Reuters Health E-Line, 26 March 2008
Disparity seen in breast cancer surgery
By Karla Gale
NEW YORK (Reuters Health) - The likelihood that a woman with early breast cancer will undergo a staging procedure called sentinal lymph node biopsy is largely influenced by her age, ethnicity, and insurance status, and not by the relevant disease factors, new research indicates.
Axillary lymph node dissection, which involves removing all lymph nodes in the armpit, has been the traditional operation to determine whether cancer has spread beyond the breast. Sentinal lymph node biopsy, by contrast, is a newer, less extensive procedure in which only a single "sentinel" node in the armpit is removed to determine if the cancer has spread.
Better outcomes are associated with sentinal lymph node biopsy compared with axillary lymph node dissection, including decreased arm swelling and pain. According to Dr. Amy Y. Chen, with the American Cancer Society in Atlanta, and colleagues, little is known about factors that influence the choice of procedure.
They examined these issues using the National Cancer Database, which covers facilities approved by the American College of Surgeons Commission on Cancer. Their study included 491,000 patients with breast cancer who underwent surgical treatment including lymph node sampling between 1998 and 2005.
The use of sentinal lymph node biopsy increased from 26.8 percent in 1998 to 65.5 percent in 2005, Chen and her colleagues report in the Journal of the National Cancer Institute.
Age over 72 years, belonging to a racial/ethnic minority, and having Medicaid or no health insurance were all associated with undergoing axillary lymph node dissection rather than sentinal lymph node biopsy. Not graduating from high school and a lower household income were also predictive of undergoing the more extensive operation.
The research team examined trends over time and found that, in contrast to disparities that existed in 2005, some factors, including older age, income, and health insurance status, were not associated with the chances of undergoing sentinal lymph node biopsy in 1998. The disparities associated with minority status widened.
"Even when we controlled for low income and health insurance status, racial disparities still persisted," Chen added. "It is concerning to see that as dissemination of sentinal lymph node biopsy increased across all facility types, racial and socioeconomic status disparities increased."
However, because the database does not include individual hospital characteristics, she added, they could not tell if "disproportionate groups of poorer individuals, for example, seek medical care at facilities that do not offer sentinal lymph node biopsy."
These findings imply, the authors state, that "those who are more likely to receive axillary lymph node dissection may lack resources to deal with the added burdens associated with its adverse effects."
SOURCE: Journal of the National Cancer Institute, April 2, 2008.UPDATE 1-Study debunks personality link to breast cancer
By Will Dunham
29 January 2008
(c) 2008 Reuters Limited
WASHINGTON, Jan 29 (Reuters) - The idea that a woman's personality traits can make her more prone to breast cancer appears nothing more than a myth, according to a Dutch study.
Women who were unemotional, depressed or anxious were no more or less likely to get breast cancer than any other women, the study found. Nor were women who were optimistic, angry or understanding, or had any combination of personality traits.
The Dutch researchers measured 11 personality traits in 9,705 Dutch women in a survey in 1989 and 1990, then tracked them through 2003 to see who got breast cancer.
"The present results indicate that women should not worry about a possible impact of personality factors as a risk factor for breast cancer," Eveline Bleiker of the Netherlands Cancer Institute and Antoni van Leeuwenhoek Hospital in Amsterdam, who led the study, said by e-mail.
"Moreover, women with breast cancer should not worry that their character might have contributed to the development of their disease."
Bleiker noted that some researchers in the 1980s had advanced the idea of a "cancer-prone" personality with such traits as stoicism and difficulty in expressing emotions.
"The earlier studies had a number of methodological flaws," Bleiker said, adding that more recent, large studies have not found the existence of a "cancer-prone" personality. "In summary, there is currently no convincing evidence that such a personality profile exists," Bleiker said.
In 1996, the Dutch team studied the same group of women for five years and found that one of the 11 personality traits -- what they called "anti-emotionality" -- actually was associated with a slight increased risk for breast cancer.
But after tracking the women for a longer time in the new study, this association vanished. This suggests it may have been only a chance finding, Bleiker said.
Women with the "anti-emotionality" trait responded negatively to survey questions such as: "In important situations, I trust my feelings," "I respond emotionally to people," and "My behavior is influenced by my emotions."
The findings were published in the Journal of the National Cancer Institute.
Kevin Stein, a researcher at the American Cancer Society who was not involved in the Dutch study, said it is inappropriate and factually incorrect to blame a woman's personality for her breast cancer.
"I am pleased to see this stuff knocked down," Stein said in a telephone interview. "There's really no support for the idea that your personality or your attitude can either cause a cancer or prevent or help avoid a cancer."
Cancer experts often work to shoot down various cancer myths. Among other misconceptions about cancer, the American Cancer Society debunks the idea that using underarm deodorants or antiperspirants can increase breast cancer risk, or that wearing under-wire bras raises the risk for breast cancer. (Editing by Maggie Fox and Mohammad Zargham)
Smoking ups risk with radiation for breast cancer
22 January 2008
(c) 2008 Reuters Limited
NEW YORK (Reuters Health) - Cigarette smoking dramatically increases the risk that a woman who has undergone radiation treatment for breast cancer will develop lung cancer later on, a new study shows.
Radiation after mastectomy may be considered for some high-risk breast cancer patients, Dr. Elizabeth L. Kaufman and colleagues from Columbia University in New York City point out in their report. However, radiation can cause many complications, including increasing the likelihood that a patient will develop lung cancer 10 or more years after treatment, they add.
An earlier, small study by Kaufman and her team had suggested that cigarette smoking could boost this risk even more. To investigate further, she and her colleagues looked at breast cancer patients included in the Connecticut Tumor Registry who had been diagnosed with the disease between 1965 and 1989. They compared 113 women who had developed lung cancer 10 or more years after their breast cancer diagnosis with 364 women who did not.
Non-smoking women who had undergone radiation were no more likely than those who hadn't had radiation therapy to develop lung cancer, the researchers found. However, women who smoked but didn't have radiation therapy were nearly six times as likely to be diagnosed with lung cancer than non-smokers who didn't have radiation, while women who smoked and did undergo radiation therapy were at nearly 19-fold greater risk.
Combined smoking and radiation therapy increased the risk that a woman would develop cancer in the lung on the same side of the body as her affected breast nearly 38-fold, while the risk of developing cancer in the opposite lung was more than 10-fold greater.
The findings suggest, the researchers say, that women who have smoked and undergone radiation therapy for breast cancer should undergo screening for lung cancer using a scanning technique called spiral computed tomography.
Furthermore, doctors should consider a patient's smoking history when discussing her breast cancer treatment options, they add, especially if radiation may offer only a "marginal" survival advantage.
SOURCE: Journal of Clinical Oncology, January 20, 2008.
Extended therapy may benefit breast cancer patients
11 December 2007
Reuters News
(c) 2007 Reuters Limited
NEW YORK (Reuters Health) - Postmenopausal women with breast cancer who successfully complete 5 years of tamoxifen therapy derive significant benefit from an additional 3 years of therapy with the anastrozole, an aromatase inhibitor, according to study findings published in the Journal of the National Cancer Institute.
Dr. Raimund Jakesz, of Vienna Medical University and members of the Austrian Breast and Colorectal Study Group, randomly assigned 856 hormone receptor-positive breast cancer patients, who were disease-free following primary surgery and 5 years of tamoxifen therapy, to 3 years of anastrozole or no further treatment.
After approximately 5 years, the women who received anastrozole had a statistically significant 38 percent reduced risk of local and regional recurrence; cancer in the other breast; and distant spread of the disease, compared with women who received no further treatment.
However, there was no significant difference in overall survival between the treatment groups.
Three years of anastrozole following 5 years of tamoxifen was generally well tolerated and "no unexpected adverse events were reported," Jakesz and colleagues note.
They suggest that the "more manageable side effect profile of anastrozole compared with tamoxifen may allow the duration of adjuvant treatment to extend beyond the 5-year period recommended for tamoxifen."
In an accompanying editorial, Drs. Tatiana Powell and Vered Stearns of Johns Hopkins University School of Medicine, Baltimore, say these results offer additional support for extending the duration of therapy with tamoxifen followed by an aromatase inhibitor to 8 years.
"However, whether such a course of extended adjuvant therapy is superior to either aromatase inhibitor monotherapy or shorter courses of sequential therapy is presently unknown," they add.
Powell and Stearns also point out that while the safety profile of extended therapy with an aromatase inhibitor "appears to be generally acceptable," the increasing use of these drugs has suggested the prevalence and severity of musculoskeletal side effects may be underestimated.
Recent observational studies, the physicians note, have shown that nearly half of the patients taking aromatase inhibitors experienced symptoms of joint pain and stiffness. One quarter of these symptoms were described as severe and up to 13 percent women stopped taking the medication within the first year because of these symptoms.
SOURCE: Journal of the National Cancer Institute, December 11, 2007.
Avoiding weight gain important after breast cancer
By Megan Rauscher
11 December 2007
Reuters Health E-Line
© 2007 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
NEW YORK (Reuters Health) - Women who put on weight after being diagnosed with breast cancer substantially increase their risk of dying, research suggests.
"Our results generally support the recognized health benefits and potentially a mortality reduction associated with avoiding weight gain after breast cancer diagnosis," Dr. Hazel B. Nichols told the Sixth International Conference on Frontiers in Cancer Prevention, sponsored by the American Association for Cancer Research.
The results "add to a growing body of evidence that post-diagnosis lifestyle factors - the things that you incorporate after a breast cancer diagnosis, such as diet and exercise -- do have potential to improve survival," added Nichols, from the Johns Hopkins School of Public Health, Baltimore.
The study involved 4,021 women diagnosed with breast cancer between 1988 and 2001. In 1998-2001, all surviving women provided details about their change in weight, physical activity, diet and lifestyle.
After an average of about 6 years of follow up, 121 women died of breast cancer and 428 died of other causes.
"What we found -- not surprisingly -- was that as BMI (body mass index) and weight gain increased, the risk of death from breast cancer and other causes also went up," Nichols told the conference. "For every 5 kilograms (11 pounds) of weight gain, the risk of death went up by 14 percent."
Women who reported gaining more than 10 kilograms (22 pounds) since their breast cancer diagnosis had approximately an 80-percent increase in their risk of death; women who had a BMI in the obese range after diagnosis had more than twice the risk of breast cancer mortality compared to women with a normal BMI.
"These findings suggest that efforts towards preventing post-diagnosis weight gain may positively affect breast cancer survival," Nichols and colleagues conclude in a meeting abstract.
Sunlight may cut breast cancer risk for some women
29 October 2007
Reuters News
(c) 2007 Reuters Limited
NEW YORK, Oct 29 (Reuters Life!) - Exposure to sunlight may reduce the risk of advanced breast cancer in women with light skin pigmentation, according to a new study.
It is not the first study to link sun exposure with a reduced risk of breast cancer but the researchers said they measured exposure in a new way.
"We believe that sunlight helps reduce women's risk of breast cancer because the body manufactures the active form of vitamin D from exposure to sunlight," Dr. Esther M. John, of the Northern California Cancer Center in Fremont, said in a statement.
"It is possible that these effects were observed only among light-skinned women because sun exposure produces less vitamin D among women with naturally darker pigmentation."
The researchers measured women's skin pigmentation on the forehead, which is usually exposed to the sun, and on the upper inner arm, which normally is not. They used the difference between the two measurements as an indication of past sun exposure. Other studies have usually relied on self-reported sun exposure.
The study published in the American Journal of Epidemiology included 1788 women with breast cancer and a comparison group of 2129 healthy women. In addition to the sun exposure test, skin specimens were obtained and analyzed in a subgroup of women in each group.
High levels of sun exposure were associated with a 47 percent reduced risk of advanced breast cancer in light-skinned women, the results show. Mutations of the vitamin D receptor gene did not affect the association.
But the association was not seen in women with medium or dark skin and was only apparent for advanced disease.
The researchers believe the results could have important public health implications but said more research is needed.
"While the public needs to be advised to avoid excessive sun exposure and sun burns in particular because of the known risk of skin cancer and melanoma, never getting any sun exposure leads to vitamin D deficiency," John said.
The evidence is increasing that vitamin D may decrease the risk of certain cancers, such as breast, prostate and colon cancers.
Study confirms breast cancer worse in US blacks
By Maggie Fox
6 September 2007
Reuters Health E-Line
© 2007 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
WASHINGTON (Reuters) - Black American women are more likely to have a hard-to-treat form of breast cancer, they get it earlier and they are more likely to die of it, researchers said on Thursday.
Their findings, presented at a breast cancer conference in San Francisco, support other studies that show clear ethnic differences in breast cancer that are likely to be genetic in origin.
The findings held regardless of a woman's income, education or insurance coverage, Dr. Catherine Lee of the University of Michigan Comprehensive Cancer Center said.
"We found overall that African-Americans are diagnosed at younger ages and at more advanced stages than their white American counterparts," Lee told reporters in a telephone briefing.
Blacks are also far more likely to have a form of cancer called estrogen receptor-negative cancer -- the type that is not helped by estrogen-based drugs such as tamoxifen.
Lee's team analyzed data on 170,079 cases of breast cancer from 1,600 hospitals in all 50 states. White women accounted for 90 percent of the cases, with black women making up nearly 10 percent.
Thirty-nine percent of black women had ER-negative tumors, compared with 22 percent of white women. Black women were diagnosed at an average age of 57, compared to 62 for white women, yet their cancer was more advanced, with just 29 percent having stage 1 tumors that had not spread yet, compared to 42 percent of white women.
The findings bolster a growing body of evidence that shows breast cancer is different biologically in African-American women, Lee told the Breast Cancer Symposium, co-sponsored by the American Society of Breast Disease, the American Society of Breast Surgeons and other groups.
"Differences in tumor biology have a significant impact on survival," Lee said in a statement.
"The fact that breast cancers in black women are more aggressive biologically suggests that we need to focus more of our research energy on developing better treatments targeting ER-negative tumors," she added.
"These findings also point to a need for improved cancer education and screening in black women, particularly those in younger age groups."
Breast cancer is the second most common cancer killer of women, after lung cancer. It will be diagnosed in 1.2 million people globally this year and will kill 500,000.
Last Updated: 2007-09-06 10:01:08 -0400 (Reuters Health)