Montclair Breast Center

Women’s Health Weekly, 21 August 2008
Breast Cancer; Researchers from Hadassah University, Department of Diagnostic Radiology detail findings in breast cancer

(c) Copyright 2008 Women's Health Weekly via NewsRx.com

2008 AUG 21 - (NewsRx.com) -- Researchers detail in 'Breast magnetic resonance imaging characteristics in women with occult primary breast carcinoma,' new data in breast cancer. According to recent research from Jerusalem, Israel, "Occult breast cancer without clinically or mammographically detectable breast tumor is an uncommon presentation. To assess the role of breast MRI in women with metastatic carcinoma and an occult primary, and to define the MRI characteristics of the primary breast tumor."

"This retrospective study evaluated 20 women with metastatic carcinoma of unknown origin who underwent breast MRI between 2000 and 2006. Four women were excluded, leaving 16 in the study group. Probability of malignancy was assessed according to BIRADS classification. MRI performance in detecting lesions and evaluating disease extent was assessed, with the gold standard being surgical or biopsy pathology. MRI detected suspicious lesions in 15 patients.

Lesion size ranged from 0.4 to 7 cm (median 1.5 cm). MRI detected a single lesion in 6 patients (40%), multifocal disease in 3 (20%), multicentric disease in 4 (27%), and bilateral breast lesions in 2 (13%). In 13 patients MRI depicted the primary breast cancer. Initial treatment was surgical in 9; MRI correctly estimated disease extent in 6 (67%), underestimated disease extent in 1 (11%), and overestimated it in 2 (22%). Four patients had biopsy followed by chemotherapy; one had multicentric disease and one had multifocal disease. MR findings were false positive in two patients and false negative in one. MRI is sensitive in detecting the primary tumor and beneficial in assessing tumor extent. Small size and multiple foci are common features," wrote S. Lieberman and colleagues, Hadassah University, Department of Diagnostic Radiology.

The researchers concluded: "We suggest that bilateral breast MRI be part of the evaluation of women with metastatic carcinoma and an occult primary."

Lieberman and colleagues published their study in Israel Medical Association Journal (Breast magnetic resonance imaging characteristics in women with occult primary breast carcinoma. Israel Medical Association Journal, 2008;10(6):448-52).

For additional information, contact S. Lieberman, Hadassah-Hebrew University Medical Center (Ein Kerem Campus), Dept. of Diagnostic Radiology, Jerusalem, Israel.

Publisher contact information for the Israel Medical Association Journal is: Israel Medical Association Journal, 2 Twin Towers, 11TH FL, 35 Jabotinsky St., PO Box 3604, Ramat GaN 52136, Israel.

Women's Health Weekly, 17 July 2008
The North American Menopause Society; The North American Menopause Society NAMS Issues New Recommendations Regarding Management of Breast Cancer Risk in Postmenopausal Women

(c) Copyright 2008 Women's Health Weekly via NewsRx.com

2008 JUL 17 - (NewsRx.com) -- The North American Menopause Society (NAMS) has just released a supplement to its official journal Menopause to meet the need for current clinical recommendations for managing breast cancer risk in postmenopausal women.

Breast cancer is the most common cancer among women, except for nonmelanoma skin cancers, and is the second leading cause of cancer death for women worldwide. According to the American Cancer Society, 182,460 new cases of invasive breast cancer will be diagnosed in US women in 2008 with 40,930 deaths anticipated. Women living in North America have the highest rate of breast cancer in the world.

"The single most important risk factor for breast cancer is age. The risk of breast cancer increases among women older than 50 years of age who have either atypical hyperplasia or lobular carcinoma in situ, a first-degree family history of breast cancer, and BRCA1 or BRCA2 genetic mutations," said Victor G. Vogel, MD, MHS, Professor of Medicine and Epidemiology, University of Pittsburgh School of Medicine, Co-Director, University of Pittsburgh Institute Biochemoprevention Program, who served as Guest Editor of the supplement.

"More than 10 million women in North America are at increased risk of breast cancer, and clinicians have an imperative to identify these women and manage their risk appropriately."

While breast cancer rates have slowly declined for the past 15 years, especially in postmenopausal women aged 55 to 69 years, these decreases were primarily evident for small tumors (less than or equal to 2 cm) and local and regional disease. Breast cancer mortality rates have also declined, due to earlier detection through screening and more effective treatment options. The impact of screening, however, has likely reached a plateau. Clinicians are now challenged to counsel their high-risk patients who will receive the maximum benefit from chemoprevention with oral medications. Findings from a number of prospective, randomized, controlled trials have established the efficacy of tamoxifen and raloxifene for the prevention of breast cancer in these women.

The best approach to breast cancer risk estimation and management involves collecting comprehensive data on risk factors from all perimenopausal and early postmenopausal women and evaluating that data with an appropriate quantitative risk model. There is evidence to suggest, however, that such assessments are not routinely conducted by all healthcare providers. This special issue provides an overview of the critical findings and issues regarding breast cancer risk and chemopreventive agents to reduce that risk.

"Written by eight specialists in women's health and cancer, these articles aim to support clinicians who care for adult women, some of whom might be at increased risk for breast cancer and need advice about interventions, where appropriate, to decrease the likelihood that they will develop an invasive breast cancer in their lifetimes," explained Dr. Vogel.

This educational supplement, designated a continuing medical education activity by NAMS, has been developed according to the policies established in 2004 by the Menopause Editorial Board and the NAMS Board of Trustees. Publication standards are as strict as with any regular issue of the journal, including the same peer-review process. NAMS appreciates the efforts of the authors and the educational grant from Eli Lilly and Company.

The Mission of NAMS, a nonprofit scientific organization, is to promote the health and quality of life of women through an understanding of menopause. The Society's membership of 2,000 professionals representing a variety of disciplines--including clinical and basic science experts from medicine, nursing, pharmacy, anthropology, sociology, psychology, and complementary/alternative medicine--makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause. (www.menopause.org)

Women's Health Weekly, 17 July 2008

University of Michigan Health System; Lack of CHFR gene expression sets stage for breast cancer

2008 JUL 17 - (NewsRx.com) -- A University of Michigan study reveals in detail how breast cells produce new cells that are predisposed to become cancerous, unless they receive the protective action of the CHFR gene.
CHFR expression is missing in more than a third of breast cancers. Analysis of this gene is also a hot area of interest among researchers trying to explain colorectal, stomach, lung and other forms of cancer.

The new study reveals how and why new "daughter" cells, produced as cells in body tissues renew themselves, receive too few or too many chromosomes if expression of the CHFR gene is missing or low. The loss of CHFR can lead to the survival of genetically unstable cells loaded with too many chromosomes, which can lead to cancer.

"Our findings show that loss of CHFR disrupts normal chromosome segregation in breast cells during cell division and creates genomic instability, which can drive genetic mechanisms that accelerate the development of cancer," says Elizabeth Petty, M.D., a U-M professor in the departments of human genetics and internal medicine and the senior author of the study. The article appears online ahead of print in the journal Neoplasia.

The new knowledge eventually could provide the scientific basis for diagnostic markers and identify which patients can benefit from specific types of cancer drugs.

"Our previous findings, and the work of others, have shown that cancer cells cultured in the lab that have low or absent CHFR expression are more susceptible to treatment with a class of drugs called taxanes, such as paclitaxel (Taxol) and docetaxel, that attack the dividing cells when they are trying to separate their chromosomes," says Lisa Privette, Ph.D., the study's first author, a recent U-M Medical School graduate and now a researcher at Cincinnati Children's Hospital.
"These drugs are frequently used to treat breast cancer and other types of cancer and they work by targeting the structure used to separate chromosomes. Our work provides further evidence for this correlation and begins to explain how the expression of CHFR alters the cell's response to these kinds of drugs."

Why do some women lack CHFR function or have low function in the first place? Petty says that there's no evidence that women inherit mutations that lead to low or absent CHFR protein.

"It's likely that some other mechanism is shutting down CHFR," she says. "Currently, we are actively looking at ways in which CHFR may be turned off in normal cells, in hopes that we can find a molecular switch to keep it turned on and decrease the risk of cancer development."

Context: The study adds important insights in the continuing search for the roles different genes play in breast cancer. In cell culture studies, Petty's research team previously showed that loss of CHFR was associated with increased tumor size, and that normal breast epithelial cells would develop traits of cancer cells if CHFR was blocked. In the new study, the researchers report what happens inside a dividing cell nucleus when CHFR is missing.

One prime moment in which cancer can begin is when alterations in certain biochemical signals disturb the process by which one cell divides into two. In normal cell division, chromosomes inside the nucleus copy themselves, then line up in the middle of a structure, the mitotic spindle, which forms to aid cell division. The two copies then neatly separate and move to the ends of the spindle, where they become two bundles of identical genetic material. These become the cell's operating instructions for two new daughter cells.

If the spindle doesn't form correctly, genetic material becomes unstable and doesn't divide properly, resulting in cancer-prone cells containing too many chromosomes. The fact that the spindle is affected is important, because some cancer drugs interact with the mitotic spindle as a way to curb cell division.

Research details: Petty and her team studied normal and cancerous human breast tissue samples in cell culture to find out how CHFR affects certain proteins. They focused on proteins that regulate how spindles form and how chromosomes divide and form along the spindle. The team found that CHFR interacts with alpha tubulin, a protein important in forming mitotic spindles, and with a key mitotic spindle checkpoint regulator, MAD2, previously implicated in breast cancer. They found that when CHFR is absent, MAD2 does not do its job.

"Cells without CHFR not only have problems creating the structure or apparatus necessary to separate the chromosomes between the two daughter cells during cell division. They also have an impaired ability to detect and correct the problem before the chromosomes separate," says Privette.

"Prior to our findings, we knew that breast cancer cells often had the wrong number of chromosomes, but no one had identified any gene, or group of genes, that could account for the high frequency of this problem," says Privette.
The new study, she says, "provides one reason why the majority of breast cancer cells have too many chromosomes, which is a major hallmark of malignant cancers. Although a lot of work remains, and other genes are likely involved, our work on the role of CHFR in breast cancer development is an interesting and important piece of a very large puzzle."

Women's Health Weekly, 17 April 2008

Breast Cancer; Chemotherapy-induced anemia increases risk of local breast cancer recurrence

2008 APR 17 - (NewsRx.com) -- Patients with breast cancer who developed anemia during chemotherapy had nearly three times the risk of local recurrence as those who did not, according to a study published in the April 1 issue of Clinical Cancer Research¸ a journal of the American Association for Cancer Research (see also Breast Cancer).

"We speculate that there may be an interaction between chemotherapy/radiotherapy and anemia," said lead researcher Peter Dubsky, MD, a senior consultant in the department of surgery at the Medical University of Vienna, Austria. "Both treatment modalities have been shown to be less effective in anemic patients. Since we do not see the effect in terms of relapse-free survival, the interaction with local adjuvant treatment may play a more important role."

Dubsky and his colleagues from the Austrian Breast and Colorectal Cancer Study Group examined data from a randomized, clinical trial comparing adjuvant hormonal treatment and tamoxifen with the standard treatment of cyclophosphamide, methotrexate and 5-fluorouracil (CMF). All women in the trial were premenopausal and had positive estrogen and/or progesterone receptor status. Patients who underwent breast-conserving surgery received mandatory radiation. Radiation was optional in women who underwent modified radical mastectomy.

For the current analysis, the researchers focused on anemia data from the 424 patients in the CMF arm, as the rates of anemia among those who received the hormonal treatment were low. They examined local relapse-free survival, relapse-free survival and overall survival.

Anemia occurred in 18.2 percent of patients who received CMF chemotherapy. Anemia was defined as an incidence of at least one serum hemoglobin level below 12 g/dL during chemotherapy through the first follow-up date three months after adjuvant treatment concluded.

After a median follow-up of 61 months, 39 local relapses occurred: 6.9 percent in patients without anemia and 19.5 percent in patients with anemia. The 5-year rates of relapse were 8.2 percent among nonanemic patients and 19.6 percent among anemic patients. Patients without anemia experienced a significantly longer local relapse-free survival than patients with anemia, according to the study.

Other factors that significantly increased local relapse-free survival were younger age at diagnosis and negative lymph node status. Any relationship between anemia and tumor size, postoperative radiation or type of surgery did not have an effect on local relapse-free survival, researchers say.

Relapse-free survival did not differ significantly with the presence or absence of anemia. "There seemed to be no difference when distant or contralateral events were part of the analysis," said Dubsky. "The effect was limited to local recurrences. Any explanation of the limit is pure speculation."

No difference in overall survival was evident, but Dubsky says he doubted one would be seen given the number of patients and the length of follow-up. Follow-up of 10 to 15 years would be needed to observe any significant differences, he says.

Women's Health Weekly, 17 April 2008

Breast Cancer; Integrating genetic information with breast cancer risk factors may help refine prognosis

2008 APR 17 - (NewsRx.com) -- Incorporating genetic information known as gene expression signatures with clinical and other risk factors for breast cancer may help refine estimates of relapse-free survival and predicted response to chemotherapy, according to a study in the April 2 issue of JAMA (see also Breast Cancer).

"The advent of genomic technology for the analysis of human tumor samples has now added an additional source of information to aid prognosis and clinical decisions. In particular, the development of genomic profiles that accurately assess risk of recurrence offers the hope that this information will more precisely define clinical outcomes in breast cancer. The dimension and complexity of such data provide an opportunity to uncover clinically valid trends that can distinguish subtle phenotypes [physical manifestations] in ways that traditional methods cannot," the authors write. Few studies have examined the value in integrating genomic information with the traditional clinical risk factors to provide a more detailed assessment of clinical risk and an improved prediction of response to therapy.

Chaitanya R. Acharya, M.S., of the Duke Institute for Genome Sciences and Policy, Duke University, Durham, N.C., and colleagues conducted a study to determine the value in incorporating genomic information with clinical and pathological risk factors to refine prognosis and to improve therapeutic strategies for early stage breast cancer. The study included patients with early stage breast cancer who were candidates for supplemental chemotherapy; 964 breast tumor samples were used. All patients were assigned relapse risk scores based on their respective clinicopathological features. Genetic testing was performed and gene expression signatures (characteristic profiles) were applied to these samples to obtain patterns of deregulation that correspond with relapse risk scores to refine prognosis with the clinicopathological prognostic model alone. Predictors of chemotherapeutic response were also applied to further characterize clinically relevant heterogeneity (diversity) in early stage breast cancer.

The researchers found that integrating gene expression signatures into clinical risk stratification could refine prognosis for patients in three risk subgroups (low, intermediate, and high) and help predict relapse-free survival and response to chemotherapy.

"Pending future prospective clinical validation, these results provide preliminary evidence that the profusion of gene expression signatures in defining breast cancer, if used appropriately, represent less of a paradox and should be viewed as an important complementary approach to current clinicopathological risk stratification systems. Furthermore, knowledge of increased likelihood of sensitivity to specific chemotherapeutic agents from a repertoire of drugs that are commonly used to treat breast cancer is something that could be more immediately used in current clinical practice, once issues regarding cost and accessibility are addressed, in instances wherein multiple chemotherapeutics or chemotherapeutic combinations are Food and Drug Administration approved, as in early stage breast cancer, and are considered the standard of care," the authors conclude.

Women's Health Weekly, 17 April 2008

Breast Cancer; Lack of patient-provider discussion contributes to disparities in use of breast reconstruction

2008 APR 17 - (NewsRx.com) -- CHICAGO (April 2, 2008) – In a new study examining disparities in postmastectomy breast reconstruction, researchers at Brigham and Women's Hospital (BWH) and Dana-Farber Cancer Institute (DFCI) in Boston, Mass., concluded that lack of patient-provider discussion may contribute to socioeconomic, age and race-related inconsistencies in the use of breast reconstruction after mastectomy. However, the study also found that reconstruction was more likely to occur after the surgeon discussed options with the patient, suggesting that efforts are required to increase and improve these conversations. The full study appears in the April issue of the Journal of the American College of Surgeons (see also Breast Cancer).

Breast reconstructive surgery is an expensive elective procedure, but for many women it is a vital component of surgical care for breast cancer. The choice to have breast reconstruction is a complex decision that is influenced by access to care, patient preference and the provider's interaction with the patient.

"Patient preferences should be respected, but an informative discussion of reconstruction is required to help patients understand and weigh the risks and benefits of this procedure," said Caprice C. Greenberg, MD, Instructor of Surgery in the Center for Surgery and Public Health at BWH and the Center for Outcomes and Policy Research at DFCI. "We learned that physicians need to improve communications with patients and whenever possible, universally address the issue of reconstruction with all women undergoing a mastectomy, regardless of age, race or socioeconomic status."

Using the National Initiative on Cancer Care Quality database, researchers evaluated 626 patients who underwent mastectomy for breast cancer. The data had been collected in a study commissioned by the American Society of Clinical Oncology (ASCO) and undertaken by researchers at the Rand Corporation and the Harvard School of Public Health. Researchers reviewed data collected via survey and chart review approximately four years after diagnosis of breast cancer. Of these patients, 253 (40.4 percent) received breast reconstruction, and 249 (39.8 percent) had medical records documenting the occurrence of a discussion about this option.

"The data from the NICCQ study are continuing to reveal important opportunities to improve cancer care," said ASCO President Nancy Davidson, MD, professor of oncology and breast cancer research chair at the Sidney Kimmel Cancer Center at Johns Hopkins University in Baltimore. "As oncologists, we need to be sure that we are thoroughly communicating with patients about all of their options for care."

Approximately 70 percent of patients who had a documented discussion about breast reconstruction with their provider underwent the procedure. However, researchers found that increasing age and lower levels of education were associated with lower rates of a documented discussion. Hispanic patients, patients born outside the United States and those whose primary language was not English were less likely to actually receive reconstruction once the procedure was discussed

Based on these results, the study authors suggest that physicians should systematically address the issue of reconstruction with all patients undergoing mastectomy, including why she is or is not a candidate. They also recommend optimizing physician-patient discussions by using interpreters and appropriate educational materials to ensure an informative conversation regardless of primary language, ethnicity, or education level.

Women's Health Weekly, 17 April 2008

Breast Cancer Research; New breast cancer research research from J. West and co-researchers described

2008 APR 17 - (NewsRx.com) -- "Angiosarcomas are aggressive tumors of endovascular origin. Although angiosarcomas are relatively rare, they are being reported wit's, increasing frequency in patients who have previously undergone breast conserving therapy," scientists in the United States report (see also Breast Cancer Research).

"The initial clinical presentation of angiosarcomas after breast irradiation is often similar to the presentation of recurrent breast carcinomas. In addition, the histologic and cytologic appearance of posttreatment angiosarcomas can be highly suggestive of recurrent breast carcinoma. Immunohistochemical stains are often required to make an accurate distinction between the 2 entities. An accurate diagnosis is essential, because prognosis and treatment are different for each condition. An early and accurate diagnosis is aided by a high index of suspicion by clinician and pathologist," wrote J. West and colleagues.

The researchers concluded: "Herein, a case history is presented that underscores the pitfalls in attempting to achieve an accurate diagnosis."

West and colleagues published their study in Clinical Breast Cancer (Angiosarcoma after breast conservation: Diagnostic pitfalls. Clinical Breast Cancer, 2008;8(1):94-96).

For additional information, contact J. West, Breast Care & Imaging Center Orange County, 33 Creek Rd., Ste. C300, Irvine, CA 92604, USA.

The publisher's contact information for the journal Clinical Breast Cancer is: Cig Media Group, Lp, 3500 Maple Avenue, Ste. 750, Dallas, TX 75219-3931, USA.

Women's Health Weekly, March 6, 2008

Breast Cancer; Report says half a million cancer deaths have been averted since death rate drop

(c) Copyright 2008 Women's Health Weekly via NewsRx.com
2008 MAR 6 - (NewsRx.com) -- Feb. 20, 2008 – The American Cancer Society’s annual cancer statistics report finds that death rates from cancer in the United States have decreased by 18.4 percent among men and by 10.5 percent among women since mortality rates began to decline in the early 1990s, which translates to the avoidance of more than half a million actual cancer deaths (534,500) in the United States. Society epidemiologists predict that in the U.S. in 2008 there will be 1,437,180 new cancer cases (745,180 in men and 692,000 in women) and 565,650 cancer deaths (294,120 among men and 271,530 among women) (see also Breast Cancer).

The findings come from Cancer Statistics 2008, published in the March/April issue of CA: A Cancer Journal for Clinicians, as well as in the 57th edition of its companion publication, Cancer Facts & Figures 2008.

Despite a continuing decline in the cancer death rate from 2004 to 2005, there was an increase of 5,424 actual deaths (559,312 cancer deaths in 2005 compared to 553,888 cancer deaths in 2004). This increase follows a decrease in the number of cancer deaths in the two previous years. The change is largely due to a smaller decline in the cancer death rate between 2004 and 2005 compared with that in the two previous time periods. From 2004 to 2005, overall cancer mortality dropped about 1 percent, compared to a 2 percent drop from both 2002 to 2003 and 2003 to 2004. With respect to the four major cancer sites, colorectal cancer death rates decreased by about 3 percent from 2004 to 2005, compared to about 6 percent from 2003 to 2004. The decrease in death rates for cancers of the lung and bronchus and prostate in men and breast in women was also smaller from 2004 to 2005 than from 2003 to 2004. It is important to understand that for the number of cancer deaths to decrease, the decline in the overall cancer mortality rate must be large enough to offset the increasing numbers due to growth and aging of the population.

"The increase in the number of cancer deaths in 2005 after two years of historic declines should not obscure the fact that cancer death rates continue to drop, reflecting the enormous progress that has been made against cancer during the past 15 years," said John R. Seffrin, Ph.D., American Cancer Society chief executive officer. "While in 2005 the rate of decline was not enough to overtake other population factors, the fact remains that cancer mortality rates continue to drop, and they’re doing so at a rate fast enough that over a half million deaths from cancer were averted between 1990/1991 and 2004."

The cancer incidence and mortality data were collected by the Centers for Disease Control, the National Cancer Institute, the North American Association of Central Cancer Registries, state and local health agencies, and thousands of cancer registrars throughout the country. Since 1952, when the first edition of Cancer Facts & Figures consisted of four typewritten pages, the American Cancer Society’s annual estimate of new cancer cases and deaths has become a critical tool for scientists, public health experts, and policymakers in assessing the current burden of cancer. These estimates are some of the most widely quoted cancer statistics in the world. The Society’s leading team of epidemiologic researchers, in collaboration with scientists from the National Center for Health Statistics, compiles and analyzes incidence and mortality data to estimate the number of new cancer cases and deaths for the current year nationwide and in individual states.

Highlights from this year’s publications:

Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for one in two (50 percent) of all newly diagnosed cancers. Prostate cancer alone accounts for one in four (25 percent) of the total cases in men. The three most commonly diagnosed types of cancer among women in 2008 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for 50 percent of estimated cancer cases in women. Breast cancer alone is expected to account for one in four (26 percent) new cancer cases among women. Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. Lung cancer is expected to account for 26 percent of all female cancer deaths in 2008. Cancer incidence rates stabilized in men from 1995 to 2004 and in women from 1999 to 2004. Between 2002 and 2004, death rates for all cancer sites combined decreased by 2.6 percent per year in males and by 1.8 percent per year in females. Mortality rates have continued to decrease across all four major cancer sites in men and in women except for female lung cancer, in which rates continued to increase by 0.2 percent per year from 1995 to 2004. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990/1991 and 2004, death rates from cancer decreased by 18.4 percent among men and by 10.5 percent among women. Lung cancer incidence rates are declining in men and appear to be plateauing in women after increasing for many decades. Colorectal cancer incidence rates decreased from 1998 through 2004 in both males and in females. Female breast cancer incidence rates decreased by 3.5 percent per year from 2001 to 2004, after increasing since 1980. The decreases may reflect the saturation of mammography utilization and reduction in hormone replacement therapy use that followed the publication of study results from the Women’s Health Initiative in 2002. Among males under age 40 years, leukemia is the most common fatal cancer, while lung cancer predominates in men aged 40 years and older. Among females, leukemia is the leading cause of cancer death before age 20 years, breast cancer ranks first at age 20 to 59 years, and lung cancer ranks first at ages 60 and older. African American men have a 19 percent higher incidence rate and 37 percent higher death rate from all cancers combined than white men. African American women have a 6 percent lower incidence rate, but a 17 percent higher death rate than white women for all cancers combined. Among other racial and ethnic groups, cancer incidence and death rates are lower than those in whites and African Americans for all cancer sites combined and for the four most common cancer sites. Cancer is the second leading cause of death among children between ages one to 14 years in the U.S., after accidents. The five-year relative survival rate among children for all cancer sites combined improved from 58 percent for patients diagnosed in 1975 to 1977 to 80 percent for those diagnosed in 1996 to 2003.

Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted with caution. These estimates may vary considerably from year to year, particularly for less common cancers and in states with smaller populations. Despite these limitations, the American Cancer Society’s estimates of the number of new cancer cases and deaths in the current year provide reasonably accurate estimates of the burden of new cancer cases and deaths in the United States. Such estimates will assist in continuing efforts to reduce the public health burden of cancer.

Each year, Cancer Facts & Figures features a Special Section highlighting one aspect of cancer prevention, early detection, or treatment. In recent years, the section has focused on tobacco, obesity, infectious causes of cancer, environmental pollutants, and cancer-related pain. The Special Section of Cancer Facts and Figures 2008 is "Insurance and Cost-Related Barriers to Cancer Care." About 47 million people in the U.S. are uninsured; minority populations and/or those with low income are disproportionately represented in this category. Recognizing that reducing barriers to cancer care is critical in the fight to eliminate suffering and death due to cancer, the American Cancer Society and its sister advocacy organization the American Cancer Society Cancer Action Network (ACS CAN) are working together to bring the need for meaningful healthcare reform to the forefront of public and political debate. One important goal of this campaign is to educate Americans about the extent of the access to care problem and to motivate them to take action in support of change. The Special Section provides an overview of systems of health insurance and describes the impact of being uninsured or underinsured on cancer prevention, diagnosis, treatment, and outcome.

"The progress that has been made in reducing cancer death rates is a direct result of investment in approaches that we know work, such as comprehensive tobacco control and screening for breast, cervical, and colorectal cancers, as well as research that has identified more successful treatments," said Otis W. Brawley, MD, chief medical officer of the American Cancer Society. "However, we believe that lack of health insurance and inadequate health insurance is one of the most important barriers to continued progress. A growing body of data shows that compared to those with private insurance, those without health insurance are less likely to receive smoking cessation advice and treatment, about half as likely to receive cancer screening, more likely to be diagnosed at late stage, and less likely to survive after a cancer diagnosis. We are committed to addressing this critical issue."

Women's Health Weekly, September 20, 2007

Breast Cancer; 13 Percent of Women Stop Taking Breast Cancer Drug Because of Side Effects

2007 SEP 20 - ( NewsRx.com) -- More than 10 percent of women with breast cancer stopped taking a commonly prescribed drug because of joint and muscle pain, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

The women in the study were taking aromatase inhibitors, a type of drug designed to block the production of estrogen, which fuels some breast cancers. The treatment is generally given after surgery, chemotherapy or radiation therapy to prevent the cancer from returning. It’s typically prescribed as one pill each day for five years. Use of these drugs has increased because they have been shown to be more effective than tamoxifen, the previous standard of care.

“We know 25 percent to 30 percent of women taking aromatase inhibitors have aches and pains. What was surprising here was the number of people who actually discontinued the drugs because of the side effects. Up to 15 percent of patients in previously reported studies stopped taking aromatase inhibitors for a variety of reasons, but in our study, we had 13 percent drop out just because of musculoskeletal problems,” says N. Lynn Henry, M.D., Ph.D., lecturer in internal medicine at the U-M Medical School.

Henry will present the findings Sept. 8 in San Francisco at the 2007 Breast Cancer Symposium, a scientific meeting sponsored by five leading cancer care societies.

The study looked at the first 100 women enrolled in a trial to study how genetics play a role in the way individuals metabolize drugs and experience side effects. The women in this analysis were all post-menopausal following treatment for hormone-responsive breast cancer. They were assigned to take one of two aromatase inhibitors, exemestane or letrozole, and were followed for at least six months.

Study participants completed questionnaires about their health and side effects. If their reported joint and muscle concerns scored above a certain threshold on these questionnaires, the women were referred to a rheumatologist. Referrals were based on worsened pain or a change in function from the start of the study that resulted in more difficulty performing tasks such as rising from a chair, climbing out of a car or opening a jar.

In women who developed symptoms while taking the medication, the symptoms typically came on soon after starting treatment, at a median just under two months. The specific symptoms varied among the study participants, including tendonitis in the shoulder or wrist, inflammation in the knees or arthritis-type symptoms in the hands or hips. Some women reported joint pain while others had muscle pain.

The researchers are looking at interventions to determine how to manage the musculoskeletal side effects of these drugs. Symptoms almost always improve after stopping the drug. Researchers are trying to determine if switching to a different aromatase inhibitor will prevent the side effects in women who are affected, and they’re testing interventions to manage the side effects. Another option is to switch from an aromatase inhibitor to tamoxifen, which also blocks estrogen but which is not known to cause as much joint and muscle pain.

Large randomized studies have shown aromatase inhibitors work better than tamoxifen in post-menopausal women to prevent breast cancer from recurring. But, Henry points out, given the risks and side effects an individual woman might face, tamoxifen might be the better choice for some women.

“Tamoxifen has been around 20-30 years and has a long track record. We know about its benefits and its risks. Aromatase inhibitors are new, and we don’t have as much experience with them. We have to see in the long term which one ends up being better,” Henry says.

The goal of the larger study, which is led by the Consortium on Breast Cancer Pharmacogenomics, is to determine if breast cancer treatment can be personalized based on an individual woman’s genetic make-up. At this point, the sample size is not large enough to determine any genetic markers. Eventually, the researchers hope to enroll 500 women in the study. Finding a marker that predisposes a woman to more severe side effects could help doctors make personalized treatment decisions.

The 2007 Breast Cancer Symposium is sponsored by the American Society of Breast Disease, the American Society of Breast Surgeons, The American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology.

Funding for the study was from the National Institutes of Health, Pfizer and Novartis.

In addition to Henry, study authors were Daniel Hayes, Monika Mohan, Dina Dadabhoy and Daniel Clauw from the University of Michigan; Vered Stearns and Jon T Giles from Johns Hopkins University; and Anna Maria Storniolo and Dennis Ang from Indiana University.

Reference: American Society of Clinical Oncology Breast Cancer Symposium, Sept. 7-8, 2007, San Francisco

Women's Health Weekly, September 20, 2007

Breast Cancer; Exercise and yoga improves quality of life in women with early-stage breast cancer

2007 SEP 20 - ( NewsRx.com) -- Two studies report that exercise and yoga can help maintain and in some cases improve quality of life in women with early-stage breast cancer. The first study found that resistance and aerobic exercise improved physical fitness, self-esteem and body composition, and that resistance exercise improved chemotherapy completion rates. The second study demonstrated that yoga was particularly beneficial for women who were not receiving chemotherapy during the study period. Both studies will be published online in the Journal of Clinical Oncology (JCO).

Resistance and Aerobic Exercise
In the first study, Canadian investigators explored the effects of exercise on quality of life, physical fitness and body composition in women receiving chemotherapy for early-stage breast cancer. This study, the Supervised Trial of Aerobic versus Resistance Training (START) trial, is the largest to date to explore the effects of exercise during chemotherapy and one of the first to evaluate a regimen of resistance exercise.

Researchers divided women into three groups: supervised resistance exercise three times weekly (82 women), supervised aerobic exercise three times weekly (78), and no aerobic or resistance exercise, also known as the “usual care” group (82). The median duration of chemotherapy and exercise was 17 weeks. Participants were surveyed at the beginning and middle of chemotherapy and up to four weeks after completing treatment.

They found that resistance exercise was better than usual care for improving muscle strength, lean body mass and self-esteem. Aerobic exercise was better than usual care for improving aerobic fitness, self-esteem and body fat percentage. Exercise did not cause lymphedema or other adverse side effects.

“Breast cancer patients can exercise while they’re receiving chemotherapy and achieve meaningful benefits in terms of physical fitness, body composition and self-esteem,” said lead author Kerry Courneya, PhD, professor and Canada research chair in physical activity and cancer at the University of Alberta.

Unexpectedly, the study found that women in the resistance exercise group had the best chemotherapy completion rate. The percentage of women who received 85 percent or more of their recommended chemotherapy dose was 78 percent in the resistance exercise group, 74.4 percent in the aerobic exercise group and 65.9 percent in the usual care group. Although it is unclear why exercise may improve chemotherapy completion rates, the authors speculate that exercise may cause an increase in white blood cell counts, which could allow chemotherapy treatments to continue on schedule. The authors caution that this finding should be replicated before it is considered reliable.

Benefits of Yoga
In the second study, researchers compared various quality of life measures between 84 women with early-stage breast cancer who took a weekly yoga class for 12 weeks and 44 women who did not take yoga. This was the first study to evaluate the benefits of yoga in an ethnically diverse population of women with breast cancer (primarily Hispanic and African-American women). About half of the women received chemotherapy or radiation therapy during the study period, the remainder had either already completed treatment or not required it. Overall, the women had lower than average levels of quality of life at the beginning of the study.

“Yoga can promote better quality of life for women with breast cancer by helping them connect with others and feel calmer,” said lead author Alyson Moadel, PhD, assistant professor in the department of epidemiology and population health at the Albert Einstein College of Medicine. “Because yoga was well-received by all cultural and socioeconomic groups, it has the potential to help many women with early-stage breast cancer.”

Among all women in the study, those who did not take yoga reported a drop in social well-being scores (a measure of perceived support from and closeness with others) compared with those who took yoga. All other measures (physical, functional, emotional and spiritual well-being; fatigue; anxiety/sadness; irritability; and confusion) did not differ significantly between the groups. As expected, the benefits of yoga were greater in women who adhered to the prescribed regimen and took more classes.

However, among women not undergoing chemotherapy, those taking yoga reported improved overall quality of life as well as better emotional well-being and mood compared with those not taking yoga, who experienced declines in quality of life, mood, and social and spiritual well-being.

“Given the physical and emotional challenges for women undergoing chemotherapy, they may need more yoga to experience these quality of life benefits,” explained Dr. Moadel. “If attending frequent classes isn’t feasible, women should consider using videotapes at home or doing breathing exercises while they receive treatment.”

In an editorial accompanying both studies, Wendy Demark-Wahnefried, PhD, RD, LDN, of the school of nursing and department of surgery at Duke University Medical Center, writes “These results suggest that the timing of lifestyle interventions may be key if [quality of life] is the primary outcome. They point to the challenges in developing effective interventions that must overcome the host of barriers in patients who are under active treatment. Behavioral interventions that are instituted in these patients come during a period when patients are saddled with competing time constraints and also when their emotional and physical energies are being drained. However, such interventions also may demonstrate their greatest impact during this time of treatment.”

Women's Health Weekly, September 13, 2007

Breast Cancer; Hypnosis reduces pain and costs in breast cancer surgery

2007 SEP 13 - ( NewsRx.com) -- The use of hypnosis prior to breast cancer surgery reduced the amount of anesthesia administered during the operation, the level of pain reported afterwards, and the time and cost of the procedure, according to a study published in the Journal of the National Cancer Institute.

Breast cancer surgery patients often suffer side effects such as pain, nausea, and fatigue during and after their operation. These complications can lengthen their hospital stay, lead to hospital readmission, or require additional medications—all of which increase medical costs. Several previous studies have suggested that hypnosis may reduce pain, recovery time, and the need for medications after surgery.

Guy Montgomery, Ph.D., of Mount Sinai School of Medicine in New York and colleagues conducted a clinical trial to examine the effects of hypnosis when it is given within one hour before surgery. Two hundred women were randomly assigned to either 15 minutes of hypnosis by a psychologist or a control session in which they spoke with a psychologist. The researchers then compared the use of pain medications and sedatives during surgery, as well as the levels of pain and other side effects reported afterwards.

The hypnosis session began with suggestions for relaxation and pleasant visual imagery. The patients were also given suggestions on how to reduce pain, nausea, and fatigue, and instructions on how to use hypnosis on their own.

Patients in the hypnosis group required less anesthesia than patients in the control group. They also reported less pain, nausea, fatigue, discomfort, and emotional upset after surgery. They spent less time in surgery (almost 11 minutes less), and their surgical costs were reduced by about $773 per patient, mainly due to the time savings.

“Together, the combination of potential improvements in symptom burden for the hundreds of thousands of women facing breast cancer surgery each year and the economic benefit for institutions argues persuasively for the more widespread application of brief presurgical hypnosis,” the authors write.

In an accompanying editorial, David Spiegel, M.D., of the Stanford University School of Medicine in Palo Alto, Calif., describes the history of hypnosis in medicine and the evidence for why hypnosis could reduce pain.

“It has taken us a century and a half to rediscover the fact that the mind has something to do with pain and can be a powerful tool in controlling it … It is now abundantly clear that we can retrain the brain to reduce pain: ‘float rather than fight,’” Spiegel writes.

Women's Health Weekly, July 19, 2007

Breast Cancer; MRI Plus X-ray Mammography Doubles Breast Cancer Detection in Women at High Risk

2007 JUL 19 - ( NewsRx.com) -- For women at high risk of breast cancer, use of magnetic resonance imaging (MRI) plus X-ray mammography for screening will detect more breast cancers than mammography alone, a new technology assessment has found. But the number of false positives —indicating a problem where none exists — will rise significantly also.

MRI is an imaging procedure that uses a magnetic field and pulses of radio wave energy to make images of organs and structures inside the body. The report aimed to determine whether the combination of MRI and mammography was more accurate than mammography alone in finding breast cancer.

The TARGET™ emerging technology evidence report is published by ECRI Institute, an independent nonprofit health services research agency that researches the best approaches to improving patient care. The institute produces systematic reviews on medical devices, drugs, biotechnologies, procedures and health services.

Lead author Wendy Bruening, a senior research analyst at ECRI Institute, said she was not surprised that her analysis of the evidence showed that MRI detected more cases of cancer than X-ray mammography. These findings, in fact, are consistent with the current guidelines of leading cancer organizations, such as the American Cancer Institute and the American Society of Breast Disease, that recommend screening that includes MRI, X-ray mammography and ultrasound for patients at high risk of breast cancer.

According to the National Cancer Institute, breast cancer is the most frequent newly diagnosed non-skin cancer in women in the U.S., and the second leading cause of cancer-related death. In 2007, an estimated 178,480 women will be diagnosed with breast cancer and an estimated 40,460 women will die of the disease.

While the causes of breast cancer are unknown, heredity has been identified as one risk factor. The authors write that about 50 percent of breast cancers associated with genetic risk factors are linked to a mutation of the BRCA1 or BRCA2 genes. Women with multiple relatives who developed breast or ovarian cancer at a young age, and those who are found to carry BRCA mutations face a decision about whether to have prophylactic surgery or undergo a lifetime of intensive screening.

For the report, the authors analyzed data from six studies that screened a total of 1,920 women thought to be at very high risk of breast cancer due to their family history. The average age of these women ranged from 38 to 46 and they were estimated to have a 30 percent or higher risk of developing breast cancer in their lifetime. A total of 3,770 screening exams were done. Each year, the participants were screened by MRI, X-ray mammography, ultrasound, and breast examination.

The authors’ analysis found that when MRI was combined with X-ray mammography, more breast cancers were detected. Using both methods made it 2.7 times more likely to find true positives than using X-ray alone. Also, when women were screened with only MRI, the procedure was still more accurate in finding cancers than when only mammography was done — making it 2.3 times more likely to find true positives.

The report also found, however, that while screening with MRI plus X-ray mammography finds more cancers, it also leads to more false-positive results. Adding MRI to the screening program will lead to more women undergoing unnecessary follow-up procedures. ECRI Institute’s analysis suggests that for every 10 additional cancers detected by MRI, an additional 16 false positives will occur. Bruening said, however, in this high-risk population, a higher rate of false positives may be considered acceptable.

“These women at high risk may be willing to go through additional unnecessary testing just to get reassurance that they do not have cancer,” Bruening said. “In high-risk women, the cancer can be more aggressive, so you want to detect it as soon as possible. Whenever you increase the cancer detection rate you have to expect some additional false positives. But for women at high risk of cancer, the benefit of finding more cancers earlier may outweigh the harms of unnecessary testing.”

Carol Lee, M.D., chair of the Commission on Breast Imaging at the American College of Radiology, reviewed Bruening’s results and said the organization also endorses the American Cancer Society's recommendation that screening MRI be performed on women at very high risk for breast cancer, including those with BRCA1 or BRCA2 mutations.

“This screening should be in addition to, not in place of regular mammography,” Lee said. “Although it has not yet been shown that mortality from breast cancer is reduced by the addition of MRI to mammography for screening the high risk population, a growing body of evidence [like this study] demonstrates that MRI can detect cancers in these women that are not detected by mammography or physical examination. Also, there are some cancers that are visible on mammography and not on MRI, so mammography should not be abandoned.”

ECRI is a nonprofit international health services research agency that researches the best approaches to improving patient care.

Bruening W, et al. Screening women at high risk of breast cancer by magnetic resonance imaging (MRI). TARGET 2007.

Women's Health Weekly, February 15, 2007

Breast Cancer Therapy; Research conducted at University of Texas, M. D. Anderson Cancer Center has updated our knowledge about breast cancer therapy

2007 FEB 15 - (NewsRx.com) -- A new study, "WNT/beta-catenin mediates radiation resistance of mouse mammary progenitor cells," is now available. "Recent studies have identified a subpopulation of highly tumorigenic cells with stem/progenitor cell properties from human breast cancers, and it has been suggested that stem/progenitor cells, which remain after breast cancer therapy, may give rise to recurrent disease. We hypothesized that progenitor cells are resistant to radiation, a component of conventional breast cancer therapy, and that that resistance is mediated at least in part by Wnt signaling, which has been implicated in stem cell survival," scientists writing in the journal Proceedings of the National Academy of Sciences of the United States of America report.

"To test this hypothesis, we investigated radioresistance by treating primary BALB/c mouse mammary epithelial cells with clinically relevant doses of radiation and found enrichment in normal progenitor cells (stem cell antigen 1-positive and side population progenitors). Radiation selectively enriched for progenitors in mammary epithelial cells isolated from transgenic mice with activated Wnt/beta-catenin signaling but not for background-matched controls, and irradiated stem cell antigen 1-positive cells had a selective increase in active beta-catenin and survivin expression compared with stem cell antigen 1-negative cells. In clonogenic assays, colony formation in the stem cell antigen 1-positive progenitors was unaffected by clinically relevant doses of radiation. Radiation also induced enrichment of side population progenitors in the human breast cancer cell line MCF-7," wrote W.A. Woodward and colleagues, University of Texas, M. D. Anderson Cancer Center.

The researchers concluded: "These data demonstrate that, compared with differentiated cells, progenitor cells have different cell survival properties that may facilitate the development of targeted antiprogenitor cell therapies."

Woodward and colleagues published their study in Proceedings of the National Academy of Sciences of the United States of America (WNT/beta-catenin mediates radiation resistance of mouse mammary progenitor cells. Proceedings of the National Academy of Sciences of the United States of America, 2007;104(2):618-23).

Additional information can be obtained by contacting W.A. Woodward, University of Texas M D Anderson Cancer Center, Dept. of Radiation Oncology, Houston, TX 77030 USA.

The publisher of the journal Proceedings of the National Academy of Sciences of the United States of America can be contacted at: National Acad Sciences, 2101 Constitution Avenue NW, Washington, DC 20418, USA.

Keywords: United States, Houston, Breast Cancer Therapy, Breast Cancer, Breast Carcinoma, Oncology, Progenitor Cell, Stem Cell Research, Women's Health.