Breast Cancer Prevention, Breast Cancer Treatment, Cancer News : Info Centre

Resource
Directory

Frequently Asked Questions
Articles
Reports
Useful Links
Book Review
Clipping Files
Cancer Brochures
Chat Transcripts

Clippings

The following are extracts of recent cancer-related news items from local daily newspapers.
Do you see something you want to know more about? Would you like to be sent the whole article? Please contact us.

BREAST CANCER

Study Focuses On Pinpoint Attacks Against Breast Cancer (Yahoo News- 5/11/2007)

Reacting to a concern over whether some breast cancer patients are being "overtreated," a group of doctors in Texas are laying the groundwork for a study about whether chemotherapy is necessary for every cancer patient. Chemotherapy can save the lives of cancer patients, but it is a very wide and sloppy approach, killing healthy cells as well as cancerous ones, with side effects ranging from hair loss to heart damage. "It is possible that as many as 15,000 women are being overtreated with chemotherapy where they either don't really need it or get any benefit from it," said Dr. Robyn Young, an oncologist at the Center for Cancer and Blood Disorders in Forth Worth, Texas.

Now, however, recent scientific advances in genetics and drug delivery are making it possible to attack specific cancers while leaving healthy cells intact. Young and her colleagues are taking part in a study examining whether treatment could be tailored to specific genes in the tumor that might be vulnerable to a pinpoint attack. Results, however, won't be known for another decade, since it will take about five years to enroll 10,000 women in the trial and another five years to follow their progress.

[Back]

Adult weight gain raises breast cancer risk: study (Yahoo News- 22/10/2007)

Women who put on a lot of weight at any stage of adulthood increase their risk of breast cancer, likely because the hormone estrogen accumulates in the acquired fat and promotes tumors, researchers said on Monday. Women who became overweight or obese had 1.4 times the risk of breast cancer compared to women whose weight remained stable or declined, their study found. "The present findings indicate that the relations of adult weight gain to breast cancer is evident throughout the entire adulthood life span rather than being limited to a specific time in life," Jiyoung Ahn of the U.S. National Cancer Institute wrote in the Archives of Internal Medicine. "These findings may reinforce public health recommendations for the maintenance of a healthy weight throughout adulthood as a means of breast cancer prevention," Ahn wrote. The nearly 100,000 women in the study reported their weights at age 18, 35, 50 and now. Of them, 2,111 developed breast cancer.

On average, women in the study gained more than 34 pounds (15.6 kg) during their adult lives, roughly evenly divided in the ages between 18 and 35, 35 and 50, and 50 and their current age, while 8 percent maintained their weight. "Women who gained weight or were overweight or obese were more likely to develop advanced disease or hormone receptor-positive tumors," Ahn wrote.

The relationship between weight gain and breast cancer is complicated, researchers say, because the timing of estrogen exposure and levels of the hormone can be hard to pinpoint. In this study, for instance, weight gain was less of a risk factor among women who began menstruating relatively early in life or who took hormone-replacement therapy during or after menopause -- both of which acclimated their bodies to more estrogen.

Women in the study who lost weight during their adult lives did not have a lower risk of breast cancer, unlike indications of such an association reported in some earlier studies. But the study did conclude that weight gain at any stage of adulthood increased breast cancer risk. Some earlier studies have suggested the riskiest time to put on weight was after menopause, when a woman's ovaries stop producing estrogen and fat cells become the primary source of the hormone. It was unclear from the study whether modest weight gains increased the risk of breast cancer. In the United States, there will be an estimated 178,000 new cases of breast cancer this year, with 40,000 deaths.

[Back]

Pregnant cancer patients winning their fight for two lives-(Yahoo News- 28/09/2007)

Pregnant, and fighting cancer In the span of a few days last April, Linda Sanchez's doctors found within her body the seeds of both life and death.n Suddenly pregnant with her first child and diagnosed with breast cancer, Sanchez was overwhelmed by the contradiction, a mess of emotions. They only got worse as she received another jolt. "The doctor told me I wouldn't be able to carry the pregnancy to term," says Sanchez, 26, a U.S. immigration and customs officer who recently relocated from Houston to Laredo. "All I really remember after that was breaking down in tears."

For years, the dreadful choice given to pregnant women with cancer was really no choice at all. Delay treatment until delivery and they risk losing their lives; start treatment while pregnant and the babies are likely to be harmed. Women who didn't want to abort their babies had a hard time even finding doctors who would accept their cases. But Sanchez found her way to the University of Texas M.D. Anderson Cancer Center, where doctors have pioneered the treatment of pregnant breast cancer patients since 1989. They told her they could treat her cancer without injuring the baby and — five rounds of chemotherapy later — Sanchez just began her 28th week of pregnancy, due to deliver Dec. 26. Her cancer has shrunk 67 percent and, in ultrasounds, the baby looks healthy.

The diagnosis of cancer in pregnant women is rare, but oncologists believe the numbers are growing as more women put off childbearing until their 30s and 40s, the age when the risk starts growing. Estimates put the number of pregnancies among women with breast cancer at 1 in 3,000; among women with any form of cancer, at 1 in 1,000. M.D. Anderson's work, once controversial, last year formed the basis of the first national guidelines for the treatment of pregnant women with breast cancer. Announced at the 11th annual conference of the National Comprehensive Cancer Network, the guidelines say chemotherapy can be safely administered beginning in the second trimester. Radiation shouldn't be given until after birth.

But beyond the nation's cancer centers, the word is still trickling out. Most of the women who come to M.D. Anderson — a few a year, although the number seems to be increasing — are refugees from doctors who recommended terminating their pregnancies. "They tend to be distraught, in shock when they come in," says Dr. Richard Theriault, a professor of breast medical oncology and the leader of M.D. Anderson's program. "They've often been told they should have a therapeutic abortion, but the idea isn't therapeutic to them in any way."

'Protect my baby'
Theriault describes as heroic those women who came to him in the program's early years, intent on not letting cancer come between them and their babies. One devout Christian would lay her Bible on her belly and pray, "God, please protect my baby." It's not hard to understand fears of chemotherapy's danger to a developing baby. Drugs typically used to treat particular cancers have caused eye abnormalities, absent toes and cleft palates in babies exposed during the first trimester, before doctor and patient knew of the pregnancy. The first trimester is the most formative period for organ development.

But in studying the case reports back in the late 1980s, Theriault noticed there wasn't much difference in the rate of abnormalities in babies exposed to chemotherapy during the second trimester and the rate in babies never exposed. The risk was just under 20 percent when chemotherapy was given in the first trimester, but less than 1.5 percent when given in the second trimester and when not given at all. Theriault decided to research treatment beginning in the second trimester with those women who didn't want to abort. In the 18 years since, 68 breast cancer patients at M.D. Anderson have given birth, all of whom are developing normally except for one born with Down syndrome. Doctors say the condition was unrelated to the chemotherapy regimen.

Among the patients was Amy Langford, a League City woman pleasantly surprised to learn that she was pregnant at 42, then unwilling to accept her doctor's recommendation that she have an abortion when she was diagnosed a month later with breast cancer. She and her husband, Gregg, got on the Internet and quickly found there were options. But the ordeal was not without anxious moments — waiting a "nerve-wracking" month to get into M.D. Anderson, choking up and thinking "we don't want to be here" the first time they walked in the door. But the Langfords say their attitude soon changed to "we're going to be OK" — and they were. Amy had amniocentesis, a lumpectomy and four rounds of chemotherapy and then delivered Bryan, a healthy 6-pound, 12-ounce boy, on May 23, 2005. She had radiation after that.

The biggest symbol of Bryan's health: a head full of hair, a sign the chemotherapy didn't have the toxic effect that leaves mothers bald. That's something of a mystery. Cancer doctors think the placenta acts as a barrier, but why it blocks chemotherapy while allowing alcohol, caffeine, cocaine and thalidomide to wreak such damage is unknown. The leading theories are that chemotherapy drugs have a hard time penetrating the placenta because they consist of large molecules, whereas the other agents are made up of small molecules that can enter easily. Also, the placenta is rich in a protein that acts to reject chemotherapy.

Since 2001, M.D. Anderson doctors have teamed with Dr. Mildred Ramirez, a high-risk obstetrician at the UT Medical School at Houston who monitors mother and child to ensure that a pregnancy is progressing appropriately. Pregnant cancer patients typically go from M.D. Anderson appointments to Ramirez appointments in the same day. "What I'm struck by, the first time I see a pregnant cancer patient, is that they initially tend to have a fear of hurting their unborn child — much more than a fear of their own death," said Ramirez, looking at Sanchez's ultrasound on a recent visit.

Chemo and pregnancy
Breast cancer is the most common cancer treated during pregnancy, but chemotherapy also has been administered to expectant mothers with leukemia, lymphoma, thyroid and even ovarian, lung and colon cancer. But Theriault says he does not know of any studies of those cancers and pregnancy. Theriault also says there's no truth that chemotherapy could hurt a woman's chances of conceiving again nor that pregnancy might reduce her chances of survival. Because most breast cancers in premenopausal women are not estrogen- or progesterone-linked, pregnancy-related hormone surges don't feed the tumor.

Still, the patients' own fate is no certainty. Twenty-five percent of the women in the M.D. Anderson study have died, a reflection on the stage and size of their tumors when they got to the cancer center, Theriault says. It's not uncommon for the diagnosis to have been delayed because some signs of breast cancer — lumps, for example — are similar to changes that occur in pregnancy.

Such was the experience of McAllen patient Maria Ramirez last fall. Told by her doctor not to worry about a lump she'd detected because it probably was related to the pregnancy, she finally insisted on a biopsy. A week later, she got the news that it was cancer. No night was harder than that one for Ramirez, 30, who already had one child. Her doctor gave her no indication of what lay ahead, so the only thing she knew came from her husband's phone call to a doctor he knew, who said abortion was the usual option.

"It's all about knowledge," said Ramirez, whose mind was put at ease two days later when she learned of M.D. Anderson's program. "If I just knew that first night what I learned later, I would have saved myself a lot of pain and fear and anxiety." Although she had her emotional ups and downs, Ramirez marvels at how smooth her pregnancy and delivery went, a common occurrence. For reasons doctors don't understand, most pregnant women on chemotherapy have less nausea and vomiting than non-pregnant patients. It's not because the regimen is "chemo-lite" — doctors fear recurrence in pregnant women no less than in any other patients. A couple of drugs are avoided, but the dosage is essentially the same, recalculated because of the woman's weight gain.

Alejandro Ramirez, now 3 months old and a little on the fussy side, according to his mother, weighed in at 7 pounds, 15 ounces at birth — a bit heavy by the standards of most chemo-babies. Theriault's study found that chemotherapy caused early delivery and slightly lower birth weight than normal. Of course, it's too early to pronounce the treatment of pregnant cancer patients completely risk-free. Theriault and others acknowledge it could be decades before the effects of chemotherapy show up. But so far, with the eldest child born in the program now 18, the news is only good. It's also heart-tugging, as when Theriault pulls out a scrapbook showing many of the children as babies and as they've gotten older. He reminisces about each, recalling one's curly locks, musing about a recent conversation with another's mother. "It's like having a lot of grandchildren," says Theriault, stopping at one page. "There's a happy feeling you get, knowing you were able to help the moms have normal kids."

[Back]

Breast cancer afflicting younger Asian women-(Reuters- 28/09/2007)

Breast cancer is becoming more prevalent in Asia and affecting younger women than those in the U.S. and Europe, a cancer specialist in Hong Kong said. "We are seeing younger women with breast cancer throughout the whole region. It's the same in China, Taiwan, Hong Kong, (South) Korea and Singapore," said Louis Chow, executive director of the Hong Kong-based Organization for Oncology and Translational Research (OOTR).

"Compared to (victims in the) U.S. and Europe, we're seeing pre-menopausal women in Asia, whereas in developed countries we are seeing post-menopausal women, in their mid-50s. In Asia, we see those in their 40s and we are not even surprised to see those in their 30s," he said in an interview. Breast cancer is the most common cause of cancer in women. In the United States, it affects one in eight women and is the second most common cause of cancer deaths in women after lung cancer. Eighty percent of breast cancer cases occur in women over 50 in the United States. Breast cancer is rare for men.

While the median age of women stricken with the disease in Hong Kong is 52, it is increasingly seen in younger women. Between 1993-1997, 88 cancer cases were seen in the 40-49 age group per every 100,000 of the population, up nearly 63 percent compared to 54 cases in the years 1978-1982. But cancer cases in the 50-59 age group grew more slowly. Between 1993-1997, there were 98.5 cases per every 100,000 of the population, up just 31 percent compared to 75 cases in 1978-82.

Cases in the 30-39 age group grew 43 percent over the same period. But while breast cancer has been extensively studied in the West, experts have little idea as to the risk factors in Asia. "In the West, the risk factors are a very strong family history, uterine and ovarian cancers. These may also apply here, but we can't just use them," said surgeon Chow. "We can't borrow the model from the West and put it here. We have a different genetic makeup. We have different clinical presentations especially in terms of age, we can't just borrow."

In a survey carried out in March with 1,000 women in Hong Kong over the age of 18, 70 percent of participants did not have annual mammograms, or screening for early breast cancer. While 80 percent of those with primary education were aware that annual screening was necessary for women over 40, only 63 percent of those with tertiary education were aware of that. Those with more education ignore the facts of breast cancer, they are very deficient in knowledge, maybe they have no time," said Chow, who urged governments in Asia to put more resources into screening to reduce mortality rates. Approximately 240,510 new cases of breast cancer are expected to be diagnosed in the U.S. in 2007 and 40,460 women will die from it. In Hong Kong, where the population stands at nearly 7 million, 2,273 new cases were diagnosed in 2004 and 454 women died from it.

[Back]

Breast cancer gene test disputed-(Yahoo News- 30/09/2007)

A one-minute television ad masquerading as a public service announcement about hereditary breast cancer over-simplifies and exaggerates the risk of the disease, omits important caveats and encourages women to take an expensive genetic test that most do not need, doctors and genetic counselors contend. Myriad Genetic Laboratories of Salt Lake City, Utah, began the breast cancer campaign on Sept. 10, with television and radio advertisements urging women to "be ready for breast cancer" by undergoing a $3,100 test that Myriad has under patent. At issue are two genetic mutations, BRCA 1 and BRCA 2, that are passed through generations and significantly increase the lifetime risk for breast and ovarian cancer.

Because of Myriad’s patents, it is the only company that can offer tests for the two flawed genes. However, only 5 to 10 percent of breast cancers are hereditary, cancer specialists said. And the Myriad test, called BracAnalysis, could miss cancer causing mutations in a small percentage of women, and suggest a risk where none exists, according to a study in the Sept. 27 Journal of the American Medical Association.

Moreover, the genetics of hereditary cancer are exceedingly complex and many primary care doctors might not be able to judge test results or advise patients knowledgeably, said Dr. Molly Brewer, associate professor of gynecology in the University of Connecticut Health Center’s Neag Comprehensive Cancer Center.
"Most doctors are not familiar with genetic cancer. Publicizing the test is good, but it’s not something everyone should be tested for. Advertising to patients that they should be genetically tested is inappropriate," Brewer said.

Dr. Gregory C. Critchfield, president of Myriad Genetic Laboratories, said the television and radio ads are intended to make women with a "family history" of breast or ovarian cancer aware of the test and its importance."It’s designed to raise public awareness of hereditary breast and ovarian cancer and to encourage women to talk to their health care providers," he said. "Actually, they’re ads by a company with an exclusive patent that has an incentive to sell their tests," said Ellen T. Matloff, director of cancer genetic counseling at the Yale Cancer Center.

The cost of the BracAnalysis blood test is only covered by health plans if the woman has real risk factors for hereditary cancer. "The television ad doesn’t mention any of the risk factors for hereditary breast and ovarian cancer, or that a minority of breast cancers are hereditary," she said. "Only one in 10 breast cancer cases are hereditary, and only one in 400 people carry one of these mutations," Matloff said.

The ads have caught the attention of Attorney General Richard Blumenthal, who has subpoenaed Myriad for information about the ads, the test and other subjects. Critchfield said Myriad is cooperating with Blumenthal and is assembling the requested documents. "They seem to exaggerate, and oversimplify the benefits of taking the test," Blumenthal said. The ad consists of women talking into the camera. "Breast cancer runs in my family," says one. "My mother," says another. "My grandmother," a third. Then a woman says, "I wondered if it would be inevitable." The first woman returns to say, "I found out it doesn’t have to be. I found my risk though BracAnalysis."

The problem with the ad up to this point, is that having family members with breast cancer does not mean the cancer is hereditary, said Robin Schwartz, assistant professor of genetics and developmental biology and pediatrics at the UConn health center.

Signs of hereditary cancer include multiple cancers in a family and early onset of breast cancer, Brewer said. While most breast cancer occurs in post-menopausal women, hereditary breast cancer often appears in women 25 to 40 years old, she said. These cancers also usually run down one side of a family. Then a woman in the ad says, "BracAnalysis is a blood test that has helped thousands of women find out their risk for breast and ovarian cancer." The first woman again: "After BracAnalysis I realized I could do something now."

The fact is that about 1 in 8 women in the U.S. will develop breast cancer. Risk factors include age, age at the first menstrual period and age of first live birth. BracAnalysis could identify a much less likely cause of breast cancer. Women with normal genes face a 1.7 percent lifetime risk of ovarian cancer and a 12 percent lifetime risk of breast cancer, Brewer said. Women with a BRCA 1 mutation have an 85 percent risk of breast cancer and a 40 to 60 percent chance of ovarian cancer. However, the number of women carrying mutations of BRCA 1 or 2 is so small that their cancers comprise 5 to 10 percent of breast cancers.

The rate of the BRCA 1 mutation is about 8.6 percent, and BRCA 2 is about 5 percent, studies suggest. This means that BracAnalysis is of no use for at least 90 percent of women in the U.S. Of the small remaining pool, the BracAnalysis test does not detect all BRCA mutations, either. Researchers at the University of Washington found that genetic testing in the U.S. for BRCA 1 and 2 mutations — necessarily performed by Myriad — missed about 12 percent of the cancer-predisposing genes, according to the JAMA report of Sept. 27.

Schwartz said BracAnalysis test results require expert interpretation. The possible results are:

• Positive for a "deleterious mutation" of BRCA 1 or 2.

• Positive for a genetic variant suspected of being deleterious.

• Positive for a genetic variant that is not believed to cause cancer.

• Positive for a genetic variant of uncertain significance.

• Negative for mutations.

Each of these findings presents the women who was given the test with a quandary, Schwartz said. sContrary to the Myriad ad, medical options for women with confirmed BRCA 1 or 2 mutations are limited. The safest, though most disruptive option, is removal of both breasts and the uterus. Many women instead opt for frequent cancer screening tests. But these results have ramifications for more than the one woman patient, Schwartz said.

"If someone approaches this as ‘just a blood test’ they may be unaware of the implications for other family members," she said. Positive results mean that the patient’s siblings and children may also carry the mutations. Should the woman notify all affected? How will they react? What about estranged family members?

If the finding is of "uncertain significance," what should the woman do? Matloff said, "Recently I consulted with a woman who had a finding of variant of uncertain significance, and she was about to get both breasts removed." A double mastectomy was not indicated, as it was not clear whether the mutation was even harmful, she said. Blumenthal said the tone of the ad is also troublesome. The test might give some women a false sense of security, or convince them to undergo unnecessary measures, he said.

Furthermore, a general practitioner can request the test without receiving appropriate training, Blumenthal said. Critchfield said physicians can depend on medical society guidelines or take continuing medical education courses. "This is a service. It allows doctors to learn what their societies are saying," he said. "The importance of discussion between the patient and health care worker cannot be overemphasized," he said. However, Myriad does not offer training on the use, application or interpretation of the test, he said.

Still, the Myriad campaign could help thousands of women, Critchfield said. "This is a very important story to get out into the community. There is a large number of women at risk for hereditary cancer," Critchfield said. Critchfield said 97 percent of carriers of BRCA 1 or 2 mutations do not know it. Experts questioned the basis for that number. Blumenthal said the ads apparently overstate the number of women who carry the mutated genes, or who could benefit from the test.

In addition, unlike ads for pharmaceuticals, the Myriad ad does not mention that hereditary breast and ovarian cancers amount to a very small percentage of the total, that the test may yield ambiguous results, and that it carries a risk of false positive and negative results, Blumenthal said. "The ad appears to be a public service announcement. That’s very concerning to us. The content and tone suggest it is a public service announcement," he said.
The subpoena was filed under the aegis of the Department of Consumer Protection. "If Connecticut finds that the ads are deceptive, we can seek restitution for consumers, and also seek fines and penalties," Blumenthal said. "Promoting awareness of ways to prevent cancer is very good. These ads are not efforts to prevent or reduce risk," he said.

[Back]

DDT, breast cancer linked. Study focuses on women's exposure as young girls (Yahoo News- 10/10/2007)

A new study has found a significant link between women's exposure to DDT as young girls and the development of breast cancer later in life. The results are something of a surprise, researchers said, because several previous studies have found no link between cancer and the insecticide, which was widely used during the 1950s and '60s but was banned in the U.S. in 1972.

The new work differs from all other studies, however, by focusing on the age at which women were exposed. Echoing the situation with some other breast-cancer risks, such as radiation, it finds that DDT increases the risk of breast cancer in adulthood only if the exposure occurred at a young age, before the breasts were fully developed. All told, girls who had the highest levels of the chemical in their blood during that crucial developmental period were five times as likely to get breast cancer years later as were girls who had the lowest levels.

That increase is a bigger boost in risk than is now attributed to hormone-replacement therapy or having a close relative with breast cancer. Although there is nothing that women today can do about their DDT exposures decades ago, the results could influence an ongoing controversy about the extent to which the chemical should still be used around the world. That question has haunted the World Health Organization because, despite its environmental and potential human health risks, DDT remains one of the most potent weapons against the mosquitoes that transmit malaria, a global scourge that kills about a million people every year, most of them children.

Once widely used, chemical banned in 1972. First synthesized in the 19th century, the chemical came into widespread use to control mosquitoes and other insect pests after World War II. In the 1950s and '60s, when its popularity peaked, trucksize foggers were often deployed in many U.S. neighborhoods, parks and summer camps, as well as on farms. Rachel Carson's seminal 1962 book, "Silent Spring," documented the chemical byproducts of DDT in the environment and its devastating effects on some bird species. It was banned in the U.S. in 1972. By the early 1980s, in response to environmental concerns, virtually every developed country had banned it.

[Back]

Taxol doesn't treat common breast cancer-( AP- 10/10/2007)

The widely used chemotherapy drug Taxol does not work for the most common form of breast cancer and helps far fewer patients than has been believed, surprising new research suggests. If further study bears this out, more than 20,000 women each year in the United States alone might be spared the side effects of this drug or similar ones without significantly raising the risk their cancer will return. That would be roughly half of all breast cancer patients who get chemo now.

"We want to make sure these data are correct before withholding it (Taxol) from some patients ... the stakes are high," said the lead researcher, Dr. Daniel Hayes of the University of Michigan. "On the other hand, we don't want to keep a therapy that doesn't work." In the study, Taxol did the most good for women who had overactive HER-2 genes — the target of the newer breast cancer drug Herceptin. These women were about 40 percent less likely to have a recurrence if they received Taxol.

Conversely, Taxol did not significantly help women whose tumors were HER-2 negative and were being helped to grow by estrogen. This is the most common form of the disease. The differences were revealed by a new analysis of a study done in the 1990s, using modern genetic tools that were not available at that time."The days of 'one size fits all' therapy for patients with breast cancer are coming to an end," Dr. Anne Moore of Weill Cornell Medical College wrote in an editorial accompanying the study in Thursday's New England Journal of Medicine. "Oncologists have a responsibility to their patients to be aware of this report."

The original study involved more than 3,000 women whose cancer had spread to nearby lymph nodes but not widely throughout the body. This is the situation of about one-fourth of the 175,000 women diagnosed with breast cancer in the U.S. each year. Researchers tested adding paclitaxel, sold as Taxol by New York-based Bristol-Myers Squibb Co. and now also in generic form. They gave it after surgery to remove the cancer and treatment with the chemo drugs Adriamycin and Cytoxan.

Taxol improved survival and became a new standard of care. But the drug frequently causes neurological side effects including numbness and tingling in the hands and feet. In the original study, 18 percent of women had this problem months and even years after taking Taxol. Even more worrisome has been the growing evidence that some women do not benefit as much from chemo as others. Hayes and other researchers wondered whether that was true in their Taxol study. They retrieved frozen tissue samples from 1,500 of the original participants, did genetic tests to better identify their types of cancer, and discovered big differences in who had responded to the drug.

The study was paid for by grants from the federal government and a breast cancer foundation. Several researchers consult for Bristol-Myers Squibb. "We should have done this a long time ago," but the tools were lacking and researchers now have the advantage of longer follow-up of these women, said another senior author, Donald Berry. He is biostatistics chief at the University of Texas M.D. Anderson Cancer Center. Berry is reanalyzing another earlier Taxol study, and Moore urged other scientists to do the same. With more evidence, "we can begin to use the biology of the cancer to decide whether the chemotherapy will work" before subjecting women to it, Hayes said.
The typical four-cycle treatment with generic paclitaxel costs $7,000 or more, including infusion fees that doctors charge. Insurance typically pays most of this.

For now, many doctors will be reluctant to skip Taxol or other chemo, said Dr. Julie Gralow, a cancer specialist at the University of Washington School of Medicine. Some may fear lawsuits if the cancer recurs and the chemo wasn't given, she said. "It's just so much easier to give the chemotherapy and know you've been super-aggressive." However, Kris Miller, a 54-year-old former nurse from Chelsea, Mich., said patients should be given the choice. She has had problems since taking Taxol two years ago for a type of breast cancer that the new research suggests would not respond to the drug. "Most people recover from it, and I guess I'm one of those unfortunate ones that did not," she said of the side effects. "I have severe numbness and tingling, mostly in my feet. It becomes painful by the end of the day. It never goes away." "I hope they give people that option," to weigh the risks and benefits and possibly skip Taxol, she said. "If I was going through it now, I would like to have that information."

[Back]

Breast cancer treatment hard on the bones: study (Reuters- 19/09/2007)

The bones of breast cancer patients tend to age prematurely as a result of chemotherapy and aromatase inhibitor therapy, according to research reported at the American Society for Bone and Mineral Research meeting this week. The researchers advise that the bone health of these women be evaluated as if this were a much older population of women. Dr. Pauline M. Camacho and colleagues at Loyola University in Chicago, Illinois, took a look back at the charts of 238 postmenopausal women referred to their institution between 2000-2005 for the management of osteoporosis or osteopenia -- a bone-thinning condition just short of osteoporosis.

Sixty-four women had a history of breast cancer, while 174 "control" women did not. The women with breast cancer had early-stage disease and were in the midst of, or considering, hormonal therapy with aromatase inhibitors. Roughly three-quarters of the women in both groups had at least one secondary cause of osteoporosis, the researchers found. Vitamin D deficiency was the most common for both groups. The investigators found that 37.5 percent of the breast cancer group and in 51.1 percent of the non-breast cancer group were vitamin D-deficient.

"There is a high prevalence of secondary causes of osteoporosis among breast cancer patients undergoing or considering undergoing adjuvant hormonal therapy with aromatase inhibitors," Camacho told meeting attendees. "This prevalence was similar to the non-breast cancer group despite a difference in age." "It is prudent" to measure bone mineral content before treatment, Camacho said, "and to screen patients with breast cancer for secondary causes of bone loss." "These women should be evaluated as if they were much older," she added in an interview with Reuters Health. "It may be wise to keep them on tamoxifen, which is bone-sparing and avoid the aromatase inhibitors, which cause bone loss." Examples of aromatase inhibitors include anastrozole, sold as Arimidex, and exemestane sold as Aromasin.

[Back]

Hazards: Heavy Drinking May Raise Risk of Endometrial Cancer - (Yahoo News- 18/09/2007)

Women who have more than two alcoholic drinks a day double their risk of endometrial cancer compared with those who drink less, a new study finds. Alcohol consumption and endometrial cancer risk: The multiethnic cohort (The International Journal of Cancer)Researchers examined a multiethnic group of 41,574 postmenopausal women, following them for an average of eight years and using questionnaires about diet and drinking habits. In that time, the team found 324 cases of endometrial cancer, the type that forms in the tissue that lines the uterus. According to the National Cancer Institute, the United States has 40,000 new cases of endometrial cancer a year and 7,400 deaths.

After controlling for variables including body mass index, age, hormone therapy and whether they had been pregnant, the researchers found that women who had less than two drinks a day had no increased risk of endometrial cancer. But those who had more than two drinks a day had slightly more than twice the risk. It made no difference whether the women drank beer, wine or hard liquor. The exact mechanism is unknown, but alcohol raises estrogen levels, and it is well established that prolonged exposure to estrogen increases mutations and DNA replication errors, predecessors of cancerous growths. “Relatively few studies have examined the relationship between endometrial cancer and drinking,” said Veronica Wendy Setiawan, the lead researcher and an assistant professor of research at the Keck School of Medicine of the University of Southern California. “If this is a true association, that’s one more lifestyle change women can make.” The study appeared online Aug. 31 and will be published in a future print issue of The International Journal of Cancer.

[Back]

Gene May Influence Breast Cancer-Estrogen Link-(HealthDay- 17/09/2007)

U.S. researchers say they've found a gene that plays a crucial role in the ability of breast cancer cells to respond to estrogen. The finding that transcription factor AP2C (TFAP2C) controls multiple pathways of estrogen signaling may lead to improved therapies for hormone-responsive breast cancer and may help explain differences in the effectiveness of current treatments, said a team from the University of Iowa.

The study was published in the Sept. 15 issue of the journal Cancer Research. "Estrogen binds to estrogen receptors and triggers a cascade of events including gene regulation," study leader Dr. Ronald Weigel, professor and head of surgery at the university's college of medicine, said in a prepared statement. "We found that elimination of TFAP2C from the cell causes all of those cascades that we associate with estrogen to go away," he said. "The treated cancer cells were not able to respond to estrogen by any normal pathway." Silencing TFAP2C inhibited tumor growth in mice. It also halted expression of another estrogen receptor called GPR30, found at the cancer cell membrane.
"Targeting this gene may be a better way to develop drugs to treat hormone-responsive breast cancers, because it targets multiple different pathways," Weigel said.

[Back]

FDA approves Evista for breast cancer prevention-(Yahoo News- 17/10/2007)

A drug used to prevent osteoporosis in postmenopausal women has gained FDA approval for use in reducing the risk of invasive breast cancer.
A unique, empowering, and often humorous story about the journey of a woman who has experienced breast cancer from many perspectives. The drug Evista® (raloxifene hydrochloride) is only the second drug approved to reduce the risk of breast cancer, the other is tamoxifen. Evista is commonly referred to as a selective estrogen receptor modulator (SERM). In reducing the risk of invasive breast cancer, SERMs may act by blocking estrogen receptors in the breast.

"Today's action provides an important new option for women at heightened risk of breast cancer," said Dr. Steven Galson, director, FDA's Center for Drug Evaluation and Research. "Because Evista can cause serious side effects, the benefits and risks of taking Evista should be carefully evaluated for each individual woman. Women should talk with their health care provider about whether the drug is right for them." The approval was based on three clinical trials involving 15,234 postmenopausal women comparing Evista to placebo (no drug) showed that Evista reduces the risk of invasive breast cancer by 44 percent to 71 percent.

A fourth clinical trial in 19,747 postmenopausal women at high risk for developing breast cancer compared Evista to tamoxifen. In this trial, the risk of developing invasive breast cancer was similar for the two treatments. The clinical trials were conducted over the last 10 years. On July 24, 2007, FDA's Oncology Drugs Advisory Committee recommended approval of Evista for reducing the risk of invasive breast cancer in postmenopausal women with osteoporosis and in women at high risk for breast cancer.

In 1997, FDA approved Evista, made by Eli Lily, for the prevention of osteoporosis in postmenopausal women and, in 1999, for the treatment of postmenopausal women with osteoporosis. Evista can cause serious side effects including blood clots in the legs and lungs, and death due to stroke. Women with current or prior blood clots in the legs, lungs, or eyes should not take Evista. Other potential side effects include hot flashes, leg cramps, swelling of the legs and feet, flu-like symptoms, joint pain, and sweating.

Evista should not be taken by premenopausal women and women who are or may become pregnant because it may cause harm to the unborn baby. In addition, Evista should not be taken with cholestyramine (a drug used to lower cholesterol levels) or estrogens. The benefits and risks of taking Evista should be carefully weighed in each individual woman. Evista does not completely prevent breast cancer. Breast examinations and mammograms should be done before starting Evista and regularly thereafter.

[Back]

Free of breast cancer, but weighing a mastectomy because of genetic tests- (Yahoo News- 16/10/2007)

Her latest mammogram was clean. But Deborah Lindner, 33, was tired of constantly looking for the lump. Ever since a DNA test had revealed her unusually high chance of developing breast cancer, Lindner had agonized over whether to have a mastectomy, a procedure that would reduce her risk by 90 percent.

She had stared at herself in the mirror, imagining the loss of her familiar shape. She had wondered, unable to ask, how the man she had just started dating would feel about breasts that were surgically reconstructed, incapable of feeling his touch or nursing their children. But she was sure that her own mother, who had had chemotherapy and a mastectomy after a bout with the cancer that had ravaged generations of her family, would agree it was necessary. "It could be growing inside of me right now," she told her mother on the phone in February, pacing in her living room here. "We could find it any time."

Waiting for an endorsement, she added, "I could schedule the surgery before the summer." But no approval came. "Oh, sweetheart, let's not rush into this," said her mother, Joan Lindner. Joan Lindner, 63, is a cancer survivor. Her daughter, by contrast, is one of a growing number of young women who call themselves previvors, because they have learned early that they are genetically prone to breast cancer, and have the chance to act before it strikes.

As they seek to avoid the potentially lethal consequences of a mutant gene, many of them turn to relatives who share its burden. But at a moment when a genetic test has made family ties even more tangible, they are often at their most strained. Parents who have fought cancer typically have no experience with the choices that confront their children, and guilt over being the biological source of the problem can color their advice. Siblings and cousins who carry the risk gene evangelize their own approach to managing it, while those who dodged its inheritance seem unqualified to judge.

Even as she searched for her own answer in the year after her DNA test, Deborah Lindner, a medical resident, found herself navigating her family's strong and divergent opinions on the imperfect options that lay before her. Her father, who once feared that he would lose his wife to cancer, encouraged the surgery. Her sister reminded her that cancer might be cured in a few years if she could wait. Her aunt said she hated to see her niece embrace a course of action akin to "leechings of the Dark Ages." A cousin declined even to take the DNA test.

But it was her mother's blessing that Deborah most eagerly sought. Joan Lindner, who had passed her defective gene to her daughter, wanted to will her more time. When she had her own breasts removed, she had been married for 27 years and had raised two daughters. Now Joan Lindner could not shake the fear that her daughter might trade too much in her quest for a cancer-free future. What if taking such a radical step made it harder for Deborah to find someone special and become a mother herself? "I have this amazing gift of knowing my risk," her daughter told her over the phone that winter night, gazing out over the frozen city from her apartment on the 38th floor. "How can I not do anything about that?" The Lindners share a defective copy of a gene known as BRCA1 (for breast cancer gene 1) that raises their risk of developing breast cancer sometime in their lives to between 60 percent and 90 percent.

Only 30,000 of more than 250,000 American women estimated to carry a mutation in BRCA1 or a related gene, BRCA2, have so far been tested. But their numbers have doubled in the last two years and, with a sharp increase in genetic testing, are expected to double again in the coming one. About a third opt for preventive mastectomies that remove the tissue where the breast cancer develops.

A majority have their ovaries removed, halving their breast cancer odds while decreasing the risk of highly lethal ovarian cancer, to which they are also prone. Some take drugs that ward off breast cancer. Others hope that frequent checkups will catch the cancer early, or that they will beat the odds. Their decisions, which require weighing an inborn risk against other life priorities, are highly individual. But with DNA forecasts of many other conditions on their way, BRCA carriers offer the first clues for how to reckon with a serious disease that may never arise - and with the family turmoil that nearly always does. Deborah Lindner's sister, Lori French, got her results first.

Long ago, before she knew about the DNA test, French, 37, had resolved to have her breasts and ovaries removed by the age of 40 to avoid the family cancer. Nor did she want reconstructive surgery, having seen her mother struggle with the pain and cosmetic disappointment of hers. "Plan on it," she had told her husband before they got married a decade earlier. "I'm going to get old and have big hips and no breasts."

The envelope with the test results that French opened with shaking hands in the summer of 2005 offered a reprieve. She and her husband sobbed, hugging each other in the knowledge that she was free of the genetic defect. While she still had the 12 percent chance any woman has of developing breast cancer, she could not have passed on the steep BRCA risk to either her daughter or son. "It's done!" French told her family. "In our line, it's ended."

For years, the sisters had united in a common dread. Now it was Deborah's alone. It could have been either, neither or both of them - each sister, she knew, had a 50 percent chance of inheriting the defective gene from their mother, dictated solely by a roll of the genetic dice. In the weeks that followed, Deborah fought off pangs of jealousy and the fantasy that fate could somehow be rearranged. "She already has a husband, she already has kids," Deborah thought about her sister on morning runs along Lake Michigan. She enrolled in a stepped-up surveillance program that required alternating mammograms and sonograms with MRIs every six months.

But on the mornings of her appointments, and at unpredictable moments in between, she was overwhelmed with fear. Often, she would examine her breasts every other day. "It's taking over my mind," she told Erin King, a close friend and fellow resident in the obstetrics and gynecology program. King, 33, who had had breast implants for cosmetic reasons, and another resident friend were proponents of pre-emptive surgery. "Get them off and get new ones," they told her. "They'll be awesome and perky and cute." But they sympathized with her distress at the appearance of traditional reconstruction, with skin grafts molded into a fake nipple that can never quite match the texture of a real one and the areola simulated by a tattoo.

Over Thanksgiving 2006 at her parents' winter home in Florida, Deborah Lindner ran through her risk analysis. Her father, Philip Lindner, listened and nodded. Mammograms and ultrasounds, she noted, may miss more than half of cancers in younger women with denser breasts. Magnetic resonance imaging tests are more reliable but produce more false positives, which can lead to unnecessary biopsies and worry. And it is not yet clear that early detection improves survival rates in women with BRCA mutations. "You can't argue with statistics," said Philip Lindner, a financial executive. "You don't want to get cancer and then say, 'I wish I would have done thus and so.' "

Joan Lindner agreed that it was important to know the risks. But not knowing them could be a luxury, too. Had she had the same options as her daughter, would she have found a man and had a family? It might have altered her whole life. Deborah Lindner began to seek support elsewhere. A genetic counselor gave her a brochure for Bright Pink, a group of young women who have tested positive for the BRCA genes.

Lindsay Avner, its founder, lived in Chicago, and their meeting over coffee in the hospital lounge one evening in March lasted four hours. Avner, 24, had had a prophylactic mastectomy last year. "You've got to see my breasts," she told Deborah Lindner, escorting her into the bathroom. Avner's surgeon at Memorial Sloan-Kettering Cancer Center in Manhattan had used a technique that preserved the breast skin and nipples, leaving a scar only under the breast. Deborah, still in her scrubs, said, "Wow."

She met with Geoffrey Fenner, the chief of plastic surgery at Evanston Memorial Hospital one evening in mid-April. If she could find a surgeon to perform the mastectomy, Fenner said, he would perform the reconstruction. Deborah announced her intention to have surgery in a long e-mail message to family members at the end of April. "I want to share with you what I feel is the right answer for me," she wrote. Like anyone who carried the defective gene, she might never get cancer, she acknowledged. Or she might only get it when she was old. "But I'm not a gambler," she wrote.

Deborah scheduled the double mastectomy with Dr. D.J. Winchester at Evanston Northwestern hospital for the last weekend in June, three days after her medical board exam. Her insurance agreed to pay after requesting a letter of support from her surgeons. There would be just enough time to recover before she began practicing in the fall. The surgery and reconstruction took seven and a half hours, twice as long as the doctors had expected. The incisions were small, Winchester explained when he came out, and hidden under the breast, so it had taken a long time to scrape out all the breast tissue. Then Joan Lindner rode up in the elevator with her daughter, still unconscious from the anesthesia. As they arrived at their floor, Deborah opened her eyes. "Mom," she said, and managed a small smile.

[Back]

Breast cancer rates tied closely to hormone use (Oregonian- 16/09/2007)

When women stopped using HRT, cancer rates showed a decline. A drop in U.S. breast cancer rates the past few years is linked to a steep decline in women using hormone replacement therapy to relieve menopause symptoms, three recent studies suggest. Researchers, including a scientist from Oregon Health & Science University, reported this month that a decline in hormone use -- not a decrease in mammography screening -- has contributed to the reduction in breast cancer incidence.

Patty Carney of OHSU's Cancer Center and her colleagues collected data on more than 600,000 mammograms taken between 1997 and 2003 on women aged 50 to 69. Use of hormone therapy among the study group declined by 7 percent each year between 2000 and 2002, then by 34 percent between 2002 and 2003. During the same period, breast cancer rates declined annually by 5 percent.

Carney said the research indicates that women who employ estrogen-progestin therapy to control postmenopausal symptoms "should be encouraged to use the therapy for the shortest time possible to minimize breast cancer risk." The study's findings -- reported in the Sept. 5 issue of the Journal of the National Cancer Institute -- challenged the idea some researchers proposed: that the decline in the incidence might have been caused by a decline in mammography screenings. A study published in the same journal Aug. 1 also supported the connection between breast cancer, hormone therapy and mammography screenings.

An analysis conducted by Kaiser Permanente's Center for Health Research reviewed the histories of 7,386 women diagnosed with invasive breast cancer and treated at Kaiser Permanente Northwest from 1980 through 2006. The study found that breast cancer rates increased 26 percent to 1991, and jumped 15 percent more through 2001. The rise in the rates paralleled increases in rates of mammography screening and use of hormone therapy.

From 2003 to 2006, however, the breast-cancer rates fell 18 percent, mirroring a 75 percent drop in the use of hormone therapy, while mammography screening rates were unchanged. Dr. Andrew Glass, the study's lead author, said the Kaiser analysis confirmed that breast cancer rates "have been moving in tandem with hormone use since 1990." He said the findings indicate to women that although nothing can be done about their genetic makeup or family history, "you can control what goes in your body" to decrease the risk of breast cancer.

Both studies supported findings reported earlier this year in the New England Journal of Medicine that found that a sharp decline in U.S. breast cancer deaths in 2003 held steady in 2004. The researchers said the study was additional evidence that the decline is related to the large number of women who stopped hormone replacement therapy. The study found that between 2001 and 2004, the number of breast cancer cases dropped 8.6 percent overall and 11.8 percent among women older than 50, the primary hormone users. The researchers said that during the two-year study, 30,000 fewer women developed breast cancer than would have been expected from previous trends, with the incidence reaching its lowest rate since 1987.

[Back]

Breast cancer/estrogen link examined-(Yahoo News- 13/09/2007)

U.S. researchers said many women genetically prone to breast cancer often benefit from removal of the ovaries but not from other anti-estrogen therapies. The study, published in Oncogene, suggested mutations of the BRCA1 gene can cause the estrogen-signaling pathway to go awry after the cancer starts to grow. Senior study author Dr. Priscilla Furth, of Georgetown University, said she believes estrogen is needed to start the cancer process but then the BRCA1 mutations somehow render the new tumors unresponsive to estrogen and unresponsive to therapies like Tamoxifen.

The researchers overexpressed the estrogen receptor in laboratory mice with a BRCA1 mutation and a p53 gene mutation -- the two gene mutations usually coexist in human cancer -- and found that when exposed to estrogen, these mice developed cancerous tumors."Estrogen is definitely necessary for these tumors to develop, but somewhere along the tumor development pathway, the emerging tumors lose their sensitivity to estrogen," Furth said in a statement. "The cells that develop into cancers frequently lose their ability to express the estrogen receptor and therefore are not sensitive to anti-estrogen therapies."

[Back]

Chemotherapy may be culprit for fatigue in breast cancer survivors- (Yahoo News- 10/09/2007)

A new study finds that, compared to healthy women, breast cancer survivors reported more days of fatigue and more severe fatigue symptoms. The study, published in the October 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, found women who received both chemotherapy and radiotherapy reported the most severe and prolonged fatigue.

Fatigue is a common complaint in the general population and, anecdotally, common among cancer patients. Comparative fatigue studies between the two populations, however, have been marred by methodological shortcomings, such as poorly matched controls and patient populations. The studies do not consistently agree whether or not fatigue is a more common complaint among cancer patients compared to the general population. Dr. Paul Jacobsen from the Moffitt Cancer Center in Tampa, Florida and co-investigators followed 221 women with non-metastatic (early stage) breast cancer treated with either radiography (n=121) or a combination of chemotherapy and radiography (n=100) and 221 age- and geographically-matched healthy women (i.e., controls) at two, four, and six months after treatment.

The authors expected to find the greatest difference in fatigue scores just after treatment, diminishing with time. Surprisingly though, they found that breast cancer patients, had a significantly greater number of days with reported fatigue at each of the four assessments, and that even at the six-month follow-up assessment, a statistically significant and clinically meaningful group difference in fatigue duration was still evident. They studied further and found that the difference was attributable primarily to heightened fatigue in those women who received both chemotherapy and radiotherapy. These findings provide strong evidence that women with non-metastatic breast cancer treated with adjuvant chemotherapy are at significantly greater risk for severe fatigue. The next step, explains Dr. Jacobsen, is to “explore whether interventions administered during or at the end of treatment are effective in preventing or limiting fatigue in the post-treatment period.” They point in particular to the role of exercise, which has been shown to reduce fatigue in breast cancer survivors.

[Back]