Montclair Breast Center

Clinical Oncology Week, 28 April 2008

Breast Cancer; MRI before surgery leads to better-adapted treatment for breast cancer

2008 APR 28 - (NewsRx.com) -- The early use of magnetic resonance imaging (MRI) in women diagnosed with breast cancer can often lead to a better adapted surgical approach to the tumour, a scientist told the 6th European Breast Cancer Conference (EBCC-6) today (Wednesday April 16). Dr. David Martinez-Cecilia, a surgeon from the General Surgery Service, directed by Prof. Rufian-Peña, in the Hospital Universitario Reina Sofia, Cordoba, Spain, said that this technique should become standard in determining the stage of the tumour before any operation (see also Breast Cancer).

Dr. Martinez-Cecilia and his team studied 249 patients who were undergoing surgery for breast cancer, and carried out routine MRI as soon as a biopsy showed malignancy. If additional lesions were discovered, a further biopsy was carried out on them.

"Using MRI, we found 20 additional malignant lesions in 18 patients," he said, "and that meant that for 15 patients we were able to change the surgical treatment to one which took care of all the tumours, as opposed to the single one that had originally been diagnosed." Three patients needed surgery in both breasts, one required a second lumpectomy in the same breast, and 11 changed from lumpectomy to mastectomy. The surgical treatment also changed in those patients where the MRI showed up a larger tumour than that which was originally identified; 16 other patients changed from lumpectomy to mastectomy, and one from lumpectomy to quadrantectomy, a partial mastectomy where the tumour and some surrounding breast tissue is removed to be sure that the margins around the tumour are cancer-free.

The scientists then carried out a retrospective analysis of the surgical outcomes. "We found that the changes in surgical treatment had been beneficial in 22 patients (9%), non beneficial in 6 patients (2.4%), and uncertain in 4 patients (1.6%)," said Dr. Martinez-Cecilia. "The results also showed us that MRI is the best imaging technique for measuring tumour size, better than mammography or ultrasound. MRI is being used more frequently in breast cancer pre-operative staging these days, and we thought it was important to validate its efficacy."

MRI is expensive, but with results such as these it should be used as widely as possible pre-surgery, say the scientists. "It will not only improve the surgical treatment, which was our main aim, but in the long run it will probably reduce costs to healthcare systems by allowing us to identify exactly what needs to be treated, and in what way, to avoid possible recurrences of the cancer and the costs associated with its treatment," said Dr. Martinez-Cecilia. "We will continue working prospectively with this issue as we would like to see MRI become a standard preoperative treatment for breast cancer, along with biopsy, mammography, and ultrasound."

Clinical Oncology Week, 28 April 2008

Breast Cancer; Vitamin D and breast cancer risk

2008 APR 28 - (NewsRx.com) -- A connection between vitamin D level and the risk of developing breast cancer has been implicated for a long time, but its clinical relevance had not yet been proven. Sascha Abbas and colleagues from the working group headed by Dr. Jenny Chang-Claude at the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), collaborating with researchers of the University Hospitals in Hamburg-Eppendorf, have now obtained clear results: While previous studies had concentrated chiefly on nutritional vitamin D, the researchers have now investigated the complete vitamin D status. To this end, they studied 25-hydroxyvitamin D (25(OH)D) as a marker for both endogenous vitamin D and vitamin D from food intake (see also Breast Cancer).

The result of the study involving 1,394 breast cancer patients and an equal number of healthy women after menopause was surprisingly clear: Women with a very low blood level of 25(OH)D have a considerably increased breast cancer risk. The effect was found to be strongest in women who were not taking hormones for relief of menopausal symptoms. However, the authors note that, in this retrospective study, diagnosis-related factors such as chemotherapy or lack of sunlight after prolonged hospital stays might have contributed to low vitamin levels of breast cancer patients.

In addition, the investigators focused on the vitamin D receptor. The gene of this receptor is found in several variants known as polymorphisms. The research team of the DKFZ and Eppendorf Hospitals investigated the effect of four of these polymorphisms on the risk of developing breast cancer. They found out that carriers of the Taql polymorphism have a slightly increased risk of breast tumors that carry receptors for the female sex hormone estrogen on their surface. No effects on the overall breast cancer risk were found. A possible explanation offered by the authors is that vitamin D can exert its cancer-preventing effect by counteracting the growth-promoting effect of estrogens.

Besides its cancer-preventing influence with effects on cell growth, cell differentiation and programmed cell death (apoptosis), vitamin D regulates, above all, the calcium metabolism in our body. Foods that are particularly rich in vitamin D include seafish (cod liver oil), eggs and dairy products. However, the largest portion of vitamin D is produced by our own body with the aid of sunlight.

Clinical Oncology Week, February 12, 2007

Breast Cancer; Research from Johns Hopkins University, U.S., broadens understanding of breast cancer

2007 FEB 12 - (NewsRx.com) -- Breast cancer study data from Johns Hopkins University, U.S., were highlighted recently in medical journals.

Study 1: New research, "Physiologic estrogen receptor alpha signaling in non-tumorigenic human mammary epithelial cells," is the subject of a report. According to a study from the United States, "Currently, a number of breast cancer cell lines exist that serve as models for both estrogen receptor alpha (ERalpha) positive and ERalpha negative disease. Models are also available for pre-neoplastic breast epithelial cells that do not express ERalpha; however, there are no ideal systems for studying pre-neoplastic cells that are ERalpha positive."

"This has been largely due to the inability to establish an estrogen growth stimulated, non-tumorigenic breast epithelial cell line, as most human breast epithelial cells engineered to overexpress ERalpha have been found to be growth inhibited by estrogens. We have developed independently derived clones from the non-cancerous MCF-10A human breast cell line that express ERalpha and are growth stimulated by 17-beta-estradiol (E2) in the absence of epidermal growth factor (EGF), a cytokine normally required for MCF-10A cell proliferation. This effect is blocked by the selective estrogen receptor modulator (SERM), Tamoxifen and the selective estrogen receptor downregulator, ICI 182,780 (Faslodex, Fulvestrant). Exposure of these cells to EGF and E2 results in a growth inhibitory phenotype similar to previous reports," wrote A.M. Abukhdeir and colleagues, Johns Hopkins University, Sidney Kimmel Cancer Center.

The researchers concluded: "These data present a reconciling explanation for the previously described paradoxical effects of ERalpha overexpression, and provide a model for examining the carcinogenic effects of estrogens in non-tumorigenic human breast epithelial cells."

Abukhdeir and colleagues published the results of their research in Breast Cancer Research and Treatment (Physiologic estrogen receptor alpha signaling in non-tumorigenic human mammary epithelial cells. Breast Cancer Research and Treatment, 2006;99(1):23-33).

For additional information, contact A.M. Abukhdeir, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Dept. of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD U.S.

Study 2: Breast cancer prevention claims associated with high soy consumption may be premature Researchers in the United States note, "High intake of soy foods has been proposed to contribute to the low breast cancer risk in Asian countries. However, results of epidemiologic studies of this association are highly variable, and experimental data suggest that soy constituents can be estrogenic and potentially risk enhancing."

"Thus, rigorous evaluation of available epidemiologic data is necessary before appropriate recommendations can be made, especially for women at high risk of breast cancer or those who have survived the disease," said B.J. Trock and colleagues of Johns Hopkins University. "We performed a meta-analysis of 18 epidemiologic studies (12 case-control and six cohort or nested case-control) published from 1978 through 2004 that examined soy exposure and breast cancer risk. Pooled relative risk estimates were based on either the original soy exposure measure defined in each study or on an estimate of daily soy protein intake."

"Risk estimates, levels and measures of soy exposure, and control for confounding factors varied considerably across studies," noted the investigators. "In a pooled analysis, among all women, high soy intake was modestly associated with reduced breast cancer risk (odds ratio [OR] =0.86, 95% confidence interval [CI] =0.75 to 0.99); the association was not statistically significant among women in Asian countries (OR=0.89, 95% CI=0.71 to 1.12)."

They continued, "Among the 10 studies that stratified by menopausal status the inverse association between soy exposure and breast cancer risk was somewhat stronger in premenopausal women (OR=0.70,95% CI=0.58 to 0.85) than in postmenopausal women (OR=0.77, 95% CI=0.60 to 0.98); however, eight studies did not provide menopause-specific results, six of which did not support an association. When exposure was analyzed by soy protein intake in grams per day, a statistically significant association with breast cancer risk was seen only among premenopausal women (OR=0.94, 95% CI=0.92 to 0.97)."

"Soy intake may be associated with a small reduction in breast cancer risk," the scientists concluded. "However, this result should be interpreted with caution due to potential exposure misclassification, confounding, and lack of a dose response. Given these caveats and results of some experimental studies that suggest adverse effects from soy constituents, recommendations for high-dose isoflavone supplementation to prevent breast cancer or prevent its recurrence are premature."

Trock and colleagues published their study in the Journal of the National Cancer Institute (Meta-analysis of soy intake and breast cancer risk. J Natl Cancer Inst, 2006;98(7):459-471).

For additional information, contact B.J. Trock, Johns Hopkins School of Medicine, Department of Urology, 600 N. Wolfe Street, 149 Jefferson Building, Baltimore, MD 21287, USA. btrock@jhmi.edu.

Study 3: Breast flap reconstruction after subcutaneous mastectomy has improved aesthetic outcome compared to implants.

According to scientists in the United States, "Subcutaneous mastectomy for women with advanced breast cancer has been historically controversial because of the increased risk for tumor recurrence. Despite this, some women remain interested in this method of treatment as a means of preserving the appearance of the breast and nipple-areola complex."

"Several studies have evaluated the feasibility of subcutaneous mastectomy; however, there has been no study that has critically analyzed the aesthetic outcome of the nipple-areola complex following this approach," noted M.Y. Nahabedian and T.N. Tsangaris of Johns Hopkins University.

"Over a 14-month interval, 12 women had subcutaneous mastectomy with preservation of the nipple-areola complex," the researchers explained. "The reconstruction was unilateral in 10 women and bilateral in two women, totaling 14 breasts. The mastectomy was for cancer in 11 and for prophylaxis in three breasts. Outcomes were assessed based on the sensation, appearance, and secondary procedures of the nipple-areola complex, and tumor recurrence and patient satisfaction."

The authors continued, "Of the five parameters, sensation was present in six breasts (42.9 percent), delayed healing was noted in four breasts (28.6 percent), symmetry with the contralateral breast was achieved in five of 10 women (50 percent) following unilateral reconstruction, tumor recurrence was noted in three of 11 breasts (27.3 percent), and secondary procedures related to the nipple-areola complex were necessary in five of the 14 breasts (35.7 percent). Outcome was graded as excellent in three, good in eight, and poor in three breasts."

"This study has demonstrated that aesthetic outcome of the nipple-areola complex is variable following subcutaneous mastectomy and immediate breast reconstruction," concluded the investigators. "However, patient satisfaction was graded as good to excellent in 11 of 14 breasts (78.6 percent). Subcutaneous mastectomy with flap reconstruction results in fewer secondary procedures and improved aesthetic outcome when compared with implant reconstruction."

Nahabedian and Tsangaris published the results of their research in Plastic and Reconstructive Surgery (Breast reconstruction following subcutaneous mastectomy for cancer: A critical appraisal of the nipple-areola complex. Plast Reconstr Surg, 2006;117(4):1083-1090).

For additional information, contact M.Y. Nahabedian, Georgetown University Hospital, Department of Plastic Surgery, 3800 Reservoir Road, NW, Washington, D.C. 20007, USA. DrNahabedian@aol.com.

Keywords: Baltimore, Maryland, United States, Breast Cancer, Breast Carcinoma, Breast Reconstruction Surgery, Breast Surgery, Mastectomy, Breast Cancer Therapy, Women's Health.