BREAST CANCER

Breast Cancer Chemo Timing Doesn't Affect Outcome-(Yahoo News-02/02/2005)

The timing of systemic chemotherapy in patients with breast cancer does not affect patient survival or disease progression, say researchers reporting in the Feb. 2 issue of the Journal of the National Cancer Institute. However, the study did find that breast cancer patients who receive systemic therapy and radiation therapy without surgery may be more likely to suffer cancer recurrence than women treated with chemotherapy after surgery. The findings may be important, since a growing number of breast cancer patients are undergoing what's called '"neoadjuvant" chemotherapy -- drug therapy given in the weeks before surgery to help shrink tumor size and reduce the amount of tissue removed.

Weight Gain Linked to Breast Cancer Death-(Reuters-31/01/2005)

Women who are overweight when diagnosed with breast cancer or who become overweight after learning of their condition are more likely to die or have the disease come back, U.S. researchers reported. The effect is particularly strong among nonsmokers, the team at Boston's Brigham and Women's Hospital and Harvard Medical School found.

They found women who had never smoked and who were overweight were nearly twice as likely to die of breast cancer than nonsmokers who were normal weight. And breast cancer patients who gained more than an average of 17 pounds (8 kg) were 1.5 times more likely to have a cancer recurrence or to die, the researchers found.

Although other studies have linked fat mass with breast cancer risk, this one teased out more and stronger detail by separating smokers, study leader Dr. Candyce Kroenke said. "Combining smokers and nonsmokers in analyzes may mask the true relationship between weight and survival after a breast cancer diagnosis, since smoking is generally related to both lower levels of weight and a higher risk of death overall," she said in a statement. "Researchers have also speculated that obesity acts on cancer by raising the body's levels of sex hormones such as estrogen, particularly in post-menopausal women," she added.

Writing in the Journal of Clinical Oncology, Kroenke and colleagues said they studied 5,204 breast cancer patients over 24 years who were taking part in the larger Nurses' Health Study. They used body mass index or BMI -- the ratio of a person's height in meters to their weight in kilograms -- to classify women as overweight. A BMI of 25 or above is considered overweight and a BMI of 30 marks a person as obese. "Women recently diagnosed with breast cancer or at high risk for the disease should take steps to maintain a healthy weight to reduce the risk of recurrence and death," Kroenke said.

Breast Cancer Genes Linked to Other Cancers-(WebMD-16/11/2004)

Family members of those who carry the inherited genetic mutations BRCA1 and BRCA2, which are involved in hereditary breast and ovarian cancer, are at moderate risk for developing other types of cancer, scientists in Sweden report. The largest population study ever conducted regarding BRCA1 and BRCA2 mutations has revealed that people with these mutations may also have an increased risk of pancreatic, prostate, and stomach cancers. Testing for the BRCA mutation is recommended only for families with a strong history of breast cancer. Adults may be eligible for such testing if they have a personal or significant family history of breast cancer.

The BRCA1 and BRCA2 genes make proteins that keep cells from growing abnormally. According to the National Cancer Institute, a woman who inherits a mutation in her BRCA1 or BRCA2 gene is three to seven times more likely to develop breast cancer than one who does not. These mutations also increase the risk of ovarian cancer. But until now, there have been no long-term studies of the rate of cancers in families who have a BRCA1 or BRCA2 mutation compared with the rates of cancers in the general population.

Researchers Justo Lorenzon Bermejo, MD, and Kari Hemminski compared the rate of cancers between genetic testing-eligible patients and the Swedish population. Their study, which evaluated data from 10.2 million people, concluded that families with hereditary breast and ovarian cancers have higher rates of pancreatic, prostate, and stomach cancers. They found that family members with two or more cases of breast cancer before the age of 50 (a criteria for BRCA testing) showed significant increases in risks for ovarian and prostate cancer, as well as an increase in pancreatic cancer before the age of 50. But most ovarian cancers in these family members were not due to the BRCA1 or BRCA2 mutation, the researchers found. They found that stomach cancer before the age of 70 was twice as frequent in families with breast and ovarian cancer as in the general population.

“The main message from our study for families which fulfill the criteria for mutation testing is that their risk for cancers other than breast and ovarian cancer is only moderate. The message for those involved in clinical counseling is that most ovarian cancers in families eligible for mutation testing are not related to BRCA1/2 mutations.” The findings are published in the latest issue of the Annals of Oncology.

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Paclitaxel chemotherapy for breast cancer not associated with serious radiation pneumonitis-(Yahoo News-16/11/2004)

The use of taxanes, such as paclitaxel, has led to improved outcomes for patients with metastatic breast cancer and for patients whose disease has spread to the lymph nodes. Radiation therapy is also an important adjuvant treatment to prevent local recurrence of breast cancer, but some of the radiation focused on the breast tissue and chest wall passes through the lungs. Although the resulting incidence of radiation pneumonitis is low with the use of modern irradiation techniques, some reports have suggested that this side effect occurs more often in patients who receive taxanes. However, only small, uncontrolled studies have investigated the effect of taxanes on the development of radiation pneumonitis.

To evaluate the association between paclitaxel chemotherapy and radiation pneumonitis, Thomas A. Buchholz, M.D., and Tse-Kuan Yu, M.D., Ph.D. of the University of Texas M. D. Anderson Cancer Center in Houston, and colleagues studied 189 breast cancer patients from a phase III randomized trial. The patients had been treated with either four cycles of paclitaxel followed by four cycles of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) and then radiation therapy or with eight cycles of FAC followed by radiation.

There was no difference in the rate of radiation pneumonitis between the two groups--5.0% in the paclitaxel–FAC group versus 4.5% in the FAC group--and no patients were hospitalized for or died from the side effect in either group. The authors conclude that patients treated with paclitaxel-based chemotherapy do not have an increased risk of clinically relevant radiation pneumonitis.

"For patients who are to receive sequential chemotherapy and radiation therapy, recommendations for radiation therapy and paclitaxel treatment should not be affected by concerns about the risk of radiation pneumonitis," the authors write. "However, the association between the risk of radiation pneumonitis and the combination of paclitaxel chemotherapy and radiation therapy given either concurrently or close in temporal proximity still needs to be clarified."

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Women Wrongly Warned Cancer, Abortion Tied-(Yahoo News-14/11/2004)

Women seeking abortions in Mississippi must first sign a form indicating they've been told abortion can increase their risk of breast cancer. They aren't told that scientific reviews have concluded there is no such risk. Similar information suggesting a cancer link is given to women considering abortion in Texas, Louisiana and Kansas, and legislation to require such notification has been introduced in 14 other states. Abortion opponents, who are pushing these measures, say they are simply giving women information to consider. But abortion rights supporters see it much differently. "In my experience, this inaccurate information is going to dissuade few women from going ahead and having the abortion," said Dr. Vanessa Cullins, vice president for medical affairs at Planned Parenthood Federation of America. "What it does do is put a false guilt trip and fear trip on that woman."

More than a year ago, a panel of scientists convened by the National Cancer Institute reviewed available data and concluded there is no link. A scientific review in the Lancet, a British medical journal, came to the same conclusion, questioning the methodology in a few studies that have suggested a link. Still, information suggesting a link is being given to women to read during mandatory waiting periods before abortions. In some cases, the information is on the states' Web sites. "We're going to continue to educate the public about this," said Karen Malec, president of the Coalition on Abortion/Breast Cancer, an anti-abortion group.

The effort to write the issue into state law began in the mid-1990s, when a few studies suggested women who had abortions or miscarriages might be more likely to develop breast cancer. The warnings are now required in Texas and Mississippi, and health officials in Kansas and Louisiana issue them voluntarily. Minnesota law requires its health department to include this information on its Web site, but the department backed down after an outcry from the state's medical community. Montana law also mandated the warning, but the state Supreme Court struck it down. The brochures still in circulation tell women the issue "needs further study." "They can do further research on their own and determine which of those studies they should put most attention on," said Sharon Watson, spokeswoman for the Kansas Department of Health and Environment. "We're just trying to provide all the information it's possible to provide."

Louisiana — which elected a Democratic governor last year, replacing a Republican — is going to change its official literature that mentions the cancer link, said Bob Johannessen, spokesman for the state's Department of Health and Hospitals. He said the department's new director did not know the state pamphlet included such information until contacted this week by The Associated Press."If there is scientific evidence, and it certainly appears there now is, we would certainly make the necessary changes in that brochure," he said Tuesday. The brochure, he said, is a reflection of the "very, very strong pro-family, pro-life leaning" of Louisiana. "Nonetheless, it's incumbent on us as the health agency to make sure any information is factually correct," he said. "We don't want to be misleading women who are making this important choice."

The issue continues to be debated in state legislatures, with bills considered this year in Georgia, Hawaii, Illinois, Iowa, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Vermont, Washington and West Virginia. On the federal level, several members of Congress complained last year after the NCI Web site included material suggesting a link between breast cancer and abortion or miscarriage. An expert panel that was asked to review the data reported in March 2003 that "well established" evidence shows no link.

Among the studies cited by the NCI expert panel was Danish research that used computerized medical records to compare women who had undergone abortions with that country's cancer registry and found no higher cancer rate. "The virtually complete consensus was that the studies that purported to show a link were methodologically flawed," said Dr. Martin Abeloff, director of the Kimmel Comprehensive Cancer Center at Johns Hopkins University. Those studies that showed no link, he said, were almost all well done.

Still, anti-abortion activists are unconvinced. Joel Brind, a biochemist at Baruch College in New York who advises the Coalition on Abortion/Breast Cancer, noted that a woman's chances of getting breast cancer go down if she gives birth at a relatively young age. He reasons that those who opt for abortion are giving up a chance of reducing their breast cancer risk. Therefore, he says, abortion increases the risk of cancer. He participated in the NCI debate — filing a minority report — and dismisses the panel's findings. "It was basically a political exercise," he said, "a charade if you will."

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Women prefer goserelin therapy to chemotherapy for early breast cancer: study-(Yahoo News-18/11/2004)

About 78 per cent of healthy pre-menopausal women would prefer goserelin (Zoladex) therapy to chemotherapy if they were to develop oestrogen-receptor positive (ER+) early breast cancer, according to a new research published in the European Journal of Cancer (EJC). Women in the study were asked to imagine that they had been diagnosed with early breast cancer and were provided with scenarios describing the administration and side-effects and impact on fertility of treatment with goserelin and treatment with standard chemotherapy (CMF). The women were then asked a series of questions to determine which treatment they would choose and why. Of a total 200 women, aged between 25 and 49 years of age, 78 per cent favoured goserelin, 11 per cent chemotherapy and 11 per cent remained undecided.

The study found that women viewed the side-effect profile of goserelin as more acceptable than standard chemotherapy. Most women questioned would prefer to avoid the side effects associated with chemotherapy, in particular hair loss. Retaining fertility was important for a subgroup of predominantly younger women who have not yet had or not completed their families, according to a release from AstraZeneca. Professor Lesley Fallowfield, the study author and director of Cancer Research UK's Psychosocial Oncology Group commented: "It is really important that women are given full information by their doctors and specialist nurses about the affect that different treatments may have physically, emotionally and practically before making any decisions about treatment options." He added, "We need to recognise that the side-effects of chemotherapy, especially hair loss, are potentially devastating to young women already coming to terms with a life-changing diagnosis of breast cancer."

Researcher Rhona McGurk, who conducted most of the interviews said," Over a third of women felt that goserelin would be more convenient and less disruptive to normal life than chemotherapy." Clinical trial data has shown the equivalent efficacy of goserelin therapy compared with CMF regimes. However, despite clinical trial results and treatment guidelines from St Gallen and EUSOMA, pre-menopausal women with hormone-sensitive early breast cancer are rarely offered the choice of goserelin. These findings suggest that pre-menopausal women with hormone-sensitive, early breast cancer should be offered the choice of either adjuvant hormone therapy or adjuvant chemotherapy. Additionally, data from breast cancer patients shows that overall quality of life is significantly better with goserelin than with CMF during the first six months of therapy.

Professor Lesley Fallowfield added, "Despite long-term efficacy and tolerability data to support the use of goserelin in the treatment of premenopausal women with hormone-sensitive, early breast cancer and the different impacts that the treatments have on quality of life, many clinicians still do not even offer women the option of goserelin." AstraZeneca's Zoladex (goserelin) is indicated in more than 100 countries for use in the hormonal (endocrine) treatment of breast cancer in pre-menopausal women. First licensed for the treatment of breast cancer in premenopausal women in 1990, its indication now covers treatment of both early and advanced stages of the disease in many countries.

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Breast Cancer Linked to Failed Screening-(Yahoo News-20/10/2004)

Why does breast cancer screening fail? Blame missed mammograms and mammograms that don't detect early breast cancers, a new study suggests. Screening for breast cancer means regular mammograms. Experts disagree about who should get mammograms and how often they should get them. But most U.S. breast cancer experts agree that women over 50 die of breast cancer at least 30 percent less often if they get regular mammograms. Most health plans pay for — and actively promote — regular mammograms. But even women with very good health insurance still show up in doctors' offices with advanced, late-stage breast cancer. Why weren't these breast cancers found earlier when they were easier to treat?

That's what Stephen H. Taplin, MD, and colleagues wanted to know. So Taplin, now a senior scientist at the National Cancer Institute (NCI), led a study that analyzed data on 1.5 million women enrolled in seven major health-care plans. They compared 1,347 women with late-stage breast cancers with 1,347 similar women with early-stage breast cancers. The results surprised Taplin. "At first we thought we were losing people in the follow-up process after breast cancer detection," Taplin tells WebMD. "But we found that the problem in follow-up is relatively small. It was really screening and detection where the problems were."

The screening problem: 52 percent of women with late-stage breast cancer hadn't had a mammogram in the last one to three years. The detection problem: Mammograms failed to find breast cancer in nearly 40 percent of the women who - in the interval between mammograms — came down with late-stage breast cancer. The findings appear in the Oct. 20 issue of The Journal of the National Cancer Institute.

Women Who Miss Mammograms: Some women were more likely to be among those who missed mammograms:

—Women with late-stage breast cancer were nearly three times as likely to miss mammograms if they were age 75 or older.
—Women with late-stage breast cancer were 78 percent more likely to miss mammograms if they were unmarried.
—Women with late-stage breast cancer were 84 percent more likely to miss mammograms if they had no family history of breast cancer.
—Nearly 60 percent of women who missed mammograms were in lower-education groups.
—Nearly 55 percent of women who missed mammograms were in lower-income groups.

That's a clue to how health plans can do better, says study co-researcher Ann M. Geiger, PhD, group leader for cancer research at Kaiser Permanente Southern California. "The message is out there: Women need to get screened for breast cancer. But there appears to be a group of women who either don't know they should do this or who don't pursue breast-cancer screening for some other reason," Geiger tells WebMD. "In our study, it isn't lack of insurance. But maybe it's other things, like getting yourself to the clinic on a workday, arranging for child care — things that become big problems for lower-income women."

Taplin says the problem really isn't missed mammograms. It's women who simply don't get screened for years on end. "If you were to focus on people who have not been screened in the prior three years and just identified them, you could begin to affect late-stage disease," Taplin says. "Whether that affects mortality is unknown. We think you will have a higher chance of affecting mortality. But the issue is not so much repeat screening as it is getting people who haven't been screened."

Screening for breast cancer is not a one-way street. Yes, mammograms detect breast cancer early, when it's easier to treat. But the tests often result in biopsies that find no breast cancer, creating physical, emotional, and sometimes financial hardship. Taplin and Geiger are quick to point out that their study does not prove mammograms save lives. It does, however, suggest that women think hard about the consequences of not having regular mammograms. "We may tend to underestimate the difficulties that breast cancer screening makes for women," Geiger says. "But the tradeoff is ending up with a cancer that is very difficult to treat. I have a mother who has issues and has to get a mammogram every six months. It freaks me out because her chances of false positives are high and she has already had some biopsies that turned out negative. But I think the tradeoff is worth it."

It's up to every woman to decide whether to undergo breast cancer screening. As the study data suggest, it's a big decision — a decision best made with a doctor's advice. "Women who refuse screening should have a chance to tell a doctor what their concerns are," Taplin says. "I am not saying they should be dragged by ropes and chains to be screened, but we should at least talk to them and find out what their concerns are."

Mammograms That Miss Breast Cancer: Women missing mammograms isn't the only reason breast cancer screening fails. Mammograms also sometimes miss breast cancers. A large proportion of women in the Taplin study got their diagnosis of late-stage breast cancer in between mammograms. "Finding the cancer when it is there is a part of the problem," Taplin says. "We don't know the percentage of these late-stage cancers that were visible on the last mammogram. About a third of the time it is visible, but we don't have that data here. We need better ways of helping radiologists improve interpretation. And we need more research at NCI to find better detection methods."

Geiger agrees that there's an urgent need for better mammogram technology. In the meantime, she says, it's a good idea to improve radiologists' skill at reading mammograms. "You could have a tumor that is not yet detectable, and it could show up in the interval before your next mammogram. There is no perfect medical test," Geiger says. "An obvious next step is to look at breast cancer detection. Kaiser Permanente Colorado has a great program looking at radiologists, providing training and specialties for mammogram readers."

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A new national study will investigate genetic and environmental causes of breast cancer by enrolling 50,000 sisters of women already diagnosed with the disease. The Sister Study, conducted by the National Institute of Environmental Health Sciences, part of the government's National Institutes of Health, is the largest study of its kind. “By studying sisters who share the same genes, often had similar experiences and environments… we have a better chance of learning what causes this disease,” Dale Sandler, the study's principal investigator, said Monday.

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Immediate Breast Repair After Mastectomy Okay-(Reuters Health- 20/09/2004)

Women who undergo mastectomy for breast cancer can have their breast rebuilt at the time of surgery without delaying chemotherapy, if this treatment is also needed, new research shows. However, reconstructing the breast at this time rather than in a separate surgery does increase the risk of problems with the wound, the authors note. Immediate breast reconstruction (IBR) is growing in popularity because it has been shown to improve psychosocial well-being and self-image, senior author Dr. Richard J. Bold and colleagues, from UC Davis Medical Center in Sacramento, California, note. However, this approach may increase the risk of wound complications, which could in delay chemotherapy, possibly decreasing the patient's chance of survival.

To investigate, the researchers analyzed data from 128 women with breast cancer who underwent a total of 148 mastectomies at their center. The subjects included 62 who underwent IBR and 66 who did not, according to the report in the Archives of Surgery. Contrary to the researcher's hypothesis, IBR increased the risk of wound complications. The rate of complications, such as infection and bleeding, in the IBR group was 22 percent compared with just 8 percent in the comparison group. Despite the increased rate of wound complications, IBR did not delay the start of chemotherapy. Just two patients in each group received chemotherapy later than 4 to 6 weeks after surgery, the window when most cancer doctors prefer to begin such therapy. The results reinforce the message that IBR is an option even in patients who need chemotherapy after surgery, the authors emphasize.

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MRIs best at detecting breast cancer, research finds-(Yahoo News-20/09/2004)

For women who carry either of two genetic flaws known to lead to breast cancer, an MRI is far more accurate in the detection than other screening methods, including mammography, researchers reported last week. The finding, in the Journal of the American Medical Association, is being hailed as significant because women with mutations in genes known as BRCA1 and BRCA2 have a higher lifetime risk than the general population. The risk has been estimated as high as 85 percent from age 25 onward. But use of an MRI "is not for the general population," said Dr. Ellen Warner, lead investigator of the study. Women with the genetic predisposition undergo annual screening and clinical breast examinations starting at age 25. Even with such surveillance, sometimes tumors are found at an advanced stage, she said. An estimated 10 percent to 15 percent of all breast cancer cases involve BRCA1 and BRCA2 mutations.

The high sensitivity of magnetic resonance imaging could improve early detection for this population, for whom prophylactic mastectomy is the only other option, said Warner, an oncologist at the Toronto Sunnybrook Regional Cancer Centre. Drs. Mark Robson and Kenneth Offit of Memorial Sloan-Kettering Cancer Center in New York City wrote in a journal editorial that the findings suggest women at risk should be screened using MRI. "A technology assessment by one large insurance carrier has already supported the rationale for MRI screening of BRCA mutation carriers and other women at high hereditary risk of breast cancer," the doctors wrote.

Dr. Melanie Palomares, a cancer specialist in the department of clinical genetics at the City of Hope National Cancer Center in Duarte, Calif., said specialists there already use MRI as the primary screening tool for women at high risk. But because it also finds a high number of "false positives," which can lead to unnecessary biopsies, it is not used for the general population. 

The study included 236 women ages 25 to 65 with BRCA1 or BRCA2 mutations who underwent one to three annual screening examinations involving MRI, mammography and ultrasound. During the study, 22 cancers were detected. Of these, 77 percent were spotted by MRI, 36 percent by mammography and 33 percent by ultrasound. Only 9.1 percent were found by clinical breast examination.

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Alcohol increases risk of breast cancer, study shows-(Yahoo News- 14/09/2004) 

Women who drink the alcoholic equivalent of more than one 350-milliliter can of beer a day are three times more likely to get breast cancer than those who do not drink at all, a group of researchers at Aichi Medical University said Tuesday. "Large amounts of alcohol may increase the amount of estrogen, which helps breast cancer to develop," said Lin Yingsong, a teacher at the university and a member of the research group led by professor Shogo Kikuchi.The research is based on an epidemiological survey conducted on about 36,000 women aged 40 to 79 across Japan for an average of seven and a half years.

Of the women studied, 151 contracted breast cancer. Of those, the number who drank more than 15 grams of alcohol a day was 2.93 times higher than the number of nondrinkers, the research shows. Women who drink less than 15 grams of alcohol a day showed no difference in incidence of breast cancer from those who do not drink, according to the study.

A 350-ml can of beer contains about 14 grams of alcohol, while 180 ml of Japanese sake contains some 22 grams of alcohol. The group plans to publish the result of the epidemiological survey, which was funded by the Ministry of Education, Culture, Sports, Science and Technology, at a three-day annual meeting of the Japanese Cancer Association beginning Sept. 29 in Fukuoka.

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Broccoli Compound Arrests Breast Cancer Cell Growth-(Reuters Health- 09/09/2004) 

In findings that could make broccoli and Brussels sprouts easier to swallow, early research suggests a chemical found in the vegetables may impede the spread of breast cancer cells. Scientists found that the compound, called sulforaphane, hindered the growth of human breast cancer cells in the lab. It did so by apparently disrupting the action of protein 'microtubules' within the cells, which are vital for the success of cell division. The findings are published in the Journal of Nutrition.

Past research has suggested a role for sulforaphane in preventing cancer, possibly due to its effects on detoxification enzymes that can defend against cancer-promoting substances. A study in rats showed that oral sulforaphane blocked the formation of breast tumors, and scientists have found that the chemical can push colon cancer cells to commit suicide. This latest research suggests a new mechanism -- microtubule disruption -- by which sulforaphane may bestow anti-cancer benefits, according to study co-author Dr. Keith Singletary, a professor of nutrition at the University of Illinois at Urbana-Champaign. What's "intriguing" about this finding, he told Reuters Health, is that certain cancer drugs work in a similar manner. It's possible that sulforaphane, perhaps in combination with other compounds or drugs, could eventually aid in the prevention or treatment of cancer, according to Singletary. 

Whether a diet rich in broccoli and other sulforaphane-containing foods packs enough of the compound to lower cancer risk is unknown. Numerous studies in the general population have linked high vegetable and fruit intake to a lower risk of cancer, including breast cancer -- but zeroing in on which components of these foods may deserve the credit is a tough task. Much remains to be learned about the chemicals in plant foods, Singletary noted, and scientists generally believe that it's important to get the full complement of nutrients and chemicals in these foods. "Most people would recommend eating a variety of whole vegetables and fruits," he said

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New clues help understanding of breast cancer growth-(Health Day News- 08/09/2004)

Scientists in New Zealand say they have made an important discovery about how breast cancer cells spread in the body. They have found a growth hormone in the cells determines how aggressively the cancer grows. One of the greatest difficulties in treating cancer is how to stop the cells multiplying and growing outside the tumour. Doctors from New Zealand's Liggins Institute believe they have found why some breast cancer cells spread. "We have found a switch which determines whether breast cancer cells stays where it's made or can spread throughout the body," Professor Peter Gluckman, director of the Liggins Institute said.

Scientists analysed samples of breast cancer cells which had invaded other parts of the body. They found 98 per cent had traces of a human growth hormone, while there was none present in the localised tumours. "We don't know why you have got the cancer but maybe we have a better way of treating it and have women survive," Dr Belinda Scott said, from the New Zealand Breast Cancer Foundation.

They stress it is not the same growth hormone produced naturally in the pituitary gland or the synthetic hormone given to children who are not growing properly. Doctors already use drugs to slow down human growth hormone in cancers in the pituitary gland. Australian experts say these findings could lead to a similar treatment for breast cancer. "We are using this research to design some new therapies which we think will be even more effective," Professor Gluckman said. Doctors believe the same hormone may also be present in some bowel cancers.

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Evanston Northwestern Healthcare Promotes Breast Cancer Early Detection with Cancer Risk Self-Screening Software from TouchVision-(Business Wire-08/09/2004)

TouchVision Inc., a wholly owned subsidiary of Trinity Learning Corp. announced that Evanston Northwestern Healthcare (ENH) has deployed the MyGenerations breast cancer risk assessment software. MyGenerations is used to self-screen for breast cancer risk. The software is deployed on three kiosks at ENH hospitals. The software is also deployed on portable laptops for community outreach efforts. MyGenerations reduces the time and effort of performing a breast cancer risk screen for both the individual and the healthcare system. In the traditional screening approach, health and family history data are collected from the subject with either paper questionnaires or interviews. The collected information is assessed and scored by a genetic counselor using risk models. The results are then provided back to the subject. The time and effort is significant for all parties involved. 

MyGenerations allows the user to enter their health and family history data through a series of intuitive screens. The health history data is then immediately evaluated and scored using several of the latest risk assessment models. Risk screening results are immediately communicated to the user during the same session. The user is provided with supplemental information and recommendations based on their risk factors. The user receives a printed copy of their family tree and a risk assessment that can be provided to their healthcare provider. The entire process takes less than 20 minutes to complete. Because MyGenerations is self-service healthcare, the user can perform the assessment at a time convenient to them.

Suzanne O'Neill, Ph.D., research assistant professor and certified genetic counselor in the Center for Medical Genetics at Evanston Northwestern Healthcare, was co-creator of MyGenerations. She commented: "A woman dies from breast cancer every 12 minutes in America. This sobering statistic can be combated though early detection. In fact, the five-year survival rate is 96 percent when breast cancer is detected early. There are over 2 million breast cancer survivors living in America today. We really want women to have access to resources that both increase awareness and help contribute to early detection. We are quite proud of having MyGenerations as one of our tools to fight breast cancer. By increasing awareness and helping women understand cancer risk factors, we can facilitate early detection and increase survival."

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Managing DCIS-(Yahoo News-07/08/2004)

As more American women are screened for breast cancer with mammograms, doctors are seeing more of a condition called ductal carcinoma in situ (DCIS). Sometimes called a pre-cancer and sometimes Stage 0 breast cancer, DCIS is a non-invasive lesion that is confined within the lining of the milk ducts of the breast that is more benign than a cancerous tumor in that it does not have the ability to invade other parts of the body. It's estimated that about 55,700 cases of DCIS were diagnosed in the United States in 2003. While some cases of DCIS will go on to become invasive cancers that have the power to travel outside of the breast and become a threat to someone's survival, it's not yet known which cases will become cancerous and which will not. As a result, everyone with DCIS receives treatment. There are concerns, however, that some women are receiving unnecessarily aggressive treatment, such as a mastectomy that is not indicated, and that others, particularly those women who have more aggressive forms of DCIS, might be undertreated with, for example, a lumptectomy without radiation.

Nancy Baxter, MD, PhD, is an assistant professor of surgery in the division of surgical oncology at the University of Minnesota, who conducted a study published last March in the Journal of the National Cancer Institute, which examined trends in the treatment of DCIS between 1992 and 1999. Below, Dr. Baxter explains how DCIS differs from invasive cancer and what the appropriate treatment involves.

What is DCIS?

DCIS is a pre-invasive cancer of the breast, which means that the cells have become cancerous but they have not gained the ability to spread outside of the breast ducts. It's a type of breast cancer that's completely localized to the breast.

How is it different from invasive breast cancer?

Invasive breast cancer has developed the ability to spread elsewhere, so anyone with invasive breast cancer has a risk of developing metastases, such as cancer in the brain, in the liver, in the bone, etc. That's a much more serious threat to survival. I think patients see the diagnosis as the equivalent of breast cancer diagnosis, and it terrifies them. So it can be quite difficult for women with DCIS to understand that their disease actually has an excellent survival rate. Over 98 percent of people with DCIS are alive 10 years after their diagnosis. They haven't died of breast cancer because breast cancer hasn't developed the ability to spread, whereas people with invasive breast cancer that has developed the ability to spread often need more treatment to try and decrease the risk of recurrence, or return, of breast cancer and of dying of breast cancer.

Why has the incidence of DCIS risen so sharply over the last decade?

It may just be becoming more common, but I think the main factor is screening mammography. Our screening mammography has improved and more women are taking advantage of it. Screening mammography is really good at finding calcifications, which are calcium deposits. Many of the cases of DCIS have calcifications that form in the ducts of the breast, which are picked up by a mammogram.

Why do we have to treat all cases of DCIS?

The main problem is that we know that if we leave DCIS alone and do not treat it all, many people will develop invasive breast cancer. They then have the same risks of dying of breast cancer as someone who develops invasive breast cancer.

Can you determine which cases of DCIS are likely to recur?

Some duct carcinoma in situs look more aggressive under the microscope than others, which we refer to as the grade. Also, there is a variant of DCIS that tends to be more aggressive called comedo-type DCIS. In these cases there are a lot of actively replicating cells, so under the microscope, you see a lot of cells that have died; the dead cells form something called a comedo. A larger tumor and a tumor that is in multiple areas of the breast are both risk factors for recurrence. But even tumors that we think are low-risk for coming back can come back, too. So we can give what we think the likelihood of it coming back is, but we can never say that the likelihood is zero.

How is DCIS usually treated?

In general, we treat with lumpectomy followed by radiation. We know that radiation after lumpectomy decreases the rate of recurrence. Some of these people, whose tumors have hormone receptors and therefore may grow in response to hormones, get treated with hormone therapy, with tamoxifen or with other hormonal compounds. We're still acquiring evidence about the effect of hormonal therapy for DCIS. If you have DCIS in multiple areas of your breast, you really can't save the breast and general mastectomy is necessary. Interestingly, mastectomy is more commonly necessary in DCIS than in your standard invasive breast cancer. So although it's a precancer, sometimes it requires a more aggressive surgical approach than invasive cancer.

Are there some people with DCIS who might not need radiation after lumpectomy?

I think that's one of the important questions that need to be answered, and that we need randomized studies to look at that specific question. If radiation doesn't really help people, then we're exposing them to problems associated with radiation for no reason. If we could be better than we are now in determining who is at high risk of having their DCIS come back, then we could just give those people the radiation and spare everyone else. That would be great, but we're not there yet.

Why wouldn't someone want the radiation?

Radiation is costly, and it does require a month of fairly intensive treatment. Radiation can lead to permanent deformities in the breast. Radiation can make it more difficult to screen the breast in the future because it can lead to changes within the breast such as scarring. It has also been associated with lung problems and heart problems in very small numbers of people.

What did your study suggest about the variability in treatment for DCIS?

Our study demonstrates that treatment is variable and changing. It seems that surgeons have adopted breast conservation for DCIS, and that the rate of mastectomy dramatically declined within a fairly short period of time, which is good. However, it is concerning that depending on where you're located geographically in the United States, your treatment for DCIS can be quite different. Part of the issue is that the treatment is fairly controversial, and it does rely a lot on individual judgment. There may also be variation in women's preferences and in the provider practice and the institutional practice where the woman lives. If one provider or institution generally prefers to perform a certain type of operation or to deliver radiation after lumpectomy or not to deliver radiation, that influences the care the woman receives.

Did you see cases of undertreatment?

In the study, there was a wide variation in terms of delivery of radiation after lumpectomy, even for the type of DCIS that we know has a greater risk of recurring: the comedo-type DCIS. Up to a third of people with that type of DCIS did not receive radiation. So it does appear that some women are inappropriately not treated with radiation.

Did you see cases of over-treatment?

We see variation in terms of the rate of mastectomy between centers. Now some of that may relate to patient preference. There may be a greater preference for mastectomy in one area of the country than the other, though it's hard to know. But it seems unlikely that it explains all the variation. If women have a diffuse (spread out) tumor, then they do generally need to get a mastectomy. But there may well be women who don't have the diffuse tumor who receive mastectomy.

What is your advice then to a woman who has just been diagnosed?

Compared to invasive breast cancer, DCIS is relatively uncommon. Although it's increased in incidence, it still only about 15 percent of all breast cancers. So not every surgeon is going to be extremely familiar with the treatment of DCIS, even if they're relatively familiar with the treatment of breast cancer. We know that the outcome for most patients is great, but if we can avoid over-treating patients, that that would be the way to go. I think that if you're completely comfortable with the treatment plan, then that's fine. But if women are uncomfortable at all about their treatment plan, obtaining a second opinion is the way to go. But it's going to be a while before we get there. I think we really have to encourage research in this area to bring us from where we are today to where we should be.

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Groups honor local cancer patient-(Yahoo News-01/09/2004)

Local breast cancer survivor and early detection advocate Shannon Potter said she isn't fighting cancer, she's living with it. "I don't think of it as a battle, I think of it as a journey," she said. Potter was honored with the BMW Ultimate Drive Hero award Saturday at the BMW of Idaho dealership in Idaho Falls. The hero award is presented by BMW and The Susan G. Komen Foundation to a community resident who has made an outstanding personal effort in the fight against breast cancer. Potter's picture is affixed to a BMW X3 Signature Vehicle that will be on display at BMW dealerships across the country. "As far as being a hero, I'm only a hero to the extent that the people around me have made it so easy for me to continue with my life," she said. Since the BMW Ultimate Drive program began in 1997, it raised more than $7 million towards breast cancer research. "The award is nice, but I just want to bring attention to the cause and mainly raise money," Potter said. "Because money leads the research and research, for me, leads to survival."

When doctors diagnosed her with stage-four breast cancer in May 2003, Shannon Potter drew from her personal experience seeing her mother live with bone marrow cancer for nine years. "I was really, really, deathly ill. But when I was told I had cancer I wasn't really scared of that," Potter said. "I only knew people who lived with cancer. That's what I knew, so that's what I did." Turning her positive attitude loose on the community, Potter is active in local breast cancer awareness events and fund-raisers. She participated in Cancer Survivor Day and Brake for Breakfast, both sponsored by Portneuf Medical Center. She also walked in Race for the Cure and is helping organize a golf tournament to raise money to provide mammograms for women in Southeast Idaho that are unable to afford the screening.

Potter's upbeat attitude is an inspiration to her friends, family members and her caregivers. "I'm living cancer as opposed to suffering from it," she said. "I don't let it stop me from doing the things that I love every day." She said she and her husband Tim travel, go to sporting events and love to mountain bike. She's even switched jobs - and health insurance - in the past year. The 33-year-old social worker is a patient of the Huntsman Cancer Center in Utah but receives chemotherapy treatment each week at as an outpatient at PMC. "I have been in chemo weekly for 17 months. I get it at PMC from the infusion therapy nurses and they have been absolutely wonderful," Potter said. "They let me live a life around chemo."

Her nurses say the treatment doesn't slow her down. She brings in her laptop computer, her cell phone and paperwork to keep her busy as she receives treatment. Shannon says she draws her inspiration from other cancer survivors, family and her community. "It is the women I work with, my husband, and the people in this community that makes it so easy to do this," she said. Potter added that local breast cancer survivor and early detection advocate Patti Farrell has been an inspiration. "She is a real mentor and a sister to everyone with breast cancer here." 

Since Potter's diagnosis, she's learned that she can do a lot more than she ever imagined. "I've learned that there's nothing I can't do or that I can't find a way around," she said. "I'm stronger for having gone through this."

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Breast cancer study launched-(Press Association-02/09/2004)

Researchers have launched an appeal to find more than 100,000 women to take part in a decades-long study to pinpoint the causes of breast cancer. Charity Breakthrough Breast Cancer and The Institute of Cancer Research hope that the Breakthrough Generations Study will lead to a better understanding of the causes of the disease, which kills 13,000 women in the UK each year. Celebrities including actress Michelle Collins, opera singer Lesley Garrett and TV presenter Tara Palmer-Tomkinson are expected to take part in the research and called for more women to join in. 

Around 40,000 cases of breast cancer are diagnosed in the UK each year, with rates rising in the past decade. But scientists believe that around half of these cases - at least 20,000 a year - could, in principle, be prevented if the causes of the disease were better understood. The study, which aims to recruit more than 100,000 UK women aged over 18, will examine genetic, environmental, behavioural and hormonal factors thought to increase the risk of developing cancer.

Each women will give a blood sample and provide information about their lifestyles, and their health will then be followed for almost half a century. Other celebrities backing the study include actresses Meera Syal, Angela Griffin, Jill Halfpenny, Pam St Clements, newsreaders Fiona Bruce and Katie Derham; and TV presenters Gail Porter, Jayne Middlemiss and Lowri Turner. The study will be led by Prof Anthony Swerdlow, head of epidemiology at The Institute of Cancer Research, and Prof Alan Ashworth, director of the Breakthrough Toby Robins Breast Cancer Research Centre at the institute. 

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Study: Older women with breast cancer could forgo radiation- (Milwaukee Journal Sentinel-01/09/2004)

Older women with early-stage breast cancer may reasonably forgo radiation therapy and not expect a recurrence after surgery and treatment with tamoxifen, according to research published Thursday in the New England Journal of Medicine. Doctors said the research suggests that every year, as many as 40,000 American women aged 70 and older may not have to undergo a daily, six-week course of irradiation, a therapy that costs up to $20,000 and which can cause side effects such as pain, swelling and redness. However, for a similar group of women in their 50s, radiation therapy offered significant protection against breast tumor recurrence, a separate study found. "These are high-quality studies that will make us think about who should get radiation therapy and who should not," said Jim Stewart, a medical oncologist at the University of Wisconsin Comprehensive Cancer Center.

The two studies address a continuing concern among the tens of thousands of women who are diagnosed with localized breast cancer each year: After surgery and beginning treatment with tamoxifen, will they also benefit much from radiation therapy? For women aged 70 and older with small tumors and who are candidates for estrogen-blocking treatment, the answer appears to be no, according to the study's authors. Older women tend to have less aggressive breast cancer, often are good candidates for estrogen-blocking drugs such as tamoxifen, and, more importantly, have a shorter life expectancy, which makes a possible recurrence years down the road less of a concern, said lead author Kevin Hughes, a surgical oncologist with Massachusetts General Hospital Cancer Center. "Most older patients ask, `Do I really need to go through this?'" he said.

The study looked at 636 women aged 70 and older who had early-stage, localized tumors. The women also were good candidates for estrogen-blocking drugs. All of the women had breast-conserving lumpectomies in which the tumor and not the entire breast was removed. They then were randomly put into a group that got tamoxifen alone or tamoxifen plus radiation therapy. After five years, the rate of cancer recurrence in the same breast was 4 percent in the tamoxifen-only group and 1 percent in the radiation group, only a slight increase and one that may be outweighed by other considerations, the authors said. There was no significant difference in survival or the rate of recurrence outside the breast. "These are women with a good breast cancer prognosis," said Julia White, a breast cancer specialist and associate professor of radiation oncology at the Medical College of Wisconsin. "What this tells me is they have options."

A second study looked at a group of 769 women aged 50 and older with localized breast cancer who had lumpectomies. The tamoxifen-plus-radiation group had a minuscule recurrence rate of 0.6 percent, compared with 7.7 percent in the tamoxifen-only group. "It (adding radiation) was better than we expected," said lead author Anthony Fyles, a radiation oncologist at Princess Margaret Hospital and the University of Toronto. "Less than 1 percent is pretty darn low." Overall survival and the rate of recurrence outside the breast essentially were the same in both groups.

However, a five-year local recurrence rate of nearly 8 percent spread over a lifetime that may last another 30 years is a major concern, said White, of the Medical College of Wisconsin. "Recurrence of a cancer is (psychologically) devastating," she said. 

However, the study raised the possibility that some patients over 60 also might reasonably decline radiation treatment. In a subgroup of those over 60 who had very small tumors, the risk of recurrence was small and not statistically significant, 1.2 percent in the tamoxifen group, compared with 0 percent in the radiation group. "If that risk is acceptable, then it's not an unreasonable choice," Fyles said

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Study Finds Immune Therapy for Metastatic Breast Cancer Possible- (Yahoo News-31/08/2004)

Researchers at the National Cancer Institute (NCI), one of the National Institutes of Health, have found promising evidence that immune cell transplant therapy can help shrink tumors in patients with metastatic breast cancer. Similar therapies, which also involve transplantation of donated immune cells, have produced dramatic anti-tumor effects in leukemias and lymphomas--cancers of the blood and lymph, respectively. However, previous studies have not proven that such therapies have clinical effects on breast cancer. Michael Bishop, M.D., of NCI, led the study, which was published on August 16 on the Web site of the Journal of Clinical Oncology.* Scientists at the Experimental Transplantation and Immunology Branch of NCI's Center for Cancer Research studied 16 women with breast cancer that had progressed to an average of three metastatic sites after conventional treatments, including chemotherapy and hormones; six of these women had tumor shrinkage after cellular immune therapy.

Bishop's group gave study patients a treatment similar to a bone marrow transplant. Each patient received cells donated by a sibling. This transplant included lymphocytes -- cells crucial to the immune system -- and the adult stem cells that produce blood cells. The active, anti-tumor component of this cellular immune therapy regimen was a class of lymphocytes called T cells, which attack and kill tumor cells. The same qualities that make transplanted T cells react against tumors --especially their pugnacious tendency to attack foreign cells -- also make them dangerous to the transplant recipient. Because the recipient's own immune system may attack donor cells, NCI scientists gave subjects an immune-suppressing chemotherapy regimen before the transplant. To help protect subjects' bodies from the toxic effects of the transplant, scientists followed the chemotherapy with a course of transplant-conditioning drugs.

Each subject received transplants with the same concentration of T cells. The initial transplants had a relatively low concentration of these cells; infusions given at 42, 70, and 98 days after the first transplant had exponentially increasing numbers of T cells. Increasing the concentration over this time period helped NCI researchers isolate patients' reactions to the transplant from their reaction to the chemotherapy, and established T cells as the active element in the transplant. Six patients of the 16 had partial or minor responses to the treatment lasting an average of three months. The transplants had a toxic effect in many of the women, causing not only anti-tumor activity but also attacking normal cells. This graft-vs.-host disease (GVHD) was observed in a majority of subjects: 10 had acute GVHD; of 13 available for a follow-up examination, four had chronic GVHD. "Although it was hoped that the women would garner clinical benefit from this research, the study was not designed to demonstrate that this immune cell therapy results in an improvement of outcome, specifically survival," Bishop explained.

"The study demonstrated that immune-based therapies, specifically the lymphocyte-based therapy we used, could result in tumor regression," Bishop said. However, it is crucial to improve cellular immune therapy by lowering the risk of toxic effects, especially GVHD. Collaborating laboratories are currently testing specialized T cells they hope will cause little GVHD while retaining strong anti-tumor effects. "These data provide support to continue efforts to develop better immune-based therapies to augment currently available therapies for metastatic breast cancer," stated Bishop. Such advancement is critical, as current chemotherapies for the disease result in an average survival of only 24 months.

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Anti cancer compound in vegetables blocks late stage breast cancer cell growth-(Yahoo News-01/09/2004)

A well-known anti-cancer agent in certain vegetables has just had its reputation enhanced. The compound, in broccoli and other cruciferous vegetables, has been found to be effective in disrupting late stages of cell growth in breast cancer. Keith Singletary and doctoral student Steven Jackson of the University of Illinois at Urbana-Champaign report their finding involving sulforaphane (SUL), which they say could ultimately be used to enhance the prevention and treatment of breast cancer, in the September issue of the Journal of Nutrition.

"This is the first report to show how the naturally occurring plant chemical sulforaphane can block late stages of the cancer process by disrupting components of the cell called microtubules," said Singletary, a professor in the department of food science and human nutrition. "We were surprised and pleased to find that SUL could block the growth of breast cells that were already cancerous."

SUL is abundant in such vegetables as broccoli, brussels sprouts and kale. Chewing causes the cell walls of these vegetables to break, and SUL is released into the body. Singletary, a researcher in phytochemicals and cancer chemoprevention, and Jackson exposed cultures of malignant human breast cancer cells to SUL. Within hours, SUL blocked cell division and disrupted microtubules, which are long, slender cylinders made up of tubulin (protein), that are essential for the separation of duplicated chromosomes during cell division. "It is not yet clear whether the doses required to produce inhibition of tubulin polymerization are higher than those achievable via dietary intakes," wrote Jackson and Singletary. "However, the results show that tubulin disruption may be an important explanation for SUL's antiproliferative action. These findings are significant since SUL's actions appear similar to a group of anticancer drugs currently in use, such as Taxol," Singletary said.

SUL is studied extensively for its effects against cancer. Previous reports have shown that SUL induces defensive mechanisms that are effective in protecting normal cells from the initiation of cancer. "More than 10 years ago, researchers at Johns Hopkins University reported that SUL is a potent inducer of enzyme systems that can defend against carcinogens," Singletary said. Such defense mechanisms are effective during the early stage of cancer. The Illinois research extends the 1992 discovery at Johns Hopkins and pinpoints how SUL works during later stages of cancer, such that SUL can suppress the orderly division process in human breast cancer cells. "The findings may be helpful in the development of new breast cancer prevention and treatment strategies," Singletary said. "For example, it may be possible that ingesting SUL in combination with certain natural compounds or drugs could enhance their anticancer effectiveness and reduce side effects."

According to the American Cancer Society, breast cancer this year will account for 15 percent of all cancer deaths in women, and approximately 275,000 new breast cancer cases of various forms will be diagnosed. Improvements in treatments such as chemotherapy have led to an 88 percent survival rate in Caucasian women and a 74 percent survival rate in African-American women, according to the most recent ACS survey in 2003. However, some current chemotherapy drugs have side effects that have the ACS and other organizations seeking new strategies that combine chemotherapy drugs with other treatments to potentially lessen the toxic effects. The new Illinois study confirms a previous study in mice. In the February 2004 issue of the journal Carcinogenesis, Singletary and Jackson reported that SUL treatments in mice with implanted cancer cells resulted in decreased tumor size.

More research is needed to assess SUL's potential in countering breast cancer development, Singletary said. "What we do not know is how specific SUL and other similar phytochemicals are toward cancer cells compared to normal cells," he said. "We also do not know against which cancers SUL's microtubule- targeting actions are most effective." Future studies in Singletary's lab will address those issues.

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Women with breast cancer detected by mammography screening have better outcomes-(Yahoo News-31/08/2004)

Women who have breast cancer detected by mammography screening have a reduced risk of distant tumor recurrence than women with breast cancer detected outside of screening, according to a study in the September 1 issue of JAMA. The incidence of cancerous tumors detected by mammography screening is increasing due to its expanding use, according to background information in the article. Selection of therapies for women diagnosed as having breast cancer is based on risk estimations for cancer recurrence. Heikki Joensuu, M.D., of Helsinki University Central Hospital, Helsinki, Finland, and colleagues compared the survival outcomes of women with cancerous tumors detected by mammography screening with women whose tumors were detected outside of screening. 

The study included 2,842 women identified from the Finnish Cancer Registry as having breast cancer in 1991 or 1992. The average follow-up time was 9.5 years. The clinical, histopathological and biological features of the tumors were compared. The researchers found that women with cancerous tumors detected by mammography screening had better estimated 10-year distant (other location in the body) disease-free survival than women with tumors found outside of screening. In analysis that included factors related to the biological aspects of the cancers, women with tumors detected outside of screening had a 90 percent increased risk for distant recurrence than women with tumors detected by mammography screening.

"Cancerous tumor detection in mammography screening was a favorable prognostic variable independent of the number of axillary lymph nodes, the primary tumor size, age at cancer detection, and the histological grade," the authors write. "Further research on factors related to cancer invasiveness and metastasis formation needs to be performed. For women with cancerous tumors detected by mammography screening, the risk of distant metastases may be overestimated unless the method of detection is taken into account in risk estimations."

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Death Risk in Breast Cancer Patients Can Vary Widely-(Reuters Health- 31/08/2004)

In women with breast cancer, the probability of dying from that malignancy, as opposed to some other cause, can range from 3 percent to 85 percent, depending on factors such as disease stage and patient age at diagnosis, new research shows. "To our knowledge, this is the first comprehensive competing-risk analysis to quantify the probability of death from breast cancer and other causes after a diagnosis of breast cancer," Dr. Catherine Schairer, from the National Cancer Institute in Rockville, Maryland, and colleagues note in the Journal of the National Cancer Institute for September 1.

The findings are based on an analysis of data from breast cancer patients entered in the Surveillance, Epidemiology, and End Results (SEER) Program, a large national database. The investigators determined the survival rates, and classified any deaths as either from breast cancer or other causes, for more than 395,000 white and 35,000 black women diagnosed with breast cancer between 1973 and 2000. 

For women with early-stage disease, the probability of death from breast cancer ranged from 3 percent to 10 percent, depending on age and race. In contrast, in patients with late-stage disease, the probability ranged from 70 percent to 85 percent.

In women with early- or late-stage disease, the probability of death from breast cancer was higher for subjects diagnosed before 50 years of age compared with those diagnosed at age 70 years or older. This was observed in black and white patients.

Regardless of age, patients with late-stage disease were more likely to die from their cancer than from all other causes. In contrast, for women with localized or regional disease, death from breast cancer only outweighed other causes when it was diagnosed before age 50 and 60 years, respectively.

For localized or regional disease, the probability of death from breast cancer was higher for black than for white patients, the investigators point out.

Patients with estrogen receptor-negative tumors were more likely to die from their disease than were those with estrogen receptor-positive tumors, they add.

"The probability of death from breast cancer versus other causes varied substantially according to stage, tumor size, estrogen-receptor status, and age at diagnosis in both white and black patients," the researchers conclude.

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Novel imaging technique shows lymph nodes, metastases in breast cancer without surgery-(Yahoo News-23/08/2004)

Breast cancer tends to progress to nearby lymph nodes, but surgeons can find it difficult to determine what tissue to remove with the breast tumor and what to leave intact. National Cancer Institute researchers hope to change that. “Our advance is that we have a non-invasive method that may minimize surgical trauma,” says the team’s leader, Martin Brechbiel, Ph.D. “At the least, surgeons can acquire a set of images and have a feel, a road map if you will, for what they need to do before the [surgical] procedure begins. Ultimately the technology could have the potential to replace surgery, though that’s not proven yet.” Brechbiel reported the technique, which uses magnetic resonance imaging and a novel MRI agent, for the first time at the 228th national meeting of the American Chemical Society, the world’s largest scientific society. The pharmaceutical chemist is looking to step up from mouse studies to Phase I clinical trials.

One in seven women will develop breast cancer, according to the American Cancer Society’s 2004 report of cancer statistics. Closely tied to deciding the best approach for the tumor’s removal — a lumpectomy is now the most common — is determining whether and how much of neighboring tissue may also contain cancer cells. That’s a question surgeons can now rarely answer until the patient is on the operating table and they can probe her lymph tissue directly. And although their decision strongly impacts her chances for cancer recovery and survival, even direct inspection can render it less than clear. Which node is the sentinel, closest in flow from the breast? Which in line after that should be the last to take? “Also, lymphatic vessels are not always easy just to find. They’re not like bone or a major organ,” Brechbiel points out.

The NCI research has the potential not only to reduce doubt but also to remove much of the decision itself from the operating room. Brechbiel proposes, and has the preliminary data to support, an approach that would send the woman first to the MRI center, where a technician would inject the new imaging agent. Its chemical properties would then light up, in real time, the flow of lymph from breast through lymph vessels to nodes under the arm. “You can actually watch the filling of nodes from the tumor,” Brechbiel says, referring to observations he and his team have made in transgenic mice. “Some will light up very early, others later. And then you can also reconstruct the data into a three-dimensional image, and rotate it for a three-dimensional road map. The surgeon can know how a patient’s lymph tissue is constructed even before surgical intervention begins.”

Brechbiel’s technique could save time on the operating table, inflict less trauma and possibly even diagnose cancerous nodes as well as delineate the local lymph network. “Cancerous cells can block normal filling of the node, and when that happens you can spot the aberration in flow,” he says. 

The imaging agent itself is also new. Other MRI compounds are small molecules, but the NCI group instead has developed a series of dendrimer complexes to carry the magnetic signal. Some of these elaborate scaffolds of polymer each hold a remarkable 256 ions of gadolinium, a rare-earth metal and common magnetic signal in MRI. Dendrimers give a stronger signal even when adjusted for their high molecular weight, and a crisper image because their bulkiness keeps them from leaking through vessel walls.

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Risk of False-Positive Mammo Reading Lower Than Thought- (HealthDayNews-23/08/2004) 

The risk of getting a false positive result on a mammogram is far less than previously estimated, Norwegian research shows. And the risk of having an invasive procedure based on a false positive is just over 6 percent, the researchers say. Over a 20-year period, women have a 1-in-5 chance of having a false positive mammogram, according to the study findings, published in the October issue of Cancer. "Women attending a biennial screening from the age of 50 until she reaches 69 years runs a cumulative risk of 20.8 percent for having a false positive recall," said study author Solveig Hofvind, a researcher at the Cancer Registry of Norway in Oslo. And, Hofvind added, the chances of having to undergo an follow-up invasive testing procedure were even lower. "The risk of undergoing a negative fine needle aspiration cytology was estimated to be 3.9 percent; a core needle biopsy, 1.5 percent, and an open biopsy, 0.9 percent," she said.

More than 215,000 American women are diagnosed with invasive breast cancer and more than 40,000 die each year, according to the American Cancer Society. As with most cancers, early detection is key. So, the ACS recommends that women over 40 have a mammogram every year. But, there's been concern that the test may have a high false positive rate, which would mean that women would have to suffer through unnecessary anxiety, and possibly invasive testing as a result of the false positive. "Women should know their risk of a false positive recall," said Hofvind, because if they know it's a possibility, having a false positive may be less psychologically distressing.

One previous study found the false positive rate to be as high as 50 percent if a woman has undergone 10 screening mammograms, according to Hofvind's study. Another study, Hofvind reported, estimated the risk to be between 5 percent and 100 percent after nine mammograms. The researchers said the differences in these studies may have been due to variants in screening programs, the threat of malpractice, or the design of the studies. 

To try to more definitively pin down the true false positive rate, Hofvind and her colleagues studied data from 83,416 Norwegian women who were between the ages of 50 and 69. The women had screening mammograms every two years beginning in 1996, and the study results were based on the first three rounds of screening. The same equipment was used for all three screenings, and each mammogram was reviewed independently by two radiologists. Overall, the authors estimate that one in five women who begin screening will have at least one false positive result after 20 years of screening. And, the cumulative risk of having an invasive test is 6.2 percent, with a less than one percent chance of having to undergo open biopsy. The authors also found that the highest rates of false positives occurred on the first round of mammograms. Accuracy improved with each subsequent screening. For example, in the 50 to 51 age group, there was a false positive rate of 3.5 percent for the first screening, 2.2 percent for the second screening and 2.0 percent for the third screening.

Dr. Yelena Novik, an oncologist at New York University's Clinical Cancer Center, said this "study makes a good, positive point. Mammography is the best way of screening we have right now. There is a strong benefit for screening and finding early cancers," Novik said. "For women who are concerned that mammograms will find some abnormality that requires a procedure and then turns out to be nothing, I would say the chance of that is not very high," Novik added.

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Medical Journals Censoring Scientific Debate on Abortion-Breast Cancer Link, Says Women's Group-(US Newswire-17/08/2004) 

The Coalition on Abortion/Breast Cancer deplores the fact that two medical journals have resorted to censorship for the purpose of suppressing scientific debate and academic criticism of flawed research on the abortion-breast cancer (ABC) link. The journals, Lancet and Cancer Epidemiology Biomarkers and Prevention, refused to publish letters critical of research showing little or no relationship between abortion and increased breast cancer risk. "The editors of these journals are silencing experts who dissent from the view that abortion is unrelated to increased risk of breast cancer," argued Karen Malec, president of the coalition. "The editors don't want a full scale scientific examination of the ABC link because they know abortion causes breast cancer. If science were on their side, then they wouldn't have to resort to petty censorship. They could dispose of the link handily through the use of a full scale scientific investigation and debate.

"Recognition of the ABC link," continued Malec, "could embarrass leading researchers and the cancer fundraising industry. Nevertheless, the increasing incidence and importance of female breast cancer merits the fullest scientific investigation and discussion." The British journal Lancet rejected for publication letters from two experts, Chris Kahlenborn, MD and Patrick Carroll. Kahlenborn authored the book, Breast Cancer: It's Link to Abortion and the Birth Control Pill. Carroll is a British actuary and statistician and the research director for the Pension and Population Research Institute in London. His research on the ABC link has been published by other reputable journals. The journal, Cancer Epidemiology Biomarkers and Prevention, rejected a letter from Joel Brind, Ph.D., professor of endocrinology at Baruch College, City University of New York. Brind was the lead author in the only quantitative and comprehensive review and meta-analysis of the ABC research. Carroll emphasized the limitations of all sample-based research. His research uses historic national data, not samples. It is free of any possibility of recall bias.

Brind and Kahlenborn provided evidence discrediting a favorite theory of abortion advocates known as "recall bias." "The editors' censorship should be a red flag for women," declared Malec. "Scientific misconduct and bias against positive findings have been a serious problem plaguing ABC research for a half-century." The letters by Kahlenborn, Carroll and Brind and the coalition's explanations of their criticisms are published at: http://www.abortionbreastcancer.com/letters/index.htm

The Coalition on Abortion/Breast Cancer is an international women's organization founded to protect the health and save the lives of women by educating and providing information on abortion as a risk factor for breast cancer.

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Blood Test Better Predicts Cancer Treatment Outcomes- (Reuters- 18/08/2004)

A new technology that counts cancer cells in the blood helps predict the success of breast cancer treatments more quickly and more reliably than established methods, researchers reported on Wednesday. A study published in Thursday's edition of The New England Journal of Medicine said the new technique allows doctors to determine within weeks, not months, whether a breast cancer patient's treatment is working. The study funded by a company that helped develop the technique could lead to more tailored treatments that would spare some women from the most potent chemotherapy or recognize which patients need more aggressive therapy at the start of treatment, said lead author Massimo Cristofanilli. "It makes a huge difference in case you have to decide how aggressive you want to be with a woman with breast cancer," Cristofanilli, of the University of Texas M.D. Anderson Cancer Center in Houston, told Reuters.

However, he noted that the system was only tested on breast cancer that had spread. Further research will be needed to see if the technique helps against less aggressive breast cancer or other types of tumors where cancer cells are less likely to be shed into the blood. More than 1.2 million people are expected to be diagnosed with breast cancer this year worldwide, and the disease will kill 40,000 in the United States alone. 

Cells of a tumor sometimes break off and circulate in the blood. When those nomadic cells find a new home and start to grow - a process known as metastasis - cancers become much harder to treat. The technique to count such cells, known as the CellSearch System, was developed by Veridex LLC, a Johnson & Johnson company, in conjunction with Immunicon Corp., which funded the study. Each test is expected to cost $300 to $400. In an editorial in the Journal, Stephan Braun and Christian Marth of Innsbruck Medical University predicted that the CellSearch technique will become widespread and thereby improve care for patients with metastatic breast cancer. "Measurement of circulating tumor cells predicts a response to treatment much more quickly than our usual clinical practice, which in the best of circumstances permits a treatment evaluation after two to three months," Braun and Marth said.

Currently, doctors use a variety of methods -- such as tumor size, tumor type, the patient's age, whether cancer cells have spread to adjacent lymph nodes, and the tumor's sensitivity to estrogen -- to try to predict which treatment will be most effective. The new technique, tested at 20 locations in the United States, involved 177 volunteers with advanced breast cancer. The Cristofanilli team found that women with high levels of cancer cells in their blood survived for an average of 10.1 months, while those with low levels survived for more than 18 months. Cristofanilli said plans are under way to test the technique against other forms of cancer, and to see if it will predict which women are more likely to have a recurrence of breast cancer. "One day, we may be able to suggest to a patient, based on personal risk, a more aggressive treatment, a less aggressive treatment, or no treatment at all," he told Reuters. "But this is going to take a few years."

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Helping Breast Cancer Patients Make Tough Choices- (HealthDayNews- 27/07/2004)

In today's everchanging health-care environment, cancer patients and their doctors are turning to computers and other technologies to help with complicated decisions concerning care. However, two new studies suggest nothing beats the human touch. Educational "decision aids" for women worried about breast cancer work just fine but can never replace expert counseling from physicians or other health professionals, such as genetic counselors, the studies found. "In the ideal world, these things are an educational tool, perhaps for use in a 'pre-counseling' session. But otherwise, trained people absolutely need to be involved," said Dr. Charis Eng, director of clinical cancer genetics at Ohio State University.

The two studies, plus Eng's commentary, appear in the July 28 issue of the Journal of the American Medical Association. According to Eng, recent advances in diagnostic procedures and treatments, plus a wider understanding of the role of genetics in disease, has made decision-making on the part of patients and their doctors tougher than ever. Especially in the area of genetics, there simply aren't enough trained genetics counselors like Eng to go around -- only about 400 in the United States. Nevertheless, "medicine is going to be pervaded by genetics and genomics," Eng said. Relying on one's doctor for up-to-date genetics information is dicey, she said, because medical schools still underemphasize genetics in their curriculum, and "most physicians aren't trained in this field." Eng said she has seen firsthand the unfortunate results of a lack of good genetics counseling, with some doctors misinterpreting gene test results for women who worry they might have a genetic predisposition to breast cancer. In some cases, these women opt for prophylactic mastectomy -- removal of the breasts to ensure they escape the disease.

In the case of dubious genetic advice from their doctors, Eng said, "some women will call us, just to be sure, and then we pick up the pieces. But many of them have also had their breast removed because their surgeon told them the wrong thing." Many women with a family history of breast cancer may worry they carry the BRCA1 or BRCA2 gene variants that can raise cancer risk.

In the first study, researcher Dr. Michael J. Green and colleagues at Penn State College of Medicine compared the usefulness of an educational, interactive computer program he created against traditional in-person genetics counseling. The goal: To see how the computer program helped women come to grips with issues surrounding BRCA1/BRCA2. The computer "decision aid" first outlines the causes of breast cancer, then talks about genetic inheritance of disease in general before focusing on specific genes such as BRCA1 and BRCA2. "We found that for improving knowledge, the computer program and the genetic counseling were both very effective," Green said. "They both raised knowledge levels considerably.On the other hand, knowledge isn't everything. For lowering anxiety, counselors did better than the computer. People like talking to a counselor, they like that one-on-one interaction."

The second study, led by Timothy Whelan of Hamilton Health Services in Hamilton, Canada, examined the effectiveness of a "decision board" - a kind of flip chart - to help breast cancer patients make informed choices about whether to have a mastectomy or a less-radical lumpectomy. The decision board guided women through various topics, such as "Treatment Choice," "Side Effects," and "Results of Treatment Choice for the Breast/for Survival." The researchers found use of the chart "helpful in improving communication and enabling women to make a choice regarding treatment." But while they may be useful tools, Eng said computer programs or decision boards should not and cannot replace the advice of a well-informed doctor or genetics counselor.

For one thing, she said, "Who's going to keep these things updated?" Genetics research is proceeding at an incredibly fast pace, she pointed out, so what seems like good information today may be obsolete a year from now. The genetics of disease is also becoming increasingly complicated, with malignancies dependent on the interaction of a number of genes, not just a single mutation, Eng said. 

Green agreed, stressing that his computer program "isn't designed to give people specific advice. It's not a substitute for talking to a health-care professional. It's designed to provide information -- it doesn't tell them whether or not to get tested, or their specific risks for breast cancer, it's much more general. If they have specific questions they should always talk to a treatment professional."

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Moffitt and FORCE Announce Collaboration to Help Families Affected by Hereditary Breast and Ovarian Cancer-(Yahoo News-20/07/2004)

Facing Our Risk of Cancer Empowered (FORCE), a national nonprofit organization for families affected by hereditary breast and ovarian cancer, and H. Lee Moffitt Cancer Center & Research Institute have announced a three-year collaborative project to improve research and care for families affected by hereditary breast and ovarian cancer. The collaboration will encourage individuals at high risk for breast and ovarian cancer to enroll in a centralized registry for hereditary breast and ovarian cancer research, the Family Cancer Genetics Network Registry (FCGN). The new collaboration will also improve the two-way communication between the high-risk community and researchers by allowing community members to provide feedback regarding the direction of research. To facilitate the collaboration, FORCE announced that it will move its national headquarters from Coral Springs to Tampa. "We are excited about collaborating with such a well-respected cancer center," says Sue Friedman, Executive Director of FORCE.

Friedman, a breast cancer survivor and carrier of BRCA-2 mutation, founded FORCE in 1999. "This unique collaboration will allow high risk individuals to weigh in on which research questions they feel are of highest priority. Those affected by hereditary cancer will be able to participate more fully in the research that will ultimately lead to better prevention, treatment and surveillance options and improved care. Access to the latest research findings will help these individuals make more informed decisions about managing their risk." Rebecca Sutphen, M.D., Director of the Cancer Genetic Counseling and Testing Service at Moffitt, says, "This exciting new collaboration aligns an active high-risk community with a major cancer center and sophisticated informatics tools. The FCGN registry makes it possible for anyone anywhere to participate in the battle to prevent cancer via the Internet and allows participants to stay in touch with researchers, receive regular updates on research progress and provide feedback to help direct the research. We expect this partnership to propel cancer prevention research forward in a way that has never been possible before."

Studies show that about 10 percent of breast and ovarian cancers are hereditary. Individuals who carry certain genetic changes face a risk for cancer that is much higher than the general population. It is critical to understand how an individual"s underlying genetic makeup affects his or her risk to develop cancer, and, more important, how to prevent cancer in individuals at increased risk. Such research requires the participation of thousands of individuals and has been hampered by lack of access to research in the community.

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Story Tips from the Front Lines of the War Against Cancer-(Yahoo News-28/06/2004)

Eyes wide shut: Exploring why our immune system doesn't "see" tumors. For Keith Jerome, M.D, Ph.D., the most intriguing question about cancer is not what causes it but why our bodies fail to defend us from the disease after it strikes. "Infection with a cold virus brings on a very noticeable immune response -- congestion, nasal swelling -- all of which is part of the infection-fighting process to clear the virus from the body," said Jerome, an immunologist at Fred Hutchinson Cancer Research Center. "Yet for many cancers, there are no obvious signs of an immune reaction, despite the fact that cancer cells clearly don't look normal."

Jerome first discovered that paradox as a graduate student at Duke University about 15 years ago while doing studies on breast cancer. When he extracted women's lymph -- a clear fluid that carries infection-fighting cells through the body -- Jerome found immune cells that reacted against a substance found on breast-cancer cells. The immune cells he identified are known as T cells, infection-fighters that destroy virus-infected and other unhealthy cells. "It had been thought previously that the immune system couldn't see tumors," Jerome said. "So the question then turned to, 'why isn't the immune system working to recognize and kill tumors when they arise in the body?'"

Today in his own laboratory at Fred Hutchinson, Jerome's research yields insight into this and other immune-system shortcomings that cause serious human health problems. Understanding how some diseases evade our body's defense system may help explain the incomplete control of chronic viral infections by the immune system, the lack of success of current vaccination approaches to many viruses, as well as the inability of the immune system to control many tumors. The work also may help researchers who are harnessing the protective power of T cells as new therapies for cancers.

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Study finds Protein Link in Cancer Growth-(Times of India-16/06/2004)

In what could be an important breakthrough in the study of breast cancer, a team led by an NRI scientist in Texas has found the link between two proteins which play vital role in the spread of the disease and the result is expected to trigger new strategies stop its growth.

A team of scientists of the University of Texas M D Anderson Cancer Centre, led by Rakesh Kumar found that a single change in a small 19 amino acid portion of one of the proteins can actually stop tumour formation. “We might be able to develop a small molecule, a drug that could target the business end of this protein to interfere with the transformation process,” says Kumar in the journal “Cancer Cell”.

The proteins the research team studied appear to be involved in the process of transforming normal breast cells into cancer cells in the majority of breast cancer cases according to the center.

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Light-to-moderate drinking appears to have little effect on the risk for breast cancer-(Yahoo News-14/07/2004)

In an effort to clarify the relationship between alcohol consumption and the risk of developing breast cancer, a study in the July issue of Alcoholism: Clinical & Experimental Research examines the influence of alcohol intake and type of beverage (beer, wine or spirits) on breast cancer in relation to menopausal status. Findings support previous research showing that heavy drinking increases risk for breast cancer, predominantly among premenopausal women; however, this risk exists independent of alcohol type. Light-to-moderate drinking appears to have little effect on a woman's risk for breast cancer.

"For a number of years, it has been known that a high alcohol intake implies an increased risk of breast cancer," said Morten Grønbæk, professor of alcohol research at the Centre for Alcohol Research at the National Institute of Public Health in Denmark. "The ongoing discussion has been whether or not there is an increased risk among light-to-moderate drinkers as well."

Grønbæk added that he and his colleagues chose to examine what effects the type of alcohol may play in cancer development due to some of their earlier research. "In quite a few previous studies, we have suggested that wine drinkers, in contrast to beer and spirits drinkers, seem to be at a lower risk for some cancers such as upper digestive tract cancer, lung cancer and colon cancer," he said. "There are several plausible biological mechanisms which may explain this, including the fact that wine comprises flavonoids and resveratrol, which have been shown to have 'anti-carcinogenic' properties."

In addition, said Grønbæk, "the reason for looking at menopausal status is that it is very likely that development of breast cancer may have different etiologies depending on hormonal status, and this may be influenced by alcohol intake."

"Prospective studies are particularly useful for studying relations between lifestyle habits such as alcohol consumption and health outcomes such as breast cancer, since the information on the lifestyle habit is collected prior to the development of the health outcome," added R. Curtis Ellison, professor of medicine & public health and director of the Institute on Lifestyle & Health at Boston University School of Medicine. "However, even prospective studies on alcohol and breast cancer can have conflicting results mainly because the association between alcohol and breast cancer is rather weak – unlike smoking and lung cancer, where the association is so strong that it does not require a large number of subjects to demonstrate it – so it requires a huge number of cases to be able to reach a conclusion on the relation."

For this study, researchers used data gathered through the Copenhagen Centre for Prospective Population Studies, a six-cohort examination of health-related issues. The study population comprised 13,074 women, aged 20 to 91 years. Researchers used self-administered questionnaires to ask about alcohol intake, smoking habits, weight and height, physical activity in leisure time, children, use of hormone replacement therapy, menopausal status, and educational levels. The women's health was tracked until diagnosis of breast cancer, death, or end of follow-up for other reasons, whichever came first.

Analysis indicates that alcohol consumption of more than 27 drinks per week – considered heavy drinking – increases the risk of breast cancer in premenopausal women, independent of alcohol type.

"Our study confirms earlier reports that heavy alcohol consumption is a risk for breast cancer," said Grønbæk, "In this case, mainly among premenopausal women. The second main finding is that there seems to be no difference in the effect of the different types of alcohol, which indicates that it is ethanol itself and not the type of drink that is responsible for breast-cancer development."

"In addition," said Ellison, "I believe this study demonstrates very well that light-to-moderate drinking of alcohol has very little effect on a woman's risk of breast cancer. These findings support the results of numerous other studies showing that an increase in breast-cancer risk, if present, is very slight. The study also has enough moderate drinkers of wine in it to be able to say that it does not support the protection against breast cancer from wine consumption."

Grønbæk concurs. "Based on our results, the average reader should not worry too much about light to moderate intake, say, in the area of one to two drinks per day."

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Virus 'linked to breast cancer' - (Yahoo News-11/07/2004)

Scientists say there is growing evidence that a virus may play a role in the development of breast cancer. Tests by researchers in the United States have found signs of a virus called MMTV in tissue taken from women with the disease. But writing in the journal Cancer, they said there were geographical variations in the numbers testing for the virus.The UK charity Breast Cancer Care said more research is needed to determine if there is a link.

Dr Paul Levine and colleagues from The George Washington University School of Public Health carried out tests on tissue samples taken from breast cancer patients in Europe, North and South America and North Africa.They found that 74% of the samples taken from patients in Tunisia showed signs of MMTV.This compared to 42% of the samples from Australia, 38% of those from Italy, 36% of those from the United States and 31% of those from Argentina.Tests on samples from women from Vietnam found that less than 1% showed signs of the virus.

MMTV or mouse mammary tumour virus is known to cause breast cancer in mice. Previous studies have found signs of the virus in breast cancer tissue taken from women.The researchers said animal studies have found high levels of this virus in aggressive cancer tumours.But they said: "Whether this can be extrapolated to humans remains to be demonstrated. The researchers suggested the geographical variations may be directly related to MMTV in mice. "The geographic differences were compatible with studies of MMTV in wild mice," they said.

Helen Graham, a breast health nurse specialist at Breast Cancer Care said: "This study adds to existing research suggesting there may be a link between the MMTV virus and the development of breast cancer. "The study had a very small sample and it is clear that more extensive research is needed into the possible link between MMTV and breast cancer. "Many of the women Breast Cancer Care talk to are anxious to understand the causes of breast cancer but it is very important for all to remember that the single most significant risk factor for breast cancer is age. "Therefore, every woman should be breast aware throughout her adult life."

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Animal research suggests plant estrogens in soy do not increase breast cancer risk-(Yahoo News-06/07/2004)

Research in monkeys suggests that a diet high in the natural plant estrogens found in soy does not increase the risk of breast or uterine cancer in postmenopausal women. "This is convincing evidence that at dietary levels, the estrogens found in soy do not stimulate cell growth and other markers for cancer risk," said Charles E. Wood, D.V.M., lead researcher, from Wake Forest University Baptist Medical Center. "The findings should be especially interesting to women at high risk for breast cancer who take soy products." The research is reported in the current issue of The Journal of Clinical Endocrinology & Metabolism.

Wood said there has been much debate about whether high levels of dietary soy are safe for postmenopausal women. Soy products are sold as a natural alternative to traditional hormone therapy. The most common form of hormone therapy, estrogen plus a progestin, has been shown to increase risk of breast cancer. 

Soy and some other plants contain estrogen-like compounds called isoflavones or phytoestrogens. These plant estrogens are thousands of times weaker than the estrogen produced by the body, but may be present in much higher concentrations in the blood. Evidence about their safety has been mixed. It is known that populations that typically consume diets high in soy have lower rates of breast cancer. On the other hand, some studies have shown that soy isoflavones can stimulate breast cancer cells grown in the laboratory. "Evidence from observational studies in women indicates that soy intake may help prevent breast cancer," said Wood. "But there has still been reluctance to conduct research studies in women because of concerns that isoflavones may stimulate breast cell growth and increase the risk of breast cancer."

Wood and colleagues measured how a diet high in soy isofllavones affected markers for breast and uterine cancer risk in postmenopausal monkeys. The monkeys ate one of three diets for three years: soy that didn't contain isoflavones, soy with the isoflavones intact, or soy without isoflavones, but with Premarin, or estrogen therapy, added. The isoflavone group consumed the human equivalent of about 129 milligrams a day, more than most people would get in a soy-rich diet. The researchers measured breast density, numbers of dividing breast and uterine cells, and levels of the estrogen produced by the body – all markers for cancer risk. 

Monkeys on the soy plus estrogen diet had increased levels of all markers, while monkeys that ate soy with isoflavones did not. In fact, the monkeys eating soy with isoflavones had lower levels of the estrogen produced by the body. High levels of this estrogen are considered an important predictor of breast cancer risk in postmenopausal women. "These findings suggest that high dietary levels of soy isoflavones do not increase markers for breast and uterine cancer risk in postmenopausal monkeys and may contribute to an estrogen profile associated with reduced breast cancer risk," said the researchers. 

Wood said it is important to note that the research addressed the effects of plant estrogens on normal breast tissue, and not in breast cancer. "A big unanswered question is whether it is safe for breast cancer survivors to turn to soy," he said. Researchers are not certain how plant estrogens and the estrogen produced by the body, or given in pills, act together. One theory is that the plant estrogens bind to cells that have estrogen receptors, such as breast tissue, and block the effects of the other types of estrogen. Isoflavones may also help reduce the amount of active estrogen in the body. To investigate these ideas, Wood and colleagues are currently looking at whether soy may block breast cell proliferation induced by estrogen therapy.

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Breast cancer mortality higher in black women-(Seattle Post-07/07/2004)

Black women with breast cancer have faster-growing, more aggressive tumors than white women, even when the malignant growths are compared at the same stage, according to a new study led by researchers at the Fred Hutchinson Cancer Research Center.The research suggests a biological explanation for black women's poorer odds of surviving breast cancer. Although African American women are less likely to be diagnosed with breast cancer than white women, they're more likely to be diagnosed at a later stage and to die from the disease. Experts have attributed the disparity in mortality rates to increased poverty among African Americans, differences in cultural beliefs and a lack of access to medical care."They may have some biological features of their cancers that are also working against them," said Dr. Peggy Porter, lead author of the study and member of Fred Hutchinson's Human Biology and Public Health Sciences division.

The study, which appears in today's issue of the American Cancer Society journal Cancer, involved 124 African American women and 397 white women, ages 20 to 54, who lived in Atlanta.Previous studies have also suggested that breast cancer tumors might be more aggressive in black women. In the current study, researchers found that African American women were more likely to have high levels of the proteins that control the pace of cell division. Elevated levels of such proteins are associated with faster-growing cancers.

Porter said it's not yet clear whether the difference in tumors is linked to higher mortality rates among black women."The question is are those abnormalities partly responsible for later-stage disease (diagnosis)," she said.Black women might be more prone to aggressive tumors for a variety of reasons, including higher rates of obesity, younger age at first menstruation or the number of children they have, suggest researchers."All of those things translate to a difference in lifetime exposure to estrogen," Porter said. "So we really want to explore whether those differences could be what is really driving the kinds of tumors one group might get."

Dr. Hannah Linden, an oncologist at Harborview Medical Center who specializes in treating breast cancer patients, called the findings "provocative." However, differences in socioeconomic status, she said, are likely more responsible for the later diagnosis of breast cancer in black women."I think those frankly are bigger issues," said Linden, adding that if the diseases were truly distinct, white and black patients would respond differently to breast cancer treatments."Blacks and whites do the same with similar treatments," said Linden. "As a practicing oncologist, it's not going to change anything (I do), but as a scientist, I think this is fascinating and needs more study."

Betty Mewborn founded a breast cancer support group for women of color in Tacoma after she was diagnosed in 1997.She attributes the higher rates of breast cancer to a fear of doctors and black women's tendency to put their own bodies last."I guess it's our culture to take care of others first," Mewborn said. Mewborn said she and many other African American women she's met were reared on the myth that cancer surgery can cause the disease to spread."The thing is they wait too long, and by the time they have the surgery it's too late," said Mewborn, 65, who had a mastectomy shortly after her diagnosis. "I'm a living example that once you're opened up it's not a death sentence."

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Gene Measurement Could Help Breast Cancer Treatment-(Health Day News-28/06/2004)

The activity of a gene called ALCAM may help doctors make early decisions about the best treatment for women with breast cancer. A study in the June 27 issue of Breast Cancer Research found the ALCAM gene, which is involved in the adhesion of cells, is less active in breast tumors with a poor prognosis. By measuring the activity of the ALCAM gene in primary breast tumors, doctors may be able to better predict the potential outcome of the disease. That could help them decide whether to use more aggressive treatment, such as chemotherapy, at an earlier stage.

Researchers from the University of South Alabama and University of Wales College of Medicine compared ALCAM (Activated Leukocyte Cell Adhesion Molecule) in normal breast tissue and in tissue samples taken from primary breast tumors.

"Tumors from patients who died of breast cancer had significantly lower levels of ALCAM transcripts than those with primary tumors but no metastatic disease or local recurrence," the study authors wrote. "The data clearly suggest that decreased ALCAM expression in the primary tumor is of clinical significance in breast cancer, and that reduced expression indicates a more aggressive phenotype and poor prognosis."

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A New Sequential Dose-Dense Chemotherapy Regimen Including ELLENCE Significantly Improves Survival in High-Risk Breast Cancer Patients-(Ascribe Newswire-28/06/2004)

New data presented at the 2004 meeting of the American Society of Clinical Oncology suggest that a chemotherapy regimen including ELLENCE (epirubicin) may significantly improve survival in breast cancer patients at highest risk of recurrence. Results from the German AGO multi-center Phase III trial show that a sequential dose-dense chemotherapy regimen of ELLENCE, paclitaxel and cyclophosphamide (ETC) as adjuvant therapy in high-risk breast cancer patients significantly improves disease-free survival (DFS) and overall survival (OS).

Interim results of a study with over 1,200 patients having 4 or more positive nodes, comparing the dose-dense ETC arm to a standard regimen of ELLENCE/cyclophosphamide (EC) followed by paclitaxel (T), were reported at a median follow up of 28 months. Estimated 3-year relapse-free survival (RFS) is 80 percent in the ETC arm vs. 70 percent in the standard arm (p=0.0009) and estimated 3-year OS is 90 percent in the ETC arm vs. 87 percent in the standard arm (p=0.030). For patients, this means that over 35 percent more women remain alive and disease free when on the ETC regimen. Moreover, these results confirm the dose dense approach seen in another study and demonstrate that women at the highest risk of recurrence benefit from this optimal dose dense therapy.

"These study results are a significant advancement in the treatment of breast cancer and confirms that dose-dense sequential regimens will become a standard option in the adjuvant treatment of node positive breast cancer patients," said V.J. Möbus, Professor and Department Head, University of Frankfurt and lead investigator of the study. "The dose-dense treatment approach of ELLENCE, paclitaxel and cyclophosphamide (ETC) used in this study allows patients to receive their chemotherapy doses more frequently, without incremental toxicities versus the standard treatment. Using this treatment approach, patients significantly improve their chances of disease-free and overall survival."

In this trial 1,284 patients were randomized to receive either 3 courses each of E (150 mg/m2, q2wks), T (225 mg/m2, q2wks), and C (2,500 mg/m2, q2wks) or the standard regimen of 4 courses EC (90/600 mg/m2, q3wks) followed by 4 courses of T (175 mg/m2, q3wks). Patients were under 65 years of age with at least 4 involved axillary lymph nodes. 1,169 were fully available for evaluation. These patients were at a high risk of recurrence with a median number of 8 positive nodes, 59 percent percent had 4 - 9 positive nodes and 41 percent had greater than or equal to 10 infiltrated nodes. No unusual toxicities were observed, especially no severe cardiotoxicity. Hematological toxicity (anemia, neutropenia and thrombocytopenia) was more frequent in the ETC arm (p<0.0001) and varied distinctly between each of the drugs within this combination. The incidence of hematological toxicity was highest during treatment with cyclophosphamide and lowest during treatment with paclitaxel. Seven percent of patients in the ETC arm vs. 2 percent in the standard arm were hospitalized for febrile neutropenia (p<0.0001). There were no treatment-related deaths during therapy.

The majority of patients completed treatment with 82 percent of patients in the ETC arm and 90 percent in the standard arm receiving the planned number of cycles. The number of dose reductions was relatively small, ranging from 6.5 percent on the ETC arm to 2 percent on the standard arm.

About Breast Cancer and ELLENCE

Breast cancer is the second leading cause of cancer death among women. It is estimated that 211,300 women in the United States will be diagnosed with breast cancer in 2003 and more than 39,800 women will lose their lives to the disease.

ELLENCE is the first chemotherapy approved by the FDA for use as a component of adjuvant therapy, in combination with cyclophosphamide and fluorouracil (FEC), in the treatment of early-stage breast cancer that has spread to the lymph nodes. It works in part by uncoiling the strands of genetic material that make up DNA (genetic information of a cell), which prevents cells from reproducing.

ELLENCE has a generally manageable side effect profile. In this and other Phase III clinical trials, the most common side effects were nausea, vomiting, mouth sores and hair loss. Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may experience low blood cell counts. Some patients may experience a severe reduction in white blood cells. Rarely, damage to the heart muscle or a type of leukemia can occur.

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"Your Breast Cancer Treatment Handbook" Called the Most Effective and Empowering Breast Cancer Book both by Patients and Family-(27/06/2004)

Across America thousands of women with breast cancer have gained the support needed to be a survivor thanks to educational and support systems pioneered by Judy Kneece, RN, OCN, author and breast health specialist. Kneece, a certified oncology nurse with a specialty in breast cancer, is author of Your Breast Cancer Treatment Handbook, (ISBN 1-886665-22-2, 210 Pages, 6th Edition, Copyright 2004, $24.95) a woman's guide to understanding the disease, treatments, emotions and recovery from breast cancer. "Breast cancer has invaded my body but it need not invade my spirit. There may be scars on my chest, but there need not be scars on my heart," is a personalized statement Kneece tries to emblazon in the thoughts of all women who have breast cancer.

The author's passion to provide breast cancer patients and their families with educational and emotional support was born out of her own personal experience. Kneece cared for her father for almost three years while he was dying of leukemia and was a continual support for her sister-in-law who battled breast cancer for seven years before dying. She learned firsthand from these experiences the need for cancer patients and their families to have someone that can answer their many questions and help them deal with this unwelcome guest. "I learned firsthand that anyone going through a crisis needs the support of someone who cares and needs to have knowledge about how to make immediate decisions and move forward through the tough times in life," says Kneece. "My philosophy is to give a person wings by supporting them during the initial period of shock upon learning they have cancer, then giving them the information they need to overcome what they are going through, and a way to reframe or make meaning out of that crisis."

Kneece was one of the first in the oncology field to conduct serious research into the recurrence of breast cancer in women and was one of the early researchers into the impact of breast cancer on a woman's sexuality after chemotherapy administration. Kneece has trained over 1000 nurses across the country to fill the role of a breast health specialist/educator in hospitals and breast centers. The breast health specialist begins working with patient from the time of diagnosis through the stages of treatment and beyond, to serve as the patient's advocate, and to provide her with education and support.

Another popular guide written by Kneece is Helping Your Mate Face Breast Cancer: Tips for Becoming an Effective Support Partner. "Men are traditionally problem solvers and breast cancer is a problem they cannot fix," says Kneece. "And men can be directive sometimes, demanding that things be done and things not be done. The woman feels overwhelmed and the man feels inadequate. Most mates are unsure of how to help. But men learn to be supportive and learn to live through their fears while helping their wife deal with her fears."

Kneece also has authored Solving the Mystery of Breast Pain and Finding a Lump in your Breast: Where to Go & What to Do, Solving the Mystery of Breast Discharge, and is creator of a computer CD-ROM featuring almost 300 breast health topics for clinics, hospitals and physicians to use for individual patient education.

Your Breast Cancer Treatment Handbook is a guide for the patient journeying through breast cancer. It provides the patient with current, easy-to-understand explanations of procedures and treatments; decision making guidelines; and inspirational support. No treatment advice is given, allowing the patient to work as a partner with her medical team for final treatment decisions.

Hospitals and cancer centers across the country provide Your Breast Cancer Treatment Handbook to their newly diagnosed patients. "This is the most complete reference for breast cancer patients that I have ever read. It covers every aspect from diagnosis through recovery; most importantly, it addresses the fears and anxieties of all patients. Facts are presented with hope. It fills a void and will empower patients to be better informed and more in control. I give it to every newly diagnosed woman in my practice", says Rosemary Lambert-Falls, MD.

"The one thing that all women should know is that breast cancer, except for inflammatory cancer, always provides enough time to gain knowledge, support and information before having to make any major decisions," stresses Kneece, "There will be time to educate yourself and make informed decisions about treatment. All we do is to help women learn to work as informed partners with their healthcare team to make decisions about their future treatment. Women need educational support to stay in control of decisions being made about their body. Getting well is more than surgery and treatments; it is a woman understanding the vital role she can play in managing her own recovery. And always remember that breast cancer is usually a treatable disease. It certainly is not an illness you would choose, but it is an illness with many proven treatments."

Your Breast Cancer Treatment Handbook covers such topics as: emotional impact of breast cancer; relationship with your mate; telling your children; calming your fears; surgical treatment decisions; reconstructive surgery; the surgical experience; understanding your pathology report; understanding treatments; radiation therapy; sexuality after breast cancer; complementary and alternative therapies; prosthesis selection; monitoring your emotional recovery; future fertility; care of the surgical arm; health insurance and employment issues; diet and exercise; monitoring your future health for recurrence. The worksheets cover such matters as fear management, questions to ask about surgery, surgical decision evaluation, questions for the reconstructive surgeon, healthcare provider records, personal treatment records, drain bulb record, hospital discharge instructions, questions for the medical oncologist, questions for the radiation oncologist, patient appointment reminder, exercise guidelines after breast cancer, and personal recovery plan. For more information on breast cancer and Kneece's book, patients and professionals may go to www.educareinc.com .

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Experts: Breast Cancer Not Spread by Biopsy-(WebMD-28/06/2004)

Still Unexplained: Why Lymph-Node Spread More Likely After Needle Biopsy. It's a puzzling finding: Women whose breast cancers have spread to their lymph nodes are more likely to have had their cancer diagnosed by needle biopsy. What the finding means isn't at all clear. But what it doesn't mean is very clear indeed, says Nora M. Hansen, MD, assistant director of the Joyce Eisenberg Keefer Breast Center at the John Wayne Cancer Institute in Santa Monica, Calif. This study does not link biopsy with spread [of breast cancer]," Hansen tells WebMD via email. "We have not changed our practice and do not plan to. We still prefer to perform a needle biopsy to confirm the diagnosis of cancer and then will proceed at another time to definitive surgical management."

Hansen and colleague Armando Giuliano, MD, developed the sentinel lymph node biopsy technique now used worldwide to help diagnose breast cancer. This technique uses dye to find the lymph node most likely to have cancer cells in a woman with a solid breast cancer mass. If this lymph node shows no sign of cancer, it's almost certain that the cancer has not spread beyond the breast. But some researchers have wondered whether the kind of biopsy a woman has might affect how well the sentinel-node technique predicts how far a breast cancer has spread.

Not long ago, there was only one way to biopsy a suspicious lump in the breast: by cutting it out. This is called an excision biopsy. If the lesion turned out to be a tumor, the surgeon proceeded to remove the breast. Nowadays, doctors often use a two-step approach. First they use a needle to get a sample of the suspicious breast tissue. If the tissue tests positive for cancer, the woman may in many cases be able to choose to have a lumpectomy instead of a full mastectomy.

Hansen's team looked at 663 women whose suspicious lumps turned out to be breast cancer. They looked at these women's sentinel lymph nodes to see whether they harbored cancer cells, small tumors (less than 2 mm in diameter), or larger tumors (larger than 2 mm in diameter). Women whose breast cancers had been diagnosed by needle biopsy were about 50% more likely to have their lymph nodes test positive for cancer than those who underwent excision biopsies. Most of this difference was due to the presence of larger tumors. The findings appear in the June issue of the Archives of Surgery.

The lymph node tumors were detected only two weeks after the needle biopsies. It seems very unlikely that tiny tumor cells dislodged by biopsy could have grown so large so fast, says Mehra Golshan, MD, associate surgeon at Boston's Brigham and Women's Hospital. "I cannot imagine that needle biopsy could cause tumor deposits greater than 2 mm in these patients," Golshan tells WebMD. "These [tumors] took months or years to grow, not days or hours after a needle core biopsy." Golshan says the study findings will spur more research. But he is sure they will not affect clinical practice. "I will not be more apt to tell my wife or anyone else to get an excision biopsy because of worry about a higher rate of metastases from needle biopsies," he says.

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Marin breast cancer studies launched-(Yahoo News-26/06/2004)

After three years of dialogue, debate and lobbying, Marin officials yesterday launched the first phase of an all-out investigative effort into the county's high breast cancer rate. County officials said they will use a $482,396 grant from the national Centers for Disease Control & Prevention to support six new research projects - three at Marin's Department of Health and Human Services, and three through local and regional groups and academic institutions. "We are absolutely committed to research-based projects that bring a greater understanding of breast cancer in Marin County, and can serve as a model of understanding for communities across the country," said Larry Meredith, health and human services department director.

The news came the same day Meredith, after telephone calls to San Francisco's Department of Public Health and San Francisco General Hospital, was able to reinstate mobile breast cancer screening services for low-income Marin women. The services, a monthly "mammovan" run by University of California at San Francisco, had been cut in recent weeks amid budget concerns. Meredith said he is negotiating a cost-sharing plan where the county will supply most of the estimated $2,000 to $5,000 daily charges for the UCSF van. Marin Supervisors Cynthia Murray and Susan Adams, who both expressed concern over the loss of the UCSF van, said yesterday they were pleased at the new development. "Mammograms can be a critical step to saving (women's) lives and catching breast cancer when it's still treatable," Murray said. Adams added it was "so important in a county where we have among the highest rates of breast cancer of anywhere in this country that we continue to have access to mammography - especially for women who are fiscally challenged."

Yolanda Gibson and Rosamaria Hayden, both of Marin Friends of Women in San Anselmo, protested the UCSF mammovan cuts at the supervisors' meeting. They said the mobile van is critical because many low-income women have child care, transportation or language issues that prevent them from getting traditional mammograms.

Marin, for reasons that have both baffled and frustrated scores of local and regional experts, leaders and residents, has one of the highest rates of breast cancer in the nation. Up-to-date figures on Marin's breast cancer rate should be available in the next few months after new data from the 2000 U.S. Census is released, Meredith said. "There will be a correction (of earlier breast cancer rate numbers) across the board, but Marin will have more of a correction than other places due to the county's homogeneity," Meredith said. Since 2001, the county health department has sponsored community forums and has established a National Breast Cancer Research Advisory Group - among other breast cancer-related projects.

The six breast cancer research projects announced were chosen from a pool of proposals submitted last year, Meredith said. The county announced a request for proposals after the national breast cancer advisory group identified research priorities for Marin. The advisory group was created after announcement last summer of the $482,396 federal grant by U.S. Sen. Barbara Boxer, D-Greenbrae, and U.S. Rep. Lynn Woolsey, D-Pet-aluma. "The excellent quality of the proposals we received shows the level of commitment researchers and community groups have to better understand this disease," said Rochelle Ereman, the county health department's chief of epidemiology. "We are confident that the projects selected have merit, will address issues of community concern and will provide valuable insight into Marin's breast cancer problem."

The projects range from a study comparing Marin's mammograms to those in San Francisco to surveys comparing Marin's risk factors with other counties in California. An Oct. 9 conference on bio-monitoring - a type of research that measures toxic chemicals carried inside human bodies by analyzing blood, urine or breast milk samples - is also included in the six projects. New technology may also be coming to Marin. Marin General Hospital officials said they are launching a $900,000 fundraising drive to support purchase of new digital mammogram machines. The digital technology - which is already in use in Marin in the UCSF mammovan - is more accurate and faster, said MGH spokeswoman Kathie Graham. "The digital system can detect up to 15 to 20 percent more tumors than traditional mammograms," Graham said. "Also, it's faster, so we will be able to do 3,400 more screenings per year in Marin." During October, Marin General will offer low-cost or free mammograms to low-income Marin women, Graham added. The hospital also has a year-round mammogram program for low-income women. For information or an appointment, call 925-7780.

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Device May Reduce Mastectomy for Breast Cancer-(Reuters Health-14/06/2004)

A new way of delivering radiation, known as balloon brachytherapy, may allow some women with breast cancer to avoid mastectomy and instead undergo an operation that spares the breast, new research suggests. Previous reports have shown that this limited surgery, called breast-conserving therapy, when followed by radiation is just as good as mastectomy at improving patient survival. Unfortunately, because radiation typically takes 6 weeks to administer and is only offered at special centers, many women are forced to undergo mastectomy simply because they don't have the time to travel to one of these centers for treatment.

Usually, radiation is given from the outside in -- that is, by an external beam of radiation. Balloon brachytherapy, by contrast, delivers radiation from the inside out, according to the report in the Archives of Surgery. The procedure involves the insertion of a balloon device, called the MammoSite catheter, through the skin incision and into the area where the cancer was removed. The balloon is then inflated and radioactive material is poured in to provide radiation to the area. After treatment is completed, the balloon is deflated and the device is removed. By reducing the radiation treatment time to just 1 week, balloon brachytherapy may help women with logistic problems of time and distance opt for breast-conserving therapy and avoid mastectomy.

In the current study, Dr. Kambiz Dowlatshahi, from Rush University Medical Center in Chicago, and colleagues describe the short-term outcomes of 112 women treated with balloon brachytherapy. The subjects adjusted quickly to the breast distension caused by the device and rated the cosmetic outcome as high. There was no evidence of cancer recurrence during follow-up. There were some complications with the new technique. Four women had a punctured or ruptured balloon that required replacement before treatment could be completed, the investigators point out. Also, seven women developed a wound infection that required drainage and antibiotics, the researchers note. Less serious complications included temporary reddening of the skin and blisters. After the device was removed, 10 women had ultrasound-detected fluid collections that were drained with a needle, Dowlatshahi's team reports. "Brachytherapy with the MammoSite catheter has distinct advantages compared with (standard radiation), including a much shorter treatment time that enables working women and those at a distance from radiation centers to consider breast conservation," the researchers conclude.

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In-depth examination of potential improvements for breast cancer screening-(11/06/2004)

A report released today by the Institute of Medicine (IOM) and the National Research Council of the National Academies provides an in-depth examination of potential improvements for breast cancer screening and detection services in the United States. The Komen Foundation supports the recommendations put forth in the report, and also stresses its continued commitment to ensuring that those who currently face a diagnosis of breast cancer have access to the best care available today. The report, Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis, categorizes its findings and recommendations into four areas: improve current application of screening mammography; integrate biology, technology, and risk models to develop new screening strategies; improve the environment for research and development; and improve the implementation and use of new technologies.

As a long-time advocate for improving and expanding options for breast cancer detection and diagnosis, the Komen Foundation has made significant inroads related to many of the issues raised in the IOM report. For example, with regard to mammography, the Foundation has been actively engaged in efforts to reauthorize the Mammography Quality Standards Act (MQSA) and the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to help reduce disparities, while also working to secure necessary changes to both programs necessary to improve patient access for all patients to quality screening services. "The focus in this report on improving the current application of screening mammography is critically important, particularly as it relates to quality assurance," said Diane Balma, J.D., director of public policy for the Komen Foundation. "The Komen Foundation has been vocal about the value of data collection and program monitoring because we believe it has greater implications for positive treatment outcomes. In fact, under the leadership of Sen. Barbara Mikulski (D-MD), Rep. John Dingell (D-MI), Sen. Judd Gregg (R-NH) and Rep. Joe Barton (R-TX), we are aiming for a federal mandate that it be studied further."

Additional ideas and recommendations put forth in the report include actions to achieve greater integration of resources for the eventual development of individualized screening strategies and to achieve maximum potential from innovative technologies, increase cooperation among stakeholder groups in order to adopt and set standards for the adoption of new technology as well as lift barriers to participation in studies, and unite research funders with private foundations to optimize the benefit of new technologies.

"More targeted, individualized risk assessments and treatments, and moving away from the widely practiced one-size-fits-all approach should greatly improve our ability to fight breast cancer," said Cheryl Perkins, M.D., senior clinical advisor for the Komen Foundation. "However while it's incredibly promising to think we might be able to develop individualized screening strategies and determine which treatments will or will not work for each individual, this is a very complex issue that will only work if changes are made to the current health care system. Overall, this is a very comprehensive report that does an excellent job of outlining barriers and possible solutions for many of the practical and scientific detection and diagnostic issues that currently surround breast cancer. It also serves as another reminder of how far the breast cancer community has come, and yet how far we have to go to move the cause forward. While we continue our quest to find a cure, we must insist on quality measures, new technologies and reducing disparities."

While investing millions of dollars annually in cutting-edge breast cancer research for the future, the Komen Foundation recognizes the urgency of helping to meet the needs of those who are facing breast cancer today. Through community needs assessments, the Foundation identifies and meets gaps in breast cancer services funding many free or low-cost screening and treatment programs, as well as numerous other patient outreach and support activities.

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Breast Cancer Factors Similar for Blacks and Whites-(Reuters Health-12/06/2004)

Having fewer children and not breastfeeding have both been shown to increase the risk of breast cancer. Now, new research indicates that the impact of these risk factors is similar for black and white women. The findings, which appear in the medical journal Cancer, also suggest that blacks could experience a more rapid rise in breast cancer rates than whites if current childbearing trends continue. Specifically, young black women seem to be having fewer and fewer children and breastfeeding rates were lower among blacks than whites.

Dr. Giske Ursin, from the University of Southern California in Los Angeles, and colleagues analyzed data from 2950 white and 1617 black women diagnosed with breast cancer between 1994 and 1998. A healthy comparison group consisting of 3012 white and 1656 black women were identified through random telephone dialing. Each pregnancy reduced the risk of breast cancer among women between 35 and 49 years of age by 10 percent in blacks and by 13 percent in whites -- not a significant difference. The risk reductions observed among older women were less pronounced, but once again similar between the racial groups. In whites and blacks, the risk of breast cancer fell as the duration of breastfeeding increased. However, breastfeeding was much less common among young black women than among their white peers. Blacks tended to have more children than whites, but in both groups there seemed to be a trend toward having fewer children.

The authors conclude that there are "only slight differences between white women and African-American women in terms of the effects of reproductive factors on breast (cancer) risk." They also point out that "breastfeeding, and doing so for a longer duration, could reduce the risk of breast (cancer) and should be encouraged, especially among young African-American women."

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Femara(R) is First Hormonal Therapy to Significantly Reduce Spread of Early Breast Cancer to Other Parts of the Body After Standard Tamoxifen Treatment in Postmenopausal Women-(PRNewswire-08/06/2004)

* Landmark MA-17 trial demonstrated significant 40% reduction in the risk of distant breast cancer recurrence post-tamoxifen (extended adjuvant)
* Femara also reduced mortality by 39% vs. placebo in postmenopausal women with early breast cancer that had spread to the lymph nodes at the time of diagnosis

New data from the landmark MA-17 study demonstrated a significant 40% reduction in the rate of distant breast cancer recurrences, or metastases, with extended adjuvant (post-tamoxifen) Femara(R) (letrozole tablets) in postmenopausal women with early breast cancer. These data were presented today during the "Best of Oncology" session at the annual meeting of the American Society of Clinical Oncology (ASCO) in New Orleans.

Distant metastases are a well-established risk factor for breast cancer death. At the median 2.5-year follow-up, a survival advantage has now become apparent in those women whose cancer had already spread to lymph nodes at the time of diagnosis (node-positive). In this group of trial participants, which comprised approximately 50% of all patients in MA-17, deaths were reduced by a significant 39% vs. placebo. Patients with node-positive breast cancer are more likely to develop distant metastases and, therefore, may be at greater risk of dying from the disease. These results from the MA-17 trial indicated that Femara is the first hormonal therapy to demonstrate a survival advantage in any population in the extended adjuvant setting.

Across the entire study population, survival differences did not reach statistical significance in this analysis. The term extended adjuvant describes the period following standard adjuvant treatment with tamoxifen. Even years after breast cancer diagnosis and primary treatment the ongoing risk of breast cancer recurrence and mortality remains significant for all patients. Extended adjuvant treatment with Femara is the first therapy to effectively address this ongoing risk.

"Overall, the results of MA-17 may provide a new option for postmenopausal women completing standard adjuvant treatment with tamoxifen," said Paul Goss, MD, PhD, director of Breast Cancer Prevention and Research, Princess Margaret Hospital, Toronto, Canada. "Treatment with Femara resulted in a marked reduction in the risk of recurrent breast cancer and the occurrence of new breast cancer. Most importantly, treatment with Femara also reduced distant metastases, which are very often fatal."

Coordinated by the National Cancer Institute of Canada Clinical Trials Group at Queens University in Kingston, Ontario and supported by Novartis, the MA-17 study evaluated extended adjuvant treatment with Femara vs. placebo in nearly 5,200 postmenopausal women with early breast cancer. The results showed that Femara significantly lowered the risk of metastases overall by 40%. At the median 2.5-year follow-up, overall survival was unchanged in node-negative patients, but reductions in local recurrences, new primary tumors, and distant recurrences were consistent with those seen in node-positive patients. The data also showed that extended adjuvant treatment with Femara reduced mortality by 39% in women with node-positive disease (P=0.035). Across all patients, 18% fewer deaths occurred with Femara, a difference that, at the median 2.5-year follow-up, had not reached statistical significance.

In addition, an improvement in disease-free survival (reduced risk of disease recurrence in the breast, chest wall, lymph nodes or metastatic sites), the primary endpoint of the study, was achieved across all patients in the Femara group. The data showed that taking Femara after standard adjuvant therapy with tamoxifen cut a woman's risk of recurrence nearly in half as compared with placebo (42% reduced risk of recurrence; including metastases, contralateral breast cancer and recurrence within or near the original site; P=0.00003).

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Exercise Shown To Improve Quality Of Life For Cancer Survivors-(Yahoo News-03/06/2004)

Every year more than 200,000 women will be diagnosed with breast cancer, but the key to survival is early detection. Of the 200,000 people diagnosed, some will die, but many more will survive. As WAVE 3's Lori Lyle reports, physical activity is improving the lives of breast cancer survivors. New research shows exercise can improve the quality of life, spirit and health among cancer survivors. Renowned exercise expert Dr. Walter Bortz studies the effects of exercise on cancer.

Bortz says it's a valuable prescription. "If you give me 100 people who put their tails down and go scurrying off, versus the 100 others who've got their tails up and said, 'I'm going to do this exercise today,' I'll bet on this gang over here with absolute confidence that they're going to do better."

Suanne is a survivor who's ready for the challenge. "I'm definietly not going to sit home," she says, "and I'm not going to collect dust."

Results from the recent study showed a 20 percent reduction in breast cancer risk held true even when exercise was started after menopause. Researchers also point out that exercise doesn't need to be strenuous, but it should consistent -- such as taking a brisk, 30-minute walk five days a week.

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Two-Gene Signature Predicts Breast Cancer Relapse-(Reuters Health-03/06/2004)

The level of two genes in breast cancer tissue can accurately identify women who are at high risk for recurrence of the disease after tamoxifen therapy, new research shows. Tamoxifen, an anti-estrogen, is often given to women whose cancer has been removed and has been shown to be sensitive to estrogen. Knowing which women are most likely to not benefit from tamoxifen would allow earlier use of alternative therapies that might be more effective. "But until now, we haven't been able to identify which of these women would be at risk for recurrence in the setting of adjuvant tamoxifen," Dr. Dennis C. Sgroi, director of breast pathology at Massachusetts General Hospital in Boston said in a telephone interview with Reuters Health.

Sgroi and his colleagues analyzed gene levels in 60 archived estrogen-receptor-positive breast tumor tissue samples. All 60 patients had been treated exclusively with tamoxifen after surgery. According to the medical records, 32 women remained free of breast cancer for an average of eight years, while 28 had a recurrence or spread of their cancer.

As reported in the medical journal Cancer Cell, the team found that the ratio of two genes- HOXB13 to IL17BR- was a strong predictor of treatment outcome. Women who had a higher level of expression of HOXB13 over IL17BR, and a low level of expression of IL17BR, had seven-fold higher odds of recurrence compared with women without this expression pattern. Sgroi told Reuters Health that the results from an independent validation sample of 20 more tamoxifen-treated breast cancer cases confirmed the predictions of the two-gene expression ratio. Also, he explained, the HOXB13 gene may play a role in tumor progression and invasiveness. This suggests that the cellular chemistry controlled by HOXB13 might be a new treatment target for breast cancer, Sgroi added. 

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Advanced breast cancer diagnosis more likely for deprived women-(Yahoo News-03/06/2004)

Are there socioeconomic gradients in stage and grade of breast cancer at diagnosis? Cross sectional analysis of UK cancer registry data BMJ Online First Women living in deprived areas of the United Kingdom tend to have more advanced breast cancer at diagnosis than those living in affluent areas, finds new research on bmj.com. Researchers analysed data on stage and grade of cancer at diagnosis for nearly 23,000 women with breast cancer in the Northern and Yorkshire region of England. Socioeconomic position was calculated using a recognised scoring method. They found strong socioeconomic trends in the likelihood of breast cancer being diagnosed at high grade or advanced stage. Women living in more materially deprived areas tended to have more advanced disease at diagnosis than those living in less deprived areas. These trends were stronger in women potentially exposed to the national breast cancer screening programme. This suggests that the programme may have led to social and economic inequalities in disease progression at diagnosis, say the authors. Further consideration of the possible impact of interventions on socioeconomic inequalities in health is needed, they conclude.

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An aspirin a day could keep breast cancer away-(Yahoo News-26/05/2004)

Regularly taking aspirin appeared to lower women's risk of developing the most common type of breast cancer, according to research published today in the Journal of the American Medical Association. The Columbia University study of 2,862 women found that those who reported taking at least one aspirin a week for six months or longer had a 20 percent lower risk of getting breast cancer than women who didn't take the commonly used pain-killer. The drug's protective effects against breast cancer seemed to be strongest among the heaviest aspirin users, those who took at least seven tablets a week.

As intriguing as these findings might seem, doctors stressed that it's too early to put women on aspirin to ward off breast cancer. That's because long-term aspirin use can have serious side effects, such as deadly stomach bleeding. And researchers would need to make sure aspirin's preventive effects hold up under a rigorous clinical trial, the gold-standard for testing a therapy's true worth. "Tomorrow, I'm not going to tell my patients they should be taking aspirin for breast cancer prevention," said Dr. William Gradishar, director of breast oncology at Northwestern Memorial Hospital. "This study is a very interesting observation, but it's nothing definitive."

Earlier studies have suggested that aspirin might have a protective role against breast cancer, but this was the first time researchers looked at the painkiller's impact on specific kinds of breast tumors. They found that aspirin only seemed to inhibit tumors that react to hormones, which make up roughly 75 percent of breast cancer cases. This kind of breast malignancy is most commonly found in women who've gone through menopause. This new insight makes the research "a landmark study," said Dr. Sheryl Gabram, director of Loyola University's Breast Care Center in Maywood. She said aspirin and similar anti-inflammatory painkillers can thwart the body's production of hormones such as estrogen, which could explain why hormone-dependent tumors were less common among aspirin users.

Gabram anticipates the study's results will prompt plenty of her high-risk patients to wonder whether they should start popping aspirin on a regular basis. "The answer is, 'No,' " Gabram said. "I'm going to tell my patients that if you need to take aspirin for other reasons - say your primary-care doctor tells you you're at high risk for cardiac disease and you should be taking a baby aspirin a day - then it might be helping to reduce your breast cancer risk, too

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Antibiotics May Raise Risk for Breast Cancer-(Washington Post-17/02/2004)

Antibiotic use is associated with an increased risk for breast cancer, a new study has found, raising the possibility that women who take the widely used medicines are prone to one of the most feared malignancies. The first-of-its-kind study of more than 10,000 women in Washington state concluded that those who used the most antibiotics had double the chances of developing breast cancer, that the association was consistent for all forms of antibiotics and that the risk went up with the number of prescriptions, a powerful indication that the link was real. A variety of experts quickly cautioned, however, that the findings should not stop women from taking the often lifesaving drugs when needed to treat infections. There could be other explanations for the association, and much more research is needed before scientists understand what the surprising results mean, they said.

"This is not saying that women should stop taking antibiotics. Women should take antibiotics for infections," said Stephen H. Taplin, a senior scientist at the National Cancer Institute who helped conduct the study. "We need to follow up and find out if this is a real association."

Nevertheless, the consistency of the findings in a study with such careful methodology could indicate that antibiotic use is an important, previously unrecognized risk factor for breast cancer, experts said. Antibiotics could increase the risk for breast cancer by, for example, affecting bacteria in the digestive system in ways that interfere with the way the body uses foods that protect against cancer, experts said. Another possibility is that antibiotics increase the risk by affecting the immune system. Even if it turns out that antibiotics do not increase the risk for breast cancer, the finding is likely to be important because it could lead to the discovery of whatever it is about women who use the drugs that appears to make them prone to the disease, researchers said. "This has opened up a picture that people had not been thinking about," Taplin said. "The important thing is more research and asking more questions about what it could be."

Until the results are sorted out, experts said, the findings provide yet another reason for doctors to more judiciously prescribe antibiotics, which are often used unnecessarily. "It's a very provocative finding, but it's not entirely clear what it means," said Roberta B. Ness, an epidemiologist at the University of Pittsburgh who co-authored an editorial accompanying the study in this week's Journal of the American Medical Association. "The first thing you have to ask is if it's real. I think a cautious interpretation is very reasonable."

The researchers tried to find other explanations for the association, such as the possibility that breast cancer is more likely to be diagnosed in women who take antibiotics because they see doctors more often. But the association remained even after they excluded that and the other most likely possibilities

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Cholesterol Drugs May Cut Breast Cancer Risk-(Reuters Health-26/04/2004)

Treatment with cholesterol-lowering drugs, such as Lipitor and Zocor, does not increase the risk of breast cancer in women past menopause, new research suggests. On the contrary, the data suggest that long-term use of such drugs, called statins, may actually reduce the risk of breast cancer, according to the findings in the journal Cancer. "The current study results both provide reassurance concerning the safety of statin use among older women and support the emerging evidence that statins may" protect against breast cancer, the Seattle-based investigators conclude.

There are conflicting reports on the risk of cancer associated with statins, Dr. Denise M. Boudreau from the Center for Health Studies, Group Health Cooperative, and colleagues note in their report. They therefore investigated the association between breast cancer and statin use in a study involving 975 older women with breast cancer and 1007 without the disease. "We found no evidence of an increased risk of breast carcinoma among statin users," the authors report. In fact, current users who had taken statins for more than 5 years had a 30-percent lower risk of breast cancer compared with non-users.

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Should women try gene testing at time of breast cancer diagnosis?-(Yahoo News-19/04/2004)

Jeannine Salamone was just 30 when genetic testing made her abandon hope that removing the aggressive tumor growing in one breast would be treatment enough. She switched to a double mastectomy. "Granted, that was a tough decision," she says. "It was pretty clear to me I didn't want to go through the rest of my life worried about another breast cancer."

Salamone was unusual: Few women today are offered genetic testing soon after a diagnosis of breast cancer. More often, they recover from the first tumor and then decide whether to learn if they're at risk for additional cancer fueled by the notorious BRCA genes. Why? Testing can take two months; most patients don't want to delay treatment. And doctors have feared overwhelming patients with such a complex topic at an already traumatic time. But new rapid testing can speed results in just 10 days — and now a study evaluating that option among the newly diagnosed shows learning gene status does affect women's treatment choices.

Women who harbored a BRCA mutation were twice as likely as noncarriers to choose double mastectomy, says research published this month in the Journal of Clinical Oncology. It's a much more aggressive operation than the breast-sparing surgery many of these women could have considered for their current tumors. But it greatly reduces the risk of later cancer in the other breast. Moreover, it's a decision the women eventually would have faced had they undergone later gene testing, which means earlier testing potentially can reduce the number of trips to the operating room. So the Georgetown University researchers are recommending that oncologists ensure the newly diagnosed know that gene testing is an option and help those who want it to get the necessary genetic counseling quickly.

The recommendation will be hard to follow, cautions Dr. Mary Daly of Philadelphia's Fox Chase Cancer Center. Rapid BRCA testing can cost over $4,000, more than the usual $2,900 bill for slower testing. Insurance usually covers the routine slow test for appropriate candidates, but rarely pays for the rapid version. So rapid testing is rare outside of studies, like Georgetown's, that offer it without charge. Also, genetic counselors still are uncommon on oncology teams, and many surgeons consider preventive mastectomies very contentious. But because BRCA mutations bring up to a 60 percent risk of later cancer in the other breast, learning gene status and taking protective steps might save people's lives, Daly says, urging oncologists to work to overcome testing barriers. "With some clinical judgment, with a lot of support, some women should be able to handle this" decision on top of a cancer diagnosis, she adds. "It's perhaps a little paternalistic to suggest they can't."

Some 211,000 American women will be diagnosed with breast cancer this year. Only 5 percent to 10 percent will have a hereditary form. Women who inherit mutations in the BRCA1 or BRCA2 genes are three to seven times more likely than average women to get breast cancer. They're also at greatly increased risk of ovarian cancer. Top candidates for BRCA testing have several first-degree relatives who've had cancer or who contracted their cancers at unusually early ages.

Georgetown's questions: Do women want gene testing amid the trauma of a cancer diagnosis? Aside from understanding the science, a positive test means the woman's mother, sisters or daughters could have the risk, too. If they do want testing, what do the newly diagnosed do with the information? Treating the initial tumor is no different; the quandary is how to reduce the risk of later cancer in the other breast. Options: Removing the ovaries cuts a premenopausal BRCA carrier's risk of breast cancer as well as ovarian cancer. The anti-cancer drug tamoxifen helps some women. They can get frequent cancer screening. Or they can remove both breasts. Georgetown studied 194 newly diagnosed cancer patients referred for BRCA testing who had not undergone definitive treatment for the first tumor. A surprising 48 percent of those who tested BRCA positive chose preventive double mastectomy. So did 24 percent of women in whom no mutation was detected, patients whose doctors had urged removing both breasts or who weren't reassured because cancer runs in their families. After all, presumably there are breast cancer genes yet to be discovered.

The researchers didn't urge a mastectomy, stresses co-author and oncologist Dr. Claudine Isaacs. "For some women it's the right choice," she said, "and for others it's not the choice they want to make then but to revisit down the road."

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Radar Research Leads to New Breast Cancer Treatment- (HealthDayNews-21/04/2004) 

MIT radar research originally focused on detecting missiles in space is the basis for a new breast cancer treatment that shows promise in the final phase of clinical testing. In this treatment, external microwave energy is directed at tumors before a women has a lumpectomy to kill tumor cells and reduce the need for more surgery after the lumpectomy. The preliminary results of the study found women who had this new treatment before a lumpectomy had a 43 percent reduction in the incidence of cancer cells found close to their lumpectomy surgical margins. Women who have cancer cells close to the edge of the lumpectomy surgical margin often require additional surgery and/or radiation therapy. 

These preliminary results are based on 64 women who have completed the study. The results will be presented April 21 at the International Congress on Hyperthermic Oncology in St. Louis. "One of the primary objectives of this randomized study is to demonstrate that heat can affect and kill early-stage breast cancer cells prior to surgery," principal investigator William C. Dooley, director of surgical oncology at the University of Oklahoma Breast Institute, said in a prepared statement. With this focused heat treatment, it may be possible for the surgeon to provide better margins for the patient and possibly avoid additional treatment procedures and avoid recurrence of the cancer." 

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Study finds certain compounds in beer, wine effective in slowing breast cancer cell growth-(Yahoo News-19/04/2004)

Numerous studies have been published showing that consuming alcohol increases the risk for breast cancer. That's what makes a new research finding from Portugal so intriguing. The study has determined that certain compounds found in wine, beer (and tea) have contributed to a significant decrease in breast cancer cell proliferation.

Numerous studies have found that regular, moderate use of alcohol affects the levels of important female hormones, especially for postmenopausal women whose bodies make much less estrogen and progesterone than before they entered menopause. As a consequence, women's breast cells are exposed to higher levels of estrogen if alcohol was consumed. This may in turn trigger the cells, which are estrogen sensitive in such women, to become cancerous. Phenolic phytochemicals are widely distributed in the plant kingdom. In various experiments, it has been shown that selected polyphenols, mainly flavonoids, confer protective effects on the cardiovascular system and have anticancer, antiviral and antiallergic properties. Flavonoids are low molecular weight compounds composed of a three-ring structure with various substitutions, which appear to be responsible for the antioxidant and antiproliferative properties. It is well known that consumption of red wine in moderation is associated with reduced risk of cardiovascular disease. Many believe that the low incidence of coronary artery disease found among the French could be partially related to the pharmacological properties of polyphenolic compounds present in red wine.

Three researchers from the Universidade do Porto, Portugal set out to examine whether phenolic compounds could have properties that would be effective in fighting breast cancer, the most commonly diagnosed nondermatologic cancer and the second leading cause of cancer-related deaths among women in the United States. They investigated the effect of three phenolic compounds -- epigallocatechin gallate (EGCG), xanthohumol (XN) and resveratrol (RES) -- substances present in significant concentrations in tea, beer and red wine, respectively, on the growth of a human breast cancer cell line, MCF-7.

The cell line (MCF-7) was cultured in appropriate medium, in different cell plates, under control conditions or in the presence of any of the three polyphenols: EGCG, XN or RES. Various concentrations and various time periods of treatment were tested for each compound. At the chosen time points, the cells were taken off the plates and counted in a Neubauer chamber after exposure to tryptan blue (0.4 percent). The colorant is excluded from live cells, and so the method allows simultaneously quantifying the number of cells (index of proliferation) and cytotoxicity (ratio between dead and live cells). In other experiments, 3H-thymidine incorporation was evaluated in each time and treatment condition, indicating the effect of treatment on DNA synthesis. All three polyphenolic compounds tested showed a significant effect, decreasing breast cancer cells proliferation. The effects were observed both over the number of cells after each time period, and over 3H-thymidine incorporation. Cytotoxicity depended on the compound concentration and duration of treatment.

XN, found in beer, was the most potent polyphenol over breast cancer cell growth: it showed its effect more rapidly and at a lower concentration (24 hours, one to 10 μM). On the other hand, cytotoxicity was observed only at 50 to 100 μM concentrations, and usually after longer time periods. XN IC50 for 3H-thymidine incorporation, at 24 h of treatment, was found to be 18.3 μM.

RES did also show an anti-proliferative effect over the growth of the breast cancer cell line, albeit with less potency than XN: at 24 hours, treatment anti-proliferative effect was significant only for the higher tested concentrations, 50 and 100 μM.

On the other hand, the effects of RES over 3H-thymidine incorporation were not in linear correlation with the effects over cell number, indicating that it is probably acting on more than one biochemical event. Its IC50 for 3H-thymidine incorporation decrease, at 24 hours treatment, was found to be 71.2 μM.

EGCG showed an inhibitory effect upon cell growth, but was less potent than XN and RES. Only at the highest concentration tested, 100 μM, the proliferative inhibitory effect was statistically significant after 24 hours of treatment. At 50 μM, the inhibitory effect was significant only after 72 hours exposure. On the other hand, EGCG showed no cytotoxicity.

The researchers concluded that three polyphenolic compounds, EGCG, XN and RES, known to be abundant in tea, beer and red wine, respectively, when present in the nutritive medium of a breast cancer cell line (MCF-7), were all able to reduce cell proliferation. These effects could be observed at concentrations that were not cytotoxic. A decrease in 3H-thymidine incorporation, a commonly used index of DNA synthesis, was also observed in the presence of the compounds, very much in correspondence with the anti-proliferative effect in the case of XN. EGCG, in this selection of polyphenols, was the least potent on a weight basis, although that may have no therapeutic meaning since it was also the least toxic compound (i.e. it can be given in higher doses). These biochemical results, over breast cancer cells, add support and meaning to epidemiological studies that relate consumption of certain beverages with a lesser incidence and prevalence of cancer.

This study does not call for women to increase alcohol consumption as a means of breast cancer prevention. The authors state that their findings suggest that further studies, namely in vivo studies, are necessary to fully support the inclusion of these compounds and/or beverages in diet recommendations in the perspective of cancer prevention.

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New HRT research suggests it is safer than previously reported-(Yahoo News-15/04/2004)

New research showing that oestrogen-only hormone replacement therapy (HRT) used to treat the effects of menopause could reduce the risk of breast cancer provides "food for thought", Wellington Menopause clinic director Bev Lawton says. Dr Lawton said she did not expect the Health Ministry to change its HRT advice on the basis of the study but said it was something they would need to look at. After earlier studies such as the Million Women Study highlighted the risks of HRT, the ministry changed its advice to say women on the treatment should be reviewed six-monthly, and HRT should be taken at the lowest dose for the shortest period of time.

The studies showed the risks of HRT outweighed the benefits for everything other than for short-term use to relieve moderate to severe symptoms of menopause. However, the latest research -- a United States study of 11,000 women -- paints a different picture showing a non-significant decrease in breast cancer risk. Dr Lawton said it was too early to suggest the ministry should change advice. "I don't think anyone will be changing its advice at the moment I think we need to spend a lot of time actually studying the result before we do that. It appears to be less risk with oestrogen alone. We are already saying there is a slightly increased risk of stroke but there are some perplexing results here that are different from the other study."

The Women's Health Initiative (WHI) study found fewer women who used oestrogen-only HRT developed breast cancer than those taking a placebo. The women on the treatment had had hysterectomies and were not being treated for menopause symptoms -- such as hot flushes and night sweats. Often progesterone is used in combination with oestrogen to treat symptoms. Dr Lawton said further analysis could look at how HRT affected the development of osteoporosis among other things. "It's very interesting though because there is this unexplained trend toward reduced breast cancer. It does tend to implicate the progesterone that was used in the other study, but we've stopped using that largely anyway."

Following the previous Million Women Study the number of women using combined HRT dropped drastically worldwide. Dr Lawton said whatever the advice for some women the benefits of using HRT outweighed the risks

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Smoking-Breast Cancer Risk Even Stronger-(Yahoo News-06/01/2004)

A new study indicates that active smoking may play a much larger role in increasing breast cancer risk than previously thought. The research shows women who smoke have a much higher risk of developing breast cancer compared with women who have never smoked. Researchers say tobacco smoke contains a number of known carcinogens (cancer-causing agents), and by-products of cigarette smoke have been found in the breast fluid of smokers. But studies on the link between breast cancer and smoking have produced inconsistent results because they did not separate the effects of contributing factors such as passive or secondhand smoke exposure, age of breast cancer diagnosis, family history of breast cancer, and if the woman was a smoker at the time she was diagnosed with breast cancer.

In the study, published in the Jan. 7 issue of the Journal of the National Cancer Institute, researchers looked at breast cancer risk among 116,544 women in the California Teachers Study who reported their smoking status. Between 1996 and 2000, 2,000 of the women developed breast cancer. The prevalence of breast cancer among current smokers was 30% higher than the women who had never smoked -- regardless of whether the nonsmokers had been exposed to secondhand or passive smoke. In fact, breast cancer risks among people who never smoked that reported exposure to secondhand in the household were not greater than those found among never smokers without such exposure.

Among current smokers, the risk of breast cancer was significantly higher among those who started smoking before age 20, who began smoking at least five years before their first full-term pregnancy, and who had smoked for longer periods of time or smoked 20 or more cigarettes per day. Current smoking was associated with a higher risk of breast cancer among women with no family history of breast cancer, but not among those with a family history of the disease.

Researchers say their results indicate that active smoking may play an important role in increasing the risk of breast cancer and merit further research into the connection.

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Stem cells 'fail in cancer care'-(Yahoo News-10/04/2004)

Stem cell transplants do not benefit patients with breast cancer, research has shown. Studies had suggested they improved the success of chemotherapy in patients with breast tumours. But Swiss research, published in the journal Annals of Oncology, found the transplants had failed to live up to early hopes. However the transplants do help some patients with blood cancers, as the illnesses react differently. 

Stem cell transplants have been used in cancer treatments as a way of trying to enable the body to cope with high doses of chemotherapy and radiotherapy. Both treatments can severely damage bone marrow cells because they, like cancer cells, reproduce rapidly. This prevents the body from being able to make the blood cells needed to carry oxygen, defend against infection, and prevent bleeding. In a bone marrow transplant, marrow containing healthy stem cells is given to patients to replace damaged cells. It was hoped that using stem cell transplants to boost the bone marrow supply would allow tumours to be treated with one big dose of chemotherapy, rather than a series of smaller doses. Stem cells are the body's master cells, with the ability to become many different types of tissue.

An international research team has looked at transplant numbers in Europe since 1991. They found that the use of stem cell transplantation in breast cancer treatment soared in the early and mid 1990s. Nearly 28,000 transplants were carried out for various types of solid tumours in Europe between 1991 and 2002. Breast cancer accounted for around half of the procedures (more than 13,500). The number of transplants given to breast cancer patients rose from 94 in 1991 to 2,629 in 1997. But, from that year, numbers fell sharply as studies revealed stem cell transplants had little benefit. In 2002, just 330 breast cancer patients received stem cell transplants.

Professor Alois Gratwohl from the Department of Internal Medicine at Kantonsspital Basel in Switzerland, who led the research, said: "Most recent results remain ambiguous and the value of stem cell transplant in breast cancer still needs to be determined in selected categories. What is encouraging is that the fall in the numbers of stem cell transplants illustrates that doctors have been quick to react to the negative findings in the trials and to share that information."

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Scientists Strive for Breast Cancer Vaccine-(HealthDayNews-04/04/2004) 

The prospect of breast cancer vaccines, from ones that would attack the cancer to others that would prevent it, generates tremendous hope among cancer patients and their doctors. But the reality, researchers say, is at least a decade away. "Probably dozens of breast cancer vaccines are under study," says Dr. Robert Vonderheide, an assistant professor at the Leonard and Madlyn Abramson Family Cancer Research Institute at the University of Pennsylvania. "It has been a huge area of research for a long time," he adds. "It's a goal over the next decade to have a vaccine against breast cancer. But it's important to recognize how long this will take."

To understand the urgency for a cancer vaccine, consider that the immune system doesn't see tumors as dangerous, so it fails to mount an aggressive attack against them, cancer experts say. Vaccines that are being designed to treat existing cancers are called therapeutic vaccines, while those intended to prevent cancers are known as prophylactic vaccines, the National Cancer Institute (NCI) says. Most therapeutic vaccines under development -- including those not just for breast cancer but for other cancers such as melanoma, lung, ovarian and prostate tumors -- focus on "kick-starting" the immune system. The goal: to prevent the further growth of existing cancers, block the recurrence of treated cancers or kill cancer cells not destroyed by previous treatment.

Currently, the only cancer-related vaccine approved by the U.S. Food and Drug Administration is a prophylactic vaccine for the hepatitis B virus, which is associated with liver cancer. Yet, several breast cancer vaccines show preliminary promise. If the research bears fruit, it may be possible some day to administer such a vaccine to women at high risk for breast cancer. "The majority [of breast cancer vaccines under study] are in the early stages," says Dr. Teresa Gilewski, a medical oncologist on the breast cancer service at Memorial Sloan-Kettering Cancer Center in New York City.

The first step is to perfect a therapeutic vaccine or vaccines that would treat women with breast cancer by preventing a recurrence of their disease or shrinking their tumors, Gilewski says. Once that goal has been reached, researchers can focus on preventive vaccines, she says. Using vaccines to treat breast cancer is still considered experimental, so there are several different approaches under review.

Vonderheide and his team, for instance, are studying the effectiveness of a telomerase peptide as a vaccine. "Telomerase is an enzyme," explains Vonderheide. "Tumor cells have more telomerase than found in normal cells. Our vaccine is designed to generate a particular kind of white blood cell." These blood cells should, in theory, attack the telomerase in the cancer cells, killing off the tumor, he says. Vonderheide has started a Phase I clinical trial to evaluate the effectiveness of a telomerase peptide as a vaccine. The study will measure potential tumor cell shrinkage in women after an immune response has been triggered to the telomerase peptide, which is found in more than 90 percent of breast cancer tumors, the researchers say.

The type of therapeutic vaccine under review by Vonderheide falls under the category of antigen/adjuvant vaccines, the NCI says. These antigen vaccines use specific protein fragments or peptides to mobilize the immune system. Sometimes the antigens are combined with another substance -- known as an adjuvant -- that triggers an immune response. Sometimes vaccines are made by taking cells from a patient's own tumor or from the tumor of other patients, and then these vaccines are used to bring about an immune response.

There are still other approaches, such as taking specialized white blood cells, known as dendritic cells, from a patient's blood through a process called leukapheresis. In a laboratory, these cells are stimulated with the patient's own cancer antigens, grown and then re-injected into the patient. The vaccine then activates cancer-fighting T-cells in the immune system, causing them to multiply and attack tumor cells that produce the antigen.

Gilewski's team is testing breast-cancer vaccines using a variety of synthetic antigens. "Antigens can come from the patient's own tumor or from others' tumors," Gilewski says. Antigens can be peptides, proteins, carbohydrates, DNA or other substances, she says. "There may be numerous antigens in the same vaccine," she adds. Whatever the antigen or antigens, she says, "you are giving the immune system something to react to."

Dr. Herman Kattlove, a spokesman for the American Cancer Society, calls the concept of breast cancer vaccines "wonderful." If cancer is to be cured when surgery doesn't work, he adds, "some kind of immunologic method will be necessary." But he, too, cautions that vaccines are at early stages. Vonderheide agrees. "There are many roadblocks and many questions to be answered," he says.

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OXiGENE Announces Positive Pre-Clinical Results for OXi4503 in Cancer Models-(Business Wire-29/03/2004)

OXiGENE, Inc. today announced the presentation of new data showing pre-clinical efficacy of the Company's lead second-generation vascular targeting agent (VTA), OXi4503, in several human cancer models. The results of these studies will be detailed this week in poster presentations at the American Association for Cancer Research's (AACR) 95th Annual Meeting in Orlando, Florida. Professor Klaus Edvardsen, M.D., Ph.D., of Lund University in Sweden will present a poster on his study evaluating the synergistic effects of OXi4503 with standard-of-care chemotherapy drugs Carboplatin and Paclitaxel in the MDA-MB-231 human breast adenocarcinoma and the ES-2 ovarian carcinoma models grown in mice. "At doses ranging from 10 to 50mg/kg, OXi4503 significantly enhanced the anti-tumor effects of the chemotherapeutic agents," said Dai Chaplin, Ph.D., OXiGENE's chief scientific officer and head of research and development. "At doses above 10 mg/kg tumor growth was completely repressed, while doses above 25 mg/kg actually triggered tumor regression."

In another study, researchers concluded that OXi4503 not only shuts down blood flow to tumors, but also might play a direct role in killing tumor cells, suggesting that the VTA could be used as a single agent therapy. Conducted by the University of South Florida in Tampa and the University of Florida in Gainesville, the study measured OXi4503's pre-clinical efficacy and histopathologic effects in rodent KHT and human KSY sarcoma models as well as in a Caki-1 model of human renal cell carcinoma. Using image analysis, researchers determined that, 24 hours after treatment with a 25 mg/kg dose of OXi4503, less than six percent of the KHT tumor cells remained viable. While cell death was evident in skeletal muscle infiltrated by the tumor, "adjacent uninvolved muscle and soft tissue remained viable," researchers said. The compound also caused significant delays in tumor growth. "The data from these studies is both impressive and encouraging, suggesting that OXi4503 has a distinct mechanism of action and potentially potent anti-tumor effects," said Fred Driscoll, OXiGENE's president and chief executive officer. "Additional studies are underway to further evaluate OXi4503 in vitro and in vivo, and we are well on the way toward our goal of bringing this compound into the clinic."

Cancer Research UK, the world's largest volunteer-sponsored cancer research organization, is completing pre-clinical toxicology testing on OXi4503 with plans to move the compound into Phase I clinical trials in late 2004.

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Studies: Fight Cancer With Exercise-(Yahoo News-29/03/2004)

There's more evidence that exercise is a powerful weapon against breast and other types of cancer. NewsCenter 5's Liz Brunner reported that three new studies all point to a link between even moderate amounts of exercise and real protection against life-threatening illness. Nobody had to convince Kristen Pluntze to exercise after her breast cancer diagnosis five years ago. She started working out again soon after her mastectomy. "It's been a huge part of my recovery. It healed me not only physically, but emotionally," she said.

Pluntze said that exercise helped her heal faster and cope with the side effects of chemotherapy and radiation. Now, research suggests another benefit. "Even modest levels of exercise, even one hour walking per week, was shown to improve survival after breast cancer diagnosis," Dana Farber Cancer Institute Dr. Wendy Chen said. The evidence comes from the ongoing Nurses' Health Study. Preliminary data shows the risk of death from breast cancer was 19 percent less among women who exercised just one hour per week.

Chen points out that women with breast cancer often survive that disease, but suffer from diabetes, heart disease, and other life-threatening illnesses. Exercise can reduce all of those and give patients a sense of power and control. "It gives them something they can do proactively aside from the treatment or medical-related issues," Chen said.

"To know that you can actually do something healthy for yourself on a daily basis, or even just every other day, it improves your outlook on life and physical well-being," Pluntze said.

Exercise also seems to have an effect on another women's cancer -- endometrial. Chinese researchers found walking or doing household chores for just one hour per day can reduce a woman's risk of endometrial cancer by 30 to 40 percent. A third study shows that exercise can decrease levels of proteins in the blood associated with cancer risk.

It's all the more reason for all women to get moving. "Once you get the OK from your doctor after surgery, I mean, go for it," Pluntze said.

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Physical activity and survival after breast cancer diagnosis-(AACR Annual Meeting)

Researchers from Brigham and Women's Hospital and Harvard University tested the hypothesis that physical activity increases survival rates among women with breast cancer. "We already knew that exercise improves the quality of life after a breast cancer diagnosis," said lead investigator Michelle D. Holmes, M.D., Dr.P.H., "but little is known about how physical activity affects survival."

Holmes and her team drew on participants in the Nurses' Health Study, reviewing data on women with stages I, II, and III breast cancer, diagnosed between 1984 and 1996. In that study, leisure-time physical activity is measured in metabolic equivalent task hours per week (met-hours/week – one met is the energy expenditure and caloric requirement at rest. One hour of walking represents three met-hours of physical activity.) The researchers looked specifically at exercise beginning two years after diagnosis, in order to avoid inclusion of women undergoing treatment. The cohort of 2,296 women were followed from 1986 until either their death from breast cancer or June 2002, whichever came first.

Taking into account the stage of disease, obesity and other factors, the relative risk of death from breast cancer was decreased with every level of physical activity compared with being sedentary. The risk of death from breast cancer was 19 percent less among women who undertook 3-8.9 met-hours/week of exercise; 54 percent less for 9-14.9 met-hours/week; 42 percent less for 15-23.9 met-hours/week; and 29 percent less for 24 or more met-hours/week of recreational exercise.

"We were able to show that even a moderate amount of physical activity improved the odds of surviving breast cancer," Holmes said. "It is especially heartening for women recovering from breast cancer to know that the benefit is as readily accessible as walking for 30 minutes on most days of the week."

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Effect of a yearlong exercise intervention on markers of inflammatory response among postmenopausal women-(AACR Annual Meeting)

Another approach to the association between exercise and cancer survival and prevention was presented by researchers from the Fred Hutchinson Cancer Research Center in Seattle, led by Cornelia M. Ulrich, PhD. C-reactive protein (CRP) and serum amyloid A (SAA) are signals for inflammation that have been associated with cancer risk and survival. Knowing that these biomarkers often are elevated among the overweight, the team investigated the effects of a moderately intense, yearlong exercise program on CRP and SAA. The study population consisted of 114 postmenopausal, overweight (body mass index greater than 24) and sedentary women, ages 50 to 75. About half of these performed moderate physical activity 45 minutes per day, five days a week, for one year, while the other half participated in weekly stretching exercises. The concentrations of CRP and SAA in their blood were measured at the beginning and the end of the test period.

"Among obese women, those with a body mass index of 30 or higher," Ulrich reported, "concentrations of CRP declined steadily over the course of the year from a baseline of 0.40 milligrams per deciliter to 0.32 milligrams. This effect of exercise on inflammatory markers may help to explain in part the associations observed between increased physical activity and reduced risk for cancer and other chronic disease."

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New paclitaxel analog kills more cancer cells than natural product-(Yahoo News-29/3/2004)

A multi-university research team led by Virginia Tech University Distinguished Professor of Chemistry David G.I. Kingston has succeeded in enhancing the structure of paclitaxel (TaxolTM) to make it more effective in killing cancer cells. Having determined how paclitaxel fits into a cancer cell's reproductive machinery, the team is optimistic that simpler molecules can be designed as future medicines. 

Paclitaxel, a natural compound from yew trees, is a relatively scarce resource, but synthetic forms and analogs have, so far, been less effective. So scientists have continued to study how the paclitaxel molecule works in order to develop more effective products. Kingston explains that paclitaxel binds to tubulin, a protein molecule that forms the backbone of microtubules. Microtubules are a cell component whose duties include allowing chromosomes to move into the correct position for the cell to divide into two daughter cells. "When paclitaxel binds to tubulin, it stabilizes the microtubules and messes up the equilibrium between tubulin and microtubule," says Kingston. "A cell with stable microtubules proceeds to programmed cell death without dividing,"

How does paclitaxel bind to tubulin? There is a binding pocket in the protein into which part of the paclitaxel molecule fits. This binding pocket has been visualized by some elegant electron crystallography experiments carried out by scientists at the Lawrence Berkeley National Laboratory (Nogales et al., Cell, 1999, 96, 79). Paclitaxel consists of a rigid ring system attached to a flexible side chain, but the exact arrangement of the side chain in space is not known. Kingston explains, "The issue has been, what is the shape or orientation of the side chain when paclitaxel is sitting on the microtubule? If we could figure that out, we could design a molecule that would plug in better than paclitaxel for better binding and possibly better activity against cancer. What is the right conformation of the side chain?"

One hypothesis was put forward by Jim Snyder of Emory University. Based on a computer model of the paclitaxel binding site, he proposed a particular orientation of the side chain. Kingston, his colleagues, and Snyder then designed molecules with bridges between the ring and the side chain. "We thought that if we linked the bridge in the right position, maybe it would hold the side chain in the right place," Kingston says. It wasn't a new idea. Gunda Georg of the University of Kansas and Iwao Ojima of the State University of New York (SUNY) Stony Brook both made bridged paclitaxel derivatives, but these were all less effective than natural paclitaxel. Kingston collaborated with Snyder and Susan Bane of SUNY Binghamton to design a paclitaxel analog that linked in a new way. "We synthesized a number of the compounds and refined the details of how the link is formed until, last summer, we were able to get activity as good as paclitaxel."

Presently, their best compound is about 20 times more active in one assay, or biological test measuring the analog's ability to kill cancer cells. In another assay, the compound is one and a half times more active; and in a third assay, it is three times more deadly to cancer cells. "In measurements of interaction with tubulin, it is two to three times more active than paclitaxel," Kingston says. The research is significant because it has validated Snyder's model, provided a more exact picture of the shape that paclitaxel takes in order to bind to tubulin, and "it offers the exciting possibility that now that we know that shape, we can design simpler molecules with a similar shape, which is what we are doing now," Kingston says.

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Computer Program Evaluates Breast Cancer Risk-(Reuters-22/05/2004)

Scientists have developed a computer program to evaluate a woman's individual risk of developing breast cancer. Charity Cancer Research UK said the IBIS risk evaluator uses information about a woman's family history of the disease to determine whether she has a genetic propensity to develop it. Other factors including age, height, weight, use of hormone replacement therapy (HRT) and whether a woman has had children are included to give a projected risk. "For many women, particularly those who have a relative affected by breast cancer, it's their biggest health concern," said Professor Jack Cuzick, head of the research team. 

IBIS is not the first computer program to evaluate the risk of breast cancer but Cuzick said it models more carefully what scientists know about the disease and includes more risk factors. Although the program was originally developed to find women with a high risk of breast cancer to take part in the IBIS cancer prevention trial, its developers realized it would have a broader appeal because breast cancer it is such a common cancer. "This tool will initially be available only to doctors. In the longer term we do see something that would potentially be available for the population at large," Cuzick added in an interview. 

The program gives a woman's individual chance of suffering from breast cancer as a percentage along with the average risk. Patients with a high risk are given guidance and advice about weight loss, use of HRT and screening programs to detect earlier signs of the disease. They can also join the IBIS trial to determine whether the drug anastrozole, which is used to treat cancer, can also prevent the disease in high risk women. Anastrozole, which is made by AstraZeneca PLC under the brand name Arimidex, has already been shown to be as good or better than the drug tamoxifen in older women with hormone sensitive tumors. 

Details of the IBIS program are reported in the journal Statistics in Medicine. Cuzick said IBIS is already used in hospitals in Britain, the United States and Australia and could be made more widely available soon. There are also plans to use the program to evaluate the risk of other illnesses such as heart disease and different types of cancer. "We see it as the first step toward a project providing information to both men and women of their risk of major diseases and what they might do," said Cuzick. "Rather than having health education that is blanketed to everyone, this would be personal, individualized information as to what your personal risk factors are based on your personal history." 

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FISH technology reduces cost of therapy in breast cancer: Study- (PharmaBiz-24/03/2004)

A study published in the Journal of Clinical Oncology suggests that targeted therapy for women with HER-2 positive metastatic breast cancer is more effective and less costly when fluorescence in situ hybridization (FISH) technology is used to determine a patient's HER-2 gene status. The study, a cost-effectiveness model developed by the Harvard University Center for Risk Analysis and School of Public Health, the Dana-Farber Cancer Institute, and Beth Israel Deaconess Medical Center, compared the use of FISH testing alone with its use in confirming the results of immunohistochemistry (IHC) testing to identify candidates for Herceptin (trastuzumab) therapy. The study states that the effectiveness of targeted therapeutic intervention depends on the identification of potentially responsive patients.

"Our analysis demonstrates the importance of considering both testing and treatment when estimating the cost-effectiveness of a biologically targeted intervention," wrote the authors of the study. "From a societal perspective, the diagnostic performance of the test used to identify trastuzumab candidates has considerable influence on cost-effectiveness, independent of test cost, due to the high cost of treating patients with false-positive test results and the missed opportunity for patients with false-negative test results to benefit from trastuzumab."

In clinical practice, HER-2 status is determined with IHC testing to detect protein overexpression and FISH is used to detect gene amplification. Currently, two IHC test kits (HercepTest and Pathway) and one FISH assay (Abbott's PathVysion) have U.S. Food and Drug Administration (FDA) approval for the selection of trastuzumab patients. The study concludes that it is more cost-effective to use the FISH method alone or as confirmation of all positive IHC results, rather than using FISH to confirm only weak positive results or using IHC testing alone. "When multiple tests are available to identify treatment candidates, test characteristics may have a substantial impact on aggregate costs and effectiveness of treatment," the authors wrote.

Supported by a grant from the National Library of Medicine Research Training Program in Medical Informatics, the study was based on an analytical model designed to simulate clinical practice and estimate the incremental cost-effectiveness of different test methods currently used to identify and treat women with HER-2 positive metastatic breast cancer. The model simulated treatment outcomes in a hypothetical group of 65-year-old women newly diagnosed with metastatic breast cancer. "This seminal study highlights the importance of pharmacogenomic testing of patients to identify those most likely to respond to a particular treatment and the clear need to consider all components of patient management before formulating conclusions about cost," said Steven Seelig, M.D., Ph.D., divisional vice president, molecular diagnostics research and development, Abbott Laboratories. "Personalized medicine, using therapies targeted to specific patient populations identified by molecular tests, are critical to the cost-effective practice of medicine. FISH plays an important role in the personalized medicine paradigm and specifically in the fight against breast cancer."

The presence of multiple copies of the HER-2 gene on a single chromosome, called "gene amplification," leads to overexpression of the HER-2 protein, which plays a pivotal role in the rapid growth of tumor cells. Accurate determination of HER-2 gene status is critical for determining therapeutic options. Women with HER-2 positive breast cancer experience resistance to certain therapies and decreased survival and are potential candidates for Herceptin, which is designed to block cell growth stimulated by the HER-2 protein. Herceptin is a monoclonal therapy that specifically targets tumor cells that overexpress the HER-2 protein. Among the 20 to 30 percent of metastatic patients who are HER-2 positive, trastuzumab combined with chemotherapy significantly improves overall response rate, time until disease progression, and overall survival, compared to chemotherapy alone.

PathVysion is the only FISH-based test the FDA has approved for inclusion in the Herceptin package insert for the selection of patients who may respond to treatment. Using FISH technology, Abbott's PathVysion test is designed to detect amplification of the HER-2 gene in breast cancer tissue. In addition to Herceptin therapy selection, PathVysion is also FDA approved for assessing patient prognosis and response to Adriamycin-based therapies. PathVysion FISH measures the number of copies of the HER-2 gene at the DNA level. Using fluorescent colors and a microscope, physicians count the actual number of HER-2 genes present in the cell nucleus. The common alternate HER-2 testing method, IHC, measures the HER-2 protein overexpression on the surface of the cell, and is subjectively scored. In comparison, FISH technology offers objective, quantitative results.

In 2003, the National Comprehensive Cancer Network updated its Practice Guidelines in Oncology to indicate that FISH, the diagnostic technology used in Abbott's PathVysion test, may be more accurate than IHC. The organization's guidelines are widely recognized and used as the standard for clinical policy in cancer care, and are the only comprehensive set of guidelines updated annually by any national organization in any area of medicine. The PathVysion HER-2 DNA Probe Kit is designed to detect amplification of the HER-2/neu gene via FISH in formalin-fixed, paraffin-embedded human breast cancer tissue specimens. Results from the PathVysion kit are intended for use as an adjunct to existing clinical and pathologic information currently used as prognostic factors in stage II, node-positive breast cancer patients. The PathVysion kit is further indicated as an aid to predict disease-free and overall survival in patients with stage II, node positive breast cancer treated with adjuvant cyclophosphamide, doxorubicin, and 5-fluorouracil (CAF) chemotherapy. The PathVysion kit is indicated as an aid in the assessment of patients for whom Herceptin treatment is being considered.

PathVysion is not intended for use to screen for or diagnose breast cancer. It is intended to be used as an adjunct to other prognostic factors currently used to predict disease-free and overall survival in stage II, node-positive breast cancer patients and no treatment decision for stage II, node-positive breast cancer patients should be based on HER-2/neu gene amplification status alone. Selected patients with breast cancers shown to lack amplification of HER-2/neu may still benefit from CAF (cyclophosphamide, doxorubicin, 5-fluorouracil) adjuvant therapy on the basis of other prognostic factors that predict poor outcome (e.g. tumor size, number of involved lymph node and hormone receptor status). Conversely, selected patients with breast cancer shown to contain gene amplification may not be candidates for CAF therapy due to pre-existing or intercurrent medical illnesses.

All patients in the Herceptin clinical trials were selected using an investigational immunochemical assay (clinical trial assay). None of the patients in those trials were selected using the PathVysion assay. The PathVysion assay was compared to the clinical trial assay on a subset of clinical trial samples and found to provide acceptably concordant results. The actual correlation of the PathVysion assay to Herceptin clinical outcome in prospective clinical trials has not been established.

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Support needed for elderly breast cancer patients and for independent academic research-(Yahoo News-20/03/2004)

Safeguarding academic research, improving individual risk assessment, greater attention to elderly cancer breast cancer patients, and a rethink on care after breast cancer were the four areas highlighted by participants at the 4th European Breast Cancer Conference (EBCC-4) in Hamburg (20 March 2004). Delegates used an electronic voting system to select these issues for special attention in the next two years. Clinicians, scientists and patients agreed the Hamburg Statement at the end of a five-day conference at which they heard about the latest developments in breast cancer, the most frequent cause of cancer death among European women.

Participants underlined the importance of independent academic research and called for the allocation of money from the EU central budget – for example the Tobacco Fund - to translational research, and for the encouragement of private donations to breast cancer research by increasing tax deductibility levels in Member States. Increasingly, women wish to know about their individual risk of getting breast cancer and the conference called for risk-reducing interventions to be made available to patients without cost. For women with a serious family history of breast cancer, delegates wished full genetic counselling and testing to be made available to the patient free of charge. 

The needs of elderly breast cancer patients are often neglected, despite the demographic changes which mean that this is a growing problem. The conference called for there to be no upper age limit in the design of standard treatment plans, and for patient participation in clinical trials to be decided according to performance status and not by age. Finally, delegates said that after-care for breast cancer patients should not be limited to detecting relapse but should include psychological support and the management of treatment side effects. Care after breast cancer should be planned by a multidisciplinary clinic after discussion with the patient.

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Vitamin D may fight breast cancer-(Yahoo News-18/03/2004)

Scientists at Birmingham University and St George's Hospital, London, found breast tissue contains an enzyme that activates vitamin D. Levels of the enzyme were elevated in breast tumours - suggesting the vitamin is produced to try to combat the spread of cancer. The research was presented at a meeting of the British Endocrine Societies. Previously it was thought that the active form of vitamin D - calcitriol, which is a potent anti-cancer agent, was only made in the kidney. The researchers think having a local cancer-fighting 'factory' is part of the breast's natural immune response to a tumour. And they suggest that the rise in breast cancer rates in the UK may be linked to the fact that we have low levels of vitamin D in our bodies.

Exposure to sunlight is the greatest source of vitamin D and population studies have previously suggested higher vitamin levels may contribute to the lower incidence of breast cancer seen in sunny climates such as the Mediterranean. Lead researcher Dr Martin Hewison said: "Our work shows that the breast has its own local 'factory' for generating the anti-cancer form of vitamin D. Unfortunately women who live in cloudy countries like the UK may not have enough of the raw material, vitamin D, to fuel this factory. Exposure to sunlight is the most efficient way of generating vitamin D in our bodies, but we all know of the dangers of sunbathing. Perhaps now it's time to look at improving our dietary intake through fortification of more foods with Vitamin D."

Delyth Morgan, of the charity Breakthrough Breast Cancer, said previous research had also suggested that vitamin D may help prevent and treat some cancers, including breast cancer. However, she said the effect had yet to be confirmed in human trials. "Further research is needed before any firm conclusions about the role of vitamin D in breast cancer prevention can be established."

Vitamin D is generated by exposing the skin to sunlight. It is also found in dairy products, fish oils and breakfast cereals. However, too much vitamin D is thought to disrupt the body's phosphate and calcium levels. The UK Food Standards Agency recommends a daily allowance of 5 micrograms.

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Breast cancer drug switch cuts recurrence-(AP-10/03/2004)

A drug for advanced breast cancer prevents localized tumors from returning after surgery better than the current mainstay drug, according to a large, international study that promises new hope and treatment strategies for many patients. Recurrence of such early cancer was reduced by one-third in women who started on the gold standard treatment, tamoxifen, then switched after 2 1/2 years to the newer drug, exemestane, compared to those who took tamoxifen the whole time. The women switching to exemestane, a hormonal drug sold under the brand Aromasin, also had less serious side effects, were 56 percent less likely to get cancer in the other breast and were half as likely to develop unrelated cancer in other body areas.Dr. Jeff Abrams, the National Cancer Institute's associate chief of clinical research, said a recent study on exemestane "cousin" letrozole showed important advantages over tamoxifen for their class of drugs, called aromatase inhibitors. Abrams was not involved in the new study.

Lead researcher Dr. R.C. Coombes, professor of cancer medicine at Imperial College School of Medicine in London, predicted doctors will give exemestane to many women at high risk for recurrence, such as those whose breast cancer spreads to multiple lymph nodes. "More work needs to be done to understand what's going on" at the molecular level, he said. The study, which included 4,742 postmenopausal women in 37 countries, focused on women with breast cancer in which the hormone estrogen fuels tumor growth -- the type causing about 70 percent of breast cancer. The results do not apply to premenopausal women or those with tough-to-treat breast cancer not driven by estrogen.

Normally, early-stage breast cancer is treated by surgery to remove the tumor, plus radiation, if part of the breast is conserved. If tumor cells had spread to underarm lymph nodes, cell-killing cancer drugs often are given, particularly in the United States. Then, if the cancer is undetectable and it's the type fueled by estrogen, women take daily tamoxifen pills for five years -- to prevent any microscopic cancer cells lurking in the body from later triggering cancer in another spot. Such metastasized cancer is virtually incurable. But cancer cells grow resistant to tamoxifen in many patients, sometimes within 12 months, and prolonged use can cause uterine cancer and dangerous blood clots. Those problems sparked interest in hormonal drugs such as aromatase inhibitors, which dramatically suppress estrogen production by adrenal glands and other tissues by blocking the effects of the enzyme aromatase. Tamoxifen binds to specific tumor cell sites to keep estrogen from attaching and directing the cells to multiply.

Aromatase inhibitors have been around since the 1970s, but high toxicity limited use. Today's "third generation" aromatase inhibitors -- including Aromasin, Femara and Arimidex -- work better and are less toxic but still increase bone loss, a serious problem for elderly women, Coombes said. His team reported interim results through last June from the study, which is nearly complete, in the New England Journal of Medicine. The research was partly funded by Pfizer Inc., the maker of Aromasin. Among the women switching to exemestane, 54 died of breast cancer, compared with 67 in the tamoxifen-only group. Overall, 91.5 percent of women in the exemestane group were cancer free three years after switching drugs, compared with 86.8 percent for women who stayed on tamoxifen. "It confirms a trend that we've been seeing in treatment with metastatic disease," said Dr. Julia Smith, clinical associate professor of oncology at the NYU school of medicine and cancer institute. "This whole class of drugs looks very promising, very active."

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New Test to Become Available for Breast Cancer-(Reuters-16/03/2004)

A new diagnostic tool for breast cancer that will allow doctors to look at the genetic make-up of tumors to personalize treatment could be available later this year, researchers said. Dr Alane Koki, chief scientific officer of the French biotechnology company Ipsogen, told a conference the test will provide genetic information about the tumor to help doctors select the best treatment for the patient. "Understanding differences in gene expression can help both patients and clinicians to decide what treatment would be most effective and appropriate with a personalized approach," Koki told the Fourth European Breast Cancer Conference.

The Breast Cancer Profile Chip (BCPC) uses microarray technology to look at the genetic signature of the tumor. Microarray enables scientists to analyze the expression of many genes at the same time. The technology has been used mainly in research, but Koki said the BCPC, which is being tested and should be ready by the summer, will be available to pathology laboratories. "The BCPC will simultaneously measure expression of more than 900 important genes to augment conventional methods to clinically assess breast cancer," said Kofi. The company is also planning clinical trials of the test to determine how it can optimize the treatment of breast cancer, which accounts for about a quarter of all cancers in European women.

An estimated 346,118 women in Europe were diagnosed with breast cancer in 2000 and more than 129,000 women died. About 4,000 delegates from 80 countries are attending the five-day conference.

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Breast Cancer Treatment Varies Across U.S.-(ET-17/03/2004)

Treatments for women with an early form of breast cancer vary widely depending on where they live, which suggests doctors and patients are uncertain about the best treatment, researchers said. As wider screening leads to more women being diagnosed with ductal carcinoma in situ, or DCIS, it is becoming more urgent to develop consistent treatment guidelines, the researchers said. "There is a fair amount of confusion out there," Dr. Nancy Baxter of the University of Minnesota, who led the study published in the Journal of the National Cancer Institute, said in a telephone interview. Until clearer guidelines are developed, she said, "It is probably a good idea for women to get a second opinion."

About 50,000 U.S women are diagnosed with DCIS each year. It looks like cancer, but the tumor cells have not spread from the breast ducts. DCIS itself is rarely deadly, killing just about 2 percent of patients, but it can turn into a more dangerous invasive cancer if left alone or if it returns. "The key point about DCIS is that it lacks the ability to spread to other parts of the body. Therefore, no matter what treatment a woman chooses, her risk of dying of breast cancer is extremely low," Dr. Monica Morrow, director of breast surgery at Northwestern Memorial Hospital in Chicago, said in a statement. Baxter studied the records of more than 25,000 women diagnosed with DCIS between 1992 to 1999. As expected due to a rise in mammogram screenings, many more cases were diagnosed by 1999. While more than 97 percent of patients had some kind of surgery, the number who had mastectomies-removal of the breast-fell from 42 percent in 1992 to 28 percent in 1999. But the treatment varies greatly by region.

For example, 74 percent of women in Connecticut got breast-conserving surgery for DCIS-meaning they did not have full mastectomies. But only 55 percent of patients in Utah did. "We can't say from this that you are getting bad care in Utah and good care in Connecticut," Baxter cautioned in a telephone interview. "It may be that women in Utah are requesting mastectomy more because they live a long way from a radiation center. We don't know what led to those figures."

Experts strongly recommend that women get radiation therapy after having DCIS removed, yet Baxter found regional variations here, too. For example, just 39 percent of DCIS patients in San Francisco got radiation, compared to 74 percent in Hawaii. "DCIS can come back," Baxter said. "It has a very high rate of recurrence if you just remove the breast and don't radiate people. And about half the time it comes back as invasive cancer-that is cancer cancer." She said there may be medically legitimate reasons for the variations, but treatment guidelines could help limit any unwarranted regional differences. "What we need to start doing is to start, as a group, coming up with some sort of recommendations in terms of treatment." If doctors cannot agree, she added, then research needs to be done to find out what the most effective treatments are and for who.

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Breast Cancer Risk Tied to Wine, Fat Intake-(HealthDayNews-17/03/2004)

A new Swedish study finds postmenopausal women who consume high amounts of alcohol, especially wine, are at a higher risk for breast cancer. According to the study, women who drank more than roughly 1.5 glasses of wine per day were twice as likely to get the disease compared to women with little or no alcohol intake. Moderate drinkers, meanwhile, were found to be at a 12 percent lower risk of breast cancer. Scientists had previously suspected that women who drink alcoholic beverages are at a greater risk of breast cancer. But not all studies have demonstrated a link, and the amount of alcohol required to boost the risk of the disease has been sketchy. "There seems to be a threshold under which there is no effect of alcohol," explains study author Dr. Irene Mattisson, of the Department of Medicine, Surgery and Orthopaedics at Sweden's Lund University. "However, we cannot say anything on the exact level of the threshold because self-reported alcohol data is unreliable."

High dietary fat, long suspected to be a culprit in breast cancer, also was associated with the disease, the authors report. As amounts of fat in women's diets increased, so did their risk of breast cancer. Those who consumed the highest amounts saw their risk of getting breast cancer rise by 34 percent. The authors observed the dietary and drinking habits of 11,726 postmenopausal women in the city of Malmö, using interviews and self-recorded diet histories. Physical exams were performed at the beginning of the study and the women were followed for an average of 7.6 years. A total of 342 breast cancer cases were documented during the study period. While high intakes of wine boosted breast cancer risk, the study found no elevated risk for women reporting high levels of total alcohol consumption, including beer and spirits. The study appears in the March 17 online issue of the International Journal of Cancer.Teasing out the effects of different beverages becomes complicated due to misreporting, Mattisson notes. It's suspected that women reported the amount of wine they drank more accurately than the amount of total alcohol they consumed.

So should women who drink regularly and indulge in fatty foods modify their diets? "If they drink alcohol regularly, they should definitely reduce their alcohol intake," Mattisson says. "There is so much evidence from different studies now pointing in the same direction. Alcohol should be used in moderation only." Cindy Moore, a spokeswoman for the American Dietetic Association, says women should limit their alcohol intake to one drink per day to reduce their cancer risk, as the American Cancer Society advises. Women also should eat a variety of foods to get the nutrients and chemicals their bodies need to fend off disease, she says.

Fruits and vegetables, for example, contain antioxidants that help prevent cell damage from chemicals called free radicals. Nutrients found in protein give the body strength to resist disease. "It's sort of like a one-two punch," she says. Reducing total fat to recommended levels is also highly advisable, Mattisson adds. Keep in mind that all fats are not equal. Previous studies from the Malmö Diet and Cancer Study have shown that high intakes of omega-6 fatty acids, such as those found in sunflower and corn oils, increase the risk of postmenopausal breast cancer. Most Americans consume too many omega-6 fatty acids, research shows, but do not get enough fatty acids from the omega-3 family, which includes rapeseed oil, fatty fish, and flax seed. Mattisson advises women to increase their intakes of polyunsaturated fatty acids from the omega-3 family and not to eat omega-6 oils in abundance.

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New Fertility Hope for Women Cancer Patients-(Reuters-09/03/2004)

Young cancer patients left infertile by their treatment have been given new hope of having children as scientists announce they have produced the first human embryo from frozen ovarian tissue. Researchers at the New York Presbyterian Hospital/Weill Cornell Medical Center in the United States restored the fertility of a 36-year-old woman who had suffered from breast cancer by transplanting previously frozen ovarian tissue beneath the skin of her abdomen. Three months after the transplant, her fertility was restored. The woman had several cycles of in-vitro fertilisation (IVF) and although she did not become pregnant, the scientists said the prospect of restoring fertility to patients with frozen ovarian tissue and enabling them to become mothers is now more promising. "In humans this is definitely the first embryo (from an ovarian transplant,)" Dr. Kutluk Oktay, who headed the research team, told Reuters. "It creates a potentially viable option (to have children) for hundreds of thousands of cancer patients of reproductive age around the world."

The research, reported online by The Lancet medical journal, shows that women can preserve their fertility by freezing their ovarian tissue and that pregnancy may be possible even after the tissue remains frozen for a long time. The tissue from the woman had been frozen six years earlier. The research is significant because cancer treatments such as radiotherapy, chemotherapy and radical surgery can cause premature menopause and infertility in hundreds of thousands of young cancer patients each year. By removing and freezing ovarian tissue before treatment, scientists hope to enable these women to give birth to children using their own eggs. The technique has been used successfully in sheep to produce live animals. "It (the tissue transplant) is likely to give years of function which would be sufficient to generate a baby and that is the goal," Oktay said.

Fertility centers are already freezing ovarian tissue and eggs from women before undergoing cancer treatment. But freezing can damage eggs, which are very fragile and few survive the freezing and thawing process. Transplanting the ovarian tissue back into the patients is also difficult and there is the danger that the tissue may contain cancerous cells. But putting the transplant beneath the skin of the abdomen reduces the health risks and it can be easily removed if necessary. Dr. John Smitz, of the Center for Reproductive Medicine at Vrije University in Brussels, Belgium, said the research is an important advancement in reproductive technology. "This is the first time a human embryo has been produced from ovarian tissue," he said in an interview. "It will encourage a lot of other centers to work out the conditions for transplantation." But Smitz added that more research is needed to improve the technique and to show that the method, which he said offers the best potential of restoring fertility to women cancer patients, is safe.

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Calories Have 'Important' Role in Breast Cancer-(Reuters Health-10/03/2004)

Results of a study of women who suffered from anorexia indicate that caloric restriction at an early age protects against breast cancer. "Our observations suggest an important role for caloric intake in the etiology of breast cancer," the researchers write in the Journal of the American Medical Association. Among some 7300 Swedish women hospitalized for anorexia nervosa before their 40th birthday between 1965 and 1998, researchers noted a significant 53 percent decrease in breast cancer cases compared with what would be expected in the general Swedish population of women. The analysis showed that breast cancer rates among the anorexic women were 23 percent lower for those who had never had children, and 76 percent lower among those who were mothers, they report.

"We have known for decades that restricting caloric intake in animals is one of the most effective ways to reduce cancer risk," Dr. Karin B. Michels from Harvard Medical School in Boston, said in an interview with Reuters Health. It's been unclear, however, whether the same is true in humans. "Our study tells us that the animal model also holds in the human and that apparently diet is important for breast cancer risk, at least as far as caloric intake is concerned, and that it is probably more pronounced during earlier phases of life," Michels said. Breast cancer research is now looking at earlier phases of a woman's life, she explained, "because we haven't been very successful in pinning down dietary risk factors for breast cancer in later phases."

The results of the present study suggest that "maybe we should be looking at the role of diet in puberty or adolescence and breast cancer," she said. Michels and her colleagues will next explore the underlying mechanisms of the apparent protective effect of caloric restriction on breast cancer. "There are two main hypotheses," she said: one, that caloric restriction influences breast cell growth and development, and, two, that lower levels of estrogen and growth factors induced by caloric restriction are involved.

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Breast Cancer Treatment Delayed in Blacks-(Reuters Health-09/03/2004)

African American women are more likely than white women to experience delays in the diagnosis and treatment of breast cancer, new research indicates. Moreover, these racial differences remained even after accounting for poverty status and factors that affect access to care. Numerous reports have shown that African American women with breast cancer fare worse than their white counterparts. The current findings suggest that the speed with which breast cancer is detected and treated may explain the racial gap in outcomes.

In the new study, Dr. Karin Gwyn, from the M. D. Anderson Cancer Center in Houston, and colleagues analyzed data from 251 African American women and 580 white women with invasive breast cancer to assess racial differences in diagnostic and treatment delays. The findings are reported in the medical journal Cancer. Overall, for more than 75 percent of the women the time from first seeing a doctor to starting treatment was less than 3 months. However, African American women were 73 percent more likely than whites to have a longer delay. Adjusting for access to care factors, such as method of detection and insurance status, and mammography history, reduced but did not eliminate this elevated risk. Compared with white women, African American women were 61 percent more likely to experience a diagnostic delay of greater than 2 months and twice as likely to experience a treatment delay of at least 1 month. "Potentially clinically significant differences in terms of delayed diagnosis and treatment exist between African American women and white women," the authors note. "Improvements in access to care and in socioeconomic circumstances may address these differences to some degree, but additional research is needed to identify other contributing factors," they add.

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Research links antibiotics, breast cancer-(Yahoo News-17/02/2004)

Women who take even moderate amounts of antibiotics appear to have an increased risk of breast cancer, Seattle researchers have found. The risk of the disease as much as doubles in those who take the most antibiotics, compared with women who don't take the medications, the scientists concluded in a large study of Group Health Cooperative members. "A study trend indicated that the more antibiotics taken, the higher the risk for the cancer," said Christine Velicer, an epidemiologist at Group Health's Center for Health Studies and lead author of the research report appearing in the Journal of the American Medical Association. The study design took into consideration the age of the women; whether they had used hormone-replacement therapy, which has been linked to increased breast-cancer risk, and how long they were enrolled at Group Health.

The scientists don't know why antibiotics might increase the risk of the disease. They emphasized that more research is needed to verify their findings. Factors other than the antibiotics could be involved, they said. But they also said the research indicated the risk increased with all types of antibiotics, in addition to increasing with the amount of the medications taken. "All of this suggests that there's something going on with exposure to antibiotics," said John Potter, co-author of the study and director of the Public Health Sciences Division at the Fred Hutchinson Cancer Research Center. Scientists from the University of Washington and the National Cancer Institute also participated in the research.A limited study in Finland in 2000 found similar results in women who took antibiotics for urinary-tract infections.

The Group Health research is the first of its kind in the United States. Using medical records, the research team compared the antibiotic use of 2,266 breast-cancer patients and 7,953 women who did not have the disease. All of the women were Group Health members for at least one year between Jan. 1, 1993, and June 30, 2001, and were followed for an average of 17 years. The scientists found that women who took antibiotics for more than 500 days cumulatively, or had more than 25 individual prescriptions, had twice the relative risk of breast cancer as those who didn't take the drugs. Those who had one to 25 prescriptions had about 1½ times the relative risk. If the findings are supported by additional research, Velicer said, the increased risk from antibiotic use will fall in the same range as other known breast-cancer risks, including obesity, hormone use and a family history of the disease.

The scientists speculated that antibiotics affect bacteria in the intestines that might, in turn, affect the metabolism of foods believed to protect against cancer. Or, they said, some drugs could cause inflammation, which has been linked to breast cancer. Perhaps the antibiotics aren't even the cause of the increased risk, the researchers said: Maybe the women who needed the drugs had weaker immune systems than those who didn't take the medications. Or perhaps the illnesses that required the drugs contributed to development of breast cancer.

"As is often true for reports of new associations, this study provides many, or more, questions than answers. Is the observed link between use of antibiotics and risk of breast cancer confounded by unmeasured factors?" said University of Pittsburgh researchers Roberta Ness and Jane Cauley in an editorial in the Journal of the American Medical Association. Velicer and her colleagues readily agree more research is needed. "The next steps in the research need to revolve around these questions," Velicer said. "This study is a spring-off point for other studies." The scientists said the study is certainly not a basis for making public-health or policy recommendations. But they said it adds fuel to the argument that antibiotics should be used prudently. Experts have warned for years that an increasing number of bacteria are becoming resistant to antibiotics and that the medications should be used sparingly. Meanwhile, Velicer said, women should talk with their doctors about the risks and benefits of using antibiotics for any given illness. They also should continue following recommendations for screening for breast cancer, she said

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Estrogen Alone May Not Raise Breast Cancer Risk-(ET-02/03/2004)

Preliminary results of a study of estrogen-only hormone replacement therapy (HRT) suggest it does not raise breast cancer risk the way combination estrogen-progestin therapy does. However, government researchers found that estrogen alone does increase the risk of strokes to the same degree as combination HRT-so they stopped the study ahead of schedule. The study was part of the Women's Health Initiative (WHI), a large-scale research project sponsored by the National Institutes of Health (NIH) to evaluate risk factors for heart disease, cancer and osteoporosis. The 11,000 women in this arm were taking estrogen to determine whether it could protect them against heart disease, not to relieve menopausal symptoms. They were followed for an average of almost 7 years.

The researchers found that estrogen therapy neither prevented heart disease nor made it worse, but it did raise the risk of stroke. Although that risk was small, the researchers felt it was in the participants' best interest to stop the trial. "We did not want to put women at increased risk for stroke when we found the answer for heart disease," said Barbara Alving, MD, director of the Women's Health Initiative. "We've learned all we think we're going to learn, so we're stopping [the trial]."

Estrogen alone also protected women against hip fractures, and did not appear to increase breast cancer risk. That latter finding came as something of a surprise, Alving said, because an earlier trial in the WHI has already shown that combination estrogen and progestin therapy raises a woman's risk of developing breast cancer. However, she emphasized that researchers are still analyzing data from the study and may learn more as their evaluation continues. It may be, for instance, that the trial did not last long enough to detect an increased risk of breast cancer. Or researchers may find that, like combination therapy, estrogen alone makes mammograms more difficult to read and delays diagnosis of breast cancer. The final analysis is expected to be published next month.

Until then, Alving advised women to talk with their doctors about the risks and benefits of estrogen-only hormone therapy, especially because the findings from this study may not apply to everyone. Women in the study were, on average, about 70 years old and had taken the pills for many years. The study did not look at the effects of short-term estrogen use by younger women who need it to combat troublesome menopause symptoms like hot flashes and vaginal dryness. Estrogen-only HRT is approved to relieve menopause symptoms only in women who no longer have a uterus, because it can raise the risk of uterine cancer. The FDA recommends that women who use hormone therapy take the lowest effective dose and for the shortest time possible to get relief. "Women need to work with their physicians to determine how long they want to be on this medication and what [preparation and dosage] they want to take," Alving said. "Women need to look at their individual risks."

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Symptoms Common After Breast Cancer Treatment-(Reuters Health-02/03/2004)

Women who have completed treatment for breast cancer may seem to be out of the woods, but new research suggests that a broad range of physical symptoms persists in women making the transition from cancer patient to cancer survivor. In a new study, women who had just completed treatment seemed to be in good emotional shape, but they reported a wide variety of physical symptoms, including hot flashes and aches and pains. Steps to address common post-treatment symptoms should be considered, according to the study's authors. Plenty of research has examined the psychological and social impact of breast cancer, but it has mostly focused on newly diagnosed women or on survivors, who completed treatment in the past. There is much less information on the experience of women who have just completed treatment. Now, a team led by Dr. Patricia A. Ganz at the University of California at Los Angeles Jonsson Comprehensive Cancer Center has taken a closer look at this group of women.

The study involved 558 women who had just completed treatment for breast cancer. The women had undergone mastectomy or lumpectomy either with or without chemotherapy. Despite having a serious illness and undergoing sometimes prolonged treatment, the women in the study reported a normal level of mental health, Ganz's team found. In terms of mental health, there were no significant differences among the four treatment groups. But women who had just completed cancer treatment did report a wide range of physical symptoms, including hot flashes, night sweats, aches and pains and vaginal dryness. Women who had had a mastectomy tended to report more physical problems than women who had had a lumpectomy. After treatment for cancer, women also reported sexual problems, such as painful intercourse and insufficient lubrication. Women who had undergone chemotherapy were more likely than women who had surgery alone to report sexual problems. The findings appear in the Journal of the National Cancer Institute.

Ganz and her colleagues point out that physicians prepare women for the side effects that they may experience during treatment, such as nausea, vomiting, hair loss and fatigue. But doctors have had little information with which to guide patients through the post-treatment period, the authors note. "From this study, we now have an accurate description of how women are functioning at the end of primary treatment," the authors write. The authors plan to continue following these women, who are enrolled in a study that compares two behavioral interventions designed to help women in the transition from treatment to recovery.

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UK Says Two-View Mammogram Ups Cancer Detection-(ET-27/02/2004)

The number of breast cancers detected in Britain shot up 13 percent to 9,848 last year - largely because of improved mammography, according to the Department of Health. Detection rates have been steadily increasing since 1998, when only 7,561 cases were detected, but officials say that the latest increase can be largely attributed to the introduction of two-view mammography. This involves taking two x-ray views of each breast at the screening appointment. Research has shown that this technique can increase the detection rate of small cancers by 42 percent, the department said in a statement. It said that by December 2003, 86 percent of local screening services were doing two-view mammographies. Last year, they screened 1.3 million women and detected 13 percent more cancers than the previous year. Over 50 percent of these were small cancers, which might not have been found by self-examination or by general practitioners.

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Study: Weight Gain Tied to Breast Cancer-(Yahoo News-26/02/2004)

The amount of weight a woman gains after age 18 is a strong signal as to whether she will get breast cancer later in life, according to new research released by the American Cancer Society. In one of the largest studies of weight and breast cancer to date, researchers said older women who gained 20 to 30 pounds after high school graduation were 40 percent more likely to get breast cancer than women who kept the weight off. The risk doubled if a woman gained more than 70 pounds, said Heather Spencer Feigelson, senior epidemiologist with the American Cancer Society. "Breast cancer is strongly dependent on body weight," Feigelson said. "Even modest amounts of weight gain lead to a significantly increased risk of breast cancer."

Weight gain and body mass have long been known to be risk factors for breast cancer. The cancer society estimates weight contributes to between one-third and one-half of all breast cancer deaths among older women. Fat tissue makes estrogen, and estrogen can help breast cancer grow. Weight gain also is the second leading cause of all cancers, according to research the Atlanta-based society published last year in the New England Journal of Medicine. But the cancer society researchers wanted to examine more specifically the link between weight gain amounts and breast cancer, and this was the first in such a large group. "The more fat you have - fat cells are capable of synthesizing estrogen - the heavier you are, the higher your estrogen levels," said Dr. Paul Tartter, associate professor of surgery at Columbia University, who was not a researcher in the study. "There's no question that estrogen is the common denominator of most of our risk factors for breast cancer."

The cancer society study included 1,934 breast cancer cases among 62,756 women involved in a separate long-term cancer prevention study. Post-menopausal women ages 50 to 74 were asked their weight when the study began in 1992 and their weight when they were 18 years old. Surveys were sent to the women in 1997, 1999 and 2001 to inquire about any new cancers. Women taking estrogen hormones were not included in the study. Lean post-menopausal women not taking hormone replacement therapy produce very little estrogen and had the lowest cancer risk in the study, Feigelson said.

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Double Mastectomies Reduce Chances of Cancer-(HealthDayNews-23/02/2004)

Women at high risk for breast cancer who have a preventive double mastectomy reduce the risk of developing the disease by 90 percent, new research says. These new findings relate specifically to women who have the BRCA1 or BRCA2 mutation, which puts them at a greatly increased risk of developing breast (and ovarian) cancer over their lifetime. Some 3 percent to 10 percent of breast cancers are thought to be related to these genetic mutations. "This is a first-class paper," says Dr. Jay Brooks, chief of hematology/oncology at the Ochsner Clinic Foundation in New Orleans. "This clearly gives tremendous direction to physicians, in my opinion, on how to handle BRCA 1 and 2 positive patients."

Nevertheless, the decision to undergo such a procedure is not one to be taken lightly. "[The findings are] good news on the clinical risk-reduction side of things," says Timothy R. Rebbeck, co-program leader of the Cancer Epidemiology and Risk Reduction Program at the University of Pennsylvania's Abramson Cancer Center. "Clearly, if you have prophylactic mastectomy, you'll eliminate most of the breast cancer risk and that's good. [But] most people have not studied the psychosocial, behavioral and other implications of that surgery, and that's not trivial." Rebbeck is lead author of the study outlining the new findings, which appear in the March 15 issue of the Journal of Clinical Oncology.Although some women with the BRCA1 and BRCA2 mutations do elect to have prophylactic mastectomies, there is little data on how effective the strategy is. According to Rebbeck, there really are no other effective options for lowering risk.

This is the first study to quantify the risk reduction related to the procedure. The study followed 483 women with BRCA1 and BRCA2 mutations from 11 sites in North America and Europe for six years. Women who chose to have prophylactic mastectomies were compared with women with the mutations who did not have the procedure. Two of the 105 women who had double mastectomies (1.9 percent) developed breast cancer, while 184 of the 378 controls (48.7 percent) were diagnosed with the disease. Double prophylactic mastectomies reduced the risk of breast cancer by about 90 percent in women who kept their ovaries and by about 95 percent in women who also had their ovaries removed.

Rebbeck says he was not surprised by the findings. "If you remove the vast majority of tissue that's at risk, you would expect the risk to go down-and that's what we saw," he says. The two women in the mastectomy group who developed breast cancer both had subcutaneous mastectomies, meaning some of the breast tissue and nipple were preserved. "Many women are actually using these surgeries, and their clinicians are suggesting that they have it," Rebbeck says. "Now, women will have actual numbers to work from to make these decisions. No matter what the ultimate decision is, they have to be made on a personal level. There can't be a global recommendation, but now at least there'll be data."

Still, the holy grail is to find a nonsurgical way to reduce risk. The paper points out that most of the study participants in North America refused to have a bilateral mastectomy. "That is a very important finding because what we have to do is find a way to reduce the risk nonsurgically," says Dr. Julia A. Smith, a clinical assistant professor of medicine at New York University School of Medicine in New York City. "Surgery can be very effective, but it is a very gross and crude attack on cancer." She adds, "What we need is much more refined, where we're attacking at the cellular and molecular level to prevent or reverse early changes so that we don't have to decimate the organ as a preventive strategy

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New Proof That Early Detection Aids Breast Cancer Fight-(HealthDayNews-23/02/2004)

New research shows breast cancer screening can save lives; in some cases, up to 20 years later. Two studies, appearing in the Feb. 23 online edition of Cancer, found that when breast cancer tumors are detected early, women have a better chance of survival. One study followed women with breast cancer for 20 years to evaluate if the stage of the cancer at the time of diagnosis made any difference up to two decades later. The other study tracked the introduction of a mass screening program and found women with breast cancer detected at screening tended to have a better prognosis than women whose cancers were detected between screenings. Nearly 216,000 women will be diagnosed with breast cancer in the United States this year, and more than 40,000 will die from the disease, according to the American Cancer Society. The society recommends that every woman over 40 have an annual mammogram to check for breast cancer.

"Our study's results show that the size and node status of a tumor continue to influence survival for many years after diagnosis," says Jane Warwick, a research fellow at Cancer Research UK in London and author of the first study. "This suggests that early detection is still conferring a benefit many years later." Warwick and her colleagues examined more than 20 years of data from Swedish women, aged 40 to 74, diagnosed with breast cancer. The researchers looked at the effect that tumor size, tumor grade and lymph node involvement had on long-term survival. As time progressed, the researchers found the effects from these factors diminished, but did not disappear. "The influence of these tumor attributes on survival was smaller in later years, but still present, contrary to the widespread belief that the tumor attributes at diagnosis no longer affect survival after 10 years or so," Warwick says. "The classic predictors of prognosis are still good predictors 20 years down the line," says Dr. Jay Brooks, chief of hematology and oncology at the Ochsner Clinic Foundation Hospital in New Orleans. Brooks says this information is important because it gives clinicians confirmation that they can continue to use tumor attributes when making treatment decisions five or 10 years after cancer diagnosis.

The other study followed the 1992 introduction of biannual breast cancer screening for women between the ages of 50 and 69 in one town in the Netherlands until 1999. The researchers also looked at women diagnosed with breast cancer between 1985 and 1992. "With the introduction of the breast cancer screening program, much attention was paid to the expected increase in breast-conserving surgery and decrease in mortality rates," says study author Dr. Miranda Ernst, who was a surgical resident at St. Elisabeth Hospital in Tilburg, The Netherlands, at the time of the study. During the 14-year study period, 1,400 women were diagnosed with breast cancer. Surprisingly, only 40 percent of the women had their cancer detected at screening, while nearly 30 percent were diagnosed between screenings.

The researchers didn't find any statistically significant change in the rate of breast-conserving surgery. However, breast cancer screening still had a positive influence. According to Ernst, after the introduction of screening, women aged 50 to 69 had a better prognosis and smaller tumors than before screening was implemented. Brooks says he was surprised by the large number of women who developed breast cancer between screenings in this study, and says it points to the need to be screened at a place that does a lot of breast cancer screenings. "Mammograms should be done by people who do lots of them, because they're better at it," notes Brooks, who recommends getting your mammogram done at a center that does at least 200 mammograms a month.

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Another Trial Ties HRT to Breast Cancer-(HealthDayNews-02/02/2004)

For the third time in less than two years, researchers have halted a hormone therapy trial because the drugs posed unacceptably high breast cancer risks to women. The latest trial, based in Sweden, was the first randomized study to look at the effects of hormone replacement therapy (HRT) on women who have had breast cancer. It was halted early because the risks of a recurrence of cancer were judged to be too great. The finding prompted the head of the American Cancer Society to say it would be "unwise" to prescribe HRT to women with a history of breast cancer. The Swedish study was originally scheduled to enroll at least 1,300 women and follow them for five years. The trial was stopped on Dec. 17, 2003, after following 345 women for about two years. Twenty-six women in the HRT group and seven in the non-HRT group had a recurrence of breast cancer while they were receiving hormones.

"That's a substantial absolute risk," says lead investigator Dr. Lars Holmberg, a professor of clinical cancer epidemiology at the Regional Oncologic Centre of University Hospital in Uppsala, Sweden. "Most of us on the steering committee were prepared that, despite earlier studies, we might see a slightly increased risk but that the risk-benefit ratio still would be reasonable. So this was to us a surprise and also a very worrying result." The finding will appear in the form of a research letter in the online edition of The Lancet on Feb. 3 and in the Feb. 7 print edition of the journal.A concurrent study in Stockholm did not find a higher risk of cancer recurrence. But because a pooled analysis of the trials found an increased overall risk, that trial was also terminated. The results are not yet in on a third study, this one being conducted in the United Kingdom. The latest announcements come on the heels of the early endings of two other high-profile HRT studies.

In July 2002, the hormone therapy arm of the U.S.-based Women's Health Initiative (WHI) was halted when women taking hormones were found to have higher risks of coronary heart disease, stroke, blood clots and breast cancer. In October of the same year, the Women's International Study of Long Duration Oestrogen after Menopause (WISDOM), a British trial evaluating hormone therapy, was also stopped after finding elevated risks of breast cancer.

The results of the Swedish study have some doctors reevaluating their views on HRT. Dr. Harmon J. Eyre, chief medical officer of the American Cancer Society, says in a statement: "Many women experience menopausal symptoms after treatment for breast cancer, some because they stopped using HRT, some as a result of chemotherapy and others as a natural part of aging. In the past, some doctors have offered HRT to selected breast cancer survivors who suffered from severe menopausal symptoms because a handful of small, preliminary studies had failed to show a risk. This study will no doubt change that," he adds. "It is large enough and clear enough to show that HRT appears to increase the chance of a new or recurring breast cancer. Because of that, offering HRT to women with a history of breast cancer would be unwise." Dr. Steven Goldstein, a professor of obstetrics and gynecology at New York University School of Medicine in New York City, says the findings are "very, very significant. It's big news."

Many clinicians had felt HRT was safe for breast cancer survivors because observational studies, which are less stringent than randomized studies, had found no risk or only a slightly elevated risk, Holmberg says. The halted Swedish study began recruiting in 1997. Women were randomized either to receive HRT or not to receive HRT. Participants in both groups were similar in age and other characteristics, although they might have varied in whether they had estrogen-receptor positive or negative cancers, the study authors write. When results were compiled after about two years of follow-up, women in the HRT group were found to have a three-and-a-half times greater risk of having a recurrence of breast cancer than women in the non-HRT arm of the trial. The absolute risk of having a recurrence was 7.5 percent in the HRT group and 2 percent in the non-HRT group.

In addition to breast cancer, eight women in the HRT group and four in the non-HRT group experienced other serious health problems such as blood clots. "I had been telling those patients going through menopausal transition that there is some data suggesting they can safely take HRT. This study suggests that is not true," Goldstein says. Will he stop recommending hormone therapy to his patients who have had breast cancer? "We still have to take this one pace at a time," Goldstein said. "If you have a 51-year-old woman nine years after her breast cancer with negative nodes who is absolutely beside herself [with menopausal symptoms], we may still decide on short-term therapy." Holmberg adds: "I don't think this is the final word because our estimate is imprecise because it's so few women and the long-term results might be different." Still, he notes, this is what doctors have to guide them for the foreseeable future.

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Protein May Point Out Most Dangerous Breast Tumour (MidDay-08/12/2003)

Doctors said last week that they have found a protein that makes breast cancer tumors more dangerous, but they believe new drugs may help protect patients against it. The protein, called Epidermal Growth Factor Receptor [or EGFR), is a growth stimulator that has been found in other cancers to produce a more aggressive disease. It was the first time its effects have been studied in breast cancer, the team told a meeting of breast cancer experts in San Antonio. "This is potentially important news in that new drugs have been developed that block the EGFR pathway. 'I'hese data provide a rationale for studying these agents in selected patients with breast cancer," Dr Thomas Buchholz of Houston's MD Anderson Cancer Centre, who led the study, said in a statement.

One such drug is Iressa, made by AstraZeneca Plc. Known generically as gefitinib, Iressa has shown remarkable effects in some lung cancer patients. Researchers have said it will probably work best when given to patients whose cancers are marked by EGFR. Buchholz and colleagues looked for EGFR in tissue samples from 82 patients whose cancer had spread locally in the breast. '1'hey found EGFR in 14 cases, or 16 percent. The patients with EGFR positive disease were more likely to have their cancer come back and more likely to die, Buchholz reported. Only 43 per cent of the 14 EGFR-positive patients survived nine years after treatment; compared to 60 percent in EGFR-negative patients. "This is a small study, but we can clearly see that EGFR expression correlated with survival ", Buchholz said. His team was planning to test Iressa in breast cancer patients, along with other breast cancer drugs.

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DOCTORS, PATIENTS WARY OF HRT USAGE "Now, more doctors will take the middle path, using it for only short-term symptomatic cases."-(Times of India-05/01/2004)

Until early this year, city gynaecologist Kiran Coelho often prescribed a combination of the hormones estrogen and progestin to help women through menopause. Like many doctors, Dr Coelho believed that hormone replacement therapy (HRT) was a panacea for older women, not only for easing menopause symptoms like hot flushes and insomnia but preventing long-term disorders like osteoporosis, Alzheimer's and heart disease. But a series of studies on HRT published over the last year has changed all that. The studies-beginning with a survey in the US of more than 16,000 women over a period of five years-not only called into question the long-term benefits of combined hormone therapy but also showed that the risk of breast cancer was much higher than previously believed. Experts say the usage of HRT has dropped since the recent findings have left both gynaecs and patients wary.

Dr Coelho now uses HRT only for short-term treatment of selective patients. "I prescribe it for a year or two and only for women who are symptomatic and who don't have contra-indications like a family history of cancer" she says, adding, "We always thought that the benefits outweighed the side-effects, now we have to think anew." "Usage has definitely come down after these studies," agrees Dr. Rashmi Shah, deputy director of the National Institute for Research into Reproductive Health, adding, "HRT usage is not high in India anyway and those who do go in for it are educated and upper middle-class women who read the headlines." Dr Shah says the treatment has always been controversial, with doctors divided on its efficacy. "Now more doctors will take the middle path, using it for only short-term symptomatic cases."

Pharmaceutical companies are cagey about the exact figures, but admit that sales have come down and strategies are shifting to accommodate the new research. Wyeth India, for example, now markets its HRT product Premarin for primarily short-term symptomatic relief and no longer makes claims about preventing Alzheimer's or heart disease. Pharma companies describe HRT usage in India euphemistically and hopefully as a "nascent market". What this means is that unlike Europe and America, where HRT usage is high among older women seeking to stay young and has become part of their lifestyle, in India it is used by barely ten per cent of working women of similar age in the metros. While low awareness and high costs are important factors here, it also appears that menopause is not as severe for Indian women.

A study conducted by the Indian Menopause Society Mumbai chapter on 500 women in 1998-99 found that only 20 per cent complained of menopause symptoms. Compared to this, the prevalence ranges from 70 to 80 per cent among Western women. Experts attribute this to the traditional Indian diet and the social and family support system. "We know that diet is one reason Japanese women have so few menopause symptoms, but more studies need to be done to establish this," says Dr Shah, referring to Japan's high consumption of soya, which is a natural estrogen producer.However, some believe that low awareness has led to poor reporting. "Women in India are more adjusting, they bear pain and distress uncomplainingly and their perception about menopause are very different," claims Dr. Vishwas Sovani, medical director of Wyeth India. He adds that women also tend to reject treatment because their mothers and grand mothers never had them.

If doctors are more careful about prescribing HRT, what are they looking at as alternatives? Some are switching to newer drugs called 'selective estrogen receptor modulator', or serm, for alleviating long-term symptoms like osteoporosis. While estrogen is generally not prescribed alone because it can cause cancer these "designer estrogens" are so engineered that they give the benefits of the hormone without the bad side effects. "They have a good effect on the heart and bones, but don't cause breast cancer. " says Dr Usha Saraiya, head of the Federation of Obstetricians and Gynaecological Societies of India. Dr Saraiya feels that usage of HRT has not so much reduced but has been "rationalised". "So, we can use combined hormone therapy for short-term selective use and designer estrogens for the longer term benefits," she says, adding that doctors have to be careful even with the newer drugs since they carry a risk of deep vein thrombosis.

Doctors are also advocating lifestyle changes to deal with menopause. This includes switching to low cholesterol and fat diets, upping the intake of soya, sprouts and calcium as well as doing regular exercise. "Some women sail through menopause on this combination." Says Dr. Coelho.

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Breast Implants Can Mar Mammo Detection-(HealthDayNews-27/01/2004)

Mammograms are less likely to detect breast cancer in women who have implants. However, women with implants don't seem to be diagnosed with breast cancer any later than women without implants. Those findings, which appear in the Jan. 28 issue of the Journal of the American Medical Association, corroborate previous research. "There's nothing there that doesn't fit in with all the previous studies and nothing about it that doesn't make good sense," says Dr. Nolan Karp, an associate professor of surgery at New York University School of Medicine and a plastic surgeon with New York University Medical Center.

According to the study authors, about a quarter of a million U.S. women received breast implants for cosmetic reasons in 2002, 11 percent more than in 2000. The study included data on 10,533 women with implants and without breast cancer, and 974,915 women without implants and without breast cancer at seven locations throughout the United States. The study authors also looked at 137 women with implants who had breast cancer, and 685 women without implants who had breast cancer. Screening mammography missed 55 percent of breast cancers in women who had undergone breast augmentation, compared to 37 percent in women who had not undergone the procedure. But when women with and without implants were diagnosed with breast cancer, the stage, size and type of tumor was not significantly different, the researchers found. No one is sure why this seeming paradox exists, but there are some convincing theories. "When you put the implant underneath the breast it's like a platform, so you're more likely to feel a [cancerous] mass," Karp says. "It seems that [women with implants] are finding cancers manually," agrees study author Diana L. Miglioretti, an assistant investigator at the Center for Health Studies at the Group Health Cooperative in Seattle. "The breast implant is firm and it pushes the breast tissue up against the skin so it makes a lump easier to feel." Miglioretti is a statistical consultant for Silimed Inc., which manufactures breast implants.

The study was supported by the National Cancer Institute. It's also possible that women with implants check their breasts more often and are more body conscious than women without the enhancements, Miglioretti adds. The bottom line is that women with implants should still get mammograms. They should just be aware that cancers can be missed, and need to be attuned to what they feel in their own bodies. "Our recommendation to all women who have breast augmentation is to go to a real breast imaging center where they can get multiple images of the breast," Karp says. "The other thing you can do is put the implant underneath the muscle. It's been shown statistically that if you do that, the percentage of the breast that is obscured by the implant is much less." On the other hand, women who have had the cosmetic surgery can be reassured that implants don't seem to affect survival. "This shows that if you get breast cancer with implants, you don't live any shorter," Karp says.

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Tamoxifen Not for All Women with Breast Cancer-(Reuters Health-26/01/2004)

More than 40 percent of women who undergo treatment for an early type of breast cancer called DCIS choose not to take tamoxifen, a drug that can reduce the odds of the cancer returning, new research shows. The proportion of women offered the drug depended on the doctor, and ranged from 14 to 73 percent. Findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) study showed that tamoxifen helps prevent DCIS from returning after surgery and radiation therapy. In the new study, Dr. Tina W. F. Yen, from M. D. Anderson Cancer Center in Houston, and colleagues assessed the impact of the NSABP results on current practices.

One hundred sixty-six (60 percent) of 277 patients had been offered tamoxifen after surgery for DCIS, the authors report in the medical journal Cancer, and only 90 patients (54 percent of those offered) agreed to take the drug. Women who underwent partial breast removal were more likely than women who underwent total mastectomy to be offered tamoxifen, as were women with smaller tumors. Two-thirds of the women who refused tamoxifen treatment had no documented reason for refusal, the investigators note, but 22 of the 26 remaining patients declined tamoxifen because of the fear of treatment-related side effects. After a follow-up of about 13 months, 70 percent of the women taking tamoxifen reported no complications, the report indicates, whereas 22 percent did have documented complications or side effects possibly related to tamoxifen use.

"We do not strongly advocate the use of tamoxifen after surgery for DCIS in any particular patient group," senior author Dr. Henry M. Kuerer told Reuters Health. "However, based on the results of our study we discuss the absolute potential benefit and risk of tamoxifen in all patients with DCIS. We also encourage our patients who are post-menopausal to participate in a new important study called NSABP B-35, which is a...study of tamoxifen versus anastrozole for women (who undergo surgery) for DCIS. Anastrozole is a promising drug that prevents estrogen (production), as opposed to blocking its effects like tamoxifen. Certain rare side effects associated with tamoxifen are not known to occur with anastrozole."

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Research Raises Cancer Concerns Over Deodorants-(Reuters-12/01/2004)

Chemicals found in underarm deodorants have been detected in the tumors of breast cancer sufferers, British scientists said. Researchers at the University of Reading found traces of the chemicals called parabens in tissue samples, proving that the preservatives can accumulate inside the body, although a direct link with breast cancer has not been proven. "Their detection in human breast tumors is of concern since parabens have been shown to mimic the action of the female hormone estrogen, and estrogen can drive the growth of human breast tumors," Dr. Philippa Darbre, lead author of the study, said in a statement. "It would therefore seem especially prudent to consider whether parabens should continue to be used in such a wide variety of cosmetics applied to the breast area," she added.

But Dr. Philip Harvey, European editor of the Journal of Applied Toxicology, which published the research, stressed the need for more investigation. "Further work is required to examine any association between estrogenic, and other, chemicals in underarm cosmetics and breast cancer," he said. Despite previous suggestions that chemicals in deodorants and anti-perspirants may be adding to a rising incidence of breast cancer, charities stress that no evidence exists to support any link. "Breast cancer is a complex disease and we do not yet understand all its causes," said Delyth Morgan, Chief Executive of breast cancer charity Breakthrough. "There has been a lot of discussion surrounding a link between anti-perspirants and the disease but there is still no scientific evidence of a causal link," she added. Breast cancer is the most common cancer in women worldwide, with one in nine UK women likely to develop the disease at some time in their life

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Breast Cancer Survival Has Improved in Last Decades-(Reuters Health-13/01/2004)

Between 1974 and 2000, women with repeat bouts of breast cancer have experienced a significant improvement in survival, new research shows. Previous reports have shown that overall breast cancer death rates have declined in recent years. However, it was unclear if this trend was due to a greater proportion of patients being diagnosed at an earlier, more treatable stage or to actual improvements in treatment. In the current study, Dr. Sharon H. Giordano and colleagues, from M. D. Anderson Cancer Center in Houston, assessed the survival outcomes of 834 women who had a recurrence of breast cancer between 1974 and 2000. The findings are reported in the medical journal Cancer. The patients were all initially treated with chemotherapy protocols approved by the review board at the authors' institution. Based on when their cancer returned, the patients were divided into five groups: 1974-1979, 1980-1984, 1985-1989, 1990-1994, and 1995-2000. The patients were followed for around 9 years after recurrence.

The authors found that survival improved steadily with each more recent recurrence group. With each 1-year increase in the recurrence date, the risk of death fell by 1 percent. Other factors associated with increased survival after recurrence included smaller initial tumor size, less severe disease, and limited spread to lymph nodes. Also, survival was better for cancers that tested positive for hormone binders called estrogen receptors. "These findings, although not conclusive, suggest that breast cancer survival has been improving," the researchers state. "We present these data to encourage further research to clarify whether advances in therapy have translated into improvements in survival for women with recurrent breast cancer."

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Antidepressant May Lower Effectiveness of Tamoxifen-(ET-21/12/2003)

Although antidepressants can help women taking tamoxifen avoid some unpleasant side effects, a new study raises the possibility that at least one of these drugs may also cause them to lose some of the benefits. Researchers have found that paroxetine (Paxil) can interfere with the metabolism of tamoxifen. Their report appears in the Journal of the National Cancer Institute (Vol. 95, No. 23: 1758-1764). Only 12 women took part in the study. A larger study is needed, researchers caution, before it's known whether women should stop combining tamoxifen and antidepressants. For now, treatment recommendations should not change, they say. "Women should absolutely not stop taking tamoxifen," said lead researcher David Flockhart, MD, PhD, of the Indiana University School of Medicine. "It's an important drug and we don't think this compromises its reputation."

Not only can tamoxifen shrink breast cancers, it can also prevent them from developing in high-risk women. And for many years, women who have had surgery for breast cancer have been put on the drug for 5 years afterward to prevent the cancer from coming back. Nevertheless, tamoxifen does have some side effects. As many as 80% of women who take the drug get hot flashes, and 45% rate them as severe. Recently, doctors have found that SSRI (selective serotonin reuptake inhibitor) antidepressants such as Prozac (fluoxetine), Paxil (paroxetine), and Effexor (venlafaxine) can reduce the severity and frequency of these hot flashes. Using both types of drugs together, though, may be a problem because of the way each drug works. Before tamoxifen can have an effect on breast cancer cells, the body must convert it (metabolize it) into an active substance. SSRI antidepressants are metabolized by the same pathway as tamoxifen, causing researchers to worry that the SSRIs might hinder tamoxifen's conversion.

The researchers studied 12 breast cancer survivors who were taking tamoxifen to prevent a recurrence and were having troublesome hot flashes. They were all given Paxil for four weeks. The researchers examined blood samples taken before Paxil was given and after 4 weeks of taking both drugs. They found that one important anticancer by-product of tamoxifen, a compound named endoxifen, was lowered by an average of 56% during the month on Paxil. Other compounds were unaffected. Because the enzyme responsible for converting tamoxifen to its active form varies among individuals, endoxifen was found to be lower in some women than in others. This means that some, but not all, women may metabolize tamoxifen abnormally if they also take antidepressants. Flockhart said only about 7% of women have the particular genetic mutations that would cause them to have the lowest concentrations of tamoxifen by-products.

The researchers are quick to point out that they don't know if this impact on metabolism will actually cause tamoxifen to be less effective. "We don't know what effects it has on [breast cancer] recurrence," Flockhart said. More studies are under way, but they will take years to complete. More research is also needed to determine if SSRIs other than Paxil will have the same effect on tamoxifen's metabolism. There is data to suggest that venlafaxine (Effexor) does not interfere with tamoxifen, Flockhart said. Women who are concerned about combining antidepressants with tamoxifen should talk to their doctor about the possibility of switching to venlafaxine, Flockhart said.

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Breast-Saving Cancer Surgery OK for Young Women-(Reuters Health-29/12/2003)

Young women with breast cancer - a group that typically has more severe disease than older women - have similar outcomes whether they are treated with breast-conserving therapy or mastectomy, new research suggests. Unlike mastectomy, breast-conserving therapy (BCT) doesn't involve the removal of the entire breast, just the part containing cancer. Patients treated with BCT are also often given radiation therapy and chemotherapy. Previous studies have established the equivalence of BCT and mastectomy in middle-aged and older women, but it was unclear if this also applied to women younger than 35 years. To investigate, Dr. Mads Melbye, from the Statens Serum Institut in Copenhagen, Denmark, and colleagues assessed the outcomes of more than 9000 women who were diagnosed with breast cancer before 50 years of age and treated with either breast-conserving therapy (BCT) or mastectomy.

Of the 719 women who were younger than 35 years at diagnosis, 500 underwent mastectomy and 219 received BCT. The researchers' findings are reported in the medical journal Cancer. Consistent with previous reports, women younger than 35 years were more likely than older women to have larger cancers as well as ones that spread to the lymph nodes. Moreover, younger women were also more likely to receive BCT than older women. Young women treated with BCT were about five times more likely to experience a return of their cancer than their older counterparts. Still, as compared with mastectomy, BCT was not tied to worsened survival in any of the age groups. The comparable survival outcomes held true when the analysis was limited to women with small tumors. "Although the high frequency of local recurrence among younger patients represents a problem in itself, the current study did not find survival to be significantly different for young women who received BCT compared with those who underwent (mastectomy)," the investigators state.

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Experts Dispute Abortion-Cancer Link-(Yahoo News-08/12/2003)

Abortion politics led the state Health Department to publish unreliable information about a link between abortions and breast cancer, state health workers wrote in e-mails obtained by the Star Tribune of Minneapolis. Government e-mails obtained under the state's open records laws reveal that a division director and others questioned an assertion on the department's Web site and in a pamphlet that having an abortion may increase the risk of breast cancer. The statement, posted in late September, was viewed inside the Health Department as a disservice to citizens and damaging to the department's credibility, according to e-mails circulated in the department in October. Critics of the department's position on abortion and breast cancer say the statement is designed to frighten women considering abortion. The e-mails also show that Gov. Tim Pawlenty's office had a role in approving the language on breast cancer risk as well as another controversial statement on fetal pain.

Manning circulated a memo to her division's staff members in October, saying they should tell anyone who asks that having an abortion does not increase a woman's risk for breast cancer. The e-mail cited findings of the National Cancer Institute. A panel of 100 breast cancer experts reviewed all the research and concluded last spring that some small, flawed studies published before the mid-1990s had found a link to breast cancer, but larger, more reliable studies showed no connection. Manning told staff members that if anyone questioned the discrepancy between the institute and the Health Department's published position, he or she should be referred to higher-ups.

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Drug Shows Promise Vs. Breast Cancer-(Health AP-05/12/2003)

An experimental chemotherapy drug called Abraxane was more effective in treating advanced cases of breast cancer and carried fewer side effects than its widely used cousin Taxol, according to a study. In another chemotherapy-related study, the drug docetaxel - widely used for late-stage breast cancer since the mid-1990s - was found to be dramatically better at battling a common early-stage form of the disease than fluorouracil, long a standard treatment. Research by the Breast Cancer International Research Group determined that five years after initial treatment, the docetaxel patients had a 28 percent lower risk of recurrence than the fluorouracil patients. "I think this will be convincing to a lot of doctors," said Dr. John Mackey, a breast cancer specialist at the University of Alberta in Canada and a co-leader of the study. "People change their (drug recommendations) based on a 2 to 3 percent improvement."

A study involving 454 women with breast cancer that had spread elsewhere in the body found that 33 percent of tumors shrank or experienced slower growth with Abraxane, compared with 19 percent for Taxol. Abraxane also slowed tumor growth significantly in those patients. The studies were outlined at a breast cancer conference in San Antonio. Abraxane is on a fast-track approval schedule with the Food and Drug Administration. Its maker, American BioScience Inc., which sponsored the study, plans to file its final data for approval in early 2004, said spokeswoman Susan Bro. Both Taxol and Abraxane are derived from paclitaxel, which works by interfering with a cancer cell's ability to divide.

A big difference is how they make their way through the body, and thus how large the dosage can be. Taxol is combined with an oil-based solvent known as Cremophor, whose often harsh side effects limit how much paclitaxel can be delivered to a patient per treatment session. Abraxane, on the other hand, hitches a ride on the naturally occurring human protein albumin, allowing researchers to administer about 50 percent more paclitaxel per treatment. This approach "allows us, for the first time, to fully maximize the tried-and-true power of paclitaxel," said Dr. William Gradishar, a Northwestern University medical professor and a co-director of the study. Edith Perez, who did early research on Taxol, says Cremophor's toxic nature - it can cause hypertension and life-threatening allergic reactions - has long made it a candidate for replacement. "The existing agent (paclitaxel) has been taken and made into a new drug," said Perez, who teaches at the Mayo Clinic's medical school in Jacksonville, Fla. "I think this is a major improvement."Neil Desai, research vice president at American BioScience, said Abraxane's delivery system - known as nanoparticle albumin-bound technology - may also be used for other water-insoluble drugs injected into the bloodstream.

The docetaxel study involved nearly 1,500 pre- and postmenopausal women in 20 countries with early-stage breast cancer that had spread into the lymph nodes in the armpit. After five years, 75 percent of the docetaxel patients had not developed new breast cancer, compared with 68 percent of the fluorouracil patients. Using statistical analysis, the researchers calculated that the chances of relapse using docetaxel are 28 percent lower than with the other drug. "These results offer a promising new treatment option for reducing the risk of recurrence and mortality of early breast cancer patients," said Susan Braun, president of the Susan G. Komen Breast Cancer Foundation, based in Dallas. The study was sponsored by Aventis Pharmaceuticals, which markets docetaxel under the brand name Taxotere

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Simple blood test could detect breast cancer: Norwegian research-(AFP-04/12/2003)

A simple blood test could in the future be used to detect breast cancer, a disease which affects 10 percent of women in the Western world, a Norwegian group developing the method said "When you get a disease, it's not only the primary site of the disease that responds. There are responses in other parts of the body as well. Our method aims at detecting those responses," said Anders Loenneborg, the head of the DiaGenic research company told AFP. "Cancer provokes a different activity of genes in the blood. We are trying to find a pattern of gene activity that is characteristic to breast cancer," he added. Loenneborg, whose firm employs just nine people, said his group had already managed to detect a "pattern" of 49 genes found in women with breast cancer where the illness had been detected by traditional methods, such as mammography and ultrasound. DiaGenic is currently researching whether this pattern is specific to breast cancer or applies to other kinds of cancer or illnesses. If their results prove conclusive, the detection method could be put on the market in two years, "if we have all the optimal conditions", that is, if financing and opportunities permit, Loenneborg said. He said he was already in negotiations with several market players.

The biggest advantage of the blood test method is that it provides the possibility of early detection. "These changes in the gene activity are the first changes that take place. So you can detect the cancer at a very early stage," Loenneborg said. The method would make it possible to detect a tumour measuring less than five millimeters (a fifth of an inch). The blood test is also a simple method. "You can take a blood sample anywhere and send the sample to a centralised lab," he said. This would allow people to avoid waiting queues and eliminate the need for each hospital to install special equipment. The method would at least at first be used as a complement to mammographies, not as a replacement. "The first product would be something that would complement mammography. But we will continue to develop it," Loenneborg said. Breast cancer is the second leading cause of death among women in Western countries, after lung cancer. In very rare cases, the disease can also affect men.

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Red Wine May Protect Against Breast Cancer-(HealthDayNews-04/12/2003)

Red wine may do more than reduce the risk of heart disease. The grape skin and seeds appear to hold a natural cancer-fighting chemical, California researchers report. Scientists at City of Hope Cancer Center in Los Angeles isolated a phytochemical, called procyanidin B dimer, that when given to mice with breast cancer reduced the size of their tumors. While there are already drugs on the market that can control estrogen-dependent breast cancer development in post-menopausal women, this is the first naturally occurring phytochemical that appears to have the same effect, says study author Shiuan Chen. "It was surprising that we were able to identify this chemical in a natural source," says Chen, director of surgical research at City of Hope. "Further, there was a pretty significant reduction of tumor size in all the mice, and a number of animals ended up with no tumors."

However, Chen says that natural phytochemicals are more likely to be used in a preventive way than as treatment for breast cancer because existing drugs are far stronger. "We are talking about prevention," he says. "By having this in the diet, one can keep the estrogen at a lower level, which can be preventive for breast cancer." For post-menopausal women who have breast cancer tumors that are fed by estrogen, which make up about 75 percent of breast cancers in this age group, estrogen-suppressing therapy is aimed at the estrogen produced outside of the ovaries, in peripheral tissue like fat and skin cells, Chen says. New drugs like anastrozole, letrozole and exemestane, which are taken in pill form, work by reducing the activity of an enzyme called aromatase that is key to the production of estrogen. The estrogen is no longer available to breast cancer tumors, inhibiting their growth.The phytochemicals work in the same way as these drugs, but have the advantage of naturally occurring in grape skins and seeds, Chen says. The study was published this week in the journal Cancer Research.

Chen cautions that the research is based on an animal study, and that clinical trials on post-menopausal women are needed to confirm any benefit to humans. He says he's conducting such trials now. "We have to be careful," he adds. "We don't support the idea of people drinking a lot of red wine, as alcohol is a risk factor for breast cancer." For instance, he notes, that for women to ingest the comparable amount of procyanidin B dimer given to the mice, they'd have to drink a half bottle of red wine daily. But he adds, for normal, healthy women, a glass of red wine a day or eating grapes with skins and seeds may just reduce the overall circulation of estrogen in the body.

Why does red wine confer this potential benefit and white wine doesn't? Chen says red wine is made by fermenting not just the juice from a wine grape, but the skin and seeds as well, which is where the phytochemical is located. White wine is most often made by using just the juice from the grape and discarding the skin and seeds, he says. Tom Klassen, assistant winemaker of Landmark Vineyards in Kenwood, Calif., says, "The general tendency is that red wines get fermented with skins and seeds, and white wines do not. Red wines will spend a week with skins and seeds, and sometimes much longer -- they may be on the skins for a month or more." Dr. Jay Brooks, chief of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge, La., calls the new research "very interesting work that shows that many of the foodstuffs we eat have beneficial effects. "A lot of epidemiologic studies show that a glass of red wine may be beneficial for reducing heart disease," he says. He adds that, despite the studies showing alcohol consumption is a risk factor for breast cancer, "if a woman drinks a glass of red wine per day, it will not increase her risk of breast cancer dramatically."

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Better Breast Scans-(HealthDayNews-01/12/2003)

New computer-aided diagnosis (CAD) systems that help doctors analyze mammograms and ultrasound breast scans may improve the ability to detect breast cancer and track changes in a woman's breast over time These systems, designed by University of Michigan Health System (UMHS) scientists, are in various stages of development. The UMHS scientists presented an update on their research on Dec. 1 at the annual meeting of the Radiological Society of North America in Chicago. Among the test results, the UMHS team says one of their CAD systems improved the ability of highly experienced radiologists to distinguish cancerous tumors from benign growths on ultrasound breast scans. These scans are often used after a suspicious finding on a mammogram to help doctors decide if they need to do a biopsy. In such cases, the assistance offered by the CAD system could mean that fewer women with benign disease would need to have an invasive biopsy procedure.

"In the near future, it won't be possible for computers to replace radiologists for this kind of test, because a radiologist looks at the patient's entire case, not just her ultrasound images. But if radiologists work with computers, they could improve their accuracy and spare some women benign autopsies," UMHS associate research professor Berkman Sahiner says in a prepared statement. Sahiner suggests that since the ultrasound CAD system helped highly experienced breast radiologists, it may be able to prove even more helpful to less experienced doctors.

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Breast Cancer's Emotional Impact Greater for Young-(Reuters Health-02/12/2003)

The long-term emotional impact of breast cancer may be greater for young women, new research suggests. The study of nearly 600 breast cancer survivors found that several years after diagnosis, women who developed the disease in their 20s or early 30s reported poorer emotional well-being than did older women. These younger women were also more likely to say they lacked energy, according to findings published in the Journal of Clinical Oncology. However, the results do not mean a young woman who survives breast cancer then faces the prospect of poor mental health. Instead, the study shows that if a woman feels long-term emotional effects, it's normal and she's "not alone," lead author Dr. Patricia A. Ganz told Reuters Health.Women who go through breast cancer treatment in their 20s or 30s may need more time or more help to deal with the psychological aftermath, according to Ganz, who is with the University of California Los Angeles Jonsson Cancer Center.

For the study, Ganz and her colleagues surveyed 577 women who were 50 years old or younger when they were diagnosed with breast cancer--42 of whom were between the ages of 25 and 34. At the time of the study, all had been free of the disease for two to 10 years. Overall, the researchers found, women of all ages were doing fairly well physically--a finding Ganz called "good news." Women in the youngest age group, however, scored lowest on measures of emotional well-being. Early menopause caused by chemotherapy emerged as one important factor. Besides this treatment effect, Ganz noted, young women may be particularly distressed by a breast cancer diagnosis because they often have young children, or are forging careers or relationships. They also have less experience than older women in dealing with health crises.

Few women in their 20s or 30s develop breast cancer. Of the roughly 200,000 U.S. women diagnosed with the disease each year, less than one quarter are younger than 50. Since the number is relatively small, less is known about the long-range impact of breast cancer and its treatment on young women. "This is really the largest study to look at this in a comprehensive way," Ganz said. The hope, she noted, is that doctors can use the information to identify women who might need special attention in the years after the cancer treatment is over.

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Researchers find missing link between hereditary and sporadic breast cancers-(CP-25/11/2003)

An international team of researchers, including several from British Columbia, has discovered a new gene for breast and ovarian cancer they believe may be a missing link between hereditary and sporadic forms of breast cancer. If the findings hold true in further studies, they may help doctors determine at an early stage which women have a highly virulent form of cancer so they can tailor treatment accordingly. "We see these mutations in breast cancers that have a particularly aggressive behaviour," said Dr. David Huntsman, a genetic pathologist with the British Columbia Cancer Agency. "And these are breast cancers which, since they're node negative breast cancers, we would have thought they would have been less aggressive tumours." The findings were published in Cell, one of the most prestigious international scientific journals.

The team, led by researchers at Cambridge University, has shed light on a conundrum which has puzzled breast cancer researchers for some time involving the activity of a gene known to cause some hereditary breast cancers. BRCA 1 and BRCA 2 are genes which help restore damaged DNA before it can become cancerous in normal breast tissue. But women who carry a mutated form of these genes run a high risk of developing breast and ovarian cancer. Breast cancers attributable to these mutations make up only a small portion - less than five per cent - of all breast cancer cases. The rest are sporadic cases which occur in women without strong family histories of the disease. Researchers haven't been able to figure out why the BRCA genes aren't implicated in the development of sporadic breast cancer - why they behave normally in 95 per cent of women with breast cancer but not in the other five per cent. While trying to puzzle that out, the British teams discovered a new gene, which they dubbed EMSY. The gene, which produces a protein of the same name, interacts with BRCA 2. With the help of scientists at the BC Cancer Agency and Vancouver Coastal Health Research Institute, the researchers determined that in some sporadic cancers the problem isn't BRCA 2, it's EMSY. "What they've discovered - and we've determined the clinical relevance of their discovery - is that instead of having abnormalities in BRCA 2 itself, it's its partner gene EMSY which is abnormal in the cancers," Huntsman said.

By studying hundreds of tissue samples from the cancer agency's breast cancer archive, they saw that in 13 per cent of sporadic breast cancers, EMSY ran amok. For some unknown reason, the gene reproduced itself many more times than it should have, creating too much of its protein. Examination of the clinical files of the women showed these cancers were very aggressive; women with extra copies of the EMSY gene survived an average of 6.4 years, compared with 14 years for women with normal EMSY levels. The difference was particularly striking in women whose cancers had been caught before they moved into the lymph nodes. Such early detection is generally thought to improve survival chances but not so with the women who had the mutated EMSY gene. "Discovering such an important new gene is very exciting and gives us a piece in the jigsaw we've been looking for," Prof. Tony Kouzarides, leader of the Cambridge team, said in a statement. "It's going to give us new lines of investigation and potentially exciting angles of attack."

Huntsman said future research will look at whether this type of breast cancer responds better to some forms of existing chemotherapies than others. As well, the researchers are hoping they may be able to figure out how to turn off the mutated EMSY gene in these types of tumours. "If we could develop a drug that would work really well for 13 per cent of breast cancer women, and use a test so that we could just target those 13 per cent of women and offer just those women the drug, we will have made a huge difference," he said. But he cautioned it will be some time before research can be translated into changes in treatment. "This is a tantalizing lead which may be a useful test for the laboratory, but a lot of work has to be done before it's ready for prime time."

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Rise in Large Breast Cancers Seen in U.S. Women-(Reuters Health-19/11/2003)

In the 1990s, a small but unexpected rise in the rate of large breast cancers was observed among white women in the US, new research reveals. Although large tumors are twice as common in African Americans, rates in this group remained stable during the same period The findings are based on a study conducted by Dr. Michael Thun and colleagues at the American Cancer Society in Atlanta. Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program and from the National Center for Health Statistics were analyzed to assess recent breast cancer trends by race and ethnicity. This year, the researchers predict more than 250,000 new cases of breast cancer and nearly 40,000 deaths among women in the US. The findings are reported in CA: A Cancer Journal for Clinicians.

Since the early 1980s, increases in breast cancer rates were observed among all women, the authors note. These rates have stabilized for African American women since 1992, but continued to rise in other ethnic groups except American Indians/Alaska Natives. In the latter group, a drop in rates actually occurred between 1992 and 2000. The rates of large tumors (greater than 5 centimeters in diameter) among white women increased from 5.6 to 6.3 cases per 100,000 between 1992 and 2000, the authors note. Although this finding is partially responsible for the overall increase in cancer rates, a rise in small and localized tumors was mainly to blame for the overall trend in white women. With the exception of small (no greater than 2 cm) tumors, all other tumor sizes were more commonly seen in African American women than in white women. In addition, African Americans were more likely to be diagnosed with advanced disease than whites. Other ethnic groups had lower breast cancer rates than African Americans or whites. However, compared with whites, all other ethnic groups were more likely to have their disease diagnosed at an advanced stage and with larger tumor size.

Despite the rise in breast cancer rates, deaths from the disease have actually dropped since the early 1990s. For whites, death rates fell by 2.5 percent per year, whereas for African Americans the annual drop was more modest--1 percent. By 2000, ethnic difference trends resulted in a 32 percent higher death rate for African Americans compared with whites. Currently, 63 percent of breast cancers are diagnosed at an early stage and 29 percent are diagnosed at a more advanced stage, the authors note. The corresponding five-year survival rates are 97 percent and 79 percent. "Although continued research is needed on the causes, prevention, and treatment of breast cancer, much progress can be made by applying current knowledge fully and equitably to all segments of the population," the researchers conclude.

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