Women At High Risk For Breast Cancer Benefit From Screening MRI

• Magnetic resonance imaging (MRI) enables radiologists to accurately identify tumors missed by mammography and ultrasound, according to a multicenter study comparing the three screening methods in women at high-risk for breast cancer. The findings of the study appear in the August issue of the journal Radiology.

• "Women at high risk for breast cancer can benefit from undergoing screening MRI," said the study's lead author, Constance Dobbins Lehman, M.D., Ph.D., professor of radiology at the University of Washington School of Medicine and director of breast imaging at the Seattle Cancer Care Alliance. "Of all the breast imaging tools we have currently available, MRI is clearly the best at detecting cancer."

• According to the National Cancer Institute, genetic predisposition accounts for five to 10 percent of all breast cancers. Women who are genetically at high risk for breast cancer need to begin screening at a younger age, because they often develop cancer earlier than women at average risk. However, women below age 50 are more likely to have dense breast tissue, which can limit the effectiveness of mammography as a screening tool. The American Cancer Society recommends that women with a high risk of developing breast cancer should be screened with MRI in addition to their yearly mammogram beginning at age 30.

• "It is frightening to be told that you're at very high risk for developing breast cancer," Dr. Lehman said. "It's important that these women understand that there is something they can do to increase their chances of early detection in the event that they do develop breast cancer."

• For this study, researchers at six facilities studied 171 asymptomatic women over age 25 (average age 46) with at least a 20 percent lifetime risk of developing breast cancer to compare screening performance of MRI and mammography in high-risk patients. Each of the women underwent MRI, mammography and ultrasound.

• Sixteen biopsies were performed, and six cancers were detected for an overall cancer yield of 3.5 percent. All six of the cancers were detected with MRI, while two cancers were detected with mammography and only one cancer was detected with ultrasound. The four cancers found in women with dense breast tissue were only detected with MRI. Biopsy rates were 8.2 percent for MRI and 2.3 percent for mammography and ultrasound. The positive predictive value (PPV) of biopsies performed as a result of MRI findings was 43 percent.

• Based on these findings, the researchers estimate that, compared to mammography and ultrasound, screening with MRI will allow detection of 23 more cancers per 1,000 high-risk women screened.

• While MRI has been shown to be an effective screening tool for women genetically predisposed to developing breast cancer, there is no evidence to support MRI screening in average-risk women. "Although MRI is a very powerful tool for detecting cancer, it is not perfect," Dr. Lehman cautioned. "There are benign areas of breast tissue that can look suspicious but do not represent breast cancer and yet may lead to a biopsy."

• ----------------------------
• Article adapted by Medical News Today from original press release.
• ----------------------------

• Radiology is a monthly scientific journal devoted to clinical radiology and allied sciences. The journal is edited by Anthony V. Proto, M.D., School of Medicine, Virginia Commonwealth University, Richmond, Va. Radiology is owned and published by the Radiological Society of North America, Inc. (http://rsna.org/radiologyjnl)

• The Radiological Society of North America (RSNA) is an association of more than 40,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (http://rsna.org/)

• "Cancer Yield of Mammography, MRI, and Ultrasound in High Risk Women: Prospective Multi-institution Breast Cancer Screening Study." Co-authors of the paper are Thomas Claudine Isaacs, M.D., Mitchell D. Schnall, MD, Ph.D., Etta Pisano, M.D., Susan M. Ascher, M.D., Paul T. Weatherall, M.D., David A. Bluemke, M.D., Ph.D., Deborah J. Bowen, Ph.D., P. Kelly Marcom, M.D., Deborah K. Armstrong, M.D., Susan M. Domchek, M.D., Gail Tomlinson, M.D., Ph.D., Steven Skates, Ph.D., Constantine Gatsonis, Ph.D.

• This study was funded by the International Breast MRI Consortium and the Cancer Genetics Network.

• Source: Linda Brooks
• Radiological Society of North America

Potential Cost-Effective Cancer Diagnosis Using Gold Nanoparticles

• When it comes to searching out cancer cells, gold may turn out to be a precious metal.

• Purdue University researchers have created gold nanoparticles that are capable of identifying marker proteins on breast cancer cells, making the tiny particles a potential tool to better diagnose and treat cancer. The technology would be about three times cheaper than the most common current method and has the potential to provide many times the quantity and quality of data, said Joseph Irudayaraj, an associate professor of agricultural and biological engineering.

• "We hope that this technology will soon play a critical role in early detection and monitoring of breast cancer," said Irudayaraj (pronounced ee-roo-THY'-a-razh), leader of a research team that developed a new method for fabricating the nanoparticles that is published online in the journal Analytical Chemistry. "Our goal is to see it in commercial use in about four years."

• The gold nanoparticles, or nanorods, are tiny rod-shaped gold particles, even smaller than viruses, which are equipped with antibodies designed to bind to a specific marker on cell surfaces. Researchers analyze these surface markers, proteins on a cell's exterior, because they can contain valuable information about what type of cell they belong to or what state that cell may be in.

• "In cancer diagnosis, the ability to accurately detect certain key markers will be very helpful because certain types of cancers have specific surface markers," Irudayaraj said.

• In another study published in Nano Letters, Irudayaraj showed that the nanorods, when combined with a special imaging technique, were capable of recognizing cancer stem cells by binding to known markers on their exterior. Cancer stem cells are important to detect because they are particularly invasive and more likely than other types of cancer cells to spread, or metastasize, to other organs. These and other types of cells the technology utilizes are obtained from blood tests as opposed to biopsies.

• The nanoparticles, or "gold nanorod molecular probes," are fabricated so that their size is unique to their target marker. That way, when nanorods bind to their marker, they "scatter," or disrupt light in a characteristic manner that researchers can then pair to the nanorod's dimensions, its antibody and the target cancer marker, which must be present for binding to occur.

• More than 200,000 women are diagnosed with breast cancer every year in the United States, and 80 percent of those women receive some type of therapy, Irudayaraj said. Since 40 percent of them will have a relapse, regular monitoring, which this technology aims to do, is vital.

• Irudayaraj said using gold nanorods for cancer detection will be about one-third the cost of the current analogous technology, called flow cytometry. This method works by attaching fluorescent probes to cancer cells, whereas the nanorod technology has its basis in sensing plasmons, or sub-atomic particles present in the gold nanoparticles

• The nanorods also require only a few cells, whereas flow cytometry requires hundreds to thousands of cells. This could be advantageous when dealing with scarce sample sizes, Irudayaraj said.

• Irudayaraj and his team -- postdoctoral researcher Chenxu Yu and Harikrishna Nakshatri, a researcher at the Indiana University School of Medicine -- demonstrated that the nanorods bind to three different markers. Two of the markers were used to calculate the invasiveness of the cancer cell, while one marker -- present equally among the different cancer types -- was used to calculate the degree to which the other markers were expressed, or present. Irudayaraj said his gold nanorods may be able to detect as many as 15 different markers in the future, possibly opening the door for even more comprehensive tests.

• Ultimately, Irudayaraj imagines a new kind of routine and cost-effective procedure for the identification of cancer cells. A patient gives blood, from which cancer cells are obtained. Nanorods are then added to bind to specific markers, if present. Next, the cells are placed on a microscopic slide for imaging. After the rods absorb and re-emit radiation, a special camera records the scattered light, which a computer helps to analyze. Finally, based upon the data, a diagnosis is made.

• ----------------------------
• Article adapted by Medical News Today from original press release.
• ----------------------------

• Irudayaraj received funding from Purdue and the Indiana University School of Medicine, and the work was conducted at the Bindley Bioscience Center, of which he is a member. He plans to further develop the technology in the future and is researching mechanical properties of the nanorods and the surface markers to which they bind. He hopes to create nanoparticles that are capable of binding to more markers and to provide more information about these markers and what they reveal about the state of the cell.

• Source:

• Joseph Irudayaraj
• Douglas M. Main
• Purdue University

Robin Roberts, From Good Morning America, Has Breast Cancer

• Robin Roberts, "Good Morning America" anchor, announced earlier this week that she has breast cancer. After doing a story on how important early detection is following the colon cancer death of colleague Joel Siegel, she underwent screening herself.

• Siegel had been ABC's film critic for many years. During a tribute to Siegel Roberts presented a story on the importance of early detection for cancer survival. When she arrived home she checked her own breasts and detected a lump. She went in for tests, had a mammogram (breast X-ray) and an ultrasound. The ultrasound transmits high-frequency sound waves to help determine if a lump is a liquidy cyst or solid mass. The ultrasound test detected something solid and a subsequent biopsy identified the cancer. Roberts is undergoing surgery sometime today (Friday 3 August).

• While she was on air, Roberts said that hearing the words and saying it and seeing was surreal (as she had shortly before been talking about other people's cancer but this time it was about her). She added that she is very blessed and thankful she found it early.

• Breast cancer is the most common cancer for women, after skin cancer (American Cancer Society). This year over 170,000 American women will be diagnosed with invasive breast cancer.

• We do not yet know what stage of breast cancer Robin Roberts has - most likely it is an early stage. The good news is that women with Stage 1 breast cancer who have treatment during that stage have a 97% cure rate.

• What is Breast Cancer?

• Breast cancer is a tumor that has become malignant - it has developed from the breast cells. A 'malignant' tumor can spread to other parts of the body - it may also invade surrounding tissue. When it spreads around the body, we call it 'metastasis'.

• A woman's breast consists of lobules. Lobules are milk-producing glands. The breast is also full of ducts - milk passages that connect the lobules to the nipple. There is also fatty and connective tissue surrounding the ducts and lobules - this is called stroma.

• The most common breast cancers start in the cells around the ducts. Others can start in the cells that line the lobules. A smaller number of breast cancers can start in other parts of the breast.

• The human body has two ways of moving fluid about. One is through the blood stream, which carries plasma, red and white blood cells and platelets. Lymphatic vessels carry tissue fluid, waste products and infection fighting cells (immune system cells). Immune system cells are located in the lymph nodes - the nodes are shaped like a bean.

• It is common for cancer cells to grow in the lymph nodes. They get there via the lymphatic vessels.

• The lymphatic system of the breasts connect to the lymph nodes in three areas: Under the arm (axillary lymph node), in the chest (internal mammary node) and by the collarbone (supra or infraclavicular node).

• Doctors guess that if cancer cells are in the lymphatic system, they are most likely to be in the bloodstream and will spread to other organs in the body. It is very hard to test for breast cancer cells in the bloodstream.

• If breast cancer cells have got to the nodes under the arm (axillary), it will most likely swell. Whether or not it has swollen there, will decide what type of treatment a patient should have. If cancer cells are found in more lymph nodes, then the likelihood of it turning up in different parts of the body is greater. However, there is no hard and fast rule here. Women have had swellings in many nodes and did not develop metastases, while some women with no swellings in their nodes did.

• Most breast lumps are benign (harmless)

• Although most breast lumps do not develop into anything dangerous (benign) some will need to be biopsied (doctor takes a piece out and tests it). Most lumps are harmless cysts - sacs filled with fluid.

• A benign tumor cannot spread to other parts of the body - it stays inside the breast. They pose no threat to the patient's life. They are not cancer. Some of them, however, can increase the woman's chance of developing breast cancer later on. Tumors such as papillomas and atypical hyperplasia are examples of this.

• How common is breast cancer?

• Breast cancer is the most common cancer for women. About one in every nine women will develop breast cancer in her lifetime. 99% of all breast cancers are diagnosed in women, 1% affect men.

• In the USA there were 100,000 new cases in 1985. In 1994 the number rose to 180,000. The main reason for the increase is better awareness leading to more diagnostic tests.

• Why do some women get breast cancer?

• We don't know the answer to that yet. We know that heredity plays a part. The more close relatives a woman has who had breast cancer, the higher is her risk of developing it.

• -- Online Breast Exam
• -- About Robin Roberts - ABC News
• -- About Robin Roberts - Wikipedia

• Written by: Christian Nordqvist
• Copyright: Medical News Today
• Not to be reproduced without permission of Medical News Today

Rep. Weiner To Introduce Legislation To Increase Medicare Reimbursement For Mammograms

• Rep. Anthony Weiner (D-N.Y.) said he plans to introduce a bill this week that would increase Medicare reimbursement rates for mammograms, with the aim of reversing a decline in the number of women receiving the exams, the Orlando Sentinel reports. Weiner said the measure, called the "Assure Access to Mammography Act," would help clinics offering mammograms stay open.

• According to a report released last week by Weiner, the number of mammography clinics nationwide has decreased by more than 1,200, or 12%, since 1999 (Wessel, Orlando Sentinel, 7/31). The average cost for a mammogram has increased by 25% to $125 since 2005, while the Medicare reimbursement increased by 2% to $83.69 during the same time period, the report found. Sixty-seven mammography facilities have closed in New York City since 1999, a 26% decrease, according to the report (Weiner release, 7/22). The number of certified mammography clinics in Florida also decreased from 505 to 456 since 2001, according to the American Cancer Society.

• Nina Entrekin, director of cancer prevention and detection for ACS's Florida division, said low Medicare reimbursements for mammograms has caused many clinics to close, leaving longer wait times at other clinics that might discourage some women from undergoing the screening (Orlando Sentinel, 7/31). Wait times for mammograms in New York City have increased 171% in the last decade, according Weiner's report.

• "Increasing access to mammograms clearly saves lives," Weiner said, adding, "Raising the reimbursement rate will ensure that women have increased options to protect their most important asset, their health" (Weiner release, 7/22). Entrekin said that if the decline in national mammogram rates during the past five years is not reversed, breast cancer mortality rates could increase (Orlando Sentinel, 7/31).

• ABC's "World News" on Tuesday reported on declining mammogram rates. The segment includes comments from Lisa Carey of University of North Carolina's School of Medicine and David Dershaw, director of breast imaging at Memorial Sloan-Kettering Cancer Center (McKenzie, "World News," ABC, 7/31). A video excerpt of the segment also is available online. Expanded ABC News coverage is available online.

• Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Newly Available Guidelines Promise Better Results In Breast Cancer Care

• International guidelines for the detection, care and management of breast cancer are now available in Spanish thanks to a partnership between the Pan American Health Organization (PAHO) and the Breast Health Global Initiative (BHGI).

• The Guidelines for International Breast Health and Cancer Control, published in English in an updated form last year, are intended to help policymakers and health care providers in low- and middle-income countries improve breast cancer outcomes through evidence-based, economically feasible, and culturally appropriate practices. The guidelines address a full range of issues including early detection and access to care, diagnosis and pathology, treatment and resource allocation, and health care systems and public policy.

• Breast cancer is newly diagnosed in more than 1 million women each year and is the most common cause of cancer-related deaths among women worldwide. Women in low- and middle-income countries are more likely to die of the disease than those in richer countries, in part because their cancers are commonly detected and treated in advanced stages, when treatment is more expensive and least successful.

• "Breast cancer is a growing problem in Latin America, with some 90,000 cases reported every year, many of them at advanced stages because of poor access to preventive and curative services," said PAHO Director Dr. Mirta Roses. "The availability of these guidelines in Spanish will be an important contribution for those interested in expanding health services to reach Latin American women early and to improve their quality of life."

• Major scientific advances in detection and management of breast cancer have improved outcomes in developed countries, but health care providers in lower income countries face resource constraints that limit their ability to apply these advances to improve breast cancer care. The Guidelines for International Breast Health and Cancer Control address this problem by recommending the most appropriate and applicable "best practices" for countries with limited resources.

• The guidelines recommend a stepwise, tiered system of resource allocation on four levels-basic, limited, enhanced and maximal-depending on the availability of resources. In the areas of detection and access to care, for example, they recommend that countries with very basic health systems educate women about performing breast self-examination to detect lumps. For countries with more but still limited resources, they recommend targeted outreach and education on clinical breast examination to women in at-risk groups, followed by ultrasound or mammography to confirm the discovery of suspected lumps.

• In the area of detection and diagnostics, the guidelines recommend both ultrasound and mammography as cost-effective. However, ultrasound, which can be used to diagnose other conditions, may be implemented before mammography if resources do not allow for both.

• In terms of treatment, breast-conserving procedures require more health care resources and infrastructure than mastectomy but can be provided in a carefully designed limited-resource setting. Systemic treatments are critical for improved survival, the guidelines note. The selection of appropriate hormonal treatments for individual patients requires estrogen receptor testing. Chemotherapy requires adequate resources and infrastructure and should be used to treat node-positive locally advanced breast cancers, the most common clinical presentation of the disease in low-resource countries. If chemotherapy is not available, patients with locally advanced, hormone receptor - negative cancers can only receive palliative care.

• The guidelines call for additional research to assess how these recommendations can be best implemented in limited-resource settings.

• Translation of the Guidelines for International Breast Health and Cancer Control into the world's major languages is a long-standing goal of BHGI, and future plans include translation into Russian, Chinese, and Arabic. The partnership with PAHO to produce a Spanish translation grew out of discussions at the International Union Against Cancer Conference in Washington in July 2006.

• "The availability of these guidelines in Spanish is a major leap forward in reaching ministries of health, health care providers, and policymakers in Spanish-speaking countries," said Dr. Benjamin O. Anderson, chairman and director of BHGI. "With this and future translations, we hope to lessen the global burden of this devastating disease."

• The Spanish version of Guidelines for International Breast Health and Cancer Control (Normas internacionales para la salud de mama y el control del cáncer de mama) may be downloaded in Spanish through the websites of PAHO and BHGI.

• The Breast Health Global Initiative, an extensive international alliance of organizations and individuals around the world devoted to medically underserved women, is sponsored by the Fred Hutchinson Cancer Research Center and Susan G. Komen for the Cure.

• The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It serves as the Regional Office of the World Health Organization (WHO).
• http://www.paho.org

Screening Matters This Breast Cancer Awareness Month, UK

• As Breast Cancer Awareness Month approaches, Cancer Research UK is launching a brand new campaign to raise awareness of the importance of cancer screening. All women aged 50 to 70* in the UK, around 6 million people, are eligible for breast screening (mammograms), yet currently a quarter of those who are invited do not attend. Cancer Research UK has launched Screening Matters to get another three million people into the cancer screening programmes (breast, cervical and bowel) and ensure the best possible programmes are available.

• Mammograms are vitally important in tackling breast cancer as the disease can be treated much more easily when found early. Women who are diagnosed with breast cancer in the earliest possible stage have a nine in ten chance of a successful recovery. This falls to two in ten if the cancer is very advanced at the point of diagnosis.

• Since the breast cancer screening programme was introduced in 1988 it has saved 1,400 lives every year in England alone, reducing the breast cancer death rate by up to a quarter in women within the screening age range. Having a mammogram takes only a few minutes and can usually be done a short distance from home.

• Cancer Research UK is asking people to pledge their support for Screening Matters by signing a card or signing up online to show their agreement for what the charity is asking of government, and to pledge that they personally will attend screening if asked to do so and encourage friends and family to do the same.

• Maxine Taylor, executive director of policy and communication at Cancer Research UK, said: "Screening has a hugely important role to play in the effective prevention and treatment of cancer and in reaching many of the charity's goals in beating the disease.

• "Current estimates suggest that for every 500 women who have breast screening, one life will be saved. I hope this figure will help to show those not attending screening that doing so could be the best decision they ever make."

• To pledge your support for Screening Matters visit http://www.cancercampaigns.org.uk.

• --50 to 64 in Northern Ireland. -- Women throughout the UK above the upper age range can request a mammogram through their GP.

• Cancer Research UK

• Together with its partners and supporters, Cancer Research UK's vision is to beat cancer.

• -- Cancer Research UK carries out world-class research to improve understanding of the disease and find out how to prevent, diagnose and treat different kinds of cancer. -- Cancer Research UK ensures that its findings are used to improve the lives of all cancer patients. -- Cancer Research UK helps people to understand cancer, the progress that is being made and the choices each person can make. -- Cancer Research UK works in partnership with others to achieve the greatest impact in the global fight against cancer.

• For further information about Cancer Research UK or to find out how to support the charity, visit http://www.cancerresearchuk.org/.

BC Cancer Agency Study Tests Value Of Online Emotional Support, Canada

• The BC Cancer Agency, an agency of the Provincial Health Services Authority, is launching a new pilot study, the first of its kind in Canada, to test the value of online emotional support in improving the quality of life of young women with breast cancer.

• In the study, Moving Forward After Breast Cancer, eligible young women with breast cancer will be randomized to join one of two trial groups. Participants in the first group will connect with each other in a 10-week internet skills and support group led by a professional counselor while also completing a self-directed at home coping skills program. The second group will only complete the at home coping skills program.

• "The internet is a powerful tool with the potential to reduce geographical and other barriers; and by comparing the two trial groups in this study, we can test whether an online resource is an effective way of providing counseling support for cancer patients," says Dr. Joanne Stephen, a researcher who is leading this study at the BC Cancer Agency.

• "While there are existing support groups and educational resources for young women, these are often limited to those living in major cities," explains Dr. Stephen. "With an online resource, young women regardless of where they live will be able to benefit from accessing companionship and information."

• The study will investigate whether the online skills and support group can reduce distress, change perception of how much breast cancer interferes with the physical well-being, and increase participants' confidence in coping with future challenges.

• Participants will discuss issues and share information specific to young breast cancer patients, and learn about goal setting and other coping skills in a professionally-led environment.

• "By evaluating the outcome of this study, we can optimize the uptake of online support in other areas of cancer care," adds Dr. Stephen.

• For Denise Graham, the internet was the first place she turned to for information when diagnosed with breast cancer at age 34, several years ago. "I felt very alone and needed answers to what I should expect during and after treatment. Unfortunately, I wasn't able to find much tailored for women my age."

• "A web-based community is a great idea since the internet is really a second language for most young people," says Graham, who celebrated her five year anniversary as a breast cancer survivor this June. "We simply don't have time to access face-to-face support."

• Young women with breast cancer face issues unique to their older counterparts, such as the medical and physical consequences of treatment including chemotherapy-induced menopause, and changes with sexuality and fertility; and problems related to returning to work and family relations.

• "I received advice to slow down and to do only as much as I can," adds Graham, recalling her experience at support groups for older women. "I kept thinking to myself, I still have so much to do! The reality is I'm still young; I still have to work and support a mortgage."

• The study, funded by the Canadian Breast Cancer Foundation, is open to breast cancer patients who have completed treatment for up to three years or are close to completing treatment. Participants need to be under the age of 46 who live in BC or the Yukon. For more information, please visit http://canada.thewellnesscommunity.org. Core support for research at the BC Cancer Agency is provided by the BC Cancer Foundation.

• The BC Cancer Agency, an agency of the Provincial Health Services Authority, is committed to reducing the incidence of cancer, reducing the mortality from cancer, and improving the quality of life of those living with cancer. It provides a comprehensive cancer control program for the people of British Columbia by working with community partners to deliver a range of oncology services, including prevention, early detection, diagnosis and treatment, research, education, supportive care, rehabilitation and palliative care. The BC Cancer Foundation raises funds to support research and enhancements to patient care at

• the BC Cancer Agency. http://www.bccancer.bc.ca

FDA Panel OKs Osteoporosis Drug To Cut Breast Cancer Risk

• Despite concerns over cardiovascular side effects, a U.S. Food and Drug Administration panel last Tuesday recommended the osteoporosis drug Evista (raloxifene) for use in preventing breast cancer in certain high-risk groups of older women.

• In a vote of 8 to 6, the FDA's Oncologic Drugs Advisory Committee recommended approval of the drug for postmenopausal women with osteoporosis, and, in a 10 to 4 vote, it also recommended the drug for postmenopausal women at high risk for breast cancer.

• While the FDA usually follows the recommendations of its expert panels, it is not obligated to do so.

• Evista's approval would give women a valuable option in fighting breast cancer, one expert said.

• "We've got a drug out there, tamoxifen, with its advantages and its possible flaws,'' panel member David Harrington, chairman of the biostatistics department at Dana-Farber Cancer Institute in Boston, told Bloomberg news service. "Women at high risk for breast cancer, it would be very nice to have a second option for them," he said.

• However, not everyone agrees with the panel's recommendation.

• "The reason that we are concerned and will continued to be concerned about it is the history of every drug that's ever been used to 'prevent breast cancer,' " explained Barbara Brenner, the executive director of Breast Cancer Action.

• Brenner noted that even women who do take these drugs can get breast cancer.

• "In addition, the number of women who are going to be exposed to a drug with very serious and potentially fatal side effects in the interest of reducing very small numbers of breast cancer is very frightening to us," Brenner said. "We would like to see this disease prevented but not at the risk to women's health," she said.

• While Evista has been shown to reduce the risk of breast cancer among postmenopausal women with osteoporosis, and postmenopausal women at high risk for breast cancer, it also increases their risks for blood clots and stroke.

• In the Raloxifene Use for The Heart (RUTH) trial -- which included more than 10,000 postmenopausal women -- researchers found that, compared with placebo, Evista had no significant effect on the risk of first-time coronary events.

• At the same time, it reduced the risk of invasive breast cancer by 44 percent -- meaning about 1.2 fewer cases of cancer per 1,000 women treated with raloxifene per year.

• However, while the study showed no significant difference in deaths from any cause, or total deaths from stroke, women in the raloxifene group did have a 55 percent increased risk of fatal stroke (0.7 excess fatal strokes per 1,000 women treated per year) and a 44 percent increased risk of blood clots (1.2 more cases per women treated per year), according to a report published last July in the New England Journal of Medicine.

• "We fail to understand why any woman in her right mind would want to expose herself to such risks," Brenner said. "If the drug is approved by the FDA, Eli Lilly & Co. [the maker of Evista] will heavily promote the drug, and many women will be made sick by in the interest of preventing breast cancer that will be in nobody's interest," she said.

• Women should learn what this drug can and cannot do for them and make an informed choice, Brenner said. "Do not depend on the FDA to do that for you.

• "However, another expert backed the FDA panel's recommendation.

• "The drug has been demonstrated to have benefit in preventing breast cancer in women at increased risk," said Dr. Len Lichtenfeld, the deputy chief medical officer at the American Cancer Society. "The drug should be approved. That would then give us two options, and Evista may have a better safety profile than tamoxifen," he said.

• In the STAR (Study of Tamoxifen and Raloxifene) trial published last June, almost 20,000 postmenopausal women at increased risk for breast cancer took either tamoxifen or Evista daily for five years. Tamoxifen is the only drug approved for reducing breast cancer risk.

• That trial found that both drugs reduced the risk of breast cancer by about 50 percent -- from eight cases per 1,000 women per year to about four per 1,000 women per year.

• However, Evista was not as effective in preventing non-invasive breast cancers as tamoxifen, according to a report, which appeared in the Journal of the American Medical Association.

• But the debate over Evista's fate goes on.

• "We feel that the drug should not be approved, because it's an approach that's going expose healthy women to increased risks for one disease [heart trouble] to protect them from another," said Amy Allina, a program director at the National Women's Health Network.

• "Even women at very high risk for breast cancer are taking on other risks with this drug," Allina said. "If they are not at very high risk of breast cancer, they are probably getting more harm than help," she said.

• But Lichtenfeld contends that Evista has been long used by doctors in the treatment of osteoporosis, so physicians will be more comfortable in prescribing it to women to help prevent breast cancer. "Doctors are not talking to women about breast cancer prevention, and it's an area where more attention needs to be paid," the cancer society expert said.

• "Both Evista and tamoxifen have risks," Lichtenfeld acknowledged. "But Evista has been used widely for the treatment of osteoporosis, so physicians are comfortable with that. While this is not a perfect answer to the increased risk of breast cancer, it is the best answer we have right now," he said.

• The drug's maker was optimistic about the panel's decision. "Today is an especially good day for postmenopausal women," Gwen Krivi, vice president of Lilly Research Laboratories, said in a prepared statement. "If approved, Evista would be the first and only therapy available to address two leading health issues for postmenopausal women --osteoporosis and breast cancer. Following today's vote, our intention is to continue working with the FDA to make this important option a reality for patients."

• Eli Lilly and Evista have a somewhat checkered past, however. In 2005, the company plead guilty and paid a $36 million fine for illegally promoting Evista to reduce the risk of breast cancer, a violation of the Food, Drug, and Cosmetic Act.
• http://www.healthday.com

National Breast Cancer Foundation Unveils Innovative Web Site For Survivors

• National Breast Cancer Foundation, Inc.(R) (NBCF) has launched an innovative new Web site, http://www.nationalbreastcancer.org, that inspires and educates, with the best online social network community available today for breast cancer patients, survivors and their families and friends.

• Since 1991 NBCF has focused on educating women about the importance of early breast cancer detection and providing free mammograms to low-income women and those without insurance. The organization is headquartered in Frisco, Texas, just north of Dallas, and provides funding to programs throughout the United States and internationally.

• The Web site features MyNBCF a special online gathering place for people who are searching for information and looking for support from others that are touched by breast cancer. Individuals can create a customized web page, download photos, journal their experiences while undergoing breast cancer treatment, then email or RSS feed their journal to friends and family. They can also participate in lively discussions on a wide variety of topics relevant to their life, diagnosis, treatment and recovery. Members can also build a support network of friends by discovering and identifying others with similar experiences and interests.

• "As a 27-year breast cancer survivor, I know the value of a strong support system," said Janelle Hail, founder and CEO of NBCF. "Many women have no one to encourage them through their breast cancer experience. We offer friendship and inspiration while they receive the latest in educational knowledge of breast cancer."

• Hail additionally writes Janelle's Blog on the site about her life experiences, her travels, her work as CEO of NBCF, and inspiring stories. She is a strong voice in the breast cancer community, leading women through a difficult journey in their lives and moving them toward hope.

• Also featured on the site is Beyond the Shock(R), a video presentation produced for NBCF, with the input of U.S. oncologists, to help people face the daunting task of understanding and coping with breast cancer. Beyond the Shock(R) is an interactive tutorial that uses a virtual woman and a virtual tour of the body and simplifies complex medical information. It can be viewed by chapters or the entire program and even purchased as a DVD to give as a gift. Beyond the Shock(R) is has been distributed to hospitals, oncologists and the medical community as a leading educational tool. It is currently offered in English, Spanish and Mandarin Chinese on the Web site.

• National Breast Cancer Foundation has created a Web site to give people breast cancer education, a place to connect with family and friends using the latest web socializing tools, and most of all, hope.

• National Breast Cancer Foundation (NBCF) extends women's lives through education about breast cancer and early detection and provides funding for free mammograms for underserved women. NBCF has been classified as one of the most fiscally sound non-profits in America by Charity Navigator, the largest charity evaluator in the nation. "Less than 12 percent of the charities we've rated have received at least two consecutive 4-star evaluations, indicating that the National Breast Cancer Foundation outperforms most charities in America in its efforts to operate in the most fiscally responsible way possible," stated Trent Stamp, executive director of Charity Navigator. NBCF has received three consecutive 4-star ratings.

• National Breast Cancer Foundation, Inc.
• http://www.nationalbreastcancer.org

Breast Cancer And Hormone Therapy - New Study Examines Whether Trends In Breast Cancer Incidence And Use Of HT May Be Directly Linked

• The medical community has been debating for many years whether, and to what extent, postmenopausal hormone therapy (HT) use is associated with a higher risk of breast cancer, says Professor Amos Pines, President of the International Menopause Society. Although it is agreed that long-term HT slightly increases that risk, the definition of long-term use is still unclear, particularly in view of data showing that it may vary significantly by type of HT (estrogen-alone vs. estrogen-progestin, brand of progestin, dosage). A new study from the Kaiser Permanente health plan[1] raises the question whether trends in breast cancer incidence and use of HT over the past 25 years may be directly linked.

• The Women's Health Initiative (WHI) trial was a landmark in menopause medicine since it provided information based on the best available study methodology[2]. By adopting its results as the ultimate source of information, many organizations, medical societies and health authorities actually declared that data derived from observations in the postmenopausal population are less valuable. Nevertheless, during the past few months, several studies have used databases on the incidence of breast cancer, on the one hand, and sales of HT on the other hand, in order to suggest a direct link between trends of hormone use and the number of newly diagnosed breast cancer patients. While such information, by itself, is very important and interesting, conclusions must be drawn with great caution. It is tempting to simplify the observed year-by-year figures on HT use and breast cancer incidence and establish a 'mirror glass' equation: the more postmenopausal hormone use, the more breast cancer, and vice versa. But human biology is far too complicated and the pathophysiology of breast cancer is far too complex to adopt such a mechanistic approach, as the authors of those studies and related Editorials rightly say.

• The mere fact that the incidence of lung cancer is higher among people carrying a lighter in their pocket does not mean that lighters cause lung cancer. Thus, having two parallel time trends, for breast cancer incidence and for hormone use, still makes it necessary to investigate further in order to better understand if and how those trends could be linked. For example, a third important player has now been added, namely the rate of mammography screening, which has proved to have similar fluctuations as HT use and breast cancer incidence1. According to the Kaiser Permanente registry[1], the rate of women aged 45-59 undergoing screening mammography in 2002-2004 (post-WHI period) decreased from 48% to 44%. Thus, awareness of the need for periodic breast examinations may ease, and the likelihood of women coming to be examined may decrease in a population that uses HT less frequently, which could lead to under-diagnosis of breast cancer.

• On the other hand, the 28% increase in breast cancer incidence between the early 1980s and the early 1990s observed in the Kaiser Permanente cohort probably reflects the outcome of implementation of the mammography screening program during that period. The largest group among HT users in most of the countries (excluding the USA) has always been women younger than 60 years. The Kaiser Permanente data show that, for women aged 45-59, the 70% drop in HT use (defined as dispensation of at least one hormonal prescription) in the year 2006 (post-WHI period) as compared to the year 2000 (pre-WHI period) was associated with a non-significant decrease of 4.9% in breast cancer incidence, which translates into a reduction of less than one case of breast cancer per 10,000 women per year. Furthermore, a welcome but unexplained fact is that, in younger women (age groups <>

• Professor Pines concludes that the new epidemiological data coming from the Kaiser Permanente study do have scientific merits, but may be confusing when interpreted for the lay public. Health-care providers should stay with the first-grade information coming from the WHI study when discussing this issue with their patients: breast-wise, in women younger than 60, HT (particularly estrogen-alone) is safe. Long-term use may be associated with a small increased risk, in the order of one extra case per 1000 women per year. Discontinuation of HT brings this risk back to the values for age-matched non-users after 3-5 years. Weighing the overall benefits and risks of HT in the younger postmenopausal population clearly favors the use of HT for symptomatic women.

• ----------------------------
• Article adapted by Medical News Today from original press release.
• ----------------------------

• References

• 1. Glass AG, Lacey JV Jr, Carreon D, Hoover RN. Breast cancer incidence, 1980-2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst 2007;99:1152-61

• 2. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321-33

• THE INTERNATIONAL MENOPAUSE SOCIETY

• The aims of the Society (IMS) are to promote knowledge, study and research on all aspects of aging in men and women; to organize, prepare, hold and participate in international meetings and congresses on menopause and climacteric; and to encourage the interchange of research plans and experience between individual members. The Society is a non-profit association, within the meaning of the Swiss Civil Code. It was created in 1978 during the first World Congress on the Menopause. In addition to organizing congresses, symposia, and workshops, the IMS owns its own journal: Climacteric.

• For further information please go to: http://www.imsociety.org/
• Source: Jean WrightInternational Menopause Society

Confirmed: A Link Between Breast Cancer And Hormone Therapy

• Breast cancer is second only to lung cancer as the leading cause of cancer death among women. This year alone, nearly 180,000 women in the U.S. will be diagnosed with invasive breast cancer, and some 40,000 will die from it, according to the American Cancer Society. There are some risk factors that a woman cannot control, such as her age and race as well as genetics, or family history, but there are also choices she can make to lower her odds of getting it. Among them, says a new study: steering clear of hormone replacement therapy, which new research confirms increases a woman's chances of developing breast cancer.

• Researchers at the Kaiser Permanente Center for Health Research in Portland, Ore., concluded there is definitely a link between breast cancer and the use of menopausal hormone therapy, particularly estrogen-progestin treatment combinations. Since 1990, "breast cancer rates dropped in parallel with hormone use just as it rose in parallel to it," says oncologist Andrew Glass, lead author of the study published in the Journal of the National Cancer Institute.

• Glass and his colleagues reviewed the medical histories of 7,386 women (in the database of Kaiser Permanente Northwest) diagnosed with invasive breast cancer between 1980 and 2006. They found that breast cancer incidence rose 25 percent from the early 1980s to the early 1990s-a period when an increasing number of women were getting mammograms and also undergoing hormone therapy to control menopause symptoms and prevent chronic disease. Glass acknowledges that the jump in breast cancer could be attributed to more women getting mammograms, because the test can find cancers that might otherwise go undetected until the disease has progressed.

• But Glass notes that mammography rates among women in the Kaiser plan leveled off in the early 1990s, providing researchers with a perfect opportunity to study the relationship between breast cancer and hormone therapy use. They discovered that breast cancer incidence had moved in tandem with hormone use from the early 1990s onward. During the 1990s, the incidence of breast cancer climbed by about 15 percent, in synchrony with a growing number of women receiving hormone replacement therapy.

• In 2001 the trend reversed: Breast cancer rates initially dipped gradually, but dropped sharply in mid-2002, when many women in the U.S. stopped hormone replacement therapy after the Women's Health Initiative, a large clinical trial involving estrogen-progestin therapy, was stopped after it was determined that the risks-most notably the increased likelihood of developing breast cancer-outweighed the benefits

• Consistent with the national trend, the number of women in the Kaiser plan taking hormone replacement therapy plummeted in 2002; from 2003 to 2004, breast cancer incidence slid 18 percent then continued on a downward trajectory. These patterns were largely limited to women aged 45 years and older, those most likely to use estrogen to control hot flashes, and to the types of breast cancer that grow when exposed to hormones.

• "It's not exact cause and effect, but it's as close as you can be in epidemiology," Glass says. "There is no other explanation [besides hormone therapy] for what we've found."

• "This is a corroboration…other analyses in the U.S. and Europe have shown the same thing," says Donald Berry, a professor and chairman of the biostatistics department at the University of Texas M.D. Anderson Cancer Center in Houston.

• But does hormone therapy-once touted as being heart-healthy and preventing bone-thinning osteoporosis-offer any benefits? "To get rid of hot flashes and to make it through the night, it's probably a reasonable thing," Berry says. "But don't count on it having any long-term beneficial effects."

• Glass stresses that there are other treatments for cardiovascular and bone health that are more effective and less risky. "The only reason to take…[hormones]…now is for menopausal symptoms," he says, "and it should be the smallest dose for the shortest time."

• By Coco Ballantyne Scientific Americanhttp://sciam.com

Researchers Identify Gene Involved In Breast Cancer

• Researchers at the University of Michigan Comprehensive Cancer Center have identified a gene linked to the development of an aggressive form of breast cancer.

• The researchers found that the gene, FOXP3, suppresses tumor growth. FOXP3 is located on the X chromosome, which means a single mutation can effectively silence the gene. This is unusual, as only one other gene linked to cancer has been found on the X chromosome.

• When one copy of the FOXP3 gene is silenced, the researchers found in studying mice, 90 percent of the mice spontaneously developed cancerous tumors. The researchers also looked at FOXP3 in human breast tissue cells, comparing cancerous and non-cancerous cells. FOXP3 was found to be either deleted or mutated in a substantial portion of the cancer sample: about 80 percent of the cancer tissues studied did not express the gene at all.

• In addition, the researchers found FOXP3 to be a repressor of HER-2, a protein that typically marks a more aggressive form of breast cancer. The researchers believe FOXP3 suppresses the HER-2 gene. HER-2 can be activated by many different factors, but the researchers found that when FOXP3 is normal, it keeps HER-2 levels low; when FOXP3 is missing or mutated, HER-2 levels are likely to rise.

• The researchers have shown that FOXP3 was reduced or missing in about 80 percent of the more than 600 cases of breast cancer tissue examined. At this point, the researchers do not know if FOXP3 can predict breast cancer risk, like the BRCA1 and BRCA2 genes, both of which are linked to a higher risk of breast cancer.

• "FOXP3 defects promote cancer development. We do not know whether this is a genetic defect that puts women at higher risk. For treatment, this gene could be quite important, but for diagnosis, it's too early to tell," says study author Yang Liu, Ph.D., deNancrede Professor of Surgery at the U-M Medical School and co-director of the cancer immunology program at the U-M Comprehensive Cancer Center. Results of the study appear in the journal Cell.

• Initially, the researchers were studying FOXP3's role in autoimmune disease, when they noticed that female mice with one copy of the mutated form of the gene were developing breast cancer. Moreover, the tumors expressed high levels of ErbB2, the mouse equivalent of HER-2. Breast cancer is rare in mice, and ErbB2-positive breast cancer is even more rare.

• "FOXP3 is the first X chromosome-linked gene that suppresses breast cancer and represses the HER-2/ErbB2 oncogene. Given the significant role HER-2 plays in breast cancer and the widespread defects we found on FOXP3, it is likely that this gene play an important role in suppressing breast cancer," says Pan Zheng, M.D., Ph.D., associate professor of surgery and pathology at the U-M Medical School.

• The research is still in early stages. No predictive or diagnostic test is available involving this gene finding. More than 180,000 women will be diagnosed with breast cancer this year, and 40,900 will die from the disease, according to the American Cancer Society.

• In addition to Zheng and Liu, U-M study authors were Lizhong Wang, Xing Chang, Huiming Zhang, Weiquan Li, Yan Liu, Yin Wang, Bae Keun Park and Cun-Yu Wang. Additional authors are Tao Zuo, Carl Morrison, Michael W.Y. Chan, Jin-Qing Liu, Chang-gone Liu, Rulong Shen, Xingluo Liu, Tiany Yang, Tim H.-M. Huang, and Richard Love from Ohio State University; and Virginia Godfrey from the University of North Carolina, Chapel Hill.

• Funding for the study was from the National Institutes of Health and U.S. Department of Defense.

• The University of Michigan has filed a patent application on this research technology, and is currently looking for a corporate partner to help bring the technology to market.

• Reference: Cell, Vol. 129, issue 7, pp. 1275-1286

University of Michigan Health System2901 Hubbard St., Ste. 2400Ann Arbor, MI 48109-2435United Stateshttp://www.med.umich.edu