Breast Health News

Vitamin D Decreased Breast Cancer Risk

2008-07-19T21:07:18Z

1. The Annual meeting of the American Association for Cancer Research reported on a meta analysis of 2,274 wonmen with breast cancer and 2,268 women without breast cancer.
2. The meta-analysis included 4 studies.

]]> A. The studies seemed to indicate a inverse dose-response gradient between 25(OH)D (Vit D) levels and the risk of developing breast cancer. The lower the vitamin D level the more likely the patient will develop breast cancer
B. When the studies were combined, a dose-response gradient was observed between serum25(OH)D and risk of breast cancer and was consistent across all studies.
C. The authors suggest that the standard should be raised for Vit D to 30ng/ml or more
D. The authors stated that, "We could prevent half of the breast cancers in the US by raising the serum vitamin D levels to 32ng/mL".
E. There are opposing researchers that state that the analysis was too selective, did not include negative studies, and that it does not prove 'causation' or that the findings do not prove that elevated Vit D will prevent breast cancer

New DVD on Breast Self Examination now available

2008-06-18T17:25:48Z

A new Breast Self Examination video on DVD, incorporating actors and animation, now available at www.safetouchsheets.com

Vaccine Reduces Recurrence, Death in Patient with HER2 Breast Cancer

2008-05-22T00:06:08Z

1. Reported at the annual meeting of the American Association for Cancer Research.

]]> A. Vaccination with a human epidermal growth factor receptor 2/neu peptide vaccine increased immunogenicity, decreased breast cancer recurrance, and reduced mortality 50% after a median of 3 years of treatement in node-positive and node-negative breast cancer patients with all degrees of HER2/neu expression.
B. Women with low expressing HER2/neu tumors derived the greatest benefit from the vaccine.
C. At 36 months of follow up, the recurrence rate for both low and overexpressers of HER2/neu in the control arm was 18%. In the vaccinated group, the recurrence rate was 14% for overexpressers and 11% for low expressers.
D. The absolute mortality rate for control overexpressers was 9%, compared to 3% for overexpressers who were vaccinated.
E. In the contro low-expressers the mortality was 7%,compared to 0% in the vaccinated group of low-expressers.
F. The women were vaccinated 6 times over a 6 month period and then boosters were given , as needed, every 6-12 months.

Surgery without Irradiation now an option for DCIS

2008-05-21T23:42:57Z

A. Results reported at the annual conference of the National Comprehensive Cancer Network
B. The previous guidelines distinguished between the majority of women with ductal carcinoma in situ (DCIS) and the small subset of women with very small DCIS (<.5cm), unicentric, and of low grade.
C.The women with very small DCIS were treated with lumpectomy alone without irradiation. All other women with DCIS were treated with total mastectomy without lymph node disection or by lumpectomy plus irradiation.

]]> 1. The new guidelines make lumpectomy without irradiation an option for all women with DCIS.
2. The new options are;
a. Lumpectomy without lymph node surgery, plus whole breast radiation therapy.
b. Total mastectomy with or without sentinel node biopsy, and with or without breast reconstruction.
c. Lumpectomy alone, with no lymph node surgery and no radiation therapy.
3. The breast cancer guidelines committee now urges the use of radiation therapy for women who have 1-3 positive nodes.
4. Also new are recommendations on the use of breast reconstruction. The guidelines now warn that reconstruction, prior to radiation, has the potential to affect delivery of radiation therapy.
5. In one study, 52% of women who received radiation after reconstruction had some compromise in the application of radiation, either in terms of the field or the dosing to underlying structures.
6. Reconstruction before irradiation may lead to a worse cosmetic outcome.

Vitamin D May Prove Protective Against Breast Cancer

2008-05-18T18:42:24Z

1. Meta-analyasis of 3 observational studies presented to a med conference in San Diego, CA
2. "A serum 25-hydroxyvitamin D level of 30 mg/mL or higher was associated with at least a 50% lowering of breast cancer." (Dr. Cedric Garland)
3. Study authors suggest that women should have their Vitamin D levels checked yearly
4. "We're confident that we can prevent half of the breast cancer in women in the United States, if we raise the serum vitamin D levels to 32 ng/mL."
5. To reach a level of 32 ng/mL, it would take 2,000 IU/day in New York and probably 1,000 IU/day in San Diego.

]]> A. Not everyone is convinced of the conclusions arrived at by the study authors, "I don't care how many observational studies there are, it does not establish causality."
B. "This was a selective meta-analysis. It's not comprehensive, and there are negative studies that were not included." (Dr. Rowan Chlebowski)

Breast Cancer Leads Mortality Drop in the US and Britian

2008-05-05T01:56:31Z

From the San Antonio Breast Cancer Symposium
1. Through a series of modest gains in breast cancer screening plus advances in endocrine therapy, chemotherapy, and radiotherapy breast cancer mortality in women 35-69yrs has been almost halved in the US and Britian.
2. Although each improvement in breast cancer care has added only a small improvement in survival, taken together, the improvement has been remarkable.
3. The data show that chemotherapy is equally effective in women with and without estrogen receptor positive breast cancer.

]]> A. The bottom line is; "If you give effective chemotherapy to women with or without estrogen receptor-positive disease, you'll reduce their mortality by about one third if they are old and by about one half if they are young".
B. Incidentally, the biggest contributor to the declining death rate in women in the US and Britian has been the drop in lung cancer deaths.
C. Women's dealths due to intestinal cancer, uterine cancer, stomach cancer are all going down.

Treatment Pearl for Common Breast Cancer Related Symptoms

2008-04-28T01:34:56Z

The San Antonio Breast Cancer Symposium
With the decline in breast cancer deaths has come the increase in treatment related symptoms
The focus of the talk was evidence based treatments of the 5 most common breast cancer related issue;
Vaginal dryness
Fatigue
Chemotherapy related neuropathy
Diminished libido
Hot Flashes

]]> Suggested treatments'
1. Vaginal dryness
Salagen (pilocarpine) is under investigation because relief of vaginal dryness has been reported in studies using pilocarpine to treat the oral and ocular dryness of Sjogren's syndrome
Estrogen can improve vaginal dryness but is not recommended because of concern for breast cancer recurrence.
2. Fatigue
"Exercise is the answer, not more rest!"
3. Chemotherapy induced neuropathy
Gabapentin has been widely prescribed for this without research evidence of benefit.
Vitamin E has been reported to be of benefit base on one small (50 pt) study.
A larger study to evaluate this is currently being done
4. Low Libido
Sexual counseling is the only recommended treatment.
Transdermal testosterone cream has proven ineffective in trials
5.Hot Flashes
Studies have shown the oral anttidepressants venlafaxine, fluoxetine, and paroxetine have all been shown to be of some effect in the treatment of hot flashes.

Lifetime Cancer Risk is High in Unaffected BRCA Carriers

2008-02-16T20:59:23Z

1. As reported in Family Practice News, Jan 15, 2008.

]]> A. Most women age 55 and older are discovered to be BRCA carriers when they are tested at the behest of their familys, when a daughter may have developed breast cancer and proven to be BRCA positive.
B. Most of these women do not undergo any special screening as a result of the finding.
C. Estimated lifetime risk at age 55 for a BRCA 1 carrier is 55% for breast cancer and 45% for ovarian cancer.
D. Estimated lifetime risk at age 55 for a BRCA 2 carrier is 47% for breast cancer and 13% for ovarian cancer.
E. The authors feel that based upon these risk estimates, it is very appropriate for older, unaffected BRCA-positive women to adopt more intensive cancer screening and preventive measures.

BRCA1 Carriers May Require More Frequent Imaging

2008-02-16T20:17:56Z

1. As reported in Family Practice News, January 15,2008
2. Midterm report of the Dutch MRI Screening Study, as reported at the San Antonio Breast Cancer Symposium
3. A radomized study of the utility of mammography and MRI in screening women at increased risk breast cancer, involving 2,177 Dutch women, begun in 1999. Median follow up at the time of this report is 5.3 yrs.
4. The protocol is for clinical breast examination every 6 months with yearly MRI and mammography at the same visit. The participants were encouraged to perform self breast examinations.

]]> A. To date, 94 breast cancers have been found. The detection rates were 70.3 cases per 1,000 BRCA 1 carriers, 92.8 cases per 1,000 BRCA 2 carriers, 28.7 cases per 1,000 in the highest risk group, and 32.5 cases per 1,000 in the moderate risk group.
B. The most surprising findings were the differences in the breast cancers arising in BRCA 1 vs BRCA 2 mutation carriers. Cancers in the BRCA 1 carriers tended to occur at a younger age, they were larger when found, they grew more rapidly, and they were significantly less likely to be ductal carcinoma in situ (DCIS) the the breast cancers of the BRCA 2 carriers.
C. Thirteen of the 16 breast cancers detected among study participants in the intervals between screenings occured in BRCA 1 carriers.
D. Seven per cent of the breast cancers in the BRCA 1 group were DCIS , compared with 37% in the BRCA 2 carriers.
E. 31% of the invasive tumors in the BRCA 1 group were greater than 2 cm in size, as were 10% of the BRCA 2 group.
F. Fifty seven percent of all breast cancers in the BRCA 1 group occured before age 40, as did 44% in the BRCA 2 group.
G. As to screening methods; 40% of the breast cancers were found only with MRI, 25% with MRI and mammography, and 18% by mammography screening alone. (The authors state this points out the complementary nature of the two screening methods)
H. Mammography, in this study, found many more cases of DCIS. (67% vs 33%)
I. 30% of all cancers detected in this screening program were lymph node positive at the time of discovery.

Genetic Mutation Less of a Risk Factor for Breast Cancer than once thought

2008-01-17T02:17:54Z

A. From the Journal of the American Medical Association as reported in the Wall Street Journal
B. The study was sponsored by the National Cancer Institute.
C. Researchers interviewed and tested 1,400 women with cancer in one breast and 700 women with cancer in both breasts, who carried the BRCA1 or BRCA2 genes.

]]> 1. Women with BRCA 1 and BRCA2 genes have been found to have less of a risk of developing breast cancer than previously thought.
2. The reevaluated risk is calculated at 40-51% risk for women who carry this gene to develop breast cancer by the age of 70.
3. The previous estimate was 50-80% risk by age 70.
4. It is suspected that the over estimation is caused by researchers focus on families with cancer, rather than sampling unaffected families.
5. It is estimated that one half of 1%, or about 750,000 women in the US, carry the affected genes.
6. Women in the study faced a higher risk if a relative's breast cancer was diagnosed at a young age or the relative had cancer in both breasts.
7. Costing as much as $3,000, the tests are recommended for women with a family history of breast cancer and not for general population screening. Most insurances cover the cost of the tests.

Breast Cancer Deaths decrease by half from 1990

2008-01-17T02:03:07Z

1. From San Antonio Breast Cancer Symposium
2. A report of the Oxford based Early Breast Cancer Trialist's Collaboration (EBCTCG) which reported on 350,000 women in over 400 randomized clinical trials.
3. Early breast cancer in women from 35 to 69 yrs has decreased by half since 1990.
4. Credit for the decline has been given to breast cancer screening, endocrine therapy, chemotherapy, and irradiation.

]]> A. There has been no 'one' cause for the decrease. Indeed, the decline seems to have been in steps as various therapies have become standard therapy.
B. Data show the the decline has been about equal in women with estrogen receptor (ER) positive genes and ER negative patients.

Ultrasound Breast Cancer Screening, Not ready for Prime Time

2008-01-08T03:53:37Z

A Report from the Radiological Society of North America on the Amer College of Radiology Imaging Network (ACRIN)6666 study;
1. A multicenter study of 2,637 women at high risk for breast cancer.
2. High risk was defined as a personal history of breast cancer (53%), familial high risk (42%), prior atypical ductal hyperplasia, atypical lobualr hyperplasia, lobular carcinoma in situ, or atypical papilloma (3%), BRCA1 or BRCA2 mutations (1%), or prior mediastinal/chest radiation therapy (1%)

]]> A. The addition of screening ultrasound to mammography identified an additional 4.2 cancers per 1,000 high risk women screened.
B. In the study, 40 women were diagnosed with cancer, 15% of which were ductal carcinomain situ. Twelve (30%) of the women had cancers found by mammography alone, 12 (30%) by ultrasound alone, 8 (20%) seen by mammography and ultrasound, and 8 (12%) found by neither.
C. The vast majority of the cancers detected by ultrasound were small (median 10mm), and node negative (9/10).
D. The supplemental ultrasound screening resulted in additional biopsies in 136 (5.2%) women, of whom only 12 (8.8%) were found to have cancer.

Ultrasound Breast Cancer Screening, Not ready for Prime Time

2008-01-08T03:53:37Z

Ultrasound Breast Cancer Screening, Not ready for Prime Time

2008-01-08T03:53:37Z

Breast-Conserving Therapy is as Effective as Mastectomy in DCIS

2008-01-07T02:13:52Z

A retrospective study from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program Database;
1. DCIS, Ductal Carcinoma in Situ, is often considered a precancer that has the potential to become an invasive cancer over time.
2. The two treatments for this condition have been;
a. Total mastectomy sometimes followed by tamoxifen or an aromatase inhibitor for women who are not considered candidates for radiation therapy
b. Breast conserving surgery followed by irradiation with or without tamoxifen or an aromatase inhibitor.
3. The data base, for this study, included 27,728 women who underwent total mastectomy and 25,240 women who underwent breast conserving surgery.

]]> Results;
A. No difference in breast cancer specific survival between the total mastectomy and breast-conserving surgeries ( 98.6% and 99.5% respectively)
B. Factors that may help determine prognosis include race, hormone receptor status, and tumor grade
Better results were seen in:
---Caucasian vs African-American women
---Estrogen receptor (ER-positve)/progesterone receptor (PR-positive) versus ER-positive/ PR-negative and ER-negative/ PR-negative.
---Lower versus higher tumor grade.