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duminică, 5 august 2012

Awareness, Detection And Treatment Programs Required To Improve Breast Health Care In Pakistan

Among most women in Pakistan, there is limited awareness of breast cancer occurrence, detection, and screening practices, or the importance of self-breast exams and clinical breast exams, according to a study in the August issue of the Journal of the American College of Radiology. In Pakistan, breast cancer is the most common cancer affecting women and the incidence is rising. It is usually diagnosed in later stages and often at a younger age compared with populations in the West.

"Breast cancer care in limited-resource countries generally suffers because of multiple obstacles, including a lack of recognition of breast health as a public health priority, a shortage of trained health care workers and social or cultural barriers. An improved understanding of existing obstacles in breast cancer care is critical to identify those factors that may be correctable and thereby devise effective interventions for improving early breast cancer detection and treatment in disadvantaged countries," said Sughra Raza, MD, co-author of the study.

Questionnaires were developed to address demographics, financial and educational levels, knowledge regarding breast cancer occurrence and treatment, and religious and cultural beliefs that may affect seeking care for breast disease. Using the questionnaires, one-on-one surveys were administered by community health workers in Karachi to 200 women and 100 general practitioners.

Survey results showed that women's knowledge of breast cancer incidence, diagnosis and treatment was proportionate to educational level, while willingness to address breast health issues and interest in early detection were high regardless of education level. Very few women had ever undergone clinical breast examinations or mammography. Among general practitioners, most understood major risk factors and importance of early detection. However, 20 percent did not believe breast cancer occurs in Pakistan, and 30 percent believed that it is a fatal disease. Female general practitioners were more likely to perform clinical breast examinations than male general practitioners.

"Although there is limited awareness regarding breast cancer occurrence, detection, and screening practices, as well as the importance of self-breast exams and clinical breast exams, the majority of women are very keen to learn more, to participate in their own care and to lower their risk," said Raza.

"Awareness and educational activities, including training female clinical health workers to perform clinical breast exams, will be beneficial, as we begin instituting awareness, detection and treatment programs in the face of a rapidly rising incidence and late-stage detection of breast cancer in Pakistan," said Raza.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Breast Cancer Slowed By Plant-Based Compound In Mouse Model

The natural plant compound phenethyl isothiocyanate (PEITC) hinders the development of mammary tumors in a mouse model with similarities to human breast cancer progression, according to a study published in the Journal of the National Cancer Institute.

Edible plants are gaining ground as chemopreventative agents. PEITC has shown to be effective as a chemopreventative agent in mice for colon, intestinal, and prostate cancer, by inducing apoptosis.

In order to determine the efficacy of PEITC in mammary tumors in mice, Shivendra V. Singh, Ph.D., of the University of Pittsburgh Cancer Institute and colleagues, placed mice on two diets: a control diet, and a diet supplemented with PEITC for 29 weeks. The researchers performed histopathological assessments, and measured the incidence and size of the mammary tumors, along with cell proliferation, apoptosis, and neoangiogenesis, which were determined in tumor sections.

The researchers found that administering PEITC for 29 weeks was linked with a 56.3% reduction in mammary carcinoma lesions greater than 2mm. "Although PEITC administration does not confer complete protection against mammary carcinogenesis, mice placed on the PEITC-supplemented diet, compared with mice placed on the control diet, clearly exhibited suppression of carcinoma progression," the authors write. PEITC was also well-tolerated. Since chemoprevention trials are both expensive and time-consuming and necessitate years of follow-up, the authors feel that, "The discovery of biomarker(s) associated with exposure and activity is critical for clinical development of promising cancer chemopreventative agents." This study was able to identify certain biomarkers that may be useful in future clinical investigations.

The authors also point out certain limitations of their study, namely that the results may be different in humans than in mice; also both the relevance of other altered proteins from PEITC and the mechanism by which PEITC causes apoptosis are unclear.

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Self-Help For Men Supporting Their Spouses Through Breast Cancer

Male partners of breast cancer patients are likely to take a pass on spousal support groups in favour of exercise or an evening out with friends to cope with stresses associated with the disease, according to new research from the University of Alberta.

Faculty of Nursing professor Wendy Duggleby said spouses of women with breast cancer have unique needs when it comes to retaining a sense of hope at a time when they provide important physical and emotional support for their partners.

"There are many programs out there for women, but for men a lot of support mechanisms are support groups, and it was very clear from the participants in our study that's not what they wanted," said Duggleby, Endowed Nursing Research Chair in Aging and Quality of Life.

"What these spouses needed was help finding ways to do things for themselves to help reduce their stress."

The study, published in this month's Oncology Nursing Forum, is the first to look at the hope experience of male spouses of breast cancer patients, said Duggleby. Ensuring men have a sense of hope not only helps decrease their risk for depression, it helps their partners, too.

"If their husbands lose hope, the wives are really, really worried about them and they often lose hope themselves. For women with breast cancer, it actually helps with their own quality of life if we can do something to help the men. It's very interconnected."

In the study, men in Edmonton and Saskatoon were surveyed about hope and their ability to cope with their spouses' disease. Many reported that their partner's diagnosis was their darkest day, and that they struggled to find hope and balance after juggling career, added household duties and care.

Fighting back

Warren Tasker called upon a fighter's will when his partner Gwen Borowski was diagnosed with breast cancer on March 1, 2007. He made Borowski's needs a priority and together they put everything toward the fight, learning all they could about the disease and pressing physicians to explain treatment in detail.

"It was all I thought about, night and day," said Tasker, an Edmonton-based writer and editor, who wrote about the experience for the Canadian Breast Cancer Foundation - Prairies/NWT chapter.

After years of writing about boxing for the Edmonton Journal, he took up the sport to cope with stress, in addition to his regular running and cycling routine.

"I was getting hit and I was getting to hit back. It felt good - it felt really good," he said. "You need an outlet, you need to find something to release all the pent-up frustration, the fear, the apprehension, the anxiety."

In study interviews, filmed and posted online, spouses reported similar experiences, turning to exercise, music, hobbies and time away with friends to find balance. Many expressed a strong desire to be able to talk to or hear from other spouses who went through similar struggles - without taking time from work or family to attend support groups, Duggleby said.

Work schedules also presented challenges with attending medical appointments with their spouses to hear information first-hand, which was another strong need spouses expressed.

"If you're a working man, it becomes difficult to go to some appointments, although some of that is just perception. They're not being excluded but they feel like they're being excluded. It's part of breaking down some of those barriers in cancer care," said Duggleby.

Duggleby said the findings should help health-care providers and agencies provide the specific support and resources these men need. For many spouses, an easy solution would be a guide showing where to find online information about breast cancer without information overload.

"They really do want something that's specific for them, tailored for their needs. It doesn't have to be done through a research study. There is a lot that can be done just based on what these spouses said and the ideas they provided. It would make a huge, huge difference."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our men's health section for the latest news on this subject. The study was funded by the Canadian Breast Cancer Foundation - Prairies/NWT.
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marți, 13 decembrie 2011

Vaccine Developed That Attacks Breast Cancer In Mice; Implications For Ovarian, Colorectal And Pancreatic Cancers

Main Category: Breast Cancer
Also Included In: Pancreatic Cancer; Ovarian Cancer; Immune System / Vaccines
Article Date: 13 Dec 2011 - 3:00 PST

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Researchers from the University of Georgia and the Mayo Clinic in Arizona have developed a vaccine that dramatically reduces tumors in a mouse model that mimics 90 percent of human breast and pancreatic cancer cases - including those that are resistant to common treatments.

The vaccine, described this week in the early edition of the journal Proceedings of the National Academy of Sciences, reveals a promising new strategy for treating cancers that share the same distinct carbohydrate signature, including ovarian and colorectal cancers.

"This vaccine elicits a very strong immune response," said study co-senior author Geert-Jan Boons, Franklin Professor of Chemistry and a researcher in the UGA Cancer Center and its Complex Carbohydrate Research Center. "It activates all three components of the immune system to reduce tumor size by an average of 80 percent."

When cells become cancerous, the sugars on their surface proteins undergo distinct changes that set them apart from healthy cells. For decades, scientists have tried to enable the immune system to recognize those differences to destroy cancer cells rather than normal cells. But since cancer cells originate within the body, the immune system generally doesn't recognize them as foreign and therefore doesn't mount an attack.

The researchers used unique mice developed by Sandra Gendler, Grohne Professor of Therapeutics for Cancer Research at the Mayo Clinic in Arizona and co-senior author on the study. Like humans, the mice develop tumors that overexpress a protein known as MUC1 on the surface of their cells. The tumor-associated MUC1 protein is adorned with a distinctive, shorter, set of carbohydrates that set it apart from healthy cells.

"This is the first time that a vaccine has been developed that trains the immune system to distinguish and kill cancer cells based on their different sugar structures on proteins such as MUC1," Gendler said. "We are especially excited about the fact that MUC1 was recently recognized by the National Cancer Institute as one of the three most important tumor proteins for vaccine development."

Gendler pointed out that MUC1 is found on more than 70 percent of all cancers that kill. Many cancers, such as breast, pancreatic, ovarian and multiple myeloma, express MUC1 with the shorter carbohydrate in more than 90 percent of cases.

She explained that when cancer occurs, the architecture of the cell changes and MUC1 is produced at high levels, promoting tumor formation. A vaccine directed against MUC1 has tremendous potential, Gendler said, as a preventative for recurrence or as a prophylactic in patients at high risk for particular cancers. A vaccine also can be used together with standard therapy such as chemotherapy in cancers that cannot be cured by surgery, such as pancreatic cancer.

Boons noted that MUC1 is also overexpressed in 90 percent of the subset of patients who are not responsive to hormonal therapy, such as Tamoxifen or aromatase inhibitors, or the drug Herceptin. These so-called "triple-negative" tumors are extremely aggressive and difficult to treat, Boons said, and a new treatment option is urgently needed.

"In the U.S. alone, there are 35,000 patients diagnosed every year whose tumors are triple-negative," Boons said. "So we might have a therapy for a large group of patients for which there is currently no drug therapy aside from chemotherapy."

Therapeutic vaccines received renewed attention last year when the Food and Drug Administration approved the first cancer treatment vaccine, a drug known as Provenge that is used to treat metastatic prostate cancer. Treatment with the drug, which is manufactured in Georgia, requires clinicians to isolate immune cells from the patient and then to send the cells to a lab, where they are linked to a protein that stimulates the immune system. The cells are returned to the patient's treating physician, who then infuses the drug over three treatments, usually two weeks apart.

Boons' vaccine, on the other hand, is much simpler. It is fully synthetic, meaning that its components can be manufactured in a lab with assembly-line precision. The vaccine consists of three components - an immune system booster known as an adjuvant, a component that triggers the production of the immune system's T-helper cells, and a carbohydrate-linked peptide molecule that directs the immune response to cells bearing MUC1 proteins with truncated carbohydrates.

Biotechnology is a key industry in Georgia, and this year Boons founded an Athens-based company, known as Viamune, to help develop and commercialize the vaccine and the technologies used to create it. The company is one of nearly 30 that are affiliated with the University's BioBusiness Center, which is an incubator for life sciences start-up companies associated with UGA.

"Companies like these have the potential to create stable, high-paying jobs that have a significant social and economic impact," said Stefan Schulze, associate director of the Georgia BioBusiness Center. He noted that Viamune was a one four finalists selected from 40 companies at an investor's forum hosted this year by the non-profit organization Southeast BIO.

Boons, Gendler and their colleagues are currently testing the vaccine's effectiveness against human cancer cells in culture and are planning to assess its toxicity. If all goes well, they anticipate that phase I clinical trials to test the safety of the vaccine could begin by late 2013.

The vaccine represents nearly a decade of work on the part of Boons and his team. A 2007 study demonstrated the vaccine's effectiveness in another mouse model, and Boons is cautiously optimistic about his most recent results. Although promising results in mice often don't translate to humans, Boons said he is confident that vaccines that target the specific carbohydrate signatures of cancer cells will ultimately play an important role in the treatment of the disease.

"We are beginning to have therapies that can teach our immune system to fight what is uniquely found in cancer cells," Boons said. "When combined with early diagnosis, the hope is that one day cancer will become a manageable disease."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject. In addition to co-senior authors Boons, Ph.D., and Gendler, Ph.D., the co-first authors on the paper are Vani Lakshminarayanan, Ph.D., at the Mayo Clinic in Arizona and Pamela Thompson at the University of Georgia. Additional authors include, at UGA, Margreet Wolfert, Ph.D., and Therese Buskas, Ph.D., and, at the Mayo Clinic, Judy Bradley, Latha Pathangey, Cathy Madsen and Peter Cohen, M.D.
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How Do BRCA1 Mutations Harm Breast Cells? Researchers Demonstrate

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Academic Journal
Main Category: Breast Cancer
Also Included In: Cancer / Oncology; Genetics
Article Date: 13 Dec 2011 - 9:00 PST

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Researchers at the Johns Hopkins Kimmel Cancer Center have demonstrated during their work with breast cells that breast cells become vulnerable to cancer if a single copy of the breast cancer gene BRCA1 is inactivated. It causes genetic instability in the cells through reducing their ability to repair DNA damage.

The leading risk factor for hereditary breast cancer is an inherited mutation in the BRCA1 gene which requires close monitoring or prompt preventive mastectomy.

The breakthroughs might help researchers develop a drug that prevents hereditary breast cancer, as well as tools to identify those who benefit most from prophylactic treatments. The study is published in the Proceedings of the National Academy of Sciences Oct. 25.

Exactly how BRCA1 inactivation increases the risk of cancer has remained a mystery. BRCA1 is believed to be a "tumor suppressor" gene. Usually, cancer is not caused by the loss of one copy of such genes, as each individual is born with two copies of each gene (one from each parent), and the second copy is sufficient in keeping cells healthy in a similar way that a car can stop safely after losing control of the front brakes as the rear brakes are still working.

According to the researchers, cancer seems to develop in such cases only after the second copy of the gene is damaged, i.e. random mutation during cell division, resulting in uncontrolled cell growth.

Mouse models of BRCA-related cancers have demonstrated that damage to genes, such as TP53, occurred prior to damage to the second copy of BRCA.

Ben Ho Park, M.D., Ph.D., associate professor of oncology at the Johns Hopkins Kimmel Cancer Center, explained:

"In theory, this process would take a long time and BRCA-related breast cancers
occur at an early age."

For the investigation, the team used novel technology in order to insert a single copy of a typical BRCA1 mutation into normal breast cells.

The main theory has been that the original inactivation of a single copy of BRCA1 produces additional DNA mutations to expand more rapidly than normal - a condition called "genomic instability."

Park explains:

"The protein coded by BRCA1 is involved in repairing major DNA breaks, so it would make sense that its inactivation could weaken a cell's resistance to DNA mutations."

However, Park adds that the consequence of losing a single copy of BRCA1 was hard to model and difficult to investigate. Results from prior attempts to produce mice with single-copy BRCA1 mutations were uncertain as the mice were unable to demonstrate the pattern of human cancers. Furthermore, it has been hard for investigators to create human cell lines in which the only flaw is a single mutated copy of BRCA1.

In order to test their theory, the team first selected cell lines obtained from non-cancerous human breast epithelial cells - where BRCA1 breast cancers originate. An advanced gene-targeting method was then used to generate novel cell lines that have a typical cancer-associated BRCA1 mutation in just one copy of the gene.

? Following this, tests were conducted on both cell types - cells with the BRCA1 mutation, and the original cells with two healthy copies of BRCA1 - to compare their DNA repair activity. The team demonstrated that cells with BRCA1 mutations were not as effective at carrying out the type of DNA repair known to involve the BRCA1 protein.

They found that when exposed to a DNA-damaging chemotherapy medication or radiation the BRCA1-mutated cells were more likely to die. In addition, BRCA1-mutated cells that were allowed to divide for many weeks were more likely to lose additional genes, includes those frequently mutated in breast tumors. Similar genetic losses were observed on non-cancerous breast cells taken from women with BRCA1 mutations.

Park said:

"What this shows is that having only a single working copy of BRCA1 really does bring about changes in a cell that would be expected to give rise to cancer.
We hope to use this new system to introduce other known BRCA1 mutations, to get a better idea of the relative cancer risk each individual mutation represents, because right now there are few good ways to do that. In the future, we hope to further define risk so that family members with one type of BRCA1 mutation may be advised to get preventative treatment or surgery, and those with other BRCA1 mutations could rely on careful screening."

In addition, the cell models might be helpful in determining the susceptibility of various BRCA1 mutations to drugs, Park adds. At present, anti-cancer medications known as PARP inhibitors are in clinical trials against tumors with BRCA1-mutations.

The lifetime risks of developing breast cancer has been shown among women born with a mutated copy of BRCA1 to range between 50% to 90%. In addition, they have high, but variable risks of ovarian and other cancers.

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Cognitive Problems Still Evident Several Years After Breast Cancer Treatment

Main Category: Breast Cancer
Also Included In: Neurology / Neuroscience
Article Date: 13 Dec 2011 - 3:00 PST

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A new analysis has found that breast cancer survivors may experience problems with certain mental abilities several years after treatment, regardless of whether they were treated with chemotherapy plus radiation or radiation only. Published early online inCANCER, a peer-reviewed journal of the American Cancer Society, the study indicates that there may be common and treatment-specific ways that cancer therapies negatively affect cancer survivors' mental abilities.

Previous research suggests that chemotherapy can cause problems with memory and concentration in breast cancer survivors. To compare the effects of different types of cancer treatment on such mental abilities, Paul Jacobsen, PhD, of the Moffitt Cancer Center and Research Institute in Tampa, and his colleagues examined 62 breast cancer patients treated with chemotherapy plus radiation, 67 patients treated with radiation only, and 184 women with no history of cancer. Study participants completed neuropsychological assessments six months after completing treatment and again 36 months later, which is further out from the end of treatment than most previous studies of this type.

The study confirmed that chemotherapy can cause cognitive problems in breast cancer survivors that persist for three years after they finish treatment. In addition, the investigators found that breast cancer survivors who had been treated with radiation (and not chemotherapy) often experienced problems similar to those in breast cancer survivors treated with both chemotherapy and radiation. They did not find that hormonal therapy (such as tamoxifen) caused cognitive difficulties.

"These findings suggest that the problems some breast cancer survivors have with their mental abilities are not due just to the administration of chemotherapy," said Dr. Jacobsen. "Our findings also provide a more complete picture of the impact of cancer treatment on mental abilities than studies that did not follow patients as long or look at mental abilities in breast cancer survivors who had not been treated with chemotherapy," he added.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject. Article: "Cognitive functioning after cancer treatment: A three-year longitudinal comparison of breast cancer survivors treated with chemotherapy or radiation and non-cancer controls." Kristin M. Phillips, Heather S. Jim, Brent J. Small, Christine Laronga, Michael A. Andrykowski, and Paul B. Jacobsen. CANCER; Published Online: December 12, 2011 (DOI: 10.1002/cncr.26432).
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Increasing Number Of Imaging Visits Faced By Breast Cancer Patients Before Surgery

Main Category: Breast Cancer
Also Included In: MRI / PET / Ultrasound; Radiology / Nuclear Medicine
Article Date: 13 Dec 2011 - 1:00 PST

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Breast cancer patients frequently undergo imaging like mammograms or ultrasounds between their first breast cancer-related doctor visit and surgery to remove the tumor. Evaluations of these scans help physicians understand a person's disease and determine the best course of action. In recent years, however, imaging has increased in dramatic and significant ways, say researchers from Fox Chase Cancer Center. More patients have repeat visits for imaging than they did 20 years ago, and single imaging appointments increasingly include multiple types of imaging.

The researchers, led by Richard Bleicher, M.D., surgical oncologist at Fox Chase, found that between 1992 and 2005, the percentage of patients who had multiple (2+) imaging visits nearly quadrupled. Bleicher says additional visits present a burden to patients, many of whom are elderly, but the stress may be alleviated through better coordination and evaluation by physicians. Bleicher presented his group's findings at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

"The burden to the patient is increasing substantially," Bleicher says. "The number of days patients are having mammograms, MRIs, and ultrasounds is going up steadily year by year. They're having imaging done more frequently on separate dates during the preoperative interval than ever before. It's surprising."

The preoperative interval begins when a patient first reports to a doctor with a breast complaint and ends when the patient undergoes therapeutic surgery to resect a tumor. For the more than 65,000 patients involved in the study, the preoperative interval lasted 37 days on average. The Fox Chase researchers found that in 1992, roughly one in 20 cancer patients (4.9 percent) diagnosed with invasive, non-metastatic cancer underwent imaging twice or more during the preoperative interval. By 2005, that portion had climbed to about one in 5 (19.4 percent). In the extreme case, a small subset of 20 patients underwent mammograms on five or more visits during the preoperative interval.

The researchers also found that a single imaging visit increasingly includes multiple imaging types. In 1992, 4.3 percent of patients underwent multiple types of imaging; in 2005, that rate rose to 27.1 percent.

With the increased use of imaging, Bleicher says that for physicians, "the question becomes, 'How are we affecting patients overall with what we're ordering nowadays?'"

Previous studies have examined patient burden in terms of cost, but Bleicher says he hasn't seen studies that focus on the patient burden in terms of the patient's time. "I wanted to take a look at how things have been changing for patients and how many times they have to travel back and forth to get more imaging," he says. "Physicians need to keep in mind that it's hard enough for working people to take off from work and trek back and forth to appointments, but older people have infirmities, and it's harder to get around. The coordination of care is very important. We need to focus more on the burden to the patient."

Other studies have shown an increase in the cost of breast cancer care - but the cost of imaging is rising even faster. "We know the costs are going up, but we don't know why," he says. "One reason might be the frequency and amount of imaging."

He points out that when more than one set of imaging is done on the same day, "There are perversities of the reimbursement system that may foster these separate visits, although I don't know if that's why we're seeing this phenomenon."

The researchers discovered the climbing trend after studying data on Medicare patients from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program. Their results came from the records of 67,751 women who were treated for invasive, non-metastatic breast cancer with surgery and lymph node staging. The researchers omitted patients diagnosed with either metastatic disease or DCIS because those types of breast cancer require different approaches to imaging and treatment. The median age of the study participants was 75.

Bleicher says the patient's burden may be reduced if patients ask their providers why imaging is being done, and work together to make the process smoother. "If they do need imaging, then they might ask their physician, especially if they're of an older age, whether or not they think they're going to need additional types of imaging and if those can be scheduled together," he says.

The researchers are now diving deeper into their data to understand the trend and look for a better way to help breast cancer patients with imaging, Bleicher says. "We want to see whether or not there is a more efficient method of imaging the patients so that we're improving outcomes without increasing costs."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject. Co-authors include Karen Ruth, Elin R. Sigurdson, Kathryn Evers, Yu-Ning Wong, Marcia Boraas, and Brian L. Egleston from Fox Chase.
The study was supported, in part, by a US Public Health Services grant, an appropriation from the Commonwealth of Pennsylvania, an American Cancer Society grant, and by generous private donor support.
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luni, 12 decembrie 2011

Side Effects Of Breast Cancer Drugs Can Be So Bad Women End Treatment And Risk Return Of Cancer

Main Category: Breast Cancer
Also Included In: Compliance; Pain / Anesthetics
Article Date: 12 Dec 2011 - 1:00 PST

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Why do so many postmenopausal women who are treated for estrogen-sensitive breast cancer quit using drugs that help prevent the disease from recurring?

The first study to actually ask the women themselves -- as well as the largest, most scientifically rigorous study to examine the question -- reports 36 percent of women quit early because of the medications' side effects, which are more severe and widespread than previously known. The Northwestern Medicine research also reveals a big gap between what women tell their doctors about side effects and what they actually experience.

"Clinicians consistently underestimate the side effects associated with treatment," said lead investigator Lynne Wagner, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine and a clinical psychologist at Robert H. Lurie Comprehensive Cancer Center of Northwestern University. "They give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don't want to be complainers and don't want their doctor to discontinue treatment. So no one knew how bad it really was for patients."

The symptom most likely to cause women to stop using the drugs was joint pain. Other side effects women reported as compromising their quality of life were hot flashes, decreased libido, weight gain, feeling bloated, breast sensitivity, mood swings, irritability and nausea.

Wagner's research was presented at the 34th Annual San Antonio Breast Cancer Symposium.

The drugs, aromatase inhibitors, stop the production of estrogen in postmenopausal women, whose breast cancer cells are stimulated by estrogen. About two-thirds of breast cancers are estrogen sensitive, and aromatase inhibitors reduce the recurrence of cancer in postmenopausal women.

The women at highest risk for quitting the medications before the recommended five years are those who still are experiencing residual side effects from recent chemotherapy or radiation therapy when they start the aromatase therapy, according to the study. Women who had surgery for breast cancer but not chemotherapy or radiation therapy, or who weren't taking many other medications, were more likely to keep taking the aromatase medication.

"The more miserable they were before they started, the more likely they were to quit," Wagner said. "By the time they get through chemotherapy or radiation, they have to face five more years of another medication that will make them feel lousy. They feel like they already lost enough time to cancer and have reached their threshold for feeling bad."

"This is a wake-up call to physicians that says if your patient is feeling really beaten up by treatment, the risk of her quitting early is high," Wagner said. "We need to be better at managing the symptoms of our patients to improve their quality of life."

The new research exposes the disparity between clinicians' reporting of side effects and women's actual experiences. In a previous study, clinicians reported 5 percent of their patients experienced moderate to severe symptoms as a result of taking aromatase inhibitors. The new Northwestern study surveyed 686 women with a detailed questionnaire about their symptoms before treatment and at three, six, 12 and 24 months after starting treatment. The researchers found after three months of treatment that 33 to 35 percent of women had severe joint pain, 28 to 29 percent had hot flashes, 24 percent had decreased libido, 15 to 24 percent had fatigue, 16 to 17 percent had night sweats and 14 to 17 percent had anxiety. These numbers increased as women were on treatment longer.

Earlier studies also asked women to recall their symptoms after treatment ended, which is less accurate than reporting them at regular intervals while taking the drugs.

As a result of the side effects, 36 percent of women ended treatment before an average of 4.1 years. After two years, 10 percent had quit; the remainder quit between 25 months and the 4.1 years.

"These findings can help us identify women at risk for quitting the therapy, counsel them about the importance of staying on it and provide treatment for troubling side effects," Wagner noted.

Weight gain can be addressed with nutritional counseling, while mood swings and irritability can be treated with cognitive behavioral therapy or mind-body techniques, Wagner said. Joint pain can be tempered with nonsteroidal anti-inflammatory drugs, or women may be switched to a different hormonal medication. Nausea can be reduced with medication.

For the study, patients who had postmenopausal breast cancer filled out a 46-question survey rating their quality of life and symptoms associated with breast cancer and endocrine treatment. The survey included an item asking how much they were bothered by side effects of treatment from zero (not bothered) to four (severely bothered). For each additional one-point increase on this item, the patient's risk of quitting treatment early rose 29 percent. The patients were randomized to take one of two hormonal treatments (anastrozole or exemestane) daily for five years.

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Northwestern University. "Side Effects Of Breast Cancer Drugs Can Be So Bad Women End Treatment And Risk Return Of Cancer." Medical News Today. MediLexicon, Intl., 12 Dec. 2011. Web.
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In Newly Diagnosed Inflammatory Breast Cancer, Circulating Tumor Cells Not Linked To Survival

Main Category: Breast Cancer
Also Included In: Medical Devices / Diagnostics
Article Date: 12 Dec 2011 - 1:00 PST

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The presence of circulating tumor cells in the blood appears to have no relationship to survival in women who have just been diagnosed with inflammatory breast cancer, according to new research from Fox Chase Cancer Center. However, the research shows that these stray tumor cells may signal that the disease has spread to other parts of the body, even before imaging reveals any metastases. The results were presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

If a woman is diagnosed with inflammatory breast cancer, a particularly fast-growing form of the disease, doctors should consider close imaging to monitor and possibly continue aggressive treatment if she also has circulating tumor cells (CTCs), regardless of what imaging shows, recommends study author Massimo Cristofanilli, M.D., F.A.C.P., chair of the department of medical oncology at Fox Chase. "You should be carful before stopping treatment in someone who has evidence of circulating cells, particularly when dealing with a disease like inflammatory breast cancer, which can progress rapidly."

Previous research by Cristofanilli and his colleagues found that the number of stray cancer cells circulating in the blood is the best predictor of both how long a woman with metastatic breast cancer will live and the amount of time until her cancer progresses. But the researchers have also found that the presence or lack of CTCs has little to say about prognosis in women with metastatic inflammatory breast cancer, an aggressive disease with extremely poor outcomes in spite of multidisciplinary modality treatment.

During the current study, Cristofanilli and his team reviewed the records of 84 women who had just learned they have inflammatory breast cancer, either in stage III or stage IV. A total of 64 (76.2%) women had at least 1 CTC and 29 (34.5%) had at least 5. The researchers found that women with no CTCs had comparable survival and spent the same amount of time progression-free as women with one or more CTCs. The results suggest that there is little prognostic value in measuring CTCs in women newly diagnosed with inflammatory breast cancer.

It's not clear why CTCs appear to be linked to prognosis in some forms of cancer but not others, says Cristofanilli. Inflammatory breast cancer is already an aggressive disease, he says, so compared to other forms of breast cancer whether or not cells have broken off and entered the blood may say little more about an otherwise already aggressive disease.

Inflammatory breast tumors are typically fast-growing, and travel quickly to lymph nodes and the brain. During follow-up in the current study, which lasted more than 22 months for half of patients, more than 30% of the entire group had died.

Perhaps "the most important finding from the study," says Cristofanilli, is that more than three-quarters of women who just learned they have inflammatory breast cancer had CTCs that can be detected in the blood. In comparison, he adds, only 15% of women with non-inflammatory breast cancer typically have CTCs. "So there is a huge difference in inflammatory breast cancer and other forms of breast cancer." These stray tumor cells, therefore, may indicate something about inflammatory breast cancer, he reasons, perhaps serving as an early sign that it has already spread. Indeed, only approximately one-third of women with inflammatory breast cancer have detectable metastases at diagnosis, but 60% will eventually develop them.

Currently, says Cristofanilli, doctors primarily measure CTCs in women with metastatic disease, since a decrease in CTCs can signal that treatment is working. But given that most women with inflammatory breast cancer are likely metastatic at the time of diagnosis, this test could serve another purpose - to guide doctors towards more aggressive and prolonged forms of treatment, says Cristofanilli. "If women with inflammatory breast cancer have CTCs, perhaps we should continue to treat them as if they have already established metastatic breast cancer, even if imaging does not show metastases."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject. Co-authors include Michal Mego, Antonio Giordano, Ugo De Giorgi, Limin Hsu, Anthony Lucci, Shaheenah Dawood, Wendy A. Woodward, Naoto T. Ueno, Vicente Valero, Eleni Andreopoulou, Gabriel N. Hortobagyi, and James M. Reuben.
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Fox Chase Cancer Center. "In Newly Diagnosed Inflammatory Breast Cancer, Circulating Tumor Cells Not Linked To Survival." Medical News Today. MediLexicon, Intl., 12 Dec. 2011. Web.
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Starch Intake May Influence Risk For Breast Cancer Recurrence

Main Category: Breast Cancer
Also Included In: Nutrition / Diet
Article Date: 12 Dec 2011 - 0:00 PST

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Researchers have linked increased starch intake to a greater risk for breast cancer recurrence, according to results presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

"The results show that it's not just overall carbohydrates, but particularly starch," said Jennifer A. Emond, M.S., a public health doctoral student at the University of California, San Diego. "Women who increased their starch intake over one year were at a much likelier risk for recurring."

Researchers conducted a subset analysis of 2,651 women who participated in the Women's Healthy Eating and Living (WHEL) Dietary Intervention Trial, a plant-based intervention trial that enrolled about 3,088 survivors of breast cancer. WHEL researchers studied breast cancer recurrence and followed the participants for an average of seven years.

The subset analysis involved an examination of how changes in carbohydrate intake influenced breast cancer recurrence. "The WHEL dietary trial, even though it focused on fruits and vegetables, fiber and fat, didn't really have a specific carbohydrate goal," Emond said.

She and her colleagues obtained carbohydrate intake information from multiple 24-hour dietary recalls at baseline and at one year. In an annual phone interview, participants reported everything they had eaten during the last 24 hours.

At baseline, carbohydrate intake was 233 grams per day. Results showed that women whose cancer recurred had a mean increase in carbohydrate intake of 2.3 grams per day during the first year, while women whose cancer did not recur reported a mean decrease of 2.7 grams per day during the first year.

Starches were particularly important, Emond said. Changes in starch intake accounted for 48 percent of the change in carbohydrate intake. Mean change in starch intake during the first year was 0.1 grams per day among women whose cancer recurred vs. 0.7 grams per day among women whose cancer did not recur.

When change in starch intake during one year was grouped into quartiles of change, the rate of an additional breast cancer event was 9.7 percent among women who decreased their starch intake the most during one year, compared with an event rate of 14.2 percent among women who increased their starch intake the most during one year.

The change in starch intake was "independent of dietary changes that happened in the intervention arm," Emond said. "It is independent of more global changes in diet quality."

After stratifying patients by tumor grade, Emond and colleagues found that the increased risk was limited to women with lower-grade tumors.

These results indicate a need for more research on dietary recommendations that consider limited starch intake among women with breast cancer.

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American Association for Cancer Research. "Starch Intake May Influence Risk For Breast Cancer Recurrence." Medical News Today. MediLexicon, Intl., 12 Dec. 2011. Web.
12 Dec. 2011. APA

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