Doctors Failing to Incorporate New Breast Cancer Treatments

Elderly women having unnecessary radiology

Elderly women having unnecessary radiology

New research published in the Journal “Cancer” highlights some problems in the changing treatment options for patients and doctors. The study looked at the use of radiology in elderly patients with early stage breast cancer.

Some research indicates that most elderly women see no change in life expectancy after using radiology to treat their early stage breast cancer. The radiology treatments can be painful and in many cases, ultimately unnecessary. The research found that many doctors are continuing to follow treatment paths that are not providing any actual increase in the life expectancy of their patients.

The study looked at survival rates and cancer recurrence for women who had surgery and chemotherapy, then compared that to women who had surgery, chemotherapy and radiology. The women who undertook radiology saw no additional benefit in terms of survival rate.

The data from the research indicates that adjuvant radiotherapy could be safely omitted from the treatment program in elderly women with breast cancer. The research points out that — while there has been a large decrease in radiotherapy, almost two-thirds of women are still receiving radiotherapy unnecessarily.

68.6% of patients treated between 2000 and 2004 compared with 61.7% of patients who were treated between 2005 and 2009 received some form of adjuvant radiotherapy. There was an increase in the use of implant radiotherapy from 1.4% between 2000 and 2004 to 6.2% between 2005 to 2009 (P < .001).Radiology carries some significant side effects including nerve damage, swelling, blistering, lymphedema and tiredness.The fact that doctors are continuing to use radiology on elderly women indicates they are not aware of the latest research into survival rates. This highlights a disconnect between treatment practices and research that must be addressed.

Genetic Testing For Breast Cancer

Protein BRCA1 Breast Cancer Risk

Protein BRCA1 Breast Cancer Risk

The role of the BRCA1 and BRCA2 gene mutations in increasing breast cancer risk is now well known. More women are interested in having a test to determine if they carry the gene mutations.

Should you get tested?
The women who are most at risk of carrying the gene mutation have a family history of breast cancer. The more cancer in your family, the more important it is that you are tested. Researchers estimate that BRCA gene mutations account for between 5-10% of all cases of breast cancer. They account for 20-25% of all hereditary breast cancers.

So if your mother, aunt, sister had breast cancer or ovarian cancer, it’s important for you to get tested. If you have no family history of breast cancer, it may be unusual for the BRCA gene mutations to cause breast cancer.

Breast or Ovarian cancers before the age of 50 are also an indication of the presence of the BRCA gene mutation. So if only 1 woman in your family has had cancer, but she had it in her 30s or 40s, it’s worth getting tested. If you have a male in the family who has had breast cancer, it may indicate the gene mutation is present in your family.

Certain ethnic groups like Ashkenazi jews are more likely to carry the gene mutation also.

What will they test for?
Everyone has the BRCA1 and BRCA2 genes. The test actually looks for mutations within those genes. There is some evidence that these kinds of gene mutations can also cause pancreatic cancer and melanoma. The test is painless and takes about 10 minutes of your time.

What happens if you have the mutation?
For young women with the mutation, they should have annual mammograms and MRIs of their breast tissue. While the chance of breast cancer developing is greater than it is for the average woman, it is not certain you will get it. There are medications you can take to reduce the risk of breast cancer, including chemoprevention. Other women opt for a mastectomy to ensure cancer never develops in their breast tissue. Most health insurance plans now cover mastectomies as well as breast reconstruction, so women maintain their appearance.

It is recommended that women who have this test get counseling before and after as it can be very emotional finding out you have this gene mutation and increased cancer risk.

October is Breast Cancer Awareness Month

Breast Cancer Awareness Month

Breast Cancer Awareness Month

The year is moving incredibly quickly and we are almost up to September. The American Cancer Society has reminded us that October is Breast Cancer Awareness month. The National Breast Cancer Awareness Month (NBCAM) aims to increase awareness of the disease and raise funds for research.

Breast Cancer continues to be one of the most dangerous forms of cancer, with death rates higher than any other form of cancer. More than 232,000 new cases diagnosed in 2013 and nearly 40,000 women died from breast cancer in the same year.

It is a very common and very deadly form of the disease, which makes it a focal point for a of cancer research.

In the past couple of years, public awareness of the gene mutations which are responsible for some breast cancers, has increased. This is largely thanks to Angelina Jolie, who had the gene mutation and undertook a double to avoid breast cancer.

With breast cancer, early detection is incredibly important. Take a read of the breast cancer early detection guidelines at cancer.org.

The Angelina Jolie Effect – Women Screening for BRCA Mutation Increases

Angelina Jolie BRCA Mutation

Angelina Jolie BRCA Mutation

Angelina Jolie became famous thanks to a string of successful films and her amazing beauty. In recent years she has turned her focus to humanitarian and health issues. One of the health issues she has helped highlight is breast cancer and the BRCA gene mutation that can lead to breast cancer.

Jolie had a double mastectomy because she was found to be carrying the gene mutation that greatly increases the chances of cancer. Her high publicity case has seen an increase in the number of women who have come forward for screening for the gene mutation. For women who have a history of breast cancer in their family, it is an essential test. For women have the gene mutation, a double mastectomy is the most extreme option they can pursue but it may guarantee they will not have breast cancer in the future.

There is one caveat though — the double mastectomy solution may be best only when breast cancer is not already present. Recent studies have indicated that for women who already have breast cancer, a lumpectomy followed by radiation may be more effective than a double mastectomy.

Andrea Eisen, head of the Familial Cancer Program in Toronto recently presented some research on the “Angelina Jolie Effect”, which highlighted the increase in breast cancer screenings. Women with a family history are flocking to the doctor for screenings that test for BRCA mutations.

In recent years the number of mastectomies has greatly increased, largely because of increasing awareness about BRCA mutations and breast cancer. Additionally, most health insurance companies cover the cost of both the mastectomy and breast reconstruction surgery now. Women can now have their breasts removed and in the same procedure have implants added.

Angelina Jolie made a very public statement about her mastectomy by writing an opinion piece for the New York Times in 2013. The media jumped onto the story and thousands of women applauded Jolie for her bravery. In Jolie’s case she had more than an 80% chance of getting breast cancer.

The study found that the number of women who opted for genetic screening doubled after the Jolie story was published, the vast majority of which were in the high risk group for breast cancer. Of those women, 61 were found to have the BRCA mutation.

New Research – Double Mastectomy Not Improving Survival Rates

Breast Cancer Mastecomy Research

Breast Cancer Mastecomy Research

A new research paper suggests that women with breast cancer who decide to have a double mastectomy are not improving their chances of survival. The research indicates that having the tumors incised from the breasts, followed by radiotherapy, has a similar rate of survival as a double mastectomy.

The research used the records of nearly 190’000 women in California to determine the findings. According to Dr Allison Kurian from Stanford University: “the average breast cancer patient who has bilateral mastectomy will have no better survival than the average patient who has lumpectomy plus radiation”.

A decade after having breasts removed, 18.8% of women had died, compared to 16.8% of women who had the tumors removed, followed by radiotherapy. These findings have surprised many in the medical community and will surely lead to a reduction in the number of women having mastectomies.

Recently high some profile women, including Angelina Jolie, have had double mastectomies because they carry the BRCA1 gene mutation. The mutation dramatically increases the chance that a woman will have breast cancer. The data in this research does not reflect the women who had completely preventative mastectomies like Jolie. Only the ones who were diagnosed with breast cancer before taking their choice of procedure.

Mastectomies are a substantial surgical procedure that women usually take months to recover from. Having a lumpectomy has a shorter recovery period and allows the woman to retain most of her breast tissue.

The study also highlighted the increase in the number of women have mastectomies. In 1998 only 2% of women diagnosed with breast cancer would choose to have a double mastectomy. That increased to 12.3% in 2011, perhaps a sign that women thought the mastectomy would completely remove the risk of cancer. Many more private health insurers also began to cover mastectomies and breast reconstruction as a part of their policies also

Interestingly the 10 year death rate was highest in women who chose to have only one breast removed, coming in at just over 20%.

Double mastectomies are less common in other countries with the standard procedure in the United Kingdom being a lumpectomy and radiotherapy.

New Biomarker Discovered for Breast Cancer

p66ShcA Biomarker for Breast Cancer

p66ShcA Biomarker for Breast Cancer

Researchers have discovered a protein which may be able to act as a biomarker for the most dangerous forms of breast cancer.

The protein p66ShcA, has higher expression levels in metastatic breast cancers. By detecting this protein, doctors will be able to determine if the breast cancer has started to spread.

The research was published in the October issue of Molecular and Cellular Biology. According to the researchers:

We showed that elevated p66ShcA expression levels are strongly associated with expression of numerous epithelial to mesenchymal transition genes in all breast cancer subtypes,” lead study author Josie Ursini-Siegel of McGill University said in a press release. “Thus, p66ShcA may serve as one of the first prognostic biomarkers to identify poor outcome breasts cancers regardless of their molecular subtype.

Breast cancer usually kills by metastasizing to other parts of the body and killing the patient from cancer in those areas. Patients with metastatic breast cancer usually see the breast tumors expressing cancer cells to other organs via the bloodstream.

This biomarker could allow doctors to better determine the prognosis of patients and put them on the right course of treatment sooner. If a patient presents with this biomarker, doctors would know that the tumors may have metastasized and aggressive forms of treatment are needed.

Calorie Intake and Breast Cancer

Weight Gain Breast Cancer

Weight Gain Breast Cancer


A new study in the United States has highlighted the role that calorie intake may play in the development of breast cancer.

Researchers discovered that when radiotherapy was being used to treat breast cancer in women with a specific form of the disease, the treatment was more effective if their calorie intake was lower.

The “triple negative” form of breast cancer is a particularly aggressive form of breast cancer and affects about 20% of all women with breast cancer. This form of cancer also tends to be found more often in young women, below 40 years of age.

Women with this form of breast cancer often see it spread very quickly with stubborn tumors returning after treatment.

Researchers aren’t sure why a reduced calorie intake helps prevent the tumors return, but it may be to do with reduced calorie intake changing the tissue surrounding the tumor.

The problem is that many of the treatments which women are given to help them fight cancer promote weight gain. Treatments like hormonal therapy and steroids which are used to slow the growth of tumors can increase weight gain by slowing metabolism, making the tumors more resilient!

We know from other studies that being overweight is actually linked to breast cancer if you have a particular genetic marker. Many other forms of cancer are also linked to being over weight, so there are plenty of reasons to maintain your fitness and weight.

Studies also show that breast cancer treatment is less effective if you are overweight and people who gain a lot of weight during their breast cancer treatment are likely to have worse outcomes.

These studies have made researchers more interested in the role of metabolism in the treatment of cancer. If they can make sure the treatments don’t adversely affect metabolism and induce weight gain in patients, then better outcomes for patients are more likely.

Dr Nicole Simone, the study leader of the most recent research says that from the findings: ‘We found that the diet turned on a programme that protected mice from metastatic disease,’. The study was published in the journal Breast Cancer Research and Treatment, and found that in the dieting mice, cancer cells decreased their production of microRNAs 17 and 20 (miR 17/20).

Those two molecules play an important role in influencing disease pathways. In the triple negative breast cancer patients, this group of MicroRNAs is usually larger.

Researchers used mice in the study and found that the mice who undertook radiation and calorie restriction had the best outcomes.

This latest research is only one of many studies that backup the role of a healthy diet, exercise and maintaining a healthy weight. In 2009 a study at the University of Alabama at Birmingham (UAB) found that:

restricting consumption of glucose, the most common dietary sugar, can extend the life of healthy human-lung cells and speed the death of precancerous human-lung cells, reducing cancer’s spread and growth rate.

Which researchers saw as another indicator that moderating calorie intake helps prevent cancer.

However this is not an argument for unhealthy dieting, but rather an argument for maintaining a healthy and balanced diet, exercising and avoiding processed foods.

The excess weight and cancer link is not a new one either. In 1987 studies were suggesting that people watch their weight: “a complete review of the data suggests that reducing caloric intake and relative body weight may lead to a considerable decrease in cancer risk in humans.”

Most Mastectomy Surgeries are Unnecessary

Breast Cancer Surgery

Breast Cancer Surgery

New research has revealed that most women who have mastectomies are actually at low risk of having breast cancer recurrence. The research was carried out by University of Michigan Comprehensive Cancer Center and shows there may be too many women opting for mastectomies to safeguard against the risk of cancer.

The study was recently published in the JAMA Surgery journal and finds that up to 70% of women who are opting for contralateral prophylactic mastectomies may not need the procedure as their cancer recurrence risk is low.

Researchers suggest that women tend to err on the side of caution because of the emotional and physical trauma of dealing with breast cancer. Many see having a mastectomy as a complete removal of a potential problem and a way to ensure the cancer is eliminated.

The study looked at 1447 women who had been successfully treated for breast cancer and did not have a recurrence. They found that 8% opted for mastectomies and 18% considered having a mastectomy. Researchers found that women with a higher level of education were more likely to go for a mastectomy because they believe it gave them the best chance of survival and preventing any additional cancer.

The reality is that 10 years after diagnosis, only 3% of women will have a breast cancer recurrence in healthy breast tissue.

There are risk factors that do increase the chance of breast cancer recurrence including the BRCA 1 and BRCA 2 gene mutations. Those gene mutations do substantially increase the risk of breast cancer recurrence and doctors do suggest those patients have the surgery. About 10% of breast cancer cases have the gene mutation.

Despite that small number carrying the BRCA 1 and BRCA 2 gene mutations, the number mastectomies if rapidly increasing and went from 39 per 1000 in 1998 to 207 per 1000 in 2008. That means many women who are not carrying those genes and are at low risk of breast cancer recurrence are opting to have their healthy breast tissue removed.

Besides the fear of cancer recurrence driving the increase in mastectomies, new insurance policy requirements may also be contributing. In recent years health insurance companies have been compelled to offer reconstructive breast surgery at the same time as a mastectomy. That means when women opt for a mastectomy, the insurance company will be compelled to pay for a new pair of breasts.

The trend is concerning because there are various risks and side effects of having a mastectomy including pain and a loss of sensation in the breasts.

Obesity Breast Cancer Linked Confirmed

Overweight Women and Breast Cancer

Overweight Women and Breast Cancer

Another study has been released that looks at the link between obesity and breast cancer, this time finding a genetic marker that increases the risk of cancer. Researchers found that white women with the genetic marker are 70% more likely to have breast cancer than those without it. Additionally, women with the marker saw their breast cancer risk increased by a massive 210% if they were overweight or obese. The genetic marker in question is within the mTOR gene and it’s identification gives researchers some hope that women with high risk of breast cancer being notified early and alert to the risk.

Researchers have established a link between obesity and cancer in general, with a number of studies concluding that people who are obese are more likely to die from cancer. Obese people have “death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight”.

So we know that weight loss is a good idea if you are interested in preventing cancer in general, but for women with this genetic marker, it is even more crucial that they get their weight under control. Once additional studies have confirmed the role that this genetic marker has, doctors will be able to screen women for it at an early age so they can change their life style and be extremely vigilant about breast cancer.

The genetic marker appears to increase risk of a particular form of breast cancer called estrogen receptor-negative breast cancer. This type of breast cancer does not respond to hormonal breast cancer treatment so is considered generally tougher to treat. Overweight or obese white women with the marker are eight times more likely to have this form of estrogen receptor-negative breast cancer develop.

This is not the first time being overweight has been linked to breast cancer with earlier research papers backing up the findings. Both the International Agency for Research on Cancer and the World Cancer Research Fund concluded that there is “convincing” evidence that being overweight or obese increases breast cancer risk after menopause. The American Cancer Society Cancer Prevention Study-II found that weight gain as an adult increases that risk for when you are older. Women who gain 60 or more pounds after age 18 have twice the risk of being diagnosed with breast cancer later in life. The increase in risk is thought to be due to higher levels of estrogen, which is held in fat tissue.

A 2007-2008 National Health and Nutrition Examination Survey (NHANES) showed that 68 percent of U.S. adults age 20 years and older are overweight or obese. That is up from close to 56%, 20 years ago. The number of overweight children is also increasing in the United States with an extraordinary 17% considered to be obese. Being overweight or obese doesn’t just increase the risk of various forms of cancer, but also heart disease and diabetes which are big killers in the United States.

Being overweight has already been associated with increase in risk of other forms of cancer including cancers of the Esophagus, Pancreas, Colon and rectum, Endometrium (lining of the uterus), Kidney, Thyroid and Gallbladder. According to cancer.gov, in 2007 about 34,000 new cases of cancer in men (4 percent) and 50,500 in women (7 percent) were due to obesity in the United States.

However there are still many questions to answer regarding weight gain and breast cancer risk. Researchers are trying to understand how the relationship between obesity and breast cancer may be impacted by the stage of life in which a woman gains weight. Gaining weight during your adult life, from 18 to the ages of 50 and 60, has been confirmed to increase risk of breast cancer after menopause.

The most recent study looked at 1300 white women and 1300 black women living on the Eastern coast of the United States, around New York and New Jersey. About half the women in each racial group had breast cancer and the women ranged in age from 20 to 75 years old.

Interestingly, the marker appeared to only increase breast cancer risk for white women which means the impact of this marker is tied to ethnicity. The mTOR gene is an integral part of cell growth and blood vessel formation within the human body. The gene can be more active from excessive energy intake, which is where the overall number of calories that overweight women take in could be playing a role.

The gene is regulated by energy intake, so when women eat large amounts of food and signal the gene it may be promoting cancer growth.

The research is at an early stage but the potential for screening and potentially gene therapy makes it a very exciting development.

Preventing Hair Loss from Chemotherapy

Dignacap

Dignacap

When most people are first diagnosed with cancer and informed they will have to undergo various forms of treatment including chemotherapy, they are flooded with anxiety and fear. Most people are worried about surviving if it is a dangerous form of cancer, and worried about their family coping, but they are also worried about the short term effects of the chemotherapy cancer treatment. Everyone has seen how much chemotherapy can wear a person down and one of the most noticeable side effects is hair loss.

Well a product which helps prevent hair loss during chemo may soon be available in the United States! Researchers in the United States are currently testing the effectiveness of a head cooling system called “DignaCap”, which has been available in Europe for more than a decade. The Food and Drugs Administration has not approved the treatment yet, but researchers are hoping their trials help sway the FDA to approve it in 2015.

The DignaCap system provides a cold scalp freezing treatment during chemotherapy treatments that prevents the chemicals reaching the scalp and killing the hair follicles. The treatment has been shown to prevent hair loss in patients with early stage breast cancer in European studies.

Dr Tessa Cigler is heading up the research trial at the Weill Cornell Breast Center which is specifically looking at the DignaCap device and it’s effectiveness. The device was developed in Sweden and was first launched in 1999 in the European market.

In addition the research at the Weill Cornell Breast Center, researchers in California and North Carolina are looking at the device and and will present their findings to the FDA shortly.

Dr Cigler says of the DignaCap: “Cold-cap therapy is empowering, It allows women to maintain their self-esteem and sense of well-being, as well as to protect their privacy.” Without these caps, 100% of the women lose their hair by the second treatment.

Many women report that one of the hardest aspects of undergoing chemotherapy is that every time they look in the mirror, they are reminded of the disease that is currently attacking their system. Additionally some women report that losing their hair impacts their confidence and quality of life.

The cap is room temperature when placed on the patients head 30 minutes prior to the chemotherapy treatment beginning. The internal coils in the cap are attached to a refrigeration unit that cools the cap to 37 degrees. The cooling cap is kept on the entire time that the chemotherapy treatment is running and a further one or two hours after the chemo treatment is complete.

Patients have to also be gentle with their hair, so avoid excessive hair washing, excessive brushing and harsh chemical treatments. It is an exciting development for women who have enough of a battle without feeling additional anxiety about their appearance while undergoing chemotherapy.