Most breast cancer surgeons' practices do not follow standards associated with the best quality of care, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center. These standards include consulting with other specialists and providing resources and education to help patients make treatment decisions.
"Despite the mantra for multidisciplinary decision-making and care intake for patients, surgeons in the community are reporting relatively little of that in their practices," says lead study author Steven J. Katz, M.D., M.P.H., professor of internal medicine at the U-M Medical School and professor of health management and policy at the U-M School of Public Health.
Researchers surveyed 318 surgeons who treated breast cancer patients in the Detroit and Los Angeles metropolitan areas. Surgeons were asked about the processes and services available in their practice, including:
* Consulting with medical oncologists, radiation oncologists and plastic surgeons
* Collecting or reviewing biopsy specimens or mammograms
* Offering patient education videos or presentations
* Connecting patients with peers, for example through support groups
The measures were developed by the researchers based on accepted standards in other areas of chronic care. Results of the study appear in the January issue of Medical Care.
About one-quarter to one-third of surgeons reported they had routinely discussed patients' treatment plans with medical or radiation oncologists. Only 13 percent routinely consulted with a plastic surgeon. About one-third of surgeons said their patients typically participate in patient decision support activities, such as viewing a video or Web-based materials or attending peer support programs.
Surgeons who treated mostly breast cancer patients were more likely to report these services, compared to surgeons who saw fewer breast cancer patients. But a program's status with the National Cancer Institute or the American College of Surgeons did not correspond with meeting more of the quality of care measures.
"Either doctors are not convinced these elements matter or there are logistical constraints in terms of building these standards into their practices. What the implications are for patients is unknown. These results suggest patients might find a more integrated practice among surgeons with higher volume. But we don't know whether that matters with regards to patient decision making, quality of life and satisfaction," says Katz, who is also co-director of the socio-behavioral program at the U-M Comprehensive Cancer Center.
Breast cancer statistics: 194,280 Americans will be diagnosed with breast cancer this year and 40,610 will die from the disease, according to the American Cancer Society
Additional authors: Sarah T. Hawley, Ph.D., Jennifer J. Griggs, M.D., M.P.H.; and Reshma Jagsi, M.D., D.Phil.; Christopher R. Friese, R.N., Ph.D.; and Timothy P. Hofer, M.D., M.S.C., all from U-M; Monica Morrow, M.D., Memorial Sloan-Kettering Cancer Center; Ann S. Hamilton, Ph.D., University of Southern California; and John J. Graff, Ph.D., Karmanos Cancer Institute
Funding: National Cancer Institute
Reference: Medical Care, Vol. 48, No. 1, pp. 45-51, January 2010
Source:
Nicole Fawcett
University of Michigan Health System
суббота, 30 апреля 2011 г.
пятница, 29 апреля 2011 г.
Cost Of Noncompliance Revealed By Study Of Adjuvant Endocrine Treatment For Breast Cancer
The largest study in the world of treatments for post menopausal, hormone positive breast cancer has shown that patients who continue to take exemestane or tamoxifen do significantly better than patients who start to take one or other drug (or tamoxifen followed exemestane) but then stop.
Professor Cornelis van de Velde, principal investigator at the central data office for TEAM (tamoxifen exemestane adjuvant multinational) trial told Europe's largest cancer congress, ECCO 15 - ESMO 34 [1], in Berlin on 22 September that differences in compliance between the nine countries involved in the trial shed light on the role that it played in patient outcome.
"In the Dutch/Belgian part of the TEAM trial, more patients were node positive compared to those in other countries (and were therefore at higher risk of recurrences), because the existing Dutch treatment guidelines (which have since been changed) indicated that only 'high risk' patients should receive chemotherapy, endocrine treatment or both. Yet despite this handicap, recurrences of breast cancer in The Netherlands and Belgium were 12% for patients using tamoxifen and 9% of patients using exemestane compared to 8% and 7% internationally. This is probably due to better compliance with treatment in The Netherlands, which was significantly better than in other countries.
"Across the whole study, up to a cut-off point of two years nine months, non-compliance amongst women on tamoxifen was 19.8% and 12.9% for women on exemestane. However, these percentages were considerably lower in the Dutch/Belgian part of the TEAM trial where non-compliance was 14% for tamoxifen and 9% for exemestane Patients who stopped study treatment (tamoxifen or exemestane) had significantly higher chance of a recurrence; the chance was between four and five times higher among this group than among those who continued their treatment. This underlines the need for good information for patients concerning the side-effects of drugs and treatment efficacy," said Prof van de Velde, who is Professor of Surgery at the Leiden University Medical Centre (Leiden, The Netherlands) and President of the European Society of Surgical Oncology. Compliance with medication in the TEAM study was lower than in any previous study of adjuvant aromatase inhibitors.
The TEAM study is a randomised phase III clinical trial comparing the efficacy of the aromatase inhibitor exemestane versus the current "gold standard" treatment tamoxifen as adjuvant endocrine therapies for hormone sensitive early breast cancer in postmenopausal women. After two years nine months a total of 9,779 women had been included in the trial from nine countries: France (1230 patients), Germany (1480), Greece (211), Japan (184), The Netherlands (2753), Belgium (414), UK/Ireland (1275), and the USA (2232).
The trial was started in 2001 but in 2004, based on results from another trial (Intergroup Exemestane Study) that showed a significant survival advantage for patients on exemestane, the TEAM study was changed so that patients receiving tamoxifen were switched to exemestane after having been in the trial for between two and a half to three years. The results presented today relate to data on disease-free survival in patients on the trial for no longer than two years nine months and they focus particularly on issues of compliance in the Dutch/Belgian TEAM patients, as well as on side effects, and disease-free and overall survival across the whole of the study.
Prof van de Velde said: "Adverse side effects were the main reasons why patients discontinued their treatment - about half of all patients who discontinued did so because of side effects. Out of all the patients in the study, 6.3% discontinued tamoxifen and 4.4% discontinued exemestane because of side effects.
Adverse side effects included heart, skin, hormonal, digestive, metabolic, neurological, muscle and skeletal problems. Exemestane was associated with significantly higher rates of arthralgia, carpal tunnel syndrome, diarrhoea and high cholesterol levels, but with significantly lower rates of hot flushes, vaginal bleeding and discharge, and thromboembolism than tamoxifen. Fractures and heart problems were similar between the two groups.
"The safety profile has been better for exemestane than for tamoxifen and I think this is a contributory factor to the lower discontinuation rates amongst the patients on exemestane," said Prof van de Velde.
After two and three-quarter years of follow-up, among the women on exemestane there were 11% fewer cases of a local recurrence of the tumour, distant metastases, breast cancer in the other breast (contralateral breast cancer) and deaths occurring without a relapse of the disease, than among the women on tamoxifen (352 in the exemestane patients and 388 in the tamoxifen patients). There were no differences between the two groups for time to contralateral breast cancer or overall survival, and no unexpected safety issues were reported. Patients aged 70 or over and women with breast cancer that had spread to only one to three lymph nodes had a significantly better disease-free survival on exemestane than on tamoxifen.
"The current analysis covers a short period of time with relatively few deaths occurring and this makes it difficult to see significant differences between the two groups. However, the data from TEAM indicate that early use of exemestane in these high risk patients appears to be safe and a more effective endocrine treatment than tamoxifen for reducing breast cancer recurrence," said Prof van de Velde. "The study is continuing and the next end point has already been reached, so that we now have enough events to conclude whether starting with tamoxifen and switching to exemestane is better or worse than starting with exemestane. These results will be presented at the San Antonio breast cancer symposium in December."
Source:
Emma Mason
ECCO-the European CanCer Organisation
Professor Cornelis van de Velde, principal investigator at the central data office for TEAM (tamoxifen exemestane adjuvant multinational) trial told Europe's largest cancer congress, ECCO 15 - ESMO 34 [1], in Berlin on 22 September that differences in compliance between the nine countries involved in the trial shed light on the role that it played in patient outcome.
"In the Dutch/Belgian part of the TEAM trial, more patients were node positive compared to those in other countries (and were therefore at higher risk of recurrences), because the existing Dutch treatment guidelines (which have since been changed) indicated that only 'high risk' patients should receive chemotherapy, endocrine treatment or both. Yet despite this handicap, recurrences of breast cancer in The Netherlands and Belgium were 12% for patients using tamoxifen and 9% of patients using exemestane compared to 8% and 7% internationally. This is probably due to better compliance with treatment in The Netherlands, which was significantly better than in other countries.
"Across the whole study, up to a cut-off point of two years nine months, non-compliance amongst women on tamoxifen was 19.8% and 12.9% for women on exemestane. However, these percentages were considerably lower in the Dutch/Belgian part of the TEAM trial where non-compliance was 14% for tamoxifen and 9% for exemestane Patients who stopped study treatment (tamoxifen or exemestane) had significantly higher chance of a recurrence; the chance was between four and five times higher among this group than among those who continued their treatment. This underlines the need for good information for patients concerning the side-effects of drugs and treatment efficacy," said Prof van de Velde, who is Professor of Surgery at the Leiden University Medical Centre (Leiden, The Netherlands) and President of the European Society of Surgical Oncology. Compliance with medication in the TEAM study was lower than in any previous study of adjuvant aromatase inhibitors.
The TEAM study is a randomised phase III clinical trial comparing the efficacy of the aromatase inhibitor exemestane versus the current "gold standard" treatment tamoxifen as adjuvant endocrine therapies for hormone sensitive early breast cancer in postmenopausal women. After two years nine months a total of 9,779 women had been included in the trial from nine countries: France (1230 patients), Germany (1480), Greece (211), Japan (184), The Netherlands (2753), Belgium (414), UK/Ireland (1275), and the USA (2232).
The trial was started in 2001 but in 2004, based on results from another trial (Intergroup Exemestane Study) that showed a significant survival advantage for patients on exemestane, the TEAM study was changed so that patients receiving tamoxifen were switched to exemestane after having been in the trial for between two and a half to three years. The results presented today relate to data on disease-free survival in patients on the trial for no longer than two years nine months and they focus particularly on issues of compliance in the Dutch/Belgian TEAM patients, as well as on side effects, and disease-free and overall survival across the whole of the study.
Prof van de Velde said: "Adverse side effects were the main reasons why patients discontinued their treatment - about half of all patients who discontinued did so because of side effects. Out of all the patients in the study, 6.3% discontinued tamoxifen and 4.4% discontinued exemestane because of side effects.
Adverse side effects included heart, skin, hormonal, digestive, metabolic, neurological, muscle and skeletal problems. Exemestane was associated with significantly higher rates of arthralgia, carpal tunnel syndrome, diarrhoea and high cholesterol levels, but with significantly lower rates of hot flushes, vaginal bleeding and discharge, and thromboembolism than tamoxifen. Fractures and heart problems were similar between the two groups.
"The safety profile has been better for exemestane than for tamoxifen and I think this is a contributory factor to the lower discontinuation rates amongst the patients on exemestane," said Prof van de Velde.
After two and three-quarter years of follow-up, among the women on exemestane there were 11% fewer cases of a local recurrence of the tumour, distant metastases, breast cancer in the other breast (contralateral breast cancer) and deaths occurring without a relapse of the disease, than among the women on tamoxifen (352 in the exemestane patients and 388 in the tamoxifen patients). There were no differences between the two groups for time to contralateral breast cancer or overall survival, and no unexpected safety issues were reported. Patients aged 70 or over and women with breast cancer that had spread to only one to three lymph nodes had a significantly better disease-free survival on exemestane than on tamoxifen.
"The current analysis covers a short period of time with relatively few deaths occurring and this makes it difficult to see significant differences between the two groups. However, the data from TEAM indicate that early use of exemestane in these high risk patients appears to be safe and a more effective endocrine treatment than tamoxifen for reducing breast cancer recurrence," said Prof van de Velde. "The study is continuing and the next end point has already been reached, so that we now have enough events to conclude whether starting with tamoxifen and switching to exemestane is better or worse than starting with exemestane. These results will be presented at the San Antonio breast cancer symposium in December."
Source:
Emma Mason
ECCO-the European CanCer Organisation
четверг, 28 апреля 2011 г.
Increased EGFR Levels May Be An Early Marker Of Breast Cancer
Levels of epidermal growth factor receptor (EGFR) may be elevated in the blood of women within 17 months prior to their breast cancer diagnosis, according to findings presented at the American Association for Cancer Research 101st Annual Meeting 2010, held here April 17 - 21.
The goal of the study led by Christopher Li, M.D., Ph.D., an associate member of the Epidemiology Program at the Fred Hutchinson Cancer Research Center, Seattle, was to discover and validate blood markers that could potentially be used for the early detection of breast cancer.
The study was conducted on 420 estrogen receptor-positive breast cancer patients whose blood was drawn within 17 months prior to their cancer diagnosis. The researchers validated promising markers in a similar, but completely independent set of 198 cases and controls from the Women's Health Initiative database.
One of the promising markers that was discovered and could be validated was EGFR.
EGFR levels were significantly elevated among cases compared to controls. Overall, those with the highest levels had a 2.9-fold increased risk of developing breast cancer compared to those with the lowest level.
When EGFR levels were evaluated among current users of estrogen plus progestin hormone therapy, a much larger ninefold increased risk of developing breast cancer was observed. As a single marker among current estrogen plus progestin users, EGFR had a specificity, the rate of true negative tests, of 90 percent and a sensitivity, the rate of true positive tests, of 31 percent as a breast cancer marker.
"While our results require confirmation and EGFR's performance is insufficient for it to be used as a single marker, this study is unique in that no prior studies have validated a single breast cancer early detection biomarker specimen to the degree we have here," said Li. "Our results suggest that there may indeed be detectable changes of proteins in blood within two years of making a clinical breast cancer diagnosis. Identification of these proteins could have a major impact on our ability to detect breast cancer early, when it is most treatable."
EGFR is part of the HER2 family, which has been shown to be quite important in breast cancer. Specifically, increased EGFR activity can increase the uncontrolled growth of cancer cells and EGFR is elevated in 20 percent to 81 percent of all human breast cancers. Several therapies targeting members of the HER2 family, including EGFR, have already been approved for cancer treatment.
"While our results require confirmation and EGFR's performance is insufficient for it to be used as a single marker, this study is unique in that no prior studies have validated a single breast cancer early detection biomarker specimen to the degree we have here," said Li. "Our results suggest that there may indeed be detectable changes of proteins in blood within two years of making a clinical breast cancer diagnosis. Identification of these proteins could have a major impact on our ability to detect breast cancer early, when it is most treatable."
EGFR is part of the HER2 family, which has been shown to be quite important in breast cancer. Specifically, increased EGFR activity can increase the uncontrolled growth of cancer cells and EGFR is elevated in 20 percent to 81 percent of all human breast cancers. Several therapies targeting members of the HER2 family, including EGFR, have already been approved for cancer treatment.
The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes 31,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.
Source: American Association for Cancer Research (AACR)
The goal of the study led by Christopher Li, M.D., Ph.D., an associate member of the Epidemiology Program at the Fred Hutchinson Cancer Research Center, Seattle, was to discover and validate blood markers that could potentially be used for the early detection of breast cancer.
The study was conducted on 420 estrogen receptor-positive breast cancer patients whose blood was drawn within 17 months prior to their cancer diagnosis. The researchers validated promising markers in a similar, but completely independent set of 198 cases and controls from the Women's Health Initiative database.
One of the promising markers that was discovered and could be validated was EGFR.
EGFR levels were significantly elevated among cases compared to controls. Overall, those with the highest levels had a 2.9-fold increased risk of developing breast cancer compared to those with the lowest level.
When EGFR levels were evaluated among current users of estrogen plus progestin hormone therapy, a much larger ninefold increased risk of developing breast cancer was observed. As a single marker among current estrogen plus progestin users, EGFR had a specificity, the rate of true negative tests, of 90 percent and a sensitivity, the rate of true positive tests, of 31 percent as a breast cancer marker.
"While our results require confirmation and EGFR's performance is insufficient for it to be used as a single marker, this study is unique in that no prior studies have validated a single breast cancer early detection biomarker specimen to the degree we have here," said Li. "Our results suggest that there may indeed be detectable changes of proteins in blood within two years of making a clinical breast cancer diagnosis. Identification of these proteins could have a major impact on our ability to detect breast cancer early, when it is most treatable."
EGFR is part of the HER2 family, which has been shown to be quite important in breast cancer. Specifically, increased EGFR activity can increase the uncontrolled growth of cancer cells and EGFR is elevated in 20 percent to 81 percent of all human breast cancers. Several therapies targeting members of the HER2 family, including EGFR, have already been approved for cancer treatment.
"While our results require confirmation and EGFR's performance is insufficient for it to be used as a single marker, this study is unique in that no prior studies have validated a single breast cancer early detection biomarker specimen to the degree we have here," said Li. "Our results suggest that there may indeed be detectable changes of proteins in blood within two years of making a clinical breast cancer diagnosis. Identification of these proteins could have a major impact on our ability to detect breast cancer early, when it is most treatable."
EGFR is part of the HER2 family, which has been shown to be quite important in breast cancer. Specifically, increased EGFR activity can increase the uncontrolled growth of cancer cells and EGFR is elevated in 20 percent to 81 percent of all human breast cancers. Several therapies targeting members of the HER2 family, including EGFR, have already been approved for cancer treatment.
The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes 31,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.
Source: American Association for Cancer Research (AACR)
среда, 27 апреля 2011 г.
Surgery May Induce Angiogenesis in Dormant Breast Cancer
Analysis of breast cancer relapse patterns from two independent databases suggests that surgery initiates angiogenesis (new blood supply) in dormant distant micrometastases in approximately 20% of cases for premenopausal node-positive patients.
The study published online by the INTERNATIONAL JOURNAL OF SURGERY may help to explain the mammography paradox for women aged 40 - 49: a counterintuitive temporary excess in mortality for the screened population compared to controls. Calculations predict that surgery-induced angiogenesis would accelerate disease by a median of two years and produce 0.11 early deaths per 1000 screened young women in the third year of screening. The predicted timing as well as the magnitude of excess mortality agree with trial data and relapse patterns.
Dr Michael Retsky, lead author of the study comments: "Cancer outgrowth after surgery has been observed for over 100 years, and the mechanisms have not been fully identified. As we show in this paper, biology may be the underlying cause rather than something going wrong during surgery. Our results suggest most young women benefit from early detection of breast cancer, but a small percentage will relapse and die early of metastatic disease. The paper suggests remedial steps that might prevent the sudden growth from occurring. The results of this study could also be considered when designing treatment protocols for young women with positive nodes, since it may not be a coincidence that adjuvant chemotherapy works best for those patients. Importantly, young women need to be advised of the risk of accelerated tumor growth and early relapse before giving informed consent for mammography." Coauthors include Dr. Romano Demicheli and Dr. William Hrushesky.
International Journal of Surgery
You can read its full text at journal-surgery
The study published online by the INTERNATIONAL JOURNAL OF SURGERY may help to explain the mammography paradox for women aged 40 - 49: a counterintuitive temporary excess in mortality for the screened population compared to controls. Calculations predict that surgery-induced angiogenesis would accelerate disease by a median of two years and produce 0.11 early deaths per 1000 screened young women in the third year of screening. The predicted timing as well as the magnitude of excess mortality agree with trial data and relapse patterns.
Dr Michael Retsky, lead author of the study comments: "Cancer outgrowth after surgery has been observed for over 100 years, and the mechanisms have not been fully identified. As we show in this paper, biology may be the underlying cause rather than something going wrong during surgery. Our results suggest most young women benefit from early detection of breast cancer, but a small percentage will relapse and die early of metastatic disease. The paper suggests remedial steps that might prevent the sudden growth from occurring. The results of this study could also be considered when designing treatment protocols for young women with positive nodes, since it may not be a coincidence that adjuvant chemotherapy works best for those patients. Importantly, young women need to be advised of the risk of accelerated tumor growth and early relapse before giving informed consent for mammography." Coauthors include Dr. Romano Demicheli and Dr. William Hrushesky.
International Journal of Surgery
You can read its full text at journal-surgery
вторник, 26 апреля 2011 г.
Newly Available Guidelines Promise Better Results In Breast Cancer Care
International guidelines for the detection, care and management of breast cancer are now available in Spanish thanks to a partnership between the Pan American Health Organization (PAHO) and the Breast Health Global Initiative (BHGI).
The Guidelines for International Breast Health and Cancer Control, published in English in an updated form last year, are intended to help policymakers and health care providers in low- and middle-income countries improve breast cancer outcomes through evidence-based, economically feasible, and culturally appropriate practices. The guidelines address a full range of issues including early detection and access to care, diagnosis and pathology, treatment and resource allocation, and health care systems and public policy.
Breast cancer is newly diagnosed in more than 1 million women each year and is the most common cause of cancer-related deaths among women worldwide. Women in low- and middle-income countries are more likely to die of the disease than those in richer countries, in part because their cancers are commonly detected and treated in advanced stages, when treatment is more expensive and least successful.
"Breast cancer is a growing problem in Latin America, with some 90,000 cases reported every year, many of them at advanced stages because of poor access to preventive and curative services," said PAHO Director Dr. Mirta Roses. "The availability of these guidelines in Spanish will be an important contribution for those interested in expanding health services to reach Latin American women early and to improve their quality of life."
Major scientific advances in detection and management of breast cancer have improved outcomes in developed countries, but health care providers in lower income countries face resource constraints that limit their ability to apply these advances to improve breast cancer care. The Guidelines for International Breast Health and Cancer Control address this problem by recommending the most appropriate and applicable "best practices" for countries with limited resources.
The guidelines recommend a stepwise, tiered system of resource allocation on four levels-basic, limited, enhanced and maximal-depending on the availability of resources. In the areas of detection and access to care, for example, they recommend that countries with very basic health systems educate women about performing breast self-examination to detect lumps. For countries with more but still limited resources, they recommend targeted outreach and education on clinical breast examination to women in at-risk groups, followed by ultrasound or mammography to confirm the discovery of suspected lumps.
In the area of detection and diagnostics, the guidelines recommend both ultrasound and mammography as cost-effective. However, ultrasound, which can be used to diagnose other conditions, may be implemented before mammography if resources do not allow for both.
In terms of treatment, breast-conserving procedures require more health care resources and infrastructure than mastectomy but can be provided in a carefully designed limited-resource setting. Systemic treatments are critical for improved survival, the guidelines note. The selection of appropriate hormonal treatments for individual patients requires estrogen receptor testing. Chemotherapy requires adequate resources and infrastructure and should be used to treat node-positive locally advanced breast cancers, the most common clinical presentation of the disease in low-resource countries. If chemotherapy is not available, patients with locally advanced, hormone receptor - negative cancers can only receive palliative care.
The guidelines call for additional research to assess how these recommendations can be best implemented in limited-resource settings.
Translation of the Guidelines for International Breast Health and Cancer Control into the world's major languages is a long-standing goal of BHGI, and future plans include translation into Russian, Chinese, and Arabic. The partnership with PAHO to produce a Spanish translation grew out of discussions at the International Union Against Cancer Conference in Washington in July 2006.
"The availability of these guidelines in Spanish is a major leap forward in reaching ministries of health, health care providers, and policymakers in Spanish-speaking countries," said Dr. Benjamin O. Anderson, chairman and director of BHGI. "With this and future translations, we hope to lessen the global burden of this devastating disease."
The Spanish version of Guidelines for International Breast Health and Cancer Control (Normas internacionales para la salud de mama y el control del cГЎncer de mama) may be downloaded in Spanish through the websites of PAHO and BHGI.
The Breast Health Global Initiative, an extensive international alliance of organizations and individuals around the world devoted to medically underserved women, is sponsored by the Fred Hutchinson Cancer Research Center and Susan G. Komen for the Cure.
The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It serves as the Regional Office of the World Health Organization (WHO).
paho
The Guidelines for International Breast Health and Cancer Control, published in English in an updated form last year, are intended to help policymakers and health care providers in low- and middle-income countries improve breast cancer outcomes through evidence-based, economically feasible, and culturally appropriate practices. The guidelines address a full range of issues including early detection and access to care, diagnosis and pathology, treatment and resource allocation, and health care systems and public policy.
Breast cancer is newly diagnosed in more than 1 million women each year and is the most common cause of cancer-related deaths among women worldwide. Women in low- and middle-income countries are more likely to die of the disease than those in richer countries, in part because their cancers are commonly detected and treated in advanced stages, when treatment is more expensive and least successful.
"Breast cancer is a growing problem in Latin America, with some 90,000 cases reported every year, many of them at advanced stages because of poor access to preventive and curative services," said PAHO Director Dr. Mirta Roses. "The availability of these guidelines in Spanish will be an important contribution for those interested in expanding health services to reach Latin American women early and to improve their quality of life."
Major scientific advances in detection and management of breast cancer have improved outcomes in developed countries, but health care providers in lower income countries face resource constraints that limit their ability to apply these advances to improve breast cancer care. The Guidelines for International Breast Health and Cancer Control address this problem by recommending the most appropriate and applicable "best practices" for countries with limited resources.
The guidelines recommend a stepwise, tiered system of resource allocation on four levels-basic, limited, enhanced and maximal-depending on the availability of resources. In the areas of detection and access to care, for example, they recommend that countries with very basic health systems educate women about performing breast self-examination to detect lumps. For countries with more but still limited resources, they recommend targeted outreach and education on clinical breast examination to women in at-risk groups, followed by ultrasound or mammography to confirm the discovery of suspected lumps.
In the area of detection and diagnostics, the guidelines recommend both ultrasound and mammography as cost-effective. However, ultrasound, which can be used to diagnose other conditions, may be implemented before mammography if resources do not allow for both.
In terms of treatment, breast-conserving procedures require more health care resources and infrastructure than mastectomy but can be provided in a carefully designed limited-resource setting. Systemic treatments are critical for improved survival, the guidelines note. The selection of appropriate hormonal treatments for individual patients requires estrogen receptor testing. Chemotherapy requires adequate resources and infrastructure and should be used to treat node-positive locally advanced breast cancers, the most common clinical presentation of the disease in low-resource countries. If chemotherapy is not available, patients with locally advanced, hormone receptor - negative cancers can only receive palliative care.
The guidelines call for additional research to assess how these recommendations can be best implemented in limited-resource settings.
Translation of the Guidelines for International Breast Health and Cancer Control into the world's major languages is a long-standing goal of BHGI, and future plans include translation into Russian, Chinese, and Arabic. The partnership with PAHO to produce a Spanish translation grew out of discussions at the International Union Against Cancer Conference in Washington in July 2006.
"The availability of these guidelines in Spanish is a major leap forward in reaching ministries of health, health care providers, and policymakers in Spanish-speaking countries," said Dr. Benjamin O. Anderson, chairman and director of BHGI. "With this and future translations, we hope to lessen the global burden of this devastating disease."
The Spanish version of Guidelines for International Breast Health and Cancer Control (Normas internacionales para la salud de mama y el control del cГЎncer de mama) may be downloaded in Spanish through the websites of PAHO and BHGI.
The Breast Health Global Initiative, an extensive international alliance of organizations and individuals around the world devoted to medically underserved women, is sponsored by the Fred Hutchinson Cancer Research Center and Susan G. Komen for the Cure.
The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It serves as the Regional Office of the World Health Organization (WHO).
paho
понедельник, 25 апреля 2011 г.
Researchers Find Two Biomarkers With Potential To Predict Breast Cancer Spread
Expression of two different proteins taken from primary tumor biopsies is highly associated with spread of breast cancer to nearby lymph nodes, according to researchers who say this protein profile could help identify at an early stage those patients whose disease is likely to metastasize.
In the December 15 issue of Cancer Research, the researchers say over-expression of one unidentified protein and under-expression of another is 88 percent accurate in identifying breast cancer that has spread in a group of 65 patients, compared to an analysis of lymph nodes and outcomes.
If the predictive and diagnostic power of these proteins is validated, they could be analyzed in primary tumor biopsies that are routinely collected at the time of diagnosis, saving some women from extensive and possibly unnecessary treatment as well as from undergoing a second surgery to collect lymph nodes for analysis, the researchers say.
“We want to be able to predict, at the earliest stages, if a tumor has spread and how dangerous it will be,” said the study’s lead author, Dave S. B. Hoon, Ph.D., director of Molecular Oncology at the John Wayne Cancer Institute, Saint Johns Health Center, in Santa Monica, California. “These two proteins may allow us to target aggressive tumors with more extensive therapy management to some women, while sparing others from needless treatment.”
“Our approach is not to rely on hunting for lymph nodes during surgery, which will then only tell you whether the nodes are positive or negative, but to look at the primary tumor to predict how aggressive the cancer is at early stages,” Hoon said.
The lymph system collects the fluid that surrounds tissue cells, which is then processed by nearby draining lymph nodes, so checking these nodes for the presence of cancer is currently one of the most important prognostic factors predicting breast cancer survival, he said. “One of the best predictors of systemic cancer spread is whether the draining lymph node has any signs of metastasis,” he said.
Biopsy of this “sentinel” node occurs after the tumor has been removed in an initial surgery, and if metastasis is found there, surgeons continue to sample “downstream” nodes to check for degree of spread. While this procedure, called “sentinel node biopsy” is now practiced routinely in the U.S. and in many other countries, there remains controversy in the accurate assessment of micrometastasis in sentinel lymph nodes, according to Hoon. He said recent studies have found that it can produce both false positive and false negative results.
Furthermore, microdisease seen in the sentinel lymph node doesn’t always predict that a patient will go on to develop metastatic breast cancer, said Hoon. “If the primary tumor and nodes are removed in some women, they will not develop recurrent disease, but in other women, removal of the nodes may have no impact on the spread of the metastatic disease that has already occurred prior to surgery.”
In this study, 65 patients with invasive cancer who underwent surgery and biopsy of the sentinel lymph node and/or other lymph nodes were enrolled, and investigators were blinded as to the findings of these lymph node biopsies.
In all, 24 patients (37 percent) were found to have cancer in their nodes and 41 patients (63 percent) were node negative. To predict lymph node metastasis, the investigators used a ProteinChip™ to identify biomarkers that distinguished between the tumor profile with paired positive and negative nodes.
Two protein peaks associated with lymph node metastasis were identified. Specifically, over-expression of protein peaks at 4,871 Da (which represents the molecular weight of the protein) and under-expression of a protein peak at 8,596 Da were highly predictive of lymph node metastasis.
Patients with two or more positive lymph nodes were significantly more likely to show over-production of 4,871 Da, compared to patients with no lymph node spread. The peak at 4,871 could also predict patients with four or more metastatic nodes who have significantly worse outcomes.
Although they don’t know what these proteins are, by searching a protein database Hoon suggests that 4,871 Da may represent thymosin beta-10, a peptide that has already been associated with out-of-control growth and cell differentiation, and that 8,596 Da could represent an ubiquitin protein associated with a good prognosis in node-negative breast cancer.
“Protein peaks found in our study may be useful as prognostic biomarkers, but we must be cautious until the identities of these proteins are known and validated in a larger study,” Hoon said.
The study was funded by the California Breast Cancer Research Program of the University of California, the Avon Foundation, and the Leslie and Susan Gonda Foundation. Investigators from Saint John’sHealth Center, Joyce Eisenberg Breast Center, in Santa Monica also contributed to the study.
The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 24,000 basic, translational, and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 70 other countries. AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special Conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment, and patient care. AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. Its most recent publication, CR, is a magazine for cancer survivors, patient advocates, their families, physicians, and scientists. It provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship, and advocacy.
Contact:
Staci Vernick Goldberg
AACR
For further information please visit:
The American Association for Cancer Research
In the December 15 issue of Cancer Research, the researchers say over-expression of one unidentified protein and under-expression of another is 88 percent accurate in identifying breast cancer that has spread in a group of 65 patients, compared to an analysis of lymph nodes and outcomes.
If the predictive and diagnostic power of these proteins is validated, they could be analyzed in primary tumor biopsies that are routinely collected at the time of diagnosis, saving some women from extensive and possibly unnecessary treatment as well as from undergoing a second surgery to collect lymph nodes for analysis, the researchers say.
“We want to be able to predict, at the earliest stages, if a tumor has spread and how dangerous it will be,” said the study’s lead author, Dave S. B. Hoon, Ph.D., director of Molecular Oncology at the John Wayne Cancer Institute, Saint Johns Health Center, in Santa Monica, California. “These two proteins may allow us to target aggressive tumors with more extensive therapy management to some women, while sparing others from needless treatment.”
“Our approach is not to rely on hunting for lymph nodes during surgery, which will then only tell you whether the nodes are positive or negative, but to look at the primary tumor to predict how aggressive the cancer is at early stages,” Hoon said.
The lymph system collects the fluid that surrounds tissue cells, which is then processed by nearby draining lymph nodes, so checking these nodes for the presence of cancer is currently one of the most important prognostic factors predicting breast cancer survival, he said. “One of the best predictors of systemic cancer spread is whether the draining lymph node has any signs of metastasis,” he said.
Biopsy of this “sentinel” node occurs after the tumor has been removed in an initial surgery, and if metastasis is found there, surgeons continue to sample “downstream” nodes to check for degree of spread. While this procedure, called “sentinel node biopsy” is now practiced routinely in the U.S. and in many other countries, there remains controversy in the accurate assessment of micrometastasis in sentinel lymph nodes, according to Hoon. He said recent studies have found that it can produce both false positive and false negative results.
Furthermore, microdisease seen in the sentinel lymph node doesn’t always predict that a patient will go on to develop metastatic breast cancer, said Hoon. “If the primary tumor and nodes are removed in some women, they will not develop recurrent disease, but in other women, removal of the nodes may have no impact on the spread of the metastatic disease that has already occurred prior to surgery.”
In this study, 65 patients with invasive cancer who underwent surgery and biopsy of the sentinel lymph node and/or other lymph nodes were enrolled, and investigators were blinded as to the findings of these lymph node biopsies.
In all, 24 patients (37 percent) were found to have cancer in their nodes and 41 patients (63 percent) were node negative. To predict lymph node metastasis, the investigators used a ProteinChip™ to identify biomarkers that distinguished between the tumor profile with paired positive and negative nodes.
Two protein peaks associated with lymph node metastasis were identified. Specifically, over-expression of protein peaks at 4,871 Da (which represents the molecular weight of the protein) and under-expression of a protein peak at 8,596 Da were highly predictive of lymph node metastasis.
Patients with two or more positive lymph nodes were significantly more likely to show over-production of 4,871 Da, compared to patients with no lymph node spread. The peak at 4,871 could also predict patients with four or more metastatic nodes who have significantly worse outcomes.
Although they don’t know what these proteins are, by searching a protein database Hoon suggests that 4,871 Da may represent thymosin beta-10, a peptide that has already been associated with out-of-control growth and cell differentiation, and that 8,596 Da could represent an ubiquitin protein associated with a good prognosis in node-negative breast cancer.
“Protein peaks found in our study may be useful as prognostic biomarkers, but we must be cautious until the identities of these proteins are known and validated in a larger study,” Hoon said.
The study was funded by the California Breast Cancer Research Program of the University of California, the Avon Foundation, and the Leslie and Susan Gonda Foundation. Investigators from Saint John’sHealth Center, Joyce Eisenberg Breast Center, in Santa Monica also contributed to the study.
The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 24,000 basic, translational, and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 70 other countries. AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special Conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment, and patient care. AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. Its most recent publication, CR, is a magazine for cancer survivors, patient advocates, their families, physicians, and scientists. It provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship, and advocacy.
Contact:
Staci Vernick Goldberg
AACR
For further information please visit:
The American Association for Cancer Research
воскресенье, 24 апреля 2011 г.
Breast cancer patients benefit from decompression chambers used for divers
Decompression chambers, used to treat deep-sea divers with the bends, may hold the key to relieving painful side effects
of breast cancer treatment.
Breathing pure oxygen in a decompression chamber could help women who have been left with lymphoedema - a painful and
irreversible condition characterised by a severely swollen arm following radiotherapy.
Scientists funded by Cancer Research UK are now launching a trial to test this new treatment after a pilot study, led by the
Royal Marsden Hospital and The Institute of Cancer Research, found it could reduce swelling permanently in many cases.
The treatment, called hyperbaric oxygen therapy (HBO), will be available in Hull, Plymouth, Gosport and Leytonstone.
Leading the trial is Professor Yarnold, Professor of Clinical Oncology at the Institute of Cancer Research and Consultant at
the Royal Marsden.
Prof Yarnold says: "Radiotherapy following breast cancer surgery can damage the lymphatic system, meaning that fluid fails to
drain properly and builds up in the arm causing swelling.
"Some women might have slight swelling that doesn't cause much of a problem. Others can suffer serious swelling, pain and
discomfort. We hope to show that HBO treatment can succeed in reducing this swelling."
Two thirds of volunteers recruited to the trial will receive 90 minutes of HBO therapy, five days a week for six weeks. They
will wear a large transparent dome over the head that supplies pure oxygen through tubes. They can read or talk normally at
all times. The remaining third of volunteers will receive standard care for lymphoedema including bandaging, exercise and
massage.
Barbara Pearce, age 62 from London, took part in the pilot study and says it changed her life.
"I had breast cancer 25 years ago and had surgery and radiotherapy. I felt so angry when later I developed lymphoedema - one
arm weighed a stone more than the other one. It was both distressing and disabling.
"The hyperbaric oxygen therapy was a life-changing experience. My 'swollen' arm is now about a third the size it was, I can
wear fitted jackets and sleeveless dresses for the first time in 20 years. It has raised my self-esteem and I have entered my
60s feeling more confident than I have felt for a long time. The treatment took nearly two hours a day for six weeks but it
was worth every minute. I could chat and read and didn't feel at all claustrophobic."
Professor Robert Souhami, Director of Policy and Communication at Cancer Research UK, which is funding the study says,
"Current therapies for lymphoedema aim to control the symptoms rather than treating the cause. There are encouraging signs
that hyperbaric oxygen therapy might be an effective treatment and this trial will provide stronger evidence."
Women wishing to check if they are eligible for the study should contact Mrs Lone Gothard, Research Coordinator on 020 8661
3460 or visit the cancer trials database on Cancer Research UK's patient information website at cancerhelp.uk.
--- This study is looking to recruit 63 volunteers to take part from April 2005
--- Volunteers should live within easy reach of one of the 5 participating centres
- Royal Marsden Hospital, Sutton, Surrey
- Hyperbaric Unit, BUPA hospital Hull & East Riding, Anlaby, Hull
- Diving Diseases Research Centre, Plymouth
- Hyperbaric Medicine Unit, Royal Hospital Haslar, Gosport
- London Hyperbaric, Whipps Cross University Hospital, Leytonstone
--- Women may be eligible if they have had surgery for breast cancer had radiotherapy to the breast and arm pit at least 2
years ago have no signs of cancer now
--- The trial is funded jointly by Cancer Research UK and the Department of Health
--- For enquiries about the trial, please contact Lucy Twitchin or Susan Massey at the Royal Marsden Hospital on 020 7808
2383/2605.
SOURCE: Cancer
Research UK
of breast cancer treatment.
Breathing pure oxygen in a decompression chamber could help women who have been left with lymphoedema - a painful and
irreversible condition characterised by a severely swollen arm following radiotherapy.
Scientists funded by Cancer Research UK are now launching a trial to test this new treatment after a pilot study, led by the
Royal Marsden Hospital and The Institute of Cancer Research, found it could reduce swelling permanently in many cases.
The treatment, called hyperbaric oxygen therapy (HBO), will be available in Hull, Plymouth, Gosport and Leytonstone.
Leading the trial is Professor Yarnold, Professor of Clinical Oncology at the Institute of Cancer Research and Consultant at
the Royal Marsden.
Prof Yarnold says: "Radiotherapy following breast cancer surgery can damage the lymphatic system, meaning that fluid fails to
drain properly and builds up in the arm causing swelling.
"Some women might have slight swelling that doesn't cause much of a problem. Others can suffer serious swelling, pain and
discomfort. We hope to show that HBO treatment can succeed in reducing this swelling."
Two thirds of volunteers recruited to the trial will receive 90 minutes of HBO therapy, five days a week for six weeks. They
will wear a large transparent dome over the head that supplies pure oxygen through tubes. They can read or talk normally at
all times. The remaining third of volunteers will receive standard care for lymphoedema including bandaging, exercise and
massage.
Barbara Pearce, age 62 from London, took part in the pilot study and says it changed her life.
"I had breast cancer 25 years ago and had surgery and radiotherapy. I felt so angry when later I developed lymphoedema - one
arm weighed a stone more than the other one. It was both distressing and disabling.
"The hyperbaric oxygen therapy was a life-changing experience. My 'swollen' arm is now about a third the size it was, I can
wear fitted jackets and sleeveless dresses for the first time in 20 years. It has raised my self-esteem and I have entered my
60s feeling more confident than I have felt for a long time. The treatment took nearly two hours a day for six weeks but it
was worth every minute. I could chat and read and didn't feel at all claustrophobic."
Professor Robert Souhami, Director of Policy and Communication at Cancer Research UK, which is funding the study says,
"Current therapies for lymphoedema aim to control the symptoms rather than treating the cause. There are encouraging signs
that hyperbaric oxygen therapy might be an effective treatment and this trial will provide stronger evidence."
Women wishing to check if they are eligible for the study should contact Mrs Lone Gothard, Research Coordinator on 020 8661
3460 or visit the cancer trials database on Cancer Research UK's patient information website at cancerhelp.uk.
--- This study is looking to recruit 63 volunteers to take part from April 2005
--- Volunteers should live within easy reach of one of the 5 participating centres
- Royal Marsden Hospital, Sutton, Surrey
- Hyperbaric Unit, BUPA hospital Hull & East Riding, Anlaby, Hull
- Diving Diseases Research Centre, Plymouth
- Hyperbaric Medicine Unit, Royal Hospital Haslar, Gosport
- London Hyperbaric, Whipps Cross University Hospital, Leytonstone
--- Women may be eligible if they have had surgery for breast cancer had radiotherapy to the breast and arm pit at least 2
years ago have no signs of cancer now
--- The trial is funded jointly by Cancer Research UK and the Department of Health
--- For enquiries about the trial, please contact Lucy Twitchin or Susan Massey at the Royal Marsden Hospital on 020 7808
2383/2605.
SOURCE: Cancer
Research UK
Researchers Identify New Genetic Marker For Breast Cancer
An international group of investigators led by scientists at Memorial Sloan-Kettering Cancer Center (MSKCC) and the National Cancer Institute has identified a new genetic marker of risk for breast cancer. Women with this DNA variation are at a 1.4 times greater risk of developing breast cancer compared to those without the variation. The findings are to be published online on March 3, 2008 in the journal Proceedings of the National Academy of Sciences.
"These results are exciting because they point us to new molecular pathways that may be associated with breast cancer," said the head of the research team and the study's senior author, Kenneth Offit, MD, MPH, Chief of the Clinical Genetics Service at MSKCC.
The study used a methodology called genome-wide association mapping, which looks at genetic variations across the entire genome that alter the individual building blocks of DNA makeup. These alterations may occur more frequently in individuals who have certain types of disease than in carriers without such disease. In this study, a new gene locus, a specific place on a chromosome where a gene is located, was associated with breast cancer risk. That gene locus is on the long arm of chromosome 6.
"These research findings are of great interest because of the method of genome- wide association used to discover this new locus as well as others in recent months," said Bert Gold, PhD, a Staff Scientist at the National Cancer Institute in Frederick, MD., and first author of the current study.
While the risk associated with this genetic marker is much lower than that of BRCA genetic mutations for example, this discovery will increase the understanding of the genetic variants that contribute to breast cancer.
Researchers used samples largely from MSKCC, but also from other sites in the US, Canada, and Israel. Participants were all of Ashkenazi (Eastern European Jewish) ancestry. The study used a three-phase design centered on 249 families with multiple cases of breast cancer and no mutations of the BRCA genes.
"This newly identified genetic marker will not have any immediate clinical implications or impact on current screening guidelines for familial breast cancer," said Dr. Offit. "As such, a test for these markers is not available to the general public and these tests should be performed only as part of research studies."
Dr. Offit's research team is now confirming that this risk marker is observed in other populations, and is studying possible changes in two genes in the chromosome 6q region.
The study was funded in part by federal funds from the Intramural Research Program of the National Cancer Institute, Center for Cancer Research, the Breast Cancer Research Foundation, the Susan Komen Foundation, the Lymphoma Foundation, and the Niehaus, Southworth, Weissenbach Cancer Research Fund.
Memorial Sloan-Kettering Cancer Center is the world's oldest and largest private institution devoted to prevention, patient care, research, and education in cancer. Our scientists and clinicians generate innovative approaches to better understand, diagnose, and treat cancer. Our specialists are leaders in biomedical research and in translating the latest research to advance the standard of cancer care worldwide. For more information, go to mskcc/.
Source: Jeanne D'Agostino
Memorial Sloan-Kettering Cancer Center
"These results are exciting because they point us to new molecular pathways that may be associated with breast cancer," said the head of the research team and the study's senior author, Kenneth Offit, MD, MPH, Chief of the Clinical Genetics Service at MSKCC.
The study used a methodology called genome-wide association mapping, which looks at genetic variations across the entire genome that alter the individual building blocks of DNA makeup. These alterations may occur more frequently in individuals who have certain types of disease than in carriers without such disease. In this study, a new gene locus, a specific place on a chromosome where a gene is located, was associated with breast cancer risk. That gene locus is on the long arm of chromosome 6.
"These research findings are of great interest because of the method of genome- wide association used to discover this new locus as well as others in recent months," said Bert Gold, PhD, a Staff Scientist at the National Cancer Institute in Frederick, MD., and first author of the current study.
While the risk associated with this genetic marker is much lower than that of BRCA genetic mutations for example, this discovery will increase the understanding of the genetic variants that contribute to breast cancer.
Researchers used samples largely from MSKCC, but also from other sites in the US, Canada, and Israel. Participants were all of Ashkenazi (Eastern European Jewish) ancestry. The study used a three-phase design centered on 249 families with multiple cases of breast cancer and no mutations of the BRCA genes.
"This newly identified genetic marker will not have any immediate clinical implications or impact on current screening guidelines for familial breast cancer," said Dr. Offit. "As such, a test for these markers is not available to the general public and these tests should be performed only as part of research studies."
Dr. Offit's research team is now confirming that this risk marker is observed in other populations, and is studying possible changes in two genes in the chromosome 6q region.
The study was funded in part by federal funds from the Intramural Research Program of the National Cancer Institute, Center for Cancer Research, the Breast Cancer Research Foundation, the Susan Komen Foundation, the Lymphoma Foundation, and the Niehaus, Southworth, Weissenbach Cancer Research Fund.
Memorial Sloan-Kettering Cancer Center is the world's oldest and largest private institution devoted to prevention, patient care, research, and education in cancer. Our scientists and clinicians generate innovative approaches to better understand, diagnose, and treat cancer. Our specialists are leaders in biomedical research and in translating the latest research to advance the standard of cancer care worldwide. For more information, go to mskcc/.
Source: Jeanne D'Agostino
Memorial Sloan-Kettering Cancer Center
суббота, 23 апреля 2011 г.
UWE Cancer Expert Reports New Global Guidelines For Breast Cancer Testing
A cancer research specialist from the University of the West of England, Bristol is one of a panel of international experts who have had a report published in the Journal of Clinical Oncology that gives new global guidelines for testing regimes for breast cancer patients. The guidelines relate to cancer patients with oestrogen and progesterone receptor (ER/PgR) positive breast tumours. This approximates to around 70% of the 42,000 new cases of breast cancer occurring each year in the UK.
The international expert panel was convened by the American Society of Clinical Oncology and the College of American Pathologists to conduct a systematic review of the literature in partnership with Cancer Care Ontario to develop comprehensive evidence based recommendations for optimal ER/PgR testing performance.
Dr Anthony Rhodes from UWE explains, "Not all treatments will be effective on all women who have breast cancer. There are some important tests that need to be carried out to ascertain what treatments will work. Inaccuracies in results on some occasions have led to erroneous results and emphasize the importance of standardising each stage of the testing process so that patients are given the most appropriate treatments.
"About three years ago international guidelines relating to Human Epidermal Growth Factor 2 (HER2) hit the headlines (Journal of Clinical Oncology 2007; 25: 118-45). I was on the panel that determined these guidelines and it is this and previous experience that has led to my involvement in the new set of recommendations that will have an even greater impact in terms of the numbers of patients with ER/PgR positive tumours. It is known that Herceptin is an effective treatment in approximately 25% of patients who show positive results for HER2 and these guidelines had considerable impact globally in helping to standardize the clinical tests that predict the likely response to Herceptin therapy.
"However, a lot more breast tumours (around 70%) are driven by oestrogen which acts as a powerful growth stimulant when it binds to receptors in the tumour cells. The new guidelines relate to the most appropriate testing regimes for oestrogen receptors and progesterone receptors for predicting response to therapies such as tamoxifen. The new guidelines include recommendations for standardised tests for specimen handling, proper use of controls, and interpretive and reporting criteria.
"The key is to reliably identify those patients whose cancers are driven by oestrogen patients who fall into this category are likely to benefit from the drug tamoxifin, or similar drugs such as aromatase inhibitors. In cases where oestrogen is not driving the tumours growth other drugs are more appropriate."
Source: West of England University
View drug information on Herceptin.
The international expert panel was convened by the American Society of Clinical Oncology and the College of American Pathologists to conduct a systematic review of the literature in partnership with Cancer Care Ontario to develop comprehensive evidence based recommendations for optimal ER/PgR testing performance.
Dr Anthony Rhodes from UWE explains, "Not all treatments will be effective on all women who have breast cancer. There are some important tests that need to be carried out to ascertain what treatments will work. Inaccuracies in results on some occasions have led to erroneous results and emphasize the importance of standardising each stage of the testing process so that patients are given the most appropriate treatments.
"About three years ago international guidelines relating to Human Epidermal Growth Factor 2 (HER2) hit the headlines (Journal of Clinical Oncology 2007; 25: 118-45). I was on the panel that determined these guidelines and it is this and previous experience that has led to my involvement in the new set of recommendations that will have an even greater impact in terms of the numbers of patients with ER/PgR positive tumours. It is known that Herceptin is an effective treatment in approximately 25% of patients who show positive results for HER2 and these guidelines had considerable impact globally in helping to standardize the clinical tests that predict the likely response to Herceptin therapy.
"However, a lot more breast tumours (around 70%) are driven by oestrogen which acts as a powerful growth stimulant when it binds to receptors in the tumour cells. The new guidelines relate to the most appropriate testing regimes for oestrogen receptors and progesterone receptors for predicting response to therapies such as tamoxifen. The new guidelines include recommendations for standardised tests for specimen handling, proper use of controls, and interpretive and reporting criteria.
"The key is to reliably identify those patients whose cancers are driven by oestrogen patients who fall into this category are likely to benefit from the drug tamoxifin, or similar drugs such as aromatase inhibitors. In cases where oestrogen is not driving the tumours growth other drugs are more appropriate."
Source: West of England University
View drug information on Herceptin.
пятница, 22 апреля 2011 г.
Improving Understanding Of Cell Behaviour In Breast Cancer
The invasion and spread of cancer cells to other parts of the body, known as metastasis, is a principal cause of death in patients diagnosed with breast cancer. Although patients with early stage, small, breast tumours have an excellent short term prognosis, more than 15 to 20 per cent of them will eventually develop distant metastases, and die from the disease. Vascular invasion through lymphatic and blood vessels is the major route for cancer spreading to regional lymph nodes and to the rest of the body.
Dr Stewart Martin, Professor Ian Ellis and their colleagues at The University of Nottingham, and worldwide, are combining a number of approaches in a dynamic effort to improve our understanding of cell behaviour in breast cancer. Discovering how these cells operate is vital in improving diagnosis and treatment for the cancer patient in the longer term, and in identifying therapeutic targets. Already the results of their work have been excellent with findings in relation to the spread of cancer through the lymphatic vessels prompting a much larger study funded by Cancer Research UK.
A research student within the Nottingham team, Rabab Mohammed, showed recently that specific factors that regulate the growth of blood and lymphatic vessels can identify a subset of tumours which have a high probability of recurring or spreading.
The team subsequently identified the crucial importance of assessing both the level of blood and lymph vessel invasion by cancer cells at the earliest stages of detection. It has, until recently, been very difficult to distinguish between the two. With advances in immunohistochemical techniques, blood vessels can today be reliably identified and differentiated from lymphatics. Currently clinical approaches for the assessment of vascular invasion are insufficiently robust and can result in a failure to detect some lesions accurately, or fail to differentiate adequately between blood and lymph vessels. The Nottingham team has shown using tumour sections from 177 patients that 96 per cent of vascular invasion in primary invasive breast cancer is predominantly of the lymph vessels. This is significant.
It is important that this finding is verified in a larger cohort of patients. The researchers are now working to accomplish this, through funding recently obtained from Cancer Research UK, using specimens from more than a thousand women with early stage breast cancer. Results from this study will also allow them to determine whether Lymphatic Vascular Invasion can be incorporated into an improved prognostic index for early stage breast cancer.
This work is being combined with gene expression studies, with bioinformatic approaches and using in vitro (cells in culture) models to identify novel therapeutic targets. It is being conducted in collaboration with a number of groups, industrial and academic, from both the UK and overseas.
NOTTINGHAM UNIVERSITY
University Park
Nottingham
NG7 2RD
nottingham.ac.uk
Dr Stewart Martin, Professor Ian Ellis and their colleagues at The University of Nottingham, and worldwide, are combining a number of approaches in a dynamic effort to improve our understanding of cell behaviour in breast cancer. Discovering how these cells operate is vital in improving diagnosis and treatment for the cancer patient in the longer term, and in identifying therapeutic targets. Already the results of their work have been excellent with findings in relation to the spread of cancer through the lymphatic vessels prompting a much larger study funded by Cancer Research UK.
A research student within the Nottingham team, Rabab Mohammed, showed recently that specific factors that regulate the growth of blood and lymphatic vessels can identify a subset of tumours which have a high probability of recurring or spreading.
The team subsequently identified the crucial importance of assessing both the level of blood and lymph vessel invasion by cancer cells at the earliest stages of detection. It has, until recently, been very difficult to distinguish between the two. With advances in immunohistochemical techniques, blood vessels can today be reliably identified and differentiated from lymphatics. Currently clinical approaches for the assessment of vascular invasion are insufficiently robust and can result in a failure to detect some lesions accurately, or fail to differentiate adequately between blood and lymph vessels. The Nottingham team has shown using tumour sections from 177 patients that 96 per cent of vascular invasion in primary invasive breast cancer is predominantly of the lymph vessels. This is significant.
It is important that this finding is verified in a larger cohort of patients. The researchers are now working to accomplish this, through funding recently obtained from Cancer Research UK, using specimens from more than a thousand women with early stage breast cancer. Results from this study will also allow them to determine whether Lymphatic Vascular Invasion can be incorporated into an improved prognostic index for early stage breast cancer.
This work is being combined with gene expression studies, with bioinformatic approaches and using in vitro (cells in culture) models to identify novel therapeutic targets. It is being conducted in collaboration with a number of groups, industrial and academic, from both the UK and overseas.
NOTTINGHAM UNIVERSITY
University Park
Nottingham
NG7 2RD
nottingham.ac.uk
четверг, 21 апреля 2011 г.
Digital Mammograms Deliver Less Radiation Than Film Version, Study Finds
Digital mammograms deliver an average of 22% less radiation than film mammograms, according to a study partially funded by the National Cancer Institute and published in the American Journal of Roentgenology, Reuters reports. For the study, researchers analyzed the results of the 2005 Digital Mammographic Imaging Screening Trial involving 49,528 women. That trial found that digital mammograms detected up to 28% more cancers than film mammograms in women under age 50 who had not experienced menopause and women with dense breast tissue.
Carol Lee, chair of the American College of Radiology Breast Imaging Commission, said the new study showed that the benefits of digital mammograms "can be achieved with overall a lower radiation dose." She said that the level of radiation from either type of mammogram is not large enough to warrant concern and that women should not avoid recommended mammograms if the digital version is not available in their area. However, in general, lowering the dose of radiation is preferable, she said, adding, "We certainly want to keep radiation doses as low as possible and still achieve the desired goal of a good image" (Steenhuysen, Reuters, 1/22).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2010 The Advisory Board Company. All rights reserved.
среда, 20 апреля 2011 г.
Hitting The High Notes: UK Women And Celebrities Unite For Charity Record
Cancer Research UK re-release 'Girls Just Wanna Have Fun' to launch Race for Life 2010
Hundreds of women from across the UK have joined over 20 celebrities to record a unique charity single in aid of Cancer Research UK's Race for Life. The track, led by DJ and Singer Sonique, who herself is currently undergoing treatment for breast cancer, is a remake of Cyndi Lauper's 1980s classic 'Girls Just Wanna Have Fun.' The single, due to be released in late April to mark the start of Race for Life - the UK's largest women-only fundraising series, will be sold exclusively by official Race for Life partner Tesco and available to download on iTunes, with proceeds going directly to help beat cancer.
Sonique, whose lines on the track see her returning to the microphone for the first time since her diagnosis last June, is joined on the song by a host of female celebrities including Coronation Street's Kym Marsh, singer Liz McClarnon, actress Caroline Quentin, GMTV presenter Penny Smith, Big Brother star Nicola T and the X-Factor's Lucie Jones. The track also features a number of inspirational women who have been personally affected by cancer, as well as the contributions of women from around the UK, captured by mobile producers who have been touring shopping centres over the last six weeks.
Sonique said: "Girls Just Wanna Have Fun" really embodies the spirit of Race for Life because, although there's a serious message behind the activity, it really does feel like the ultimate girls' day out. The fact that any woman, no matter how good their voice is, has been able to get involved is brilliant and really captures the essence of Race for Life. It's not competitive and women of all ages, shapes and sizes can take part. I'd urge every woman to sign up for an event this year!"
Denya Dessena, a breast cancer survivor aged 39 from Crawley, who recorded her lines for the track this weekend, said: "I loved every minute of my day in the recording studio - if you'd have told me a few months ago that I was going to record a single with so many famous singers, I'd have said you were mad! It's great to come together with so many different women to take part in this, because cancer is something that doesn't discriminate - it can affect women from all walks of life, regardless of age, money or status. It's been great fun recording the single and I would love for it to go to number one so that we can raise as much money as possible for Cancer Research UK."
Now in its 17th year, Race for Life is the UK's largest women-only fundraising series, with over 230 events taking place this summer. Women from across the UK come together to simply walk, jog or run 5k and raise money to help beat cancer. Since Race for Life began in 1994, there has been a 15 per cent drop in the death rate from cancer, something that money raised from Race for Life has helped to achieve. This year the charity is hoping over 700,000 women come together to raise an incredible ВЈ60 million to fund Cancer Research UK's life saving work.
Each Race for Life event covers a distance of 5k and Cancer Research UK is encouraging women of all ages and levels of fitness to participate. To sign up for a Race for Life event and for more information on how to take part in the 'Girls Just Wanna Have Fun' single, go to raceforlife
'Girls Just Wanna Have Fun', in aid of Cancer Research UK's Race for Life, will be released in late April and will be sold exclusively in over 800 Tesco stores and available to download on iTunes. Tesco has been a proud partner of Race for Life since 2002 and during the past nine years over 152,000 female members of staff have taken part, raising over an incredible ВЈ5.6 million to support Cancer Research UK.
About Sonique and her cancer experience
Sonique (real name Sonia Clarke), aged 41, is a British Singer and DJ who is currently being treated for breast cancer. Sonique was diagnosed less than a year ago in May 2009. After a biopsy, it was revealed that the disease had spread to the lymph nodes under her arms and she was rushed straight into hospital for an operation to remove both the lump and lymph nodes. A week later Sonique had another operation to remove further tissue, which was then followed by five months of intensive chemotherapy that finished two months ago in November. Soon after this, doctors recommended that Sonique went though her third operation to remove additional tissue as a preventative measure. January and February will see Sonique go through six weeks of preventative radiotherapy which will hopefully signify the end of her cancer journey.
'Girls Just Wanna Have Fun' contributors (to date) include:
- Sonique, 41, British DJ and singer
- Lucie Jones, 18, X Factor Finalist 2009
- Nicola Tappenden, 27, Model and Celebrity Big Brother contestant
- Liz McClarnon, 29, TV presenter and former member of girlband Atomic Kitten
- Jaime Jay, 27, British singer
- Carol Decker, 53, British Recording Artist (80's band T'Pau)
- Kym Marsh, 34, Actress/singer
- Nina Wadia, 42, Eastenders actress
- Kelli Young, 29, Singer who found fame with pop band Liberty X
- Penny Smith, 52, TV presenter (GMTV)
- Danielle Lloyd, 27, British glamour model
- Lucy Benjamin, 40, Actress
- Sam and Amanda Marchant, both 22, twins whose career started on Big Brother
- Su-Elise Nash, 29, British singer who found fame in girlband Mis-Teeq
- Cheeky Girls, aka, Gabriella and Monica Irimia, both 28, female duo
- Lisa Scott-Lee, 35, British recording artist
- Hollyoaks actresses Loui Bately, Georgie Porter, Nicole Barber-Lane, Melissa Walton, Dominique Jackson and Alice Barlow
- Hundreds of women in shopping centres across the UK
Source
Cancer Research UK
Hundreds of women from across the UK have joined over 20 celebrities to record a unique charity single in aid of Cancer Research UK's Race for Life. The track, led by DJ and Singer Sonique, who herself is currently undergoing treatment for breast cancer, is a remake of Cyndi Lauper's 1980s classic 'Girls Just Wanna Have Fun.' The single, due to be released in late April to mark the start of Race for Life - the UK's largest women-only fundraising series, will be sold exclusively by official Race for Life partner Tesco and available to download on iTunes, with proceeds going directly to help beat cancer.
Sonique, whose lines on the track see her returning to the microphone for the first time since her diagnosis last June, is joined on the song by a host of female celebrities including Coronation Street's Kym Marsh, singer Liz McClarnon, actress Caroline Quentin, GMTV presenter Penny Smith, Big Brother star Nicola T and the X-Factor's Lucie Jones. The track also features a number of inspirational women who have been personally affected by cancer, as well as the contributions of women from around the UK, captured by mobile producers who have been touring shopping centres over the last six weeks.
Sonique said: "Girls Just Wanna Have Fun" really embodies the spirit of Race for Life because, although there's a serious message behind the activity, it really does feel like the ultimate girls' day out. The fact that any woman, no matter how good their voice is, has been able to get involved is brilliant and really captures the essence of Race for Life. It's not competitive and women of all ages, shapes and sizes can take part. I'd urge every woman to sign up for an event this year!"
Denya Dessena, a breast cancer survivor aged 39 from Crawley, who recorded her lines for the track this weekend, said: "I loved every minute of my day in the recording studio - if you'd have told me a few months ago that I was going to record a single with so many famous singers, I'd have said you were mad! It's great to come together with so many different women to take part in this, because cancer is something that doesn't discriminate - it can affect women from all walks of life, regardless of age, money or status. It's been great fun recording the single and I would love for it to go to number one so that we can raise as much money as possible for Cancer Research UK."
Now in its 17th year, Race for Life is the UK's largest women-only fundraising series, with over 230 events taking place this summer. Women from across the UK come together to simply walk, jog or run 5k and raise money to help beat cancer. Since Race for Life began in 1994, there has been a 15 per cent drop in the death rate from cancer, something that money raised from Race for Life has helped to achieve. This year the charity is hoping over 700,000 women come together to raise an incredible ВЈ60 million to fund Cancer Research UK's life saving work.
Each Race for Life event covers a distance of 5k and Cancer Research UK is encouraging women of all ages and levels of fitness to participate. To sign up for a Race for Life event and for more information on how to take part in the 'Girls Just Wanna Have Fun' single, go to raceforlife
'Girls Just Wanna Have Fun', in aid of Cancer Research UK's Race for Life, will be released in late April and will be sold exclusively in over 800 Tesco stores and available to download on iTunes. Tesco has been a proud partner of Race for Life since 2002 and during the past nine years over 152,000 female members of staff have taken part, raising over an incredible ВЈ5.6 million to support Cancer Research UK.
About Sonique and her cancer experience
Sonique (real name Sonia Clarke), aged 41, is a British Singer and DJ who is currently being treated for breast cancer. Sonique was diagnosed less than a year ago in May 2009. After a biopsy, it was revealed that the disease had spread to the lymph nodes under her arms and she was rushed straight into hospital for an operation to remove both the lump and lymph nodes. A week later Sonique had another operation to remove further tissue, which was then followed by five months of intensive chemotherapy that finished two months ago in November. Soon after this, doctors recommended that Sonique went though her third operation to remove additional tissue as a preventative measure. January and February will see Sonique go through six weeks of preventative radiotherapy which will hopefully signify the end of her cancer journey.
'Girls Just Wanna Have Fun' contributors (to date) include:
- Sonique, 41, British DJ and singer
- Lucie Jones, 18, X Factor Finalist 2009
- Nicola Tappenden, 27, Model and Celebrity Big Brother contestant
- Liz McClarnon, 29, TV presenter and former member of girlband Atomic Kitten
- Jaime Jay, 27, British singer
- Carol Decker, 53, British Recording Artist (80's band T'Pau)
- Kym Marsh, 34, Actress/singer
- Nina Wadia, 42, Eastenders actress
- Kelli Young, 29, Singer who found fame with pop band Liberty X
- Penny Smith, 52, TV presenter (GMTV)
- Danielle Lloyd, 27, British glamour model
- Lucy Benjamin, 40, Actress
- Sam and Amanda Marchant, both 22, twins whose career started on Big Brother
- Su-Elise Nash, 29, British singer who found fame in girlband Mis-Teeq
- Cheeky Girls, aka, Gabriella and Monica Irimia, both 28, female duo
- Lisa Scott-Lee, 35, British recording artist
- Hollyoaks actresses Loui Bately, Georgie Porter, Nicole Barber-Lane, Melissa Walton, Dominique Jackson and Alice Barlow
- Hundreds of women in shopping centres across the UK
Source
Cancer Research UK
вторник, 19 апреля 2011 г.
Radiation Therapy After Lumpectomy For Breast Cancer Can Be Safely Reduced To 4 Weeks
Researchers at Fox Chase Cancer Center found that radiation treatment for women who had a lumpectomy for early-stage breast cancer can be safely reduced to four weeks, instead of the usual six to seven weeks, by delivering a higher daily dose - greatly reducing the length of treatment time. The five-year results of the phase II study were presented at the annual meeting of the American Society for Radiation Oncology.
The study showed that treatment time can be shortened from the historical six to seven weeks to just four weeks using IMRT (intensity-modulated radiation therapy), a highly sophisticated system of delivering external-beam radiation. This system uses advanced computer optimized planning and radiation delivery techniques that create more optimal dose distributions, greater sparing of the skin and lower doses to organs such as lung and heart - thus reducing potential side effects.
"When delivering high doses of radiation, we have to consider the level of side effects and the cosmetic result," explained Gary Freedman, M.D., radiation oncologist at Fox Chase. "In this phase II study, women reported acceptable side effects that were no different than would be expected from a usual, more prolonged length of treatment. In addition, with long term follow-up we see cure rates and cosmetic results that are similar to a longer six-week treatment course."
Using IMRT, this study examined the delivery of a higher daily dose of radiation over four weeks (versus a lower dose over six to seven weeks). Another way of reducing treatment length was by incorporating a "boost" into the same four weeks. The lumpectomy site where the tumor was removed is usually treated with a high-dose radiation "boost." The standard "boost" is typically administered after the five weeks of whole breast irradiation and can add another one to two weeks to the treatment time.
Freedman and his colleagues demonstrated that in addition to safely increasing the dose to the whole breast during the four-week period, it is possible to deliver the "boost" concurrently, eliminating the extra two weeks.
"This more accelerated treatment regimen should be an option for women who want to be treated in a shorter period of time," says Freedman. "This may particularly appeal to women who drive a long distance for radiation, have busy schedules at home or work, or have a large insurance co-pay for each daily radiation treatment."
Freedman cautioned that this treatment schedule may not be for all women. "There may be patients who are uncomfortable with the idea of an accelerated treatment and want to be treated with a more conventional six to seven week course of treatment," he says. "In addition, we need more research to determine which women are ideal candidates for this treatment because of differences in anatomy or other treatments for their breast cancer."
The study included 75 women treated with 2.25 Gy for 20 days (versus 2 Gy per day with conventional therapy) and a 2.8 Gy boost concurrently (versus sequentially delivering the boost after whole breast irradiation). The risk of recurrence within five years in the treated breast was low - 4% - which compares favorably to results with conventional radiation. In addition, patients and their physicians considered the cosmetic results good or excellent in most women.
Source: Diana Quattrone
Fox Chase Cancer Center
The study showed that treatment time can be shortened from the historical six to seven weeks to just four weeks using IMRT (intensity-modulated radiation therapy), a highly sophisticated system of delivering external-beam radiation. This system uses advanced computer optimized planning and radiation delivery techniques that create more optimal dose distributions, greater sparing of the skin and lower doses to organs such as lung and heart - thus reducing potential side effects.
"When delivering high doses of radiation, we have to consider the level of side effects and the cosmetic result," explained Gary Freedman, M.D., radiation oncologist at Fox Chase. "In this phase II study, women reported acceptable side effects that were no different than would be expected from a usual, more prolonged length of treatment. In addition, with long term follow-up we see cure rates and cosmetic results that are similar to a longer six-week treatment course."
Using IMRT, this study examined the delivery of a higher daily dose of radiation over four weeks (versus a lower dose over six to seven weeks). Another way of reducing treatment length was by incorporating a "boost" into the same four weeks. The lumpectomy site where the tumor was removed is usually treated with a high-dose radiation "boost." The standard "boost" is typically administered after the five weeks of whole breast irradiation and can add another one to two weeks to the treatment time.
Freedman and his colleagues demonstrated that in addition to safely increasing the dose to the whole breast during the four-week period, it is possible to deliver the "boost" concurrently, eliminating the extra two weeks.
"This more accelerated treatment regimen should be an option for women who want to be treated in a shorter period of time," says Freedman. "This may particularly appeal to women who drive a long distance for radiation, have busy schedules at home or work, or have a large insurance co-pay for each daily radiation treatment."
Freedman cautioned that this treatment schedule may not be for all women. "There may be patients who are uncomfortable with the idea of an accelerated treatment and want to be treated with a more conventional six to seven week course of treatment," he says. "In addition, we need more research to determine which women are ideal candidates for this treatment because of differences in anatomy or other treatments for their breast cancer."
The study included 75 women treated with 2.25 Gy for 20 days (versus 2 Gy per day with conventional therapy) and a 2.8 Gy boost concurrently (versus sequentially delivering the boost after whole breast irradiation). The risk of recurrence within five years in the treated breast was low - 4% - which compares favorably to results with conventional radiation. In addition, patients and their physicians considered the cosmetic results good or excellent in most women.
Source: Diana Quattrone
Fox Chase Cancer Center
понедельник, 18 апреля 2011 г.
Overexpression of Gene That Interacts With Brca2 May Play Role in Genesis of Breast Cancer
The protein encoded by the EMSY gene interacts with the Brca2 protein, whose gene has been linked to familial breast cancer. Mutations in BRCA2 are not found in sporadic breast cancers, but the EMSY gene is amplified in 13% of these cancers. It has been suggested that overexpression of the EMSY gene may be an alternate mechanism for suppression of the activity of the Brca2 protein, which could lead to the development of malignant breast cells.
Connie J. Eaves, Ph.D., and David Huntsman, M.D., of the British Columbia Cancer Agency in Vancouver, and colleagues conducted a series of experiments in a human breast cell line to determine whether overexpression of the EMSY gene would mimic the chromosome instability found in breast cancer cells that have lost functional Brca2 protein. They found that ESMY overexpression induced a chromosome instability phenotype that was similar to that found in BRCA2-deficient cells and conclude that EMSY overexpression may play a role in the genesis of breast cancer.
Sarah L. Zielinski
jncimediaoxfordjournals
301-841-1287
Journal of the National Cancer Institute
jncicancerspectrum.oupjournals
The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Visit the Journal online at jncicancerspectrum.oxfordjournals.
Connie J. Eaves, Ph.D., and David Huntsman, M.D., of the British Columbia Cancer Agency in Vancouver, and colleagues conducted a series of experiments in a human breast cell line to determine whether overexpression of the EMSY gene would mimic the chromosome instability found in breast cancer cells that have lost functional Brca2 protein. They found that ESMY overexpression induced a chromosome instability phenotype that was similar to that found in BRCA2-deficient cells and conclude that EMSY overexpression may play a role in the genesis of breast cancer.
Sarah L. Zielinski
jncimediaoxfordjournals
301-841-1287
Journal of the National Cancer Institute
jncicancerspectrum.oupjournals
The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Visit the Journal online at jncicancerspectrum.oxfordjournals.
суббота, 16 апреля 2011 г.
FDA Scientists Request Investigation Into Agency Approval Of Breast Imaging Device
Scientists at FDA have requested that Congress and President-elect Obama investigate their allegations that an FDA official approved the sale of a breast cancer imaging device over the objections of the front-line scientists after receiving a phone call from a Connecticut congressman, according to the New York Times. The Times reports that the call from the congressman and its "effect on what is supposed to be a science-based approval process" represent "only one of many accusations in a trove of documents" the newspaper received regarding disputes within the FDA Office of Device Evaluation.
According to the Times, the documents show through e-mail correspondence that top agency scientists allege that an agency supervisor inappropriately forced them to modify reviews of the iCAD SecondLook Digital Computer-Aided Detection System for Mammography -- a computer device to assist in the detection of breast tumors -- after former Rep. Christopher Shays (R-Conn.) called an agency supervisor a few years ago to voice concerns about the future of the device. According to the Times, the device is used with screening equipment made by Fujifilm Medical Systems, which is based in Shays' former district. According to the FDA documents, the nine scientists involved with the iCAD decision said that the company "never tested the device by the intended users (i.e. radiologists) under the intended conditions of use. This is the most basic and fundamental requirement of all FDA submissions." The risks of iCAD include missed cancers, "unnecessary biopsy or even surgery (by placing false positive marks) and unnecessary additional radiation," according to an internal review. Courtney Kraemer, spokesperson for Fujifilm Medical, said that the company called its "local congressional offices to ask them to help us get clarification on the FDA process." Shays said that he called the FDA supervisor only to demand the agency make a final decision on the device but that he did not request that it be approved. He added that it would be "idiotic for someone to approve something they don't think should be approved."
The internal review was ordered in May 2008 after nine scientists complained to FDA Commissioner Andrew von Eschenbach, the Times reports. However, the scientists were "dissatisfied with the pace of that review," so they wrote a letter to Congress in October 2008 to request an investigation, which the House Committee on Energy and Commerce said it began in November 2008. A similar letter was written to President-elect Barack Obama's transition team last week, the Times reports. William McConaghah, FDA assistant commissioner for integrity and accountability, said that officials in the Office of the Commissioner are "extremely concerned about allegations like this" and that he is still investigating the scientists' claims.
Broader Concerns
The Times reports that a "growing chorus of critics" have expressed concern that FDA requires few devices to complete the most thorough of the agency's three-tiered review process and "instead allows most devices to be cleared with minimal oversight." The internal documents show that other FDA scientists "seem to agree with these critics," according to the Times. Forty-one devices went through the most thorough review process in 2007, compared with 3,052 that underwent abbreviated reviews. One internal memorandum made available to the Times argued that FDA managers had pushed agency reviewers to use the abbreviated process "even to approve devices that are so complex and novel that extensive clinical trials should be required," the Times reports (Harris, New York Times, 1/13).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2008 The Advisory Board Company. All rights reserved.
According to the Times, the documents show through e-mail correspondence that top agency scientists allege that an agency supervisor inappropriately forced them to modify reviews of the iCAD SecondLook Digital Computer-Aided Detection System for Mammography -- a computer device to assist in the detection of breast tumors -- after former Rep. Christopher Shays (R-Conn.) called an agency supervisor a few years ago to voice concerns about the future of the device. According to the Times, the device is used with screening equipment made by Fujifilm Medical Systems, which is based in Shays' former district. According to the FDA documents, the nine scientists involved with the iCAD decision said that the company "never tested the device by the intended users (i.e. radiologists) under the intended conditions of use. This is the most basic and fundamental requirement of all FDA submissions." The risks of iCAD include missed cancers, "unnecessary biopsy or even surgery (by placing false positive marks) and unnecessary additional radiation," according to an internal review. Courtney Kraemer, spokesperson for Fujifilm Medical, said that the company called its "local congressional offices to ask them to help us get clarification on the FDA process." Shays said that he called the FDA supervisor only to demand the agency make a final decision on the device but that he did not request that it be approved. He added that it would be "idiotic for someone to approve something they don't think should be approved."
The internal review was ordered in May 2008 after nine scientists complained to FDA Commissioner Andrew von Eschenbach, the Times reports. However, the scientists were "dissatisfied with the pace of that review," so they wrote a letter to Congress in October 2008 to request an investigation, which the House Committee on Energy and Commerce said it began in November 2008. A similar letter was written to President-elect Barack Obama's transition team last week, the Times reports. William McConaghah, FDA assistant commissioner for integrity and accountability, said that officials in the Office of the Commissioner are "extremely concerned about allegations like this" and that he is still investigating the scientists' claims.
Broader Concerns
The Times reports that a "growing chorus of critics" have expressed concern that FDA requires few devices to complete the most thorough of the agency's three-tiered review process and "instead allows most devices to be cleared with minimal oversight." The internal documents show that other FDA scientists "seem to agree with these critics," according to the Times. Forty-one devices went through the most thorough review process in 2007, compared with 3,052 that underwent abbreviated reviews. One internal memorandum made available to the Times argued that FDA managers had pushed agency reviewers to use the abbreviated process "even to approve devices that are so complex and novel that extensive clinical trials should be required," the Times reports (Harris, New York Times, 1/13).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2008 The Advisory Board Company. All rights reserved.
Breakthrough In Neuroblastoma And Breast Cancer Research Identifies New Treatment Targets, Australia
In neuroblastoma, the most common tumour of infants, and breast cancer, levels of the Myc proteins are commonly elevated in tumour cells. High levels of the protein are also associated with poor treatment outcomes. However, the way in which these proteins cause cancer has remained unknown.
For the first time, researchers at Children's Cancer Institute Australia for Medical Research (CCIA), and collaborators in Italy, describe how the Myc proteins lead to tumour formation.
"Our results show that Myc proteins cause cancer by switching off genes involved in cancer prevention, such as transglutaminase 2 (TG2)," says Professor Glenn Marshall, Head of CCIA's Molecular Carcinogenesis Program and Director of the Centre for Children's Cancer and Blood Disorders at Sydney Children's Hospital.
"In addition to this, we have also shown that when the neuroblastoma and breast cancer cells are treated with a new class of anti-cancer drugs called histone deacetylase inhibitors (HDACIs), they are able to turn the TG2 gene back on, which then inhibits tumour growth."
The results which will be published this week in the prestigious Proceedings of the National Academy of Science USA journal, describe in detail the complex interaction between the Myc protein, TG2 gene and HDACI drug within tumour cells.
"This work highlights the importance of HDACIs for the treatment of cancers caused by the high levels of Myc proteins," says Professor Marshall.
"More importantly, we identify TG2 as a potential drug development target for the treatment of these cancers.
"We believe that TG2 mimetics, combined with HDACIs in cancer therapy, will have potent anticancer effects in cells driven by Myc proteins."
This work was supported by funding from the National Health and Medical Research Council, Cancer Council New South Wales, Cancer Institute New South Wales, United States National Cancer Institute, University of New South Wales, Italian Association for Research on Cancer, Italian Ministry of University and Research, University of Bologna, and Regional Program for Industrial Research-ITT Emilia Romagna Region, Italy.
Children's Cancer Institute Australia for Medical Research is affiliated with the University of NSW and Sydney Children's Hospital.
This is a joint media release from Children's Cancer Institute Australia for Medical Research, Sydney Children's Hospital and University of New South Wales.
Note:
The following manuscript will be published in the November issue of Proceedings of the National Academy of Sciences USA:
Liu T, Tee AEL, Porro A, Smith SA, Dwarte T, Liu PY, Iraci N, Sekyere E, Haber M, Norris MD, Diolaiti D, Della Valle G, Perini G and Marshall GM (2007) "Activation of tissue transglutaminase trascription by histone deacetylase inhibition as a therapeutic approach for Myc oncogenesis".
About CCIA
Children's Cancer Institute Australia for Medical Research (CCIA) is the only independent medical research institute in Australia devoted to research into the causes, better treatment, prevention and cure of childhood cancer. The vision of the Institute is to save the lives of all children with cancer and to eliminate their suffering, and its mission involves achieving this through world-class research.
Founded in 1976 by a dedicated group of parents and doctors who wanted to do something more in the fight against childhood cancer, CCIA opened its first laboratory in 1984. The Institute now employs over 150 staff and students, including more than 100 scientists.
Research at CCIA comprises a multifaceted approach to improving the outcome of childhood cancer sufferers. Overall, the research program includes basic, preclinical and clinical studies aimed at defining and achieving improved treatment for children with cancer.
Children's Cancer Institute Australia
For the first time, researchers at Children's Cancer Institute Australia for Medical Research (CCIA), and collaborators in Italy, describe how the Myc proteins lead to tumour formation.
"Our results show that Myc proteins cause cancer by switching off genes involved in cancer prevention, such as transglutaminase 2 (TG2)," says Professor Glenn Marshall, Head of CCIA's Molecular Carcinogenesis Program and Director of the Centre for Children's Cancer and Blood Disorders at Sydney Children's Hospital.
"In addition to this, we have also shown that when the neuroblastoma and breast cancer cells are treated with a new class of anti-cancer drugs called histone deacetylase inhibitors (HDACIs), they are able to turn the TG2 gene back on, which then inhibits tumour growth."
The results which will be published this week in the prestigious Proceedings of the National Academy of Science USA journal, describe in detail the complex interaction between the Myc protein, TG2 gene and HDACI drug within tumour cells.
"This work highlights the importance of HDACIs for the treatment of cancers caused by the high levels of Myc proteins," says Professor Marshall.
"More importantly, we identify TG2 as a potential drug development target for the treatment of these cancers.
"We believe that TG2 mimetics, combined with HDACIs in cancer therapy, will have potent anticancer effects in cells driven by Myc proteins."
This work was supported by funding from the National Health and Medical Research Council, Cancer Council New South Wales, Cancer Institute New South Wales, United States National Cancer Institute, University of New South Wales, Italian Association for Research on Cancer, Italian Ministry of University and Research, University of Bologna, and Regional Program for Industrial Research-ITT Emilia Romagna Region, Italy.
Children's Cancer Institute Australia for Medical Research is affiliated with the University of NSW and Sydney Children's Hospital.
This is a joint media release from Children's Cancer Institute Australia for Medical Research, Sydney Children's Hospital and University of New South Wales.
Note:
The following manuscript will be published in the November issue of Proceedings of the National Academy of Sciences USA:
Liu T, Tee AEL, Porro A, Smith SA, Dwarte T, Liu PY, Iraci N, Sekyere E, Haber M, Norris MD, Diolaiti D, Della Valle G, Perini G and Marshall GM (2007) "Activation of tissue transglutaminase trascription by histone deacetylase inhibition as a therapeutic approach for Myc oncogenesis".
About CCIA
Children's Cancer Institute Australia for Medical Research (CCIA) is the only independent medical research institute in Australia devoted to research into the causes, better treatment, prevention and cure of childhood cancer. The vision of the Institute is to save the lives of all children with cancer and to eliminate their suffering, and its mission involves achieving this through world-class research.
Founded in 1976 by a dedicated group of parents and doctors who wanted to do something more in the fight against childhood cancer, CCIA opened its first laboratory in 1984. The Institute now employs over 150 staff and students, including more than 100 scientists.
Research at CCIA comprises a multifaceted approach to improving the outcome of childhood cancer sufferers. Overall, the research program includes basic, preclinical and clinical studies aimed at defining and achieving improved treatment for children with cancer.
Children's Cancer Institute Australia
New Sensor Could Help Treat, Combat Diabetes, Other Diseases
A tiny new sensor could provide fresh, inexpensive diagnosis and treatment methods for people suffering from a variety of diseases.
University of Florida engineers have designed and tested versions of the sensor for applications ranging from monitoring diabetics' glucose levels via their breath to detecting possible indicators of breast cancer in saliva. They say early results are promising - particularly considering that the sensor can be mass produced inexpensively with technology already widely used for making chips in cell phones and other devices.
"This uses known manufacturing technology that is already out there," said Fan Ren, a professor of chemical engineering and one of a team of engineers collaborating on the project.
The team has published 15 peer-reviewed papers on different versions of the sensor, most recently in this month's edition of IEEE Sensors Journal. In that paper, members report integrating the sensor in a wireless system that can detect glucose in exhaled breath, then relay the findings to health care workers. That makes the sensor one of several non-invasive devices in development to replace the finger prick kits widely used by diabetics.
Tests with the sensor contradict long-held assumptions that glucose levels in the breath are too small for accurate assessment, Ren said. That's because the sensor uses a semiconductor that amplifies the minute signals to readable levels, he said.
"Instead of poking your finger to get the blood, you can just breathe into it and measure the glucose in the breath condensate," Ren said.
In the IEEE paper and other published work, the researchers report using the sensor to detect pH or alkalinity levels in the breath, a technique that could help people who suffer from asthma better identify and treat asthma attacks - as well as calibrate the sensitivity of the glucose sensor. The engineers have used other versions to experiment with picking up indicators of breast cancer in saliva, and pathogens in water and other substances.
As with the finger prick standard, tests for pH, breast or cancer indicators typically already exist, but they are often cumbersome, expensive or time-consuming, Ren said. For example, the current technique for measuring pH in a patient's breath requires the patient to blow into a tube for 20 minutes to collect enough condensate for a measurement.
At 100 microns, or 100 millionths of a meter, the UF sensor is so small that the moisture from one breath is enough to get a pH or glucose concentration reading - in under five seconds, Ren said.
Ren said the sensors work by mating different reactive substances with the semiconductor gallium nitride commonly used in amplifiers in cell phones, power grid transmission equipment and other applications.
If targeting cancer, the substance is an antibody that is sensitive to certain proteins identified as indicative of cancer. If the target is glucose, the reactive molecules are composed of zinc oxide nanorods that bind with glucose enzymes.
Once the reaction happens, "the charge on the semiconductor devices changes, and we can detect that change," Ren said.
While the sensor is not as acutely sensitive as those that rely on nanotechnology, the manufacturing techniques are already widely available, Ren said. The cost is as little as 20 cents per chip, but goes up considerably when combined with applications to transmit the information wirelessly to computers or cell phones. The entire wireless-chip package might cost around $40, he said, although that cost could be cut in half with mass production.
The team has patented or is in the process of patenting several elements of the technology, and several companies have expressed interest in pursuing the research, Ren said.
"This is an important development in the field of biomedical sensors and a real breakthrough," said Michael Shur, professor of solid state electronics at Rensselaer Polytechnic Institute. "Professors Fan Ren and Steve Pearton have made pioneering contributions to materials and device studies of nitrides, and now their work has led to the development of sensors that might improve quality of life for millions of patients."
Other faculty members on the research team include Steve Pearton, a distinguished professor of materials science and engineering; Tanmay Lele, an assistant professor of chemical engineering; Jenshan Lin, a professor of electrical and computer engineering and Wenhsing Wu, a lecturer in electrical and computer engineering. Numerous graduate students in several departments have also contributed.
Source:
Aaron Hoover
University of Florida
University of Florida engineers have designed and tested versions of the sensor for applications ranging from monitoring diabetics' glucose levels via their breath to detecting possible indicators of breast cancer in saliva. They say early results are promising - particularly considering that the sensor can be mass produced inexpensively with technology already widely used for making chips in cell phones and other devices.
"This uses known manufacturing technology that is already out there," said Fan Ren, a professor of chemical engineering and one of a team of engineers collaborating on the project.
The team has published 15 peer-reviewed papers on different versions of the sensor, most recently in this month's edition of IEEE Sensors Journal. In that paper, members report integrating the sensor in a wireless system that can detect glucose in exhaled breath, then relay the findings to health care workers. That makes the sensor one of several non-invasive devices in development to replace the finger prick kits widely used by diabetics.
Tests with the sensor contradict long-held assumptions that glucose levels in the breath are too small for accurate assessment, Ren said. That's because the sensor uses a semiconductor that amplifies the minute signals to readable levels, he said.
"Instead of poking your finger to get the blood, you can just breathe into it and measure the glucose in the breath condensate," Ren said.
In the IEEE paper and other published work, the researchers report using the sensor to detect pH or alkalinity levels in the breath, a technique that could help people who suffer from asthma better identify and treat asthma attacks - as well as calibrate the sensitivity of the glucose sensor. The engineers have used other versions to experiment with picking up indicators of breast cancer in saliva, and pathogens in water and other substances.
As with the finger prick standard, tests for pH, breast or cancer indicators typically already exist, but they are often cumbersome, expensive or time-consuming, Ren said. For example, the current technique for measuring pH in a patient's breath requires the patient to blow into a tube for 20 minutes to collect enough condensate for a measurement.
At 100 microns, or 100 millionths of a meter, the UF sensor is so small that the moisture from one breath is enough to get a pH or glucose concentration reading - in under five seconds, Ren said.
Ren said the sensors work by mating different reactive substances with the semiconductor gallium nitride commonly used in amplifiers in cell phones, power grid transmission equipment and other applications.
If targeting cancer, the substance is an antibody that is sensitive to certain proteins identified as indicative of cancer. If the target is glucose, the reactive molecules are composed of zinc oxide nanorods that bind with glucose enzymes.
Once the reaction happens, "the charge on the semiconductor devices changes, and we can detect that change," Ren said.
While the sensor is not as acutely sensitive as those that rely on nanotechnology, the manufacturing techniques are already widely available, Ren said. The cost is as little as 20 cents per chip, but goes up considerably when combined with applications to transmit the information wirelessly to computers or cell phones. The entire wireless-chip package might cost around $40, he said, although that cost could be cut in half with mass production.
The team has patented or is in the process of patenting several elements of the technology, and several companies have expressed interest in pursuing the research, Ren said.
"This is an important development in the field of biomedical sensors and a real breakthrough," said Michael Shur, professor of solid state electronics at Rensselaer Polytechnic Institute. "Professors Fan Ren and Steve Pearton have made pioneering contributions to materials and device studies of nitrides, and now their work has led to the development of sensors that might improve quality of life for millions of patients."
Other faculty members on the research team include Steve Pearton, a distinguished professor of materials science and engineering; Tanmay Lele, an assistant professor of chemical engineering; Jenshan Lin, a professor of electrical and computer engineering and Wenhsing Wu, a lecturer in electrical and computer engineering. Numerous graduate students in several departments have also contributed.
Source:
Aaron Hoover
University of Florida
Apricot Seeds At High Doses Can Be Fatal
Apricot seeds are taken by many people as a cancer treatment as they contain high doses of Vitamin B17, an immune system enhancer. However, apricot seeds also contain cyanide, a poison.
The Food Standards Agency (UK) has advised people to take no more than two bitter apricot kernels a day. Higher doses could be dangerous for human health.
According to the Food Standards Agency (FSA), it has received reports from various parts of the world of people overdosing with apricot seeds.
A UK retailer, Julian Gray, was selling 10 seeds a day doses of apricot seeds. The retailer says it will re-sell them at not such a high dose (the present dose is not longer for sale).
There is controversy about apricot seeds and the claims made about it as a cancer cure. At we have had hundreds of letters from patients on this subject. Some people say it is wonderful while others say it made them feel worse.
Written by:
The Food Standards Agency (UK) has advised people to take no more than two bitter apricot kernels a day. Higher doses could be dangerous for human health.
According to the Food Standards Agency (FSA), it has received reports from various parts of the world of people overdosing with apricot seeds.
A UK retailer, Julian Gray, was selling 10 seeds a day doses of apricot seeds. The retailer says it will re-sell them at not such a high dose (the present dose is not longer for sale).
There is controversy about apricot seeds and the claims made about it as a cancer cure. At we have had hundreds of letters from patients on this subject. Some people say it is wonderful while others say it made them feel worse.
Written by:
Univ. Of Arkansas For Medical Sciences' V. Suzanne Klimberg, M.D. Authors Book On Breast Surgical Techniques
The University of Arkansas for Medical Sciences (UAMS) announces the publication of the "Atlas of Breast Surgical Techniques" by V. Suzanne Klimberg, M.D., director of the Breast Cancer Program at the UAMS Winthrop P. Rockefeller Cancer Institute.
Written for practicing surgeons, surgical residents and medical students, the book presents surgical procedures - many developed by Klimberg - intended to improve outcomes for breast cancer patients.
"I have heard many residents say how easy they think breast surgery is. Yet even in these modern times, as many as 40 percent of patients require a second surgery to remove additional malignant tissue," said Klimberg, who also holds the Muriel Balsam Kohn Chair in Breast Surgical Oncology at UAMS.
The 440-page atlas includes 550 illustrations and operative photos, biopsy specimens, and artists' renderings of key anatomy. It is part of the Surgical Techniques Atlas Series published by Elsevier.
The atlas' six sections cover excisional biopsy/partial mastectomy, lymph node biopsy, mastectomy, breast reconstruction, extensive resections and surgical techniques to assist irradiation.
Among the topics presented are axillary reverse mapping (ARM) and excision followed by radiofrequency ablation (eRFA), both procedures developed by Klimberg at UAMS.
eRFA begins with standard removal of the tumor. Then, an RFA probe is inserted and heated to 100 degrees for 15 minutes, creating a one centimeter zone of dead tissue around the cavity. The procedure is intended to give the patient a cancer-free area around the site where the tumor was removed so that a second surgery in the area is unnecessary.
The ARM procedure prevents one of the most common side effects associated with breast cancer treatment - lymphedema or swelling of the arms due to faulty drainage of the lymph nodes.
"The removal and analysis of the lymph nodes under the arm remains the most important factor in determining the severity of disease in breast cancer patients," Klimberg said.
To prevent the arm swelling, Klimberg developed the ARM procedure. The technique evaluates the ways in which fluid drains through the lymph node system in the arm through the injection of blue dye, thus decreasing the chances of unintended disruption of the lymph node system during surgery and reducing the risk of developing swelling in the arm.
Source
University of Arkansas for Medical Sciences
Written for practicing surgeons, surgical residents and medical students, the book presents surgical procedures - many developed by Klimberg - intended to improve outcomes for breast cancer patients.
"I have heard many residents say how easy they think breast surgery is. Yet even in these modern times, as many as 40 percent of patients require a second surgery to remove additional malignant tissue," said Klimberg, who also holds the Muriel Balsam Kohn Chair in Breast Surgical Oncology at UAMS.
The 440-page atlas includes 550 illustrations and operative photos, biopsy specimens, and artists' renderings of key anatomy. It is part of the Surgical Techniques Atlas Series published by Elsevier.
The atlas' six sections cover excisional biopsy/partial mastectomy, lymph node biopsy, mastectomy, breast reconstruction, extensive resections and surgical techniques to assist irradiation.
Among the topics presented are axillary reverse mapping (ARM) and excision followed by radiofrequency ablation (eRFA), both procedures developed by Klimberg at UAMS.
eRFA begins with standard removal of the tumor. Then, an RFA probe is inserted and heated to 100 degrees for 15 minutes, creating a one centimeter zone of dead tissue around the cavity. The procedure is intended to give the patient a cancer-free area around the site where the tumor was removed so that a second surgery in the area is unnecessary.
The ARM procedure prevents one of the most common side effects associated with breast cancer treatment - lymphedema or swelling of the arms due to faulty drainage of the lymph nodes.
"The removal and analysis of the lymph nodes under the arm remains the most important factor in determining the severity of disease in breast cancer patients," Klimberg said.
To prevent the arm swelling, Klimberg developed the ARM procedure. The technique evaluates the ways in which fluid drains through the lymph node system in the arm through the injection of blue dye, thus decreasing the chances of unintended disruption of the lymph node system during surgery and reducing the risk of developing swelling in the arm.
Source
University of Arkansas for Medical Sciences
'Basal-Like' Breast Cancer Does Not Originate From Basal Stem Cells
New research uncovers a case of mistaken identity that may have a significant impact on future breast cancer prevention and treatment strategies. The study, published by Cell Press in the September 3rd issue of the journal Cell Stem Cell, suggests that despite their "stem cell-like" characteristics, most aggressive breast tumors are not derived from normal mammary gland stem cells.
The glandular tissue of the breast contains two main cell types, outer "basal" cells and inner "luminal" cells. The basal layer consists mostly of differentiated cells with a small population of mammary stem cells. The luminal layer contains differentiated cells and several types of cells which are intermediates between the luminal cells and stem cells. The different cell types can be identified and separated on the basis of specific molecular markers.
"In breast cancer, it has been proposed that different tumor subtypes may originate from different stem and intermediate cells, with more aggressive 'basal-like' breast cancers originating from basal stem cells and less aggressive breast cancers from the luminal intermediates," explains senior study author, Dr. Matthew J. Smalley from The Breakthrough Breast Cancer Research Centre at the Institute of Cancer Research in London. "Strikingly, the vast majority of breast tumors with mutations in BRCA1, a breast cancer susceptibility gene, have basal-like characteristics, suggesting a stem cell origin."
More recently, however, it was demonstrated that increases in abnormal luminal intermediate cells are associated with BRCA1 mutations and that there are similarities between the genes switched on in normal human luminal intermediate cells and basal-like breast cancer cells. "To resolve the true origin of BRCA1 breast cancer, we designed the first direct comparison of the effects of creating identical BRCA1-associated tumor predisposing events in basal stem versus luminal intermediate cells," says Dr. Smalley.
Specifically, the researchers deleted the BRCA1 gene in mouse basal stem cells or luminal intermediate cells. They discovered that although BRCA1 deletion caused tumors to form from both basal stem cells and luminal intermediate cells, only the latter had features that were identical to both human BRCA1 tumors and the majority of human basal-like breast cancers not associated with BRCA1 mutations.
Taken together, these findings suggest that the majority of so-called basal-like breast cancers are derived from luminal intermediate cells and not from basal stem cells as was originally expected. "Our results highlight luminal intermediate cells as a key to understanding the origins of basal-like breast cancer," concludes Dr. Smalley. "This has important implications for treatment and prevention strategies for this aggressive disease."
The reseachers include:
Gemma Molyneux, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Felipe C. Geyer, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Fiona-Ann Magnay, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Afshan McCarthy, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Howard Kendrick, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Rachael Natrajan, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Alan MacKay, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Anita Grigoriadis, Breakthrough Breast Cancer Research Unit, Guy's Hospital, King's Health Partners AHSC, London, UK; Andrew Tutt, Breakthrough Breast Cancer Research Unit, Guy's Hospital, King's Health Partners AHSC, London, UK; Alan Ashworth, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Jorge S. Reis-Filho, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; and Matthew J. Smalley, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK.
Source:
Cathleen Genova
Cell Press
The glandular tissue of the breast contains two main cell types, outer "basal" cells and inner "luminal" cells. The basal layer consists mostly of differentiated cells with a small population of mammary stem cells. The luminal layer contains differentiated cells and several types of cells which are intermediates between the luminal cells and stem cells. The different cell types can be identified and separated on the basis of specific molecular markers.
"In breast cancer, it has been proposed that different tumor subtypes may originate from different stem and intermediate cells, with more aggressive 'basal-like' breast cancers originating from basal stem cells and less aggressive breast cancers from the luminal intermediates," explains senior study author, Dr. Matthew J. Smalley from The Breakthrough Breast Cancer Research Centre at the Institute of Cancer Research in London. "Strikingly, the vast majority of breast tumors with mutations in BRCA1, a breast cancer susceptibility gene, have basal-like characteristics, suggesting a stem cell origin."
More recently, however, it was demonstrated that increases in abnormal luminal intermediate cells are associated with BRCA1 mutations and that there are similarities between the genes switched on in normal human luminal intermediate cells and basal-like breast cancer cells. "To resolve the true origin of BRCA1 breast cancer, we designed the first direct comparison of the effects of creating identical BRCA1-associated tumor predisposing events in basal stem versus luminal intermediate cells," says Dr. Smalley.
Specifically, the researchers deleted the BRCA1 gene in mouse basal stem cells or luminal intermediate cells. They discovered that although BRCA1 deletion caused tumors to form from both basal stem cells and luminal intermediate cells, only the latter had features that were identical to both human BRCA1 tumors and the majority of human basal-like breast cancers not associated with BRCA1 mutations.
Taken together, these findings suggest that the majority of so-called basal-like breast cancers are derived from luminal intermediate cells and not from basal stem cells as was originally expected. "Our results highlight luminal intermediate cells as a key to understanding the origins of basal-like breast cancer," concludes Dr. Smalley. "This has important implications for treatment and prevention strategies for this aggressive disease."
The reseachers include:
Gemma Molyneux, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Felipe C. Geyer, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Fiona-Ann Magnay, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Afshan McCarthy, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Howard Kendrick, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Rachael Natrajan, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Alan MacKay, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Anita Grigoriadis, Breakthrough Breast Cancer Research Unit, Guy's Hospital, King's Health Partners AHSC, London, UK; Andrew Tutt, Breakthrough Breast Cancer Research Unit, Guy's Hospital, King's Health Partners AHSC, London, UK; Alan Ashworth, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; Jorge S. Reis-Filho, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK; and Matthew J. Smalley, The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK.
Source:
Cathleen Genova
Cell Press
National Consistency In Gov't Reimbursement For Breast Prostheses, Australia
The Australian Medical Association welcomed the long-awaited Federal Government rollout of a program that will help cancer survivors with the cost of new and replacement breast prostheses.
AMA President, Dr Rosanna Capolingua, said the AMA had been concerned for patients and their ability to afford breast prostheses.
"Up until now, women with breast cancer in different States of Australia received differing levels of support for breast prostheses. In some States, the support has been low, making it very difficult for a woman who has had a mastectomy from breast cancer to manage that part of her recovery," she said.
"This program will make a significant difference to the quality of life of many breast cancer survivors," she said. "The Government has recognised this need and this financial support is most welcome."
Dr Capolingua said doctors would be able to provide patients, who have undergone a mastectomy, with consistent advice and information on how they can get guaranteed assistance with the cost of breast prostheses.
"Doctors welcome this excellent program for patients.
"Women will now be able to access up to $400 towards the cost of breast prosthesis through a quick and easy national system. They can also claim replacement prostheses every two years," she said.
The AMA will continue to advocate for patients from both the health care and financial viewpoints.
Australian Medical Association
AMA President, Dr Rosanna Capolingua, said the AMA had been concerned for patients and their ability to afford breast prostheses.
"Up until now, women with breast cancer in different States of Australia received differing levels of support for breast prostheses. In some States, the support has been low, making it very difficult for a woman who has had a mastectomy from breast cancer to manage that part of her recovery," she said.
"This program will make a significant difference to the quality of life of many breast cancer survivors," she said. "The Government has recognised this need and this financial support is most welcome."
Dr Capolingua said doctors would be able to provide patients, who have undergone a mastectomy, with consistent advice and information on how they can get guaranteed assistance with the cost of breast prostheses.
"Doctors welcome this excellent program for patients.
"Women will now be able to access up to $400 towards the cost of breast prosthesis through a quick and easy national system. They can also claim replacement prostheses every two years," she said.
The AMA will continue to advocate for patients from both the health care and financial viewpoints.
Australian Medical Association
Alternative To Biopsy For Women With Probably Benign Lesions
Radiologists can, with confidence, recommend a six-month follow-up diagnostic mammogram rather than an immediate biopsy for patients with "probably benign" breast lesions, a new study emphasizes.
The study found that six-month short-interval follow-up examinations had an 83% sensitivity, which is similar to the sensitivity of other diagnostic mammograms, said Erin J. Aiello Bowles, MPH, lead author of the study from the Group Health Center for Health Studies. High sensitivity means identifying a high proportion of "true positives" (actual cancer cases) and a low proportion of "false negatives" (cases mistakenly deemed benign).
The study included 45,007 initial short-interval follow-up mammograms. "Short-interval follow-up mammograms are done to monitor for changes in 'probably benign' breast lesions (findings seen on mammograms that have a very low probability of being cancer). Because the probability of cancer is so low, we don't want to put the patient through an unnecessary biopsy, which is an invasive procedure that increases both patient anxiety and medical costs," said Aiello Bowles. "At the same time, we want to closely monitor these patients, because changes in 'probably benign' lesions occasionally mean cancer, and we want to detect the cancers as early as possible," she said. In the study, 360 women with "probably benign" lesions were diagnosed with breast cancer within six months; and 506 women were diagnosed with cancer within 12 months (altogether about one in 100 of the "probably benign" lesions), Aiello Bowles said.
"The Breast Imaging-Reporting and Data System (BI-RADS) recommends that women with a BI-RADS category 3 (probably benign) lesion get a six-month diagnostic mammogram, with follow-up continued for the next two to three years until long-term stability is demonstrated," said Dr. Edward Sickles, a coauthor and radiologist involved in the study from the University of California San Francisco. "This study emphasizes that radiologists and patients need to follow that recommendation," he said.
The study appears in the May issue of the American Journal of Roentgenology.
Source: Necoya Tyson
American Roentgen Ray Society
The study found that six-month short-interval follow-up examinations had an 83% sensitivity, which is similar to the sensitivity of other diagnostic mammograms, said Erin J. Aiello Bowles, MPH, lead author of the study from the Group Health Center for Health Studies. High sensitivity means identifying a high proportion of "true positives" (actual cancer cases) and a low proportion of "false negatives" (cases mistakenly deemed benign).
The study included 45,007 initial short-interval follow-up mammograms. "Short-interval follow-up mammograms are done to monitor for changes in 'probably benign' breast lesions (findings seen on mammograms that have a very low probability of being cancer). Because the probability of cancer is so low, we don't want to put the patient through an unnecessary biopsy, which is an invasive procedure that increases both patient anxiety and medical costs," said Aiello Bowles. "At the same time, we want to closely monitor these patients, because changes in 'probably benign' lesions occasionally mean cancer, and we want to detect the cancers as early as possible," she said. In the study, 360 women with "probably benign" lesions were diagnosed with breast cancer within six months; and 506 women were diagnosed with cancer within 12 months (altogether about one in 100 of the "probably benign" lesions), Aiello Bowles said.
"The Breast Imaging-Reporting and Data System (BI-RADS) recommends that women with a BI-RADS category 3 (probably benign) lesion get a six-month diagnostic mammogram, with follow-up continued for the next two to three years until long-term stability is demonstrated," said Dr. Edward Sickles, a coauthor and radiologist involved in the study from the University of California San Francisco. "This study emphasizes that radiologists and patients need to follow that recommendation," he said.
The study appears in the May issue of the American Journal of Roentgenology.
Source: Necoya Tyson
American Roentgen Ray Society
New Form Of Targeted Antibody Therapy Offers Further Hope To Patients With Incurable HER2-positive Breast Cancer
Final results from a phase II study presented at ASCO show that 25% of women with advanced HER2-positive breast cancer experienced significant shrinkage of their tumours, when treated with a first in class combination antibody called trastuzumab-DM1 (T-DM1). T-DM1 potentially represents another option for patients with metastatic disease, for which there is no cure.
T-DM1 is potentially a new and highly specialised cancer treatment that combines two approaches to treating cancer in one medicine. It represents the first treatment for breast cancer in a new class of powerful drugs known as antibody-drug conjugates (ADC) - monoclonal antibodies linked with cytotoxic agents that are designed to selectively kill cancer cells. These are results from a phase II study and T-DM1 is not currently licensed in the UK.
The two components of the T-DM1 are: the well-known and proven treatment trastuzumab (Herceptin®), an antibody that specifically targets HER2, and DM1, a chemotherapy treatment. By combining both of these treatments the monoclonal antibody element allows the chemotherapy to be targeted directly to the HER2 genes that encourage the cancer to grow. In this way T-DM1 is able to specifically target cancer cells and maximise clinical benefit, while minimising some of the side effects seen with non-targeted chemotherapy.
Principal UK study investigator for the T-DM1 Phase III study EMILIA, Dr David Miles (Medical Oncologist, Mount Vernon Hospital, UK) said, "These results are welcome news for the thousands of women with advanced HER2-positive breast cancer who have few, if any remaining treatment options. To see such efficacy with one treatment is unusual. It is important that we continue to explore further this promising treatment that takes the drug directly and selectively to kill the cancer cells," Dr Miles said.
In the phase II study approximately 35% of patients either saw their tumours shrink, or their disease stabilised for at least six months. The single-arm, open-label phase II study enrolled 112 patients and was conducted in the US. EMILIA, a global phase III study investigating T-DM1 in patients whose breast cancer has become worse following previous anti-HER2 therapy is ongoing.
Results from the phase I study of TDM-1, presented at ASCO 2008, showed that adverse events, over grade 2, were infrequent and manageable[i].
In addition no cardiac-specific toxicity was observed.
About ASCO
ASCO - the American Society of Clinical Oncology is the world's largest conference on cancer treatments. The annual meeting attracts 37,000 delegates and is renowned as the world's premier cancer conference.
About HER2 positive breast cancer
In 2006, 45,508 women were diagnosed with breast cancer in the UK[ii]. It is thought that about 1 in 5 women with breast cancer will have HER2-positive tumours[iii]. In HER2-positive breast
cancer, increased quantities of the HER2 protein are present on the surface of the tumour cells. This is known as 'HER2 positivity'. This is a distinct form of breast cancer that demands attention because HER2 positive tumours are fast growing and are associated with poor prognosis and a high chance of relapse.
About the Phase II study
The T-DM1 phase II study was a multi-institutional, open-label, single arm trial. The study took place in the United States of America and enrolled 112 women whose breast cancer had progressed following previous treatment with two or more HER2-targeted therapies. The primary endpoint was objective response rate (ORR) as determined by an independent review and the secondary endpoints include:
- duration of response (DoR)
- progression-free survival (PFS)
- clinical benefit rate (CBR)
T-DM1 is the first and only single-agent molecule being studied in a class of investigational agents known as antibody-drug conjugates (ADC) in HER2-positive breast cancer. T-DM1 is made up of trastuzumab (Herceptin), a well-known and proven treatment for HER2-positive cancer, and DM1, a highly potent anti-microtubule derivative. The rationale behind this coupling is to increase the anti-tumour efficacy by bringing trastuzumab and DM1 directly to the cancer cell with limited or no increase in treatment-related side effects. Results from the first phase were presented at ASCO last year.
About EMILIA (phase III study)
Currently a global phase III study (EMILIA) evaluating T-DM1 for second-line advanced HER2-positive breast cancer is ongoing. The 580-patient randomised study was initiated in February 2009 and is comparing single agent T-DM1 to lapatinib plus capecitabine.
References
[i] Beeram et al. A phase I study of trastuzumab-DM1 (T-DM1), a first-in-class HER2 antibody-drug conjugate (ADC), in patients (pts) with advanced HER2+ breast cancer (BC). J Clin Oncol 26: 2008 (May 20 suppl; abstr 1028).
[ii] Cancer Research UK Breast Cancer incidence statistics - info.cancerresearchuk/cancerstats/types/breast/incidence/ Last accessed 27.05.09
[iii] Macmillan Support / Cancerbackup.
cancerbackup.uk/Cancertype/Breast/Causesdiagnosis/HER2testing Last accessed 27.05.09
Source
Roche
View drug information on Herceptin.
T-DM1 is potentially a new and highly specialised cancer treatment that combines two approaches to treating cancer in one medicine. It represents the first treatment for breast cancer in a new class of powerful drugs known as antibody-drug conjugates (ADC) - monoclonal antibodies linked with cytotoxic agents that are designed to selectively kill cancer cells. These are results from a phase II study and T-DM1 is not currently licensed in the UK.
The two components of the T-DM1 are: the well-known and proven treatment trastuzumab (Herceptin®), an antibody that specifically targets HER2, and DM1, a chemotherapy treatment. By combining both of these treatments the monoclonal antibody element allows the chemotherapy to be targeted directly to the HER2 genes that encourage the cancer to grow. In this way T-DM1 is able to specifically target cancer cells and maximise clinical benefit, while minimising some of the side effects seen with non-targeted chemotherapy.
Principal UK study investigator for the T-DM1 Phase III study EMILIA, Dr David Miles (Medical Oncologist, Mount Vernon Hospital, UK) said, "These results are welcome news for the thousands of women with advanced HER2-positive breast cancer who have few, if any remaining treatment options. To see such efficacy with one treatment is unusual. It is important that we continue to explore further this promising treatment that takes the drug directly and selectively to kill the cancer cells," Dr Miles said.
In the phase II study approximately 35% of patients either saw their tumours shrink, or their disease stabilised for at least six months. The single-arm, open-label phase II study enrolled 112 patients and was conducted in the US. EMILIA, a global phase III study investigating T-DM1 in patients whose breast cancer has become worse following previous anti-HER2 therapy is ongoing.
Results from the phase I study of TDM-1, presented at ASCO 2008, showed that adverse events, over grade 2, were infrequent and manageable[i].
In addition no cardiac-specific toxicity was observed.
About ASCO
ASCO - the American Society of Clinical Oncology is the world's largest conference on cancer treatments. The annual meeting attracts 37,000 delegates and is renowned as the world's premier cancer conference.
About HER2 positive breast cancer
In 2006, 45,508 women were diagnosed with breast cancer in the UK[ii]. It is thought that about 1 in 5 women with breast cancer will have HER2-positive tumours[iii]. In HER2-positive breast
cancer, increased quantities of the HER2 protein are present on the surface of the tumour cells. This is known as 'HER2 positivity'. This is a distinct form of breast cancer that demands attention because HER2 positive tumours are fast growing and are associated with poor prognosis and a high chance of relapse.
About the Phase II study
The T-DM1 phase II study was a multi-institutional, open-label, single arm trial. The study took place in the United States of America and enrolled 112 women whose breast cancer had progressed following previous treatment with two or more HER2-targeted therapies. The primary endpoint was objective response rate (ORR) as determined by an independent review and the secondary endpoints include:
- duration of response (DoR)
- progression-free survival (PFS)
- clinical benefit rate (CBR)
T-DM1 is the first and only single-agent molecule being studied in a class of investigational agents known as antibody-drug conjugates (ADC) in HER2-positive breast cancer. T-DM1 is made up of trastuzumab (Herceptin), a well-known and proven treatment for HER2-positive cancer, and DM1, a highly potent anti-microtubule derivative. The rationale behind this coupling is to increase the anti-tumour efficacy by bringing trastuzumab and DM1 directly to the cancer cell with limited or no increase in treatment-related side effects. Results from the first phase were presented at ASCO last year.
About EMILIA (phase III study)
Currently a global phase III study (EMILIA) evaluating T-DM1 for second-line advanced HER2-positive breast cancer is ongoing. The 580-patient randomised study was initiated in February 2009 and is comparing single agent T-DM1 to lapatinib plus capecitabine.
References
[i] Beeram et al. A phase I study of trastuzumab-DM1 (T-DM1), a first-in-class HER2 antibody-drug conjugate (ADC), in patients (pts) with advanced HER2+ breast cancer (BC). J Clin Oncol 26: 2008 (May 20 suppl; abstr 1028).
[ii] Cancer Research UK Breast Cancer incidence statistics - info.cancerresearchuk/cancerstats/types/breast/incidence/ Last accessed 27.05.09
[iii] Macmillan Support / Cancerbackup.
cancerbackup.uk/Cancertype/Breast/Causesdiagnosis/HER2testing Last accessed 27.05.09
Source
Roche
View drug information on Herceptin.
Tennis Mom Betty Agassi Shares Her Battle With Breast Cancer And Champions Disease Awareness At The US Open
Betty Agassi,
mother of world tennis champion Andre Agassi, today will be launching a
global initiative at the US Open to educate women battling breast cancer
about ways that will help them minimize the risk of their cancer coming
back.
This education initiative, which is sponsored by Novartis Oncology,
focuses on the need for women with breast cancer to pay continued attention
to their health and conduct ongoing communication with their doctors. Mrs.
Agassi and Novartis Oncology in collaboration with the United States Tennis
Association are launching this education initiative from the US Open to
encourage international awareness of this issue.
"I was diagnosed with breast cancer in 2000, and it was a shock," said
Mrs. Agassi. "The thought of it returning is frightening; yet, I know the
risk is real. However, with the help and support of my family, I am here
today to encourage women with breast cancer to stay on top of their own
health. It is so important for women to understand that the battle with
breast cancer does not stop after initial treatment."
Regardless of all the diagnostic and treatment advances that have been
made, breast cancer still is a fearsome opponent. According to the World
Health Organization, more than 1.2 million people worldwide will be
diagnosed with breast cancer this year.(1) Medical experts attribute the
decline in breast cancer deaths to earlier detection and innovative
medicines, yet the disease is still a leading cause of cancer death among
women worldwide.(2) Tumors can often be removed, but can grow back, invade
surrounding tissues and organs, and travel to other parts of the body.
Through the education initiative, Mrs. Agassi is encouraging women with
breast cancer to embrace knowledge and communication as two of the most
powerful tools to use in reducing the risk of breast cancer recurrence.
Ribbon of Pink
During this year's US Open, the USTA has dedicated today, August 29, as
'Ribbon of Pink' Day to spotlight breast cancer awareness and the need for
ongoing vigilance against the risk of recurrence. Attendees are invited to
visit the Ribbon of Pink booth for more information on how to help reduce
the risk of breast cancer recurrence.
In addition, Mrs. Agassi is directing women to
RibbonofPink, an Internet site that provides information on
how women can stay informed about progress in breast cancer treatment and
tips for healthy living to help protect themselves after surgery.
"Researching and developing treatments for breast cancer has been a
focus for Novartis for more than 30 years," said Diane Young, M.D., vice
president, global head, Clinical Development, Novartis Oncology. "Making
sure women are as knowledgeable as they can be about advances in diagnosis
and treatment is our goal in supporting this campaign. Together with Betty
Agassi, we have a truly winning team to encourage all breast cancer
patients to continue to follow up on their treatment with their doctors."
About Breast Cancer Recurrence
While advances in breast cancer treatment have increased the likelihood
of survival, many breast cancer patients still may experience a recurrence
of their disease. Options exist to reduce recurrence, but communication
between patients and health care professionals about treatment choices is
crucial. Approximately one-third of women with estrogen receptor-positive
early breast cancer experience a recurrence, and over half of those
recurrences occur more than five years after surgery. Through at least 12
years of follow-up, the risk of breast cancer recurrence remains
appreciable; even some patients who are considered low risk have some risk
of the cancer coming back. Studies show that more than half of all breast
cancer recurrences and two-thirds of all breast cancer deaths occur after
completion of five years of standard tamoxifen therapy.
About Treatment Advances
Innovative medications, such as aromatase inhibitors, exist to help
reduce recurrence, but communication between patients and health care
professionals about ongoing treatment is critical. The goal of an aromatase
inhibitor is to deprive cancer cells of estrogen, thus helping to slow or
even halt the growth of the tumor. Leading professional organizations such
as the American Society of Clinical Oncology and the National Comprehensive
Cancer Network recommend aromatase inhibitors as part of optimal adjuvant
treatment for postmenopausal women with hormone-sensitive breast cancer.
About Novartis
Novartis Pharmaceuticals Corporation researches, develops, manufactures
and markets leading innovative prescription drugs used to treat a number of
diseases and conditions, including central nervous system disorders, organ
transplantation, cardiovascular diseases, dermatological diseases,
respiratory disorders, cancer and arthritis. The company's mission is to
improve people's lives by pioneering novel healthcare solutions.
Located in East Hanover, New Jersey, Novartis Pharmaceuticals
Corporation is an affiliate of Novartis AG (NYSE: NVS) - a world leader in
pharmaceuticals and consumer health. In 2005, the Group's businesses
achieved sales of USD 32.2 billion and pro forma net income of USD 6.1
billion. The Group invested approximately USD 4.8 billion in R&D.
Headquartered in Basel, Switzerland, Novartis Group companies employ
approximately 97,000 people and operate in over 140 countries around the
world. For further information please consult novartis.
(1) imaginis/breasthealth/statistics.asp
(2) uuhsc.utah/healthinfo/adult/breast/stats.htm
Novartis
novartis
RibbonofPink
mother of world tennis champion Andre Agassi, today will be launching a
global initiative at the US Open to educate women battling breast cancer
about ways that will help them minimize the risk of their cancer coming
back.
This education initiative, which is sponsored by Novartis Oncology,
focuses on the need for women with breast cancer to pay continued attention
to their health and conduct ongoing communication with their doctors. Mrs.
Agassi and Novartis Oncology in collaboration with the United States Tennis
Association are launching this education initiative from the US Open to
encourage international awareness of this issue.
"I was diagnosed with breast cancer in 2000, and it was a shock," said
Mrs. Agassi. "The thought of it returning is frightening; yet, I know the
risk is real. However, with the help and support of my family, I am here
today to encourage women with breast cancer to stay on top of their own
health. It is so important for women to understand that the battle with
breast cancer does not stop after initial treatment."
Regardless of all the diagnostic and treatment advances that have been
made, breast cancer still is a fearsome opponent. According to the World
Health Organization, more than 1.2 million people worldwide will be
diagnosed with breast cancer this year.(1) Medical experts attribute the
decline in breast cancer deaths to earlier detection and innovative
medicines, yet the disease is still a leading cause of cancer death among
women worldwide.(2) Tumors can often be removed, but can grow back, invade
surrounding tissues and organs, and travel to other parts of the body.
Through the education initiative, Mrs. Agassi is encouraging women with
breast cancer to embrace knowledge and communication as two of the most
powerful tools to use in reducing the risk of breast cancer recurrence.
Ribbon of Pink
During this year's US Open, the USTA has dedicated today, August 29, as
'Ribbon of Pink' Day to spotlight breast cancer awareness and the need for
ongoing vigilance against the risk of recurrence. Attendees are invited to
visit the Ribbon of Pink booth for more information on how to help reduce
the risk of breast cancer recurrence.
In addition, Mrs. Agassi is directing women to
RibbonofPink, an Internet site that provides information on
how women can stay informed about progress in breast cancer treatment and
tips for healthy living to help protect themselves after surgery.
"Researching and developing treatments for breast cancer has been a
focus for Novartis for more than 30 years," said Diane Young, M.D., vice
president, global head, Clinical Development, Novartis Oncology. "Making
sure women are as knowledgeable as they can be about advances in diagnosis
and treatment is our goal in supporting this campaign. Together with Betty
Agassi, we have a truly winning team to encourage all breast cancer
patients to continue to follow up on their treatment with their doctors."
About Breast Cancer Recurrence
While advances in breast cancer treatment have increased the likelihood
of survival, many breast cancer patients still may experience a recurrence
of their disease. Options exist to reduce recurrence, but communication
between patients and health care professionals about treatment choices is
crucial. Approximately one-third of women with estrogen receptor-positive
early breast cancer experience a recurrence, and over half of those
recurrences occur more than five years after surgery. Through at least 12
years of follow-up, the risk of breast cancer recurrence remains
appreciable; even some patients who are considered low risk have some risk
of the cancer coming back. Studies show that more than half of all breast
cancer recurrences and two-thirds of all breast cancer deaths occur after
completion of five years of standard tamoxifen therapy.
About Treatment Advances
Innovative medications, such as aromatase inhibitors, exist to help
reduce recurrence, but communication between patients and health care
professionals about ongoing treatment is critical. The goal of an aromatase
inhibitor is to deprive cancer cells of estrogen, thus helping to slow or
even halt the growth of the tumor. Leading professional organizations such
as the American Society of Clinical Oncology and the National Comprehensive
Cancer Network recommend aromatase inhibitors as part of optimal adjuvant
treatment for postmenopausal women with hormone-sensitive breast cancer.
About Novartis
Novartis Pharmaceuticals Corporation researches, develops, manufactures
and markets leading innovative prescription drugs used to treat a number of
diseases and conditions, including central nervous system disorders, organ
transplantation, cardiovascular diseases, dermatological diseases,
respiratory disorders, cancer and arthritis. The company's mission is to
improve people's lives by pioneering novel healthcare solutions.
Located in East Hanover, New Jersey, Novartis Pharmaceuticals
Corporation is an affiliate of Novartis AG (NYSE: NVS) - a world leader in
pharmaceuticals and consumer health. In 2005, the Group's businesses
achieved sales of USD 32.2 billion and pro forma net income of USD 6.1
billion. The Group invested approximately USD 4.8 billion in R&D.
Headquartered in Basel, Switzerland, Novartis Group companies employ
approximately 97,000 people and operate in over 140 countries around the
world. For further information please consult novartis.
(1) imaginis/breasthealth/statistics.asp
(2) uuhsc.utah/healthinfo/adult/breast/stats.htm
Novartis
novartis
RibbonofPink
Hope For Targeted Gene Therapy Of Selected Cancers
A protein with the ironic name "Srcasm" can counteract the effects of tumor-promoting molecules in skin cells, according to new research by investigators at the University of Pennsylvania School of Medicine. Using animal models, the researchers discovered that Srcasm acts like a brake in epithelial cells, preventing uncontrolled cell growth caused by a family of proteins called Src kinases. This finding, published online in the Journal of Biological Chemistry, suggests a target for future gene therapy to treat skin, head, neck, colon, and breast cancers.
Investigators have known for decades that Src kinase proteins can promote tumor formation. Src kinase activity is elevated in most skin cancers and in common carcinomas, including those of the breast and colon. At the same time, levels of the signaling molecule Srcasm are typically low in tumor cells, notes senior author John Seykora, MD, PhD, Assistant Professor of Dermatology. The current findings show that Srcasm can reduce the amount of Src kinases in cells; they have also shown that increased activity of these kinases is associated with cancerous skin lesions.
Src kinase proteins act like messengers, sending signals that control cellular growth. Found just inside the cell membrane, they conduct signals from cell surface receptors to the proteins that promote growth. Src kinases can be activated during cell division or through mutation. If these proteins are too active, they promote rapid cell growth that can spin out of control. In skin cells, Src kinases and Srcasm are involved in signaling pathways that control cell growth and differentiation.
See Saw Action
The researchers decided to test whether Srcasm could counteract the errant effects of Src kinases. They developed strains of mice with high levels of Srcasm, which had normal skin, and other strains that over-expressed the Src-kinase called Fyn, which resulted in uncontrolled cell growth with thick, scaly, hairless plaques on the skin. These plaques, or lesions, resembled precursors of cancer. Breeding experiments with the mice indicated that high Srcasm levels counteracted the effects of Fyn.
The findings reveal that levels of Fyn and Srcasm work in a kind of see-saw - when Srcasm production is low, dangerous amounts of Fyn can build up in cells. But when Srcasm production is increased, Fyn levels go down. "The binding of Srcasm to Fyn regulates Fyn's persistence in the cell," says Seykora. "If Srcasm is low, Fyn persists longer and sends more growth-promoting signals."
Reversing Tumors
Eventually, Srcasm might play a role in targeted gene therapies for cancers that are triggered by activated Src kinases. Such a therapy would likely use an adenovirus to carry a gene that codes for Srcasm into skin cells to increase Srcasm production, as used in some other gene therapy treatments. Initially, clinicians may try this method on oral cavity and skin cancers.
Next, the Penn researchers will determine whether Srcasm can actually reverse tumor formation in skin. Seykora's team has already prepared an adenovirus and mice with the tumor-forming Src kinases expressed in their skin. Within six months, the group expects to know whether Srcasm can decrease squamous cell carcinoma formation in skin, mentions Seykora.
This research was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Other co-authors in addition to Seykora are Weijie Li, Christine Marshall, Lijuan Mei, and Joel Gelfand, all from Penn.
PENN Medicine is a $2.9 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #3 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.
The University of Pennsylvania Health System includes three hospitals, all of which have received numerous national patient-care honors (Hospital of the University of Pennsylvania; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center); a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.
Contact: Karen Kreeger
University of Pennsylvania School of Medicine
Investigators have known for decades that Src kinase proteins can promote tumor formation. Src kinase activity is elevated in most skin cancers and in common carcinomas, including those of the breast and colon. At the same time, levels of the signaling molecule Srcasm are typically low in tumor cells, notes senior author John Seykora, MD, PhD, Assistant Professor of Dermatology. The current findings show that Srcasm can reduce the amount of Src kinases in cells; they have also shown that increased activity of these kinases is associated with cancerous skin lesions.
Src kinase proteins act like messengers, sending signals that control cellular growth. Found just inside the cell membrane, they conduct signals from cell surface receptors to the proteins that promote growth. Src kinases can be activated during cell division or through mutation. If these proteins are too active, they promote rapid cell growth that can spin out of control. In skin cells, Src kinases and Srcasm are involved in signaling pathways that control cell growth and differentiation.
See Saw Action
The researchers decided to test whether Srcasm could counteract the errant effects of Src kinases. They developed strains of mice with high levels of Srcasm, which had normal skin, and other strains that over-expressed the Src-kinase called Fyn, which resulted in uncontrolled cell growth with thick, scaly, hairless plaques on the skin. These plaques, or lesions, resembled precursors of cancer. Breeding experiments with the mice indicated that high Srcasm levels counteracted the effects of Fyn.
The findings reveal that levels of Fyn and Srcasm work in a kind of see-saw - when Srcasm production is low, dangerous amounts of Fyn can build up in cells. But when Srcasm production is increased, Fyn levels go down. "The binding of Srcasm to Fyn regulates Fyn's persistence in the cell," says Seykora. "If Srcasm is low, Fyn persists longer and sends more growth-promoting signals."
Reversing Tumors
Eventually, Srcasm might play a role in targeted gene therapies for cancers that are triggered by activated Src kinases. Such a therapy would likely use an adenovirus to carry a gene that codes for Srcasm into skin cells to increase Srcasm production, as used in some other gene therapy treatments. Initially, clinicians may try this method on oral cavity and skin cancers.
Next, the Penn researchers will determine whether Srcasm can actually reverse tumor formation in skin. Seykora's team has already prepared an adenovirus and mice with the tumor-forming Src kinases expressed in their skin. Within six months, the group expects to know whether Srcasm can decrease squamous cell carcinoma formation in skin, mentions Seykora.
This research was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Other co-authors in addition to Seykora are Weijie Li, Christine Marshall, Lijuan Mei, and Joel Gelfand, all from Penn.
PENN Medicine is a $2.9 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #3 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.
The University of Pennsylvania Health System includes three hospitals, all of which have received numerous national patient-care honors (Hospital of the University of Pennsylvania; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center); a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.
Contact: Karen Kreeger
University of Pennsylvania School of Medicine
Relief From Fatigue In Cancer Survivors With The Aid Of Acupressure
As thousands of breast cancer survivors battle persistent fatigue, a Michigan State University nursing researcher is studying whether acupressure - a technique where physical pressure is applied to acupuncture points by the hand, elbow or various devices - can help alleviate symptoms.
Gwen Wyatt will study 300 breast cancer survivors to examine the effects of two acupressure treatments on persistent cancer-related fatigue, a state of being tired or weary that affects up to 82 percent of survivors within the first five years of diagnosis.
"There are more than two million breast cancer survivors today, and persistent cancer-related fatigue is one of the most common and distressing symptoms," said Wyatt, a professor with the College of Nursing. "It is associated with decreased quality of life, poor sleep quality and depression."
With acupressure - derived from acupuncture, a component of traditional Chinese medicine - pressure is applied to acupuncture points on the body to treat disease. Wyatt said pilot research has shown self-administered acupressure can significantly decrease fatigue by as much as 70 percent in cancer survivors, as well as improve sleep quality.
As part of the study, the breast cancer survivors (all at least 12 months after completion of cancer treatments and suffering from persistent fatigue) will be randomly divided into three groups receiving relaxation acupressure, stimulating acupressure or routine standard care for six weeks.
In addition to measuring the impacts of the treatments on cancer-related fatigue, Wyatt and her team will examine the effects on sleep quality.
"There are few treatment options for persistent cancer-related fatigue, and these costly treatments often require a trained practitioner or have unacceptable side effects," Wyatt said. "On the other hand, self-administered acupressure is nontoxic, inexpensive and requires minimal instruction. It appears to be a promising treatment for persistent fatigue."
The study, part of a subcontract via the University of Michigan, is being funded by the National Cancer Institute. Wyatt is working with Suzanna Zick and Richard Harris from U-M's departments of Anesthesiology and Family Medicine on the overall project.
Wyatt has researched multiple complementary and alternative medicines for women recovering from breast cancer in hopes of creating a viable treatment intervention. Recent research published by Wyatt in the journal Nursing Research found 57 percent of women are using such therapies, and the sicker a woman is the more likely she is to use multiple therapies.
"Improving quality of life is a research priority at the College of Nursing," she said. "If a patient has to live with breast cancer, then the health care community needs to ensure that patient has the highest quality of life possible during treatment and aftercare."
Source:
Michigan State University
Gwen Wyatt will study 300 breast cancer survivors to examine the effects of two acupressure treatments on persistent cancer-related fatigue, a state of being tired or weary that affects up to 82 percent of survivors within the first five years of diagnosis.
"There are more than two million breast cancer survivors today, and persistent cancer-related fatigue is one of the most common and distressing symptoms," said Wyatt, a professor with the College of Nursing. "It is associated with decreased quality of life, poor sleep quality and depression."
With acupressure - derived from acupuncture, a component of traditional Chinese medicine - pressure is applied to acupuncture points on the body to treat disease. Wyatt said pilot research has shown self-administered acupressure can significantly decrease fatigue by as much as 70 percent in cancer survivors, as well as improve sleep quality.
As part of the study, the breast cancer survivors (all at least 12 months after completion of cancer treatments and suffering from persistent fatigue) will be randomly divided into three groups receiving relaxation acupressure, stimulating acupressure or routine standard care for six weeks.
In addition to measuring the impacts of the treatments on cancer-related fatigue, Wyatt and her team will examine the effects on sleep quality.
"There are few treatment options for persistent cancer-related fatigue, and these costly treatments often require a trained practitioner or have unacceptable side effects," Wyatt said. "On the other hand, self-administered acupressure is nontoxic, inexpensive and requires minimal instruction. It appears to be a promising treatment for persistent fatigue."
The study, part of a subcontract via the University of Michigan, is being funded by the National Cancer Institute. Wyatt is working with Suzanna Zick and Richard Harris from U-M's departments of Anesthesiology and Family Medicine on the overall project.
Wyatt has researched multiple complementary and alternative medicines for women recovering from breast cancer in hopes of creating a viable treatment intervention. Recent research published by Wyatt in the journal Nursing Research found 57 percent of women are using such therapies, and the sicker a woman is the more likely she is to use multiple therapies.
"Improving quality of life is a research priority at the College of Nursing," she said. "If a patient has to live with breast cancer, then the health care community needs to ensure that patient has the highest quality of life possible during treatment and aftercare."
Source:
Michigan State University
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