Articles filed under 'Breast Cancer'
Women with very dense breast tissue are five times more likely to get breast cancer than those whose breasts contain more fatty tissue, according to a recent study. Doctors should discuss this particular risk factor with their patients who have mammograms.
Fat appears dark on mammograms, but dense tissue is light like tumors, thus more easily hiding cancers. Not only are breast cancers more likely to be hidden by white on white, they also appear more frequently in dense breasts.
Density is a true risk factor, along with other strong predictors such as the woman’s age and whether she carries BRCA1 and 2 gene mutations. Yet, this condition is rarely taken into consideration or discussed between doctor and patient.
This new study — involving 1,112 women whose medical records were examined at cancer centers in Toronto and Vancouver, Canada — is published in a January 2007 issue of the New England Journal of Medicine. Women taking part who had at least 75% dense breasts showed five times more likelihood of developing cancer over the time frame studied than women with less than 10% density. It confirms previous studies that pointed to the masking effect and a separate biological risk.
In this particular study, cancers were 18 times more likely to be found in women with the densest breasts within the first year after their mammograms. These cancers were judged to have been present earlier but masked by the difficulty in diagnosing their condition.
Breast density involves the presence of more connective, duct-lining and milk-gland tissue than fat tissue. It is impossible for a woman to judge the density herself. It must be routinely evaluated with a mammogram.
This most important factor to note is that extremely dense breaks are “an incredible risk factor†that probably accounts for a large percentage of breast cancers being found. Woman whose mammograms indicate dense breast tissue should be followed up rapidly with more sensitive technologies such as digital mammograms, sonograms or magnetic resonance image (MRI).
Some medical experts believe that women with this significant risk factor may be one day be cautioned to make lifestyle changes and even be prescribed medications for cancer prevention. If genes that promote density can be identified, they could serve as targets for cancer drugs.
Source:Â Associated Press; CNN HealthÂ
January 20th, 2007
For the first time in years, breast cancer rates declined by more then 7% in 2003. The decline was greater in women 50 to 69, those most likely to use hormone replacement therapy (HRT). In those with estrogen-dependent types of tumors, the drop was 12%.
According to presenters at the recent San Antonio Breast Cancer Symposium, breast cancer was diagnosed in 14,000 fewer women than expected in 2003.
After the Women’s Health Initiative Study was stopped in July 2002 due to evidence of more risk than benefit of long-term HRT, many doctors urged post-menopausal women to go off their hormones. Within a year of this medical news, about half of the U.S. women who had been on HRT stopped their use.
Breast cancer had been steadily rising, about 2% annually, for decades. It is the most common major cancer in American women and the second leading cause of cancer deaths in women. All U.S. cancer registries reporting to the federal government in 2003 showed a decline in their statistical information on this type of female cancer.
Researchers believe it possible that some breast cancers were already present, but that cutting off estrogen stopped their growth or caused them to shrink to an undetectable size. They also postulate that mammogram usage has been leveling off, thus contributing to the decline in cancer detection and smaller statistics. A trend toward lower-dose and shorter duration HRT could also have played a role.
Statistics from one year do not tell the entire story. It will take time to know whether breast cancer is truly on the decline and establishing a definite downward trend. Breast cancer might still be present in some menopausal women who abandoned HRT, but slower growing, taking longer to be detected.
In 2006, some 213,000 cases of breast cancer are expected in U.S. women, with over a million new cases worldwide.
Source:Â CNN.com
December 15th, 2006
A new model for assessing a woman’s risk of developing breast cancer indicates that breast density is as important a factor as their age, family history, or prior breast biopsy. In a study that included more than 1 million women receiving annual screening mammograms, 11,638 women were diagnosed with breast cancer within a year.
Those more likely to develop breast cancer were found to have very dense breasts. These women are more difficult to image, as milk gland tissue and cancer tumors both appear white on the mammogram. Fatty tissue is less dense, appears clear, and is therefore easier for radiologists to find tumors.
After adjustment for age, study researchers found that the risk of developing breast cancer was nearly four times greater for women with very dense breasts, compared to women with mostly fat tissue in their breasts. Post-menopausal women tend to have less dense breasts that include more fatty tissue.
The new prediction models are expected to help doctors identify women who are most at risk for breast cancer so that necessary interventions may take place. Additional screening using sonograms or MRI are more effective for identifying tumors in women with dense breasts.
This study, published in the September 6 issue of the Journal of the National Cancer Institute, is the largest study so far in terms of population size and the number of risk factors examined.
Source:Â ScienceDaily.com
September 26th, 2006
Women who have inherited gene mutations that increase their risk for breast cancer may benefit from having annual magnetic resonance imaging (MRI) in addition to mammograms.
Defective BRCA1 and BRCA2 genes can increase a woman’s lifetime risk of getting breast cancer by 45% to 65%, according to a study published recently in the Journal of the American Medical Association. However, inherited gene mutations account for only 5% to 10% of all breast cancer cases.
Mammography is usually an effective screening tool for detecting breast cancer, but the results are not always accurate. For women with especially dense breasts, mammography can be inadequate. MRI is a much more sensitive imaging technology for these women. The drawbacks are that MRI is ten times as expensive and can increase the risk of false-positive results.
Women from families with strong histories of breast cancer often have genetic testing to learn whether they have inherited mutations in their BRCA1 and/or BRCA2 genes. If these genes are defective, they are also at higher risk for ovarian cancer.
Women with known genetic susceptibility sometimes opt to have both breasts removed (bilateral mastectomy), or they take drugs such as tamoxifen in hopes of preventing cancer. Others decide to follow screening guidelines and deal with breast cancer if and when it occurs.
After age 25, annual mammograms are recommended for women with mutations in BRCA1 and BRCA2 genes. Breast cancers are generally rare in women under age 35. For high-risk women between ages 35 and 55, annual screening with MRI and mammography would be a sound investment in their health. After age 55, women’s breasts are not as dense, and mammography alone would probably detect even small cancers.
Improvements in mammography including digital mammograms could soon make that technology almost as sensitive as MRI and also more cost effective.
Source: WebMD
Technorati Tags: Cancer, Breast Cancer, Womens Healthcare
June 3rd, 2006
In April, the National Cancer Institute announced that raloxifene (evista) was as good as tamoxifen at preventing invasive breast cancer. Their conclusion was based on a study of 20,000 high-risk women in which half were given tamoxifen and half raloxifene for a five-year period.
Statistical results were roughly equal, although raloxifene was touted as having fewer unwanted side effects than tamoxifen. There were 163 cases of breast cancer in the group taking tamoxifen, compared to 167 in women taking raloxifene. With either group, the cases of breast cancer that developed during the study were about half as many as if the women had not been treated.
Like those on tamoxifen, a very small number got uterine cancer or developed blood clots, potential side effects of either drug. With those on raloxifene, these conditions developed at a slightly lower rate, but the numbers are small and therefore not very statistically significant. These conditions could have developed by chance and not have been related to taking the drug.
The principal difference found was that raloxifene lowered the risk of “invasive†breast cancer, but did not protect for lobular and ductal carcinomas in situ. These non-invasive cancers can develop into invasive cancers, which are the type that kill, but they can be effectively treated when found early. Tamoxifen appears to lower the risk for both invasive and non-invasive cancers.
Taking either drug is risk reduction, not prevention. You are treating a large number of healthy women, who might develop unwanted side effects, while helping only a small number to avoid breast cancer. In 1,000 high-risk women, approximately 20 women treated would avoid getting breast cancer, while another 20 would develop it despite taking the medications. This means that 980 women are exposed to the drugs’ risks but will get no cancer benefit.
Since there is no way to predict who will get breast cancer, high-risk women must choose whether they wish to take the medications that can have unpleasant side effects such as hot flashes and other menopausal symptoms.
At some point in the future, we may be able to pinpoint who is actually at high risk of breast cancer. Then, taking these medications will make more sense for women who are otherwise healthy.
Another development on the horizon is a study to test a class of drugs called aromatase inhibitors, which are used to treat breast cancer. They may do a better job of prevention than either tamoxifen or raloxifene.
Source:Â New York Times, May 9, 2006, by Denise Grady
May 15th, 2006
In women treated for breast cancer, large numbers of them are not returning for annual mammograms. A new study at the University of Massachusetts Medical School looked at compliance with mammography guidelines in 797 breast cancer survivors over the age of 55.
Average age was 69, and 80% were Caucasian. Forty percent had one breast removed, while the others had a lumpectomy or other breast-conserving therapy.
About 80% of women had mammograms within the first year after surgery. By the fifth year, the percentage dropped to 63%. Women who had lumpectomies were more likely to get annual mammograms than those who received a mastectomy.
All taking part in the study had health insurance. For those who don’t, their mammography screenings are assumed to be even lower. Follow-up with imaging technology is vital, as women with cancer in one breast have three-times the risk of cancer recurring in the other breast.
Regular screening increases the survival rate for a breast cancer diagnosis. When a recurrence is detected earlier, the chances of successful treatment are improved.
• Although researchers in this study did not investigate reasons for low compliance, the answers are probably: fear of what may be found, complacency, or problems in communication between patient and health care providers.
Women who are five years or more past their diagnosis should not consider themselves “home free.†Breast cancer can recur in a breast or metastasize to other parts of the body many years later. For this reason, breast cancer survivors should be followed for life.
After the five-year marker, some HMOs have a policy that medical or radiation oncologists will discontinue their involvement in the woman’s care.
In that case, she needs to receive a thorough annual breast exam by her gynecologist, general practitioner or surgical oncologist. The American Cancer Society recommends that all women over age 40 get an annual mammogram, but less than two-thirds do.
Those who have undergone double mastectomies do not need mammogram follow-up. The blood test CA15-3 can give additional reassurance, although results are not completely reliable. If their doctor doesn’t offer it, women should ask for this simple lab test.
Breast cancer remains the most common cancer in women. In the U.S., 180,000 cases were diagnosed in 1994. About 41,000 die of the disease each year. Men can also get breast cancer but account for only 1% of total cases.
Sources:Â Medical News Today, editor, Christian Nordqvist;
MSNBC.Com
May 8th, 2006
A widely used test for breast cancer risk failed to detect defective BRCA1 and BRCA2 genes in 12 percent of American women from high-risk families with multiple cases of breast or ovarian cancer.
The standard commercial test used in the U.S. is more accurate for women of Ashkenazi Jewish descent, a group highly susceptible to breast cancer. Myriad Genetics currently has a corner on the market for this type of the test, which can cost up to $3,000.
In the United States, only 5 to 10 percent of white women develop breast or ovarian cancers due to inherited mutations in BRCA genes. The lifetime risk for women with mutations in BRCA1 and BRCA2 genes is a staggering 80 percent for breast cancer. Young women with either of these genetic mutations are especially at risk for ovarian cancer.
They have a 40 percent or greater lifetime risk with a BRCA1 mutation and a 20 percent or higher risk if BRCA2 is involved. When these mutations are found through testing, many at-risk women opt for frequent screening or removal of their breasts and/or ovaries.
The Journal of the American Medical Association recently published results of a 2002-2005 study at the University of Washington of 300 breast cancer patients who were first in their family to be diagnosed. Researchers used a number of screening tests to identify not only BRCA genes, but also CHEK2, TP53 and PTEN — other inherited mutations that can also predict breast cancer.
The technique they used, MLPA, is a molecular way to detect genetic variations. This test is available in the U.S. to study authors only at this time. Researchers found that seventeen percent of patients had mutations previously undetected in testing, and 12 percent had “rearrangements†in the critical BRCA genes. The failure rate was higher for women who were under age 40 when first tested.
A more thorough test may be available through Myriad Genetics by the end of 2006, according to Dr. Gergory Critchfield, president of the genetic testing division of that company.
He noted that with the current test, the rate of false negatives for all women tested is less than 1 percent. The chance of missing genetic mutations in testing is generally much smaller for women who are not from very high-risk families.
Sources:Â MedicineNet.com and New York Times
April 5th, 2006
For various reasons, women of African-American descent are more likely to die from breast cancer than their Caucasian counterparts. Recent findings published in the Journal of Clinical Oncology indicated that black women were nearly 20 percent more likely than white women to succumb to their disease. Researchers took into consideration variables such as socioeconomic status and disease stage.
Another study, conducted at Mount Sinai School of Medicine in New York, showed that women in minority groups – including Hispanics — were unlikely to receive complete follow-up treatment after breast cancer surgery. Treatments including radiation, chemotherapy or hormonal therapy are often given as an extra precaution against recurrence.
The two studies were controlled for socioeconomic differences, the presence of other illnesses, and whether or not a woman had health insurance. The likelihood of not getting the best adjuvant therapy (follow-up care) was 16 percent among white women, 23 percent for Hispanics and 34 percent for blacks.
Further investigation is needed as to the role of biologic, genetic, and socio-cultural factors in breast cancer mortality among minority women, especially among black women. Progress toward reducing racial disparities in cancer deaths can be made by providing equal opportunities for breast cancer treatment.
Breast cancer screening and early detection play a vital role in finding and treating the disease at its most curable stage. Minority women often do not seek treatment or have access to care until breast cancer is in advanced stages.
Source Article Â
March 31st, 2006
The drug Trastuzumab (Herceptin) has been shown to transform the grim prognosis of breast cancer to a relatively good one — according to evidence from several recent trials.
Women with an early stage of this highly aggressive breast cancer can especially benefit from this newer drug. Women with HER2-positive cancers need rapid treatment, as their disease can return in an incurable form more readily than other types of early breast cancers.
Overproduction of the protein HER2 appearing on the surface of cancer cells spurs their division and rapid growth. After the drug Herceptin binds to HER2-positive cells, it blocks their growth and causes them to be destroyed by the woman’s immune system. Studies show that Herceptin cut the chances of having a relapse in half in patients followed for three years.
Herceptin is used only selectively, as only 20 to 30 percent of women have breast tumors positive for HER2. The cancer-fighting drug is given by intravenous infusion, usually weekly or every few weeks in a doctor’s office. It has its risks, however, and may cause debilitating side effects in some patients. Infrequently, it causes severe allergic reactions, heart failure and lung problems. In many cases, cardiac abnormalities have been found to be reversible.
Because the drug targets the cancerous cells and works with the woman’s immune system, Herceptin causes fewer side effects than conventional chemotherapy. In a few cases, women have died from complications arising from their treatment. This is also true for standard chemotherapy. In some cases, Herceptin is given in combination with or after chemotherapy. It is not yet known whether trastuzumab works best when given after or simultaneously with chemotherapy.
For patients without heart disease and who are most at risk of succumbing to their cancer, Herceptin may prove to be the answer to their prayers.
Johns Hopkins Medical Letter, Health After 50, February 2006
March 19th, 2006
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