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.

FDA Warning About Device Capable of Spreading Cancer

FDA Warns of Laparoscopic power morcellator

FDA Warns of Laparoscopic power morcellator

The U.S. Food and Drug Administration has taken action to stop the use of a gynecological device that can spread pre-existing cancer in women.  Laparoscopic power morcellators are used in the removal of the uterus, or to remove fibroids.

The device is used to destroy fibroids, which are then removed by key hole surgery.  There is no way to know if the fibroids contain cancer cells. If they do, the destruction process may released some of those cells, allowing cancer to spread to other organs.

This can lead to more dangerous forms of cancer developing, which cannot be treated as easily.

In a press release,William Maisel, M.D., M.P.H., deputy director for science and chief scientist at the FDA’s Center for Devices and Radiological Health said: “Updating the device label with a boxed warning and contraindications will provide clinicians and patients with critical information about the risk of spreading cancerous tissue when these procedures are performed.”

The FDA was made aware of the flaw with this device by surgeon Hooman Noorchashm.  Dr Noorchashm’s wife, Amy Reed, had the procedure as a part of her hysterectomy and was diagnosed with stage 4 cancer.  The use of the device had spread cancer cells throughout her body.  Thankfully Amy is currently in full remission.

Whilst Dr Noorchashm was arguing for a complete ban on the device, the FDA was chosen to add a compulsory warning to the device.  The warning indicates that the device may spread cancer cells throughout the body.

The FDA chose to only use a warning because younger women may still safely use the device in their procedures.  That is due to the fact younger women are much less likely to have cancer cells in regions that can be spread.  If the device is not used, fertility can be affected.

Some hospitals have already stopped using the device, well aware of the risk before the FDA decision.  One of the companies that manufacture the device has also pulled it off the market, a sure sign that the risk of the procedure is well known.

So while this device might still play a role in certain surgeries, for older women with a higher chance of cancer, it is too risky.

FDA Approves Ovarian Cancer Drug “Avastin”

Avastin Receives FDA Approval for Ovarian Cancer

Avastin Receives FDA Approval for Ovarian Cancer

Drugmaker Roche has notified the public that the FDA has approved Avastin as a treatment for Ovarian cancer.

The new drug is designed to work in conjunction with chemotherapy in recurrent cases where there is resistance to platinum-based chemotherapy. The drug has already been approved for Glioblastoma (GBM), Metastatic Colorectal Cancer (mCRC), Non–Small Cell Lung Cancer (NSCLC) and Metastatic Kidney Cancer (mRCC).

Avastin is a angiogenesis inhibitor, that slows the growth of new blood vessels. It blocks angiogenesis by inhibiting vascular endothelial growth factor A (VEGF-A), which is a chemical signal used by cancer to help the disease spread.

The drug was first approved in 2004 by the FDA for metastatic colon cancer. In the past Roche also tried to have the drug approved for breast cancer, but it was shown to be ineffective in trials.

The drug is a big money maker for Roche, having netted them a whopping $6.25 billion in 2013.

Side Effects
The drug carries a number of serious side effects that cancer patients must be aware of.

Some of the more serious ones are:

  • GI perforation (a hole that develops in your stomach or intestine)
  • Wounds that don’t heal
  • .

  • Serious bleeding
  • (This includes vomiting or coughing up blood; bleeding in the stomach, brain, or spinal cord; nosebleeds; and vaginal bleeding)

Other side effects can include severely high blood pressure, kidney problems, infusion reactions, stroke, heart problems, nervous system problems and vision problems.

The drug carries some serious side effects, but is an important part of the cancer treatment regime for many people.

Research Suggests Meditation May Help Cancer Patients

Cancer and Meditation

Cancer and Meditation

For many years now, spiritualists and alternative medicine devotees have suggested that meditation can help a person beat cancer. In a world first, some research may have demonstrated that meditation can alter cells within the human body and play a role in battling cancer.

The canadian-based research, “Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors“, has been published in the journal Cancer. It indicates that meditation and yoga can alter cellular activity of cancer survivors.

Protein caps at the end of chromosome called telomeres stayed at the same length in cancer survivors who meditated or took part in support groups over a 3 month period. This is contrasted with people who did not participate in support groups or meditation, and saw a shortening of their telomeres. Telomeres determine how quickly a cell ages.

The question here is what role telomeres play in regulating disease. There is some evidence that longer telomeres can help protect people from diseases like breast cancer.

There was already evidence that meditation, mindfulness and support groups could make you feel better, but this is the first mind-body link discovered for these practices.

88 breast cancer survivors took part in the research. The average age of the participants involved was 55. One third of the group was asked to attend a weekly 90 minute support session and to practice meditation or yoga for 45 minutes each day.

Another third just used the support group to talk about their emotions. The third group attended a single seminar about stress management and was not asked to meditate.

The people who used the support group and meditated had lower stress levels and maintained their telomere length. The control group saw a shortening.

This is very exciting research for people who have advocated for meditation and mindfulness. While we don’t know exactly what role telomeres play in human health just yet, we do know that maintaining telomere length is positive for human health.

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.

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.

Trials Show Good Results For Cancer Drug Neratinib

Puma Biotechnology

Puma Biotechnology

Continuing trials for a new breast cancer drug called Neratinib have shown some encouraging results. The drug has been developed by biotechnology company Puma Biotechnology and is currently in mid stage trials. In the trials it was shown to be more effective than Herceptin, a similar drug developed by pharmaceutical company Roche. The drugs have been developed to work for patients with hormone receptor (HR)-negative, HER2-positive breast cancer.

The trial consisted of nearly 200 patients who had just been diagnosed with breast cancer and had not yet had surgery. 40% of the patients were given a combination of Neratinib and chemotherapy and achieved a pathological complete response (pCR) which means there is no longer evidence of tumors in the breast tissue. That compares to Herceptin and chemotherapy which only achieved 23% pathological complete response.

The drug also has a higher level of pCR than other conventional treatments, 45% compared to 29% in women who have a high risk of cancer returning, determined by genetic indicators.

The company is planning to launch Stage 3 trials in the near future which will look at HER2 positive patients as well as women who have issues with returning breast cancer.

Researchers are also going to look at other cancer indicators to determine the effectiveness of the drug in further studies. The stage 2 results are going to be presented at the American Association for Cancer Research conference in San Diego shortly.

About 25 percent of breast cancers are HER2 positive so this treatment could affect thousands of women.

The most recent study was conducted with adaptive randomization which means that patients were assigned to the best possible treatment for their cancer sub-type. Researchers also looked at the hormone sensitivity of patients before putting them into different groups.

The best thing about this new cancer drug is that it uses a different action than previous drugs like Herceptin and Perjeta. So theoretically a number of drugs could be used at the same time to aggressively go after the cancer.

Unfortunately Breast Cancer is still one of the most common forms of cancer in the world with over 1.4 million new cases diagnosed each year and nearly half a million women dying annually. This new drug will hopefully be another positive step forward in the battle against this insidious disease.

More Women Having Breast Reconstruction

Breast Reconstruction

Breast Reconstruction

According to the most recent figures, this year in the United States over 230’000 women will be diagnosed with breast cancer. Of those women a shocking 40’000 will die from the disease.

Many women who do survive in their battle against breast cancer must have a mastectomy to do so (the removal of one or both breasts). For many women, their breasts are an important part of their sexuality and the loss of them is a difficult thing emotionally and physically. Unfortunately, some women feel less attractive after they have had their breasts removed. For many women a mastectomy can be especially traumatic because it is a constant reminder of their illness, whenever they look in the mirror. It can also hurt a woman’s confidence and lead to other social and employment issues if they don’t have good confidence in their health and appearance.

New breast cancer research suggests that to overcome negative feelings associated with the loss of an important body part, more women are opting to have breast reconstruction. Breast reconstruction attempts to maintain the shape of a woman’s breasts through one or more surgical procedures. A breast reconstruction can be undertaken at the same time as the mastectomy operation or at a later date.

Most insurance plans that pay for mastectomies will also pay for breast reconstruction, thanks to a federal government law enacted in the 1980s. The increase in the number of women opting for breast reconstruction may be in part due to this law, which saw their insurance plans update to provide the extra coverage.

The research, published in the Journal of Clinical Oncology, looked at more than 20’500 women who had mastectomies between 1998 (when the law passed) and 2007 and examined how many went for a breast reconstruction. 46% of women opted for reconstruction in 1998 and that number rose to 63% by 2007. Many more women are aware of the option to have breast reconstruction and breast cancer treatment options are much more widely known now.

Interestingly, the study found that there was a great disparity in the number of women opting for reconstruction, based upon their location. The lowest was North Dakota where only 18% of women opted for breast reconstruction and the highest was Washington DC, where 80% underwent the procedure. Researchers suggest that may be to do with the number of plastic surgeons in the area, with women in North Dakota unaware of the reconstruction options and outcomes due to a lack of plastic surgeons.

There are two forms of breast reconstruction, one using fake breast implants and the other using tissue from other parts of the body, “tissue flap reconstruction”.

There are advantages and disadvantages to both types of breast reconstruction surgery:

Implant Surgery

Use silicone or saline implants which are inserted under the muscle tissue in the breast and attached to the chest wall.

The main advantages of implants are:

  • A very simple operation with a high success rate
  • Short recovery time
  • Scarring is only around the breasts

The main disadvantages of implants are:

  • The breasts may not look as natural as the other form of reconstruction
  • They may not look the same as your original breasts
  • If you lose or gain weight, the breasts will stay the same size, which can lead to an odd appearance.

Using your own Tissue

“Tissue flap reconstruction” will use your own tissue, fat and skin from another section of your body. There are two types: attached flaps and free flaps. Attached flaps will use material from your back or abdomen, the material is “tunneled” up to the breast area. Free flaps will use material from buttocks or abdomen, but the material is detached and then reattached to the breast area with arteries and veins attached to the blood supply of the breast wall.

The main advantages of tissue flap reconstruction are:

  • The breasts look more natural and can look similar to your original breasts.
  • The breast will gain and lose size as your weight changes so it can look more natural.

The main disadvantages of tissue flap reconstruction are:

  • The recovery time is longer than implant surgery
  • You will have additional scarring on the area where the tissue was found.
  • You may lose strength in your abdominal muscles if you sourced tissue from that area
  • There is a small risk the flap tissue will die due to a lack of blood supply, and will need to be replaced

The research paper indicated that most women opted for implants instead of tissue flap reconstruction, but women are more aware of the all of the options now. Some women report that going through reconstruction surgery after having received a mastectomy years before actually felt like a very positive and healing process.

The main thing for women to be aware of is that there are options and with modern surgical practices, the end results look fantastic.