approach to earlier efforts that attached radiation to antibodies such as Herceptin, instead of toxic chemicals, Krop said. Those approaches struggled commercially because oncologists must collaborate with nuclear medicine specialists. Included in the old approach is Biogen Idec Inc.'s radiation-antibody combination Zevalin, which recorded $16.4 million in sales in its fourth year on the market. The company is now seeking to divest that drug, according to the Cambridge, Massachusetts-based company's annual report with the Securities and Exchange Commission. 

Past Combinations 
Past combinations have failed because the toxins either snapped off in the blood before reaching the tumors or hit healthy cells on the way, causing side effects. Seattle Genetics says it has developed new synthetic linkers designed to remain stable in the blood, yet let go of its toxic payload inside tumors. ImmunoGen has worked on the linking technology since it was founded in 1981. The company doesn't yet have a marketed drug, or one in the final stage of testing, according to its Web site. If the high-powered version of Genentech's Herceptin advances, it could energize the field, said Mitchel Sayare, ImmunoGen's chief executive officer, in a telephone interview. ``It represents many years of hard work in trying to execute what should be a straightforward thing,'' Sayare said. 

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Study Links Breast Cancer Risk To Epigenetic Changes Related To Race, Smoking And Birth Size (Yahoo News-16/04/2007)

Women can encounter environmental factors that increase their risk of breast cancer at various periods of their physical development, beginning before birth and extending until menopause. These non-inherited, or epigenetic, changes in DNA can correlate with risk factors for breast cancer, according to research being presented at the 2007 Annual Meeting of the American Association for Cancer Research. To study the effects of epigenetic changes in DNA, a team of researchers from Columbia University School of Public Health, led by Mary Beth B. Terry, Ph.D., collected information from former participants of the National Collaborative Perinatal Project born between 1959 and 1966. "We've been following a birth cohort of women who were all born at Columbia in the late 50s and early 60s," said Terry. "We're interested to find if early life factors are associated with breast cancer susceptibility." The researchers gathered data on childhood and adult exposures, along with blood samples and mammograms, from 263 women. Terry and her colleagues looked at an epigenetic effect called DNA methylation, whereby DNA is tagged by a molecular "methyl" fragment, which alters activation of the genes. In this instance, the researchers looked at global hypomethylation aberrant methylation throughout the entirety of a person's DNA. The researchers found differences in global DNA hypomethylation depending on breast cancer risk factors including racial group, smoking status, and infant and childhood size. "Birth size in particular has been correlated with breast cancer later in life, but nobody really knows why," Terry pointed out. "This is a small pilot study to look at one possible mechanism."

Other correlating factors included ethnic group and smoking or nonsmoking status. Twenty-one percent of whites, 39 percent of blacks, and 13 percent of Hispanics were in the highest quartile, while 35 percent current smokers were in the highest quartile compared with 15 percent former smokers and 26 percent of women who never smoked. The researchers also plan to look at gene-specific hypermethylation in a variety of different genes that might be important for breast cancer, according to Terry. Terry notes that although this pilot study used a very diverse sample, it was still a relatively small group, and the next step is a much larger study using samples from hundreds of women. Such an effort is currently in progress. "We're going to try to see if we find these patterns holding up in a much larger sample now," Terry said. "We see this as a first step to understand why measures from birth might be related to adult disease much later in life."

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Breast cancer drop is no '1-year wonder' (Yahoo News-18/04/2007)

After government researchers reported in July 2002 that long-term hormone therapy's benefits did not outweigh its risks, millions of postmenopausal women stopped taking their pills. 
One of the risks of taking estrogen plus progestin is a greater chance of breast cancer, and a study presented in December found that, indeed, the U.S. rate of new cases dropped nearly 7% from 2002 to 2003. Still, some scientists wondered whether the drop might be only temporary. Perhaps stopping hormone therapy only delays diagnosis and doesn't prevent it, they said. But an analysis of 2004 data released today found that the rate of new cases remained stable, which, the authors say, reinforces the finding they reported in December. "We know now that at least this isn't a one-year wonder," says Peter Ravdin, lead author of the new report in The New England Journal of Medicine. "I'm not surprised that the number didn't drop further, but what I think is really important is that the drop was sustained."

ON DEADLINE: Studies reinforce cancer risks with hormone drugs
That sustained drop means roughly 16,000 fewer U.S. women were diagnosed with breast cancer in 2003 and in 2004 than in 2002, says Ravdin, a cancer doctor at the University of Texas M.D. Anderson Cancer Center in Houston. He and his co-authors analyzed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results, or SEER. From 2001, the last full year before scientists reported findings from the large government hormone therapy trial, to 2004, the rate of new breast cancer cases fell 8.6%, Ravdin and his co-authors write. Ravdin cautions that a population-based study such as his cannot prove that the dramatic drop in hormone therapy use caused the decline in breast cancer diagnoses. Other factors, such as a 3.2% decline in screening mammography between 2000 and 2003 for women 50 to 65, could have played a role, they write. However, he and his co-authors write, the timing of the decline in relationship to the drop in hormone therapy use was probably not a coincidence. For one, the decline in new cases was seen only in women 50 or older, the age of the vast majority of hormone users. For another, the decline was mainly seen in cancers that were estrogen-receptor positive, a type of tumor fueled by estrogen. Take away the estrogen in hormone therapy, Ravdin says, and early, undetectable breast tumors might stop growing or even regress.

American Cancer Society epidemiologist Ahmedin Jemal says he isn't so sure: "It is too soon to tell." How estrogen fuels breast tumors is not yet clear, he says. Only anecdotal reports suggest that blocking it could have a rapid effect on cancer growth, Jemal says. He called for at least two or three more years of analyses to be sure the drop in hormone use didn't just delay diagnoses. A separate study posted online Wednesday by The Lancet concludes that hormone therapy also raises women's risk of ovarian cancer. The study followed nearly 1 million postmenopausal British women, half of whom had taken or were taking hormones. Researchers found that current users were 20% more likely to develop and die from ovarian cancer than women who had never used hormones. That equaled one extra ovarian cancer death in out of every 3,300 users. 

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Chemo fails to root out breast cancer stem cells: study (AFP-29/04/2008)

While chemotherapy can remove breast cancer tumors, it fails to root out the stem cells that can revive the cancer, researchers said in a study published Tuesday. Comparing the challenge to eradicating stubborn weeds from a garden, the researchers at Baylor College of Medicine (BCM) in Houston, Texas, said chemotherapy often fails because it leaves behind many of the stem cells that help re-ignite tumors. "It's not enough to kill the dandelion blossom and stalk that appear above ground," said Michael Lewis, assistant professor of molecular and cellular biology at the BCM Breast Cancer Center. "You have to kill the root beneath the soil as well." The discovery underscores the need to develop a treatment that can target stem cells in addition to the tumor, Lewis said. "What we found is that one reason chemotherapy frequently does not work is that you kill the bulk of the tumor but leave many of the stem cells behind," he said. "It appears that these cells, by their nature, are resistant to the effects of anti-cancer drugs," said Lewis, whose findings appear online in the Journal of the National Cancer Institute. A cocktail of anti-cancer medicines together with the drug lapatinib appears to kill both the tumor and the stem cells, he said. The promising drug, still being evaluated, would be used to treat breast cancer that has metastasized and contains the protein marker called HER2.

The Baylor researchers took biopsies from the tumors of patients with and without the HER2 marker before and after different treatments. In the group of people whose tumors did not carry the HER2 marker, the 31 patients received conventional chemotherapy. While the number of tumors significantly decreased, the proportion of cancer stem cells was greater than before the treatment, the study said. The other group -- 21 patients with HER2 -- were given lapatinib and two common breast cancer drugs. That group saw a dramatic drop in tumor cells, and the percentage of cancer stem cells remained unchanged or even dropped slightly, the researchers said. "The tumor shrank dramatically," said Jenny Chang, associate professor of medicine and medical director of the BCM Breast Care Cancer Center. "But in contrast to treatment with conventional chemotherapy, the relative proportion of stem cells did not go up. This means the stem cells were killed off with the same frequency as the bulk of the tumor. This is the first time this has been demonstrated."

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New genes linked to breast cancer (UPI-28/04/2008) 

Scientists in Iceland said they have found a fourth set of genetic variants linked to an increased risk of estrogen receptor-positive breast cancer. The findings, published in the journal Nature genetics, are being used to develop a DNA test to identify women who should be closely screened at an early age for the disease, the biopharmaceutical company deCode Genetics said Sunday in a release. The test is expected to be released later this year, the company's report said. Researchers reported the discovery of two common single-letter variants on chromosome 5 of the human genome that are associated with risk of estrogen receptor-positive breast cancer. They said more than 60 percent of the general population carries at least one copy of the risk variant rs4415084. Women who have inherited the variant from both parents are at approximately 50 percent greater risk of developing ER+ breast cancer than women who have not inherited the variant, the report said. The second variant occurs only in tandem with the first, adding slight risk of the disease. The variants are estimated to account for about 11 percent of breast cancers overall.

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Protein test predicts invasive breast cancer (Yahoo News-27/04/2008)

Thousands of women could be spared surgery for breast cancer with a test that can predict the likelihood of developing an invasive tumour. Thea Tlsty and colleagues at the University of California, San Francisco, analysed breast tissue from 70 women who had been diagnosed with a breast-cancer precursor called ductal carcinoma in situ. They looked for abnormal expression of the proteins p16 and ki67, which are linked to tumour growth and cell proliferation, and also for the enzyme Cox-2. Women with high levels of either p16 or Cox-2, combined with high levels of ki67, had a very high probability of developing invasive breast cancer. If ki67 was absent, however, high levels of p16 and Cox-2 indicated a very low risk. As less than 25 per cent of women diagnosed with DCIS go on to develop an invasive tumour, those identified as high risk could be given aggressive treatment, says Tlsty, while those at low risk could be spared unnecessary surgery and drugs (Cancer Cell, DOI: 10.1016/j.ccr.2007.10.017).

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Weekly Doses of Taxol Prolonged Lives of Breast Cancer Patients By Amanda Gardner (HealthDay News-16/04/2008)

Women who take the drug Taxol weekly after receiving chemotherapy for 12 weeks live longer and live longer without a recurrence of their breast cancer, compared to women who take four taxol treatments every three weeks. The study also evaluated another drug in the same family, called Taxotere (docetaxel), but found that weekly Taxol (paclitaxel) was more effective. "The findings suggest that weekly Taxol for 12 weeks is more effective than four cycles of Taxol and should be considered a new standard," said study author Dr. Joseph A. Sparano. The findings are detailed in the April 17 issue of the New England Journal of Medicine. Prior to this study, four cycles of Taxol was considered the standard, although many oncologists were administering the drug weekly. "We have been using Taxol weekly for at least a year," said Dr. Kumud Tripathy, a clinical assistant professor of internal medicine at Texas A & M Health Science Center College of Medicine and an oncologist with the Bryan-College Station Cancer Clinic. Women with breast cancer who receive drugs known as taxanes after standard chemotherapy have a substantially reduced risk of recurrence and of death. The other taxane, Taxotere (docetaxel) is more potent than Taxol.

About a decade ago, a study showed that adding Taxol to standard chemo reduced the risk of breast cancer recurrence. The drug was subsequently approved in the United States, with the standard of care being four doses once every three weeks. A later study showed that giving the same dosage every two weeks was more effective than every three weeks, so that became common practice. In the meantime, questions were raised as to whether taxanes were effective for the most common type of breast cancer, or that which is hormone-receptor positive and HER2-negative. "It raised a lot of concerns," said Sparano, director of breast evaluation center at Montefiore-Einstein Cancer Center in New York City. "People were saying, 'Wait a minute. We thought Taxol was very effective, and maybe it's not as effective as we thought, and are we treating people unnecessarily?'" Here, Sparano and his colleagues compared the effectiveness of giving standard chemo (doxorubicin and cyclophosphamide at three-week intervals) plus four cycles or doses of Taxol every three weeks versus every week for 12 doses at a lower dose. They also compared Taxol with Taxotere (four cycles every three weeks) or Taxotere given either every three weeks for four treatments or weekly for 12 treatments. The study involved almost 5,0 00 women. There were no significant differences in survival between those treated with Taxol and those treated with Taxotere or between the groups treated weekly or every three weeks. There was no indication that weekly Taxol was less effective in women with hormone-receptor-positive, HER2-negative breast cancer. "Taxol is effective in patients with one or more common subtypes [of breast cancer] and, if it is going to be used in that population, should be delivered weekly for 12 weeks rather than every three weeks for four treatments," Sparano said.

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