Breast Cancer News Archive 2007- 2009
New Drug Offers Hope in Women with BRCA + Breast Cancer
June 1, 2009
New drug olaparib offers hope to women with genetic breast cancer
Charlotte Sword
Charlotte Sword, 40, has had breast cancer diagnosed twice
David Rose
A new drug for genetic breast cancer could help thousands of women with hereditary forms of the disease, the first tests on patients suggest.
A study involving 54 women with advanced genetic breast cancer found that the drug olaparib could stop the growth of tumours, and shrink them in more than 40 per cent of cases.
In one case, a woman’s tumour disappeared completely after treatment with the drug, according to results to be presented at a science conference today.
About 5 per cent of the 46,000 cases of breast cancer in Britain each year are caused by defects on the BRCA-1 and BRCA-2 genes, which put women at much higher risk of developing aggressive cancers of the breast or ovaries.
Many women who test positive for the mutations have their breasts removed as a precaution, as they have an 80 per cent risk of developing breast cancer in their lifetime.
Olaparib, made by AstraZeneca , is the first of a new class of drugs specifically designed to treat BRCA-related cancers to be tested on patients. If further tests are successful, they could be used at an early stage to treat or prevent disease occurring within affected families, scientists say.
Pharmaceutical companies are also due to present targeted therapies for cancers of the lung, stomach and ovaries this week at the American Society of Clinical Oncology conference in Orlando, Florida, the world’s largest gathering of cancer scientists.
Andrew Tutt, director of the Breakthrough Breast Cancer Research Unit at King’s College London, who led the trial, said that the results for olaparib were “very promising”.
“We are hopeful that olaparib could provide a targeted treatment for women with BRCA-related breast cancer,” he said. “Some women also develop breast cancer before they know they are carrying the gene, or see it recur if they have been diagnosed previously.”
Charlotte Sword, 40, has had breast cancer diagnosed twice, because of the potentially deadly mutation to the BRCA-1 gene which runs in her family. Her younger sister Audrey has suffered it three times. Both women have had double mastectomies and their ovaries removed.
“Breast cancer has left a horrific mark on our family due to a mutation being passed down the paternal line”, Mrs Sword said yesterday. “I have three nieces who could benefit from this treatment, and could be spared the dreadful illness and side-effects of treatment that my sister and I had to go through.”
Olaparib works by blocking a protein that makes cancer cells which have a BRCA fault unable to repair their own DNNA. This causes the cancer cell to die and means that the tumour should either stop growing or get smaller.
Because the drug works in a targeted way, it kills cancer cells while leaving healthy cells alone in a way that chemotherapy does not, which could help to reduce the punishing side-effects of cancer treatment.
In the study carried out at hospitals in Britain, Europe, the US and Australia, 27 patients took 100mg oral doses of olaparib while another 27 took 400mg doses. More than 40 per cent of tumours in the higher dose group reduced significantly in size, while all tumours were prevented from progressing for an average of six months.
The Times reported this year that the London community of Ashkenazi Jews is being offered screening for BRCA genes that raise risks of breast, ovarian and prostate cancers. Ashkenazi have a high incidence of BRCA-related breast cancer.
The NHS currently offers BRCA testing, but only for women whose relatives have had cancer because of the mutations. But up to 50 per cent of people with the faulty genes do not have a family history of the diseases, largely because the gene can be carried by men.
Dr Tutt said that orlaparib may also have potential as an early-stage or preventative treatment. He added: “It is important to remember this drug is at a very early stage of development.” Herbie Newell, Cancer Research UK scientist at the Northern Research Institute, Newcastle University, said he was “extremely encouraged” by the study’s results.
He said: “Olaparib is one of a family of targeted therapies currently in clinical trials and Cancer Research UK expect that this new class of anti-cancer treatments will make a significant impact in the fight against cancer."
In the family
8% Proportion of cases of breast cancer in women thought to be triggered by genetic factors, although many of the exact causes remain a mystery
2,000 Number of breast cancer cases a year (5 per cent of the total) known to be caused by changes in either the BRCA-1 or BRCA-2 genes that were the first to be associated with a much higher risk of developing breast cancer
1 in 800 Proportion of women in whom a faulty BRCA-1 gene is present. One in 500 carries a faulty copy of the BRCA-2 gene
50-80% Chances of a woman with these genes of getting breast cancer in their lifetime, up to seven times higher than those who do not carry the mutations. They also have a 60 per cent increased risk of ovarian cancer
Sources: Cancer Research UK; Times database
New Breast Cancer Genes Discovered....
MONDAY, March 30 (HealthDay News) -- U.S. researchers say they've spotted new gene variations that could boost the risk of sporadic breast cancer.
The same team also confirmed previously identified associations between certain regions in the human genome and breast cancer risk.
The newly identified genetic variations are located on chromosomes 1 and 14. The region on chromosome 1 contained the rs11249433 single nucleotide polymorphism (SNP). SNPs, the most common type of genetic variation, affect just a single building block of DNA.
The function of the rs11249433 SNP is unknown, but the region on chromosome 1 where it's located is predominately associated with estrogen receptor-positive breast cancer, the most common molecular type of breast cancer, the researchers said.
The region identified on chromosome 14 includes the rs999737 SNP, which is located near a gene called RAD51L1, which is a pathway implicated in breast cancer.
The Cancer Genetic Markers of Susceptibility (CGEMS) team also confirmed previous studies that found that six other genomic regions -- located on chromosomes 2, 5, 8, 10 and 16 -- are associated with breast cancer. Further study of all these regions may help improve understanding of what causes breast cancer.
"By studying large populations of individuals with and without disease, CGEMS research can provide powerful indicators as to which SNP variations are associated with breast cancer," Dr. Stephen Chanock, director of the U.S. National Cancer Institute's Core Genotyping Facility and chief of the Laboratory of Translational Genomics in the Division of Cancer Epidemiology and Genetics, said in an NCI news release.
"The two new regions identified in our study open up great possibilities for research into novel pathways contributing to the development of breast cancer. In turn, an in-depth understanding of the biology underlying the contribution of these genetic variations could one day lead to new approaches for therapy or prevention of breast cancer," he said.
The study was published online March 29 in the journal Nature Genetics.
Biopsy of Recurrent Breast Cancer is Very Important!
Study shows that breast cancer can change receptors which means that if your doctor does not biopsy a new cancer found elsewhere in your body and treats it like your original cancer, drugs may fail.
If your new cancer is biopsied and found to have a different receptor, you could benefit from proper treatment.
For example, if your first cancer was HER2 negative and your new cancer is HER2 Positive, you can fight the new one with Herceptin or Tykerb.....
Biopsy Of Recurrent Breast Cancer Can Alter Treatment
ScienceDaily (Mar. 18, 2009) — For women with recurrent breast cancer, the treatment the doctor chooses is usually based on the properties of their original breast cancer. A group from Toronto has recently completed the world's first study that compared original breast cancer tumors with a biopsy of suspected tumors that recurred elsewhere in the body.
Researchers found that the biopsy resulted in 20% of the women having a significant change in their treatment. In some cases, this was a change in drug treatment and in others, the biopsy showed the woman did not actually have an advanced cancer, but a benign condition.
"The results show that cancers may change over time and not respond to treatment that was appropriate for the original cancer," says principal investigator Dr. Mark Clemons, a medical oncologist specializing in breast cancer in the Princess Margaret Hospital Cancer Program, University Health Network (UHN).
"These early findings are leading us in a new direction as we understand more about why some women don't respond to treatment. This knowledge will help us in our quest to always deliver the right treatment, to the right patient, at the right time."
Dr. Clemons's study -- funded by a $100,000 research grant from the Canadian Breast Cancer Foundation - Ontario Region -- evaluated 29 biopsies of accessible, recurrent tumors taken from women whose breast cancer had spread to bone, skin, lymph nodes, lung or liver.
Pathologists compared the results of the original cancer with the results of the new biopsy by analyzing the predictive markers that influence breast cancer tumor growth – estrogen, progesterone and Her2 status. The presence, absence and/or combinations of these markers become the map oncologists use to determine the most effective treatment for each patient.
In 15 cases, the diagnosis was unchanged; in 10 cases the markers in the cancer changed; in three cases, women originally felt to have metastatic breast cancer had benign disease, and in one case, the "recurring" cancer was a different type of cancer, lymphoma which is treated in a very different way to breast cancer.
Co-author Dr. Christine Simmons says: "For some of the women in the study, the findings dramatically altered their treatment and made a big difference in their lives."
Study participant Danielle Lee couldn't agree more. Two years ago, the then 30-year-old mother of a toddler and eight-month-old was coping with a diagnosis that her breast cancer had spread to her spine. The results of the new biopsy confirmed that there was no cancer in her spine.
The first two years post diagnosis of estrogen and progesterone receptive breast cancer are the highest for risk of recurrence. New study further proves ARIMIDEX is superior to Tamoxifen in preventing recurrence.....
ARIMIDEX Offers Women Greater Protection Against HR+ Early Breast Cancer Returning In The 1st 2 Yrs
13 Mar 2009
"Anastrozole is the only aromatase inhibitor (AI) which has now been shown to prevent recurrences in women with hormone receptor positive early breast cancer both during the initial high-risk two years after surgery, and also well beyond the completion of treatment. In breast cancer there are no guarantees and we can't predict which women will experience a recurrence or when, so it is essential we have a treatment that has sustained efficacy against all types of recurrence that persists even after treatment is completed. If we can stop breast cancer returning, we can stop women dying from it." - Professor Tony Howell, Christie Hospital, UK
Macclesfield, UK, Friday 13 March 2009: A new analysis of the ATAC (ARIMIDEX, Tamoxifen, Alone or in Combination) trial, presented today at the 11th International St Gallen Oncology Conference, Switzerland, shows that during the first two years after surgery, anastrozole is superior to tamoxifen at reducing the risk of breast cancer returning in postmenopausal women with hormone receptor positive early breast cancer (n=5,216).1 Anastrozole has consistently demonstrated superiority over tamoxifen, both during the five-year treatment period and beyond treatment completion.2 This latest analysis provides further reassurance that prescribing anastrozole from the start protects women in the crucial first two years when the risk of recurrence is highest, meaning that fewer patients have to be told the devastating news that their breast cancer has returned.
When breast cancer returns, particularly outside the breast at distant sites such as bone, liver or lung, it is no longer curable. Therefore protecting women from recurrence is the number one priority for doctors and is imperative to saving lives. Although the risk of recurrence can persist for up to at least 15 years,3 the risk is at its greatest within the first two years following surgery, as seen in the ATAC study where over half of all excess recurrences and deaths among patients taking tamoxifen occurred in the first two and a half years.2
This latest analysis confirms that in women who benefit from treatment with AIs (84% of the total ATAC population) anastrozole is even more effective at preventing all types of early recurrence (32%; 2 years post surgery) than previously seen in the broader study population (17%; 2.5 years post surgery).1
Professor Howell continued, "It is now standard practice to assess the hormone receptor status of breast tumours to guide the best course of treatment. ATAC is a ground breaking study which has led to a significant change in treatment strategies in breast cancer with aromatase inhibitors, such as anastrozole, now replacing tamoxifen as the standard of care for postmenopausal women with hormone receptor positive disease in many countries. These new findings confirm that in the women who receive it in routine clinical practice, anastrozole offers reassuring protection against their cancer returning at the time of greatest risk, giving women the best chance of continuing their lives cancer-free."
The ATAC trial is one of the world's largest and longest-running clinical studies in postmenopausal women with early breast cancer. With a median follow-up of 100 months - significantly longer than any other adjuvant AI trial - ATAC provides further information on the safety profile of anastrozole which remains predictable, with no long-term safety concerns. As a result of the weight of efficacy and safety evidence for anastrozole, it is now the most widely prescribed AI worldwide, with over twice as many prescriptions as the next most widely prescribed AI and over 4 million patient years' experience.4 These new data will offer doctors treating hormone receptor positive postmenopausal early breast cancer further confidence that initial treatment with anastrozole offers women the best chance of staying recurrence free.
Anastrozole offers sustained protection against recurrence, demonstrating significantly superior disease free survival, time to recurrence, time to distant metastases and reduced incidence of contralateral breast cancer compared with tamoxifen - a benefit which increases over time and persists even after treatment ends.2
In ATAC, there were fewer recurrences in women with hormone receptor positive breast cancer treated with anastrozole (n= 2,618) than tamoxifen (n=2,598) at 2, 5 and 9 years post-surgery (91 vs 133; 245 vs 312; 385 vs 488 respectively).1
At a median follow-up of 2 years, compared to tamoxifen, anastrozole:1
- reduces the risk of all recurrences by 32% (HR 0.68 [0.52-0.88])
- reduces the risk of distant metastases by 21% (HR 0.79 [0.58-1.07])
- reduces the incidence of contralateral breast cancer by 78%.
ATAC Trial
The ARIMIDEX, Tamoxifen, Alone or in Combination (ATAC) trial is one of the world's largest and longest-running clinical studies in postmenopausal women with early breast cancer. ATAC is designed to investigate the comparative efficacy and tolerability of two adjuvant therapies: ARIMIDEX (anastrozole) and tamoxifen.
This analysis of ATAC reinforces the significant superiority of ARIMIDEX over tamoxifen at reducing the risk of breast cancer returning (also known as 'recurrence') in postmenopausal women with hormone receptor positive early disease.1 The ATAC data also show that, even approximately four years after treatment completion, the absolute reduction in the risk of disease recurrence continues to increase with ARIMIDEX compared with tamoxifen.2
AstraZeneca
AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of $26.47 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4 Good Index. http://www.astrazeneca.com
ARIMIDEX (anastrozole) is a trademark, the property of the AstraZeneca group of companies.
References
1. Howell A, Forbes J, Cuzick J et al. Initial adjuvant therapy with anastrozole - early and late event data from the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial in the hormone-responsive population. St Gallen 2009 Poster
2. Saphner T, Tormey DC, Gray R. Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol 1996; 14(10): 2738-46
3. ATAC Trialists' Group. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 2008; 9: 45-53
4. AstraZeneca IMS data on file
Systematic Estimation Of Breast Cancer Risk Appears Justified In Postmenopausal Women
12 Mar 2009
Screening for breast cancer risk in all postmenopausal women, using a combination of risk factors and breast density, can identify women at high risk of disease, according to systematic literature reviews and meta-analyses reported in the March 10 online issue of the Journal of the National Cancer Institute. The reviews and meta-analyses also support the use of chemoprevention in women at high risk of disease and the value of positive lifestyle changes in all women irrespective of their breast cancer risk.
Systematic Estimation Of Breast Cancer Risk Appears Justified In Postmenopausal Women
12 Mar 2009
Screening for breast cancer risk in all postmenopausal women, using a combination of risk factors and breast density, can identify women at high risk of disease, according to systematic literature reviews and meta-analyses reported in the March 10 online issue of the Journal of the National Cancer Institute. The reviews and meta-analyses also support the use of chemoprevention in women at high risk of disease and the value of positive lifestyle changes in all women irrespective of their breast cancer risk.
Although models have been developed to estimate a postmenopausal woman's risk of breast cancer, it has not been clear whether the routine use of the models in clinical practice is supported by clinical trial data.
To determine whether regular screening for the risk of breast cancer was justified, Steven Cummings, M.D., of the San Francisco Coordinating Center at the California Pacific Medical Center Research Institute in San Francisco, and colleagues used systematic literature reviews and conducted meta-analyses of clinical trials that examined the predictive accuracy of risk assessment models and breast density measurement to identify women at high risk of disease. They also reviewed prospective studies that examined the impact of lifestyle factors on breast cancer risk, and they conducted a meta-analysis of clinical trials with tamoxifen and raloxifene for primary prevention of breast cancer.
The researchers found that risk assessment models that were based on demographic characteristics and medical history alone had moderate ability to discriminate women's risk of breast cancer. However, accuracy improved when the models were combined with breast density information. A meta-analysis supported the efficacy of either tamoxifen or raloxifene for primary prevention of breast cancer. Finally, a systematic review and meta-analysis also found that exercise, weight reduction, low-fat diet, and reduced alcohol intake may reduce a woman's risk of breast cancer.
"In conclusion, evidence from these reviews supports systematic assessment of postmenopausal women for breast cancer risk with risk factors and assessment of breast density. Chemoprevention should be considered for those at high risk; however, cost-benefit analyses are needed to provide specific recommendations about who should be offered chemoprevention," the authors write. "Several lifestyle changes can be recommended to postmenopausal women, regardless of their estimated risk category."
Citation:
Prevention of Breast Cancer in Postmenopausal Women: Approaches to Estimating and Reducing Risk.
Cummings et al.
J Natl Cancer Inst 2009;101:384-398.
Herceptin Proven To Benefit Women With HER2 Positive Early Breast Cancer Latest Results From The HERA Study
12 Mar 2009
Study confirms Herceptin's promise of extra years of living cancer free
The Breast International Group (BIG) in collaboration with Roche announced that women with HER2 positive early breast cancer continue to benefit from Herceptin (trastuzumab) several years after treatment completion and as a result enjoy a longer life disease free. The patients were treated for one year with Herceptin and followed up for four years. These data from the HERA study were presented at the Primary Therapy in Early Breast Cancer conference in St. Gallen, Switzerland.
Herceptin Proven To Benefit Women With HER2 Positive Early Breast Cancer Latest Results From The HERA Study
12 Mar 2009
Study confirms Herceptin's promise of extra years of living cancer free
The Breast International Group (BIG) in collaboration with Roche announced that women with HER2 positive early breast cancer continue to benefit from Herceptin (trastuzumab) several years after treatment completion and as a result enjoy a longer life disease free. The patients were treated for one year with Herceptin and followed up for four years. These data from the HERA study were presented at the Primary Therapy in Early Breast Cancer conference in St. Gallen, Switzerland.
The HERA (HERceptin Adjuvant) study showed that women treated with Herceptin had a 25% reduction in the risk of their cancer coming back compared to women who did not receive Herceptin, and after four years of medical observation on average, almost 90% of the Herceptin-treated women were still alive. In addition to the significant treatment benefit, this analysis confirmed the long-term safety profile of Herceptin, with good cardiac safety and tolerability maintained throughout the four-year follow-up period.
"These data are extremely important for the treatment of breast cancer" commented Dr Martine Piccart, lead investigator of the HERA study and Chair of BIG. "HERA is the first of the four large Herceptin studies in early HER2 positive breast cancer to substantiate the long-term benefit derived from one year of treatment".
"These important long-term results from the HERA trial reinforce that women with this aggressive type of cancer have the best chance of cure with Herceptin", said William M. Burns, CEO of Roche's Pharmaceuticals Division.
Historically, HER2 positive breast cancer has been associated with a poor prognosis, but the first analysis of the HERA trial, released in 2005, established unprecedented benefits in terms of lowering the risk of cancer returning (disease-free survival). "It is rewarding to see that women with HER- 2 positive early breast cancer can be confident about their future with Herceptin as the foundation of their treatment" said Dr Luca Gianni from the Istituto Nazionale Tumori Milano, Italy, lead investigator of the HERA study.
To date, four large studies HERA, NSABP B-31, NCCTG N9831 and BCIRG 006 have consistently demonstrated that Herceptin prolongs survival in women with HER2 positive early breast cancer.
About the HERA study
HERA is a large international phase III study conducted as collaboration between BIG and Roche. The study, with over 5000 patients enrolled, is assessing the benefits of adjuvant Herceptin treatment in women with HER2 positive early breast cancer. The primary endpoint is disease-free survival (DFS), the secondary endpoint is overall survival (OS) and cardiac safety.
Previously, with 2 years of median follow up, the HERA study demonstrated that one year of treatment with Herceptin given at three-weekly intervals after the completion of adjuvant chemotherapy and/or radiotherapy achieved a highly significant improvement in DFS versus the observation group (no Herceptin), reducing the relative risk of relapse by 36% (hazard ratio [HR]: 0.64; 95% confidence interval [CI]: 0.54, 0.76; p=0.0001).1 Herceptin also reduced the risk of death by 34% compared to observation (HR: 0.66; 95% CI: 0.47, 0.91; p=0.0115). Upon publication of these unprecedented results in 2005, more than 50% of the patients in the observation arm opted to receive Herceptin ('crossed-over' to Herceptin treatment).
The focus of the current analysis was to evaluate the efficacy and safety of one year of Herceptin treatment versus no Herceptin at a median of four years follow-up after entry onto the study. The results of the analysis including all women involved in the trial (intent to treat, ITT) showed a 25% reduction in risk of cancer recurrence for women receiving Herceptin compared to those on observation (no Herceptin) (HR 0.76; p=0.0001). At four years of follow-up, nearly 79% of women receiving Herceptin remained cancer-free, a significant increase compared to 73% of women in the observation arm. With regard to safety, it was shown that the incidence of severe cardiac dysfunction associated with adjuvant Herceptin-based therapy was low (0.8%). These results confirm the benefit and safety of one year of Herceptin treatment in women with HER2 positive tumors despite the substantive crossover of patients from the observation group to active treatment. The present analysis also suggests that women who crossed over derived benefit from Herceptin even if they started Herceptin therapy late after completion of adjuvant chemotherapy.
The HERA study is ongoing and final results are expected in 2011.
About breast cancer
Breast cancer is the most common cancer among women worldwide.2 Each year more than one million new cases of breast cancer are diagnosed worldwide, and nearly 400,000 people will die of the disease annually.3
In HER2 positive breast cancer, increased quantities of the HER2 protein are present on the surface of the tumour cells. This is known as 'HER2 positivity' and affects approximately 20-25% of women with breast cancer.
About Herceptin
Herceptin is a humanised antibody designed to target and block the function of HER2, a protein produced by a specific gene with cancer-causing potential. The mode of action of Herceptin is unique in that it activates the body's immune system and suppresses HER2 to target and destroy the tumour. Herceptin has demonstrated unprecedented efficacy in treating both early and advanced (metastatic) HER2 positive breast cancer. Given on its own as monotherapy as well as in combination with or following standard chemotherapy, Herceptin has been shown to improve response rates, disease-free survival and overall survival while maintaining quality of life in women with HER2 positive breast cancer.
Herceptin received approval for use in the European Union for advanced (metastatic) HER2 positive breast cancer in 2000, and for early (adjuvant) HER2 positive breast cancer in 2006. In the advanced (metastatic) setting, Herceptin is approved for use as a first-line therapy in combination with paclitaxel where anthracyclines are unsuitable, as first-line therapy in combination with docetaxel, and as a single agent in third-line therapy. It is also approved for use in combination with an aromatase inhibitor for the treatment of post-menopausal patients with HER2 and hormone receptor co-positive metastatic breast cancer. In the early (adjuvant) setting, Herceptin is approved for use following standard (adjuvant) chemotherapy.
About BIG
The Breast International Group (BIG) is an international non-profit organisation for academic breast cancer research groups from around the world, based in Brussels, Belgium. Created by leading European opinion leaders in 1996, BIG now constitutes a network of 44 groups based in Europe, Canada, Latin America, and the Asia-Pacific region. These research entities are tied to approximately 3000 specialised hospitals and research centres worldwide. BIG also collaborates with the U.S. National Cancer Institute (NCI) and North American collaborative groups, with BIG and the North Americans together representing an impressive integrating force in the breast cancer research arena. To make significant scientific advances in breast cancer research, reduce the wasteful duplication of effort, and optimally serve those affected by the disease, large-scale cooperation is crucial. Therefore BIG facilitates breast cancer research at international level, by stimulating cooperation between its members and other academic networks, and collaborating with, but working independently from, the pharmaceutical industry.
References
(1) Smith I, Procter M, Gelber RD, et al., Lancet 2007; 369:29-36 1
(2) World Health Organization, http://www.who.int/cancer/detection/breastcancer/en
(3) Ferlay J, et al., GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No.5, Version 2.0. IARCPress, Lyon, 2004. 2004
Roche
http://www.roche.com
Twin Nanoparticle Shown Effective At Targeting, Killing Breast Cancer Cells
11 Mar 2009
Breast cancer patients face many horrors, including those that arise when fighting the cancer itself. Medications given during chemotherapy can have wicked side effects, including vomiting, dizziness, anemia and hair loss. These side effects occur because medications released into the body target healthy cells as well as tumor cells.
Twin Nanoparticle Shown Effective At Targeting, Killing Breast Cancer Cells
11 Mar 2009
Breast cancer patients face many horrors, including those that arise when fighting the cancer itself. Medications given during chemotherapy can have wicked side effects, including vomiting, dizziness, anemia and hair loss. These side effects occur because medications released into the body target healthy cells as well as tumor cells.
The trick becomes how to deliver cancer-fighting drugs directly to the tumor cells. Brown University chemists think they have an answer: They have created a twin nanoparticle that specifically targets the Her-2-positive tumor cell, a type of malignant cell that affects up to 30 percent of breast cancer patients.
The combination nanoparticle binds to the Her-2 tumor cell and unloads the cancer-fighting drug cisplatin directly into the infected cell. The result: Greater success at killing the cancer while minimizing the anti-cancer drug's side effects.
"Like a missile, you don't want the anti-cancer drugs to explode everywhere," explained Shouheng Sun, a chemistry professor at Brown University and an author on the paper published online in The Journal of the American Chemical Society. "You want it to target the tumor cells and not the healthy ones."
The researchers created the twin nanoparticle by binding one gold (Au) nanoparticle with an iron-oxide (Fe3O4) nanoparticle. On one end, they attached a synthetic protein antibody to the iron-oxide nanoparticle. On the other end, they attached cisplatin to the gold nanoparticle. Visually, the whole contraption looks like an elongated dumbbell, but it may be better to think of it as a vehicle, equipped with a very good GPS system, that is ferrying a very important passenger.
In this case, the GPS comes from the iron-oxide nanoparticle, which homes in on a Her-2 breast-cancer cell like a guided missile. The attached antibody is critical, because it binds to the antigen, a protein located on the surface on the malignant cell. Put another way, the nanoparticle vehicle "docks" on the tumor cell when the antibody and the antigen become connected. Once docked, the vehicle unloads its "passenger," the cisplatin, into the malignant cell.
"It's like a magic bullet," said Chenjie Xu, a Brown graduate student and the lead author on the paper. Baodui Wang, a visiting scientist at Brown and now an associate professor at Lanzhou University in China, contributed to the paper.
In a neat twist, the Brown-led team used a pH-sensitive covalent bond to connect the gold nanoparticle with the cisplatin to ensure that the drug was not released into the body but remained attached to the nanoparticle until it was time for it to be released into the malignant cell.
In laboratory tests, the gold-iron oxide nanoparticle combination successfully targeted the cancer cells and released the anti-cancer drugs into the malignant cells, killing the cells in up to 80 percent of cases. "We made a Mercedes Benz now," Sun joked. "It's not a Honda Civic anymore."
The research builds on previous work in Sun's lab where researchers created peptide-coated iron-oxide nanoparticles that, in tests with mice, successfully located a brain tumor cell called U87MG.
The researchers will test the breast-cancer nanoparticle system in laboratory tests with animals. They also plan to create twin nanoparticles that can release the drug via remote-controlled magnetic heating.
Notes:
The breast-cancer nanoparticle research was funded by the National Institutes of Health.
Gene That Triggers Metastasis DIscovered
This new gene discovery has the potential to not only protect women who currently carry it, but it will one day be isolated for targeted therapy which could lead to the PREVENTION of Mets!
Breast Cancer Gene Linked to Disease Spread, Fatality
March 02 2009
After 3 years of work, a team of researchers has identified a gene that gets switched on in 30% to 40% of all breast cancer patients, according to a recently published study from scientists at Princeton University and The Cancer Institute of New Jersey. The gene, called “Metahedrin” or MTDH, is responsible for spreading the disease, resisting traditional chemotherapies, and eventually leading to death.
“In short, I think the most immediate impact of this study is the potential development of a diagnostic test to help identify high risk breast cancer patients, so that they can be treated more aggressively and followed up more closely,” says lead researcher Yibin Kang, PhD, an assistant professor of molecular biology at Princeton.
The gene aids in metastasis by helping tumor cells stick tightly to blood vessels in distant organs and making tumors more resistant to chemotherapeutic agents (Hu G et al. Cancer Cell. 2009;15[1]:9-20).
“Inhibiting this gene in breast cancer patients will simultaneously achieve 2 important goals—reduce the chance of recurrence and, at the same time, decrease the risk of metastatic dissemination,” says Kang. “Clinically, these are the 2 major reasons why breast cancer patients die from the disease.”
The discovery not only identifies the gene, but also boosts understanding of the ways the gene is expressed.
“Not only has a new metastasis gene been identified, but this also is one of a few such genes for which the exact mode of action has been elucidated,” says Michael Reiss, co-author and director of the Breast Cancer Research Program at The Cancer Institute of New Jersey. “That gives us a real shot at developing a drug that will inhibit metastasis.”
The team also found that MTDH may be involved in the progression of other types of cancers, including prostate cancer.
A new study released by the University of California, Irvine, shows patients whose breast cancer metastasizes to their spines may have a better option than the usual treatment, which can include up to 10 sessions of radiation therapy. The study looked at alternative -- injecting radioactive bone cement into the vertebral body -- with promising results.
Breast Cancer Patients May Have a New Treatment Option When Cancer Spreads
New procedure could offer a safer, more convenient treatment for spine tumors
LAS VEGAS, Feb. 22 /PRNewswire-USNewswire/ -- For orthopaedic researcher Joyce Keyak, Ph.D., finding ways to battle breast cancer is a personal as well as a professional mission. Her cousin died from the disease several years ago. Dr. Keyak still remembers the incredible pain her cousin experienced when the cancer spread to her spine. A new study released by Dr. Keyak and her colleagues at the University of California, Irvine, shows patients whose breast cancer metastasizes to their spines may have a better option than the usual treatment, which can include up to 10 sessions of radiation therapy. The study looked at alternative -- injecting radioactive bone cement into the vertebral body -- with promising results.
The UCI researchers collaborated with a colleague from St. Jude Heritage Medical Group in Fullerton, Calif., to investigate this technique. Dr. Keyak is presenting the team's findings in the paper "Feasibility of Using Radioactive Bone Cement to Treat Vertebral Metastases" during the 55th Annual Meeting of the Orthopaedic Research Society, Feb. 22-25, 2009, in Las Vegas.
"With further development, this technology may yield a clinically feasible procedure that would eliminate the need for 10 radiation therapy sessions, making it more convenient for the patient," says Dr. Keyak, an associate professor in UCI's department of orthopaedic surgery. "This procedure would also deliver a higher dose to the bone metastases and a lower dose to the spinal cord and other normal tissues than conventional external beam radiation therapy, potentially improving the clinical outcome," she explains. "The negligible dose to the spinal cord would also make it possible to treat recurrent spinal tumors in patients who have already received the maximum allowable radiation dose to the spinal cord."
According to the American Cancer Society, almost 185,000 people in the United States -- mainly women -- were diagnosed with invasive breast cancer in 2008. In addition, a study published in the journal Spine showed that, of those patients whose breast cancer metastasizes, almost 75 percent develop spine tumors.
Spinal metastases can cause pain and vertebral collapse. And, due to the proximity of the spinal cord and nerves, those tumors can lead to serious neurological complications. Conventional treatment often occurs in two phases:
1. A surgical procedure (vertebroplasty or kyphoplasty) in which bone cement is injected into the body to stabilize the bone
2. Subsequent external beam radiation therapy (or EBRT) to control tumor growth
The effectiveness of EBRT for spinal metastases is limited because the spinal cord restricts the dose of radiation that can be safely delivered. In addition, EBRT is typically provided in multiple sessions to reduce toxicity to the spinal cord, making treatment inconvenient for the patient.
The therapy investigated by Dr. Keyak and her colleagues would combine the two treatment phases into one procedure by mixing a radioactive compound with the injected cement. A single procedure using this radioactive bone cement would provide structural reinforcement to the bone while simultaneously irradiating the tumor from within (i.e., vertebral brachytherapy). Results of the study showed that a therapeutic dose of radiation would reach the intended bone without undue risk to tissue beyond a certain range (such as the spinal cord).
Once the results are validated, subsequent studies will look at the following:
* Refining the choice of radioisotope(s), amount of activity and geographic distribution of the cement
* Sensitivity of the radiation dose distribution to variations in bone size, density and tumor type; differences in bone cement formulations; and other factors associated with a potential clinical application
An abstract of the study is available online at http://www.ors.org/web/Media.asp.
For more information about the Orthopaedic Research Society, visit the ORS Web site (http://www.ors.org/web/about_the_ors/welcome.asp).
Warning: Drug Given to Combat Menopausal Symptoms In Place of Estrogen Shown to Increase Breast Cancer Recurrence in Survivors
A breast cancer patient´s risk of recurrence increases considerably with the use of Tibolone, a synthetic steroid used in preventing osteoporosis and treating menopausal symptoms. As a result, breast cancer survivors and current patients should not be givenTibolone....
Breast Cancer Survivors At Higher Risk Of Recurrence With Use Of Synthetic Steroid
19 Feb 2009
An article in The Lancet Oncology's February issue reports that a breast cancer patient´s risk of recurrence increases considerably with the use of Tibolone, a synthetic steroid used in preventing osteoporosis and treating menopausal symptoms. As a result, breast cancer survivors and current patients should not be givenTibolone.
Early menopause is frequently a result of breast cancer treatments, such as chemotherapy. Hot flushes, night sweats, and bone loss are some of the symptoms that can be relieved with hormonal therapies. As these drugs are thought to trigger cancer recurrence, they should not be prescribed.
The use of Tibolone is approved in 55 countries for treating osteoporosis and it is licensed in 90 countries to reduce the effects of menopause. The drug is currently used by many breast cancer patients to reduce the symptoms of menopause.
Professor Peter Kenemans (VU University Medical Centre, Amsterdam, Netherlands) and his team, evaluated whether a 2•5 mg daily dose of tibolone in women surgically treated for breast cancer and suffering from menopausal symptoms raised the risk of a return of the disease. Of the 3,098 women who were assessed, 1,556 were in the Tibolone group, and 1,542 in the control group, with an average of 52.7 years of age at entry, and 2.7 years since surgery.
The results showed a 40% higher risk for Tibolone recipients - 15.2% (237) of them with recurrence of their cancer - compared to 10.7% (165) of the women receiving a placebo. The assessment was stopped 6 month early because of the evident increased risk. In addition, these recurrences (70%) involved deadly metastases.
The fact that there is no detailed study of the primary tumours, and that breast-cancer risks factors were not evaluated, limits this investigation. Upcoming studies may consider different groups of breast-cancer patients, as well as the extent of the use of tamoxifen, and whether patients are undergoing adjuvant systemic therapy.
Prof Kenemans concludes, "There are insufficient data to establish the safety of tibolone in women who have had breast cancer and do not require or have finished adjuvant therapy." There were no subgroups of breast-cancer patients identified who could safely use Tibolone. Therefore, according to the authors, for all such patients, its use should be avoided or discontinued.
This research has shown that Tibolone is and should remain contraindicated for use in women with a history of breast cancer.
Professor Kenemans and colleagues conducted the study on behalf of the LIBERATE (Livial Intervention following Breast cancer: Efficacy, Recurrence, And Tolerability Endpoints) Study Group. LIBERATE was intended to evaluate the effectiveness and safety of tibolone in women with a history of breast cancer and vasomotor symptoms. The trial was multinational, multicentre, randomised, double-blind, parallel group and placebo-controlled.
The intervention group had a considerable number of distant recurrences (37.8% increase) in comparison to the placebo group.
The Lancet Oncology
http://www.thelancet.com/journals/lanonc/issue/current
Written by Stephanie Brunner (B.A.)
Late Use of Aromatase Inhibitor Still Effective Against Breast Cancer
By Sherry Baker
HealthDay Reporter
Tuesday, March 11, 2008
TUESDAY, March 11 (HealthDay News) -- There's good news for the 60 percent of women with breast cancer whose malignancies are estrogen-driven: Researchers say taking the aromatase inhibitor (AI) drug letrozole (Femara) can cut risk of a recurrence by more than half.
That benefit was seen even when women initiated the drug one to seven years after they stopped treatment with the anti-estrogen drug tamoxifen, the study found.
In other findings, letrozole lowered the risk of breast cancer metastasis by 61 percent, according to the researchers. The drug also reduced the odds of a tumor forming in a breast that was initially cancer-free by more than 80 percent, said a team reporting in the April issue of theJournal of Clinical Oncology.
"We were expecting letrozole to work from the earlier, initial results, but the actual magnitude of benefit was a bit surprising. For any woman who has had hormone-sensitive breast cancer in the past, our results show a big reduction in recurrence if letrozole is initiated any time between 1 and 7 years after 5 years of tamoxifen -- that's up to 12 years after diagnosis," said lead researcher Dr. Paul E. Goss, director of Breast Cancer Research at Massachusetts General Hospital Cancer Center, Boston.
The findings are expected to be applied immediately to receptor-positive breast cancer treatment, Goss said.
There was one slight down side to letrozole therapy: Just over 5 percent of the 1,500 women taking the drug reported a new diagnosis of osteoporosis or bone fracture, compared to about 3 percent of 800 study participants who were not on the regimen, the researchers said.
Tamoxifen, which blocks estrogen receptor cells, is standard adjunct treatment for estrogen-sensitive cancers, but the benefits of the drug drop significantly after five years. Aromatase inhibitors block the other, less potent sources of estrogen in the body by keeping androgens from the adrenal glands and other tissues from transforming into estrogen.
The current study was based on data collected from the original MA.17 trial, conducted through the National Cancer Institute of Canada and also led by Goss. MA. 17 was designed to study whether letrozole could reduce tumor recurrence and increase survival in breast cancer patients after five years of tamoxifen treatment.
In October of 2003 , the study was ended a year earlier than originally planned when preliminary data showed that women taking letrozole were significantly less likely to have a cancer recurrence. Study participants in the placebo arm were offered letrozole when the study was halted. According to Goss, that gave the researchers the opportunity to compare the recurrence rates in women from the placebo group who chose to take the AI with those who decided on no further treatment.
Based on the new findings, "we believe every patient who has previously taken tamoxifen should discuss the findings of this study with her oncologist. Our results suggest if you take anti-estrogen, aromatase inhibitor therapy at any point of diagnosis, it is going to impact your chances of not experiencing a recurrence," Goss said.
Another expert agreed that the findings are significant.
"This study shows that the hormonal driving pathways continue to be very active after the tamoxifen has ended. And, the fact you've got a 60 percent improvement in disease-free survival with the addition of letrozole is a very powerful argument for its inclusion in treatment," said Dr. Brian Leyland-Jones, executive director of the Winship Cancer Institute at Emory University in Atlanta.
"The only imperfection of this trial, in terms of its design, is that it was not randomized -- patients chose whether or not to continue on letrozole," Leyland-Jones said. "And the only negative note is the risk of osteoporosis and increased risk of fractures for those who switched to letrozole. So, the news is very good but not all perfect."
SOURCES: Paul E. Goss, M.D, Ph.D., director, Breast Cancer Research, Massachusetts General Hospital Cancer Center, Boston; Brian Leyland-Jones, M.D., Ph.D., executive director, Winship Cancer Institute, Emory University, Atlanta; April 2008,Journal of Clinical Oncology
FDA FINALLY APPROVES AVASTIN
February 25, 2008
(Long Island, N.Y.) The Food and Drug Administration Bureau shocked experts in the medical field last Friday when it released clearance for the drug Avastin made by Genetech as a breast cancer treatment after an advisory panel of the bureau made recommendations to the opposite.
Last year, specialists convened to determine the effectiveness of Avastin as a breast cancer treatment for the FDA. Although results did show minimal slowing in growth of the tumors by using Avastin, the drug failed to improve patient condition or to diminish the cancerous tumor entirely. Subsequently they voted 5 to 4 against the approval of Genetech’s request and provided the results of their study to the FDA with their recommendation.
“All they had was progression-free survival in one trial, no increase in quality of life and patient deaths in the Avastin group,” said Fran Visco, President of National Breast Cancer Coalition. “We’re very confused why the FDA made this decision.”
Health experts fear that the decision made by the FDA to approve Avastin with very little proof of affectivity could set as precedence for other pharmaceutical companies with similar products to push for approval by the bureau thereby lowering the standards of breast cancer treatment in the market from the initial object of complete recovery to merely survival.
“If the FDA sets a precedent of approving a drug based on progression free survival, people are afraid they may stop looking at survival as the most important endpoint,” said Dr. Kay Dickersin, director of the Center for Clinical Trials at Johns Hopkins University.
Meanwhile, the Breast Cancer Organization was optimistic of Avastin’s approval for breast cancer treatment as a new option for patients. “The benefits we’re looking at here matter because they give patients hope,” said Margaret C. Kirk, the group’s chief executive. “Without disease progression they may survive to see a discovery that can help them.”
http://www.newsli.com/2008/02/25/fda-approves-avastin-as-breast-cancer-drug/
CUT-OFF CANCER PATIENT TO GET $9 MILLION IN DAMAGES
By Thomas Watkins – Associated Press 2/25/08
LOS ANGELES (AP) — A woman who had her medical coverage canceled as she was undergoing treatment for breast cancer has been awarded more than $9 million in a case against one of California's largest health insurers.
Patsy Bates, 52, a hairdresser from Lakewood, had been left with more than $129,000 in unpaid medical bills when Health Net Inc. canceled her policy in 2004.
On Friday, arbitration judge Sam Cianchetti ordered Health Net to repay that amount while providing $8.4 million in punitive damages and $750,000 for emotional distress.
"It's hard to imagine a situation more trying than the one Bates has had to endure," Cianchetti wrote in the decision. "The rug was pulled out from underneath, and that occurred at a time when she is diagnosed with breast cancer, one of the leading causes of death for women."
Bates, a mother of two, said she screamed when she heard about the damage award.
"I am elated," she said.
Bates' attorney William Shernoff said he wanted other insurers to take notice of the award.
"We are going to put a stop to this practice," he said.
Health Net said it was implementing a freeze on policy cancelations that would last until the company sets up a third-party review panel to scrutinize cases.
"Obviously we regret the way that this has turned out, but we are intent on fixing the processes to maintain the public trust," spokesman David Olson said.
The award came a day after the Los Angeles city attorney sued Health Net, claiming it illegally canceled the coverage of about 1,600 patients. City Attorney Rocky Delgadillo also said the company illegally ran an incentive program in which it paid bonuses to an administrator for meeting targets of policy cancelations.
Health Net acknowledged that such a program existed in 2002 and 2003 but was subsequently scrapped.
"It's hard to imagine a policy more reprehensible than tying bonuses to encourage the recision of health insurance that helps keep the public well and alive," Cianchetti wrote in the Bates decision.
Bates had been insured with another company but was persuaded to switch over to a Health Net policy after an agent suggested she could save money.
She said she had undergone surgery to remove a tumor and had received her first two chemotherapy treatments when doctors stopped treating her because her bills were going unpaid.
"I was devastated. I didn't know what was going to happen," Bates said. "It's boggling that someone can do that to you."
Bates went on to complete her cancer treatment through a state-funded program.
Health Net also said it would review its practices and the way its brokers and agents are trained.
http://ap.google.com/article/ALeqM5jf3kOQZF8y9J9WqUVv0NCuUHA_OgD8V07A204
MORE PROOF
STUDY: EXERCISE INCREASES BREAST CANCER SURVIVAL RATE
Anita Weier — 2/25/2008
Women who exercise after a breast cancer diagnosis can improve their chances of survival, according to a study by researchers at several universities and cancer centers, including UW-Madison.
The six-year study indicated women with breast cancer who engaged in moderate to vigorous exercise had a 35 to 49 percent decreased risk of dying from the disease. Women who had the most physical activity had higher survival rates than those with the lowest level.
A research team including investigators from the University of Wisconsin School of Medicine and Public Health made the findings in a study published in the February edition of Cancer Epidemiology Biomarkers & Prevention.
"The results suggest that women with breast cancer who exercise are more likely to survive longer than women who are less active," said epidemiologist Amy Trentham-Dietz, a UW-Madison Paul Carbone Comprehensive Cancer Center faculty member who contributed to the research.
She also published a separate study last year showing that women who are active have a lower risk of developing breast cancer.
In the new study, researchers surveyed about 4,500 participants from Wisconsin, Massachusetts and New Hampshire who were part of a 20-year-old Collaborative Women's Longevity Study. The women ranged in age from 20 to 79 years old when they were diagnosed with breast cancer between 1988 and 2001. Results were adjusted for age at diagnosis, stage of disease, body mass index, hormone therapy use, family history, education and other factors.
The principal researchers were Crystal Holick, an epidemiologist formerly from the Fred HutchinsonCancer Research Center in Seattle, and Polly Newcomb, a researcher at the Hutchinson Center who helped establish the Carbone Cancer Center in 1987 when she was an assistant scientist at the UW-Madison and is now a visiting scientist at the center.
Holick said that the new findings back up Trentham-Dietz's previous research and show that being active is important for women as a long-term lifestyle choice. The American Cancer Society also recommends 30 minutes of moderate activity at least five days a week.
The study was funded through grants from the Susan G. Komen Breast Cancer Foundation, the Avon Foundation and the National Cancer Institute.
http://www.madison.com/tct/news/274162
CALLING ALL UK WOMEN!
SURVEY ON BREAST CANCER CARE
Breast Cancer Care is calling on people in communities across England affected by breast cancer to take part in its first-ever nation-wide survey.
The findings of the questionnaire will identify key issues for those affected by breast cancer, and help influence and develop the charity's policy and campaign agendas in England.
Anna Wood, Head of Policy and Campaigns at Breast Cancer Care, the UK's leading provider of information and practical support to people with breast cancer and their families, said: "The findings will be crucial in shaping future campaigning activities and helping us to lobby for improvements in breast cancer treatment and care.
"Some of the questions also touch upon the future of healthcare, which will enable us to determine which areas of concern need to be raised with policy-makers and the Government.
"This really is your chance to have your say on the development of future breast cancer treatment, information and services.
"It's important that we get as many responses as possible to give us a clear picture of the current situation. So whatever your experience of breast cancer, please take the time to complete this important survey."
The survey is divided into sections relating to treatment, care, information and support. However, these themes are not exhaustive and people will have the chance to raise any issues that are not addressed in the questionnaire.
To receive a copy of the survey either log on to www.breastcancercare.org.uk and follow the Campaigning links or call Laura Brandon, Campaigns Officer at Breast Cancer Care, on 0207 960 3458.
http://www.thisiswiltshire.co.uk/news/headlines/display.var.2069652.0.survey_on_breast_cancer_care.php
MUSHROOM COMPOUND BOOSTS EFFICACY OF BREAST CANCER DRUGS
By David Liu, Ph. D.
SUNDAY FEB 24, 2008 (Foodconsumer.org) -- A compound found in Chinese medicinal mushroom Coriolus versicolor may help enhance efficacy of certain breast cancer drugs, according to a new Chinese study published in the March 2008 issue of International Journal of Oncology.
The researchers from the University of Hong Kong found treatment with the polysaccharopeptide (PSP) enhanced the cytotoxicity of doxorubicin (Doxo), etoposide (VP-16) but not cytarabine (Ara-C).
Earlier the researchers have found this compound was able to enhance the cytotoxicity of certain S-phase targeted-drugs on human leukemic HL-60 cells via some cell-cycle and apoptotic-dependent pathways.
In the current study, breast cancer cells treated with the PSP had a longer DNA synthesis time, suggesting that the compound boosted the apoptotic effect of Doxo and VP-16 via creating an S-phase trap in the human breast cancer cell line ZR-75-30.
Wan JM and colleagues conclude in their study report "the anticancer potentials of PSP is not limited to leukemia but may also be used as an adjuvant therapy for breast cancers."
http://foodconsumer.org/7777/8888/C_ancer_31/022406532008_Polysaccharopeptide_enhance_efficacy_of_breast_cancer_drugs_printer.shtml
SHEDDING LIGHT ON A CAUSE OF BREAST CANCER
February 21, 2008 01:31 PM ET | Ben Harder
Brightly lit communities have high rates of breast cancer, according to a new study of cancer data and satellite images of light pollution.
Brightly lit communities have high rates of breast cancer, according to a new study of cancer data and satellite images of light pollution.
When Edison invented the light bulb, did he accidentally spawn a cancer epidemic? It's certainly starting to look that way. In study after recent study, exposure to artificial light has been linked to certain kinds of tumors, especially those in the breast.
Consider some of the evidence: Blind women have low rates of breast cancer. So do women in underdeveloped countries, where artificial lighting is an uncommon luxury. By contrast, female nurses and other women who frequently work night shifts have high breast cancer rates. The reason, experts believe, is that their schedules expose them to illumination during what should be the darkest hours of their days, and that disrupts the body's production of the cancer-suppressing hormone melatonin. In lab experiments, human breast tumors have been found to grow relatively quickly when fed by the blood of women who have been in a brightly lit room in the middle of the night. When blood is drawn from women who've been sitting in darkness, it's richer in melatonin and less nourishing to the cancer.
Based on those and other observations, a unit of the World Health Organization announced in December that shift work is a "probable human carcinogen." But shift work may be merely the tip of Edison's epidemic.
In fact, any woman whose community is filled with streetlamps and other light sources may face an unnaturally high risk of breast cancer. A new study, slated to appear in the journal Chronobiology International, finds that breast cancer incidence is about 73 percent higher in communities with the greatest amount of artificial light at night than in communities with the least. The researchers assessed different communities' nocturnal light levels by analyzing satellite images of how much illumination escapes into space. (You can see this Washington Post article for details.)
Light pollution seems to have other untoward consequences, including harmful effects on animals like migratory birds and sea turtles. But the apparently carcinogenic effects of light pollution have received—and arguably deserve—the lion's share of scientists' attention. No one has paid more notice to the light-cancer connection than Richard Stevens, the University of Connecticut Health Center epidemiologist who first proposed a possible link more than two decades ago. Stevens collaborated on the new study with four colleagues in Israel, and I asked him to comment on its significance.
He was quick to say that the study falls short of proving cause and effect. But it's consistent, he said, with the hypothesis that light at night accounts for a "substantial fraction of breast cancer."
"Lighting the night is as important an ecological issue for the planet as global warming," he added. "In addition to its effects on all life forms, unnecessary lighting of the night accounts for a lot of fossil fuel consumption and also contributes to global warming."
http://www.usnews.com/blogs/thinking-harder/2008/02/21/shedding-light-on-a-cause-of-breast-cancer.html
DETECTING BREAST CANCER EARLY
DOCTORS CATCH CANCER EARLIER WITH SPECIAL MRI
WHITE PLAINS, NY
January 1, 2006 — A new kind of MRI machine helps doctors diagnose breast cancer earlier. Patients lie on their stomach and their breasts are placed in two coils, which focus radio waves and allow for more complete images that give a three-dimensional look inside the breast.
Two-hundred thousand women will be diagnosed with breast cancer this year in the United States. Mammograms, however, may not be the best way to detect it. Now, there's a new test to help doctors pinpoint and treat breast cancer.
Suzette Lipscomb knows how to get the most out of every moment and she plans to share most of those moments with her little girl, Ava. "I always wanted a little girl, but I was a little afraid that I may pass on some type of tendency toward the disease," Suzette says.
The disease she feared? Breast cancer. Her grandmother beat it and so did she. It wasn't easy though, during her battle she was forced to make a difficult decision. Suzette says, "I was trying to make a decision as to whether or not to remove both my breasts."
Richard Reitherman, a breast radiologist at CAD Imaging Sciences in White Plains, N.Y., used the new cadsciences breast imaging system to help decide which treatment would work best. For the test, patients lie on their stomach with their breasts in two coils, which help focus radio waves for more complete images.
"She and her surgeon know exactly how big the tumor is, so it gives her the best treatment," Dr. Reitherman says. For Suzette it showed her second breast was clear.
A dye injected into the patient helps pinpoint cancer and if chemotherapy treatments are working. In the scan, the red areas are cancer -- cancer that was missed in a mammogram. In fact, 20 percent of women who don't have the cad-sciences MRI will need a second surgery, something Suzette was able to avoid.
"I feel like the luckiest woman alive that not only did I have my cancer caught early enough that I'm alive, but that I was able to have a child," Suzette says.
Not all women are candidates for this cadsciences MRI. It's used for women who have already been diagnosed and need to know a course of action. It's also used for women who are high risk and have a family history of the disease. The procedure takes about 30 minutes; results are available 15 minutes later.
BACKGROUND: Women have a new imaging tool set to help diagnose breast cancer. The 3TP method generates a unique color-coded map by measuring changes (color and intensity) in contrast agent concentration in normal and cancerous tissues over time. It provides information that is not readily available from traditional mammography or MRI. In addition, the 3TP system is ergonomically designed to be comfortable for the patient, regardless of breast size.
HOW MRI WORKS: Magnetic resonance imaging uses radiofrequency waves and a strong magnetic field instead of X-rays to provide clear and detailed pictures of internal organs and tissues. These radio waves are directed at protons in hydrogen atoms -- one of the most abundant atoms in the human body, because of the body's high water content. The waves "excite" the protons, and when they "relax," they emit strong radio signals. A computer can turn those signals into a high-contrast image showing differences in the water content and distribution in various bodily tissues. It is becoming increasingly popular as an alternative to traditional X-ray mammography for the early diagnosis of breast cancer because women aren't exposed to the same radiation they experience with X-rays.
ABOUT BREAST CANCER: Breast cancer is a type of cancer in which cells in the breast become abnormal and grow and divide uncontrollably, eventually forming a mass called a tumor. Some tumors are benign, meaning that they do not invade other types of tissue, although if they become big enough, they can interfere with some bodily functions, such as the flow of blood or urine. Malignant tumors have cells that can invade nearby tissues. When a cancer "metastasizes," cells from the original tumor break off and travel to other parts of the body via the blood or lymph systems. More than 75 percent of breast cancers begin in the milk ducts within the breast. The next most common site is in the glandular tissue that makes the milk.
CHICKEN ANITOBODIES TO HELP DETECT HER2
BREAST CANCER
ScienceDaily (Feb. 25, 2008) — Generations of mothers have served up chicken soup to remedy the common cold, but now the therapeutic fowl may find use in diagnosis as well. Researchers at the National Institute of Standards and Technology (NIST), the National Cancer Institute (NCI) and the scientific research firm SAIC recently showed how chicken antibodies may one day improve the detection of an aggressive form of breast cancer.
HER2 is one of a family of genes that help regulate the growth and proliferation of human cells. Normal cells have two copies of HER2, but about 20 to 25 percent of breast cancers have multiple copies of the gene, resulting in the overproduction of a HER2-encoded protein (called HER2) that stimulates tumors to be particularly fast growing and difficult to treat in a subset of breast cancer patients.
Patients with that form of breast cancer--about 40,000 women in the United States annually--can be treated with a monoclonal antibody called trastuzumab that targets and inhibits the growth of tumor cells with higher-than-normal levels of the HER2 protein. But because the treatment can have adverse side effects, it's important to screen for those patients who would benefit from it by testing them for one or both of the two relevant biomarkers: the amplified HER2 gene or its overexpressed HER2 protein. Unfortunately, the existing tests for these biomarkers can yield a significant number of false positives--as many as 23 percent of patients in one 2006 clinical study--resulting in some women getting a somewhat risky and expensive treatment that can't help them.
In a paper in the International Journal of Cancer,* the NIST-NCI-SAIC research team found that chicken immunoglobulin Y (IgY) antibody created against the HER2 protein could be tagged with quantum dot (tiny, intense and tunable sources of colorful light) to more reliably detect the HER2 biomarker than the existing diagnostic tests using mammalian antibodies tagged with conventional fluorescent dyes. Overall, the improvement in sensitivity to the HER2 biomarker was about 40-50 percent.
The increased sensitivity of the HER2 quantum dot-based quantitative bioimaging system stems from the broad genetic differences between avian and human species. The chicken IgY antibody to HER2 reacts strongly with the target protein while ignoring other human proteins that can interfere with current diagnostic tests.
Other advantages of the novel NIST-NCI-SAIC system include faster and larger-scale production of the antibodies and a more reliable quantitative measure of HER2 biomarker level, in part because the quantum dot tags will stay bright and detectable while fluorescent dyes fade over time.
The research was funded under an interagency agreement between NIST and NCI. NIST also is funding the development of a standard reference material to support HER2 testing.
* Y. Xiao, X. Gao, G. Gannot, M.R. Emmert-Buck, S. Srivastava, P.D. Wagner, M.A.Amos and P.E. Barker. Quantitation of HER2 and telomerase biomarkers in solid tumors with IgY antibodies and nanocrystal detection. International Journal of Cancer, posted online Jan. 23, 2008.
Adapted from materials provided by National Institute of Standards and Technology.
http://www.sciencedaily.com/releases/2008/02/080219203526.htm
GENE PROFILING PREDICTS RESISTANCE TO BREAST CANCER DRUG HERCEPTIN
ScienceDaily (Feb. 21, 2007) — Using gene chips to profile tumors before treatment, researchers at Harvard and Yale Universities found markers that identified breast cancer subtypes resistant to Herceptin, the primary treatment for HER2-positive breast cancer. They say this advance could help further refine therapy for the 25 to 30 percent of breast cancer patients with this class of tumor.
In the February 15 issue of Clinical Cancer Research, the researchers found that HER2-positive tumors that did not respond to Herceptin expressed certain basal markers, growth factors and growth factor receptors. One of these, insulin-growth factor receptor 1(IGF-1R), was associated with a Herceptin response rate that was half that of tumors that did not express IGF-1R.
They also discovered that resistant tumors continue to over-express the HER2 growth factor protein -- an important finding given that many scientists had thought that loss of HER2 was likely responsible for Herceptin resistance.
"Herceptin has revolutionized the care of HER2-positive breast cancer for many patients, but unfortunately, not for some. This work demonstrates that digging deeper into the molecular subtypes of these tumors helps us understand why some tumors are resistant and may point to ways to remedy that," said the study's lead author, Lyndsay Harris, M.D., associate professor and Director of the Breast Cancer Disease Unit at Yale University Medical Center.
If additional studies validate these findings, it may be possible to select those patients that will be resistant to Herceptin and treat them with additional drugs to restore Herceptin sensitivity, according to Harris. "Our goal is to see what the tumor tells us before any treatment starts and tailor therapy accordingly," she said.
To determine Herceptin sensitivity, investigators took a small tumor biopsy from 48 patients with newly diagnosed and operable stage II/III breast cancer. They examined the biopsy tissue using both single and multi-gene microarrays, looking for RNA that has been activated to produce proteins.
They then treated the women with a combination of Herceptin and the chemotherapy drug Navelbine weekly for 12 weeks. Although this is not the first study to test Herceptin use before surgery, it is the first to examine the use of Navelbine, a drug approved for lung cancer treatment, in combination with Herceptin to treat HER2-positive tumors. "We were motivated to use Navelbine because we found it has few side effects when used to treat metastatic breast cancer," said Harris, who conducted much of the research study at Harvard before moving to Yale.
After treatment, the tumors were surgically removed and gene chips were again used to examine RNA transcription -- making these investigators the first to use such a technique on Herceptin treated tumors. "This kind of profiling has been done to look at response to chemotherapy drugs, but not at Herceptin resistance," Harris said.
The researchers then divided tumors into groups depending on how well they responded to therapy, and examined the baseline and post-therapy RNA profiles to find genes that were more commonly expressed in Herceptin sensitive and Herceptin resistant tumors.
They first found that some single gene markers, such as HER2 and ER (estrogen receptor), did not change in the majority of tumors. "That tells us that the cancer cells are still creating HER2 surface proteins even as Herceptin is being used, and that means HER2 loss does not appear to be a mechanism of resistance in early stage breast cancer," Harris said.
Then, using multigene chips, the researchers derived a bevy of transcribed genes that likely play a role in Herceptin resistance. Some, such as IGF-1R, were suspected, because this protein is frequently over-expressed in breast tumors, Harris says, but others were not. For example, non-responding tumors were more likely to express genes associated with basal-like breast cancer, which the researchers found to be surprising. "Most basal-like tumors are HER2-negative," Harris said.
Herceptin resistant tumors were also more likely to express a variety of growth factors, suggesting that "activation of parallel pathways may release tumors from dependence on HER2 proliferation and survival," she said.
Although the study was not designed to look at outcome, the researchers determined that 42 of 48 patients had a clinical response (16 complete responses and 26 partial responses) from the neoadjuvant treatment, and five patients experienced cardiotoxicity. After a median 2.6-year-follow-up, three of 48 patients relapsed and one died of her disease.
The study was funded by the National Cancer Institute's SPORE grant to the Dana-Farber/Harvard Cancer Center and the Department of Defense Clinical Translational Research Award granted to Dr. Harris in 2003.
EVEN TINY BREAST TUMORS CAN BE AGGRESSIVE AND MAY REQUIRE MAXIMUM THERAPY
Monday, December 17, 2007
SAN ANTONIO — Breast tumors that are 1 centimeter in size or smaller — no more than 0.4 inch in length — can still be very aggressive and may require more intensive therapy than is routinely offered today, say researchers at Mayo Clinic in Jacksonville, Fla.
The study, which is being presented at the San Antonio Breast Cancer Symposium, is one of the few that has looked at outcomes of women who have tiny tumors that have not spread to the lymph nodes. The findings suggest that outcome of two types of breast cancer — those classified as HER2 positive (HER2+) and triple negative — may not depend on size alone.
"This is a small study and so we can't make treatment recommendations from it, but it appears that biology and not only size matters when it comes to selecting therapy for small, invasive tumors," says the study's lead researcher, Surabhi Amar, M.D., a fellow in Hematology/Oncology at Mayo Clinic in Jacksonville.
Currently, there are no definitive treatment guidelines for tumors less than 1 centimeter in size because clinical trials are usually conducted on women whose tumors are larger or are associated with lymph node involvement, Dr. Amar says. "We just don't have extensive data on tumors this small, so treatment becomes a matter of physician discretion."
Researchers at all three Mayo sites — Jacksonville; Scottsdale, Ariz.; and Rochester, Minn. — participated in the study, which examined 401 women who were treated for breast cancer between 2001 and 2005 at the breast cancer clinics in Jacksonville and Scottsdale.
The vast majority (87 percent, or 350 women) had tumors that were classified as ER/PR positive and HER2 negative (in short, HER2 negative/ER/PR+). Twenty-seven women (6.7 percent) had tumors that were HER2+ and 24 patients (5.9 percent) were diagnosed with triple negative cancer — that is, ER/PR negative and HER2 negative. These classifications refer to receptors present on the outside of the tumor cell that are fueling growth, and cancer that is ER/PR+ is considered the least aggressive of the three categories. Generally, studies have shown that in all patients diagnosed with breast cancer, 15 to 20 percent of breast cancers are HER2+ and about 10 to 15 percent are triple negative.
Patients were followed for an average of almost three years, and so far researchers have data on all patients with HER2+ and triple negative cancers and on 219 women with HER2 negative/ER/PR+ cancer. Researchers found that:
* There were many more grade 2 and grade 3 tumors in women with the two rarer subtypes — 92 percent in HER2+ cancer and 91 percent in triple negative cancer — compared to HER2 negative/ER/PR+ cancer (36 percent). Tumors are graded 1-3, and higher grade tumors are more likely to grow faster and be more difficult to treat than lower grade tumors.
* Cancer came back more frequently in HER2+ tumors (7.4 percent of patients relapsed) and triple negative cancers (12.5 percent), compared to HER2 negative/ER/PR+ cancer (1.3 percent).
* Although the overall outcome of these small, lymph-node-negative tumors was excellent (overall survival 97.4 percent, disease free survival 95.1 percent), these outcomes were different in the three subgroups studied. The death rate was higher in triple negative breast cancer: there was one death in the 24 patients with triple negative tumors, none in the HER2+ group of 27 women, and one death related to relapse in 219 women with HER2 negative/ER/PR+ cancer.
Although only small numbers of women have the rarer cancer subtypes included in this study, the findings suggest that women with HER2+ and triple negative tumors should receive as much treatment as possible in order to prevent cancer relapse, Dr. Amar says. Researchers found that only 35 percent of women with triple negative cancer were treated with adjuvant chemotherapy (chemotherapy after surgery) despite the higher grade of the tumors. "Chemotherapy may not work as well as we would like in these tumors, but, still, physicians who treat patients with triple negative cancer should be aware of the higher risk of relapse, even if tumors are quite small," she says.
Adjuvant chemotherapy was offered to 28 percent of patients with HER2+ tumors, and only 4 percent received the targeted therapy Herceptin, which has been designed specifically to treat this class of tumors. "Should Herceptin be offered to such small node-negative tumors? There is not enough data currently to answer this question," Dr. Amar says. "But this study definitely highlights the fact that HER2 positive tumors, even if very small, may warrant more aggressive therapy."
Only 3.9 percent of patients with HER2 neg/ER/PR+ cancer were treated with chemotherapy. "So although the rates of adjuvant chemotherapy use were significantly higher in the HER2+ and triple negative subgroups, these groups still showed a higher relapse rate," she says.
The study's senior investigator is Edith A. Perez, M.D., director of Mayo Clinic's Multidisciplinary Breast Clinic in Jacksonville. Other researchers contributing to the study include Ann E. McCullough, M.D.; Xochiquetzal J. Geiger, M.D.; Rebecca B. McNeil, Ph.D; Winston Tan, M.D.; Kyle E. Coppola; Beiyun Chen, M.D.; and Judy C. Boughey, M.D.
http://www.mayoclinic.org/news2007-jax/4385.html
MAYO CLINIC-LED STUDY IMPROVES BREAST CANCER RISK PREDICTION IN WOMEN WITH ATYPIA
Women with at least three sites of cellular atypia in breast tissue are nearly eight times more likely than average women to develop breast cancer, according to findings of a Mayo Clinic Cancer Center led study of women with atypical hyperplasia. The findings are published in the July 1 issue of the Journal of Clinical Oncology.
Several previous studies have shown that atypical hyperplasia (also called atypia) in breast tissue is a major risk factor for breast cancer. Women who have a breast biopsy and are diagnosed with atypia are considered at high risk. Many are counseled to consider preventive medications such as tamoxifen or other risk-reducing approaches. However, questions remained from prior research on whether a positive family history further increases risk in women with atypia and for how long the increased risk in women with atypia lasts.
"The most commonly used tool for risk prediction in women with atypia is the Gail model, which may predict inaccurately because our study shows that family history does not change risk significantly in women with atypia," says Amy Degnim, M.D., a Mayo Clinic surgeon and study author. "Our findings indicate that women with atypia have a higher absolute risk for breast cancer than previously estimated. This risk is 25 percent over 25 years and is much higher in women with multiple areas of atypia and calcification." The Gail model predicts risk by using age at onset of menses, age at birth of first child, number of previous breast biopsies, presence of atypia, and number of close relatives with breast cancer.
While the Mayo Clinic study found that family history did not further increase risk, age at diagnosis of atypia did affect risk, with younger women (under age 45) more than twice as likely to develop breast cancer compared to women diagnosed with atypia after 55. The number of areas of atypical hyperplasia was significant as well. With one area of atypia, breast cancer risk was 2.3-fold compared to the general population; this risk more than doubled when two sites were found and increased to nearly eightfold as sites increased to three or more. The group of women with the highest risk had three or more areas of atypia and calcification — with a 10.4-fold risk over the general population.
"With the ability to stratify the risk of breast cancer in women with atypia, we can have more informed discussions with our patients regarding their personal risk," says Dr. Degnim. "This will help us to have individualized discussions regarding how aggressively to pursue risk-reduction treatments."
These findings resulted from reviewing the records of 331 women with atypia identified within the Mayo cohort of 9,376 women who had benign breast biopsies surgically obtained between 1967 and 1991. More than half (55.9 percent) of the women were over age 55 when diagnosed with atypia, and 42.9 percent had a family history of breast cancer. The majority (68.6 percent) of women showed calcification in the biopsy tissue, and 40 percent had multiple sites of atypical hyperplasia.
The American Cancer Society reports that more than 240,000 women will be diagnosed in the United States this year with breast cancer, and more than 40,000 will die from it. Dr. Degnim and her fellow researchers have been working to better understand the steps that precede breast cancer and which of them can be recognized in benign breast tissue. The current study contributes to Mayo's emerging model that seeks to define every woman's risk more precisely and to tailor screening and risk-reduction measures to women depending on their individual risks.
Other Mayo researchers included senior author Lynn Hartmann, M.D.; Marlene Frost, Ph.D.; Robert Vierkant; Shaun Maloney; V. Shane Pankratz, Ph.D.; Piet de Groen, M.D.; Wilma Lingle, Ph.D.; Karthik Ghosh, M.D.; Lois Penheiter; L. Joseph Melton III, M.D.; and Carol Reynolds, M.D. Collaborators from other institutions included Daniel Visscher, M.D., University of Michigan; Hal Berman, M.D. and Thea Tlsty, Ph.D., University of California, San Francisco; and Thomas Sellers, M.D., Ph.D., H. Lee Moffitt Cancer and Research Institute, Tampa, Fla.
The research was supported in part by a Department of Defense Center of Excellence Grant, the Susan G. Komen Breast Cancer Foundation, the Breast Cancer Research Foundation, and the Fred C. and Katherine B. Andersen Foundation. For more information about breast cancer and other research at Mayo Clinic Cancer Center, visit the Web site at http://cancercenter.mayo.edu.
To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. MayoClinic.com is available as a resource for your health stories.
NORMAL TISSUE NOT SPARED IN NEW FORMS OF BREAST CANCER RADIOTHERAPY
Tuesday, October 30, 2007
JACKSONVILLE, Fla. - A five day course of radiotherapy to treat breast cancer may, in some cases, expose as much lung and heart tissue to potentially toxic radiation as does the standard six weeks of treatment, say researchers at Mayo Clinic Jacksonville.
That because the short treatment, known as partial breast irradiation, focus radiation to a small sector of the breast through multiple beams, these beams can pass through the breast to the heart and lungs that lie behind, researchers found. Radiating the entire breast over weeks, as is standard practice, can expose much of the heart and lungs to long periods of lower dose radiation, they say.
These findings, presented at the annual meeting of the American Society for Therapeutic Radiation and Oncology (ASTRO), suggest that both methods carry risks and benefits that may be equivalent, says the study's lead investigator, Laura Vallow, M.D.
"This tells us that the standard course of therapy isn't that bad in terms of its exposure to normal tissue, but also that, sometimes, partial breast irradiation may not spare as much normal tissue as we hope," Vallow says.
Oncologists are currently testing the two modes of radiotherapy - whole breast irradiation (WBI) and 3-D conformal partial breast irradiation (PBI) - in a large federally-supported clinical trial that is enrolling thousands of women across the country who have been diagnosed with early stage breast cancer and have undergone lumpectomy.
The hope is that a short course of radiotherapy will be as effective as the much longer course, and that this could lead to increased use of breast conservation over mastectomy, Vallow says. "Many women may be opting for a mastectomy instead of a lumpectomy in order to avoid weeks and weeks of radiation treatment," she says. "If the results of both methods are equivalent, then perhaps some of these women will choose less drastic surgery."
In two studies being presented at ASTRO, Vallow, along with Ashley Gale, M.S., Anudh Jain, M.D., and a team of physicists at Mayo Clinic Jacksonville, used radiological parameters that were prepared for patients in the clinical trial and employed computers to assess how much of normal heart and lung tissue would be exposed if either WBI or PBI were used.
"We suspect there are fundamental differences in the amount of exposure to radiation a patient has using these techniques, but no one has ever looked at how much normal tissue is spared," she says. "We are interested in the finer points of treatment planning, with the ultimate goal of making treatment more tolerable with less radiation exposure."
In the first study, the researchers analyzed radiation plans for 25 patients enrolled in the clinical trial and they calculated what radiation to the lung would be if WBI or PBI was used. They found that PBI exposes a slightly larger volume of the lung to low doses of radiation, but also exposes a smaller volume of lung to high doses than WBI does.
"Patients are getting more exposure overall to their lungs with partial breast irradiation but less lung tissue is irradiated to higher doses compared to whole breast irradiation," Vallow says.
For 14 of the same patients who had a lumpectomy in their left breast, investigators calculated radiation to normal heart tissue. They found that PBI and WBI delivered about the same amount of radiation to the heart of patients whose tumor was located in the middle of the breast. In patients whose tumors were closer to the armpit, PBI did not affect normal heart tissue, Vallow says.
"This study shows how far we have really come in the delivery of radiotherapy," she says. "We are looking for nuances of tissue exposure."
To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. MayoClinic.com is available as a resource for your health stories.
DRUG COMBINATION SHRINKS BREAST CANCER METASTASES IN BRAIN
ScienceDaily (Dec. 17, 2007) — A combination of a "targeted" therapy and chemotherapy shrank metastatic brain tumors by at least 50 percent in one-fifth of patients with aggressive HER2-positive breast cancer, according to data presented by Dana-Farber Cancer Institute investigators at the San Antonio Breast Cancer Symposium.
Lapatinib (Tykerb) and capecitabine (Xeloda) were paired in an extension of a Phase 2 clinical trial in which lapatinib given alone shrank brain metastases significantly in six percent of 241 patients.
In the extension trial, capecitabine was added to lapatinib in 49 patients whose metastases -- cancerous colonies in the brain spread from their primary cancer -- had progressed while on treatment. With the combination therapy, brain metastases shrank by 20 percent or more in 18 patients (37 percent) and shrank by at least 50 percent in 10 patients (20 percent), reported Nancy Lin, MD, of Dana-Farber's Breast Oncology Center.
"Very few medications have shown activity in the treatment of brain metastases, particularly in HER-2-positive metastatic breast cancer patients," said Lin, who led the study with Eric Winer, MD, director of the Dana-Farber Breast Oncology Center. "Therefore, these data are quite encouraging, and further studies are warranted."
Lapatinib is an oral small-molecule drug from GlaxoSmithKline that is approved along with capecitabine for treating patients with advanced or metastatic breast cancer whose tumors are driven by the abnormal growth signal, HER-2, and who have already undergone therapy including trastuzumab (Herceptin), a taxane drug, and an anthracycline compound. Lapatinib, like trastuzumab, blocks the HER-2 signal.
Up to one-third of women with advanced, HER-2-positive breast cancer may develop metastases to the brain.
"Although radiation treatment is often effective, as women live longer with metastatic cancer, some develop worsening of brain metastases despite radiation," said Lin. "Because cancer in the brain can have a major impact on quality of life, it is important to have treatment options to address this problem."
BREAST CANCER RISK IN SMOKERS
Common gene boosts breast cancer risk in smokers
NEW YORK (Reuters Health) - Researchers have confirmed yet another ill effect of smoking cigarettes: it increases the risk of breast cancer in women with a common genetic variation.
The gene involved, N-acetyltransferase 2 (NAT2), is believed to help clear the body of aromatic amines, a major carcinogen in tobacco smoke. The researchers found that women with the slower-acting form of this gene -- who represent 50 percent to 60 percent of the white population and 35 percent to 40 percent of African-Americans -- are more likely to get breast cancer if they smoke.
But the study's lead author said the finding shouldn't motivate people to undergo; instead, she said, it should spur them to quit smoking. "We still know very little about what these genes do and how they might affect risk-we think the most important thing for people to do is to live a healthy lifestyle," Dr. Christine B. Ambrosone of the Roswell Park Cancer Institute in Buffalo, New York, told Reuters Health.
It has been known for years, Ambrosone noted, that the risk of bladder cancer is higher in people with the slow-acting gene version, known as the slow acetylator NAT2 genotype. However, research to date has not found any link between cigarette smoking and overall breast cancer risk. Scientists had theorized that smoking might actually reduce breast cancer risk because it can lower estrogen levels.
To investigate whether the presence of genetic mutations may influence the smoking-breast cancer relationship, Ambrosone and her colleagues analyzed data from 13 studies including a total of 11,922 women.
For women with the slow-acting gene, the researchers found, breast cancer risk increased with the number of pack years smoked, but smoking had no effect on breast cancer risk in women with the fast-acting genotype.
However, women with the slow-acting gene who smoked for at least 20 pack years -- the equivalent of a pack a day for 20 years --were 44 percent more likely to develop breast cancer than non-smokers. Theis iIncreased risk was seen for both premenopausal and postmenopausal women with the slow acetylator NAT2 gene.
"Because of the frequency of slow acetylator genotypes among non-Asian populations...smoking cessation programs need to be further targeted to women as a means for preventing breast cancer," Ambrosone and her colleagues conclude.
"What we believe is important is the public health message," the researcher said. "Here's one more adverse health outcome that smoking is likely related to."
SOURCE: Cancer Epidemiology, Biomarkers and Prevention, January 2008.
Drug Found Effective In Treating, Preventing Breast Cancer
ScienceDaily (Nov. 1, 2007) — A new study of an estrogen-derived drug shows promise as a treatment for breast cancer and breast cancer metastases to bone. A drug that has shown promise in treating sarcoma, lung and brain cancers, demonstrates that the drug may also be effective in treating breast cancer, in particular the spread of breast cancer.
The study, which was done in mice, appears on the cover of the November issue of Cancer Research.
Urszula Iwaniec, an assistant professor in the Department of Nutrition and Exercise Sciences at OSU, is the one of the authors of the study, along with OSU professor Russell Turner and researchers from the Mayo Clinic. Iwaniec and Turner are both researchers at OSU's Skeletal Biology Laboratory.
In breast cancer, the cancer commonly lodges in the bone, destroying it in a debilitating painful process called osteolysis. Osteolysis can lead to bone fractures and causes patients to feel tired, or even to lose consciousness.
Iwaniec and Turner studied the effect of 2-methoxyestradiol (meth-oxy-es-tra-di-ol), or 2ME2, on the bone. 2ME2 is derived from estrogen and works by suppressing tumor growth and blocking the formation of new blood vessels that feed tumors.
"We were expecting the drug to have an effect, but we were not expecting to have as big of an effect as it did," Iwaniec said.
In studies of other cancers, 2ME2 has been shown to induce cancer cells to self-destruct. Otherwise, tumor cells evade this process allowing them to continually divide and spread throughout the body.
Clinical trials of 2ME2 for breast cancer patients are in progress. These trials are based on an oral version of 2ME2 to treat primary tumors, but this method has limitations as the oral version of 2ME2 is poorly suited to getting into the blood system and reaching tumors. Researchers resolved this problem by delivering 2ME2 by injection and found it was much more effective.
Researchers described 2ME2 as an "attractive candidate for controlling tumor growth, metastasis to bone and bone disorders," such as osteolysis caused by the spread of breast cancer.
"This is potentially of very substantial importance because this agent has few of the unpleasant side effects of most chemotherapy drugs and targets both bone resorption and the cancerous tumor cells," Turner said. "It really is the first agent that has been clearly demonstrated to do that."
Turner said current drugs that are used to prevent bone fractures and bone pain in cancer patients are not effective in targeting the tumor cells. Turner has spent the past decade studying 2ME2 as a treatment for osteoporosis and a rare bone cancer called osteosarcoma, and is excited about its prospects as a cancer treatment.
"Often, treatments that are good for cancer are bad for the bones," he said. "2ME2 appears to be capable of treating both. If you had a treatment that both reduced the risk of bone cancer and osteoporosis, it would be extremely significant."
In summary, the researchers found that 2ME2 could:
* Effectively target breast cancer cells;
* Prevent the spread of breast cancer cells to bone;
* Protect bone from osteolysis, which is a type of bone metastasis in which the bone is eaten away by cancer cells.
The next step for the Mayo Clinic and OSU researchers is to replicate and test the finding in clinical trials.
The study was funded by a grant from the National Institutes of Health and the Mayo Clinic.
Cancer Risk Increased by Excess Body Fat, Red and Processed Meats, and Alcohol
October 31, 2007 — There is convincing evidence that excess weight and obesity can increase the risk for 6 different cancers, including those of the colon, kidney, and pancreas, according to a report issued by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund. The second expert report, Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, considered to be the most comprehensive scientific analysis of cancer prevention and causation ever undertaken, also reported that there is convincing evidence that the consumption of alcohol, red meat, and processed meat elevates cancer risk.
"The most striking finding in the report is that excess body fat increases risk for numerous cancers. That is why body weight is the focus of our first recommendation," expert panel member W. Phillip T. James, MD, DSc, from the International Obesity Task Force, in London, United Kingdom, told journalists.
The document, which was written by an international expert panel, reviewed 7000 research studies over a 5-year period and classified the accumulated evidence for specific diet-cancer links. It is the second one to be published in the past 10 years and provides the most inclusive evidence to date linking cancer risk to diet, physical activity, and weight.
Although cancer is considered to be a disease of genes that are vulnerable to mutation, evidence indicates that only a small number of cancers are inherited, write the experts. Instead, it appears that environmental factors are the most important, and these can often be modified with a resultant reduction in risk. These factors include tobacco use, infectious agents, radiation, industrial chemicals, pollution, medications, nutrition, physical activity, and body composition.
One of the strongest findings in the report was that excess body fat is associated with an increased cancer risk and can increase the risk for 6 different types of the disease: colon, kidney, pancreas, adenocarcinoma of the esophagus and endometrium, and postmenopausal breast cancer. They also reported that alcohol is convincingly linked to a number of cancers, including those of the colon, breast, esophagus, and mouth, larynx and pharynx.
To combat excess weight and maintain a healthy body-mass index, the experts recommend limiting the intake of energy-dense foods, particularly those that are highly processed. These products tend to be high in sugar and fat and low in fiber. They also advise increasing physical activity and getting some exercise for at least 30 minutes a day. Physical activity not only helps individuals keep excess weight off, but it helps reduce the risk for cancer in its own right.
Evidence has also increased since the first report, issued in 1997, which links the consumption of red meat (beef, pork, and lamb) to colorectal cancer. The panel's recommendation is to limit the consumption of red meat to 18 ounces per week because, beyond this amount, evidence shows that for every additional 1.7 ounces of red meat consumed per day, the risk for cancer rises by 15%.
Their recommendation concerning the consumption of processed meats is even more stringent. Processed meats, such as bacon, ham, sausage, and lunch meat, should be avoided entirely; the panel was unable to find a level at which the consumption of these products can be reliably considered completely safe. For every 1.7 ounces of processed meat consumed per day, the risk for colorectal cancer rises by 21%.
Evidence also indicates that the majority of diets that are protective against cancer are made up primarily of foods of plant origin. Higher consumption of several plant foods might offer protection against cancers of various sites.
"We are recommending 5 servings or more of vegetables and fruit daily because, like physical activity, they pack a double whammy against cancer. Probable evidence indicates that they help reduce cancer risk on their own and, as low energy-dense foods, they help maintain a healthy weight, which the evidence shows has a big influence on cancer risk," Dr. James said during a press conference.
The panel also looked at factors that included birth weight, childbearing, breast-feeding, and adult height and found that they all can influence the risk for cancer. High birth weight is associated with an increased risk for premenopausal breast cancer, which is likely linked to excess body fat and the resultant hormonal changes.
Exclusive breast-feeding appears to offer protection for both mother and child. It can help lower the risk for breast cancer in women and also lower the risk of becoming overweight and obese in children.
"The evidence is uniformly strong on breast-feeding, and the fact that it offers cancer protection to both mothers and their children is why we made breast-feeding 1 of our 10 recommendations to prevent cancer," said expert panel member Walter J. Willett, MD, PhD, from the Harvard School of Public Health, in Boston, Massachusetts, at a press conference.
The panel also found an association between adult height and cancer risk. Tall adults appear to have a higher risk of colorectal and postmenopausal breast cancer, and there is some evidence linking tallness to an increased risk for ovarian, pancreatic, and premenopausal cancer.
The recommendations made in this report are applicable to cancer survivors when appropriate and unless otherwise advised by their healthcare practitioner. Because increasing numbers of cancer patients survive their disease and live long enough to develop new primary cancers or other chronic diseases, the expert panel believes that these recommendations can help reduce the risk.
Recommendations for Cancer Prevention
1. Be as lean as possible within the normal range of body weight.
2. Be physically active as part of everyday life.
3. Limit consumption of energy-dense foods; avoid sugary drinks.
4. Eat mostly foods of plant origin.
5. Limit intake of red meat; avoid processed meat.
6. Limit alcoholic drinks.
7. Limit consumption of salt; avoid moldy cereals (grains) or pulses (legumes).
8. Aim to meet nutritional needs through diet alone.
9. Mothers should breast-feed; children should be breast-fed.
10. Cancer survivors should follow the recommendations for cancer prevention.
World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR; 2007
WEIGHT GAIN INCREASES RISK
Oct 23, 2007
CHICAGO - Women who put on a lot of weight at any stage of adulthood increase their risk of breast cancer likely because the hormone estrogen accumulates in the acquired fat and promotes tumors, researchers said on Monday.
Women who became overweight or obese had 1.4 times the risk of breast cancer compared to women whose weight remained stable or declined, their study found.
"The present findings indicate that the relations of adult weight gain to breast cancer is evident throughout the entire adulthood life span rather than being limited to a specific time in life," Jiyoung Ahn of the U.S. National Cancer Institute wrote in the Archives of Internal Medicine.
"These findings may reinforce public health recommendations for the maintenance of a healthy weight throughout adulthood as a means of breast cancer prevention," Ahn wrote.
The nearly 100,000 women in the study reported their weights at age 18, 35, 50 and now. Of them, 2,111 developed breast cancer.
On average, women in the study gained more than 34 pounds during their adult lives, roughly evenly divided in the ages between 18 and 35, 35 and 50, and 50 and their current age, while 8 percent maintained their weight.
"Women who gained weight or were overweight or obese were more likely to develop advanced disease or hormone receptor-positive tumors," Ahn wrote.
The relationship between weight gain and breast cancer is complicated, researchers say, because the timing of estrogen exposure and levels of the hormone can be hard to pinpoint.
In this study, for instance, weight gain was less of a risk factor among women who began menstruating relatively early in life or who took hormone-replacement therapy during or after menopause — both of which acclimated their bodies to more estrogen.
Women in the study who lost weight during their adult lives did not have a lower risk of breast cancer, unlike indications of such an association reported in some earlier studies.
But the study did conclude that weight gain at any stage of adulthood increased breast cancer risk. Some earlier studies have suggested the riskiest time to put on weight was after menopause, when a woman's ovaries stop producing estrogen and fat cells become the primary source of the hormone.
It was unclear from the study whether modest weight gains increased the risk of breast cancer.
In the United States, there will be an estimated 178,000 new cases of breast cancer this year, with 40,000 deaths.
MORE WOMEN CHOOSING 'PREVENTATIVE DOUBLE MASTECTOMY'
Oct. 23 (HealthDay News) -- Women diagnosed with breast cancer who have a mastectomy are increasingly choosing to have their other, healthy breast removed as a preventive measure.
The rate of the procedure, called a contralateral prophylactic mastectomy, more than doubled from 1998 to 2003, according to a new study.
The increase concerns study lead author Dr. Todd Tuttle, chief of surgical oncology and associate professor of surgery at the University of Minnesota Medical School. He believes many women may be making the choice for inappropriate reasons, and removing the other breast may be unnecessary.
"We don't know why women are choosing this," he said. "If they are choosing it because they think it will improve their breast cancer survival, I am very concerned. It won't improve their overall survival."
Research has failed to show a survival benefit with the second mastectomy, Tuttle said in his report, published online Oct. 22 in the Journal of Clinical Oncology. The reason: The risk of cancer spread from the original breast to other body sites often exceeds the risk of getting cancer in the second breast, he said.
Tuttle and his colleagues evaluated 4,969 women who chose contralateral prophylactic mastectomy, looking at the Surveillance, Epidemiology and End Results (SEER) database. From 1998 to 2003, the rate of preventive mastectomy for the second, healthy breast increased from 4.2 percent to 11 percent. Those most likely to choose the preventive operation were younger women and non-Hispanic whites.
Tuttle said there are times when a second mastectomy is appropriate. "I will tell patients to consider it strongly if they have a known genetic mutation -- BRCA1 or 2 [the so-called breast cancer genes] -- or a very strong family history, such as first-degree relatives who develop breast cancer before age 50," he said.
"Sometimes, we will recommend it in those who need mastectomy on one side and because of body symmetry issues, the other breast would be too big" once the cancerous breast is removed, he added.
Tuttle's advice is in line with advice from the Society of Surgical Oncology and the American Cancer Society. Many women overestimate their risk of getting cancer in the second breast, according to the Society of Surgical Oncology.
In March, a study led by researchers at Wake Forest University found that most women diagnosed with breast cancer who also chose to have their unaffected breast removed said they didn't regret their decision. And they said their quality of life equaled that of women who chose not to have a preventive mastectomy, according to the study in the Journal of Clinical Oncology.
Dr. S. Eva Singletary, professor of surgical oncology at the University of Texas M.D. Anderson Cancer Center in Houston, said the increase in requests for the preventive mastectomies found in the new study "rings true clinically" for her patient population.
Singletary credits the increase in second mastectomies to "an improvement in breast reconstruction techniques," among other factors. Women who opt for immediate reconstruction after a mastectomy may be more likely to choose contralateral mastectomy and get the second breast reconstructed at the same time, sometimes to achieve better symmetry, particularly if they are heavy, she said.
In another study, published last week in the American Journal of Epidemiology, researchers reported that increased exposure to sunlight, which boosts vitamin D levels, may reduce the risk of advanced breast cancer in light-skinned women.
The study compared 1,788 breast cancer patients in San Francisco with a control group of 2,129 women who did not have breast cancer. The study participants had a wide range of natural skin colors. Vitamin D may help slow breast cancer cell growth, the researchers speculated. But the results aren't an endorsement to sunbathe. Instead, they said, vitamin D from diet and supplements may someday be recommended to help reduce breast cancer risk.
SOURCES: Todd Tuttle, M.D., chief of surgical oncology and associate professor of surgery, University of Minnesota Medical School, Minneapolis; S. Eva Singletary, M.D., professor of surgical oncology, University of Texas M.D. Anderson Cancer Center, Houston; Oct. 22 2007, Journal of Clinical Oncology, online; The Society of Surgical Oncology, Arlington Heights, Ill.; American Cancer Society, Atlanta
Publish Date: October 23, 2007
NEW CHEMOTHERAPY DRUG GETS APPROVAL FOR BREAST CANCER
Oct. 18 (HealthDay News) -- A new chemotherapy drug called Ixempra has received U.S. Food and Drug Administration approval to treat women with advanced breast cancer who haven't responded to three other types of chemotherapy.
The drug, made by Bristol-Myers Squibb Co., was also approved for use with the chemotherapy drug capecitabine (brand name Xeloda) for treatment of women with breast cancer that's spread to other parts of the body, the Wall Street Journal reported.
Ixempra was granted priority review status by the FDA. This status, which cuts four months off the standard 10-month drug review time, is given to products that are considered to be an advance over existing therapies on the market.Ixempra, which belongs to a new class of drugs called epothilones, is designed to stop the growth of cancer cells. It does this by targeting a protein called tubulin that helps cells proliferate, the Wall Street Journal reported.
Bristol-Myers also is studying the use of Ixempra to treat earlier-stage breast cancer, as well as ovarian, prostate, renal, pancreatic and non small cell lung cancers.
WOMEN'S HIPS INCREASE DAUGHTER'S RISK
Oct. 9 (HealthDay News) -- The size and shape of a woman's hips may affect her daughter's breast cancer risk, an international group of researchers report.
The study of 6,370 Finnish women found that breast cancer rates were nearly three times higher among those born to mothers with relatively wide hips, and nearly seven times higher among women born to mothers with wide hips who’d already given birth to one or more children.
A woman was more likely to develop breast cancer if her mother’s intercristal diameter (the widest distance between the wing-like structures at the top of the hip bone) was more than 30 centimeters (11.8 inches). The risk of breast cancer was also higher if these wing-like structures were rounded, the team said.Breast cancer risk was 2.5 times higher for daughters of women in whom the widest distance was more than three centimeters greater than the distance at the front, said the American, British and Finnish researchers.
DOCTORS DEBATE WHETHER TOXIC CHEMO IS BETTER THAN ALTERNATIVE
Oct 8, 2007
WASHINGTON – Breast cancer survivors may face increased risk of heart disease — and doctors are debating whether it is time largely to abandon a chemotherapy mainstay that is one reason.
Drugs called anthracyclines are a breast chemo staple despite a well-known risk: They weaken some women’s hearts. What is new is research that suggests the drugs work no better than safer alternatives for most women.It is a controversy born of success: Treatment advances are allowing more women than ever to beat breast cancer, and some 2.4 million survivors are alive in the United States today. Now a move is under way to determine just how many are vulnerable to heart disease because of their cancer battle and how to help those who are.
NEW BREAST CANCER TREATMENT CLOSER TO CLINICAL TRIAL
10/01/07
Science Daily — University of Manchester researchers have developed new ways of controlling and treating breast cancer.
Dr Robert Clarke and his team at the University's Cancer Studies research group have been investigating human breast cancers for the presence of stem cells - cells that generate new tumours and can cause the cancer to recur - in a series of studies funded by the charity Breast Cancer Campaign.
One third of women who are successfully treated for breast cancer find that the disease recurs some years later because some of these cancer cells survive the treatment and begin to grow again.The team's research into these 'breast cancer stem cells' revealed that the cells are stimulated by the Notch gene. The team, who published the study in Journal of the National Cancer Institute, is now hoping to develop new drug therapies to target this gene and thus stop the growth of any surviving breast cancer stem cells.
One drug that is known to attack Notch is already used for the treatment of Alzheimer's Disease so, having undergone health and safety checks, its clinical trial for use on breast cancer patients could be sped up and lead to a treatment in hospital clinics within a few years. Herceptin, by contrast, took more than 15 years to go from the discovery of its gene target to treatment.The team is also aiming to identify other new pathways of controlling breast cancer stem cells by using a genetic library to shut down other genes at random to see how it affects them, in a study with Rene Bernards at the Netherlands Cancer Institute.
The team, along with Professor Tony Whetton, are using a state-of-the-art mass-spectrometry based proteomics facility at the Paterson Institute of Cancer Research to identify proteins that control breast cancer stem cells. The facility - one of only a few in the UK - enables them to break up breast cancer stem cell proteins and analyse the sequence of amino acids to identify novel proteins that control the cells' growth.
Dr Clarke says: "Our work has revealed the importance of several pathways not previously known to regulate stem cell survival and self-renewal, which is tremendously exciting. Inhibitors of signalling pathways that regulate cancer stem cells could represent a new therapeutic modality in breast cancer, to be used in combination with current treatments in the near future."
This research is being presented at the National Cancer Research Institute conference in Birmingham October 1, 2007.
The University of Manchester team includes Professor Robert Clarke, Dr Gillian Farnie and Professor Nigel Bundred and Dr Keith Brennan.
WINE, BEER, SPIRITS BOOST BREAST CANCER RISK EQUALLY
Sept. 27 (HealthDay News) – Three or more drinks a day boosts a woman’s risk for breast cancer by 30 percent. And it doesn’t seem to matter which form of alcohol – wine, beer, or spirits – is consumed, researchers report.
“The majority of previous studies have found an association between alcohol and elevated breast cancer risk,” said lead researcher Dr. Yan Li, an oncologist at Kaiser Permanente in Oakland, Calif. What hasn’t been as clear, she said, is how much alcohol raises the risk and whether one type of alcohol boosts that risk more than another.
Li tackled those questions with Dr. Arthur Klatsky, an investigator at the Kaiser Permanente Division of Research in Oakland and a long-time researcher on the health benefits and risks of alcoholic beverages. Klatsky is due to present the team’s findings Sept. 27 at the European Cancer Conference in Barcelona, Spain.The researchers first evaluated the drinking habits of more than 70,000 women, all members of the Kaiser Permanente HMO. The women had undergone health exams during the years 1978 to 1985. By 2004, more than 2,800 women had experienced a breast cancer diagnosis.
Comparing the women’s drinking habits to the incidence of breast cancer, the team found that women who drank between one and two alcoholic drinks a day increased their risk of breast cancer by 10 percent compared to light drinkers – defined as those who drank less than one drink a day.
EDUCATION LINKED TO CANCER DEATHS
Sept. 13 (HealthDay News) -- If you have a college degree, you have up to a 76 percent reduced risk of dying from cancer, a new study found.
Higher education lowers the risk for black and white women and men, according to the report in the Sept. 11 online edition of the Journal of the National Cancer Institute.
"Cancer mortality varies a great deal for all cancers by individual level of education," said study co-author Elizabeth Ward, the American Cancer Society’s director of cancer surveillance. "If we could get everyone's cancer mortality to the level we see among the best educated, it would make a huge impact on cancer in the United States."
Education is tied to socioeconomic status and access to medical care, Ward noted. The new study finding makes it clear that many of the factors that influence cancer mortality are preventable, she said.
"They are preventable by social policies -- things we can change, such as smoking prevention, access to cancer screening and opportunities to good nutrition and physical activity," Ward said.In the study, Ward and her colleagues used data from death certificates and the U.S. Census Bureau to look at the associations between education level and death rates from lung, breast, prostate and colorectal cancer. The researchers collected data on 137,708 cancer deaths from 2001 involving black and white men and women between the ages of 25 and 64.
The researchers found that more education was associated with lower death rates from cancer among all race and gender groups. The greatest difference was found between people with 12 or fewer years of education and those with more than 12 years of schooling, Ward's team found.Compared with those with the lowest levels of education, those with the highest levels of education cut their risk of dying from cancer. For the highest educated white men, the risk was cut by 48 percent, for white women it was cut by 76 percent as it was for black men, and the most educated black women had a 43 percent lower risk of dying from cancer, the researchers reported.This difference in cancer deaths is most likely due to a relationship between education and other factors directly associated with risks of developing and dying from cancer, such as smoking, cancer screening, and access to health care, the researchers speculated.
Although cancer death rates were higher among blacks than whites with the same level of education, they were almost the same for black and white men with zero to eight years of education, the researchers said."The difference between blacks and whites is most certainly due to socioeconomic conditions and access to care," Ward said.
Sholom Wacholder, an epidemiologist with the National Cancer Institute and author of an accompanying editorial in the journal, thinks the study findings account for some -- but not all -- cancer disparity rates between blacks and whites.
"I asked myself if I could use this data to figure out the difference between blacks and whites in cancer mortality," said Wacholder. "And the answer is that it is probably not possible."
The problem is that there are too many unanswered questions, Wacholder said. "We can't answer the question whether additional education by itself is the explanation or whether people with access to education have lower cancer mortality beyond the effect of education," he said.
SOURCES: Elizabeth Ward, Ph.D., director, cancer surveillance, American Cancer Society, Atlanta; Sholom Wacholder, Ph.D., National Cancer Institute, Bethesda, Md.; Sept. 11, 2007, Journal of the National Cancer Institute, online
Publish Date: September 13, 2007
Study: MRI scans might prevent breast cancer progression
WASHINGTON (Reuters) -- MRI scans may offer a new way to detect breast cancer at its earliest stages, European researchers said Thursday.Details of a German study show that magnetic resonance imaging was better than standard mammograms, a type of X-ray, at detecting a nonmalignant tumor called ductal carcinoma in-situ, or DCIS. This could give surgeons time to remove the lesion before it can turn cancerous.
The findings, published in the Lancet medical journal, suggest that MRI should be tested in more women to see whether it should become a standard screening tool, said Dr. Carla Boetes and Dr. Ritse Mann of the Radboud University Nijmegen Medical Centre in the Netherlands. "Although these results were unexpected, the pathophysiology of breast cancer provides ample justification for the findings," they wrote in a commentary in Lancet.
Boetes and Mann noted that autopsy results show that about 9 percent of women have undetected DCIS, and that almost all malignant breast cancer is believed to start out as DCIS.
"MRI should thus no longer be regarded as an adjunct to mammography but as a distinct method to detect breast cancer at its earliest stage," they wrote.
Dr. Christiane Kuhl, a radiologist at the University of Bonn and colleagues studied 7,319 women over five years for their study, which was also presented in June to a meeting of the American Society of Clinical Oncology.
MRI found DCIS in more than 90 percent of the 167 women with the condition, while mammograms only found 56 percent of DCIS cases.
"MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade," Kuhl's team wrote.
Too soon to recommend
But Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society, said it is far too soon to use MRI routinely for breast cancer screening.
"The American Cancer Society recommends that MRI screening be done annually in addition to mammography starting at age 30 for women at high risk," Saslow said in a telephone interview.
"For the most part, these are women who have had either a genetic test or found a mutation (that puts them at high risk of developing breast cancer), there is a mutation in the family, or there is a strong enough family history that would lead you to think that the risk of having a mutation is pretty high," she added.
Women who already have had breast cancer have only a moderate risk of a recurrence and are not necessarily candidates for MRI, Saslow said. The reason is that MRI is expensive -- $1,000 to $1,500 per scan -- and has a high rate of false positives, meaning it detects lesions that are harmless.
"Sometimes doctors will think they see something. With MRI it is not clear-cut," Saslow said. "Some of those women are choosing to have mastectomies."
And having an MRI does not save women from undergoing the uncomfortable mammogram process, as MRIs are always done alongside mammograms, Saslow noted. "Mammography still finds things that an MRI doesn't," she said.
SHORTER COURSE OF RADIATION ACCEPTABLE FOR SOME BREAST CANCERS
Jun 3, 2007
By MARILYNN MARCHIONE, AP Medical WriterSun
Women with early-stage breast tumors can undergo a shorter course of radiation without a greater risk that their cancer will come back years later, the largest study to test this suggests.
The results are good news for women who must quit work or travel far to receive the five-week, daily treatments usually given."This is very disruptive to your life. If we could achieve the same outcome with less frequent visits to the radiation center ... this would be a tremendous benefit," said Dr. Julie Gralow of the Fred Hutchinson Cancer Center in Seattle.
Gralow was not involved in the study, but reviewed and discussed it at a meeting Sunday of the American Society of Clinical Oncology.
Most of the 180,000 breast cancers diagnosed each year in the United States are the type this study addressed — still confined to the breast. The usual treatment is surgery plus chemotherapy or hormone therapy, followed by radiation to prevent a recurrence.
Dr. John Dewar of the University of Dundee in Scotland led a two-part study of nearly 4,500 women in the United Kingdom to test shorter courses of radiation.
Women received either the standard 50 Grays, the unit used in measuring radiation, in 25 treatments spread over five weeks, or roughly 40 Grays given in 13 treatments every other day for five weeks or in 15 treatments over three weeks.
Five years later, cancer recurrence rates were low for all groups, ranging from 2 to 5 percent. So few recurrences occurred — 158 — that doctors believe the treatments are equivalent but cannot say so with certainty.
Many will want to see what happens to these women with longer follow up, said Dr. Gary Freedman of Fox Chase Cancer Center in Philadelphia. He is testing a shorter course, too, and noted that in the United States, most doctors give a total of 60 to 64 Grays — the standard 50 plus a boost dose directly to the tumor area.
Lisa Warren is a patient who received the shorter course in Freedman's study. Warren, 46, lives nearly an hour's drive from the cancer center and was eager when the short course was offered.
"I was all for that," she said. "Seven weeks is a long time to be running back and forth. Mentally and physically, it's very draining."Gralow, whose Seattle clinic sees many Alaskan women who must travel great distances for treatment, said she would consider the shorter treatment in such situations.
"This is very exciting news for our patients," because many women around the country live in rural areas or are elderly and must have someone drive them to get care, she said.
Shorter treatment had another benefit: less swelling or shrinkage of breast tissue and less enlargement of blood vessels as a side effect of radiation.
HERCEPTIN REDUCES NEED FOR MASTECTOMY
June 4, 2007 BBC NEWS
Using the cancer drug Herceptin before surgery could reduce the number of mastectomies needed in women with breast cancer, scientists say.
A study showed using the drug with chemotherapy before surgery completely eradicated tumours in 43% of patients with HER-2 positive breast cancer.
This was almost twice as many as for patients treated only with chemotherapy - 23% of these showed the same effect.
The findings were reported to the American Society for Clinical Oncology.
Herceptin is currently used after surgery in women with HER-2 positive breast cancer to prevent tumours returning.
About a quarter of the 44,000 breast cancer patients in the UK each year have HER-2 positive tumours, which are particularly aggressive and likely to return.
Normally women with large tumours are treated with chemotherapy to shrink the tumours so that operations can be performed with less risk of having to remove the whole breast.
In the new research scientists studied 228 patients with HER-2 positive breast cancer.
115 patients received chemotherapy plus Herceptin for one year, and 113 patients received chemotherapy alone, before surgery.
Taking Herceptin made the shrinking more likely, as well as eradicating the tumours completely in many cases.In 38% pf patients tumours which had spread to other parts of the body were also removed.
Professor Alex Markham, Cancer Research UK's senior medical advisor, said it was encouraging that the cancer was eradicated from the lymph nodes of some patients.
He said the results of the study were exciting, but he added that it had only included a relatively small number of patients.
Long-term survivalDr Andrew Wardley, consultant medical oncologist at Christie Hospital, Manchester, said the results added to the already substantial evidence supporting the use of Herceptin.He said: "This is very welcome news for patients with a particularly aggressive form of breast cancer, some of whom will no longer face the prospect of losing their breasts."
He added that treating cancer early with Herceptin to eradicate it could have important implications for long-term survival.
The research was carried out by cancer organisation Group SOLTI, and drug manufacturer Roche.
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