BREAST CANCER

Study: MDs mum on breast cancer options -( AP Medical Writer- 21/12/2007) 


Most doctors don't talk about breast reconstruction with women before cancer 
surgery, depriving them of key information that can sway their decision about 
whether to have the whole breast or just a lump removed, new research suggests.  Only one-third of the roughly 1,200 women in the study said surgeons discussed 
cosmetic remedies with them in advance. When the topic did come up, women were 
four times more likely to choose the more drastic operation, mastectomy. That could be because they liked the breast reconstruction options, which include implants that are not available for fixing odd-shaped defects left after lumpectomies. But mastectomies can be a dubious choice because breast-conserving lumpectomies usually suffice. "Our point is not to say that one decision is better than another, but that women need to know all their options," said Dr. Amy Alderman, the University of 
Michigan plastic surgeon who led the study. "There are positives and negatives to 
both. We shouldn't be paternalistic and tell patients, 'This is what you need.'" Dr. H. Kim Lyerly, a breast surgeon and director of Duke University's Comprehensive Cancer Center, agreed. "This is an important issue," he said. "We clearly need to be better at it."

The study was published online Friday by the journal Cancer and will be in the 
Feb. 1 issue. It is the second report in recent days to call attention to the often-neglected cosmetic consequences of cancer surgery. Studies at last week's San Antonio Breast Cancer Symposium highlighted some of these, including the limited options for millions of women left with dimpled or cratered breasts after lumpectomies. Doctors say the latest study, done in more than 100 hospitals in the Detroit and Los Angeles areas, may overstate the doctor-patient communication problem, but they acknowledge that one exists. "I would bet that we have been so obsessed with treatment that this quality-of-life issue is one that we just haven't focused on," said Dr. Otis Brawley, chief medical officer of the American Cancer Society. Breast cancer is the most common major cancer in American women. More than 178,000 new cases are expected this year in the U.S., and more than 1 million 
worldwide. For cancer that has not widely spread, most women have a lumpectomy, but some need or prefer a mastectomy. Alderman studied whether knowing about breast reconstruction swayed which treatment women chose. Researchers surveyed 1,178 women three months after breast cancer surgery, from 2001 to 2003. Two-thirds said reconstruction never came up in discussions with general surgeons before their operations.

Younger women were more likely to have had this talk than older ones (the average 
age was 56 for those who did versus 61 for those who did not). More educated 
women also were more likely to discuss it. Who brought up the topic — patient or 
doctor — was not asked. The National Cancer Institute paid for the study. Women who see breast specialists rather than general surgeons may be more apt to get plastic surgery consultations, Lyerly said. Many women want to conserve breast tissue, and a surgeon must make sure that medical issues are not outweighed by body image concerns. "If we provide too much information, that's also not the more effective way of communicating either," he said. "It could be that they're so fixed on other issues that two sentences on breast reconstruction totally was not heard." However, treatment guidelines do not spell out what doctors should say and when, 
so "this study is likely to get some traction for that very reason," Brawley said. 

Dr. Sameer Patel, a reconstructive surgeon at the Fox Chase Cancer Center in 
Philadelphia, said some doctors are too focused on the medical part of the 
decision about what operation to have. "They're trying to take care of the cancer, and that (cosmetic impact) takes a back seat," he said. Debbie Horwitz, 35, of Raleigh, N.C., encountered that attitude three years ago, when she found a cancerous lump. Her mother had died of breast cancer and her grandmother also had the disease, so when tests showed she had a mutated gene raising her risk of future tumors, she had a double mastectomy. "I was really frustrated to find out there were no process pictures of what the reconstruction process would be like," she said. "It's a months-long process. There were a lot of before and after pictures, but there's a lot that happens in between." She formed a support group and wrote a book featuring more than a dozen photos graphically depicting her own reconstruction — "Myself: Together Again" — sold on Amazon and other outlets. If doctors do not discuss reconstruction options in advance, "it's unfair and I think it's unethical," she said. "If you were going to take off somebody's arm, or a leg had to be amputated, you would talk to them about prosthetics. I don't understand how doctors can leave that part out."

[Back]

Komen director takes breast cancer fight global- (8/08/2007)

Katie Parker has devoted most of her professional career as a radiologic 
technologist to one cause -- conquering breast cancer through early detection, 
diagnosis and treatment. Her efforts over the past 22 years included operating a breast health, mobile mammography and education program for women who wouldn't have gotten examined because they lacked health insurance and/or access to medical facilities. Along the way, Parker become interested in a nationwide grass-roots network of breast cancer survivors and activists called Susan G. Komen for the Cure. Initially involved as a volunteer, Parker saw her responsibilities take a quantum leap seven months ago when she was named executive director of the organization's Murrieta-based Inland Empire Affiliate ( www.komenie.org).

It was a move that Parker termed a new challenge and last month Komen for the 
Cure national officials increased her participation when she was selected as one 
of 25 United States delegates who will join 25 delegates from other countries for 
the inaugural Ignite the Promise: Global Advocate Summit. Planned by the Komen 
organization and billed as an international gathering focused on elevating the 
dialogue on breast cancer's global impact, the event is scheduled in Budapest, 
Hungary, Sept. 29-30. "By teaming delegates from diverse professions, cultures and experiences, the global impact of breast cancer on women, their families and society will be better understood," said Parker, an Indiana native who came to California in 1973 and has lived in Oceanside the past 22 years. "I'm excited about being picked for such an honor and to be part of the summit," she said. "The purpose is to make a big impact by bringing people together to share information, streamline our efforts and make new programs more effective." Parker operated her breast health services company for 11 years before shutting it down in 2001. That was the same year she went on a breast-health mission trip to Cuba and became convinced it was time to apply her skills and experience to help spread the early detection of breast cancer message globally. Two years later, she helped launch Breast Care International, an organization focused on procurement of mammography equipment and development of mammography and breast-health training in underdeveloped countries.

[Back]

New Cause Of Tamoxifen Resistance In Breast Cancer Cells Discovered- ( ScienceDaily - 13/08/ 2007)

When a woman receives a breast cancer diagnosis her entire life may change in the blink of an eye. But the nature of that change is governed by the smallest alterations that take place within the proteins of the tumor cells, determining what treatments she can pursue with a hope of cure and those to which her cancer is resistant. Scientists from the Lombardi Comprehensive Cancer Center announced today the discovery of a new mechanism of resistance to endocrine or anti-hormonal therapies, such as Tamoxifen and Faslodex. This research may allow oncologists to screen women for responsiveness to these treatments, and provides a much-needed clue to reversing resistance. The research, led by Robert Clarke, PhD, DSc, a professor of oncology and of physiology and biophysics at Georgetown University Medical Center, indicates that a gene previously thought to be unrelated to breast cancer may be responsible for some resistance to endocrine therapy. The gene, called human X-box binding protein-1 (XBP1), is an alternatively spliced transcription factor that participates in a stress-signaling pathway to protect cells from damage. In a paper published online in the Journal of the Federation of American Societies for Experimental Biology (FASEBJ) on July 27, Clarke and his colleagues at the Lombardi Comprehensive Cancer Center (part of Georgetown University Medical Center) found that over-expression of the spliced variant of the gene in estrogen receptor-positive breast cancer cells led to reduced sensitivity to Tamoxifen and Faslodex. According to Lombardi medical oncologist Minetta Liu, MD, it is expected that all hormone receptor positive metastatic breast cancers will eventually develop resistance to endocrine therapies. When this happens, doctors must switch their patients to a different class of drugs – throwing their lives into limbo once again as treatment schedules are changed and new side effects develop. 

“When cell lines changed from being sensitive to endocrine therapy to being 
resistant, we saw an increase in spliced XBP1 inside the cell. So then we took 
sensitive cells and added spliced XBP1, which made them resistant to the 
therapy,” explained Clarke, who is interim director of Georgetown’s Biomedical 
Graduate Research Organization and co-leader of the Breast Cancer Program at the 
Lombardi Comprehensive Cancer Center. Anti-hormonal therapies are some of the most effective treatments for breast cancer because estrogen, a natural female sex hormone, can drive the growth of the tumor. Tamoxifen and other anti-hormonal therapies cut off the tumor’s access to estrogen, causing the tumor to stabilize and sometimes even shrink. However according to Clarke, many cancers become insensitive to these treatments over time – more than half of all recurring breast cancers lose sensitivity – because they have found a way to keep growing in the absence of estrogen. Previously, Clarke and his team found that XBP1 is co-expressed with the estrogen receptor in breast tumor cells. This may mean that the effects of XBP1 over-expression occur when the protein is bound to the estrogen receptor, suggesting for the first time that these two proteins interact in the cell. This 
was the first evidence that the XBP1 protein may play a role in breast cancer  pathways. 

Through molecular profiling of the downstream effects of the spliced XBP1, Dr. 
Clarke and his colleagues discovered that expression of several anti-apoptotic 
genes responsible for programmed cell death – including BCL2 – are altered. While 
they have not yet determined the exact interactions that take place, the 
researchers believe that the overexpression of XBP1 promotes cell survival by 
affecting the activity of the intrinsic apoptosis pathway. “XBP1 may give us a much-needed clue for better predicting response to anti-estrogen therapies like Tamoxifen,” explained Clarke. “The presence of the activated protein at high levels should predict estrogen independence and thus resistance to these therapies.” In the future, Clarke also hopes to develop a new therapeutic treatment based on this discovery. He believes that the XBP1 pathway can be targeted in patients receiving treatment to ensure their tumors do not become resistant to the anti-hormonal therapies. Using this discovery, Clarke also hopes to find a way to reverse resistance to anti-hormonal therapies, making it possible for women to continue treatment with first line therapies for longer. However, Clarke said that the next step in this research will be to conduct a trial to test the predictive power of XBP1 in the clinic.

Survival differences by race most apparent in advanced stages of breast cancer
Racial differences in breast cancer survival increase according to stage of 
disease, a new study finds. Published in the September 15, 2007 issue of CANCER, 
a peer-reviewed journal of the American Cancer Society, a retrospective analysis 
of survival data demonstrates that within each stage, African American women had 
larger tumors and were more likely to have disease that had spread to nearby 
lymph nodes. After controlling for those clinical factors the racial disparities 
in survival persisted. The investigators say their finding that disparities in 
survival increased with more advanced disease was surprising and suggested that 
non-clinical factors contributed to survival differences. Epidemiology studies have long showed significant racial/ethnic differences in breast cancer survival among U.S. women. African American women have poorer five-year survival rates, and more advanced disease at the time of diagnosis than white women. Whether these disparities are due to a difference between races in tumor biology or to socioeconomic factors that impact healthcare access and/or the physician-patient relationship continues to be unclear. One key piece of evidence is that, stage for stage, African American women have worse clinical outcomes than white women. However, staging disease is complex, taking into account tumor size and regional or distant disease spread. Also, there can be significant differences in survival within each stage. For example, survival at the same stage can vary by 40 percent depending on the number of lymph nodes with disease.

Dr. Alfred Neugut from Columbia University Medical Center, Russell McBride from 
Mailman School of Public Health and their colleagues hypothesized that racial 
differences in survival within stage could be attributed to differences in tumor 
size and the number of lymph nodes with disease between the two race groups. Analysis of clinical and demographic characteristics from 256,174 women with 
breast cancer (21,861 African American and 234,313 white) diagnosed from 
1988-2003 showed that African American women were more likely than white women to be diagnosed with tumors greater than 2.0-cm and to have at least one lymph node with disease. However, racial differences in lymph node involvement were apparent only in tumors smaller than 3.0 cm. After adjusting for tumor size and lymph node status as well as other known factors, such as age, African American women were still more likely to die from their disease. The mortality rate among African American women was calculated to be up to 56 percent higher than whites. This study confirms “statistically significant differences within stage between black and white women in tumor size and nodal involvement.” However, the authors conclude, “these differences are not clinically important with respect to survival over and above the standard AJCC stage categories.” The study also found that as stage of disease at diagnosis increases, so too does the gap in mortality between African American and white women. The authors postulate that “the factors that prevent black women from receiving the same quality of care as white women may be exacerbated by the more complex treatment regimens used for more advanced breast cancer.”

[Back]

Do Pills Have a Place In Cancer Prevention? -(ET- 14/08/2007)


A major study of a drug that could reduce a woman's risk for breast cancer has 
been canceled by the National Cancer Institute, raising questions about the 
future of using pills to prevent the disease. The trial, called Stellar (which stands for Study to Evaluate Letrozole and Raloxifene) was to be the third in a series of landmark breast-cancer-prevention trials conducted by the National Surgical Adjuvant Breast and Bowel Project, a well-regarded research group that gets most of its funding from the NCI. The NSABP, based in Pittsburgh, has enrolled more than 110,000 women and men in clinical trials involving breast and colorectal cancer and its studies in the past have had a significant impact on the course of breast-cancer treatment.

The Stellar study would have answered questions about letrozole, a drug made by 
AG that is already approved to treat breast cancer but is also believed to lower 
risk for the disease by more than 70%, based on a statistical analysis of the 
drug's impact in cancer treatment. Letrozole may offer better protection for 
high-risk women and less-severe or different side effects than other prevention 
drugs, such as tamoxifen and raloxifene. The study was to be funded with $55 
million from the NCI, a $30 million grant from Novartis and free drugs from both 
Novartis and raloxifene maker & Co.

But the NCI's director, , has said that the agency's funds would be better spent 
identifying genetic and other markers to determine women at highest risk for the 
disease -- rather than focusing on giving preventive pills to a broader group of 
women, including healthy ones who may never need them. The NCI press office 
declined a request to interview Dr. Niederhuber. The agency instead provided 
copies of letters sent to the trial investigators and Pennsylvania Sen. Arlen 
Specter -- who had inquired about the study -- explaining Dr. Niederhuber's 
views. One concern of the NCI is that these drugs cause serious side effects. Tamoxifen, the only drug currently approved to prevent breast cancer, also increases 
uterine-cancer risk. Another drug, raloxifene, is currently approved to treat 
osteoporosis and may soon win Food and Drug Administration approval for 
breast-cancer prevention. The drug has far fewer side effects than tamoxifen, but 
can still cause hot flashes and blood clots.

In a letter to Sen. Specter, Dr. Niederhuber said that the evidence suggests 
healthy women don't want to take on the risks of breast-cancer-prevention drugs. 
Previous studies of breast-cancer-prevention drugs yielded "valuable 
information," he wrote, but "failed to change the practice of breast-cancer 
prevention among women and their health-care providers, perhaps because of the 
side effects of these drugs." Study investigators have appealed the trial's cancellation to National Institutes of Health Director . The final decision could have a significant impact on research into breast-cancer-prevention drugs. That's because it's unlikely other investigators will invest the time or resources to propose other studies on 
chemoprevention drugs if the NCI decision is upheld, researchers say.

Supporters of the Stellar trial say the canceled research would have yielded 
valuable blood and other samples from nearly 13,000 high-risk women, further 
aiding the effort to identify markers for breast cancer. It also would have 
answered key questions about the benefits and risks of letrozole and raloxifene 
to help women make more informed decisions. NSABP Chairman says that many women at high risk for breast cancer would willingly take on other health risks like 
osteoporosis, which can be treated, if it will lower their risk for cancer. "We're so passionate in our belief this is an extremely useful trial that will benefit women," says Dr. Wolmark, who is also chairman of oncology at the Drexel University School of Medicine. "We think an injustice has been done to women by canceling the trial." In its appeal letter to NIH director Zerhouni, the NSABP said that the cancer institute's director was "acting unilaterally" and that the decision to cancel the trial "represents a dangerous and unjustified departure" from the agency's traditional review process.

The appeal was "highly unusual" because the NSABP has a nearly 50-year 
relationship with the NCI, which is the primary source of its funding, says , 
editor and publisher of the Washington-based Cancer Letter, which tracks cancer 
research and funding. (Drug firms typically provide free drugs or additional 
funding for NSABP trials.) The NSABP has had a notable impact on breast-cancer treatment. For instance, the group's research led to the standard use of lumpectomy instead of radical mastectomy. And its STAR trial (Study of Tamoxifen and Raloxifene) showed that the drugs can lower risk of breast cancer among high-risk women by 50% or more. That study led to a July FDA committee recommendation that raloxifene (sold now as the bone drug Evista) be approved for breast-cancer prevention. The Stellar trial has been in the works since fall 2005, and had won approval from the NCI's division of cancer prevention and the agency's executive committee. But as the study was about to begin, Dr. Niederhuber stopped it, saying the agency wanted to review it further. In June, the NCI said it wouldn't fund the study after hearing reports from an expert panel convened by Dr. Niederhuber.

The medical journal Lancet noted in a recent editorial that it was "troubling" 
that the NCI director stepped in to halt a trial that had been given "high marks" 
by seven NCI committees, including its top executive committee. "An independent 
investigation into how the decision was made and whether it was made fairly is 
warranted," the Lancet wrote.The NCI declined to comment about the Lancet editorial. "Ultimately Dr. Niederhuber got the best scientific advice and acted on it," said an NCI spokesman in an email. "He feels NCI now needs to move to a position of 
leadership in prevention for the next decade, utilizing genomics, whole-genome 
scans, rapid sequencing and sub-cellular imaging. The challenge is to accurately 
determine risk and match the many considerations about interventions with that 
risk. In other words, we need to find markers and match risk with the appropriate 
level of intervention. Patients are often not willing to trade healthy lives for 
side effects associated with interventions -- unless they are convinced they know 
the risk." The National Breast Cancer Coalition says it supports the NCI's decision to focus on studies to develop better ways of predicting who is at risk for breast cancer. 
"We are very concerned about the approach of treating healthy women with drugs 
that are toxic in order to reduce the risk for very few who benefit," says , NBCC 
executive vice president. If the Stellar trial doesn't go forward, it's unlikely letrozole will ever be approved for breast-cancer prevention, because such a study is simply too 
expensive for the private sector. "We want to quantify the benefit and quantify the risk so women can make objective choices about their own care," says NSABP associate chairman . "Without this trial that sort of information won't be available."

[Back]

Area Around Breast Tumor May Predict Cancer's Spread- (HealthDay - 19/12/2007) 

Supposedly "innocent" cells in the area surrounding cancerous tumors in the breast are definitely not always innocent and can predict whether or not the cancer spreads to the lymph nodes, new research suggests. The finding of alterations in the tumor-suppressing p53 gene in the stroma -- the region surrounding the tumor -- have future implications, the researchers said. "The stroma looks innocent under the microscope, but there's an evil seed in innocent soil," said study senior author Dr. Charis Eng, chair of the Cleveland Clinic Genomic Medicine Institute in Ohio. "This could be a new type of [cancer] biomarker, p53 in the stroma," she added. In addition, the findings may one day eliminate the need to remove and dissect the lymph nodes which, as Eng points out, is a "nuisance" to patients. Even further down the line, the stroma might provide a new target for drug therapies.

"It's a significant study," said Steve A. Maxwell, an associate professor of 
molecular and cellular medicine at Texas A&M Health Science Center College of 
Medicine, in College Station. "Treatments targeting p53 in the stroma might lead 
to suppression of spread [of the cancer] or to prevention of recurrence. I don't 
see it as a cure, but it could contain future spread." Further research is needed before any of these scenarios become reality, the researchers said. The findings are published in the Dec. 20 issue of the New England Journal of Medicine.  "Communication" between a tumor and the stroma is increasingly a subject of 
research. So is p53, a much-studied oncogene. P53 is involved in repairing DNA damage and other functions which prevent cells from turning malignant. This gene is mutated in 20 percent to 50 percent of breast cancers. In 1999, Eng's group looked at seemingly harmless stromal cells and found that they had cancer-related mutations in the p53 gene. For this study, the group looked at whether genetic alterations in the stroma had any impact on clinical outcomes, and if they could predict the spread of the cancer.

To this end, they analyzed tissue samples from 218 breast cancer patients: 43 
with hereditary breast cancer and 175 with sporadic breast cancer. A technique called laser-capture microdissection was used to take individual breast cancer cells and surrounding stromal cells. Mutations in p53, in the stroma but not in the cancer, increased the chances that the cancer would spread to the lymph nodes, indicating a worse outcome for these patients. But even when the p53 alteration was not present, changes in five other markers resulted in the same outcome. In other words, changes in the microenvironment surrounding a tumor can impact how the cancer spreads, the research suggests. A second study in the same issue of the journal found that mutations in the same p53 gene were associated with shorter survival after surgery in patients with squamous-cell carcinoma of the head and neck. This type of cancer is one of the most common cancers in the world; more than 45,000 new cases are expected to be diagnosed in the United States in 2007. P53 mutations in general and a specific p53 mutation were associated with poorer survival, reported a team led by Dr. Wayne Koch, of Johns Hopkins University, Baltimore.

[Back]

Local firm explores new method for finding breast cancer- (ST. LOUIS POST- 12/20/2007)

A St. Louis company has discovered an avenue of breast cancer research that one 
day could lead to new diagnostic tests and more effective treatments for hundreds 
of thousands of patients who are stricken with the disease each year. Orion Genomics LLC, based at the Center for Emerging Technologies in the Central 
West End, has identified more than 50 sites, or biomarkers, where changes occur 
in the DNA of cancerous breast tissue. Of these, a dozen appear to be more 
closely linked with the disease than any similar genetic changes studied to date 
— and one occurred in 90 percent of 230 cancerous tissue samples studied by 
Orion, making it a very attractive target for further research.These results were detailed in a study published Wednesday in the peer-reviewed scientific journal, PLoS ONE."We're not claiming that we're going to market tomorrow with a diagnostic test. This is just the first step of many," said Nathan Lakey, president and chief 
executive. In scientific research, "whenever you answer one question, you find 
that you have 40 more to answer." 1586450 

Nevertheless, his team is excited by those questions. 

— Do these same genetic changes show up in blood, or fluid in breast ducts, which 
can be sampled through a cheaper and less invasive means than a tissue biopsy? 
That would be critical in developing a routine screening test for breast cancer.

— Do these changes indicate how the body forms and grows tumors, and could these 
mechanisms be targeted by drugmakers in developing new types of therapies?

— Are these changes tied to the aggressiveness of a patient's cancer, or indicate 
how it will react to a particular type of drug? If so, that information could 
help doctors determine the most effective course of treatment.

"The thing that is exciting is getting back to the underlying mechanisms that are 
going awry in cancer," said Jared Ordway, Orion's director of research and 
development, and lead author of the study. "We're at the point now where … we can 
prioritize … which of these areas we're going to pursue next." Orion has proprietary technology for quickly sequencing methylation changes in DNA. Methylation occurs when a certain chemical compound attaches to a part of the DNA. These changes can occur on a single gene, turning its function on or off in a way that is associated with cancer.

Other researchers have studied these changes, known as epigenetic abnormalities, 
in particular genes that already are known to be involved in cancer. By contrast, 
Orion looks at the breadth of DNA to spot methylation changes found in cancerous 
tissue that don't occur in normal samples — providing a map of previously unknown 
genetic targets. However, it does not identify mutations in genes themselves, which is a more foolproof indication of cancer. Physicians today use identification of certain 
rare genetic mutations, found in patients with a strong family history of breast 
cancer, to advise sometimes drastic courses of action such as preventive 
mastectomy. Skeptics of Orion's approach note that the company is far from that sort of clinical utility. Theirs "is a very interesting technology, which will be used predominantly for discovery for some time," said Dr. Matthew Ellis, section head of medical oncology at Siteman Cancer Center. "Maybe it will be useful, or maybe not. … It's time to roll up your sleeves and really look." Orion takes a novel approach to quickly and cost-effectively showing DNA methylation, which the company describes as the "second code" of life. It is layered on DNA and switch on or off the function of a gene, having the same effect as an actual genetic mutation, Lakey said. The company's technology is compatible with equipment commonly used in labs 
today, so it will be relatively simple to roll out if it proves effective as a diagnostic, he said. Its type of screening test also would be less expensive and more reliable than mammography. And, Ordway said, Orion's work so far has provocative advantages.

For one, epigenetic changes, such as methylation, may be involved in the earliest 
stages of tumor formation. So, they may be well suited for molecular diagnostics 
and early detection of cancer. What's more, Orion found a methylation change at a particular gene, GHSR, in more than 90 percent of the cancerous tissue it studied — which exceeds the frequency of any other single genetic or epigenetic change reported to date in breast cancer. Moving these discoveries from the lab to patients' bedsides will take time, Lakey said. Typically, development of a diagnostic takes between three and five years. And Orion still must determine which product development options it will pursue. "We are looking at these things in parallel," Lakey said. Still, Orion needs research partners and other resources to further its work.
The company is seeking patent protection for data in the study. But the results 
are public, and Orion expects other researchers will try to reproduce them — an 
important step in validating the company's work. No one can yet predict which research road will pan out as the best for developing breast cancer treatments. And there is a lot of competition, "but that is good news for the patient," Lakey said. "It's exciting that there are such strong efforts," he said. "And we are one of a handful of companies that really are focusing on the epigenome. So if that realm proves to be important, Orion has a great shot at being really important in medicine."

[Back]

Arimidex most effective in breast cancer study - (Reuters- 17/12/2007) 

After approximately 8 years, postmenopausal women with hormone-sensitive breast cancer who received (Arimidex), generically known as anastrazole, had a lower risk of recurrence than women taking tamoxifen, investigators reported at the annual meeting of the San Antonio Breast Cancer Symposium. The multinational study called the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial involved 6,241 women with localized, invasive breast cancer. Following treatment with surgery, radiotherapy, chemotherapy, or a combination of these primary treatments, the patients were randomly allocated to receive Arimidex, tamoxifen or both drugs for 5 years. After an average of 68 months, women on Arimidex had a 15-percent greater 
disease-free survival and a 25-percent longer time to disease recurrence than 
women on tamoxifen. The time it took for the cancer to spread to distant regions 
of the body was approximately 16-percent longer and the development of new 
cancers was reduced by more than 50 percent with Arimidex. More than 3 years after completion of treatment, the gap between tamoxifen and Arimidex widened for risk of recurrence and risk of distant spread, although there was no statistically significant difference between the two drugs on overall survival time.

Principal investigator in the United States, Dr. Aman U. Buzdar, of The 
University of Texas MD Anderson Cancer Center in Houston, told Reuters Health 
that "there is a persistently positive effect with Arimidex." "(Arimidex) has a lot of the same adverse effects as tamoxifen, such as nausea and vomiting, hair loss, fever and risk of infection, but they are milder. And once treatment has stopped, the risk of fractures with Arimidex drops back down to that of tamoxifen. There is no carry-over effect with fracture risk with Arimidex." "Over time, the benefits (of Arimidex) become more striking, cutting the risk of recurrence in one out of four women. The risk of uterine cancer is also lower with Arimidex than tamoxifen," Buzdar added.

"The standard of care is changing for postmenopausal women" with breast cancer, 
Buzdar said. Along with the meeting presentation, the ATAC results are being simultaneously published online December 14, 2007 by Lancet Oncology. Investigator Dr. Anthony Howell of Christie Hospital NHS Trust in Manchester, UK, 
said in a Lancet statement that the new results from the ATAC study suggest that 
physicians should not wait to start their patients with early hormone 
receptor-positive breast cancer on anastrazole. "The higher rates of recurrence (especially in years 1 through 3), and the increased numbers of adverse events and treatment withdrawals associated with tamoxifen, lend support to the approach of offering the most effective and well-tolerated therapy at the earliest opportunity." "Five years of anastrozole should now be considered as the preferred initial 
adjuvant endocrine treatment for postmenopausal women with 
hormone-receptor-positive localized breast cancer," Howell concludes.

[Back]

HER-2-positive breast cancer tied to hormone status -( Reuters- 17/12/2007) 

HER-2-positive, hormone receptor-negative breast cancer patients have a high risk of treatment failure after chemotherapy -- and the most common site of cancer recurrence after treatment failure is the brain, Mayo Clinic researchers reported at the San Antonio Breast Cancer Symposium.  Breast cancers that are estrogen-receptor and progesterone-receptor negative are associated with the worst outcomes and require aggressive treatment right from the time of diagnosis, Dr. Laura Vallow of the Mayo Clinic in Rochester, Minnesota, told Reuters Health. Her group reviewed records of 120 women with brain metastases after an initial diagnosis of breast cancer treated at their institution between June 1996 and November 2006. Of these women, data on the gene mutation HER-2 and the hormone receptor status were available for 83 women.

Of the 83 women, 39 or 47 percent were HER-2-positive. Nearly all (96 percent) 
had received radiation therapy at the time brain metastases were diagnosed. The 
brain was the first site of treatment failure in 15 of the 39 women, or 38 percent, with 11 being hormone receptor-negative and 4 being hormone-positive. HER-2-positive women with hormone receptor-positive disease had an average time from diagnosis to brain metastasis of 45 months compared with 14.5 months for HER-2-positive women with hormone-receptor negative disease. Time to death after diagnosis of brain metastasis was 10 months for HER-2-positive, hormone receptor-positive patients compared with 3 months for HER-2-positive, hormone-receptor-negative disease. "This isn't the whole population," Vallow pointed out in comments to Reuters Health. "This is just women with brain metastases and this is a retrospective look. These numbers look pretty terrible, but the most recent data show that disease-free survival has increased 12 percent and the risk of death has 
decreased 33 percent in our 2005 data." Furthermore, "With Herceptin available now, we have a drug that can really make a difference," Vallow stressed.

[Back]

Breast Cancer Genes Also Raise Men's Risk for Malignancy- ( HealthDay News -14/12/2007)

Men whose mothers, sisters or daughters test positive for a breast cancer-causing mutation in the BRCA1 or BRCA2 genes may also have the mutation and be at increased risk for cancer, a new study finds. Most of those men are unaware of the danger, noted researchers at Fox Chase Cancer Center in Philadelphia, who examined how families discuss genetic test results.

Men with a mutation in the BRCA1 or BRCA2 genes have a 14 percent lifetime risk 
of developing prostate cancer and a 6 percent lifetime risk of developing breast 
cancer, the study authors said."Despite these health implications, we have found a lack of understanding of genetic test results among men in these families," study lead author Dr Mary B. Daly, senior vice president for population science at Fox Chase, said in a prepared statement. The researchers interviewed 24 men with a first-degree female relative who tested positive for a BRCA1 or BRAC2 mutation. All the women said they told their male relative about the test results, but only 18 of the men remembered that they were told. About half the men (7) who did remember being told the test results didn't believe that they also had an increased risk of cancer. Only 5 of the men correctly assessed their chance of having a BRCA1 or BRCA 2 mutation. "We devote a significant amount of time learning how best to communicate genetic test results to women, but this study shows we also need to help them communicate the information to their male family members who may be impacted by the test results," Daly concluded.

[Back]

Man fought lonely battle against breast cancer. Condition is rare, but cases are rising -(The Salt Lake Tribune- 12/12/2007)


Jim Collvins is a breast cancer survivor. He's neither the first nor the only man who has ever battled this insidious disease. But most of the time it feels that way. Collvins, 50, has never met another man with breast cancer, or, for that matter, a woman who wants to talk to him about it. Even most doctors who have treated him - good ones with decades of work history, he said - have little experience with this brand of cancer. "I feel very alone," said Collvins, who within days of being diagnosed with an aggressive type of breast cancer in June had a mastectomy. "I feel like I'm doing this all by myself." Breast cancer is rare in men, accounting for less than one percent - or about 1,600 cases - of all breast cancer cases in the U.S. But a 2004 study shows the number of these cases have increased significantly over the last 25 years, to 1.08 from .86 per 100,000 men. 

The study, conducted by M.D. Anderson Cancer Center researcher Sharon 
Giordano and published in the journal Cancer, also shows that the disease in men 
is usually not detected until their tumors are bigger, have spread and may be 
more aggressive. Collvins' case started with a painful, bruised-looking lump in his right breast. Thinking it was some kind of cyst, doctors punctured it with a needle - two different times - and drained the blood. But twice it returned. Eventually Collvins had what he described as a brown spotted, Jelly Bean-sized lump surgically removed. Tests revealed it was more than just an atypical growth of his breast tissue. "I handed the phone to Gorgie, my wife. I said, 'It's the doctor, they say 
have I cancer. Talk to them,' " he said. "That's how I handled it." Collvins unbuttoned his shirt, revealing a flat, smooth area that used to be his right breast. His nipple is gone, replaced with red scars that mar his chest. Self conscious about the change to his body, Collvins now wears a T-shirt to the pool or beach. People tell him, "Well, it's not as bad for a man," he said. "Which I understand what they're saying. But at the same time, I want to tell them, 'Hey, I was just as fond of this [his breast] as maybe they [women] were of those." Men who have have testicular atrophy or trauma, sterilization, infertility, and liver disease - all believed to alter their hormonal balance - or have been exposed to radiation have been shown to be at higher risk for breast cancer, according to the Memorial Sloan-Kettering Cancer Center's Web site. One recent study also showed that 15 percent of male breast cancer patients have one or more first-degree relatives with breast cancer. BRCA2 gene mutations are found in about seven percent of male patients. 

Because breast cancer is so rare in men, little research has been conducted 
to determine an optimal course of treatment, according to Giordano's study. 
Clifford Hudis, chief of the Breast Cancer Medicine Service at Memorial  Sloan-Kettering Cancer Center, said breast cancer treatment for men is similar to that for post-menopausal women. Mastectomies, he said, are a "little less of a challenge and a little more common because of the relative size of the tumor and late detection." Because men don't get regular mammograms - nor should they, necessarily - they're often not diagnosed until they have palpable lesions, redness or 
discomfort, when the disease is in a later stage, Hudis said. Since undergoing a mastectomy and six rounds of chemotherapy, Collvins has been taking tamoxifen, a drug designed to treat both early and advance estrogen receptor-positive cancer - cancer fueled by estrogren - in pre- and post-menopausal women. "A lot of men don't realize they have estrogen, or that they even have breast tissue, which we do," he said. "Not as much as women, of course, because it doesn't develop, but that's where it [the cancer] sets up." Giordano's study, which looked at National Cancer Institute data from 1973 through 1998 on 2,524 cases of male breast cancer and 380,856 cases of female breast cancer, shows men are actually more likely than women to have estrogen receptor-positive tumors. 

"We are not sure why this is so," said the doctor, an assistant professor in 
the Department of Breast Oncology at M.D. Anderson and one of the world's leading 
experts on breast cancer in men, in a news release about the study. "But it may 
indicate some important differences in tumor biology." Despite these differences, however, five-year, 10-year survival rates were not different between men and women, the study showed. Self-breast exams are something more men should know how to do, said Collvins, whose family practitioner - because of his case - now conducts breast exams on all of her male patients during routine physical exams. "It has opened everyone's' eyes," he said. Collvins added, "Men need to know this stuff comes around, that they are susceptible - that that lump on their chest may not be fat. It may not be a scar or something. It may be cancer and they need to get in quickly and get it looked at, just like women do." The owner of a "raked" or stretched out 1987 Harley Davidson Electra Glider, Collvins hopes to get his friends in the Barons Motorcycle Club to stroll alongside him in next year's breast cancer survivor walk. And maybe this time the event will provide him with a blue T-shirt - instead of pink.

[Back]

Detecting breast cancer depends on doctor, study finds2 of 10 cases missed in mammograms- (Tribune - 11/12/2007)

Doctors reading mammograms miss an average of 2 in every 10 cases of breast cancer, even for women with lumps and other symptoms, researchers reported Tuesday. In a stark reminder of the limitation of the common diagnostic test, the researchers found wide variation in radiologists' ability to detect cancer in breast X-rays, with some missing as many as 7 out of 10 cases. In other words, the test's ability to detect cancer is strongly dependent on who is reading it. "Women think mammography is perfect, so if they get a negative [normal] mammogram, they think they're safe for at least the next year," said Diana Miglioretti, lead author of the study, which appears in this week's Journal of the National Cancer Institute. "The reality is, they shouldn't be falsely reassured by a negative mammogram."

That message was seconded by Dr. Leonard Berlin, chief of radiology at Rush North 
Shore Medical Center in north suburban Skokie, who was not involved in the study.
"You can have cancer and still have a normal mammogram," Berlin said. "If you 
have any sign or symptom, you need to pursue it. That's the bottom line." Researchers have known for years that two mammographers looking at the same 
images will often come up with different results.

But most previous studies were done in screening mammograms, routine tests 
performed on women who are assumed to be healthy. Little was known about the 
accuracy of diagnostic mammograms, which are done to evaluate symptoms or rule 
out cancer in women with a suspicious screening mammogram. Miglioretti and her colleagues examined the performance of 123 radiologists who interpreted nearly 36,000 diagnostic mammograms from 1996 to 2003 at 72 U.S. facilities. All the mammograms had been ordered for women who found a lump themselves or whose doctors discovered something of concern.

The researchers found that sensitivity—the ability to detect cancer when it is 
present—ranged from 27 percent to 100 percent, with a median of 79 percent. The 
false-positive rate—women who got a tentative diagnosis of cancer when they did 
not have it—ranged from zero to 16 percent, with a median of 4.3 percent. (A 
definitive diagnosis of cancer depends on a biopsy.) The radiologists who were most accurate—that is, had the highest sensitivity without too many false alarms—tended to be those based at academic medical centers, followed by those who spent at least 20 percent of their time on breast imaging.

But even for radiologists at teaching hospitals, median sensitivity was only 88 
percent, which means that on average 12 out of every 100 cases of breast cancer 
in symptomatic patients were not detected. And in the U.S.—unlike most European countries—the vast majority of mammograms are read by general radiologists in the community, not by specialists at academic centers. In the current study, one-quarter of the radiologists read fewer than 1,000 mammograms a year. "A lot of American women can't see a breast imaging specialist, especially in rural areas," said Miglioretti.

Miglioretti, a biostatistician at Group Health Center for Health Studies in 
Seattle, said her results were worrisome, especially since the women whose 
mammograms were examined in this study all had some reason to believe there was a problem. "Because the rate of breast cancer is tenfold higher among diagnostic mammograms than among screening mammograms, and the majority of women with breast cancer have a physical sign or symptom at the time of diagnosis, this variability in interpretive performance is concerning," the researchers wrote. "We need to identify ways to improve accuracy and reduce variability among all radiologists who interpret mammograms."

[Back]

New Marker To Identify Cancer Stem Cells Discovered- (ScienceDaily - 13/12/2007)

Researchers at the University of Michigan Comprehensive Cancer Center have found a marker that can be used to identify stem cells in breast tumors, suggesting a potential simple test that could help determine the best treatment for breast cancer. The finding also provides strong support for the hypothesis that a small number of cells, called cancer stem cells, are responsible for fueling a tumor's growth. U-M researchers were the first to discover stem cells in a solid tumor, finding them first in breast cancer. Generally, stem cells make up fewer than 5 percent of all the cells in a tumor, but they may be the key cells in cancer progression. The process of looking at the cell surface to identify stem cells, however, is too complex to apply to patient care.

In the new study, published in the November issue of Cell Stem Cell, the 
researchers found that cells from normal and cancerous breast tissue that had 
high levels of the enzyme aldehyde dehydrogenase activity, or ALDH, acted like 
breast stem cells. Further, of 577 human breast cancer tissue samples studied, 
those that expressed the specific form ALDH1 had the worst outcomes, suggesting 
this easily detected marker could be used to assess prognosis. "This study is a big step because it provides a marker that's easy to use in both normal and cancer cells. Clinical applications were really not possible with the previously described markers. The fact that ALDH1 was identified in stem/progenitor cells from both normal and cancer tissue lends support to the idea that those cells are the primary target of transformation to malignancy. We believe it is only a very small population of cells that really are capable of unlimited growth and therefore drive cancer recurrence and metastasis," says senior study author Gabriela Dontu, M.D., Ph.D., research assistant professor of internal medicine at the U-M Medical School.

Researchers used a reagent called ALDEFLUOR to detect the ALDH activity in the 
cells. Cells with high levels of this enzyme become fluorescent and can be 
detected. Cells can then be sorted to pull out the stained cells. When they did this, researchers found that the ALDEFLUOR-positive cells acted like stem cells, while the ALDEFLUOR-negative cells did not. Stem cells are defined by their ability to generate identical cells as well as to differentiate into other types of cells.  The study also tested whether the separated cells could produce a breast tumor. Tumors formed only from the ALDEFLUOR-positive cells, even when as few as 500 cells were used. On the other hand, 50,000 ALDEFLUOR-negative cells did not generate tumors.

In addition to identifying the stem cells, the researchers found ALDH1 can 
indicate how aggressive a tumor is. In tissue samples from 577 patients with 
breast cancer, those bearing ALDH1-positive tumors had lower overall survival and 
were 1.76 times more likely to develop metastases than patients with 
ALDH1-negative tumors. ALDH1 was expressed in 19 percent to 30 percent of the 
tumors. "The ALDH1 marker correlates with more aggressive tumors, possibly reflecting a different rate of renewal of cancer stem cells in these cancers. It's possible to use ALDH1 in association with other markers as a prognostic marker to help determine what treatment is necessary. More research is needed, though, before we can apply these findings in the clinic," Dontu says.

While this work was done specifically in breast cancer, the researchers believe 
it could have implications for other cancer types. U-M researchers are actively 
involved in stem cell research in virtually all cancer types. In addition to the 
initial breast cancer stem cell discovery, U-M researchers have been the first to 
identify stem cells in pancreatic and head and neck cancers. Work is ongoing to 
develop and test treatments that target these cells. "The lessons we've learned from breast cancer stem cells have been very valuable to us as we attack the cancer stem cells in other organs. Our hope is that some of the treatments we develop for one type of tumor like breast cancer may also work in targeting the cancer stem cells in these other types of tumors, and so we actually may make great progress in treating a wide variety of cancers," says Max S. Wicha, M.D., Distinguished Professor of Oncology and Director of the U-M Comprehensive Cancer Center. This research is still in the laboratory stage and no clinical tests or treatments are currently available. For information about currently available treatments, call the U-M Cancer AnswerLine at 800-865-1125 or visit mcancer.org.

[Back]

Extended therapy may benefit breast cancer patients- (Reuters, 11/12/2007) 

Postmenopausal women with breast cancer who successfully complete 5 years of tamoxifen therapy derive significant benefit from an additional 3 years of therapy with the anastrozole, an aromatase inhibitor, according to study findings published in the Journal of the National Cancer Institute. Dr. Raimund Jakesz, of Vienna Medical University and members of the Austrian Breast and Colorectal Study Group, randomly assigned 856 hormone receptor-positive breast cancer patients, who were disease-free following primary surgery and 5 years of tamoxifen therapy, to 3 years of anastrozole or no further treatment. After approximately 5 years, the women who received anastrozole had a statistically significant 38 percent reduced risk of local and regional recurrence; cancer in the other breast; and distant spread of the disease, compared with women who received no further treatment. However, there was no significant difference in overall survival between the treatment groups.

Three years of anastrozole following 5 years of tamoxifen was generally well 
tolerated and "no unexpected adverse events were reported," Jakesz and colleagues 
note. They suggest that the "more manageable side effect profile of anastrozole 
compared with tamoxifen may allow the duration of adjuvant treatment to extend 
beyond the 5-year period recommended for tamoxifen." In an accompanying editorial, Drs. Tatiana Powell and Vered Stearns of Johns Hopkins University School of Medicine, Baltimore, say these results offer additional support for extending the duration of therapy with tamoxifen followed by an aromatase inhibitor to 8 years."However, whether such a course of extended adjuvant therapy is superior to either aromatase inhibitor monotherapy or shorter courses of sequential therapy is presently unknown," they add. 

Powell and Stearns also point out that while the safety profile of extended 
therapy with an aromatase inhibitor "appears to be generally acceptable," the 
increasing use of these drugs has suggested the prevalence and severity of 
musculoskeletal side effects may be underestimated. Recent observational studies, the physicians note, have shown that nearly half of the patients taking aromatase inhibitors experienced symptoms of joint pain and stiffness. One quarter of these symptoms were described as severe and up to 13 percent women stopped taking the medication within the first year because of these symptoms.

[Back]

Breast cancer MRI may alter treatment plan (UPI- 6/12/2007)


Breast magnetic resonance imaging provides diagnostic information for some 20 percent of women with breast cancer, U.S. researchers said. University of Florida surgeons said that MRI, which is not routinely administered to the breast cancer patients, can find additional cancerous areas in the breast that previously evaded detection, discover cancer in the opposite breast that standard imaging tests such as mammography and ultrasound missed, or determine a tumor is actually larger than expected. 

Dr. Stephen R. Grobmyer said that MRI can help confirm which women are candidates for a breast-sparing operation or more aggressive surgery.  The surgeons did a retrospective review of 79 women ages 29 to 82, who had localized noninvasive or early-stage invasive breast cancer and were planning to have a lumpectomy. Twenty one patients underwent an MRI-guided biopsy after preoperative breast MRI revealed a suspicious area. About 40 percent of the biopsies revealed additional cancer and the MRI led to a change in treatment plan in 19 percent of the study sample. The findings were presented at the Southern Surgical Association's 119th annual meeting in Hot Springs, Va.

[Back]

First-ever “State of Breast Cancer Report” Outlines Progress Made, Remaining Challenges in Screening, Diagnosis, Treating, Preventing Top Cancer Killer  -(Yahoo News- 26/11/2007)

Susan G. Komen for the Cure, recognized as the global leader in the breast cancer movement today published the State of Breast Cancer Report, a first-ever, reader-friendly snapshot-in-time of where the United States and the global community are in the quest to end breast cancer forever.  Written for readers who have an interest in breast cancer but no formal background in the biology of the disease, The State of Breast Cancer provides information on advancements in diagnosis, treatment and research that have made breast cancer a survivable disease for more than 2 million people in the United States. But the news is not all good. The report also explores cultural, social, educational and financial barriers – or disparities – that prevent many people from getting screening and receiving life-saving breast cancer care. 


Addressing concern of complacency that breast cancer is under control and no longer a threat“Komen’s goal was to produce a report that gives people understandable information about breast cancer and reminds them that this battle is far from over,” said Eric P. Winer, M.D., Komen’s chief scientific advisor. Komen issued the report in part because of concern that there may be complacency on the part of some and a false sense among many Americans that breast cancer is under control and no longer a major threat to a woman’s life. Said Winer, “Too many people -- particularly people of certain ethnic and racial minorities and those with little or no health insurance -- still die needlessly of breast cancer.” 

Along with statistics and information about the biology of the disease and treatment approaches, The State of Breast Cancer Report provides practical ways for people to engage in the breast cancer movement. An extensive breast cancer resource list and a glossary of terms are included.  “The State of Breast Cancer will surprise and upset many readers. People who get upset are usually inspired to take action, and that is what we hope readers will do,” said Hala Moddelmog, president and CEO of Komen for the Cure. 

Prior to producing the report, Komen conducted extensive research to find out if a report like The State of Breast Cancer was available. Existing reports were written for physicians and researchers, and their language was hard for everyday people to understand. In addition to providing breast cancer information for patients, activists, family members and caregivers, this status report on breast cancer is also intended to help members of the media and public policymakers understand the basic characteristics of the disease, the ways it is detected, how it is treated and survived and the reasons why members of specific population groups die of breast cancer in disproportionate numbers, despite medical treatment that could save their lives. 

From a timeline that pinpoints major milestones in the global breast cancer movement, the report moves into an overview of screening and treatment advances and then quickly segues into healthcare disparities information that most readers will find surprising. For example: Despite all the medical advancements that have been made, just over 40,000 people -- roughly the population of Charlottesville, Virgina, will die of the disease in the U.S. this year.  African American women have a 35 percent higher breast cancer death rate than Caucasian women even though they are less likely to get breast cancer. Only 38 percent of Hispanic women age 40 or older have regular mammograms. For uninsured women, the risk of dying from breast cancer increases by 30 to 50 percent.

The centerpiece of the publication is the breast cancer mortality report, funded by Susan G. Komen for the Cure and published in April 2006. Under the direction of Dr. Harold Freeman, president and founder of the Ralph Lauren Center for Cancer Care and Prevention in New York, the study focused on eight U.S. communities plagued with high death rates from breast cancer. Its goal was to find the common issues that lead to disparities in those areas. Findings from the report include the following:

Washington, D.C. has the highest breast cancer death rate of any city in the country, due in part to healthcare access challenges and long waits for screening and follow-up care. Budget shortfalls threaten the cancer control programs in Michigan. Throughout the U.S., limitations of breast cancer legislation enable many states to deny treatment to women who need it, simply based on where they were initially screened. Although breast cancer deaths among Caucasian women in Chicago have decreased, more African American women in the city are dying of the disease. Many low-income women in Chicago had gone to a single public hospital for screening and treatment because it provided free care, but screenings are no longer offered there.

The State of Breast Cancer Report introduces readers to additional challenges that slow the progress toward delivery of the cures, including the lack of a standardized and nationwide system to preserve and archive tissue samples; difficulties associated with recruiting people of all races and ethnicities for clinical trials; budget cuts that affect the momentum of research; lack of data sharing among scientists and the slow path of research advancements from the laboratory to the bedsides of patients. The report provides a glance at global breast cancer statistics and disparities. Compounding the problem is a lack of reliable data in many countries and the lack of education and long-standing cultural barriers that stand in the way of early detection and treatment for breast cancer. For example:

Africa has the highest death rate from breast cancer in world, partially because early detection is rare. Ninety-five percent of women in Kenya have never had a clinical breast examination and screening mammography is virtually non-existent in that country. In many countries, screening is not part of the culture and indeed, ‘looking’ for disease is a completely alien concept.Susan G. Komen for the Cure founder Ambassador Nancy G. Brinker provides a foreword for the 36-page report. In it, she says, “This first-ever State of Breast Cancer Report is guided by the simple truth that has inspired Susan G. Komen for the Cure for the past 25 years: every one of us has the opportunity—in fact, the responsibility—to help save lives today and, ultimately, end this disease forever. You’re not holding just another report—you’re holding a roadmap, a detailed plan for action.” 

The State of Breast Cancer Report is available in PDF form by visiting www.komen.org/sobc2007. Komen for the Cure is also producing limited number of hard-copy versions of The State of Breast Cancer for distribution in patient waiting rooms, at health meetings, to members of the media and key government decision- and policy-makers. 

[Back]

Breast Cancer Risk Underestimated for Blacks, Study Says- (Washington Post- 28/11/2007) 

The formula that doctors use to calculate a woman's risk of breast cancer underestimates the danger for black women most of the time and especially for those age 50 and older -- the age when they are most likely to benefit from screening tests and protective drugs, according to the first major reassessment of the widely used tool. "We've been concerned about the assumptions we had to make for African American women and other racial and ethnic groups for some time," said Mitchell H. Gail, a biostatistician at the National Cancer Institute who led the reevaluation of the formula he himself developed. "It turns out that we have been underestimating the risk for African American women." 

The advance could have broad implications for many black women, prompting them to reconsider the danger they face from a disease that is women's leading type of cancer and second-leading cancer killer. That could translate into more women undergoing mammograms and other examinations to detect the disease in its earliest, most treatable stages; taking drugs such as tamoxifen to reduce their risk; and signing up for studies to identify better warning signs or risk-reducing medicines. 

"This could very much change the way we counsel African American women," said Nancy E. Davidson, a breast cancer expert who heads the American Society of Clinical Oncology. "It will make women better attuned to their personal risk and more eligible for standard interventions, as well as for trials to improve prevention or detection." The new findings, published online yesterday by the Journal of the National Cancer Institute, are the latest revelation about how breast cancer and other diseases can affect racial groups differently. A growing body of evidence suggests that breast cancer tends to be much more aggressive and deadly among black women, which could help explain why they are more likely to die from it even though fewer of them get it. More than 19,000 African American women are diagnosed with breast cancer each year, and nearly 6,000 die from it. 

"This is extremely significant," said Lovell A. Jones, director of the Center for Research on Minority Health at the University of Texas M.D. Anderson Cancer Center. "This is emblematic of a broader problem, which is: We tend to make the assumption that one size fits all. One size does not fit all." The research examined the Breast Cancer Risk Assessment Tool, more commonly known as the Gail model. Doctors use the model to calculate a woman's risk by plugging in variables such as the age at which she started having her period or had her first child and whether a mother or sister has had the disease. 

Because the model was based largely on data collected from about 240,000 white women, Gail and his colleagues decided to try to develop a more accurate alternative using data collected more recently on more than 3,200 black women, including more than 1,600 who had breast cancer. The researchers then tested the new version and showed that it would have accurately predicted how many African American women in the federal government's Women's Health Initiative would have developed breast cancer. Next, the team compared the new model to the old one by using both to assess data collected from 20,278 African American women who were screened for eligibility for a landmark breast cancer-prevention trial: the Study of Tamoxifen and Raloxifene (STAR) trial, which compared tamoxifen to the newer drug raloxifene. 

The accuracy of the two methods varied depending on each woman's particular risk factors, and the old model slightly overestimated the risk for some younger women. But overall the old model underestimated the risk in at least 90 percent of all scenarios, particularly for older women, the team found. "Because of this model, there are women whose breast cancer could have been detected earlier and maybe treated earlier who were not given that opportunity," Jones said. "If someone is told they are not at risk, they walk away and say to themselves, 'I don't have to worry about it.' I have had women tell me how frustrated and angry they are because they walked into a doctor's office and were given a clean bill of health only to be diagnosed with breast cancer within a very short period of time." 

For example, the old model calculated that a 50-year-old black woman who started having her period at age 14, had her first baby at age 32 and had a mother and sister who had breast cancer has a 1.53 percent risk of getting breast cancer within five years. The new model puts her risk at 2.26 percent, pushing her over the line into being eligible for the STAR trial. "That doesn't seem like a big difference, but even though those numbers look small, they can affect decisions," Gail said. Overall, the old model classified 14.5 percent of black women as candidates for the prevention trial, whereas the new model would classify more than twice as many, 33.3 percent, as eligible. 

There are many reasons for the discrepancy. Having a baby before age 30, for example, does not reduce the risk for black women as much as it does for white women. Based on the findings, Gail and his colleagues recommended that doctors start using the new model for their African American patients. The National Cancer Institute plans to use the new model to update its calculator, which is online at http://www.cancer.gov/bcrisktool, he said. Gail also said he plans to try to develop similar alternative models for other groups, such as Hispanics and Asians. 

The findings should also dispel long-standing myths about African Americans, some advocates said, noting that the lower risk assessments under the old model meant that many were not eligible for prevention trials. "It's always been thought that African American women were not interested in being part of clinical trials. In reality, they were denied access to those trials," said Karen Jackson of Sisters Network Inc., the leading breast cancer group for black women. "Being in clinical trials gives you access to the latest and greatest treatments. This will allow all women who are interested in being involved to have equal access to take part in trials." Better methods are still needed to tailor prevention and treatment strategies individually, other advocates said. "Ultimately, what we want and what we need are tools that are meaningful for the individual," said Carolina Hinestrosa of the National Breast Cancer Coalition, a D.C.-based advocacy group. "Women should be able to make these life-altering decisions based on information about themselves." 

Non-Caucasians at higher risk for severe metastatic breast cancer pain
A new study finds significant racial differences in the risk of pain related to metastatic breast cancer. An analysis by Dr. Liana Castel of the University of North Carolina at Chapel Hill and colleagues found that non-whites experience poorer pain control among women with this disease. The study is published in the January 1, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

Studies indicate that chronic or recurrent pain affects 30 percent of all cancer patients and 60 to 90 percent of patients with advanced cancer. Age, race, tumor type, genetics, psychosocial context, and culture can all affect pain. However, it is unclear how pain is influenced by changes over the course of disease due to factors including radiation, surgery, and chemotherapy. The current study was among the first to examine whether race plays a role in patients’ experiences in pain over the course of metastatic cancer.

Dr. Castel and co-investigators studied 1,124 women with metastatic breast cancer and bone metastases who received standard treatment in an international chemotherapy clinical trial conducted from October 1998 to January 2001. The study comprised women in 19 countries; the majority (82%) of non-whites were from the US. A test called the Brief Pain Inventory—which is based on a scale of zero to ten in pain severity—was administered repeatedly over a year to determine pain levels. The authors found that non-white women reached a pain level of seven or higher on the Brief Pain Inventory scale significantly earlier during a year of follow-up, compared with white women. A score of 7 or higher on the scale commonly designates severe (vs. moderate or mild) pain. Besides race, other predictors for greater pain were inactive performance status and preceding radiation treatment. 

Dr. Castel and her co-authors note that their findings confirm published evidence that non-Caucasians are at highest risk for undertreatment of pain, including inadequate dosing and poor access to medication. Racial/ethnic minority patients have also been shown to be at greater risk for breast cancer mortality. The authors conclude that research should seek to uncover and resolve the reasons for these racial disparities. In addition, “clinicians should use information about known risk factors to inform more aggressive and earlier intervention among non-Caucasian women with metastatic breast cancer,” say the authors. 

[Back]

Prioritizing Research Questions In Breast Cancer-(ScienceDaily - 21/11/ 2007) 

 The key priorities that will impact on the future treatment of breast cancer have been identified by a group of experts on the disease. Research published in the online open access journal Breast Cancer Research may focus research resources onto the issues highlighted as top priorities. A team led by Professor Mitch Dowsett, Head of Biochemistry at The Royal Marsden NHS Foundation Trust, based in London and Surrey, together with colleagues from the USA, Switzerland and Italy carried out an international, web-based consultation to identify the most pressing issues that could be tackled by translational research. Translational research - which is concerned with the transfer of findings from the lab to the clinic - holds huge promise for the individualisation of cancer treatment.

In this study, a database of over 4000 potential participants (breast cancer professionals, including clinicians, research scientists, academics and pathologists) was created using attendee details from two major breast cancer conferences, one held in the USA and one in Europe. Participants were asked to register online and then log the most important questions that they felt the research community should tackle. A steering committee reduced the 409 questions registered to 70 unique issues, from which participants were asked to vote for their 'top six'. In all, 420 participants from 48 countries voted; around half of voters classed themselves as clinicians. The top research priority found was the identification of molecular signatures to select patients who could be spared chemotherapy. The second most pressing issue also involved chemotherapy, namely the identification of features to help clinicians choose the optimal chemotherapy regimen for individual patients. 

While translational research in breast cancer has increased greatly over recent years, individual projects often reflect the immediate interests of the research group, rather than attempting to answer a specific question with potential to alter patient management. Identifying issues deemed important by the research community could help focus translational research resources, ensuring that opportunities for important clinical advances aren't missed. "This appears to be a novel way to identify the most important challenges for improving breast cancer treatment and prevention" explains Professor Dowsett. "The work will allow investigators globally to select the most relevant clinical research questions in their efforts to translate the major advances in basic science to improvements in the clinical management of this common malignancy. I am grateful to the participants from 48 countries who made this possible."

[Back]

More Women Are Choosing Double Mastectomy Even When Breast Cancer Is Confined To A Single Breast-(ScienceDaily -19/11/2007) 

 Researchers are reporting a 150 percent increase between 1998 and 2003 in American women opting to have both breasts removed when cancer has been found in only one breast—a procedure called contralateral prophylactic mastectomy (CPM). This is the first study to examine these trends on a national level. The authors caution that this aggressive strategy may be unnecessary since most patients will never develop cancer in the second breast, and since the risk of cancer spreading to other parts of the body is often higher than the risk that cancer will be found in the second breast. 

“Although breast cancer is now often diagnosed at earlier stages, we’re seeing more women having contralateral prophylactic mastectomy, even though there are very little data showing that this irreversible procedure improves overall survival,” explained lead author Todd M. Tuttle, MD, chief of surgical oncology and associate professor of surgery at the University of Minnesota. “We need to determine why this is occurring and use this information to help counsel women about the potential for less invasive options.”

The researchers used the Surveillance, Epidemiology, and End Results database (which provides detailed information about cancer diagnosis and treatment for 16 areas in the United States) to review the treatment of patients with unilateral (one-sided) breast cancer diagnosed between 1998 and 2003. Among 152,755 women diagnosed with stage I, II or III breast cancer during this period, 59,460 underwent a single mastectomy; 4,969 other women who were candidates for a single mastectomy chose to have CPM as well. The CPM rate among those who were candidates for a single mastectomy rose from 4.2 percent in 1998 to 11 percent in 2003. Younger women, non-Hispanic whites and women with lobular breast cancers were more likely to have CPM.

Dr. Tuttle proposed several potential reasons for the increase in the rate of CPM. There is more public awareness of the genetics of breast cancer and more frequent testing for mutations in BRCA genes, which increase contralateral breast cancer risk (although this study did not examine patients’ BRCA status). Moreover, less invasive mastectomy approaches and improved breast reconstruction techniques may persuade more women to have both breasts removed at the same time. He also emphasized that women often make the decision to have CPM quickly and at a vulnerable time. Instead, women may benefit from treating just the known breast cancer first and thinking about other options later, after their treatment is completed.

[Back]

Breast cancer campaign spreads-(Sun Media- 17/11/2007)


A grassroots campaign aimed at young women who may be susceptible to breast cancer and don't know it has branched out across Ontario. Team Shan, a breast cancer awareness campaign, has hit bus shelters, billboards, posters and brochures from Chatham to London and Toronto to parts of northeastern Ontario. The campaign is designed to inform women between the ages of 16 to 29 about the disease and its symptoms, while encouraging them to perform self-exams and speak to their health care providers, if they notice anything unusual. 

The volunteer-based group behind the campaign has been able to "spread the message even further than we had initially hoped," said Lorna Larsen, project lead and manager of health promotion at Oxford County Public Health Emergency Services. "We've had an amazing response." The campaign was inspired by Larsen's daughter Shan, who died two years ago of breast cancer at 24, after she was misdiagnosed. "I think of her every minute of every day. Her spirit has guided us in this project," she said. 

Young women are a gap in breast cancer understanding and are quite vulnerable to the disease, she said. In Ontario this year alone, 400 women between the ages of 15 and 39 will be diagnosed with breast cancer and 40 of them will die, she said. "Breast cancer is not just a disease of older women," said Larsen. "One of the difficulties in young adults is that they are often misdiagnosed because breast cancer is not on the radar," she said. The Canadian Breast Cancer Foundation provided $100,000 for the multi-media project. The campaign, begun last month, wraps up the end of December. A final evaluation of the project will be submitted to the foundation in January. 

[Back]

Cell Insights May Predict Breast Cancer's Spread- (HealthDay- 16/11/2007) 

U.S. researchers believe they're on the way to solving a major question about breast cancer: Which women have a type of lesion in their breast duct that will progress to invasive disease? "It's an exciting step forward -- people have been trying to get traction on this big clinical problem for about 40 years, and this is a big crack in the door," said lead researcher Thea Tlsty, a professor of pathology at the University of California, San Francisco.

Ductal carcinoma in situ (DCIS), as this type of lesion is officially known, is diagnosed in about 47,000 American women every year, according to the U.S. National Cancer Institute. To prevent its recurrence as invasive breast cancer, DCIS generally is treated by lumpectomy alone (approximately 25 percent of cases) or lumpectomy with adjunctive treatments such as radiation, chemotherapy, and/or hormones (approximately 40 percent).

In about 25 percent of cases, complete mastectomies are performed. Less than an estimated 5 percent of women choose "watchful waiting" in lieu of a surgical intervention, Tlsty said. But doctors are still confronted with a guessing game when it comes to predicting those patients at highest risk for recurrence, Tlsty said. "Only about 12 to 15 percent of women diagnosed with DCIS are going to have a future invasive cancer, and all the others won't. Up until now, the problem was that we couldn't distinguish the 12 to 15 percent from those who were not [at risk]," explained Tlsty.

Consequently, some women unknowingly are overtreated by having a mastectomy, and others are undertreated if they chose a course of watchful waiting rather than surgical intervention, Tlsty added. In their pilot study, published in the November issue of Cancer Cell, the UCSF team looked at how a collection of biomarkers, including molecules called p16 and ki67, interact to predict invasive tumors, she explained.

Because this initial study was done on tissue samples from 70 women, a larger retrospective study is under way at UCSF to validate the initial results, Tlsty said. Further research, including a large prospective trial, is also needed before the findings can be ready for clinical use, she added. If that work upholds the results of the pilot study, the biomarkers could be ready for clinical use within four to five years, Tlsty said.

Dr. Joseph Geradts, a professor of pathology at Duke University in Durham, N.C., said that finding biomarkers that predict the conversion of DCIS into invasive cancer is "the holy grail of breast cancer research." He said there have been a number of previous studies that have been published, but, so far, they've been "mostly a fruitless effort." According to Geradts, the UCSF study "is valuable," because "the authors propose two new biomarkers that in the past have not been looked at." The UCSF team's findings "are intriguing preliminary data" that "merit confirmation and subsequent studies," he added. Geradts said his own lab currently is researching whether changes in DNA may identify a tumor's capacity to metastasize or become invasive. Other researchers are looking at other DCIS biomarkers, he said.

"DCIS itself is a non-life threatening condition" with rare exceptions, noted Dr. Eric Winer, director of breast oncology at the Dana-Farber Cancer Institute in Boston, and women are usually treated to help prevent invasive cancer. If the findings of the initial UCSF study are confirmed, then with "careful investigation, we may get to the point where we don't have to treat all women with DCIS, and we may be able to tailor it so some women get less, and some women get more" depending upon their risk for invasive breast cancer, Winer said. "It's a very complex and interesting study" added Dr. Richard Bleicher, a surgical oncologist at Fox Chase Cancer Center in Philadelphia. "We need to be cautiously optimistic." Bleicher added that while the findings have "significant potential," women at this point shouldn't "pin all your hopes on it," because the p16 assay is not something they can ask their doctors for at this point in time.

[Back]

Simpler Way To Assess Breast Cancer Risk Found -(ScienceDaily- 14/11/ 2007) 

A new, simpler model for predicting breast cancer risk in postmenopausal women appears to be as accurate as a more complicated method currently used to decide if women would benefit from medication to reduce their risk of getting cancer, according to research published in the Journal of the National Cancer Institute.

A team of researchers led by Rowan T. Chlebowski, a lead investigator at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), sought a simpler method for measuring breast cancer risk so women and their doctors could easily determine when the women would be likely to benefit from tamoxifen treatment for reducing their chances of getting breast cancer."For the first time, a postmenopausal woman can use a simple model and determine by herself if she is at increased risk of getting breast cancer," said Dr. Chlebowski. "She could then raise this issue with her health care provider because interventions to reduce her risk of breast cancer are now available."

Using data from the Women's Health Initiative, a 15-year research program involving 161,808 postmenopausal women and funded by the National Institutes of Health, the researchers found postmenopausal women were at an "increased risk" of developing breast cancer if they were: 55 years of age or older and had either had a breast biopsy at any time, regardless of findings, or had a first-degree relative (mother, sister or daughter) who had breast cancer diagnosed at any age. "Increased risk" is defined as about a 2 percent risk of developing breast cancer over the next five years. The researchers sought a quicker and easier way to determine risk because those who are at "increased risk" may benefit from tamoxifen treatment to reduce their chances of getting breast cancer. 

Prior to this study, most physicians relied on the "Gail Model" to determine risk. But it involves so many variables that a computer is needed to determine a woman's risk of breast cancer. As a result, it wasn't used widely. Previous surveys found only 11 percent of California primary care physicians had used the Gail Model for risk assessment in the past year. In a national survey, only 16 percent agreed that it is "easy to determine" who is eligible for breast cancer risk reduction strategies and only 25 percent had prescribed tamoxifen for risk reduction in the past year.

The Gail model underestimated 5-year breast cancer incidence by almost 20 percent, but it performed better when predicting estrogen receptor-positive breast cancer than estrogen receptor-negative breast cancer. The simpler model that used only three factors for calculating risk--age, family history of breast cancer, and previous breast biopsy--was almost as accurate as the Gail model for predicting estrogen receptor-positive breast cancer. The simpler model "would be more accessible for routine and rapid prescreening in the prevention or routine care setting," the authors wrote in the Journal article. The article, entitled "Predicting Risk of Breast Cancer in Postmenopausal Women by Hormone Receptor Status," appears in The Journal of the National Cancer Institute.

[Back]

Study: Breast Density Affects Accuracy Of Cancer Tests
New Technology On Horizon To Combat Complications, Doctors Say (Yahoo News)

While it is common knowledge heredity is a determinant of a woman's chances of getting breast cancer, a new study shows that the density of breasts themselves affects risks and preventive measures. According to the New England Journal of Medicine, women with dense tissue in 75 percent of their breasts were about five times more likely to develop breast cancer than women with mostly fat tissue. "There have been a number of studies that show women with high density in their breasts have a high risk of developing breast cancer." UCSF Researcher Steven Cummings said. Experts said that density might be even more of a determinant than heredity.

Psychologist Carol Kronenwetter, who comforts women stricken with the affliction, said her own experience with breast caner 17 years ago has given her better insights as how to reach her patients. "I knew I had dense breasts but I didn't know that I had an increased risk of cancer," Kronenwetter said. Cummings said, "Breast density means there's a lot of tissue that has cells in the breast so therefore the more cells the more tissue you've got the greater the chance one of those cells will become cancer." Another side effect of high breast density is the impediments the thickness means to mammograms and MRIs. Cummings said that burgeoning technology is catching up with that problem.

"The computerized system that we've developed and we hope will be available more widely do give you a percentage density and can also give you very precisely the total amount of dense tissue in the breast," Cummings said. KNBC health expert Dr. Bruce Hensel said that the best ammunition for women to take regarding this new development is to consult with their physicians about which test fits them better. While mammograms are an obvious starting point, density is better determined by MRIs or digital tests. As women get older, the tissue's density decreases and mammograms are more accurate, Hensel said.

[Back]

Side effects vary by breast cancer maintenance therapy-(Reuters- 14/11/2007) 

Among postmenopausal women receiving adjuvant therapy for early breast cancer, exemestane is associated with fewer hot flashes than is tamoxifen, but it also causes more sleep problems, according to a study published the Journal of Clinical Oncology. "Hormonal breast cancer treatment increases menopausal symptoms in women," note Dr. Stephen E. Jones and colleagues from US Oncology Research Inc., Houston.

The investigators used questionnaires, completed by more than 1,500 women to assess 10 common symptoms in the first year of a clinical trial of tamoxifen or exemestane. Tamoxifen is sold under the trade name Nolvadex, and exemestane is sold under the trade name Aromasin. The patients had completed surgery and chemotherapy for early breast cancer. All of the women had hormone receptor-positive cancers, which respond to these two agents. The prevalence of the initial symptoms ranged from 2 percent (for vaginal bleeding) to 75 percent (for fatigue). Patients who received tamoxifen experienced significantly more vaginal discharge than those who received exemestane. Those who received exemestane had more bone and muscle aches, vaginal dryness, difficulty sleeping and decreased libido.

In both treatment groups, hot flash scores peaked at about 3 months and decreased thereafter. As mentioned, patients in the tamoxifen group had a significantly higher mean hot flash score at 12 months than those in the exemestane group. "These are common complaints and the treatments used make some worse," Jones commented to Reuters Health. "Oncologists and other oncology health professionals need to be aware of the commonplace nature (of these side effects) and attempt to help wherever possible," he said. For example, he suggested it may be necessary to treat the hot flashes if they are affecting the patient's of life.

[Back]

Early onset: For younger women, monthly self-exam especially important for breast cancer detection-(yahoo News- 8/11/2007) 

If people and statistics were the same, Caroline Kiley would have both her hair and her breasts. And her private business would still be private. By the statistics, she should not have been diagnosed with breast cancer. She's young, just 38. She had no family history of breast cancer. She's athletic and lean. And she'd just had a clear mammogram and physical exam. She eats well and takes care of herself.

Taking care of herself is why she found her breast cancer in time to save her life, a full two years before some official recommendations say she would need her first baseline mammogram. She did monthly self-examinations consistently, spurred partly by the stories her buddy, Dr. Erika Lloyd, told her about young patients who shouldn't have the disease but do. She likes to say that Lloyd saved her life, because when she first found the lump, her friend told her to get it checked. And when the biopsy was positive for cancer, it was Lloyd, a general surgeon at St. Mark's Hospital, who performed the double mastectomy Kiley decided was her best shot at survival. Lloyd says Kiley saved her own life — and other women can do it, too, if they pay attention to their own bodies. Monthly self-examinations are critical, she says. If you're someone who develops breast cancer young, it may be your only clue to what's going on until cancer has become very advanced.

The two women, who are the best of friends, met six years ago when their sons were born. Lloyd's son, Justin, was born in late July but he remained in St. Mark's newborn intensive care unit for a while. Two weeks later, Kiley gave birth to Henry, who also spent his first days in the NICU. There, the women met and found they really liked each other. When their babies were well, they kept in touch and starting doing things together. Their easy chatter is mixed with information about breast cancer, yes, but it's also full of reminiscences about the times they hiked together or their families took a trip together or the memorable occasion when Kiley was ski racing and Lloyd was packing baby Justin on her front and baby Henry on her back.

In the course of their easy, freewheeling friendship, Lloyd told Kiley about patients who were being diagnosed with breast cancer in their early 30s. Kiley was determined not to be one of them. She got screened, and in February, doctors found no sign of breast cancer. Two months later, she found a lump and began the odyssey that is breast cancer, with surgery and sentinel node tests to see if the cancer had spread, then chemotherapy and reconstructive therapy and more. Unlike some of the women who are diagnosed, she had a friend who was the perfect coach for the journey. "It's made it a little easier for me to follow the process." And while she says she's gotten personalized care, Lloyd assures her that's what a good medical team provides anyone. Your doctor doesn't actually have to also be your best friend. Lloyd is often the person who gives patients "the most devastating news you can get. I have to sit down and tell them they have breast cancer." But she's also the one who gets to help them figure the steps of their own journey, offering information, resources and support.

Kiley's cancer appeared to be confined to one breast, but it was aggressive and fast-moving. "She'd have been in trouble in three months," says Lloyd, had she decided not to worry about that lump because her recent screening test came out OK. Kiley had to have some lymph nodes removed. She opted to have a double mastectomy and the breast reconstruction began immediately, the first stages completed in the operating room right after the mastectomy. She could have chosen a lumpectomy and radiation therapy. Take your time and decide, her friend counseled. While breast cancer is certainly a worry and can be life-threatening, it's not a medical emergency that requires instant decisions. You have a little time to consider your life and the ramifications of your treatment decisions. After thinking about it and asking questions, Kiley opted for the more aggressive counterattack to her fast-growing cancer because she didn't want to worry about the other breast. A breast is just tissue, a small part of her whole person, she decided.

Initially, her sentinel node tested negative for cancer spread. But the final pathology report found that cancer had spread there, so she had another surgery to remove nodes, followed by four months of weekly chemotherapy. Lloyd sat with her during chemo. "I'd never done that before." She shared tips and tricks that other patients had told her helped them get through the treatments and the fear. And the doctor learned more about the process from a different perspective, which can only help her help her other patients, she believes.

It was Lloyd who told Kiley that losing her hair might upset her more than she expected. Kiley thought that was the last thing she'd care about. When it started to fall out, "it was actually really really hard." Lloyd's not sure how many times she's told her pal "all my patients go through this" or "say that. You get over it." They're the funniest of people, constantly amusing each other, and their banter is free-flowing. They crack each other up, and both use their hands to talk. But they are also pretty private people, they say. It took breast cancer to move them to the role of activists, willing to talk about very private things, like having your breasts removed.

Kiley, who is a kindergarten teacher's aide in Park City, says she can hardly shut up about breast cancer now, not because she's suffered through it, but because she doesn't want one life lost to it. She tells her story to young women so they, too, understand the importance of ignoring statistics and taking charge of their own bodies. She also offers those making the journey behind her tips on what helped her get through treatments that were, frankly, rough. Because she was an athlete who ran 8 to 10 miles a day before her diagnosis, she was in peak condition. When she was at her sickest, she still kept exercising and "I actually didn't have one day I couldn't get out of bed." That, despite the fact she had three major surgeries in less than a month. "I feel passionately that exercise and fitness plays into every aspect of recovery," Kiley says.

It's not just about attitude and feeling better, adds Lloyd. "Even minimal levels of regular exercise decrease recurrence. Survival increases significantly." That's something Kiley tells women she meets who have breast cancer. A friend with the disease called her once and said she simply couldn't get out of bed. Kiley talked her into walking around the block. Once she got started, she walked even further and felt a lot better. "You have to make the most of the energy you do have," Kiley says. You also have to make the most of the support network that's available, says Lloyd, whether friends or others who have been through it. "You're not alone in this," she says. She warns women to "Never say never. Caroline should not have gotten breast cancer. Period. End of story. But that's how breast cancer is."

Kiley could have worked during her treatments, but it was summer and she decided instead to devote her time to Henry. Many women do work through chemotherapy, Lloyd notes. They've become advocates for women. A couple of weeks ago, they walked together in the American Cancer Society's "Making Strides Against Cancer" fund-raiser. Kiley is happy to talk to women who've been diagnosed with the disease to give them the been-there, done-that perspective. And both are committed to warning young women that they, too, could be in danger. Kiley's prognosis is good. She's through with chemotherapy and now will take Tamoxifen for five years, before she can be considered cancer-free. She knows she's got to be diligent for the rest of her life. That's OK with her. She expects to be around a long time. As a team, "we're doing everything in our power to optimize her survival," adds Lloyd. And while she's diligent, they know that time is on Kiley's side. "There's so much progress every day, every week" against the disease, Lloyd says.

[Back]

Avoid weight gain to cut cancer risk (IANS- 4/11/2007)

If you want to avoid cancer risk, avoid weight gain, says a report that shows the higher your levels of body fat the higher your chances of developing cancer. The report published by the World Cancer Research Fund (WCRF) included contributions from 21 of the world's most renowned scientists and has 10 key recommendations. One of them is to keep the Body Mass Index (BMI) within 20-25 range, to minimize cancer risk. The higher the levels of body fat, the higher your chances of developing cancer, especially colorectal cancer (in which cancer cells are found in the colon or rectum), post-menopausal breast cancer, and four others, reported the health portal Medical News Today.We are recommending people to be as lean as possible within the healthy range, and that they should avoid weight gain throughout adulthood,' Michael Marmot, said.


'This might sound difficult, but this is what science is telling us more clearly than ever before. The fact is, putting on weight can increase your cancer risk, even if you are within the healthy range,' he said. The panel also advised people to consume processed meat 'sparingly'. Processed meat includes bacon and ham. They said there is compelling evidence that red meat if consumed more than 500 gm per week, raises the risk of developing colorectal cancer. The report said breastfeeding during the first six months protects the mother from breast cancer and the baby from becoming obese later on. Consumption of alcohol also increases cancer risk. Dietary supplements should not be used for cancer prevention. 

[Back]