Exposure to carcinogens in traffic emissions at particular lifetime points may increase the risk of developing breast
cancer in women who are lifetime nonsmokers, a study by epidemiologists and geographers at the University at Buffalo has
found.
Their study was conducted among women who lived in Erie and Niagara counties of New York State between 1996 and 2001. They
found that higher exposure around the time of first menstruation to polycyclic aromatic hydrocarbons (PAHs), potential
carcinogens found in traffic emissions, was associated with increased risk of premenopausal breast cancer.
However, for postmenopausal women, higher exposure to PAHs at the time of the first birth was associated with increased risk.
Neither association was found in women with a history of smoking.
Results of the study were presented earlier this month at the annual meeting of the American Association for Cancer Research
held in Anaheim, Calif. Jing Nie, Ph.D., a postdoctoral fellow in epidemiology in UB's School of Public Health and Health
Professions is first author on the study.
"There is growing evidence that there may be times in a woman's life when exposures to potential carcinogens may be critical
for breast-cancer initiation and development," said Nie. "Our study findings support the hypothesis that exposures in early
life contribute to breast-cancer risk."
The study was based on data from the Western New York Exposures and Breast Cancer (WEB) study. All participants were women
between the ages of 35 and 79 who lived in Erie or Niagara counties at the time of data collection. Women with primary,
histologically confirmed breast cancer served as cases. Controls were randomly selected and matched to cases on age, race and
county of residence.
Researchers in the WEB study conducted in-depth personal interviews with study participants to collect data on potential
breast-cancer risk factors and a history of where they had lived at different times in their lives. Researchers were
interested particularly in information related to four time periods: menarche (first menstrual period), first birth, 20 years
prior to the interview and 10 years prior.
Several information sources provided data on traffic volumes on roads in question for the years from 1960 to 2002 and
tail-pipe emissions, including measurements from tunnels and tests on individual vehicles. A geographic model was used to
reconstruct historic traffic PAHs, using measurements of benzo[a]pyrene, a known potent mutagen and carcinogen, as a
surrogate for total PAH exposure. Cruise emissions, cold engine emissions and intersection emissions were used to estimate
total traffic PAH emissions.
In addition, meteorological information was used in a geographic dispersion model to determine PAH exposure at each
participant's residence.
While the researchers found increased risk for exposure at menarche and first birth for premenopausal and postmenopausal
participants, respectively, who were lifetime nonsmokers, there was no association of traffic emissions with breast cancer
for the other time periods.
Nie said these findings related to PAHs need to be interpreted with caution, because they could be explained by other
compounds in vehicle exhaust or by other exposures related to the traffic emissions.
"While these results are subject to the limitations of epidemiologic observational studies, they are provocative in providing
evidence both of the importance of early exposures and of the potential importance of an environmental agent in risk of
breast cancer," said Nie. "Further examination of PAH exposure in early life is clearly warranted."
The UB researchers currently are examining whether genetic polymorphisms involving PAH metabolism may modify the risk, if
lifeline cumulative exposure may be associated with the risk and if this study may be replicated in another geographic
settings.
Jo Freudenheim, Ph.D., UB professor of social and preventive medicine, heads the WEB study.
Additional researchers were Jan Beyea, Ph.D., from Consulting in the Public Interest of Lambertville, N.J., who developed the
geographic dispersion model; Matthew Bonner, Ph.D., of the National Cancer Institute (NCI); Daikwon Han, Ph.D., Dominica
Vito, and Maurizio Trevisan, M.D., from the Department of Social and Preventive Medicine, UB School of Public Health and
Health Professions; and Peter Rogerson, Ph.D., of the Department of Geography, UB College of Arts and Sciences, along with
John Vena, Ph.D., now at the University of South Carolina, and Paola Muti, M.D., now at Italy's National Cancer Institute in
Genoa.
The research was supported in part by grants from the U.S. Army Breast Cancer Research Program and NCI.
The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the
State University of New York.
Contact: Lois Baker
ljbakerbuffalo
716-645-5000 x1417
University at Buffalo
buffalo
суббота, 25 июня 2011 г.
пятница, 24 июня 2011 г.
News And Feature Story Ideas For Breast Cancer Awareness Month (October)
Metropolitan Chicago Breast Cancer Task Force Issues Breast Cancer Disparity Report on October 17
The Chicago Breast Cancer Task Force will hold a press conference at Rush University Medical Center at 10 a.m. on October 17 to announce the group's recommendations to address breast cancer disparities and improve breast cancer care for all women. The citywide task force was created in response to a report issued in October 2006 about the alarming disparities in breast cancer mortality rates between African-American women and white women in Chicago.
Rush Researchers Study Groundbreaking Drug Avastin
Avastin, a humanized monoclonal antibody designed to interfere with the blood supply to a tumor, has been shown in clinical trials to provide significant benefit for advanced breast cancer patients. The next step is studying the drug in the adjuvant setting to determine if it can prevent tumors from reoccurring. "This is a drug that sabotages new blood vessel formation. The tumor can't grow bigger than the size of a sesame seed without an oxygen supply," said Dr. Melody Cobleigh, medical director of the Coleman Foundation Comprehensive Breast Center at Rush. Rush has been involved in the study of Avastin from the very beginning, participating in both the Phase I and Phase II studies of the drug.
Testing New Approaches to Treat Breast Cancer
Oncologist Dr. Ruta Rao is studying the use of Tarceva, a targeted drug therapy against the epidermal growth factor, for breast cancer patients whose genetic makeup puts them in a subset of patients typically very difficult to treat. Tarceva is currently approved for metastatic lung cancer and metastatic pancreatic cancer. Researcher Xiulong Xu, PhD is studying a drug used to suppress an enzyme associated with increased tumor growth and examining its potential to prevent and treat breast cancer.
New Electronic Brachytherapy Treatment System for Breast Cancer
Rush is the first medical center in the Midwest to treat breast cancer patients using a miniature X-ray source that can deliver localized and targeted radiation treatment in any clinical setting, rather than in heavily-shielded environments. The Xoft Axxent Electronic Brachytherapy System delivers therapy in 10-15 minutes, two times a day, for five days straight. "This system reduces radiation treatment from seven weeks down to five days," said surgeon Dr. Kambiz Dowlat. "With the shorter treatment time, more patients may choose breast sparing surgery over the alternative of a full mastectomy."
Breast Cancer in Perspective: Amazing Advances Greatly Reduce Mortality
In the last 20 years, with most of the progress in the last 10 years, a number of advances have led to a reduced mortality in breast cancer. According to the American Cancer Society the death rate for women under the age of 50 has been decreasing approximately 3.3% every year since 1990 and the death rate is decreasing 2% every year for women over the age of 50. New and innovative types of treatment, preventive measures, and diagnostic techniques have been developed such as Tamoxifen for the prevention of breast cancer in high-risk women, Herceptin for the treatment of tumors that express Her2/ErbB2 and aromatase inhibitors for the treatment of postmenopausal estrogen receptor-positive breast cancer. "The vast majority of patients with operable breast cancer are cured today," said Dr. Melody Cobleigh
"Venture" Initiative Funds Research at the Earliest Stages
Breakthrough ideas grow during the earliest stage of research, which is the most difficult stage to fund through grants. The Segal Foundation Research Initiative in Women's Cancers is providing the "seed" funding for seven young researchers at Rush to help them take their ideas from vision to reality. Based on the idea of "venture philanthropy," the Segal Foundation's initiative represents a new way of thinking about traditional giving. Applying venture capital principals to the philanthropic process focuses on results and provides the most gratifying return on investment. The initiative has inspired other organizations to take a similar approach. The Brian Piccolo Cancer Research Fund, with support from the Gavers Community Cancer Foundation, will provide seed monies this year to three talented researchers studying new approaches to breast cancer diagnosis and treatment. Likewise, the Rush Associates Board, an auxiliary group of mid-career professionals, will support young Rush researchers seeking to test promising ideas in a variety of clinical disciplines that are not yet ready for funding by established foundations or governmental agencies.
Awareness is Up but Fewer Women Getting Mammograms
After rising steadily during the 1990s, mammography screening rates leveled off after 2000 and began to decline about 2003, according to a recent study from the National Cancer Institute. The report says only 66% of eligible women are being screened; three million fewer women than five years ago. "Early detection saves lives and increases treatment options," says Dr. Peter Jokich, director of the Rush Breast Imaging Center. "Approximately 75 percent of women who develop breast cancer have no significant risk factors. Therefore, every woman over the age of 40 should undergo a screening for breast cancer with mammography every year."
Future Advances, Clinical Trials Stalled by Low Patient Participation
Before a new treatment becomes available, researchers must recruit hundreds or thousands of patients to participate in clinical research trials. But finding these patients is increasingly difficult. "Only 2% of cancer patients participate in clinical trials," said Dr. Melody Cobleigh. "There is a need for greater participation, especially in randomized Phase III trials." Even a modest increase of 2 to 3 percentage points would make a major impact, meaning the difference between completing a study in two years instead of three years.
Will You Get Breast Cancer? Genetic Testing for High Risk Patients
The Rush Inherited Susceptibility to Cancer Program (RISC) counsels people on their personal and family risks for developing cancer, and provides information on prevention and early detection. Cancer-causing mutations in the BRCA1 and BRCA2 genes account for approximately 5%-10% of all breast cancer cases. "We don't recommend widespread testing for these mutations, however women with a strong family history of breast cancer should undergo counseling to determine if a genetic test is appropriate," said Dr. Lydia Usha, director of the RISC program.
Holistic Cancer Treatment Focuses on the Emotional, Psychological and Spiritual Effects of Cancer
The Cancer Integrative Medicine Program at Rush is designed to relieve stress, pain and fatigue, as well as help patients take an active role in enhancing their health. The program offers integrative and behavioral medicine methods of treatment including acupuncture, biofeedback, guided imagery, medical hypnosis, yoga, massage, nutritional counseling, and herbal counseling. "Stress is a huge issue for people with cancer," said Janine Gauthier, PhD, director of clinical services for the program. "When patients get relief from stress, they gain a sense of control and may tolerate their medical treatments better."
rush
View drug information on Avastin; Herceptin; Tarceva.
The Chicago Breast Cancer Task Force will hold a press conference at Rush University Medical Center at 10 a.m. on October 17 to announce the group's recommendations to address breast cancer disparities and improve breast cancer care for all women. The citywide task force was created in response to a report issued in October 2006 about the alarming disparities in breast cancer mortality rates between African-American women and white women in Chicago.
Rush Researchers Study Groundbreaking Drug Avastin
Avastin, a humanized monoclonal antibody designed to interfere with the blood supply to a tumor, has been shown in clinical trials to provide significant benefit for advanced breast cancer patients. The next step is studying the drug in the adjuvant setting to determine if it can prevent tumors from reoccurring. "This is a drug that sabotages new blood vessel formation. The tumor can't grow bigger than the size of a sesame seed without an oxygen supply," said Dr. Melody Cobleigh, medical director of the Coleman Foundation Comprehensive Breast Center at Rush. Rush has been involved in the study of Avastin from the very beginning, participating in both the Phase I and Phase II studies of the drug.
Testing New Approaches to Treat Breast Cancer
Oncologist Dr. Ruta Rao is studying the use of Tarceva, a targeted drug therapy against the epidermal growth factor, for breast cancer patients whose genetic makeup puts them in a subset of patients typically very difficult to treat. Tarceva is currently approved for metastatic lung cancer and metastatic pancreatic cancer. Researcher Xiulong Xu, PhD is studying a drug used to suppress an enzyme associated with increased tumor growth and examining its potential to prevent and treat breast cancer.
New Electronic Brachytherapy Treatment System for Breast Cancer
Rush is the first medical center in the Midwest to treat breast cancer patients using a miniature X-ray source that can deliver localized and targeted radiation treatment in any clinical setting, rather than in heavily-shielded environments. The Xoft Axxent Electronic Brachytherapy System delivers therapy in 10-15 minutes, two times a day, for five days straight. "This system reduces radiation treatment from seven weeks down to five days," said surgeon Dr. Kambiz Dowlat. "With the shorter treatment time, more patients may choose breast sparing surgery over the alternative of a full mastectomy."
Breast Cancer in Perspective: Amazing Advances Greatly Reduce Mortality
In the last 20 years, with most of the progress in the last 10 years, a number of advances have led to a reduced mortality in breast cancer. According to the American Cancer Society the death rate for women under the age of 50 has been decreasing approximately 3.3% every year since 1990 and the death rate is decreasing 2% every year for women over the age of 50. New and innovative types of treatment, preventive measures, and diagnostic techniques have been developed such as Tamoxifen for the prevention of breast cancer in high-risk women, Herceptin for the treatment of tumors that express Her2/ErbB2 and aromatase inhibitors for the treatment of postmenopausal estrogen receptor-positive breast cancer. "The vast majority of patients with operable breast cancer are cured today," said Dr. Melody Cobleigh
"Venture" Initiative Funds Research at the Earliest Stages
Breakthrough ideas grow during the earliest stage of research, which is the most difficult stage to fund through grants. The Segal Foundation Research Initiative in Women's Cancers is providing the "seed" funding for seven young researchers at Rush to help them take their ideas from vision to reality. Based on the idea of "venture philanthropy," the Segal Foundation's initiative represents a new way of thinking about traditional giving. Applying venture capital principals to the philanthropic process focuses on results and provides the most gratifying return on investment. The initiative has inspired other organizations to take a similar approach. The Brian Piccolo Cancer Research Fund, with support from the Gavers Community Cancer Foundation, will provide seed monies this year to three talented researchers studying new approaches to breast cancer diagnosis and treatment. Likewise, the Rush Associates Board, an auxiliary group of mid-career professionals, will support young Rush researchers seeking to test promising ideas in a variety of clinical disciplines that are not yet ready for funding by established foundations or governmental agencies.
Awareness is Up but Fewer Women Getting Mammograms
After rising steadily during the 1990s, mammography screening rates leveled off after 2000 and began to decline about 2003, according to a recent study from the National Cancer Institute. The report says only 66% of eligible women are being screened; three million fewer women than five years ago. "Early detection saves lives and increases treatment options," says Dr. Peter Jokich, director of the Rush Breast Imaging Center. "Approximately 75 percent of women who develop breast cancer have no significant risk factors. Therefore, every woman over the age of 40 should undergo a screening for breast cancer with mammography every year."
Future Advances, Clinical Trials Stalled by Low Patient Participation
Before a new treatment becomes available, researchers must recruit hundreds or thousands of patients to participate in clinical research trials. But finding these patients is increasingly difficult. "Only 2% of cancer patients participate in clinical trials," said Dr. Melody Cobleigh. "There is a need for greater participation, especially in randomized Phase III trials." Even a modest increase of 2 to 3 percentage points would make a major impact, meaning the difference between completing a study in two years instead of three years.
Will You Get Breast Cancer? Genetic Testing for High Risk Patients
The Rush Inherited Susceptibility to Cancer Program (RISC) counsels people on their personal and family risks for developing cancer, and provides information on prevention and early detection. Cancer-causing mutations in the BRCA1 and BRCA2 genes account for approximately 5%-10% of all breast cancer cases. "We don't recommend widespread testing for these mutations, however women with a strong family history of breast cancer should undergo counseling to determine if a genetic test is appropriate," said Dr. Lydia Usha, director of the RISC program.
Holistic Cancer Treatment Focuses on the Emotional, Psychological and Spiritual Effects of Cancer
The Cancer Integrative Medicine Program at Rush is designed to relieve stress, pain and fatigue, as well as help patients take an active role in enhancing their health. The program offers integrative and behavioral medicine methods of treatment including acupuncture, biofeedback, guided imagery, medical hypnosis, yoga, massage, nutritional counseling, and herbal counseling. "Stress is a huge issue for people with cancer," said Janine Gauthier, PhD, director of clinical services for the program. "When patients get relief from stress, they gain a sense of control and may tolerate their medical treatments better."
rush
View drug information on Avastin; Herceptin; Tarceva.
четверг, 23 июня 2011 г.
Hormone Replacement Therapy: Real Concerns And False Alarms
In recent years, a series of highly publicized reports have warned of increases in breast cancer and other health problems in postmenopausal women who take hormone replacement therapy (HRT). But a closer look at the data suggests that those reports were often "distorted, oversimplified, or wrong," according to a paper in the March/April issue of The Cancer Journal: The Journal of Principles & Practice of Oncology. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
Despite "weak or statistically insignificant" data, scientific and media reports have emphasized the dangers of HRT, while downplaying its beneficial effects especially on menopausal symptoms, according to the article by Avrum Z. Bluming, M.D., and Carol Tavris, Ph.D. "Physicians and the public must be cautious about accepting 'findings by press release' in determining whether or not to prescribe or take HRT," according to Drs. Bluming and Tavris. Dr. Bluming is a Board-Certified Medical Oncologist, a Master of the American College of Physicians and a Clinical Professor of Medicine at the University of Southern California. Dr. Tavris is a social psychologist and writer.
Discrepancies Between Reports of HRT Dangers and Supporting Data
Doctors Bluming and Tavris cite the Harvard Nurses' Health Study, published in 1995, which employed retrospective substratification to exaggerate the association between HRT and breast cancer development. Statisticians have cautioned that spurious associations can result from this practice also called "data mining" in which researchers sift through their databases, looking for factors that might affect health outcomes. "The problem is that in a data set of many thousands of people, some relationship that is unearthed retrospectively will turn out to be statistically significant...just by chance."
The authors also criticize the Women's Health Initiative (WHI), published initially in 2002, which reported "relative risk" rather than "absolute risk" associations. This format can make "statistically modest or borderline results...look more impressive than they actually are." The authors note that the 26 percent relative risk of breast cancer in the initial WHI is similar to that reported for unlikely risk factors like eating grapefruit, working on a nightshift, or working as a flight attendant.
The core issue, according to Drs. Bluming and Tavris, is the difference between information and knowledge. "What we're trying to do is make a plea for knowledge, not just information, especially loosely based associations that are generated by epidemiologic studies. That isn't science. Post-hoc findings that make little or no scientific sense may give us clues for future investigation, but they shouldn't be accepted as proof of cause and effect."
Jumble of 'Positive, Negative and Meaningless' Findings
Press releases linking HRT to breast cancer failed to report that the initial WHI report of a 26 percent relative risk did not reach the level of statistical significance. Nevertheless, several editorials by prominent authorities highlighted the increase in risk as "statistically significant" a false claim repeated in news stories.
Subsequent analyses gave varying results: smaller but significant risk, larger but nonsignificant risk, or no significant difference in risk. "It is difficult to resist the conclusion that the WHI investigators have been doing everything they could to wring the bleakest possible interpretation from their recalcitrant data," Drs. Bluming and Tavris write.
Although concerns about breast cancer and other health risks are valid, "HRT is not the clear and present danger that the WHI and much of the media have made it out to be," Drs. Bluming and Tavris conclude. They contend that the weight of available evidence supports the use of HRT by women who are having menopausal symptoms, beginning at the start of menopause and continuing for as many years as necessary.
About The Cancer Journal
The Cancer Journal: The Journal of Principles & Practice of Oncology provides an integrated view of modern oncology across all disciplines. The Journal publishes original research and reviews, and also serves to update the content published in the textbook Cancer: Principles & Practice of Oncology
About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company. The company provides products and services for professionals in the health, tax, accounting, corporate, financial services, legal, and regulatory sectors. Wolters Kluwer had 2008 annual revenues of €3.4 billion ($4.9 billion), employs approximately 20,000 people worldwide, and maintains operations in over 35 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices.
Source: Wolters Kluwer Health
Despite "weak or statistically insignificant" data, scientific and media reports have emphasized the dangers of HRT, while downplaying its beneficial effects especially on menopausal symptoms, according to the article by Avrum Z. Bluming, M.D., and Carol Tavris, Ph.D. "Physicians and the public must be cautious about accepting 'findings by press release' in determining whether or not to prescribe or take HRT," according to Drs. Bluming and Tavris. Dr. Bluming is a Board-Certified Medical Oncologist, a Master of the American College of Physicians and a Clinical Professor of Medicine at the University of Southern California. Dr. Tavris is a social psychologist and writer.
Discrepancies Between Reports of HRT Dangers and Supporting Data
Doctors Bluming and Tavris cite the Harvard Nurses' Health Study, published in 1995, which employed retrospective substratification to exaggerate the association between HRT and breast cancer development. Statisticians have cautioned that spurious associations can result from this practice also called "data mining" in which researchers sift through their databases, looking for factors that might affect health outcomes. "The problem is that in a data set of many thousands of people, some relationship that is unearthed retrospectively will turn out to be statistically significant...just by chance."
The authors also criticize the Women's Health Initiative (WHI), published initially in 2002, which reported "relative risk" rather than "absolute risk" associations. This format can make "statistically modest or borderline results...look more impressive than they actually are." The authors note that the 26 percent relative risk of breast cancer in the initial WHI is similar to that reported for unlikely risk factors like eating grapefruit, working on a nightshift, or working as a flight attendant.
The core issue, according to Drs. Bluming and Tavris, is the difference between information and knowledge. "What we're trying to do is make a plea for knowledge, not just information, especially loosely based associations that are generated by epidemiologic studies. That isn't science. Post-hoc findings that make little or no scientific sense may give us clues for future investigation, but they shouldn't be accepted as proof of cause and effect."
Jumble of 'Positive, Negative and Meaningless' Findings
Press releases linking HRT to breast cancer failed to report that the initial WHI report of a 26 percent relative risk did not reach the level of statistical significance. Nevertheless, several editorials by prominent authorities highlighted the increase in risk as "statistically significant" a false claim repeated in news stories.
Subsequent analyses gave varying results: smaller but significant risk, larger but nonsignificant risk, or no significant difference in risk. "It is difficult to resist the conclusion that the WHI investigators have been doing everything they could to wring the bleakest possible interpretation from their recalcitrant data," Drs. Bluming and Tavris write.
Although concerns about breast cancer and other health risks are valid, "HRT is not the clear and present danger that the WHI and much of the media have made it out to be," Drs. Bluming and Tavris conclude. They contend that the weight of available evidence supports the use of HRT by women who are having menopausal symptoms, beginning at the start of menopause and continuing for as many years as necessary.
About The Cancer Journal
The Cancer Journal: The Journal of Principles & Practice of Oncology provides an integrated view of modern oncology across all disciplines. The Journal publishes original research and reviews, and also serves to update the content published in the textbook Cancer: Principles & Practice of Oncology
About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company. The company provides products and services for professionals in the health, tax, accounting, corporate, financial services, legal, and regulatory sectors. Wolters Kluwer had 2008 annual revenues of €3.4 billion ($4.9 billion), employs approximately 20,000 people worldwide, and maintains operations in over 35 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices.
Source: Wolters Kluwer Health
среда, 22 июня 2011 г.
Kansas Breast And Cervical Cancer Screening Program For Low-Income, Uninsured Women Runs Out Of Funding
The Kansas Early Detection Works program, which provides uninsured low-income women in the state with breast and cervical cancer screenings at no cost, has depleted its operating funds and will delay almost all cancer screenings until July 1, the Wichita Eagle reports. Janet Neff, director of the Cancer Prevention and Control Program at the Kansas Department of Health and Environment, said the program has received about $2.3 million annually in recent years from CDC. The program also receives some funding from the state and the Mid-Kansas affiliate of the Susan G. Komen for the Cure Foundation.
The screening program depleted its funds in March. However, program officials reserved a limited amount of funding to provide diagnostic tests until the new fiscal year begins on July 1 to women who display symptoms of breast or cervical cancer. Women who inquire about the program will be placed on a waiting list and will be screened when funding becomes available. Kansas women ages 40 to 64 who are uninsured and meet income guidelines are eligible for the program. According to Neff, about 5,800 of the at least 27,000 women in Kansas who qualify to receive no-cost screenings have done so since July 1, 2007.
Neff said she requested slightly more than $2.3 million in federal funds for FY 2009 (Shideler, Wichita Eagle, 5/5).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The screening program depleted its funds in March. However, program officials reserved a limited amount of funding to provide diagnostic tests until the new fiscal year begins on July 1 to women who display symptoms of breast or cervical cancer. Women who inquire about the program will be placed on a waiting list and will be screened when funding becomes available. Kansas women ages 40 to 64 who are uninsured and meet income guidelines are eligible for the program. According to Neff, about 5,800 of the at least 27,000 women in Kansas who qualify to receive no-cost screenings have done so since July 1, 2007.
Neff said she requested slightly more than $2.3 million in federal funds for FY 2009 (Shideler, Wichita Eagle, 5/5).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
вторник, 21 июня 2011 г.
Industry-funded Breast Cancer Trials More Likely To Yield Positive Results
Industry-funded studies of breast cancer therapies are more likely to report positive results than non-pharmaceutical funded studies, researchers from the University of North Carolina at Chapel Hill and the Dana Farber Cancer Institute have found. In addition, significant differences exist in the design and nature of clinical trials supported by the pharmaceutical industry compared to trials without industry involvement.
Published online Monday (Feb. 26) in Cancer, the journal of the American Cancer Society, the study explores the impact of pharmaceutical-company involvement on breast cancer clinical trial design and outcome. Drug-industry investment in research now exceeds the operating budget of the National Institutes of Health and previous studies have examined the impact on other areas of clinical medicine, but not breast cancer.
"Our study shines a flashlight on the issue of the rising role and potential impact of the pharmaceutical industry on breast cancer research and highlights important questions that need to be addressed through further research," said Dr. Jeffrey Peppercorn, assistant professor of medicine in UNC School of Medicine's division of hematology and oncology and a member of the UNC Lineberger Comprehensive Cancer Center.
"The significance of our study is not to say that the drug industry does anything wrong they are excellent at developing new therapies, and there are many recent examples in breast cancer research. But if more and more research is funded by drug companies, then the limited amount of funding coming from other sources may need to be directed to address other questions," Peppercorn said.
The researchers reviewed all breast cancer clinical trials published in 10 English-language medical journals in the years 1993, 1998 and 2003. They focused their formal statistical analysis on the 2003 trials because the identification of industry funded or non-industry funded research was likely more accurate due to more stringent disclosure guidelines than earlier periods.
Trials with industry involvement were more likely than non-industry studies to use a single-arm study design, without a comparison group. This isn't surprising, Peppercorn notes, because these studies are a key step in drug development.
In 2003, 57 percent of studies reported pharmaceutical involvement. Of these, 66 percent were single-arm studies. Only 33 percent of non-industry studies used single-arm design.
The industry studies were also more likely to yield positive results; 84 percent of industry-supported studies showed positive results, compared with 54 percent of non-industry studies.
"It's been seen again and again in various branches of clinical medicine that studies that involve pharmaceutical industry sponsorship are more likely to have positive outcomes," Peppercorn said. "It's not fair to say at this point that it's necessarily related to biased interpretation of results." For instance, another explanation could be that industry makes smarter or safer choices about what drugs are brought to trial.
However, as industry funding becomes an increasingly dominant source of research funding, clinical questions that aren't directly related to drug development may be neglected, Peppercorn said. Such questions include the optimal duration for giving a medication or whether certain groups of patients benefit from a medication more than others, he said.
Study co-authors are Emily Blood, Dr. Eric Winer and Dr. Ann Partridge, all of the Dana Farber Cancer Institute, where Dr. Peppercorn received his training and initiated the study.
University of North Carolina at Chapel Hill School of Medicine
101 Manning Dr., 6002 East Wing
Chapel Hill, NC 27514
United States
med.unc
Published online Monday (Feb. 26) in Cancer, the journal of the American Cancer Society, the study explores the impact of pharmaceutical-company involvement on breast cancer clinical trial design and outcome. Drug-industry investment in research now exceeds the operating budget of the National Institutes of Health and previous studies have examined the impact on other areas of clinical medicine, but not breast cancer.
"Our study shines a flashlight on the issue of the rising role and potential impact of the pharmaceutical industry on breast cancer research and highlights important questions that need to be addressed through further research," said Dr. Jeffrey Peppercorn, assistant professor of medicine in UNC School of Medicine's division of hematology and oncology and a member of the UNC Lineberger Comprehensive Cancer Center.
"The significance of our study is not to say that the drug industry does anything wrong they are excellent at developing new therapies, and there are many recent examples in breast cancer research. But if more and more research is funded by drug companies, then the limited amount of funding coming from other sources may need to be directed to address other questions," Peppercorn said.
The researchers reviewed all breast cancer clinical trials published in 10 English-language medical journals in the years 1993, 1998 and 2003. They focused their formal statistical analysis on the 2003 trials because the identification of industry funded or non-industry funded research was likely more accurate due to more stringent disclosure guidelines than earlier periods.
Trials with industry involvement were more likely than non-industry studies to use a single-arm study design, without a comparison group. This isn't surprising, Peppercorn notes, because these studies are a key step in drug development.
In 2003, 57 percent of studies reported pharmaceutical involvement. Of these, 66 percent were single-arm studies. Only 33 percent of non-industry studies used single-arm design.
The industry studies were also more likely to yield positive results; 84 percent of industry-supported studies showed positive results, compared with 54 percent of non-industry studies.
"It's been seen again and again in various branches of clinical medicine that studies that involve pharmaceutical industry sponsorship are more likely to have positive outcomes," Peppercorn said. "It's not fair to say at this point that it's necessarily related to biased interpretation of results." For instance, another explanation could be that industry makes smarter or safer choices about what drugs are brought to trial.
However, as industry funding becomes an increasingly dominant source of research funding, clinical questions that aren't directly related to drug development may be neglected, Peppercorn said. Such questions include the optimal duration for giving a medication or whether certain groups of patients benefit from a medication more than others, he said.
Study co-authors are Emily Blood, Dr. Eric Winer and Dr. Ann Partridge, all of the Dana Farber Cancer Institute, where Dr. Peppercorn received his training and initiated the study.
University of North Carolina at Chapel Hill School of Medicine
101 Manning Dr., 6002 East Wing
Chapel Hill, NC 27514
United States
med.unc
понедельник, 20 июня 2011 г.
Lapatinib Could Be Beneficial In Treating Patients With Aggressive Inflammatory Breast Cancer
An article published online First and in the June edition of The lancet Oncology reports the findings of a phase II study on inflammatory breast cancer, an aggressive form of the disease representing up to one tenth of malignant breast cancer cases. Dr Stephen Johnston, Royal Marsden Hospital, London, UK, and Dr Bella Kaufman, The Chaim Sheba Medical Center, Tel Hashomer, Israel, and colleagues discuss how lapatinib may be beneficial in the treatment of this form of cancer.
In inflammatory breast cancer, the protein epidermal growth factor receptor 2 (HER2) implicated in the signaling pathways leading to cell growth is manifested much more than in other less aggressive cancers. This disease makes up one to six percent of all invasive breast tumors in Western Europe and the USA and five to ten percent in North Africa and Arabian countries. The clinical symptoms are: rapid onset of swelling, redness of the breast skin, fluid under the skin of more than two thirds of the breast resulting in a bumpy appearance, painfulness, hardening and warming of the breast.
Lapatinib hinders tumor growth because it is an oral inhibitor of HER2. Options are limited for patients with resistance to conventional anthracycline or taxane and trastuzumab treatment. The study included 126 patients receiving a daily dose of lapatinib (1,500 mg). Every four weeks, skin disease was evaluated and cancer evolution (local and secondary) was assessed using standard criteria.
Findings showed that none of the patients had an absolute response to the treatment but 39 percent (49 patients) had a partial response with a 50 percent healing in extent of skin disease from baseline. The average progression-free survival was of fifteen weeks, with an average duration of response of twenty one weeks. Six months later, 22 percent of patients were still progression-free. The probability of response to lapatinib was not altered by prior treatment with trastuzumab. The general average of survival was accounted for four groups of patients:
• 33 patients who responded to lapatinib and had previous treatment with trastuzumab. Median survival: 18.4 months.
• 15 patients who responded to lapatinib and had no previous treatment with trastuzumab. Median survival: 14.0 months.
• 61 patients unresponsive to lapatinib and previous treatment with trastuzumab. Median survival: 8.4 months.
• 16 patients unresponsive to lapatinib with no previous trastuzumab treatment. Median survival: 8.2 months.
Undesirable events were frequent since 92 percent of patients experienced at least one. Although the majority was not considered linked to lapatinib, 32 percent of patients suffered serious adverse events: eight of them experienced shortness of breath, and six of them had fluid around the lungs. There were five deaths from adverse events that were possibly treatment related.
The researchers point out: "Patients who responded to treatment with lapatinib had a longer median overall survival than did those patients who did not respond, irrespective of previous exposure to trastuzumab. Patients exposed to previous trastuzumab treatment who experienced a response to lapatinib had the longest median overall survival. This finding confirms the clinical benefit of targeted therapy in these patients."
They write in conclusion: "Lapatinib monotherapy is potentially clinically effective in heavily pretreated patients with inflammatory breast cancer with HER2+ tumours. The objective response rate noted...coupled with the median duration of response and median overall survival supports a role for lapatinib in these patients."
thelancet
Written by Stephanie Brunner (B.A.)
In inflammatory breast cancer, the protein epidermal growth factor receptor 2 (HER2) implicated in the signaling pathways leading to cell growth is manifested much more than in other less aggressive cancers. This disease makes up one to six percent of all invasive breast tumors in Western Europe and the USA and five to ten percent in North Africa and Arabian countries. The clinical symptoms are: rapid onset of swelling, redness of the breast skin, fluid under the skin of more than two thirds of the breast resulting in a bumpy appearance, painfulness, hardening and warming of the breast.
Lapatinib hinders tumor growth because it is an oral inhibitor of HER2. Options are limited for patients with resistance to conventional anthracycline or taxane and trastuzumab treatment. The study included 126 patients receiving a daily dose of lapatinib (1,500 mg). Every four weeks, skin disease was evaluated and cancer evolution (local and secondary) was assessed using standard criteria.
Findings showed that none of the patients had an absolute response to the treatment but 39 percent (49 patients) had a partial response with a 50 percent healing in extent of skin disease from baseline. The average progression-free survival was of fifteen weeks, with an average duration of response of twenty one weeks. Six months later, 22 percent of patients were still progression-free. The probability of response to lapatinib was not altered by prior treatment with trastuzumab. The general average of survival was accounted for four groups of patients:
• 33 patients who responded to lapatinib and had previous treatment with trastuzumab. Median survival: 18.4 months.
• 15 patients who responded to lapatinib and had no previous treatment with trastuzumab. Median survival: 14.0 months.
• 61 patients unresponsive to lapatinib and previous treatment with trastuzumab. Median survival: 8.4 months.
• 16 patients unresponsive to lapatinib with no previous trastuzumab treatment. Median survival: 8.2 months.
Undesirable events were frequent since 92 percent of patients experienced at least one. Although the majority was not considered linked to lapatinib, 32 percent of patients suffered serious adverse events: eight of them experienced shortness of breath, and six of them had fluid around the lungs. There were five deaths from adverse events that were possibly treatment related.
The researchers point out: "Patients who responded to treatment with lapatinib had a longer median overall survival than did those patients who did not respond, irrespective of previous exposure to trastuzumab. Patients exposed to previous trastuzumab treatment who experienced a response to lapatinib had the longest median overall survival. This finding confirms the clinical benefit of targeted therapy in these patients."
They write in conclusion: "Lapatinib monotherapy is potentially clinically effective in heavily pretreated patients with inflammatory breast cancer with HER2+ tumours. The objective response rate noted...coupled with the median duration of response and median overall survival supports a role for lapatinib in these patients."
thelancet
Written by Stephanie Brunner (B.A.)
воскресенье, 19 июня 2011 г.
To Escape Death By Hormonal Therapy Breast Cancer Cells Recycle
Many breast cancer cells facing potentially lethal antiestrogen therapy recycle to survive, researchers say.
About 70 percent of breast cancer cells have receptors for the hormone estrogen, which acts as a nutrient and stimulates their growth. Patients typically get an antiestrogen such as tamoxifen for five years to try to starve them to death, says Dr. Patricia V. Schoenlein, cancer researcher in the Medical College of Georgia Schools of Medicine and Graduate Studies.
"About 50 to 60 percent of these women really benefit from hormonal therapy," says Dr. Schoenlein. Why others don't has been asked for at least two decades.
One reason may be breast cancer cells switch into a survival mode that normal cells also use when faced with starvation, according to research published in the September issue of Molecular Cancer Therapeutics. Dr. Schoenlein also is reporting on the research during the 2nd World Conference on Magic Bullets (Ehrlich II) Oct. 3-5 in NГјrenberg, Germany.
It's called macroautophagy - autophagy means "self eating" - and within a week, breast cancer cells can reorganize component parts, degrade non-essentials and live in this state until antiestrogen therapy is stopped or the cells mutate and resume proliferation in the presence of tamoxifen. "It's like taking your foot off of the gas pedal of your car," says Dr. Schoenlein, corresponding author on the study. "The cancer cell is in idle, unable to grow or replicate. But the cell is smart enough to use component parts generated by macroautophagy for the most necessary things required for survival." She notes that macroautophagy can't be maintained indefinitely; cells can actually self-digest. "This is a time-buying strategy."
Chemotherapeutic drugs are more direct killers but also kill healthy cells and can be tolerated by patients only for relatively short periods. Antiestrogen therapy is more specific, targeting breast cancer cells that express estrogen receptors.
In the laboratory, 20-25 percent of breast cancer cells died when Dr. Schoenlein and colleagues gave antiestrogen continuously over time - similar to how patients get it. More typically, the cells expressed increasing levels of macroautophagy and survived. "They don't grow, but they survive the therapy. They will grow if you take away the therapy." Adding a macroautophagy inhibitor promoted robust cell death.
"We believe targeting the autophagosome function will significantly improve the efficacy of hormonal treatment for estrogen-positive breast cancer," says the researcher. She recently received a three-year, $1.1 million National Cancer Institute grant to pursue that strategy.
She'll now look for ways to block macroautophagy in an animal model, including using chloroquine, a drug used to treat malaria. "We know patients can take it with few side effects," she says. If it works in animals, the drug, in combination with an antiestrogen, could move relatively quickly into human testing.
During autophagy, the internal pH for the recycling center of the reorganized cell gets acidic and chloroquine increases pH. "If you add this particular inhibitor of the recycling center, you alter the pH and block its ability to do what it is supposed to do," says Dr. Schoenlein.
A University of Pennsylvania team led by Dr. Craig Thompson reported in 2007 in The Journal of Clinical Investigation that chloroquine increased death of suicide-resistant lymphoma cells being treated with chemotherapy. Dr. Schoenlein will give chloroquine along with an antiestrogen and measure cell death.
"Most cancers probably use autophagy as a survival mechanism. You can either block the autophagosome with your therapy or you can make the cell eat itself to the point of no return and the cell self-destructs. You have to push it either way," she says. Although there are no known compounds in clinical use to induce self-destruction by autophagy, there is some evidence arsenic trioxide, a compound used in China to treat some aggressive cancers, prompts cancer cells to die from self digestion, she says. That and other compounds will no doubt be studied further, she says.
Dr. Schoenlein believes breast cancer survival during macroautophagy requires high activity of the tumor suppressor protein Rb and low levels of the lipid ceramide. Ceramide is vital but causes cell death at high levels. MCG researcher Erhard Bieberich and colleague Dr. Brian G. Condie at the University of Georgia showed in 2003 that high levels of ceramide kill cells that are unnecessary to the developing brain. The new studies will further explore the roles of Rb and ceramide in breast cancer survival during macroautophagy and determine if chloroquine can change their balance.
MCG news categories related to this story:
Cancer
School of Medicine
School of Graduate Studies
Source: Toni Baker
Medical College of Georgia
About 70 percent of breast cancer cells have receptors for the hormone estrogen, which acts as a nutrient and stimulates their growth. Patients typically get an antiestrogen such as tamoxifen for five years to try to starve them to death, says Dr. Patricia V. Schoenlein, cancer researcher in the Medical College of Georgia Schools of Medicine and Graduate Studies.
"About 50 to 60 percent of these women really benefit from hormonal therapy," says Dr. Schoenlein. Why others don't has been asked for at least two decades.
One reason may be breast cancer cells switch into a survival mode that normal cells also use when faced with starvation, according to research published in the September issue of Molecular Cancer Therapeutics. Dr. Schoenlein also is reporting on the research during the 2nd World Conference on Magic Bullets (Ehrlich II) Oct. 3-5 in NГјrenberg, Germany.
It's called macroautophagy - autophagy means "self eating" - and within a week, breast cancer cells can reorganize component parts, degrade non-essentials and live in this state until antiestrogen therapy is stopped or the cells mutate and resume proliferation in the presence of tamoxifen. "It's like taking your foot off of the gas pedal of your car," says Dr. Schoenlein, corresponding author on the study. "The cancer cell is in idle, unable to grow or replicate. But the cell is smart enough to use component parts generated by macroautophagy for the most necessary things required for survival." She notes that macroautophagy can't be maintained indefinitely; cells can actually self-digest. "This is a time-buying strategy."
Chemotherapeutic drugs are more direct killers but also kill healthy cells and can be tolerated by patients only for relatively short periods. Antiestrogen therapy is more specific, targeting breast cancer cells that express estrogen receptors.
In the laboratory, 20-25 percent of breast cancer cells died when Dr. Schoenlein and colleagues gave antiestrogen continuously over time - similar to how patients get it. More typically, the cells expressed increasing levels of macroautophagy and survived. "They don't grow, but they survive the therapy. They will grow if you take away the therapy." Adding a macroautophagy inhibitor promoted robust cell death.
"We believe targeting the autophagosome function will significantly improve the efficacy of hormonal treatment for estrogen-positive breast cancer," says the researcher. She recently received a three-year, $1.1 million National Cancer Institute grant to pursue that strategy.
She'll now look for ways to block macroautophagy in an animal model, including using chloroquine, a drug used to treat malaria. "We know patients can take it with few side effects," she says. If it works in animals, the drug, in combination with an antiestrogen, could move relatively quickly into human testing.
During autophagy, the internal pH for the recycling center of the reorganized cell gets acidic and chloroquine increases pH. "If you add this particular inhibitor of the recycling center, you alter the pH and block its ability to do what it is supposed to do," says Dr. Schoenlein.
A University of Pennsylvania team led by Dr. Craig Thompson reported in 2007 in The Journal of Clinical Investigation that chloroquine increased death of suicide-resistant lymphoma cells being treated with chemotherapy. Dr. Schoenlein will give chloroquine along with an antiestrogen and measure cell death.
"Most cancers probably use autophagy as a survival mechanism. You can either block the autophagosome with your therapy or you can make the cell eat itself to the point of no return and the cell self-destructs. You have to push it either way," she says. Although there are no known compounds in clinical use to induce self-destruction by autophagy, there is some evidence arsenic trioxide, a compound used in China to treat some aggressive cancers, prompts cancer cells to die from self digestion, she says. That and other compounds will no doubt be studied further, she says.
Dr. Schoenlein believes breast cancer survival during macroautophagy requires high activity of the tumor suppressor protein Rb and low levels of the lipid ceramide. Ceramide is vital but causes cell death at high levels. MCG researcher Erhard Bieberich and colleague Dr. Brian G. Condie at the University of Georgia showed in 2003 that high levels of ceramide kill cells that are unnecessary to the developing brain. The new studies will further explore the roles of Rb and ceramide in breast cancer survival during macroautophagy and determine if chloroquine can change their balance.
MCG news categories related to this story:
Cancer
School of Medicine
School of Graduate Studies
Source: Toni Baker
Medical College of Georgia
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