The Methodist Hospital, Houston, Cancer Tip Sheet

Thermal heat therapy for patients with recurrent brain tumors


Neuro-oncologists at The Methodist Hospital in Houston are studying a relatively new thermal therapy technology for patients with recurrent brain tumors. The investigational device uses heat therapy for recurrent metastatic tumors without damaging surrounding tissue. A laser acts like an electrode and delivers thermal therapy to the brain tumor to destroy it. With MRI guidance, physicians can see the tumor dissolve in real time.


Approximately 15 to 20 percent of cancer patients will be diagnosed with metastatic brain tumors during their lifetime. Whole brain radiotherapy (WBRT) has been the standard treatment for almost 50 years. However, average survival time for patients using WBRT is three to six months. A July 2008 study in the journal Neurosurgery reported this experimental therapy was well tolerated and effective with no tumor recurrence. The clinical study at Methodist plans to enroll 30 patients who cannot tolerate further radiation or chemotherapy or whose previous treatments failed.


Screening study evaluates markers in breast cancer patients


Breast oncologists at The Methodist Hospital in Houston are evaluating urine and tumor markers in breast cancer patients to determine whether these markers can be used to evaluate potential new therapies. The investigator-initiated study will look at 340 breast cancer patients to determine the levels of the urinary metabolite prostaglandin E (PGE-M) and COX-2 enzymes, which are responsible for inflammation and pain and tend to be more prevalent in a variety of tumors.


Methodist investigators hope this research will also identify possible ways to monitor the response to treatment, as well as lead to further exploration in earlier stages of breast cancer. Aside from non-melanoma skin cancer, breast cancer is the most common form of cancer in women. More than two million women living in the United States have been diagnosed with and treated for breast cancer.


First worldwide lung cancer vaccine study under way


Lung cancer (both small cell and non-small cell) is the second most common cancer in both men (after prostate cancer) and women (after breast cancer). Several lung cancer patients from The Methodist Hospital in Houston are taking part in a first-of-its-kind worldwide study that looks at the effectiveness of a cancer vaccine. The study will determine the benefit of periodic injections of this vaccine in treating patients with non-small cell lung cancer after surgical removal of the tumor. Earlier studies suggest that a series of vaccine doses, which target a cancer-specific antigen, led to a reduction in patients' risk of cancer recurrence. Methodist is one of more than 400 sites offering the study. Patients who qualify receive 13 injections over 27 months.


Methodist Hospital, Houston

6565 Fannin St.

Houston

TX 77030

United States

methodisthealth

Reduced Dose Anthracycline Pre Breast Cancer Surgery Has No Effect On Outcome

Canadian researchers have discovered that there is a low risk of adverse effect from reducing pre-op chemo by up to 25%, according to findings published in the online journal ecancermedicalscience.


The study, undertaken at the British Columbia Cancer Agency, Vancouver, found that women with early stage breast cancer treated with up to 4 courses of standard adjuvant anthracycline showed no relationship between dose intensity and clinical outcome, despite nearly a decade of follow-up.


Between 1990 and 1995, 484 patients were assessed in 4 groups: 1- all cycles delivered at full dose and on time; 2- one single dose reduction or dose delay; 3- >1 dose reduction or dose delay; and 4-

Ageist Healthcare Services Put Older Women At Greater Risk Of Breast Cancer, Says Help The Aged, UK

Reacting to a survey published in the British Journal of Cancer, which shows many older women are not aware that growing older can be a major risk factor for the disease, Kate Jopling, Head of Public Affairs for Help the Aged, says:


"All too often older people get a rough deal from our healthcare services and these worrying findings show breast cancer services are no exception. Women aged 70 and over aren't invited for regular screening checks - this sends entirely the wrong message to older women who are often unaware that they are at greater risk of breast cancer than others. This lack of awareness puts older women at risk.


"When it comes to breast cancer treatment, it's imperative that doctors and health professionals see the condition - rather than the age - of their patients. Age discrimination in healthcare services raises its ugly head all too often. When it comes to breast cancer, this is demonstrated not only in the lack of screening of older women but also in the treatment they ultimately receive.


"The Government has announced it intends to make age discrimination in health services illegal - this needs to happen without delay. Older people have been waiting too long for equal treatment and the example of breast cancer shows us that for the sake of their health alone we must act now."


Notes


1. The Help the Aged 'Just Equal Treatment' campaign called on the Government to make age discrimination illegal and extend the public sector equality duty - which currently requires local authorities to promote equality between people of different race, gender and disability status - to include age so older people's needs are taken into account in public services.


2. Help the Aged is the charity fighting to free disadvantaged older people in the UK and overseas from poverty, isolation, neglect and ageism. It campaigns to raise public awareness of the issues affecting older people and to bring about policy change. The Charity delivers a range of services: information and advice, home support and community living, including international development work. These are supported by its paid-for services and fundraising activities - which aim to increase funding in the future to respond to the growing unmet needs of disadvantaged older people. Help the Aged also funds vital research into the health issues and experiences of older people to improve the quality of later life.


3. Help the Aged urgently needs donations and support to help it in the increasingly challenging fight to free disadvantaged older people from poverty, isolation and neglect.

Help The Aged, UK

Imaging Diagnostic Systems Breast Scanner Performance Upgrade Program Nearing Completion

Imaging
Diagnostic Systems, Inc., (OTC Bulletin Board: IMDS) a pioneer in laser
optical breast imaging systems, announced today that the majority of
international CTLM(R) systems have been upgraded to the 4.1 Performance
Package level, which includes several significant enhancements.


According to Tim Hansen, Imaging Diagnostic Systems' Chief Executive
Officer, "When we launched our US FDA Premarket Approval data collection
study, we announced that many improvements had been made to the CTLM system
since the prior study in 2001. We wanted our global users to share in these
improvements as well; recent shipments from our factory have routinely
included the 4.1 Package. Our plan has always been to upgrade the installed
CTLM base as well." Continued Hansen, "We are now nearing completion of
that field upgrade program, done entirely at IMDS expense, to ensure
continued customer satisfaction and excellent CTLM system performance. The
remaining upgrade sites include China and sites pending final installation.
This upgrade to the highest performance level has been a major
accomplishment for our organization and a source of great satisfaction for
our users."



The 4.1 Package enhancements include: new scan control software to
reduce scan time from 12 to 9 minutes, increasing patient throughput by 25%
while adding to patient comfort and reducing patient movement artifacts;
CTLM self- diagnostic background software to monitor for potential faults
and to log quality-assurance data for service purposes; improved software
to simplify daily calibration routines; customer-driven changes to the
image presentation displays to allow faster, more flexible viewing; and,
specifically for the international installed base, operator interface
software that enables simplified translation into non-English languages.



"Our users are very pleased with the enhancements and with the support
they have received from IMDS, and our distributors are similarly pleased
that we have provided the resources to complete the upgrades and training.
Some users, who had worried about technologically 'falling behind' the US
PMA sites, are now quite content. We want them to be thrilled not only with
the new optical molecular imaging capabilities but also with our support of
their work," added Tim Hansen. "We are making steady progress in our US PMA
study with these newer systems, and now we have a solid updated installed
global base."



About Imaging Diagnostic Systems, Inc.



Imaging Diagnostic Systems, Inc. has developed a revolutionary new
imaging device to aid in the detection and management of breast cancer. The
CTLM(R) system is a breast imaging system that utilizes patented continuous
wave laser technology and computer algorithms to create 3-D images of the
breast. The procedure is non-invasive, painless, and does not expose the
patient to ionizing radiation or painful breast compression. CT Laser
Mammography (CTLM(R)) is designed to be used in conjunction with
mammography. It reveals information about blood distribution in the breast
and may visualize the process of angiogenesis, which usually accompanies
tumor growth.
















Imaging Diagnostic Systems is currently collecting data from clinical sites for the future filing of an FDA Premarket Approval (PMA) for the Computed Tomography Laser Mammography (CTLM(R)) system to be used as an adjunct to mammography. The FDA has determined that the Company's clinical study is a non-significant risk (NSR) investigational device study under
812.3(m) of the investigational device exemptions (IDE) regulation (21 CFR
812). The CTLM system is limited by United States Federal Law to
investigational use only in the United States. The CTLM system has received
other registrations including CE, CMDCAS Canadian License, China SFDA, UL,
ISO 9001:2000, ISO 13485:2003 and FDA export certification.



For more information, visit our website: imds



As contemplated by the provisions of the Safe Harbor section of the
Private Securities Litigation Reform Act of 1995, this news release may
contain forward-looking statements pertaining to future, anticipated, or
projected plans, performances and developments, as well as other statements
relating to future operations. All such forward-looking statements are
necessarily only estimates or predictions of future results or events and
there can be no assurance that actual results or events will not materially
differ from expectations. Further information on potential factors that
could affect Imaging Diagnostic Systems, Inc., is included in the Company's
filings with the Securities and Exchange Commission. We expressly disclaim
any intent or obligation to update any forward-looking statements.


Imaging Diagnostic Systems

imds

Preventive Surgeries Linked To Lower Risk Of Breast And Ovarian Cancer

Women with the inherited mutations of the BRCA1 or BRCA2 genes who had preventive (prophylactic) breast removal (mastectomy) or the removal of the fallopian tubes and ovaries (salpingo-oophorectomy) were found to have a significantly lower risk of developing ovarian and breast cancers, says a study published in JAMA (Journal of the American Medical Association), September 1st issue.


The authors wrote that females who carry the inherited mutations of the BRCA1 or BRCA2 genes have a considerably higher chance of developing breast or ovarian cancer - there is a 56% lifetime risk of breast cancer and 84% lifetime risk of ovarian cancer.


The authors added:


Women who are mutation carriers have cancer risk-management options that include risk-reducing salpingo-oophorectomy, risk-reducing mastectomy, annual cancer screening, and chemoprevention.


Susan M. Domchek, M.D., of the University of Pennsylvania School of Medicine, Philadelphia, and team carried out a study involving 2,482 women who had the BRCA 1 and BRCA 2 mutations to find out what their cancer risk reduction was following a prophylactic salpingo-oophorectomy and mastectomy, incorporating mutation type (BRCA1 vs. BRCA2), and cancer history (prior history of breast cancer vs. none). The women's gene mutations were determined between 1974 and 2008.


The study was performed at 22 clinical and research genetics centers in North America and Europe. The participants were monitored through to the end of 2009.


Breast Cancer Risk: The investigators found that:

None of the women with the mutated genes who had a prophylactic mastectomy developed cancer during the 3-year follow-up period.
7% of the women with the mutated genes who did not have a prophylactic mastectomy developed cancer during the 3-year follow-up period.

Ovarian Cancer Risk: The investigators found that:

Risk-reducing salpingo-oophorectomy was associated with a decreased risk of ovarian cancer, with no ovarian cancer events seen during the 6 years of prospective follow-up in BRCA2 mutation carriers without prior breast cancer who underwent the procedure.
Three percent of women without salpingo-oophorectomy over a similar follow-up period were diagnosed with ovarian cancer.

The researchers found no cases of ovarian cancer among women with the BRCA 1 mutation after salpingo-oophorectomy, which was also linked to a lower risk of breast cancer in BRCA1 and BRCA2 mutation carriers without prior diagnosis of breast cancer.


The authors wrote:


Compared with women who did not undergo risk-reducing salpingo-oophorectomy, undergoing salpingo-oophorectomy was associated with lower all-cause mortality (10 percent vs. 3 percent), breast cancer-specific mortality (6 percent vs. 2 percent), and ovarian cancer-specific mortality (3 percent vs. 0.4 percent).





"Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and Mortality"

Susan M. Domchek, MD; Tara M. Friebel, MPH; Christian F. Singer, MD, MPH; D. Gareth Evans, MD; Henry T. Lynch, MD; Claudine Isaacs, MD; Judy E. Garber, MD, MPH; Susan L. Neuhausen, PhD; Ellen Matloff, MS; Rosalind Eeles, PhD; Gabriella Pichert, MD; Laura Van t'veer, PhD; Nadine Tung, MD; Jeffrey N. Weitzel, MD; Fergus J. Couch, PhD; Wendy S. Rubinstein, MD, PhD; Patricia A. Ganz, MD; Mary B. Daly, MD, PhD; Olufunmilayo I. Olopade, MD; Gail Tomlinson, MD, PhD; Joellen Schildkraut, PhD; Joanne L. Blum, MD, PhD; Timothy R. Rebbeck, PhD

JAMA. 2010;304(9):967-975. doi:10.1001/jama.2010.1237


Written by

Smoking Increased Risk Of Death In Women With Breast Cancer

Being a current smoker or having a history of smoking significantly increased the risk of breast cancer progression and overall death among a group of multiethnic women with breast cancer, according to the results of a large prospective cohort study.



"We found that women who are current smokers or have history of smoking had a 39 percent higher rate of dying from breast cancer, even after we took into account a wide array of known prognostic factors including clinical, socioeconomic and behavioral factors," said Dejana Braithwaite, Ph.D, assistant professor, division of cancer epidemiology, department of epidemiology and biostatistics at the University of California, San Francisco.



Researchers presented these results at the Ninth Annual AACR Frontiers in Cancer Prevention Research Conference, held Nov. 7-10, 2010.



Although smoking is associated with lung cancer and implicated in several other cancers, it is unclear what effect smoking has on breast cancer, according to Braithwaite.



"Specifically, it is unclear how long women live following breast cancer diagnosis and whether smoking increases the risk of death because of breast cancer progression or whether there is an association between smoking and life expectancy following breast cancer diagnosis that works through affecting non-breast cancer causes of death," she said.



Therefore, Braithwaite and colleagues set out to examine the relationship between smoking and the risk of death due to breast cancer progression or non-breast cancer causes of death in a large group of women.



They enrolled 2,265 multi-ethnic women diagnosed with breast cancer between 1997 and 2000. The women were followed for an average of nine years. Researchers examined whether smoking affected death from breast cancer, non-breast cancer related causes and death from all causes.



Results showed that 164 deaths from breast cancer and 120 deaths from non-breast cancer causes occurred during follow-up.



Those women who had a history of smoking or who were current smokers also had a twofold increased risk for dying from non-breast cancer related causes compared with women with breast cancer who had never smoked.



An analysis was also conducted to examine whether body mass index, molecular breast cancer subtype or menopausal status modified risk. Women who were current or past smokers and also had a HER2-negative tumor subtype had a 61 percent increased risk for breast cancer death compared with those who never smoked. Smokers with a body mass index less than 25 kg/m2 had an 83 percent increased risk for breast cancer death, and postmenopausal women had a 47 percent increased risk for breast cancer death compared with those who never smoked.



"The implication of this research is that it is important for physicians to improve smoking cessation efforts, especially among women newly diagnosed with breast cancer, in order to improve breast cancer specific outcomes and overall health outcomes," Braithwaite said.



Source:

Jeremy Moore

American Association for Cancer Research

Distinguishing Breast Cancer-Causing Mutations From Those That Are Harmless

Women with mutations in either their BRCA1 or BRCA2 genes have a dramatically increased risk of developing breast or ovarian cancer. Identifying such women provides them with an opportunity to take preventive measures such as surgery to remove their breasts. One caveat to identifying such women by simply sequencing their BRCA1 and BRCA2 genes and detecting mutations is that not all mutations are harmful. However, Shyam Sharan and colleagues, at the National Cancer Institute at Frederick, have now developed an assay to distinguish harmful BRCA1 mutations from those that are not. As discussed by the authors and, in an accompanying commentary, Roger Greenberg, this assay has immense clinical potential to identify those patients that might benefit from treatments to prevent breast cancer.



TITLE: Expression of human BRCA1 variants in mouse ES cells allows functional analysis of BRCA1 mutations



AUTHOR CONTACT:

Shyam K. Sharan

National Cancer Institute at Frederick, Frederick, Maryland, USA.


View the PDF of this article at: https://the-jci/article.php?id=39836



ACCOMPANYING COMMENTARY

TITLE: Breast cancer gene variants: separating the harmful from the harmless



AUTHOR CONTACT:

Roger A. Greenberg

University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.


View the PDF of this article at: https://the-jci/article.php?id=40577




Journal of Clinical Investigation, Sept. 21, 2009



Source:
Karen Honey


Journal of Clinical Investigation

New Perspectives On Health Disparities In Breast Cancer Research

Breast cancer is a disease with a number of known genetic and behavioral risk factors, but scientists have seen that these risks are often compounded by social and racial inequalities. The question remains: how, exactly, do social disadvantages, genetics, race and culture add to the disparities faced by so many groups of women?


These are among the questions in breast cancer research that scientists are addressing this week at the American Association for Cancer Research conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, being held November 27-30 in Atlanta.


Today researchers present findings on how poverty can affect cancer prognosis, how ethnicity affects medical care and how genetics can affect the survival of different groups of women.


Racial disparities in early breast cancer outcomes in a mammographic screened population, Abstract no. A-45:


In a retrospective study of women with stage I or II invasive breast cancer, researchers at the University of Chicago have evidence that race-specific biology may contribute to the health disparity faced by African-American women. At eight years following a breast-conserving lumpectomy and radiotherapy, 78.1 percent of African-American women were free of disease versus 84.9 percent of non-black women of various ethnic groups. The researchers believe their data suggest that modification of the current screening mammography guidelines for breast cancer may benefit African Americans.


"All other things being equal, including age, the presence of co-morbid disease, socioeconomic status, weight, and tumor size, African-American women in our sample were at a disadvantage for disease-free survival of breast cancer," said Michael A. Nichols, M.D., Ph.D., a resident in the Department of Radiation Oncology at the University of Chicago.


According to Nichols, their study offers reasons to reassess how African-American women are screened and treated for breast cancer. "Our data suggests that although screening mammograms detect tumors of similar size, it appears that the advantage gained by early detection is relatively less in African-American women," Nichols said. "This study merits further evaluation of whether African-American women would benefit from either more frequent mammograms or the use of more sensitive screening methods, such as MRI."


The University of Chicago study began in 1986 and, in the ensuing decades, encompassed 1,246 women, aged 40 and above, treated at University of Chicago Hospitals and affiliates. The women enrolled had either stage I or II cancer, and they were all treated by lumpectomy and radiotherapy. About one third of participants were African-American, and they were more likely to present with large tumors and cancer that was detectable in the lymph nodes. The researchers determined socioeconomic status by patient's zip code and co-morbid diseases by patient report. Patients voluntarily defined their own ethnic status.















Nichols and his colleagues compared the African-American women to all other women enrolled in the study. When the researchers accounted for poverty and co-morbidity -- diseases such as hypertension, chronic pulmonary obstructive disease, coronary artery disease and diabetes -- race remained an independent trait that indicated poor prognosis for women with breast tumors detected through mammogram. Nichols cautioned that although the study controlled for many known prognostic indicators, it did not account for all. "Our study did not include important known contributors including the status of the Her2 gene or detailed information regarding hormonal therapy," Nichols said.


Overall survival was worse for African-American women (78.1 percent versus 84.9 percent). In addition, disease-free survival, that is, survival without relapse eight years after treatment was also worse for African-American women 31.6 percent of African-American women experienced relapse versus 14.9 percent of all other women.


"If early breast cancer is more aggressive in African-American women, they may benefit from earlier detection than is previously obtained by yearly screening mammograms," Nichols said. "These results should offer hope to the healthcare community, because improved, more vigilant, screening may offer a simple way to improve outcomes for African-American women with early breast cancer."


Physician perspectives on surgical treatment disparities among Asian women with early stage breast cancer, Abstract no. A-54:


According to the oncologists who treat them, Asian women with early stage breast cancer are influenced by cultural factors when they decide to choose mastectomy over breast-conserving lumpectomy, even though a lumpectomy might offer a better quality of life, say researchers at the Northern California Cancer Center (NCCC), located in Fremont, California.


An Asian patient's attitude that the breast doesn't need to be preserved primarily because of the culture's reduced emphasis on the breast and breast appearance is an important consideration that leads many Asian women to choose a mastectomy, said a majority of physicians who participated in the investigators' survey.


Other reasons cited by physicians are that Asian women may choose a mastectomy because breast size in this population is smaller to begin with, so there is less breast to preserve, as well as factors such as age and unwillingness to travel for chemotherapy and radiation treatments which often are necessary following a lumpectomy.


Reasons for why Asian women choose mastectomy are important, say the NCCC team, because in order for a breast cancer patient to make the best clinical decision, she must be thoroughly educated on the benefits of each procedure. "For patients with early stage breast cancer where there are no clear clinical contraindications to breast-conserving treatment, a lumpectomy is less invasive than a mastectomy and it offers the same survival and potentially improved quality of life," said Jane T. Pham, an epidemiologist at NCCC and doctoral candidate in epidemiology at University of California, Davis.


In earlier research, the investigators found that a statistically significant greater number of Asian women (67.5 percent) choose to have a mastectomy over lumpectomy compared to Caucasian women (57.3 percent). And while the use of mastectomy has fallen among most populations over the past decade, it has not fallen as fast among Asian women, Pham says.


Under the direction of lead investigator Scarlett Lin Gomez, Ph.D., research scientist at NCCC and associate director of the Greater Bay Area Cancer Registry,
Pham and her colleagues surveyed 80 physicians in the region who treat Chinese, Vietnamese and Filipina breast cancer patients. The survey asked physicians why they felt Asian women were choosing mastectomy significantly more often than other women.


While 74 percent of physicians surveyed said that consideration of cosmetic result is usually important to women treated with lumpectomy, most of the physicians felt cultural factors, such as a reduced emphasis on breast preservation, are the primary reasons for the higher rate of mastectomies among Asian women. Physicians also listed fear, both of reoccurrence and of radiation and chemotherapy, as another contributing factor.


All of these findings need to be probed further with Asian patients themselves, and this study is currently ongoing, Pham says. Funding for these continuing studies was provided by grants through the California Department of Health Services, National Cancer Institute and Centers for Disease Control and Prevention.


"Is it really a reduced significance of the breast when making treatment decisions, or is it fear about adverse outcomes?" Pham asked. "Although many of these cultural factors require additional research, awareness of these factors can allow physicians to directly address Asian patient concerns that may be influenced by culture, and fully inform the patient of their treatment options."


Obesity and risk for relapse of breast cancer in women of low socioeconomic status, Abstract no. A-34:


In one of the largest racially diverse studies of low income women, researchers found that women who are overweight or obese at the time they are diagnosed with breast cancer are at an increased risk of relapse.


Investigators from the Feist-Weiller Cancer Center at Louisiana State Health Science Center found that for each point gain of body mass index (BMI), the risk of cancer recurrence increased by four percent. For example, a breast cancer patient with a BMI of 30 had a 20 percent greater risk of relapse than a patient with a BMI below 25. (A BMI of 25-30 is considered overweight, and a BMI of 30 or greater is classified as obese.)


Not only was this risk evident in postmenopausal women, the researchers say, but the risk was present in premenopausal women, too. "We find that obesity, which is associated with poverty, is a significant factor in whether cancer recurs," said Amanda Sun, M.D., Ph.D., the study's lead investigator and oncologist at the Feist-Weiller Cancer Center. "The good news is weight is potentially a controllable risk factor


The research team examined medical records for 349 women diagnosed with breast cancer from 1990 to 2004. Forty-five percent of participants were African-American, and the rest were Caucasian, making the study one of the largest with a high proportion of African-American breast cancer patients, Sun says. In this group, 25 percent lived in counties with high poverty rates; 20 percent of the patients received free health care; and 25 percent were enrolled in Medicaid.


"Poverty is an important marker for limited access to healthcare, late stage disease, and worse outcomes, and the fact is that poor adults are more likely to be obese," said Dolly Quispe, M.D., hematology-oncology fellow at the Feist-Weiller Cancer Center "The goal here is to determine if there is a correlation of obesity and poverty with breast cancer recurrence, and to quantify it."


African-American patients in this study were 62 percent more likely to have limited economic means, 88 percent more likely to be overweight and obese, and 46 percent more likely to be pre-menopausal, the researchers found.


Breast cancer recurred in 69 patients, and after investigators adjusted for body weight, race, menopausal status, age at diagnosis and cancer stage, BMI at diagnosis remained a statistically significant predictor of cancer recurrence. According to Quispe, low social economic status was a marginally significant predictor of relapse after adjusting for other factors. "We can see the relationship between poverty, obesity, and cancer recurrence in this study," Quispe said


Also of note is the finding of a high rate of cancer relapse in younger patients, says Sun, "Many studies have found that obesity in postmenopausal women is a risk factor for breast cancer development, but those few that correlate excess body weight and cancer in premenopausal women have been mixed," Sun said.


The researchers say this kind of study was possible at the Feist-Weiller Cancer Center because that health center provides medical care to a significant portion of poor patients in Louisiana, a state with a poverty rate of 20 percent.


"This is a snapshot of breast cancer incidence in people without insurance," Quispe said. "It tells us that interventions targeting weight control could potentially improve outcomes in breast cancer."


The study was funded by the Feist-Weiller Cancer Center at LSU Health Sciences Center.


Disparities in receipt of lymph node assessment among early stage female breast cancer patients, Abstract no. A-65:


Examining nearby lymph nodes while a woman is undergoing surgery for early stage breast cancer is a recommended practice to determine whether the cancer has spread, although there are valid clinical reasons to omit this procedure. However, researchers at the American Cancer Society (ACS) have found that 11 percent of almost 200,000 patients in a national sample of individuals with cancer did not undergo the procedure, and these women were significantly more likely to be elderly or African-American, have no health insurance or live in an area whose residents have a low level of education.


The findings are concerning because they suggest clinical factors may not be the primary basis for decisions on breast cancer care for some disadvantaged patients, as they should be, researchers say.


"We found that significant disparities exist in who received axillary lymph node assessment, and without this procedure, an oncologist cannot appropriately stage a woman's cancer and determine optimal therapy," said Michael Halpern, M.D., Ph.D., strategic director of Health Services Research for the ACS.


Investigators specifically found that women without insurance were 24 percent less likely to receive the lymph node assessment compared to those with private insurance. Women who lived in areas with low levels of education were 13 percent less likely than those from high education areas, and African-American patients were 10 percent less likely to have the procedure than white patients.


They also found that age was a "huge" factor in who received a lymph node assessment: women age 73 or older were three times less likely to receive the procedure than were patients age 51 or younger, researchers said.


Standard practice guidelines for axillary node dissection during lumpectomy or mastectomy surgery specify when this procedure can be considered optional, such as for elderly patients, patients with other serious illnesses, or patients for whom lymph node results wouldn't affect choice of therapy.


"Ideally, factors such as race and insurance status shouldn't play any role in who receives this procedure, yet that is what we found. And while age is an important factor in deciding whether or not to perform lymph node assessments, we certainly didn't expect a three-fold difference," Halpern said.


Other studies have indicated that disparities in care may result from three different sources: structural barriers (such as health insurance or type of hospital), physician/clinical factors, and patient factors. "All three of these may be important in the disparities we observed for axillary node dissection," Halpern said.


"These disparities could result from differences in sites of care or practice patterns among healthcare providers that predominantly treat poor or uninsured women, or could reflect appropriate application of clinical guidelines in some cases," Halpern said. "We can't be sure why these disparities occur, because we just don't know how those decisions are being made at the patient and physician levels."


To conduct the study, researchers examined data from 196,732 patients who had surgery to treat early stage breast cancer from 2003-2005 from the National Cancer Database, a hospital-based registry sponsored by the ACS and the American College of Surgeons. All of these hospitals had cancer programs accredited by the Commission on Cancer; approximately 70 percent of cancer patients nationwide are treated at these hospitals.


"We need to find out why these disparities exist and what to do to make sure that everyone is getting excellent cancer care," Halpern said.


The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes nearly 26,000 basic, translational, and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 70 other countries. AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special Conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment, and patient care. AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. Its most recent publication, CR, is a magazine for cancer survivors, patient advocates, their families, physicians, and scientists. It provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship, and advocacy.


American Association for Cancer Research (AACR)

615 Chestnut Street, 17th Floor

Philadelphia, PA 19106

United States

aacr

Treating Bone Loss In Breast Cancer Survivors

Osteoporosis is a growing concern among breast cancer survivors and their doctors, because certain cancer drugs can cause bone loss.


Many breast cancer patients also experience secondary causes of bone loss, such as vitamin D deficiency.


But a Loyola University Health System study has found that bone loss can be halted with a comprehensive regimen that includes both osteoporosis drugs and treatments that target secondary causes of bone loss.


The study by Dr. Pauline Camacho and colleagues was presented at the annual meeting of the American Society for Bone and Mineral Research.


"Doctors evaluating breast cancer patients for possible bone loss should look further than cancer drugs," Camacho said.



Primary causes of osteoporosis are menopause and aging. Secondary causes are diseases or conditions that exacerbate bone loss.


A class of breast cancer drugs called aromatase inhibitors can decrease bone mineral density and increase the risk of fractures in postmenopausal women. The drugs decrease the body's production of estrogen. While estrogen feeds cancer, the hormone also protects against osteoporosis. In certain breast cancer patients, bone loss from cancer drugs can be treated with osteoporosis drugs called bisphosphonates, such as alendronate sodium (Fosamax®) and ibandronate sodium (Boniva®).


Camacho and colleagues reviewed charts of 81 consecutive breast cancer patients who were referred to Loyola's Osteoporosis and Metabolic Bone Disease Center for treatment or prevention of osteoporosis. Fifty-one patients had secondary causes of bone loss, including Vitamin D deficiency (65 percent), excessive calcium excretion in urine (16 percent) and an overactive parathyroid gland (13 percent). Thirty patients did not have secondary causes of bone loss.


Each group received similar treatment with osteoporosis drugs. Women with secondary bone loss also received additional treatments. For example, vitamin D deficiency was treated with prescription doses of vitamin D supplements. Excessive calcium excretion was treated with a "water pill" that's also used to treat high blood pressure. There were various treatments for parathyroid gland disorder, depending on the cause.


After one year, the breast cancer patients with secondary causes of bone loss had stable bone mineral density in their spines and necks. Bone mineral density improved in the group of breast cancer patients who did not have secondary causes of bone loss. (Bone mineral density -- the amount of calcium and other minerals packed into a segment of bone -- predicts osteoporosis.)


Camacho said the study demonstrates that bone loss "can be prevented in women undergoing hormonal therapy if secondary causes of bone loss are corrected and bisphosphonate osteoporosis drugs are appropriately used." Camacho is an associate professor of medicine at Loyola University Chicago Stritch School of Medicine and director of Loyola's Osteoporosis and Metabolic Bone Disease Center.


Camacho's co-authors are Dr. Kathy Albain, Dr. Patricia Robinson and Stritch medical student Naseem Helo. Albain is a professor and Robinson is an assistant professor at Stritch. Both are in the department of medicine, division of hematology/oncology.


Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 25 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 570-licensed bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Health & Fitness. Loyola's Gottlieb campus in Melrose Park includes the 250-bed community hospital, the Gottlieb Center for Fitness Center and the Marjorie G. Weinberg Cancer Care Center.


Source
Loyola University Health System


View drug information on Boniva; Fosamax.

Breast Cancer Intervention Reduces Depression, Inflammation

A psychological intervention for newly diagnosed breast cancer patients with symptoms of depression not only relieves patients' depression but also lowers indicators of inflammation in the blood.



Those are the findings of a new study by researchers at the Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (OSUCCC-James) and the Ohio State University Department of Psychology involving patients with stage II or III breast cancer.



Patients who received a psychological therapy that reduced stress and enhanced their ability to cope experienced significant relief of depressive symptoms. Moreover, that improvement was followed by a reduction in markers of inflammation.



"Previously, we knew that inflammation was associated with depression-like symptoms among cancer patients, and that both are problematic, but we did not know whether treating depression would affect inflammation," says co-author Barbara L. Andersen, professor of psychology and an OSUCCC-James researcher.



"Inflammation is considered to be a cancer promoting factor, and both depression and inflammation predict increased risk of cancer death."



Patients in the control group received only health and psychological assessments of their condition over the 12-month study period and showed no improvement in depression or inflammation indicators.



The findings are published online in the journal Psychosomatic Medicine.



"This study shows that by helping breast cancer patients with depression, they will also experience less inflammation," says study leader Dr. William E. Carson, III, professor in the division of surgical oncology and associate director for clinical research at the OSUCCC-James.



First author Lisa Thornton, a post-doctoral researcher in the Department of Psychology, noted that 25 to 30 percent of cancer patients experience significant symptoms of depression. "Our findings underscore the importance of including psychological interventions in the comprehensive care of cancer patients who experience significant distress," Thornton says.



The study's patients were participating in a larger clinical trial testing the effects of the same intervention on disease endpoints. Previously published findings showed that the intervention reduced the risk of breast cancer recurrence and death.



This follow-up study examined records from 45 patients who entered the trial with clinically significant symptoms of depression.



Twenty-three of the patients had been randomized to receive the psychological intervention plus the assessment. The remaining 22 patients received only the assessment, which consisted of a personal interview and questionnaires that evaluated mood, fatigue, health status and the influence of pain on quality of life. Blood samples were taken to assess inflammation levels, which were determined using counts of overall white blood cells and neutrophils, and the ratio of two categories of immune cells.



All patients were assessed upon starting the trial, then at four, eight and 12 months.



For the intervention, groups of eight to 12 patients and two psychologists met weekly for four months and monthly for eight months.



By the study's end, patients receiving the intervention showed significant declines in symptoms of depression, fatigue, and pain and in the markers of inflammation.



"Significant anxiety or depressive disorder symptoms are usually not recognized and might even be trivialized as a 'normal' response to cancer. However, those with clinical depression need treatment, as symptoms may not remit or even when they do, it can take months," Andersen says.



Funding from the American Cancer Society, a Longaberger Company-American Cancer Society Grant, a U.S. Army Medical Research Acquisition Activity Grant, the National Institute for Mental Health, and the National Cancer Institute supported this research.



Source:
Darrell E. Ward


Ohio State University Medical Center

Roche Files Herceptin Plus Hormonal Therapy For Advanced HER2-positive Breast Cancer With European Authorities

Roche announced today the submission of a Marketing Authorisation to the European Medicines Agency (EMEA) for Herceptin (trastuzumab) as treatment for advanced HER2-positive and hormone receptor-positive breast cancer. The application is based on data from the international TAnDEM study which showed that the addition of Herceptin to hormonal therapy doubles the median progression-free survival (amount of time a patient's cancer is kept under control), from 2. 4 months to 4.8 months.1


HER2-positive breast cancer, which affects 20 to 30 percent of women with breast cancer, is an aggressive form of the disease that requires special and immediate attention because the tumours are fast-growing and there is a higher likelihood of relapse.2 Up to a half of HER2-positive breast cancers are also hormone receptor-positive, a form of the disease that has typically been considered 'lower-risk,' due to successful treatment with hormonal therapies.3 However, TAnDEM is the first randomised study to show that this specific subset of 'co-positive' patients (both HER2- and hormone receptor positive) is actually 'higher-risk', making the positive results with Herceptin even more meaningful.


"The results from the TAnDEM study show once again that Herceptin should be the backbone for all HER2-positive breast cancer patients - it consistently benefits patients regardless of whether it is given in the early- or advanced-stage settings, or whether it is in combination with chemotherapy, hormonal therapy, or as a single agent," said Eduard Holdener, Global Head of Roche Pharma Development. "This combination offers a new treatment regimen for patients who suffer from a particularly aggressive form of breast cancer, and we are pleased to have been able to progress this application so quickly."


About the study


TAnDEM, conducted by Roche, is a randomised, phase III trial, which evaluated Herceptin in combination with the hormonal therapy anastrozole versus anastrozole alone as first-line therapy (or second-line hormonal therapy) in postmenopausal women with advanced (metastatic), HER2-positive and hormone receptor-positive (ER-positive and/or PR-positive) breast cancer. Enrolment to the trial began in 2001, and 208 HER2 and hormone receptor co-positive patients were randomized at 77 centres in 22 countries across the world.


Median progression-free survival, the primary endpoint of the trial, was 4.8 months for patients who received the combination compared to 2.4 months for patients who received hormonal therapy alone (p = 0.0016). Patients in the combination arm also responded significantly better to treatment (overall response rate was 20.3% versus 6.8%; p = 0.018). There was also a positive trend in median overall survival (28.5 months versus 23.9 months; p = 0.325); this is despite the fact that in the hormonal therapy alone arm, more than half of patients (58/104) crossed over to receive Herceptin during the trial when their disease had progressed, and an additional 15 (out of 104) patients received Herceptin at a later time point.















Overall safety data in both arms of the trial were acceptable given the known safety profile of each of the drugs in the advanced breast cancer setting. Patients in this study will continue to be followed for any side-effects.


About breast cancer and Herceptin


Eight to nine percent of women will develop breast cancer during their lifetime, making it one of the most common types of cancer in women.4 Each year more than one million new cases of breast cancer are diagnosed worldwide, with a death rate of nearly 400,000 people per year.


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.' High levels of HER2 are present in a particularly aggressive form of the disease which responds poorly to chemotherapy. Research shows that HER2-positivity affects approximately 20-30 percent of women with breast cancer.


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. It has demonstrated efficacy in treating both early and advanced (metastatic) 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 HER2-positive breast cancer in 2006. In the advanced setting, Herceptin is now 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. In the early setting, Herceptin is approved for use following standard (adjuvant) chemotherapy. Herceptin is marketed in the United States by Genentech, in Japan by Chugai and internationally by Roche.


To date, over 310,000 patients with HER2-positive breast cancer have been treated with Herceptin worldwide.


About Roche


Headquartered in Basel, Switzerland, Roche is one of the world's leading research-focused healthcare groups in the fields of pharmaceuticals and diagnostics. As a supplier of innovative products and services for the early detection, prevention, diagnosis and treatment of disease, the Group contributes on a broad range of fronts to improving people's health and quality of life. Roche is a world leader in diagnostics, the leading supplier of medicines for cancer and transplantation and a market leader in virology. In 2005 sales by the Pharmaceuticals Division totalled 27.3 billion Swiss francs, while the Diagnostics Division posted sales of 8.2 billion Swiss francs. Roche employs roughly 70,000 people in 150 countries and has R&D agreements and strategic alliances with numerous partners, including majority ownership interests in Genentech and Chugai. Additional information about the Roche Group is available on the Internet (roche).


Roche

roche


View drug information on Herceptin.

Primary Care Visits For Breast Symptoms And The Frequency Of Cancer Diagnosis

A study of 84,285 women seeking care in Dutch family physician offices between 1985 and 2003 revealed that breast symptoms were reported in about 3 percent of all visits.


Of the women complaining of breast symptoms, 3 percent of those women were subsequently diagnosed with breast cancer. Notably, those patients reporting a breast mass had a markedly elevated likelihood of breast cancer (15.04 likelihood ratio), suggesting that clinicians should aggressively work up such complaints regardless of patient age.


Characterizing Breast Symptoms in Family Practice

By Margaret M. Eberl, M.D., M.P.H, et al

Roswell Park Cancer Institute, Buffalo, New York


Annals of Family Medicine - November/December 2008


The Annals of Family Medicine is a new peer-reviewed research journal to meet the needs of scientists, practitioners, policymakers, and the patients and communities they serve. The Annals of Family Medicine is dedicated to advancing knowledge essential to understanding and improving health and primary care. The Annals supports a learning community of those who generate and use information about health and generalist health care.


annfammed/current.shtml



Angela Sharma

American Academy of Family Physicians

A Mechanism Of Resistance Of Breast Tumour Cells To The Widespread Treatment Of The So-Called Hormone-Dependent Types

Tumour cells depend upon estrogens to survive and proliferate in about 70% of all breast cancer cases. The most frequently used treatment to fight this variety of tumours relies on anti-estrogens such as tamoxifen. However, resistance to this type of therapy develops in more than 30% of the patients. Understanding the mechanisms involved in the appearance of resistance to tamoxifen is thus essential to develop new therapeutic approaches. The research done by the team of Didier Picard, professor at the University of Geneva (UNIGE), provides key answers in the 1st of April 2010 edition of Genes & Development. Their study reveals how cancer cells become impervious to the drug by activating a specific biochemical cascade. The latter, normally triggered by a chemical messenger called cyclic AMP, is permanently stimulated in cells refractory to the treatment.



Breast cancer, which is characterized by an enhanced and anarchic proliferation of mammary cells, is one of the main causes of cancer-related mortality in women. In over two thirds of the cases, estrogens play an active part in the progression of the disease, due to the presence of receptors for this hormone in the nucleus of malignant cells. Estrogens indeed modulate the expression of genes necessary to cell survival and proliferation through their interaction with these receptors.



The most frequent treatment for this type of breast cancer, called hormone-dependent, relies on anti-estrogens such as tamoxifen, which block tumour cell growth by inhibiting the activity of the receptor. However, the cancer eventually becomes resistant to the therapy in more than 30% of the patients.



The second messenger's key role



"Estrogen receptors, notably the one called ERО±, are also activated by other molecules that operate in an indirect way, without interacting with them", explains Didier Picard, professor at the Faculty of Sciences of UNIGE. "We aim precisely at understanding the mechanisms involved in the indirect stimulation of ERО± in cancer cells".



Researchers from his team have studied a molecule, cyclic AMP, which is able to convey various types of signals within the cell. Called a "second messenger", this molecule acts as an intermediary to transmit information between the exterior and the interior of the cell. Different growth factors, neurotransmitters or hormones, incapable of crossing the cell barrier, thus communicate their message by activating intracellular signalling pathways via cyclic AMP.



A novel mode of regulation



"During this project, we have studied how cyclic AMP could turn on ERО± in breast cancer cells in the absence of estrogens", says lead author Sophie Carascossa. In this case, the second messenger triggers a specific biochemical signalling cascade in which a protein called CARM1 is involved. The protein then binds ERО± and this in turn activates the receptor. "The interaction with CARM1 occurs in a domain of the receptor near the one that normally binds estrogens. This mode of regulation was completely unknown until now", specifies the scientist. The study also reveals that the signalling pathway is stimulated in a constitutive way in malignant cells resistant to tamoxifen, thus evading control in these cells.



Although the molecular mechanisms implicated in the resistance process are probably numerous, the interaction between CARM1 and ERО± could represent a promising therapeutic target in the long run.



Source:

Laura Pizurki


Cold Spring Harbor Laboratory

Study Indicates Targeted Strategies Needed To Find, Prevent And Treat Breast Cancer Among Mexican-origin Women

Specific prevention and education strategies are needed to address breast cancer in Mexican-origin women in this country, according to a study at The University of Texas MD Anderson Cancer Center, which was published online in the journal Cancer.


Among the Mexican-origin women with breast cancer who were surveyed, half were diagnosed before age 50, years earlier than the national average for non-Hispanic white women. This puts them outside the recently released U.S. Preventive Task Force guidelines that recommend screening, including mammograms, begin at 50 for the general population. The guidelines have been controversial, and MD Anderson opted to continue to recommend screening beginning at age 40.


"Under the revised Task Force guidelines, up to half of Mexican-origin women with breast cancer may be undiagnosed or diagnosed in late stages, possibly increasing disparities in rates of breast cancer mortality," said Patricia Miranda, Ph.D., a Kellogg Health Scholar post-doctoral fellow in the Department of Health Disparities Research at MD Anderson and the study's lead author. "Hispanic women are not recognized in the guidelines as a high-risk group, and we would like to see that decision revisited."


One-Size-Fits-All Approach Falls Short


Breast cancer is the leading cause of death among Hispanic women in the United States. Previous studies have shown they are more likely to be diagnosed with advanced breast cancer and 20 percent more likely to die from the cancer than non-Hispanic white women.


Hispanics are the nation's largest and fastest growing minority group. According to the American Community Survey, more than 45 million Hispanics live in this country. By 2050, the population - which has the lowest rate of insurance coverage - is expected to reach 132 million.


"As the new national health care policy is implemented, if a one-size-fits all screening recommendation is implemented as the Task Force recommends, we fear a huge number of breast cancer cases won't be picked up at an early stage, especially with the growth of the Hispanic population in this country," said Melissa Bondy, Ph.D., professor in the Department of Epidemiology and senior corresponding author.


The study, which is among the first to use a non-clinical, population-based sample to examine the risk of breast cancer in this group, identified 714 Hispanic women in the Houston area from MD Anderson's Mano a Mano Mexican-American Cohort Study: 119 with breast cancer and 595 without cancer.


Several factors were compared including:


-- Age at diagnosis


-- Family history of breast cancer


-- Marital status, number of children and education


-- Health insurance status


-- Language acculturation (ability to speak English)


-- Country of birth (U.S. or Mexico)















Family History, Acculturation Raise Risk


Women at highest risk for breast cancer - 2-1/2 times other women surveyed - had a family history of the disease, spoke English well and were born in Mexico.


The strongest risk factor was family history, which increased odds fourfold and was found to be true of 85 percent who had breast cancer. This indicates that women with a strong family history of breast cancer should receive earlier and more frequent screening, Bondy said.


The role of acculturation was striking too. Women who were born in Mexico who spoke English well had 2-1/2 times the risk of women born in Mexico who did not.


Single women were almost twice as likely as married women to develop breast cancer, and women without insurance were 1-1/2 times more likely than those with insurance to be diagnosed. Women who do not have insurance are less likely to be screened.


Although the study is fairly small, researchers believe it shows the need for clear action on several fronts.


"Going forward, we believe it's essential to create education programs specifically for this population," Miranda said.


In addition, the study recommends assistance with acquiring health insurance, which may increase access to screening and early detection, and working with affected communities to help formulate policy agendas.


More Research Planned


Although Hispanics are the fastest growing group in the country, they are markedly under-represented in medical research. MD Anderson, which has been studying Mexican-American health through the Mano A Mano study for 10 years, is involved in a major study of Hispanic women in Mexico, Arizona and Texas.


"We are looking at reasons these women are getting breast cancer earlier and tend to develop later stage breast cancer," Bondy said. "We're hoping to find answers that will help save lives."


Co-authors with Miranda and Bondy on the study include: Anna Wilkinson, Ph.D.; Carol Etzel, Ph.D. and Renke Zhou; all of MD Anderson's Department of Epidemiology, and Lovell Jones, Ph.D., of Health Disparities Research at MD Anderson; and Patricia Thompson, Ph.D. from the University of Arizona, Arizona Cancer Center. Zhou also is a graduate student in The University of Texas Graduate School of Biomedical Sciences at Houston, a joint program of MD Anderson and The University of Texas Health Science Center at Houston.


The research was supported in part by the Kellogg Health Scholars Program, the National Cancer Institute, the Caroline W. Law Fund for Cancer Prevention, the Duncan Family Institute for Cancer Prevention and Risk Assessment, and the National Center on Minority Health and Health Disparities. In addition, funds collected pursuant to the Comprehensive Tobacco Settlement of 1998 and appropriated by the 76th legislature to MD Anderson provided funding.


Source: University of Texas M. D. Anderson Cancer Center

Breast Cancer Risk And Surgical Intervention

An article appearing in the January/February issue of the Aesthetic Surgery Journal suggests that assessment of breast cancer risk prior to elective breast surgery can ultimately improve results for patients. The piece offers guidelines for plastic surgeons to help women gauge their breast cancer risk, and offer the best options for surgical intervention and reconstruction.


Estimates predict one out of every eight women will develop breast cancer at some point in her lifetime. The presence of breast cancer can be detected using MRI and mammography, however several other methods examine family history to gauge a woman's risk of developing the disease in the future. For women who are currently cancer-free, genetic testing can help identify how likely they are to develop the disease.


"Genetic testing, such as that for BRCA1 and BRCA2 (genes associated with breast cancer), has allowed clinicians to better tailor risk management strategies in patients from families with hereditary breast cancer," said Hooman Soltanian, MD, lead author of the piece. "Plastic surgeons are in a unique position to provide early preventative options to their patients."


Surgical options for high-risk patients


Early intervention with particularly high risk women can mean they can choose from more surgical and reconstructive procedures. Many high risk women with no current signs of breast cancer, for example, are excellent candidates for types of prophylactic surgery such as skin sparing mastectomy or nipple sparing mastectomy."


The risk of developing breast cancer can be cut by 90 percent in high risk women through bilateral prophylactic mastectomy. Reconstruction procedures performed simultaneously can also provide excellent cosmetic results for the patient.


Some key considerations for patients at high risk for breast cancer include:


- BRCA1 and BRCA2 related breast cancers generally occur in younger women, making detection by mammography difficult because of the denser breasts.


- The current screening recommendations for patients who test positive for BRCA1 and BRCA2 mutations include monthly self breast exams starting at age 18, semiannual clinical breast exams starting at age 25, and annual mammography and breast MRI starting at age 30.


- All breast reconstruction methods are available to patients with genetic predisposition for developing breast cancer; however, every high-risk patient must be counseled carefully and thoroughly to enable her to arrive at a decision suitable for her.


- For patients with BRCA mutation, it is important to note that bilateral reconstructions can be very lengthy and a staged approach may be advisable, and must be coordinated with the oncologic and gynecologic surgeons during combined procedures.


"Close cooperation between oncologists and plastic surgeons will improve patients' psychosocial outcomes and decrease the psychological burden for patients who have been diagnosed with a genetic predisposition for breast cancer," added Dr. Soltanian.















Elective breast surgery and risk assessment


Even for women simply seeking aesthetic breast surgery, breast cancer risk assessment is important in determining the best course of action and, ultimately, optimizing results.


Guidelines for these patients include:


- Prior to every elective breast surgery, special attention should be paid to any family history of breast or ovarian cancer.


- Patients who are at high risk for breast cancer based on their personal and family history should be referred for further evaluation by a medical oncologist and/or geneticist.


- Every woman 40 years of age and older should have a mammogram prior to an elective breast procedure. Some even recommend a preoperative mammogram in all women undergoing cosmetic breast surgery.


- It is important to note that breast augmentation, reduction, mastopexy (breast lift) and implants may have significant consequences in screening and surveillance of breast cancer, specifically with regard to future mammographic evaluation. A new mammogram should be obtained three-to-six months after surgery, to serve as the new baseline for evaluation.


- Ultrasound studies and MRI may be used to further evaluate patients with difficult or unsatisfactory mammograms.


"Plastic surgeons must play a part in monitoring women who come in for cosmetic breast procedures. These patients should be assessed for potential breast cancer risk by a physical examination as well as a family history evaluation," said Foad Nahai, MD, President of ASAPS and Associate Editor of ASJ. "It is imperative that these patients understand their potential risk, if any, as well as the implications breast surgery may have on future screening, in order for them to make the best possible decision regarding their own care."


About ASJ


The Aesthetic Surgery Journal is the peer-reviewed publication of the American Society for Aesthetic Plastic Surgery (ASAPS) and is the most widely read clinical journal in the field of cosmetic surgery, with subscribers in more than 60 countries.


About ASAPS


The American Society for Aesthetic Plastic Surgery is the leading organization of board-certified plastic surgeons specializing in cosmetic plastic surgery. ASAPS active-member plastic surgeons are certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.

American Society for Aesthetic Plastic Surgery

Breast Cancer Risk Higher For City Dwellers

A new study by UK researchers suggests that women who live in cities and urban areas are at greater risk from breast cancer because they tend to have denser breasts.


The study is the work of Dr Nicholas M. Perry, director of The London Breast Institute at The Princess Grace Hospital in London, and colleagues, and was presented yesterday, Monday 26th November, at the annual meeting of the Radiological Society of North America (RSNA), which is being held in Chicago this week.


Perry urged women who lived in cities to have more frequent screening for breast cancer, since they are at higher risk, but the irony is that women in London tend to visit screening clinics less often that their rural counterparts.


Breast tissue is made of a mixture of fatty tissue and glandular tissue. Women with a higher proportion of glandular tissue have denser breasts and nearly four times the risk of getting breast cancer compared to women whose breasts have more of the fatty tissue.


Perry and his team looked at digital mammograms of 972 women who lived in urban, suburban and rural areas in and around London, and found there was a link between where women lived and the density of their breast tissue.


The results showed that women who lived in London had significantly denser breast tissue compared to those who lived outside the city.


The chances of having increased density of breast tissue was doubled in the age range 45 to 54 years old, but further analysis showed the overall differences by area were greater in women under 50.


The researchers said that more research was needed to pinpoint the underlying cause of the geographical differences in breast tissue density in women. It could for instance be lifestyle, stress, or work related, or even other factors such as pollution.


However, whatever the reason, Perry urged all women, regardless of where they lived and worked, to stick to their recommended breast screening programme. He also recommended digital mammography be used to screen women with denser breasts since it is easier to see cancer in dense breast tissue with this technology than the more conventional film screen.


Perry said:


"Regular breast screening with mammography saves lives," adding that:


"Access to breast screening for women living in cities must be prioritized."


Another study that was presented to the RSNA in Chicago yesterday looked at the effect of the Western way of life on breast composition. Led by Dr Miriam Sklair-Levy of the Hadassah Medical Center in Jerusalem, researchers compared the breast tissue composition of Israeli women and of Ethiopian women who had immigrated to Israel.


They found that the women who had been born and raised in Ethiopia and then moved to Israel had significantly lower breast density than women born and raised in Israel. And they found that Ethiopian women who had begun to lead a Western way of life, such as having fewer children, increased use of hormones, and changed their diets, had significantly higher breast density than women who had only recently come to Israel from Ethiopia.


Click here for information about mammogram screening tests and the types of tissue abnormalities they can reveal (Cancer Research UK).


Written by: Catharine Paddock

Breast Cancer Survivors, Activists Head To Capitol Hill To Marshall Support For Comprehensive Cancer Legislation

Members of the Northeast Ohio Affiliate of Susan G. Komen for the Cure traveled to the nation's capital June 5 to help make the case for more funding for cancer research and access to screening and treatment. During their meetings with Senator Sherrod Brown, and Representatives Dennis Kucinich, Betty Sutton, Steve LaTourette and Ralph Regula, the delegation discussed the need to energize research and the disparities in access to care that exist, particularly in rural and minority communities.


"Thirty five years after our nation declared war on cancer we are still facing a cancer crisis," said Rosemary Gold, Advocacy Chair. "This week's push on Capitol Hill should help build momentum for an all-out assault on all cancer."


The Northeast Ohio delegation joined nearly 300 survivors and activists from 39 states plus the District of Columbia creating a pink wave across over 400 Capitol Hill offices helping to build a foundation of support for comprehensive cancer legislation that will soon be unveiled by Senators Edward Kennedy (D-MA) and Kay Bailey Hutchison (R-TX). Prior to Senator Kennedy's recent diagnosis of brain cancer, he chaired a hearing of the Senate Health, Education, Labor and Pension committee that discussed the issues addressed by the bill he and Senator Hutchison are crafting.


The Komen delegation reminded members of Congress that despite the many investments and advancements over the past three decades, 40 percent of Americans will be diagnosed with cancer at some point in their lives, including approximately 1.4 million new cases this year alone. Cancer will kill more than a half million people this year - about 1,500 people a day.


They also called on Congress to provide a greater government investment in cancer research, placing an emphasis on early detection, and promoting the discovery and development of biomarkers to detect cancers at the earliest possible stage. In addition, investment should be focused on personalized treatments, so early detection can be as easy as a blood test and treatments as non-invasive as an injection. At the same time, they warned Congress not to lose sight of the gaps in access to the detection and treatment options available today that impact the uninsured, underinsured and rural and minority populations.


"While we should be excited about the opportunities for the future and should do everything in our power to discover and deliver the cures, we have to close the gaps that exist today," said Ms. Gold. "If we don't, as the science surges, the gaps will only widen."


About Susan G. Komen for the Cure Northeast Ohio Affiliate


Since 1994, the Komen Northeast Ohio Affiliate has raised $12 million to provide funding and support to Northeast Ohio agencies working to create a world without breast cancer. The agencies provide mammograms and screening, breast cancer education and ongoing support to women, men, their families and friends. Up to seventy-five percent of the money raised locally funds programs in Northeast Ohio, and the remaining 25 percent helps fund the Susan G. Komen for the Cure National Research Grant Program. Our vision is to create a world without breast cancer.


komenneohio