Pink-Link is holding its first fund-raiser of 2009. To register for or donate to this event, please visit Pink-Link.org/anniversary.php.

By Stefania Medvedik

Will tamoxifen work for you? Gene test may tell

Mayo Clinic researchers and investigators from the Austrian Breast and Colorectal Cancer Study Group (ABCSG) are recommending CYP2D6 gene testing for postmenopausal women before they start treatment with the breast cancer drug tamoxifen.

Women with a deficiency in the CYP2D6 gene were shown to benefit less from tamoxifen because they poorly metabolize the drug. Testing for the gene deficiency may help clinicians devise more effective treatment plans for these women.

Zometa can boost anti-tumor activity, improve clinical outcomes

The study also showed that a smaller proportion of patients on the Zometa/chemotherapy combo (65.3%) required mastectomy compared with the chemotherapy alone group (77.9%).

Femara: BIG study supports that this AI may be better than tamoxifen post surgery in early stage ER-positive breast cancer

Researchers from the Breast International Group (BIG) 1-98 study reported that women taking the aromatase inhibitor Femara (letrozole) for five years had an improved survival benefit compared with women who took tamoxifen alone.

Metastatic breast cancer: AI resistance reversed with lower estrogen dose

A study that included six U.S. cancer centers showed that a 6 mg daily dose of estradiol was as effective at stabilizing/shrinking tumors and reversing aromatase inhibitor resistance as 30 mg daily in patients with ER-positive metastatic breast cancer who became resistant to their AI.

The Protocol Review and Monitoring Committee closed the 30 mg arm of the study early after concluding that the 6 mg dose was as effective as and safer than the higher dose, with fewer side effects.

DOXIL with Taxotere delays disease progression better than Taxotere alone in metastatic breast cancer

Researchers from the Albert Einstein College of Medicine and colleagues reported that metastatic breast cancer patients previously treated with an anthracycline who were given DOXIL (pegylated liposomal doxorubicin) in addition to Taxotere (docetaxel) had better overall response rates and significant improvement in time to disease progression than patients treated with Taxotere alone.

By Marilynn Larkin

A group intervention aimed at reducing stress, encouraging healthier behavior and increasing compliance with treatment can help women with breast cancer live longer, according to Ohio State University researchers.
Previous studies by lead author Barbara Andersen, PhD, and her colleagues showed that this focused intervention program significantly reduced stress and symptoms and improved social relationships and dietary habits. It also enhanced immunity by maintaining or increasing the activation of infection-fighting T-cells. In this follow-up study, the researchers conducted a randomized, controlled trial with newly diagnosed breast cancer patients to see if the intervention could ultimately change the course of the disease.

A total of 227 women who had undergone surgical treatment of stage II or III breast cancer participated in the study, which involved learning diet tips, ways to increase their activity level, techniques for managing chemotherapy side effects, muscle relaxation exercises and ways to stop smoking and get more sleep. After following the women for an average of 11 years, the researchers found that those in the intervention group had about half (56 percent) the risk of dying from breast cancer compared with women in the control group who didn’t attend the program. The participants also cut their risk of cancer recurrence by nearly half, which brought it down to almost 10 percent from 20 percent.

Andersen notes that her study differs from similar ones in two important ways. For one, she looked specifically at women whose chances of long-term survival were variable.

And this program was different from a traditional support group, where emphasis is on personal bonding. “Everyone in the group was supportive, but that’s not the focus,” Andersen says. “Our goal was to give specific, active strategies that participants could use to change their behaviors.”

By Marilynn Larkin

The largest study to date of a new screening technique called molecular breast imaging (MBI) suggests the method can detect three times as many cancers in women who have both dense breasts and an increased risk of cancer. MBI involves injecting patients with a radioactive agent and then using a special camera to project a clear image of any tumors. The study, from the Mayo Clinic, used an MBI camera unique to their facility, but a similar version of MBI screening is performed in about 80 other centers.

Commenting on the study in a media briefing, Eric Winer, MD, director of the breast oncology center at Dana-Farber Cancer Institute, observed that, for breast screening: “Mammography is the best tool we have. But it is not a perfect tool, and we clearly need to have better [ones].” Susan K. Boolbol, MD, chief of breast surgery at the Beth Israel Medical Center in New York, tells MAMM that while mammograms remain the “gold standard,” the MBI—which Beth Israel offers—is useful for high-risk women with dense breasts.

Mayo Clinic lead study author Carrie B. Hruska, PhD, acknowledges in a statement that larger trials are needed to validate the findings, but she adds that “it is encouraging to find that MBI can detect cancers that are not easily visible on screening mammography.”

By Marilynn Larkin

Researchers at Georgetown University and their colleagues have found that a drug called Nexavar (sorafenib) may help certain postmenopausal women with metastatic (stage IV) hormone receptor-positive breast cancer.

“Eventually [in most metastatic patients], cancer cells can become resistant to hormone therapy, and so we’re trying to figure out how to overcome the resistance and prolong the time that patients respond,” explains senior investigator Claudine Isaacs, MD.

The study involved 27 postmenopausal women with hormone receptor-positive metastatic cancer that had become unresponsive to aromatase inhibitors (AIs). All participants received 400 mg of Nexavar twice daily plus a standard dose of Arimidex, an AI. Two patients had partial responses (tumors that shrank by at least 30 percent) that lasted more than six months, and five had no evidence of disease progression during the same period, meaning that about a quarter of patients had some clinical benefit.

Isaacs speculates that the drug may be successfully interfering with certain molecular pathways that would otherwise lead the cancer to resist AIs.

An upcoming large multicenter trial is likely to yield more definitive results.

By Marilynn Larkin

Community health centers—nonprofits in medically underserved areas that provide care to anyone regardless of income or insurance status—are a lifeline for the more than 16 million patients who rely on them. And when it comes to providing preventive care, they outperform even private care providers, according to a policy brief recently published by George Washington University’s School of Public Health and Health Services.

The brief, based on an analysis of national data, reports that underserved patients are more likely to obtain preventive tests and screenings in community health centers than in private practice settings such as doctors’ offices and outpatient clinics. Among uninsured women, for example, the rate of Pap smears was 22 percent higher in community health centers; breast exams, 17 percent higher; mammography, 16 percent higher; and cholesterol and blood pressure screenings, 10 and 8 percent higher, respectively.

By helping prevent disease or catching it in its early stages, community health centers may also lower health care costs for their poor and minority patients.

By Lydia Fong

Tens of thousands of women have enrolled in the Sister Study, a federal research project involving healthy women whose sisters have had breast cancer. Now researchers want input from participants’ sisters who were diagnosed with breast cancer before age 50 and within the last four years. Women in this new study—the Two Sister Study—will answer phone interviews and submit saliva samples for DNA analysis.

“We can learn about environmental factors by comparing the affected sister and the unaffected sister to see if there are any systematic differences between them,” says principal study leader Clarice Weinberg, PhD.

The original Sister Study has almost reached its goal of 50,000 participants, but researchers are still looking for healthy non-Caucasian sisters between ages 35 and 74, as well as Caucasian women who are either between 55 and 74 or do not have bachelor’s degrees. Visit SisterStudy.org or call 1-877-4SISTER.

Radiation given from inside the breast (brachytherapy) is a relatively new option for early-stage breast cancer patients after lumpectomy, and innovations in the design of brachytherapy devices mean that it may be a viable choice for still more women in the near future. If you’re considering lumpectomy, talk to your radiation oncologist about the choices available to you.

Brachytherapy involves inserting a small device with one or more catheter tubes into the breast through a small incision; the device stays in the breast until the final treatment. The radiation oncologist then places a radioactive seed inside the catheter for five to 10 minutes twice a day to deliver radiation directly to the tumor site. The dosing takes only five days, as opposed to the six weeks of daily treatment required for external radiation. The procedure may also have fewer side effects because it focuses on the tumor site rather than the entire breast.

Newer brachytherapy devices, such as the Strut-Adjusted Volume Implant (SAVI), are designed with multiple flexible catheters to target the margins around the lumpectomy site even more precisely, with minimal radiation to the ribs, skin and other organs. As of early December 2008, more than 50 surgeons and 40 radiation oncologists working at 100 U.S. sites had performed more than 1,000 SAVI procedures. Two other FDA-approved brachytherapy devices, Contura and ClearPath, work in similar ways.

By Marilynn Larkin

Can nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Motrin or Advil lower breast cancer risk? Studies over the years have been inconsistent. Searching for more conclusive answers, a group of scientists from Spain and Canada have pooled and analyzed the results of 38 published studies spanning more than 40 years and involving 2.7 million women. Their analysis, reported in the October 15 Journal of the National Cancer Institute, showed that regular use of any NSAID was associated with a 12 percent lower risk of breast cancer. Aspirin was associated with a 13 percent lower risk, while ibuprofen (found in over-the-counter drugs such as Motrin and Advil) was linked to a 21 percent risk reduction.

But senior study author Mahyar Etminan, PharmD, MSC, an assistant professor of medicine at the University of British Columbia, warns against taking these over-the-counter meds solely for lowering one’s odds. An accompanying editorial highlights the “complexity” of the association and emphasizes the need for additional studies before any recommendations can be made.

After studies showed that hormone replacement therapy was linked to increased risk of breast cancer and heart disease, many women in the United States stopped taking HRT as a menopause treatment. As a result, the incidence of invasive breast cancer in white women ages 50 to 69 declined sharply between 2002 and 2003—from about 86 cases per quarter per 100,000 to 74 cases per quarter per 100,000.

But a similar drop was not seen among African-American women, investigators reported at the 2008 annual meeting of the American Association for Cancer Research. The rates were also stable among Asian and American Indian women during this period.

Biology might account for the difference, speculates Dezheng Huo, PhD, assistant professor of health studies at the University of Chicago Medical Center. Black women are less likely than white women to use HRT after menopause and less likely to develop estrogen receptor-positive tumors. So although fewer black women were harmed by HRT, they also benefited less from the decline in usage, he explains. Future mechanistic studies should shed additional light on the racial disparities, Huo concludes.

By Marilynn Larkin

After your breast tumor is biopsied, the pathology lab runs a number of tests on it to get a clearer picture of what kind of cancer you have, the characteristics that make it grow, and its size and location. This, in turn, helps your oncologist evaluate the best treatment for you. One of the characteristics a lab looks for is a tumor’s HER2 status.

Typically, the pathology lab starts by conducting an immunohistochemistry (IHC) test on the tumor tissue sample, which measures the amount of HER2 protein in the gene. If the results are inconclusive, the pathologist will confirm them with a fluorescent in situ hybridization (FISH) test, which uses a special microscope to examine the number of copies of the gene.

Now labs have an alternative to FISH: The Spot-Light HER2 CISH test, approved this summer by the Food and Drug Administration. Unlike FISH, which must be used in a darkroom with ultraviolet light (a feature not all pathology labs have), CISH uses a stain that makes the HER2 genes distinctive enough to be measured using an ordinary microscope in natural light.

Studies show that CISH is as accurate as FISH in confirming whether a tumor is HER2-positive. However, until pathologists become more experienced at working with CISH, it’s probably best for labs to continue using FISH, says Elizabeth Hammond, MD, a professor of pathology at the University of Utah and a former member of the College of American Pathologists’ board of governors. She adds: “As with any medical procedure, you want that test done by someone who does it all the time.”

By Marilynn Larkin

Women with stage II or III breast cancer who receive the bisphosphonate zoledronic acid (Zometa) as part of their treatment are less likely to have tumor cells in their bone marrow three months later, according to Rebecca Aft, MD, PhD, of the Washington University School of Medicine in St. Louis, who presented the findings at the 2008 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago in May.

Taken together with findings of earlier studies of Zometa and other bisphosphonates, the results suggest that “women diagnosed with breast cancer should be talking with their oncologists about the advantages of a bisphosphonate,” Aft said. “I think this is likely to become the standard of care in the future.”

Tumor cells are continually being released from the primary tumor, and scientists believe that the bone marrow harbors these cells, which may eventually evolve into metastatic disease. Exactly how this happens isn’t clear. However, Aft and other researchers believe that increased bone turnover (replacing old bone with new)—an effect of chemotherapy—creates an especially nutritive environment for tumor growth. Bisphosphonates, of which Zometa is the most potent, suppress bone turnover, making the marrow less tumor-friendly.

In the Washington University study, the investigators randomly assigned 120 women whose cancer had spread to the lymph nodes or other areas near the breast to receive either 4 milligrams of zoledronic acid intravenously every three weeks for a year, starting with their first cycle of chemotherapy, or no zoledronic acid. At the time of diagnosis, none of the women had evidence of metastatic disease on imaging tests, but about 40 percent had detectable breast cancer cells in their bone marrow.

After three months, only 30 percent of those treated with zoledronic acid had detectable tumor cells in the marrow, compared with 47 percent who did not receive the bisphosphonate. Among women without detectable tumor cells in the marrow, 87 percent of those receiving the drug remained free of tumor cells compared with 60 percent of those who did not receive it. The results support a trend in favor of bisphosphonate treatment.

By Marilynn Larkin

Nearly 70 percent of the million-plus cancer patients on chemo—many of them women with breast cancer—suffer from chemotherapy-induced nausea and vomiting (CINV). But the results of a recent survey indicate that patients aren’t being treated adequately for the dreaded side effect.

The pharmaceutical company ProStrakan sponsored a CINV survey at the Oncology Nursing Society’s 2008 congress. Although nearly all nurses said they discuss antinausea options with patients, 71 percent said that patients experience CINV for two days or longer.

Nurses felt that both chemo patients and doctors need to be more aggressive about addressing the problem. One-third said that their patients never, or only sometimes, tell them they’re feeling sick. And only 40 percent of nurses felt that the oncologists they work with take a “zero-tolerance” approach toward CINV, while others said doctors believe some breakthrough nausea is to be expected.

Although 70 percent of nurses echoed the nontolerance policy, Barbara Rogers, CRNP, of the Fox Chase Cancer Center in Philadelphia, says that doctors and nurses alike should have the same goal. She urged the nurses at the conference to help by “opening the lines of communication between health care providers and patients.” But she also stresses that patients should speak up at the first sign of a problem.

The American Cancer Society and the National Comprehensive Cancer Network have put together a brochure on the causes of CINV and the current treatment options. You can download it at http://www.nccn.org/patients/patient_gls.asp.

By Marilynn Larkin

Although about 15 to 20 percent of breast cancer patients are affected by lymphedema, there are no standard guidelines for preventing, stopping or managing the debilitating condition. However, a review of the literature on the care and management of lymphedema suggests that early identification of at-risk patients could decrease the incidence of the disorder, says Mattie Sennett McDowell, RN, BSN, a research nurse in breast medical oncology at the University of Texas M.D. Anderson Cancer Center.

At the Oncology Nursing Society’s annual meeting in May, she reported that nurses should discuss every risk-reduction strategy listed in the National Lymphedema Network (NLN)’s online guide “18 Steps to Prevention Revised” at every patient visit. Nurses should also educate patients, provide arm measurements if authorized by their institutions and be familiar with the diagnostic techniques that doctors use to identify lymphedema.

The NLN’s “18 Steps” can be found at the “Risk Reduction” link under the “Lymphedema FAQs” tab on LymphNet.org.

By Marilynn Larkin

Certain breast cancer tumors initially test positive for estrogen receptors (ERs)—which in a postmenopausal woman would indicate the need for hormonal therapy, such as an aromatase inhibitor (AI). Then, for reasons doctors don’t yet understand, the tumors become estrogen receptor-negative and continue to grow despite the therapy—a development noticeable on a patient’s follow-up scans. This transformation is associated with greater recurrence risk and poor outcomes.

Doctors haven’t been able to predict which ER-positive patients have these deceptive tumors. Now they may be able to, says Matthew Ellis, MD, PhD, of the Washington University School of Medicine’s Siteman Cancer Center in St. Louis. Ellis and colleagues were able to identify a unique genetic signature of certain ER-positive tumors. They measured the expression of this signature in a group of women before treatment with the AI letrozole (Femara), then again one and four months after they started taking the drug. The team discovered that after AI treatment began, certain tumors that had initially been positive for estrogen receptors lost a significant number of those receptors, transitioning to an ER-negative state.

The test for the gene signature should be available later this year and will be validated in clinical trials. Ellis believes that it could become standard for women with this gene signature to have their tumors’ estrogen receptor levels monitored as soon as one month after starting AI therapy, to determine whether a course of treatment for ER-negative cancer would be more appropriate.

By Lydia Fong

When talking to your surgeon about lumpectomy, perhaps you should ask: “Do you have any before-and-after photos?” Despite its name, this breast-conserving surgery can leave the affected breast looking smaller, misshapen or otherwise very different from the other one, depending on factors such as the amount of tissue removed and whether you need more surgery afterward. Asymmetry (as it’s called) after a lumpectomy is “surprisingly common,” says Jennifer Waljee, MD, a resident in general surgery at the University of Michigan Medical School, who reports that this unevenness can affect a woman’s quality of life.

Waljee and colleagues surveyed 700 women who had undergone lumpectomy at the university’s Comprehensive Cancer Center between 2002 and 2006. Of them, 68 percent reported either moderate or pronounced breast asymmetry. Those who had the most asymmetry were twice as likely as the minimally asymmetrical patients to feel depressed, less healthy and more anxious about the possibility of recurrence.

Although the study didn’t delve into the reasons women felt this way, Waljee believes the patients’ responses signal a need for surgeons to be aware of the psychological effects of asymmetry when they consult with patients. It’s also important for women undergoing lumpectomy to ask not only about the way they may look afterward, but also about ways to correct any asymmetry — such as reconstruction. You may want to talk to a plastic surgeon in addition to the breast surgeon.

By Lydia Fong

HERMove.com, poised to launch on September 16, is a health and lifestyle website created specifically for women with HER2-positive breast cancer. The site, funded and developed by GlaxoSmithKline Oncology, is intended to help women maintain an active and full life both during and after treatment for this particular type of cancer. To that end, HERMove.comwill include sections on travel, love life, food, and mind and body, plus a forum for women to share their personal stories.

By Marilynn Larkin

Studies have shown that following a healthy diet plays a role in prevention of breast cancer incidence and recurrence. Now a small study, the first of its kind, goes further by suggesting that eating foods rich in lignans—plant compounds structurally similar to estrogen and found in seeds, nuts, whole grains, vegetables and other foods—could also improve the chances of survival in postmenopausal breast cancer patients.

Susan E. McCann, PhD, RD, of the Roswell Park Institute in Buffalo, had previously conducted the Western New York Exposures and Breast Cancer Study, which analyzed the eating habits of 1,122 women with breast cancer. They found that a diet high in lignans was linked to a lowered risk of hormone receptor-negative breast cancer in premenopausal women. Curious to see what effect lignans might have on survival rates, McCann and her colleagues looked at the study results again.

Although there was no association between lignan intake and mortality in premenopausal patients, postmenopausal women who ate lignan-rich foods such as whole-grain bread, peaches, oranges, broccoli and coffee were 70 percent less likely to die of breast cancer than those who did not. McCann presented the results at the 2008 annual meeting of the American Association for Cancer Research. McCann cautions that although the results are promising, more research in larger populations is needed to confirm the findings. In the meantime, she recommends a lignan-rich diet for overall health.

By Marilynn Larkin

Women on chemotherapy frequently report problems with memory and concentration (so-called “chemobrain”), but this may actually have more to do with the shock and stress of being diagnosed than with the drugs, researchers reported at the American Academy of Neurology’s annual meeting.

One of the two small studies followed women before each of their chemotherapy cycles and one month after their final one. First, participants reported how often they suffered mental lapses such as forgetting where they put things.

Then they were given tests on memory, concentration and other cognitive skills. The women who said they had trouble with mental tasks were not necessarily the ones who performed poorly on the tests.

At Michigan State University, researchers compared cognitive ability, anxiety and quality of life among three groups: early-stage breast cancer patients who had not yet received treatment (although some did begin it during the test period), women who had recently had a benign breast biopsy and survivors who had completed treatment.

On difficult tests of learning and memory, women starting chemo performed about as well as the healthy women. Breast cancer survivors, meanwhile, were the fastest and most accurate of all.

Study author Michael Boivin, PhD, MPH, suggests that cognitive lapses may be related to the fatigue and emotional stress of the illness—a theory that could be reassuring to cancer patients reluctant to undergo chemo for fear of memory loss.

By Marilynn Larkin

The Sister Study researchers are currently looking to enroll only underrepresented groups: sisters who are African-American, Latina, Asian, Pacific Islander and Native American, as well as Caucasian women 65 to 74 or who have a high school degree or less.

To volunteer or learn more about the Sister Study, visit SisterStudy.org (for Spanish: estudiodehermanas.org) or call, toll free, 1-877-4SISTER (1-877-474-7837). People with hearing impairment can call 1-866-TTY-4SIS (1-866-889-4747).

By Marilynn Larkin

The use of sentinel lymph node biopsy (SLNB) to stage newly diagnosed breast cancer has been increasing. But minorities, older women and those from poorer areas are less likely to get the procedure, according to research published in the April issue of the Journal of the National Cancer Institute. “It’s hard to know why we see these disparities,” says Amy Y. Chen, MD, MPH, a director in the American Cancer Society’s Health Services Research division. “Most likely it’s because of insurance issues or lack of access to technology or women’s lack of awareness about the procedure.”

In SLNB, which is performed only during lumpectomy procedures, the surgeon removes up to three “sentinel” nodes in the armpit to determine whether cancer has spread beyond the breast. The newer technique is an alternative to the traditional, more invasive axillary lymph node dissection, which involves removing all the lymph nodes in the armpit.

Chen and her colleagues studied the use of SLNB versus axillary dissection using a database that includes 491,000 women who underwent lymph node sampling between 1998 and 2005. All of them were good candidates for SLNB, so the stage of their disease was not an issue. Although the use of the procedure increased from 26.8 percent to 65.5 percent during that time, the odds of getting it were lower for blacks, Hispanics and other minorities than for whites; they were also lower for women older than 72 years compared with those younger than 51. Living in a low-income neighborhood also meant a woman was less likely to get SLNB.

Based on the data, it’s hard to tell what’s behind the disparity, Chen reiterates. In some cases the communities where minority or uninsured women live may not have a hospital that provides sentinel node biopsies. Older or rural women may also consider mastectomy preferable to the six-week regimen of lumpectomy and radiation. Still, she adds, this signals the need for more widespread patient education.

By Shana Aborn

A recent survey of oncologists, oncology nurses and metastatic breast cancer patients indicates that when it comes to chemotherapy, medical professionals and patients may disagree.

In the Metastatic Breast Cancer Study, conducted on behalf of the pharmaceutical companies Abraxis BioScience and AstraZeneca, between 19 and 24 percent of oncologists said that they focus on treatment goals and side effects when discussing chemo with metastatic patients. However, more than half of the 212 women surveyed said that what they wanted most from their doctors was an understanding of how well the chemo drugs would work against their disease. They also wanted more of a say in their treatment; 71 percent said that they had been given no alternatives in chemo regimens when they were first diagnosed, and nearly 64 percent said they were never given a choice at any time in their treatment.

Doctors and patients also differed on the reason for selecting a chemotherapy regimen. The vast majority of oncologists—87 percent—said they take the drugs’ efficacy into account first and foremost. Nearly three-quarters of nurses agreed. But women with metastatic disease reported that when making their chemo choice, maintaining quality of life was just as important to them as how well the drugs worked.

Other questions in the survey revealed that the side effects of chemo may be more severe than women with breast cancer feel they can handle. A full 60 percent of oncology nurses said that their patients have asked them about changing chemotherapies, most often because they were experiencing fatigue or diminished quality of life.

By Marilynn Larkin

Physically active breast cancer patients seem to have a lower risk of recurrence than women who don’t exercise, but no one knows exactly why. Now, a new study from Harvard Medical School and the Dana-Farber Cancer Center is showing that the effect of exercise on the body’s insulin levels may contribute to this reduced risk.

Most of us think of insulin as just the “diabetes hormone.” But in test-tube studies, this hormone has promoted growth in breast cancer cells, which may help to explain why high insulin levels are associated with a greater risk of developing the cancer, having a recurrence or of dying from the disease.

Jennifer Ligibel, MD, and her colleagues decided to find out whether there might be a connection between regular exercise and insulin levels in breast cancer patients. The participants in their study were 82 women, average age 52, whose body mass index classified them as overweight or obese. (In a 5’4” woman, overweight would translate to 145 pounds or more.) They were also physically active for an average of just 11 minutes a week. Half were randomly assigned to a program of moderate exercise, while the other women continued with their usual level of activity.

Women in the exercise group did cardio on their own for an hour and a half a week, using a pedometer and heart rate monitor to help them stay in their target heart rate range. Under a trainer’s guidance, they also participated in two 50-minute strength-training classes per week at the study center. At the end of the 16-week study, the women who exercised had about a 25 percent reduction in insulin levels compared to those who didn’t. The results were reported in the February 20 issue of the Journal of Clinical Oncology.

Why is this important? “For a long time, we thought exercise influenced the risk of breast cancer and prognosis through its impact on estrogen. Now we think it somehow affects a variety of hormones—including insulin—that influence risk,” Ligibel explains. Understanding the mechanisms behind the effects of exercise could ultimately help pave the way to better treatments. In an accompanying editorial, Pamela J. Goodwin, MD, of the University of Toronto commented that the results “rais[e] the intriguing possibility that a lifestyle intervention may act as a targeted therapy in breast cancer.” Even without this benefit, though, three hours of exercise a week is still great for your overall health.

To commemorate its 30-year anniversary, the Y-ME National Breast Cancer Organization officially changed its name to Breast Cancer Network of Strength. The new title, the group believes, more accurately reflects its continuing mission of providing information, peer support and personal empowerment. The name also updates the organization’s image in an age when women are more proactive about their health care and willing to speak out. (When Y-ME was founded in 1978, breast cancer was rarely discussed and “Why me?” was a common reaction to a diagnosis.)

The group’s new logo features a stylized pink ribbon and four figures holding hands, representing the diversity and strength of the disease’s survivors and their loved ones. The organization’s website, includes tools such as My Breast Cancer Coach, which allows patients to receive personalized advice about treatment.

Services like support groups, help via e-mail, monthly teleconferences and a 24-hour hotline staffed by survivors (800-221-2141) are now under the YourShoes umbrella title. The Survivor Match and Partner Match programs pair people with breast cancer and their loved ones with peer counselors who have been through similar experiences.

In a statement announcing the re-branding, CEO Margaret C. Kirk said, “We want to encourage more people touched by breast cancer to take part in programs and services and truly experience the power of peer support and the immediate emotional relief it provides.”

By Marilynn Larkin

Restorative yoga, also called “active relaxation,” can significantly improve the quality of life of women with breast cancer. That’s the word from Suzanne C. Danhauer, PhD, who presented the findings of her study at the Society of Behavioral Medicine’s annual meeting in San Diego last spring.

Along with her colleagues, Danhauer, an assistant professor of internal medicine at Wake Forest University Health Sciences in Winston-Salem, North Carolina, studied 44 breast cancer patients whose average age was 56. Half were randomly assigned to weekly 75-minute restorative yoga classes for 10 weeks; the other half, the control group, were put on a waiting list and offered the opportunity to take the classes after the study ended. The program included standard yoga postures that could be modified to suit patients’ capabilities, plus deep breathing and meditation.

At the end of the study, yoga class participants reported feeling more positive than the women in the control group. They also had significantly fewer symptoms of depression and anxiety and better health-related quality of life overall. “A lot of the benefits are emotional, so we see this as an adjunct to, not a replacement for, traditional medical therapy,” Danhauer explains.

She sees yoga as another way to connect for patients who have reported to her that traditional support groups are unappealing. “What’s neat is that by coming into a group like ours, they get support, but it’s on their own terms,” says Danhauer. She adds that she intends to bring the program to women in local clinics to see if the findings hold.

By Marilynn Larkin

Sutent (sunitinib), an oral drug already approved to treat advanced kidney cancer and a rare digestive system tumor, now shows some efficacy in advanced breast cancer, according to a study published in the Journal of Clinical Oncology (April). Sutent is an angiogenesis inhibitor, thought to work by preventing a tumor from getting the oxygen and nutrients it needs to grow by blocking the formation of new blood vessels.

“The whole area of angiogenesis is really taking off in breast cancer,” says Harold Burstein, MD, PhD, of the Dana-Farber Cancer Institute, lead author of the study. “Several anti-angiogenesis drugs are being studied, sunitinib among them.” Sutent is in a class of drugs called receptor tyrosine kinase (RTK) inhibitors. It prevents certain growth factors necessary for angiogenesis from signaling that a tumor needs more blood vessels to survive and grow. Thus, it effectively cuts off the blood supply to the cancer and stops tumor cells from reproducing.

In the study 64 women with metastatic breast cancer who had been pretreated with other drugs were given 50 mg of Sutent once daily for four weeks, then were off treatment for two weeks. Seven patients had a partial response, resulting in an overall response rate of 11 percent. “Truthfully, this is a reasonable response rate for most single-agent chemotherapies in this population,” Burstein says. The drug was “reasonably well tolerated,” he adds, noting that fatigue was the most common side effect reported with Sutent.

Sutent is now being tested in four phase 3 and three phase 2 trials in various settings, to evaluate its safety and efficacy both as a single agent and in combination with first-line therapies to treat locally advanced and metastatic breast disease.

“What we’re really seeing is the second generation of anti-angiogenesis work in breast cancer,” Burstein explains. “With the first generation of trials, it seemed like these drugs would be valuable. Now we want to see how they compare with each other, how to integrate them and how to choose the best.” More information on the trials, which are currently recruiting patients, can be found at clinicaltrials.gov or suntrials.com.

By Rena Sandberg

Maintaining a sensible weight and making good food choices are important for everyone, but especially for breast cancer patients. Research shows that overweight women have lower breast cancer survival rates as well as a greater probability of recurrence. So if you’re trying to drop a dress size or just stay healthy, it pays to be a smart label-reader.

Cheryl Wachtel, nutritionist at Trinitas Comprehensive Cancer Center in Elizabeth, New Jersey, says that the first mistake people make when reading food labels is assuming that serving sizes don’t matter. “People don’t always stay true to the portion size listed on the label, and sometimes it takes more effort to understand what a portion size really is,” she says. The result: We may eat more than we need and consume a lot more calories than we think we do—and the pounds stay on.

Start by figuring out how many calories you need in
a typical day. The U.S. Department of Agriculture has a website that calculates this information based on your age, sex, height, weight and physical activity level. If you’re trying to lose weight, the site shows you how to cut calories and get more exercise. Now you’re ready to start looking at labels, making sure you’re staying within your calorie limit and eating the proper serving amounts.

Okay, so what is a “serving,” anyway? Look at the very top of the label, under “Nutrition Facts.” There you’ll see the serving size and the number of servings in the container. A can of soup typically has two servings; a large bag of pretzels, six; a frozen apple pie, eight.

The next line on the label tells you how many calories are in an individual serving. The more servings you eat, the more calories you take in. A single one-ounce serving of potato chips might have only 190 calories, but if you polish off an entire six-ounce bag, the total skyrockets to 1,140. Look at the single-serving calorie count even for foods that sound healthy. One bran muffin might have more calories than two individual packets of instant oatmeal.

The FDA has an interactive online guide to label reading at their site. The MyPyramid site even shows you how to estimate healthy serving sizes for products like meat and fresh vegetables that don’t have food labels. For instance, a 2- to 3-ounce serving of meat, poultry or fish is the equivalent of a deck of cards; a cup of fruit is roughly the same size as a tennis ball; a 1-ounce pancake should be a little smaller than a CD. (Keep that in mind the next time you order a heaping stack.)

By Janet Mandelstam

Breast surgery—especially mastectomy—is an assault on the body that can have a deep and lasting effect on a woman’s self-image and sexuality. It can also have a long-lasting impact on her relationship with her husband or partner. Though sexuality is a vital part of life, conversations between health care providers and breast cancer patients still may not be taking place.

These are some of the conclusions in a new Australian study on breast cancer and sexuality published in the March-April 2008 issue of The Breast Journal. Based on an extensive review of current research as well as local interviews, the study found that breast cancer causes considerable stress in sexual relationships.

Common side effects of cancer treatment that may affect a woman’s sexuality include vaginal irritation and dryness, weight gain, fatigue, painful intercourse, lowered libido, hair loss and nausea; the anxiety and depression that accompany a cancer diagnosis often play a part as well. Some partners may not initiate sex because they are disturbed by the changes in their partner’s body. Others may be responding to the fact that their partner has emotionally and sexually withdrawn from the relationship—possibly because she has misread her partner’s reaction.

This research shows that half of all women experience sexual difficulties following breast cancer treatment; about one-third feel that their partners are emotionally unavailable, and 12 percent report either a separation or a permanent split from their partner. Yet, the authors note, “Despite being an important aspect of the breast cancer experience, sexuality and body image are topics that are not often discussed by healthcare professionals with the patient or her partner.”

By Janet Mandelstam

How overweight you are may affect your prognosis if you are diagnosed with an advanced or aggressive breast cancer.

The higher a woman’s body mass index (BMI—a calculation of a person’s total body fat percentage, based on height and weight) at the time of diagnosis, the worse her prognosis if her cancer has spread to nearby tissue or lymph nodes or if she has inflammatory breast cancer (IBC), according to a new study from The University of Texas M.D. Anderson Cancer Center.

Researchers reviewed outcomes for 606 patients who were treated for those advanced or aggressive cancers. Massimo Cristofanilli, M.D., the study’s senior author, says the center began this research “because the vast majority of our newly diagnosed inflammatory breast cancer patients were overweight or obese, and IBC is associated with a poor prognosis.”

The study measured both overall survival rates and survival without a recurrence for patients whose BMI scores indicated they were normal or underweight, overweight or obese. All had received similar chemotherapy treatments. Patients with locally advanced cancer were measured together, then separately from women with IBC. Overall, and for women with each type of cancer, results were significantly worse for overweight and obese patients. For example, among those with locally advanced breast cancer, the 10-year survival rate was 42.4 percent for obese women, 44.1 percent for overweight women, and 57.3 percent for women whose BMI was normal or who were underweight.

Cristofanilli notes that more research is necessary before BMI can be used routinely to predict outcomes. Meanwhile, he urges oncologists who treat overweight and obese patients with these cancers to follow up aggressively after initial treatment, such as by doing physical exams and imaging procedures like mammography and MRI more frequently.

Can patients who lose weight after diagnosis alter their prognosis? “Probably,” Cristofanilli says, “but we haven’t studied that yet.” Doctors at M.D. Anderson are exploring a program that would motivate overweight and obese patients to adopt an exercise program and a healthy diet. “We hope this report will serve as a wake-up call,” he says. While Cristofanilli recognizes that it can be hard for overweight women to adjust their eating habits during chemotherapy, he stresses that lifestyle changes are important.

The study was published in the March 15, 2008, issue of Clinical Cancer Research.

By Jody Rosen Knower

Most online information about breast cancer is accurate, but patients still need to click with care, according to a study published in the March 15 issue of Cancer.

Entering common search terms like “breast lump,” “breast cancer risk” and “mammogram,” researchers at two University of Texas institutions used Google and four other search engines to locate breast cancer information online. Their efforts yielded a total of 343 distinct Web pages, each of which was analyzed by two medically trained researchers who found that 94.8 percent contained accurate information.

The researchers had hoped to identify criteria by which patients could distinguish reliable Web sources from those with misleading information on breast cancer, but none of the typical indicators correlated with accuracy. It made no difference whether a Web page had a .com, .gov, .edu or .org domain, for example, or if it included a disclaimer. And the problematic statements ranged from minor factual errors to potentially harmful advice.

There was one surprising result, however, regarding Web pages that included information on complementary and alternative medicine (CAM), such as acupuncture. Although such pages comprised a tiny percentage of those evaluated, they were more than 15 times as likely to contain inaccuracies as those that did not address CAM; one such Web page warned users not to undergo chemotherapy. What’s more, the incorrect information wasn’t necessarily about alternative medicine.

Despite an overall inaccuracy rate of only 5 percent, the study authors recommend surfing the Web with a “healthy skepticism.” Above all, patients should consult a doctor before taking action.

Funda Meric-Bernstam, M.D., co-author of the study and a surgical oncologist at The University of Texas M. D. Anderson Cancer Center in Houston, also cautions that online medical information, particularly about breast cancer, can quickly become stale. “Information is flowing faster than it ever has before,” she says. “With the introduction of new drugs and tests to guide therapy every year, breast cancer treatment guidelines are rapidly changing.”

By Heidi Mae Bratt

It’s hard to overestimate the power of having a shoulder to lean on. In fact, women with metastatic breast cancer value psychosocial support as highly as cutting edge information on medical treatments, according to a recent survey.

The Y-ME National Breast Cancer Organization polled 733 women diagnosed with metastatic disease on such issues as their state of mind, sources of support and side effects of treatment. Of the 474 who answered a question about the effects of their illness, 73 percent reported feeling depression, a problem that ranked only second to fatigue; 47 percent said they felt isolated. Asked what affected them most about their treatment, 29 percent experienced fear that treatment wouldn’t work; another 27 percent cited fear of the unknown.

From these responses, the organization concluded that women with metastatic breast cancer want more emotional tools to help them cope adequately with their disease. “The survey just validated what we hear on our hotline—that people are craving support and information,” says Karen Christensen Araujo, vice president of marketing and communications for Y-ME. Adds Christina Koenig, director of communications and media relations, “Psychosocial support means different things to different people. It could mean therapy, support groups, help from family and friends or all of those options.”

Communication with doctors was another major source of discontent. Forty-one percent of the 447 women who answered questions about their treatment felt that their options weren’t made clear to them at the time of their diagnosis, and 52 percent said their health care provider doesn’t offer them a variety of treatment options or let them know about drug approvals or clinical trials.

The women surveyed also said they wanted more information available to them online. An overwhelming majority of them—86 percent—said that Web-based metastatic breast cancer education materials would be helpful. Y-ME CEO Margaret C. Kirk has said these results should be a “wake-up call” for health care professionals to offer more support and education to patients and their families.

By Heidi Mae Bratt

A family of viruses, some linked to cervical cancer, is the most common sexually transmitted infection (STI) in teen girls, according to a recent study by the Centers for Disease Control. The study found that one in four young women ages 14 to 19 has an STI.

A study based on the 2003-04 National Health and Nutrition Examination Survey, led by CDC researcher Sara E. Forhan, M.D., MPH, was the first ever to examine the combined national prevalence of STIs in adolescent girls. The more than 800 teens who participated were tested for four common sexual diseases: human papillomavirus (HPV), which can cause genital warts and cervical cancer; herpes simplex virus type II, which can lead to chronic genital herpes; trichomoniasis, a parasite that can cause vaginitis and increase the risk of transmitting HIV; and chlamydia, an infection that can lead to pelvic inflammatory disease.

Of the four, HPV was by far the most prevalent, affecting 18 percent of girls. “It’s nice to have proof that we’re not just imagining how prevalent these infections are,” says Mercedes Castiel, M.D., head of general gynecology at Memorial Sloan-Kettering Cancer Center in New York.

“This study makes it clear that sexually transmitted infections commonly occur and points to our arming young women with good educational information to protect themselves,” says Forhan. To that end, she adds, the CDC recommends that young women delay their sexual debut, limit the number of partners they have, use condoms consistently and correctly, and be vaccinated against HPV before becoming sexually active, or between ages 13 and 26.

Mona Saraiya, M.D., a medical epidemiologist in the CDC’s division of cancer prevention and control, says that as sobering as it is to think of young girls contracting sexual diseases, parents should take the news as an alert, not an alarm. While HPV is very common, the incidence of cervical cancer in the United States is only about 10,000 cases annually. There are more than 100 types of HPV viruses—less than half of them affecting the genital area—and only certain types increase the risk of serious problems.

The HPV vaccine, which is administered in three doses, combats virus types 16 and 18, which cause about 70 percent of cervical cancer cases, and types 6 and 11, which are responsible for about 90 percent of cases of genital warts. Also of note: Clinical trials for the vaccine have shown it to be effective in preventing precancerous lesions of the vulva and vagina.

By Nancy Plese

Women are living longer with stage IV breast cancer, according to recent research from The University of Texas M.D. Anderson Cancer Center in Houston. Unfortunately, the statistics show a difference based on race, with white women surviving longer than black women.

“It was quite a shock to us to see that the survival rates for black women were not improving,” says Sharon Giordano, M.D., assistant professor in the department of breast medical oncology at the university. “There [are] so many new medicines and therapies, and we expected that this would have an impact on survival.” Her team studied data on 15,438 women newly diagnosed with stage IV cancer between 1988 and 2003. The difference in median survival increased over time from 20 months to 27. But while the median survival for white women rose accordingly, the figure for black women stayed the same: 17 months.

The study drew no specific conclusions about the cause of the discrepancy, but Giordano has a theory: “It is likely that a variety of factors are responsible for this, including access to health care, utilization of screening programs and differences in treatment. Further research really needs to be done to see why the disparity is increasing, so that we can reverse this phenomenon.”

Biological factors may also play an important part. A recent study by researchers at the University of Michigan Comprehensive Cancer Center showed that black women were far more likely than white women to have estrogen-receptor-negative breast tumors—regardless of their income level, age at diagnosis or cancer stage. ER-negative tumors are associated with less favorable outcomes because they are usually more aggressive biologically and thus get discovered at more advanced stages, and treatment options are limited because tamoxifen and aromatase inhibitors are ineffective against this type of cancer.

The study confirmed previous research showing that black women are more likely to be diagnosed at younger ages (the average age in the Michigan study was 57, as compared to 62 for white women) and to have more advanced disease at the time of diagnosis.

Lead investigator Lisa Newman, M.D., M.P.H., says these findings illustrate the importance of early detection and screening, particularly for those likely to have an aggressive form of the disease. She adds that women whose tumors are ER-negative are particularly needed for clinical trials. “We know so little about ER-negative disease, and the only way to know more is to have more of these patients participate in trials,” she says.

Newman is currently collaborating with cancer-treating centers in Africa, in particular the Komfo Anokye Teaching Hospital in Kumasi, Ghana, to learn more about the biological makeup of breast cancer. Their early findings suggest that women of African ancestry have an even higher frequency of ER-negative disease and a younger age at diagnosis than either African-American or white women.

The Sister Study—a long-term study of women ages 35 to 74 who have a sister with breast cancer—is close to its goal of enrolling 50,000 participants, but the researchers are still looking for women in certain underrepresented groups. By studying women who never had cancer but may be at genetic risk, they hope to tease out the roles played by environment and genes.

Launched in 2004 by the National Institute of Environmental Health Sciences (NIEHS), the study is in the final months of its recruitment effort. The 10-year observational study begins with participants answering questions about diet, jobs, hobbies and things they’ve been exposed to throughout their lives, to determine what may influence breast cancer risk. Later a female health technician collects small samples of blood, urine, toenail clippings and house dust, which will also help give researchers a better picture of each woman’s environment and genes.

By Lydia Fong

Ginseng, an herb long believed to improve health and well-being, may help to combat fatigue in cancer patients, according to a pilot study presented at last year’s annual meeting of the American Society of Clinical Oncology.

Debra Barton, Ph.D., an oncologist from the Mayo Clinic in Rochester, Minnesota, tested different doses of ginseng pills among 282 cancer patients (39 percent of whom had breast cancer) with a history of cancer-related fatigue. Among the two groups who took the highest doses—1,000 and 2,000 milligrams per day—25 percent of each group reported feeling less fatigued, and 30 percent in each group said they were “more satisfied with their treatment.”

Though the herb has a history in ancient and complementary medicine, scientists don’t know how its healing qualities work. Barton hypothesizes that the active components in ginseng, called ginsenosides, somehow balance the physiologic markers of stress (like cortisol) in the body.

The Tykerb-Xeloda combination also has some ability to shrink brain tumors that have grown following radiation. Hope Rugo, M.D., clinical professor of medicine and director of the Breast Oncology Clinical Trials Program at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, says, “Patients receiving Tykerb and Xeloda had fewer brain metastases compared to women receiving Xeloda alone.” In another study reported at the 2007 San Antonio Breast Cancer Symposium, Tykerb plus Xeloda proved useful as a treatment for brain metastases, with 60 percent of patients experiencing reduction of tumor size.

A Triple-Negative Treatment

Ixempra is also being used in a combination form to help women with Her-2-positive breast cancer. A study presented in San Antonio reported complete or partial responses in 24 of 59 patients who took Herceptin along with weekly doses of Ixempra and carboplatin.

Blocking Blood Vessels

Miller led the E2100 trial of Avastin, which studied women with metastatic breast cancer who hadn’t yet received chemotherapy. One group received the chemo drug Taxol alone, while another group was given Avastin as well. The second group showed twice the rate of survival without progression to a more advanced stage (11.8 months vs. 5.8 months). “Better progression-free survival means women had an extra six months during which their disease was under control. It means feeling as well as possible for as long as possible,” says Miller. Studies are now underway to measure Avastin’s effect as part of therapy for patients with newly diagnosed breast cancer that hasn’t metastasized. Miller says the future should hold more drugs which, like Avastin, are “hopefully more effective” than current therapies.

Coming Soon?

Luca Gianni, M.D., director of medical oncology at the Istituto Nazionale Tumori in Milan, Italy, studied women with locally recurrent or metastatic breast cancer who had relapsed after chemotherapy. After taking Sutent in combination with the chemo drug docetaxel, 13 of 18 showed a partial response, and nine experienced a decrease in tumor size after two cycles of treatment. Gianni says that in addition to cutting off the blood supply, “sunitinib increases the amount of chemotherapy drugs that reach the tumor.”

Before doing a large-scale study, the researchers wanted to be sure that the drug didn’t elevate the concentration levels of docetaxel in the patients’ blood. It didn’t in this trial, but most patients did experience a drop in white blood cell counts (neutropenia). Gianni explains, “Sunitinib may have contributed to the usual high level of neutropenia already caused by docetaxel.”

Hip Size of Mother Linked to Cancer Risk

Mothers with wide, round hips may have daughters at higher risk for breast cancer, according to David Barker and Kent Thornburg of Oregon Health & Science University in Portland. Broader hips, the researchers suggest, indicate higher levels of the sex hormone estrogen, which may be transmitted during gestation to make the daughters especially vulnerable.

To reach this conclusion, the researchers followed more than 6,000 women whose mother’s pelvic bones had been measured during routine prenatal care. The surprising finding: Breast cancer rates were more than three times higher among the women whose mothers had wide hips.

A woman’s vulnerability to breast cancer was greater if her mother’s “intercristal diameter”—the widest distance between the winglike structures at the top of the hip bone—was more than 11.8 inches. The risk also was higher if these winglike structures were round.

How to explain the strange connection? The researchers point out that mothers’ circulating sex hormones bathe the embryo and fetus during gestation—including the critical first trimester, when the primary mammary cord that gives rise to the milk-producing breast lobules is formed.

There’s much to support the theory. It’s well known that the fetal breast is stimulated by the mother’s circulating sex hormones. In fact, the stimulation is so intense and powerful that fully half of all newborn babies have breast secretions.

“High estrogen concentrations in the maternal bloodstream could produce genetic instability in differentiating breast epithelial cells” Barker states. That, in turn, “would make the breast vulnerable to cancer in later life.”
Hypnotic Advantage

In addition to helping with weight loss and smoking cessation, hypnosis appears to have some benefit for women with breast cancer. Women hypnotized prior to biopsy or lumpectomy felt reduced pain after surgery, spent less overall time in surgery and needed less anesthesia, according to Guy Montgomery, Ph.D., at the Mount Sinai School of Medicine in New York City.
Power of Prevention

Women hoping to lower their risk of invasive breast cancer now have a new weapon in the arsenal: Evista. This osteoporosis drug, manufactured by Eli Lilly, also prevents estrogen from attaching to breast cells and driving the growth of cancer. Only the second drug approved by the U.S. Food and Drug Administration to reduce the risk of breast cancer (the first was tamoxifen), Evista is recommended for postmenopausal women who may be at risk for the disease.

The approval comes in the wake of four large-scale clinical trials that show the safety and efficacy of the drug. Steven Galson, M.D., director of the FDA’s Center for Drug Evaluation and Research, calls the drug “an important new option for women at heightened risk of breast cancer.” He cautions that the benefits and risks must be weighed for each patient.
Awareness is soaring but myths abound

Breast cancer awareness has reached an all-time high, but despite the buzz, critical knowledge gaps and confusion often perpetuated in the media are leaving women vulnerable and at risk.

Buy-in to these myths has given women a false sense of security, says Fran Visco, president of the National Breast Cancer Coalition, and has lulled them into complacency about the disease and its risks.

Emphasizing the problem, NBCC has conducted a survey on women’s views. The results: 76 percent of respondents said they are knowledgeable about breast cancer, with 61 percent having recently heard or read something about the disease. Nonetheless, a majority of respondents (56 percent) believe that most breast cancers occur among women with a family history or a genetic predisposition to the disease. This is not true—the reality is that over two-thirds of women diagnosed have no known risk factor. Confusion reigns even though high risk genes are rare in the general population and are estimated to account for no more than 5 percent to 10 percent of breast and ovarian cancer cases overall.

The point is that women without the risky genes think they don’t need to worry, when they actually do.

When asked the question, “Where do you think the most progress has been made in the fight against breast cancer?” the most frequent response (39 percent overall) was “awareness about how to self-detect breast cancer.”

Women who gave this reply are convinced that breast self-examination is an effective early detection method. Yet research has shown that breast self-examinations do not reduce deaths due to breast cancer, but may greatly increase the number of benign lumps detected and result in increased anxiety, physician visits and unnecessary biopsies.

According to the U.S. Preventive Services Task Force, “the evidence is insufficient to recommend for or against breast self-exam.”
Handheld Coach

Patients undergoing chemotherapy suffer a host of side effects, especially pain, depression and fatigue. Yet unless they effectively communicate the problems to their physicians, they won’t receive available relief. Now, from the Ohio State University Comprehensive Cancer Center, comes a solution: a personal digital assistant to coach the patients.

First the patients enter their symptoms through the keypad of the handheld assistant. Then, prior to an appointment with their doctor, the electronic device uses the entered data to select and play one of several 8- to 12-minute instructional videos telling the patient how best to communicate her specific issues so the doctor will understand.

“Often patients don’t tell their doctor everything during an office visit,” says Charles L. Shapiro, M.D., director of breast medical oncology at the James Cancer Hospital and Solove Research Institute at Ohio State and a study investigator. “Or patients may minimize their symptoms because they want to put on a positive front for their doctor, which often is not in their best interest.”

“Patients often have trouble talking to doctors about pain, fatigue or depression, and the doctors may also have trouble talking to patients about these symptoms,” adds principal investigator and Ohio State psychologist Doug Post, Ph.D. Using the digital assistant, “we hope to improve communication on both ends. If these symptoms are not talked about at appointments and are not treated, they can worsen the patient’s overall quality of life."

Early Puberty, High Risk

American girls are starting puberty younger and younger—but the trend is most extreme for black girls, according to a new report from ecologist Sandra Steingraber and the Breast Cancer Fund. The finding is especially alarming because earlier puberty increases breast cancer risk.

The report describes puberty as a delicate process easily set off balance by psychological or social stress, chemical exposure and obesity. To reverse the early-puberty trend and cut breast cancer risk, says Steingraber, these factors must be addressed.

The new report delivers a list of disturbing findings:

• Today’s girls develop breasts an average of one to two years earlier than girls of 40 years ago. The mean age is about 10 years for white girls and 9 years for black girls, with 14 percent on average attaining breast buds before age 9.


• At age 10, black girls are three times as likely as white girls to have begun menstruating.


• Early onset of menstruation increases a girl’s risk of getting breast cancer later in life.


• Girls who mature early are also more likely to become depressed or anxious, have eating disorders or attempt suicide.

To help protect the heart, says study co-author Sarah Bacus, Ph.D., of the Illinois biotech company Targeted Molecular Diagnostics, oncologists might need only to combine existing drugs, making sure that one of them pulls AMP kinase into the biological loop. Herceptin combined with Tykerb might turn out to be an option. Even drugs currently used for diseases not related to cancer, such as diabetes, may prove potent collaborators in the fight against cancer, Bacus says.
her-2 vaccine on the horizon

Breast cancer patients who thought vaccinations ended in childhood with a bandage and a lollipop may be revisiting the experience in the future. Researchers at the University of California, San Francisco, are testing a special vaccine that, early evidence shows, may slow tumor growth in women with advanced, Her-2 positive breast cancer.

Results of a phase 1 trial with 18 patients showed that the vaccine, called Neuvenge, has potential. One patient experienced shrinkage in a tumor in her neck, and three had no tumor growth for a year or more.

To create the vaccine, researchers manipulated immune cells from each patient, in the lab, so they would better recognize and destroy the Her-2 receptor, then infused them back into the patient. “We’re trying to get the immune system to do a better job,” says lead investigator John Park, M.D.
Metastatic Patients Plan Second Conference

The Metastatic Breast Cancer Network (MBCN) Second Annual National Conference will be held at the M.D. Anderson Cancer Center in Houston on November 17 and 18.

Goff emphasizes that such patients are often shunted to gastroenterologists, who label them with other diagnoses, then try to treat the wrong disease. When the cancer is finally diagnosed, it is much further along. Before a patient with the target symptoms seeks any other treatment, she should first see a gynecologist and get a rectal-pelvic exam or a transvaginal ultrasound, which can diagnose ovarian cancer in the earliest stages of disease. (Supporting organizations on page 30.
Reducing Radiation

Breast cancer patients might not need as much radiation as they’re getting, according to a study presented at the American Society of Clinical Oncology (ASCO) meeting in June.

In a randomized, controlled study, European researchers compared radiation regimens of more than 4,000 postmenopausal breast cancer patients and found that after five years, fewer and lower doses of radiation were just as effective as higher doses given for longer periods of time. Patients were evaluated for changes in breast appearance, tissue effects and tumor relapse.

In the United States, radiation treatments often last for six to eight weeks, a burden that studies have shown causes some women—especially those who live far from radiation centers or have difficulty making regular appointments—to opt for mastectomies instead. If women could get by on three weeks of radiation instead of six, as was tested in the study, more women might avoid mastectomies.

Physicians in the United States also believe the findings are encouraging, but it’s too soon for any drastic changes. Many oncologists believe we won’t really know how well a shorter radiation schedule works until 10 or even 15 years have passed, says Lawrence J. Solin, M.D., professor of radiation oncology at the Hospital of the University of Pennsylvania.

That said, the study might give some patients, especially those who might not otherwise be able to receive radiation, the option of a shorter course of radiation treatment.
Saving the Nipple

Doctors in Korea are experimenting with a surgical procedure that allows women to retain their own nipples after a mastectomy. So far, studies have looked only at the procedure’s cosmetic outcome, according to findings presented at the ASCO annual meeting. Additional studies will have to show whether women who keep their nipples are more likely to have a recurrence.
Hair Relaxers Don't Cause Breast Cancer

African-American women who use hair relaxers to tame their tresses regularly endure scalp burning and itching, hair breakage, and a number of other unpleasant reactions to the products’ harsh chemicals. But do these ingredients pose greater health risks? Can they even cause breast cancer? Users can now relax—the answer is no.

“I can't say I was surprised,” says study leader Lynn Rosenberg, Sc.D., a professor of epidemiology at Boston University. “I was pleased that there wasn’t a link.” It was well worth studying, she adds, because so many young black women use the products, often for many years. It might have helped explain the high rates of breast cancer among African-American women—but it turns out not to be connected, at all.

Rosenberg used data from the Black Women's Health Study, which surveyed tens of thousands of women across the United States from 1995 to 2003. Compelled by the popularity of this beauty trend among black women, researchers included questions about use of chemical hair straighteners including age at first use, number of times a year, and the number of burns experienced. In the end, researchers concluded that there were no increases in breast cancer risk associated with any of these factors.

“The results are very clear cut in terms of breast cancer risk,” Rosenberg says, “and very reassuring.” She adds that other hair products, including shampoos that contain estrogen and hair dyes made with carcinogens, may be more worrisome.
Women Report Getting Fewer Mammograms, But Why?

Long credited with detecting breast cancer early and saving millions of lives, the mammogram has been a staple of preventive care in the United States. Yet earlier this spring, the National Health Interview Survey showed a startling finding: the number of women who report getting those mammograms has dropped. Rates had increased rapidly from 39 to 70 percent of women over age 40 between 1987 and 2000, then stabilized until 2003. But in 2005 rates reported by women fell almost four percent, according to the journal Cancer (June 15).

The most striking part of the survey, says study author and economist Nancy Breen, Ph.D., at the National Cancer Institute, is that rates dropped most among women who historically have been the highest users of mammography
those between 50 and 64 years of age, who stand to benefit most. Also dropping off in use: those with higher incomes, better educations, good health insurance and a steady source of medical care.

The big question in all this is, why? For now, the reason isn’t clear, though Breen and fellow researchers have some guesses. Among the possible explanations: higher insurance deductibles or copayments, or lower reimbursement for the screening test; skepticism about risk because breast cancer rates have dropped; or new, unfounded doubts about the effectiveness of mammograms themselves. The Institute of Medicine suggests that the decline may reflect a drop in the number of radiologists specializing in breast imaging. As lawsuits against radiologists who have missed diagnoses rise, fewer have gone into the field. There may be shortages, and it may be difficult for women to get appointments, Breen says.

There is also some concern that the recently reported drop in breast cancer incidence might actually be due to decreased mammography rates. That is, fewer women may be getting diagnosed with breast cancer simply because they aren't getting checked out.

“When mammography was [increasing], studies showed an increase in breast cancer incidence as a result. That's because some of the breast cancers that would have been diagnosed later were diagnosed earlier,” Breen says. “What we’re suggesting here is the opposite: if mammography rates decline, then some breast cancers that would have been diagnosed earlier will be in fact be diagnosed later.”

If mammography rates continue to drop, we need to address it. But since intervening is hard without knowing why the problem exists, researchers plan to examine availability of mammogram facilities, insurance coverage, and whether doctors are recommending mammograms. They also want to look at use of reminder systems in physician offices in the United States.
Portuguese Breast Cancer Genes

When it comes to genetic testing for breast cancer, those of Ashkenazi Jewish ancestry have had access to more resources than others. That’s because scientists have pinpointed three specific gene mutations that could predispose them to breast cancer, and have created tests to detect the mutated genes.

Soon, a similar approach could be available for those of Portuguese ancestry, say scientists at the Lisbon Oncology Institute in Portugal. They’ve discovered that some Portuguese people have a specific mutation in the BRCA2 gene—the second breast cancer gene to be discovered. Called a founder mutation, the genetic error originated in one population in a single geographical region, and spread from there.

The discovery is especially important because there are so many people of Portuguese descent around the world who might carry the mutation, says study author and medical oncologist Fatima Vaz. Researchers estimate that the mutation originated between 2,400 and 2,600 years ago, right before Portuguese sailors and traders fanned out into other parts of the world, enabling them to spread the gene to such places as Japan, India, Africa and Brazil. From the 1950s through the 1970s, the Portuguese (and their genes, of course) emigrated to France, Germany, Canada, and the United States.

Vaz, whose study appeared in the Journal of Clinical Oncology in May, notes that the Portuguese mutation (which she calls c.156_157insAlu) differs from those found in Ashkenazi Jews. She recommends that anyone of Portuguese ancestry with a family history of breast cancer be screened specifically for the mutation, but says that may be difficult for now. To make the test widely available, she’s trying to form an international consortium through labs in Paris and Toronto, where large Portuguese communities reside. “There’s a huge concentration of Portuguese in New Jersey and the San Jose, CA, area,” Vaz adds. “We’re trying to make contact with those places as well.”
Accupuncture & Imunity

Acupuncture may boost white blood cell counts and bolster the immune system, according to a small study whose findings were presented at the ASCO meeting. The study examined the effects of acupuncture on 11 women with gynecologic cancers. Larger studies will be necessary to confirm the findings. Acupuncture is a popular alternative treatment that involves sticking needles into the skin at specific points on the body.
Research Briefs

Tumor microenvironment influences cancer

For more information, read
How to Find a Good Doctor … and Recognize a Bad One




Healthy Pregnancy Following Herceptin

Cancer patients can take Herceptin during pregnancy and still have a healthy baby. According to a case study published in the journal Reproductive Toxicology (February), a 32-year-old woman who took Herceptin (trastuzumab) for the first 24 weeks of her pregnancy gave birth to a healthy girl who, at two months of age, showed no signs of medical abnormalities.