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.
суббота, 21 мая 2011 г.
пятница, 20 мая 2011 г.
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
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
четверг, 19 мая 2011 г.
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
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
среда, 18 мая 2011 г.
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
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
вторник, 17 мая 2011 г.
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
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
понедельник, 16 мая 2011 г.
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
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
воскресенье, 15 мая 2011 г.
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
"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
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