The More Times a Woman Gives Birth, the Higher Her Risk of Rare but Aggressive 'Triple-Negative' Breast Cancer

/PRNewswire/ -- Full-term pregnancy has long been associated with a reduced risk of breast cancer, but a new study finds that the more times a woman gives birth, the higher her risk of "triple-negative" breast cancer, a relatively uncommon but particularly aggressive subtype of the disease. Conversely, women who never give birth have a 40 percent lower risk of such breast cancer, which has a poorer prognosis than other types of breast cancer and doesn't respond to hormone-blocking therapies such as tamoxifen.

These findings, from a study led by Amanda Phipps, Ph.D., a postdoctoral research associate in the Public Health Sciences Division of Fred Hutchinson Cancer Research Center, are published online ahead of the March 16 issue of the Journal of the National Cancer Institute.

"Unlike most breast cancers, triple-negative tumors don't depend on hormonal exposures to grow and spread, so our assumption going into the study was that reproductive factors would not be associated with a woman's risk of this cancer subtype," Phipps said. "We were surprised by these findings because researchers have known for quite some time that women who have children, especially those who have them at an early age and have multiple full-term pregnancies, have a lower risk of breast cancer overall."

While never giving birth appears to be protective against triple-negative breast cancer, the researchers found that women who remain childless have about a 40 percent higher risk of estrogen-receptor-positive breast cancer - the most common form of the disease, which can be treated with estrogen-blocking drugs - as compared to those who have one or more offspring. This higher risk of estrogen-receptor-positive breast cancer among women who have not had children is well established, and it is thought to be related to the fact that such women do not undergo pregnancy-related changes in the breast that confer a lifelong protective effect.

"The mechanisms by which full-term pregnancy contributes to an increased risk of triple-negative breast cancer and a decreased risk of other forms of the disease are not clear," Phipps said. "We do know that the hormones of pregnancy induce certain changes in the cellular structure of the breast. Overall, those changes seem to make the breast less susceptible to cancer. It is possible, however, that the increased risk of triple-negative breast cancer we found in women who had given birth may be due to some abnormal response of their breast tissue to the hormones of pregnancy. Another possibility is that pregnancy somehow makes the breast more susceptible to certain carcinogens even while reducing breast cancer risk overall," she said.

For the study, which was based on data from the Women's Health Initiative, Phipps and colleagues analyzed the detailed reproductive histories of some 150,000 postmenopausal women, more than 300 of whom went on to develop triple-negative breast cancer. "This particular study is significant because it is one of the largest studies ever conducted on the impact of reproductive history on triple-negative breast cancer," Phipps said.

Triple-negative breast cancer, which refers to any breast cancer that does not express the genes for estrogen receptor (ER), progesterone receptor (PR) or Her2/neu, accounts for only 10 percent to 20 percent of all breast cancers, and only in the past decade have researchers become aware that this cancer subtype exists. "This research reinforces the notion that breast cancer is not just one disease," Phipps said.

"The mechanisms that lead to triple-negative breast cancer are likely different from those that lead to other forms of the disease. We still have a lot to learn about what causes this more aggressive form of breast cancer, but we hope that research like this will help us develop better tools to identify those women at greatest risk."

It is known that this cancer subtype is more predominant in African American women and it tends to be diagnosed at an earlier age. Researchers also know there is a strong link between genetic mutations in the so-called "breast cancer gene," BRCA1, and triple-negative breast cancer.

"More research is needed to better understand the causes of the most aggressive and lethal forms of breast cancer. While this study adds to our knowledge base, it should not change women's approaches to breast cancer screening," Phipps said.

The National Heart, Lung and Blood Institute of the National Institutes of Health funded the study, which also involved researchers from Albert Einstein College of Medicine, Georgetown University, Harbor-UCLA Medical Center, Stanford University, State University of New York at Stony Brook, the University of Buffalo, the University of Pittsburgh and Wake Forest University.

At Fred Hutchinson Cancer Research Center, our interdisciplinary teams of world-renowned scientists and humanitarians work together to prevent, diagnose and treat cancer, HIV/AIDS and other diseases. Our researchers, including three Nobel laureates, bring a relentless pursuit and passion for health, knowledge and hope to their work and to the world. www.fhcrc.org

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FDA approves first 3-D mammography imaging system

The U.S. Food and Drug Administration today approved the Selenia Dimensions System, the first X-ray mammography device that provides three-dimensional (3-D) images of the breast for breast cancer screening and diagnosis.

A mammogram is a safe, low-dose X-ray of the breast that is the best tool for early detection of breast cancer. However, with the limitations of conventional two-dimensional (2-D) imaging, about 10 percent of women undergo additional testing after the initial screening exam for abnormalities that are later determined to be noncancerous.

The Selenia Dimensions System, an upgrade to Hologic’s existing FDA-approved 2-D system, can provide 2-D and 3-D X-ray images of the breasts. The 3-D images may help physicians more accurately detect and diagnose breast cancer.

“Physicians can now access this unique and innovative 3-D technology that could significantly enhance existing diagnosis and treatment approaches,” said Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health.

The National Cancer Institute recommends women ages 40 and older have a mammogram every one to two years. Nearly 40 million mammograms are performed each year in the United States.

As part of the approval process, the FDA reviewed results from two studies where board-certified radiologists were asked to review 2-D and 3-D images from more than 300 mammography exams. In both studies, radiologists viewing both the 2-D and 3-D images obtained a 7 percent improvement in their ability to distinguish between cancerous and non-cancerous cases as compared to viewing 2-D images alone.

While the combination of the Selenia’s 2-D and 3-D images approximately doubled the radiation dose the patient received, it improved the accuracy with which radiologists detected cancers, decreasing the number of women recalled for a diagnostic workup. There is uncertainty for radiation risk estimates; however, the increase in cancer risk from having both a 2-D and 3-D exam is expected to be less than 1.5 percent compared to the natural cancer incidence, and less than 1 percent compared to the risk from conventional 2-D mammography.

The Mammography Quality Standards Act requires that all health care professionals obtain eight hours of training prior to using new mammography technology on patients. The FDA also requires that the manufacturer provide each facility with a manual clearly defining the tests required for initial, periodic, and yearly quality control measures.

According to the NCI, nearly 200,000 women will be diagnosed with breast cancer this year. And 1 in 8 women will be diagnosed with breast cancer during their lifetime. There is a 98 percent survival rate when breast cancer is detected early and still localized to the breast.

The Selenia Dimensions System is marketed by Bedford, Mass.-based Hologic Inc.

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UGA researchers identify key enzyme that regulates the early growth of breast cancer cells

New University of Georgia research, published this week in the early online edition of the journal Proceedings of the National Academy of Sciences, has found that blocking the action of an enzyme called GnT-V significantly delays the onset and spread of tumors in mice with cancer very similar to many cases of human breast cancer.

When the GnT-V enzyme activity in the cells was increased in mammary gland cells, they increased proliferation and began to take on many characteristics of cancer cells. Using a mouse model of human breast cancer, tumors appeared when the enzyme was deleted, but onset was delayed an average of 10 weeks in the mice.

“In human terms,” said Michael Pierce, director of the UGA Cancer Center and study co-author, “the corresponding delay would be many months and maybe years. You basically are slowing everything down and keeping the cancer from forming and progressing very early.” Slowing the pace of the cancer could eliminate its spread to other organs, keeping it localized where it could be treated successfully, Pierce explained.

The researchers, lead by Hua-Bei Guo, assistant research scientist in the department of biochemistry and molecular biology in the Franklin College of Arts and Sciences, stimulated breast cancer formation in mouse mammary glands by over-expressing a her-2 protein that is a growth receptor on the cell surface. The researchers note that over-expression of her-2 is associated with 25 to 30 percent of human breast cancers.

The GnT-V enzyme makes glycans, which are sugars on the cell surface that change in defined ways when the cell becomes cancerous. Glycans are released from the cell as glycoproteins, making them a promising early-detection marker in blood. The researchers studied a glycan made by GnT-V that appears when normal breast cells become cancerous. The GnT-V glycan product is found on her-2 and other receptors and acts to regulate the number of cancer stem cells in the tissue. The number of these cancer stem cells determines how rapidly the cancer will form and develop.

“Glycans often are ignored by scientists, because they’re very complicated and present unusual problems to identify and understand,” said Pierce. “This study is an example of how particular glycans that are present on various cell receptors can actually modulate the onset of tumor formation. That may give us new drug targets and new ways to kill the cancer cells specifically.”

The finding of Guo and the research team at UGA’s Complex Carbohydrate Research Center that the elimination of a glycan-synthesizing enzyme significantly reduced the population of breast cancer stem cells is unprecedented, they note.

“That population of cells appears to drive breast tumor formation in many cases,” said Pierce, who also is UGA’s Mudter Professor in Cancer Research, “and our research suggests that glycans may be potential targets to kill them selectively.”

Pierce likened the cancerous stem cells to the queen of an ant colony. “You can try to get rid of the anthill, but it will just come back if you don’t kill the queen,” Pierce said. “If we can target those cancer stem cells for elimination, that would be the most effective treatment.”

The research was supported by the National Institutes of Health. For more information on the UGA Cancer Center, see www.uga.edu/cancercenter/.

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Radiotherapy Centers of Georgia in Partnership with Northside Hospital Present Breast Health & Cancer Awareness Day

Educating the Community on Breast Cancer Awareness October 2, 2010

Have you checked your breasts today? In 2009, the American Cancer Society estimated approximately 40,170 women died from breast cancer. In Georgia, an estimated 5,840 women will be diagnosed with breast cancer and 1,140 women will die from the disease this year. October is Breast Cancer Awareness Month and Radiotherapy Centers of Georgia – Cherokee County, in partnership with Northside Hospital-Cherokee, is presenting the 2nd Annual Breast Health & Cancer Awareness Day on Saturday, Oct. 2, 2010 at the Northside Hospital–Cherokee Conference Center, located at 1130 Bluffs Parkway in Canton, GA 30114.

“Breast Cancer is the leading cause of cancer death in women behind lung cancer,” said Sandra Gregory, M.D., radiation oncologist of Radiotherapy Centers of Georgia – Cherokee County. “It is a disease which is 100 percent treatable if caught early, so it is important to be educated and aware.”

The 2nd Annual Breast Health & Cancer Awareness Day will begin at 10 a.m. and run until 2 p.m., with featured lectures from renowned female physicians and breast specialists -- moderated by Sandra Gregory, M.D. The day’s activities will feature three panels addressing three crucial topics for women: Wellness and Prevention, Latest Treatment and Technology and Recent Developments in Breast Cancer.

Each panel consists of some of the best and brightest in their field. Peahen Gandhi, M.D., OB/GYN, Courtney Sinclair, M.D., GYN and Angela Falany, M.D. will discuss wellness and prevention; Anita Johnson, M.D., Breast Surgeon, Angela Robbins, M.D., Breast Surgeon and Lynn Baxter, M.D., Diagnostic Radiologist will speak towards the latest treatment and technology; and the third panel on recent developments in Breast Cancer will feature Rosa Langella, M.D., Breast Surgeon, Kathleen Long, M.D., Medical Oncologist, Gena Volas-Redd, M.D., Medical Oncologist and Sandra Gregory, M.D., Radiation Oncologist.

This free education event is an opportunity for women of the community to learn about genetic testing, partial breast irradiation, diet and nutrition, changes in surgical management of breast disease and breast cancer prevention. Northside Hospital’s ScreenAtlanta mobile mammography van will be onsite performing mammograms and attendees will also have an opportunity to sign up with StoryCorps Atlanta to go in-studio and record their personal experiences with Breast Cancer.

“Women who have been diagnosed or have loved ones who have been diagnosed are always the most eager to learn every last detail about Breast Cancer. But it is just as important, if not more important for those who are not as aware to be educated and proactive in getting screened,” said Dr. Gregory.

Breakfast, a survivor program and luncheon will be provided with a special butterfly release to honor all those who have fought and won the cancer battle. The 2nd Annual Breast Health and Cancer Awareness Day is free and open to the public. Registration is recommended, but only required for those requesting mammograms. To register, please call 404-845-5555 and press “0,” Monday through Friday from 8:30 a.m. to 4 p.m.

Sponsorship opportunities are still available. For more information on Breast Cancer Symposium 2010 or sponsorship opportunities, contact Toni Karasik at 678-965-4756 x. 115 or e-mail tkarasik@rccancercenters.com.
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Mayo-Led Researchers Discover Genetic Variants Modifying Breast Cancer Risk

Individuals with disrupting mutations in the BRCA1 gene are known to be at substantially increased risk of breast cancer throughout their lives. Now, discoveries from an international research team led by Mayo Clinic researchers show that some of those persons may possess additional genetic variants that modify their risk. These new findings enhancing individualized medicine appear in the current Nature Genetics.

"These findings should be useful in helping determine individual risk for breast cancer in BRCA1 carriers," says Fergus Couch, Ph.D., Mayo investigator and senior author of the study. "It also provides insights into hormone-receptor-negative breast cancer in the general population."

Genetic mutations in the BRCA1 gene give carriers of these mutations an increased risk for developing breast cancer. To determine if any genetic variations would modify or alter this risk among large populations of the mutation carriers, the researchers conducted genome-wide association studies (GWAS) that ultimately spanned 20 research centers in 11 different countries.

They first studied 550,000 genetic alterations from across the human genome in 1,193 carriers of BRCA1 mutations under age 40 who had invasive breast cancer and compared the alterations to those in 1,190 BRCA1 carriers of similar age without breast cancer. The 96 single nucleotide polymorphisms (SNPs) discovered were subsequently studied in a larger sample population of roughly 3,000 BRCA1 carriers with breast cancer and 3,000 carriers without cancer. Researchers found five SNPs associated with breast cancer risk in a region of chromosome 19p13.

Further studies of those SNPs in 6,800 breast cancer patients without BRCA1 mutations showed associations with estrogen-receptor-negative disease, meaning cancer in which tumors don't possess estrogen receptors. In another GWAS involving 2,300 patients, the five SNPs also were associated with triple-negative breast cancer, an aggressive form of the disease accounting for about 12 percent of all breast cancer. Triple-negative tumors don't express genes for estrogen or progesterone receptors or Her2/neu. The researchers also found that these SNPs were not related to risk for ovarian cancer in BRCA1 mutations carriers.

By locating these risk-modifying SNPs, the researchers have provided a target for better understanding the mechanisms behind the development of breast cancer. Furthermore, when combined with other risk-modifying SNPs that remain to be identified in ongoing studies by this group, it may be possible to identify certain BRCA1 carriers who are at lower risk of cancer and, also, carriers at particularly elevated risk of cancer who may decide to change their approach to cancer prevention.

Support for the research came from the Breast Cancer Research Foundation, Susan G. Komen for the Cure, the National Institutes of Health, and Cancer Research UK. In addition to first author Antonis Antoniou, Ph.D., of Cambridge University, over 180 individuals and several consortia contributed to the research and are co-authors.
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FDA Expands Use of Approved Breast Cancer Drug

/PRNewswire/ -- The U.S. Food and Drug Administration today approved Tykerb (lapatinib) in combination with Femara (letrozole) to treat hormone positive and HER2-positive advanced breast cancer in postmenopausal women for whom hormonal therapy is indicated.

HER2 is a protein involved in normal cell growth. It is found on some types of cancer cells, including breast cancer cells. In hormone positive breast cancer, the presence of certain hormones contributes to breast cancer growth. In HER2-positive breast cancer, stimulation of the HER2 receptor contributes to cancer cell growth. Breast cancer is the second leading cause of death among women. More than 192,000 women will be diagnosed with breast cancer this year.

"This drug combination of Tykerb plus Femara provides women being treated for advanced breast cancer with an important treatment option. This entirely oral treatment regimen works by targeting both HER2 and the hormone receptors, thereby slowing the cancer cells' ability to grow or spread," said Richard Pazdur, M.D., director of the Office of Oncology Drug Products, in the FDA's Center for Drug Evaluation and Research.

Women with HER2-positive disease receiving the Tykerb plus Femara combination more than doubled the time they lived without the cancer progressing compared with those receiving Femara alone (35 weeks vs. 13 weeks). Women in the company sponsored study were randomized to receive Tykerb plus Femara or Femara alone. It is too early to determine whether an improvement in overall survival will be observed in the clinical trial.

Tykerb works by depriving tumor cells of signals needed to grow. Tykerb enters the cell and blocks the function of the HER2 protein.

Tykerb was initially approved in combination with a chemotherapy drug, Xeloda (capecitabine) in 2007. This combination was used to treat women with advanced breast cancer tumors with the HER2 protein who had received prior treatment with chemotherapy drugs, including an anthracycline and a taxane, and Herceptin (trastuzumab), an anti-cancer antibody used to treat HER2-positive advanced breast cancer.

Safety information from this study was consistent with previous Tykerb clinical studies in advanced breast cancer. The most commonly reported side effects of the combination were diarrhea, rash, nausea and fatigue. Treatment with Tykerb also has been associated with decreases in heart function, liver damage, and lung tissue inflammation. Fetal harm may occur if used to treat advanced breast cancer in pregnant women. Patients should talk to their health care provider about the potential side effects, drug interactions, and other medical conditions.

Tykerb is marketed by Collegeville, Pa.-based GlaxoSmithKline.

Femara is marketed by Lebanon, Pa.-based Novartis AG.

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American College of Surgeons Voices Strong Support for American Cancer Society Screening Mammography Guidelines

/PRNewswire/ -- The American College of Surgeons (ACoS) today released comments strongly supporting current American Cancer Society (ACS) screening mammography guidelines that recommend women get a mammogram every year, starting at age 40. The College is supporting the ACS guidelines despite the recommendations from the U.S. Preventive Services Task Force stating the women should have regular mammograms once every two years beginning at the age of 50. The College believes the ACS guidelines have resulted in an effective approach toward dealing with the possibility of breast cancer and that women should continue to follow them in consultation with their physicians.

The federal panel's position that regular mammography screening in women under the age of 50 may do more harm than good was dismissed by David P. Winchester, MD, FACS, Medical Director of ACoS Cancer Programs, and Chair of the National Accreditation Program of Breast Centers. Dr. Winchester was particularly concerned about the panel's belief that mammography may cause an increased risk of false-positive results in younger women who have denser breast tissue, observing that "the term unnecessary biopsy is misleading. In most cases," he said, "biopsy -- done by either surgeons or radiologists -- is the reliable way to rule out cancer at any age."

The College notes that the American Cancer Society has long recognized mammography "as the gold standard for early detection of breast cancer,"* and ACoS encourages women to take an active role in partnering with their physicians to determine at what age, and what interval, they should undergo screening mammography. The College agrees with the ACS that factors such as a woman's family history of the disease and her overall medical condition are some of the issues that should be addressed, particularly for women who are known to be at an increased risk for developing the disease.

"Many surgeons in this country have the tremendous responsibility and privilege of caring for breast cancer patients each day. While recognizing that mammography is not perfect and supporting continuing research for improved methods, the surgical community believes that the American Cancer Society's screening mammography guidelines offer an optimal approach to detecting breast cancer early, when it can be most successfully treated," Lamar S. McGinnis, Jr., MD, FACS, President of the American College of Surgeons and former president of the American Cancer Society, said. "Mammography is a good and safe tool, which we will continue to improve. In the meantime," he added, "let's save lives as best we can. The lives of women, mothers, and grandmothers are invaluable. Our progress has been significant, and it will continue. Let us not confuse our patients and the public with mixed messages."

About the American College of SurgeonsThe American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 77,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

In the field of cancer care, the American College of Surgeons Commission on Cancer (CoC) is a pioneer in measuring performance. All hospitals and freestanding cancer treatment facilities approved by the CoC report clinical data through the National Cancer Data Base and receive evidence-based benchmark comparison reports based on accepted standards of care for breast and colorectal cancers. These measures are endorsed by the National Quality Forum. In addition, the College administers the National Accreditation Program for Breast Centers (NAPBC), a consortium of national, professional organizations dedicated to the improvement of the quality of care and the monitoring of outcomes for patients with diseases of the breast.

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Lives Will Be Lost With Proposed Changes to Mammography Guidelines

/PRNewswire/ -- "The recommendation to change breast screening is a huge step backwards," says Dr. Marisa Weiss, a leading breast oncologist and founder and president of Breastcancer.org.

The proposed new guidelines call for mammograms to start at age 50 and to be done every other year instead of every year starting at age 40, as recommended by current guidelines.

"The data simply does not account for the human perspective. It would be an enormous mistake to allow outdated data using older technology provided by computer-generated analysis to dictate how health care professionals screen women for early detection of breast cancer. These are real people with their lives at stake ... for whom mammography has a proven survival benefit."

The letter to the Breastcancer.org community follows:

Dear Breastcancer.org Member:

The U.S. Preventive Services Task Force recently recommended dramatic changes to current breast cancer screening guidelines. Breastcancer.org is strongly opposed to these recommendations.

The proposed new guidelines recommend starting regular screening mammograms at age 50, rather than at age 40 as current guidelines recommend. They recommend screening before age 50 only for women with a much-higher-than-average risk of breast cancer. The proposed new guidelines also call for mammograms to be done every other year instead of every year, as recommended by current guidelines.

The proposed new guidelines are based on research that looks at the effect of breast cancer screening on society from a public health perspective. This means the researchers were looking at how changing breast cancer screening guidelines would affect the overall public, rather than individual women. In proposing the changes, the task force members said that starting mammograms later in life and doing mammograms less often would save a large amount of money. It also means that about 3% more women would die from breast cancer each year. The task force members felt that the amount of money saved (from fewer mammograms and side effects of extra biopsies and treatment) was greater than the value of more lives saved (3% fewer women surviving breast cancer).

At Breastcancer.org, we are deeply troubled by both the analysis that led to these proposed guideline changes and the effect these proposed changes would have on the health and lives of women. Our specific concerns:

-- The analysis was based on older mammography techniques, meaning the
researchers mostly looked at results from film mammograms instead of
digital mammograms.
-- The analysis was based on some inaccurate assumptions about optimal
treatment after breast cancer is diagnosed. For example, it assumed
that women diagnosed with hormone-receptor-positive, early-stage
breast cancer would receive and benefit from hormonal therapy but not
chemotherapy, even though we know that many of these women do receive
and benefit from chemotherapy after surgery. Inaccurate assumptions
like this may have caused the researchers to underestimate the number
of lives that would be lost should the proposed changes in screening
be adopted.
-- The analysis did not adequately consider the combined benefit of early
detection (with current screening guidelines) and new treatments that
have resulted in steadily improving survival rates in recent years.
Screening cannot be looked at in isolation as a snapshot. Screening
happens as we continue to improve both diagnosis and treatment. But we
can't treat what isn't diagnosed.
-- The proposed guideline changes would mean that many breast cancers
would be diagnosed at a later stage, making it harder to become
cancer-free. Later-stage diagnoses result in more women with
metastatic disease (that has spread to other parts of the body) and
more women with large or multiple cancers requiring mastectomy (too
late for breast-conserving treatments).
-- The proposed guideline changes would mean that younger women would be
diagnosed later. Breast cancer in younger women tends to be more
aggressive, so early diagnosis and treatment is more critical for
them. It is the lives and futures of younger women that would be lost
if the proposed changes are adopted.

Expressed as nameless, faceless numbers, the 3% decrease in breast cancer survival might seem like an acceptable trade-off when compared to the economic benefits of changing breast cancer screening policies. But breast cancer affects a very large number of women, so 3% of that number is not insignificant. The reality is that more women -- mothers, daughters, sisters, grandmothers, and aunts -- will die each year from breast cancer, which is neither reasonable nor acceptable.

We at Breastcancer.org encourage medical professionals and everyone affected in any way by breast cancer to raise their voices against these surprising and dramatic proposed changes in the guidelines for breast cancer screening. Our belief is that lives should be saved, not lost, and our commitment to you is that we will continue to strongly advocate for policies that support this fundamental mission.

Marisa C. Weiss, M.D.
President and Founder, Breastcancer.org
Director of Breast Radiation Oncology, Director of Breast Health Outreach
Lankenau Hospital

Maxine Jochelson, M.D.
Director of Radiology
Evelyn H. Lauder Breast Center
Memorial Sloan-Kettering Cancer Center
Professional Advisory Board, Breastcancer.org

Emily F. Conant, M.D.
Professor of Radiology, Chief of Breast Imaging
Hospital of the University of Pennsylvania
Professional Advisory Board, Breastcancer.org

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Three-Week Course of Breast Radiation May Be as Effective as Conventional Five to Seven Week Course for Early Breast Cancers, Says U.S. Study

/PRNewswire/ -- According to a study presented November 4, 2009, at the 51st Annual Meeting of the American Society for Radiation Oncology (ASTRO), a shortened, more intensive course of radiation given to the whole breast, along with an extra dose of radiation given to the surgical bed of the tumor (concomitant boost), has been shown to result in excellent local control at a median follow up of two years after treatment with no significant side effects.

"The observations to date suggest that a three-week course of radiation therapy with concomitant boost results in outcomes comparable to that of a five to seven week course for early stage-breast cancers. Additional studies with a larger body of data and longer follow-up period will help establish whether this type of radiation treatment should be routinely used," Manjeet Chadha, M.D., lead author of the study and a radiation oncologist at the Beth Israel Medical Center in New York, said.

This shorter treatment, called accelerated hypofractionated whole breast irradiation, is an especially attractive option because women can receive a full course of radiation therapy in half the time -- three weeks of daily treatments vs. five to seven weeks. In addition, the cost of this treatment is lower relative to the cost of the standard whole breast radiation and is also less expensive than other new approaches, such as partial breast irradiation (breast brachytherapy).

"Studies from Europe and Canada have used accelerated schedules for breast radiation therapy with favorable results reported on longer follow up. In the U.S., however, there is limited data on this topic," Dr. Chadha said. "Additionally, the radiation therapy technique used in our study is different from previously published experiences. For each patient, we developed a conformal, personalized plan using three-dimensional dosimetry data derived from the patient specific CT scan images. Radiation treatment was delivered to the whole breast using an accelerated hypofractionated schedule, with the simultaneous delivery of a boost dose given to the precise location from which the tumor was removed."

Many women with early-stage breast cancer undergo breast conserving therapy. Typically, this means they first have surgery to remove the visible cancer (a lumpectomy), and then receive a course of radiation therapy to kill any microscopic cancer cells that may remain. The standard whole breast radiation treatment takes 15 to 30 minutes every day, Monday through Friday, for five to seven weeks.

Beginning in June 2004, researchers studied 112 women with early-stage breast cancer who received accelerated hypofractionated whole breast irradiation plus concomitant boost. The results were reported on 105 patients who had completed therapy and had a minimum six-month follow up. The patient group had small breast tumors that had not spread to the lymph nodes. Women with early-stage breast cancer who received chemotherapy or underwent radiation to the lymph nodes were excluded from the study. Patients were followed at regular intervals after completion of treatment.

Findings show that the cancer did not return to the original site or to the surrounding region in these women. The median follow-up of the study was two years. Survival was greater than 95 percent for patients with five years of follow up. The study also shows there were no significant physical or cosmetic side effects from the radiation treatment.

In an era of personalized care, Dr. Chadha emphasizes, "Women with early-stage breast cancer interested in this shorter course should ask their radiation oncologists about this option to evaluate whether it is suitable for their individual case."

For more information on radiation therapy for breast cancer, visit www.rtanswers.org.

The abstract, "Results using 3-week Accelerated Whole Breast (WB) Radiation Therapy (RT) and Concomitant Boost for Early-stage Node Negative Breast Cancer," will be presented at a scientific session at 11:30 a.m. on Wednesday, November 4. To speak to the lead author of the study, Manjeet Chadha, M.D., please call Beth Bukata or Nicole Napoli November 1-4, 2009, in the ASTRO Press Room at McCormick Place West at 312-791-7005 or 312-791-7006. You may also e-mail them at bethb@astro.org or nicolen@astro.org.

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Updated NCCN Guidelines for Breast Cancer Discourages Prophylactic Mastectomy in Women Other Than Those at High Risk

/PRNewswire/ -- Despite a recent study finding that an increasing number of women who had cancer in one breast are opting to have the other breast removed, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology(TM) for Breast Cancer discourages prophylactic mastectomy in women except for those considered high risk. This recommendation is noted in the recently updated NCCN Guidelines for Breast Cancer along with a new regimen for adjuvant chemotherapy and recommendations for utilizing sentinel node mapping and excision in women with clinically negative lymph nodes.

In the updated NCCN Guidelines, it states that prophylactic mastectomy (the removal of a noncancerous breast) contralateral to a known unilateral breast cancer is not recommended except as outlined in the NCCN Guidelines for Genetics/Familial High-Risk Assessment: Breast and Ovarian and the NCCN Guidelines for Breast Cancer Risk Reduction. When prophylactic mastectomy is being considered, the NCCN Guidelines note that the small benefits must be balanced with the risk of recurrent disease from the known breast cancer, the psychological and social issues associated with bilateral mastectomy, and the overall risks of contralateral mastectomy.

The practice of removing noncancerous breasts to reduce the risk or prevent cancer has become increasingly common among women. A study recently published in the journal Cancer found that among women who had cancer in one breast, the number who opted to have the other breast removed, more than doubled from 1995 through 2005 in New York state. However, there is no data to demonstrate that having prophylactic mastectomy actually improves survival.

The NCCN Guidelines Panel suggests that high-risk women considering a prophylactic mastectomy should be evaluated by a multi-disciplinary team and counseled on the risks of the procedure.

Perhaps the most clinically important update to the NCCN Guideline is the removal of the recommendation for a full axillary lymph node dissection as an option for women with clinically negative lymph nodes. The updated NCCN Guidelines now recommend that women with stage one or two invasive breast cancer with clinically negative lymph nodes, undergo sentinel node mapping and excision provided they are being treated by a team of clinicians with experience in sentinel node biopsy.

Sentinel node biopsy is a diagnostic procedure used to determine whether breast cancer has metastasized to axillary lymph nodes (e.g., lymph nodes under the arm). Sentinel node biopsy requires the removal of only a few lymph nodes compared to a full axillary lymph node dissection, and may decrease the risk of lymphedema and pain associated with surgery.

Another important update to the NCCN Guidelines is the addition of a new regimen for adjuvant chemotherapy for invasive breast cancer. The NCCN Guidelines now include FEC [fluorouracil (Adrucil(R), Pfizer Inc.) / epirubicin (Ellence(R), Pfizer Inc.) / cyclophosphamide (Cytoxan(R), Bristol-Myers Squibb Company)] followed by weekly paclitaxel (Taxol(R), Bristol-Myers Squibb Company) as an option for adjuvant therapy, treatment given after surgery.

Although the incidence of breast cancer has increased steadily in the United States over the past few decades, breast cancer mortality appears to be declining suggesting a benefit from early detection and more effective treatment.

NCCN Clinical Practice Guidelines in Oncology(TM) are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at NCCN.org.

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Piedmont Fayette Hospital offers New Breast MRI Services

Piedmont Fayette Hospital is proud to offer breast magnetic resonance imaging (MRI) services utilizing the Invivo Breast Coil and the Siemens Magnetom Espree MRI scanner. The Magnetom Espree’s extra-large opening means it can comfortably accommodate patients of all sizes and is perfect for those who get anxious or claustrophobic during an MRI or anyone who just likes more space. This enhanced technology means Fayette community members now have access to diagnostic MRI services for breast cancer in addition to regular screening and diagnostic mammograms, and breast ultrasound scanning.

Breast MRI — is an imaging technique that captures multiple cross-sectional pictures of the breast. Breast MRI involves combining the images and using a computer to generate detailed 2-D and 3-D pictures. A breast MRI isn't used routinely for breast cancer screening, but can be performed when your doctor needs more information than a mammogram, ultrasound or clinical breast exam can provide.

“Breast MRI’s should not be considered as a replacement procedure for mammograms,” said Debora Coursey-Prah, M.D., of Piedmont Fayette Hospital’s Women’s Imaging Center and board-certified radiologist. “Mammography is still a very important component of early detection, but the availability of breast MRI’s will allow us to better treat and diagnose patients so they continue to receive the best quality care possible.”

The breast MRI procedure is relatively simple and painless. It is performed through the use of a large magnet, radio waves, and a computer to process the scan information. The images created provide a comprehensive picture of the entire breast, chest wall, and surrounding tissues.

“This is a sophisticated diagnostic procedure, administered by our staff of highly-trained and experienced radiologists and technologists, using state-of-the-art diagnostic imaging equipment,” said Darrell Cutts, president and CEO Piedmont Fayette Hospital. “We are committed to providing access to the best technology we can in order to find breast cancer early and, in turn, treat it successfully.”

The American Cancer Society recommends annual MRI’s for women at high risk due to strong family history, a genetic predisposition or other reasons. As many as 1.6 million women in the U.S. fall into this high-risk category. The guidelines stress that the exams should be done in addition to annual mammograms as well as regular physical exams in the hope of driving down the death toll from the common and widely feared malignancy.

A breast MRI may be recommended if:

You've been diagnosed with breast cancer and your doctor wishes to determine the extent of the cancer.
Your doctor finds a suspicious area on your mammogram.
You or your doctor can feel a mass or other lump in your breast, but it's not detectable on mammogram or ultrasound.
You notice a breast lump or other breast change after surgery or radiation therapy and it's not detectable on mammogram or ultrasound.
Your doctor wants to monitor your opposite breast after you've been newly diagnosed or treated for breast cancer in the other breast.
You have a suspected leak or rupture of a breast implant.
You're at high risk of breast cancer, defined as a lifetime risk of 20 percent to 25 percent or greater.
You have a strong family history of breast cancer or ovarian cancer.
You have very dense breast tissue and your prior breast cancer wasn't detected on mammogram.

Conversation with your physician is the best place to start. For more information on the PFH Women’s Imaging Center and breast cancer services, please call 770-719-6629 or visit http://www.fayettehospital.org/.
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