Breast Cancer Facts
One in eight women or 12.6% of all women will get
breast cancer in her lifetime.
Breast cancer risk increases with age and every woman
is at risk.
Every 13 minutes a woman dies of breast cancer.
Seventy-seven percent of women with breast cancer are
More than 1.7 million women who have had breast cancer
are still alive in the United States.
Breast cancer is the leading cause of cancer death in
women between the ages of 15 and 54, and the second cause of
cancer death in women 55 to 74.
Seventy-one percent of black women diagnosed with
breast cancer experience a five-year survival rate, while eighty-six
percent of white women experience five-year survival.
The first sign of breast cancer usually shows up on a
woman's mammogram before it can be felt or any other symptoms are
Risks for breast cancer include a family history,
atypical hyperplasia, delaying pregnancy until after age 30 or never
becoming pregnant, early menstruation (before age 12), late menopause
(after age 55), current use or use in the last ten years of oral
contraceptives, and daily consumption of alcohol.
Early detection of breast cancer, through
monthly breast self-exam and particularly yearly mammography after age
40, offers the best chance for survival.
Ninety-six percent of women who find and treat
breast cancer early will be cancer-free after five years.
Over eighty percent of breast lumps are not cancerous,
but benign such as fibrocystic breast disease.
Oral contraceptives may cause a slight increase in
breast cancer risk; however 10 years after discontinuing use of oral
contraceptives the risk is the same as for women who never used the
Estrogen replacement therapy for over 5 years slightly
increases breast cancer risk; however the increased risk appears to
disappear 5-10 years after discontinuing the use of estrogen replacement
You are never too young to develop breast
cancer! Breast Self-Exam should begin by the age of twenty.
American Cancer Society
National Cancer Institute
Getting tested or treated for a
life-threatening disease is nerve-racking for anyone, but it can be all
the more so when outside of your home country.
Japan's approach to
breast cancer, with the annual death toll exceeding 10,000 (lower than
typical rates in the West) is unique to some degree, what with the
country's egalitarian health-care system and particularly its
long-standing custom of surgeons doing all the work. Experts say that
surgeons here do everything from making a diagnosis to performing
surgery to even prescribing medication.This is
different from practices in the West, especially in the United States,
where treatment is divided among a team of specialists that include
radiologists, oncologists, surgeons and — in later stages of cancer
— palliative-care specialists, says Hirofumi Mukai, a breast
oncologist at the National Cancer Center Hospital East in Chiba
practice has some merit, in that there is a sense of continuity in the
treatment," Mukai says. "Many Japanese feel more comfortable
dealing with one doctor who knows everything about them."
But even the best
surgeons cannot specialize in all aspects of care, so doctors who are
strong in some areas, such as diagnostic skills or chemotherapy, can be
weak in other areas, Mukai says.
vary from country to country. The good news in Japan is that the country
has a national health insurance system, which requires everybody to be
insured, either as individuals or through their employer. This universal
care system provides treatments that are approved by the government
relatively cheaply. The bad news is that unapproved treatments,
including ones common in the West, are out of reach for most patients.
Take, for example, a
drug called trastuzumab, more commonly known under the trade name of
Herceptin. Herceptin is an antibody used in the treatment of breast
cancer, which attacks the HER2 protein that can fuel tumors. It has
"a big influence" on patients here, Mukai says, because it is
known to reduce the recurrence of breast cancer by half and is the only
"targeted therapy" drug for breast cancer approved in Japan.
Targeted therapy refers to medications that block the growth of cancer
by interfering with the molecules needed for tumor growth, rather than
simply attacking rapidly-dividing cells.
In Japan, Herceptin is
covered by insurance only after the cancer returns or spreads to
different parts of the body; Mukai says that in the United States and
many parts of Europe, the drug is available for use in post-surgery
treatment to prevent the cancer from coming back.
probably be available insurance coverage for such usage next year, but
currently those who want to have the drug prescribed must pay ¥3
million for the full-course, yearlong treatment, which excludes the cost
of consultations with doctors and other fees, according to Mukai. What
is worse, under Japanese law, patients who receive uninsured treatments
such as Herceptin have their insurance coverage cut off for all other
related procedures, because the government does not allow patients to
mix insured and uninsured treatments. This could change, though,
following a recent district court ruling that deemed such practices
In Japan, more women are now having
only parts of their breast removed and are keeping non-cancerous areas,
whereas in the United States, the trend is going in the opposite
direction. An October study published in the Journal of Clinical
Oncology found that 4.5 percent of 152,755 breast-cancer patients
examined had their unaffected breast surgically removed along with their
affected breast in 2003, up from 1.8 percent in 1998. Todd Tuttle, the
study's lead author and chief of surgical oncology at the University of
Minnesota Medical School, has been quoted in the New York Times saying:
"The comment patients make is, 'I just want to be done with it.'
They never want to have another mammogram again; they never want to have
another biopsy again."
director of breast surgical oncology and director of the Breast Center
at St. Luke's International Hospital in Tokyo, says that, unlike in the
United States, a double mastectomy immediately followed by breast
reconstruction surgery is not a treatment option here because breast
construction is not insured and, besides, few reconstruction experts
for patients in Japan is that genetic testing for BRCA1 and BRCA2 genes,
inherited mutations of which can greatly increase a woman's
breast-cancer risk, is not covered by insurance, either. St. Luke's
Breast Center is one of the few places that offer the test, but at a
hefty cost of ¥200,000, Nakamura says.
The upside is, for
anyone interested in a screening for breast cancer, most municipalities
now offer subsidized mammography X-ray tests for women aged 40 or older.
Screening programs vary from city to city, cover different age groups
and are offered at different intervals. Most cities offer an X-ray exam
every two years, either free of charge or for a nominal fee of ¥500 or
¥1,000. Some provide a combination of mammography and, if requested,
screening using ultrasound.
mammography and ultrasound screening can detect small tumors, some
experts say ultrasound is preferred for those younger than 40 because
the high density of mammary glands in women in their 30s makes it
difficult for cancerous tissues to be found. Ultrasound is also widely
used during surgery, as many Japanese surgeons are skilled at operating
ultrasound machines and removing tumors on the spot, says Nakamura.
the only thing we can be proud of as being advanced in the world,"
he says. by Tomoko Otake
10/23/2007 More women who have cancer in only one
breast are getting both breasts removed, says research that found the
trend more than doubled in just six years. It's still a rare option:
Most breast cancer in this country is treated by lumpectomy, removing
just the tumor while saving the breast.
But the new study suggests 4.5 percent of breast
cancer surgery in 2003 involved women getting cancerous and healthy
breasts simultaneously removed, a 150 percent increase from 1998 _
with no sign that the trend was slowing.
Young women are most likely to choose the
aggressive operation, researchers report Monday in the Journal of
The concern is whether they're choosing in the
heat of the moment _ breast cancer surgery often is within two weeks
of diagnosis _ or with good understanding of its pros and cons.
"Are these realistic decisions or not?"
asks Dr. Todd Tuttle, cancer surgery chief at the University of
Minnesota, who led the study after more women sought the option in
his own hospital.
"I'm afraid that women believe having their
opposite breast removed is somehow going to improve their breast
cancer survival. In fact, it probably will not affect their
survival," he said.
The initial tumor already may have sent out seeds
of spread to key organs, Tuttle explained.
But removing the remaining healthy breast does
greatly lower, although not eliminate, chances of a new cancer
developing on the opposite side.
Don't underestimate the peace of mind that brings,
said Trisha Stotler Meyer of Vienna, Va., who had her breasts
removed three weeks ago.
"Doctors are not up at night crying" in
fear of their next mammogram, said Meyer, 37, who went back for a
double mastectomy after her initial cancer surgery. "I don't
want to have to deal with the stress."
Meyer is far from alone.
In a single day last week, Dr. Shawna Willey of
Georgetown University's Lombardi Cancer Center had two patients seek
One needed her entire cancerous breast removed,
and immediately asked to have the healthy one removed, too. Another
woman had recently undergone a lumpectomy and was sick from
chemotherapy _ and returned to ask that both breasts be fully
"Her perception is, 'If I have my breasts
taken off, I never have to do this again,'" said Willey, who
asked the woman to see a counselor and finish chemo before deciding.
"I can understand that point of view,"
she added. "But I always tell them, it's not a guarantee."
The American Cancer Society estimates 178,480 U.S.
women will be diagnosed with breast cancer this year. About 40,460
will die of it.
Some women at high risk, because of notorious
breast cancer genes or family history, choose preventive
mastectomies before cancer ever strikes.
Tuttle's study is the first national look at how
many women choose to remove both a diseased and healthy breast
He used a government cancer registry that covers
16 regions, a representative sample of the U.S. population, to track
more than 150,000 breast cancer surgeries between 1998 and 2003.
Tuttle calculated that lumpectomies accounted for
almost 60 percent of those surgeries in 2003. Lumpectomies have
gradually increased since they were proven just as effective as
breast removal for early cancer in 1991.
The surprise: Single mastectomies remain the No. 2
option but are dropping _ while double mastectomies, although
uncommon, were on the rise for every stage of cancer. Even women who
qualify for anti-hormone drugs that greatly protect the remaining
breast were as likely to choose removal as women with
Why? Tuttle is planning a new study to tell, and
to see if candidates are warned about such risks as infection that
increase with the bigger surgery.
Meyer, the Virginia woman, had time to fully
consider the option. She was diagnosed with cancer in January 2005,
shortly after her son's birth. At first, she was content with a
lumpectomy, followed by chemotherapy and radiation. But she didn't
qualify for protective anti-hormone drugs. And then in March, Meyer
found a lump in her healthy breast. It wasn't cancer but a cyst that
would wax and wane, making for tense checkups.
"It really freaked me out," Meyer said.
"It was at that moment that my breasts became like tonsils. I
don't need them anymore. They're gone."
Georgetown's Willey says better reconstructive
surgery is partly spurring the trend. Still, she often encourages
women to wait to remove the second breast, as lining up
reconstruction sometimes dangerously delays treating the cancer.
"When I was younger ... I really tried to
argue with patients and talk them out of it," Willey said. Now,
if they've weighed the options, she doesn't.
"I can't recall a single patient who tells me
they regret that decision."
value of exercise during radiation therapy for breast and prostate
by Dr. Carol Kornmehl on February 25, 2007 - 2:28pm.
medicine integrates non-Western treatment methods into mainstream
medical practice. Examples include light exercise, guided imagery,
massage, yoga, reiki, tai chi, acupuncture, music therapy, and art
Fatigue is a common symptom during
cancer treatment, such as chemotherapy and radiation therapy. It can
stem from the underlying illness, insomnia/sleep deprivation, anxiety,
and/or the cancer treatment itself. Helping people manage and reduce
fatigue is an important component in enhancing their overall well-being.
After all, oncologists strive to treat the whole person and not just the
The mechanism of fatigue in
radiation therapy is not known. Often, it is not purely radiation
treatment induced, but rather, is due to one or more of the factors
In people with breast and prostate
cancer, the National Cancer Institute undertook a randomized controlled
study of cancer related fatigue in 38 individuals. 27 were women with
breast cancer and 11 were men with prostate cancer. All received at
least 30 radiation treatments, five days a week for six weeks.
Baseline tests to assess fatigue,
strength, and cardiovascular heath were performed before the people
received radiation therapy. The study compared a half the people in the
group who followed an exercise program to the half who were randomized
to receive radiation therapy without exercise therapy.
The exercise group was required to
take walks daily and to try to increase the number of steps taken each
day. They wore pedometers and kept a diary. In addition, they were
assigned to complete 11 resistance band exercises daily, performing one
set of eight to 15 repetitions daily and gradually increasing to three
to four sets. Results revealed an 82% increase in the number of steps
walked daily and the use of resistance bands an average of 3 1/2 days
per week for 20 minutes at a moderate intensity level.
The mechanism by which exercise
alleviates fatigue is not clear. Although this study is small and more
clinical trials will be helpful, the results suggest that when exercise
is non-burdensome, safe and feasible, it serves as an inexpensive,
valuable tool in improving the quality of life of cancer survivors.
For more information about radiation
therapy, visit www.ASTRO.org , the website of The American Society of
Therapeutic Radiology and Oncology.
Kornmehl is a board certified radiation oncologist and author of the
critically acclaimed consumer health book, "The Best News About
Radiation Therapy" (M. Evans, 2004). Her website is www.RTSupportDoc.com
2006-12-17 Robin Khadduri gets monthly
shots of a drug that blocks the male hormone testosterone and is often
used to treat prostate cancer.
But Khadduri doesn't have a prostate or much
testosterone either. She and many other young women are getting the
drug for breast cancer as part of a super-hormone treatment that new
research suggests may improve their survival odds.
This chemical equivalent of ovary removal has one
big advantage over surgery: it's not permanent, so it may preserve a
woman's ability to have children.
In premenopausal women, the drugs suppress the
pituitary gland, which produces hormones that control the ovaries
and cause a woman to have a period every month. Side effects of this
induced early menopause are similar to those of natural menopause _
hot flashes, night sweats, etc., according to new research presented
at the San Antonio Breast Cancer Symposium, which ended Sunday.
Women like Khadduri, who fear cancer's return,
consider that a small price to pay.
The drugs include triptorelin, goserelin,
leuprolide and buserelin, sold as Lupron, Zoladex, Prostap and other
Such drugs have been around for 20 years and are
used more in Europe than in the United States, where attention has
focused more heavily on chemotherapy, said V. Craig Jordan of Fox
Chase Cancer Center in Philadelphia, the scientist who developed
tamoxifen, a mainstay hormone drug for preventing cancer recurrence.
"This has been like tumbleweed slowing
gaining momentum," he said of ovarian suppression.
The drugs are most often used in two situations:
_ As an alternative to chemotherapy for women who
have had surgery for small, hormone-fueled tumors and are considered
at relatively low risk for recurrence.
_ As a way to keep the ovaries suppressed in women
whose periods return after temporarily stopping during chemotherapy.
"They call it 'chemopause,'" said
Khadduri, who is getting triptorelin shots now. The 37-year-old
mother of three from Needham, Mass., was found in January to have
two small tumors that had spread to at least one lymph node but not
"The thing I liked about it is, it was not
permanent," she said of the treatment. "It wasn't like I
was having surgery to have my ovaries removed. If the side effects
were too much, I could stop."
Her physician, Dr. Eric Winer of the Dana-Farber
Cancer Institute in Boston, enrolled her in one of three large
experiments currently under way to test this approach.
"It's the oldest of all treatments," but
doctors still do not know how much benefit it gives or how best to
use it, Winer said.
In the latest research, Jack Cuzick of the Wolfson
Institute of Preventive Medicine in London combined results from
more than a dozen studies involving 9,000 women from 1987 to 2001.
Those that tested ovary-suppressing drugs on top
or in place of chemotherapy and standard hormone therapy with
tamoxifen found a lower risk of recurrence after an average of seven
years _ 24 percent versus 29 percent _ among women given the more
Such women also had a smaller risk of death _ 11
percent versus 13 percent.
A second report at the cancer conference
reinforced the value of ovarian suppression.
Dr. Michael Gnant of the Medical University of
Vienna in Austria reported that women whose periods did not return
after chemotherapy had lower cancer relapse rates than those
"Additional hormone suppression may be
advisable" to keep periods from returning, he said.
On the Net:
Cancer conference: http://www.sabcs.org
2006-12-16 The first experiment ever to
show that low-fat diets could help prevent a return of breast cancer
now reveals, with longer follow-up, that the benefit was almost
exclusively to women whose tumor growth was not driven by hormones.
That could be huge _ the new results suggest but
cannot prove that these women might be able to cut their risk of
dying by up to 66 percent with such diets.
"That's as great or better than any treatment
intervention that we've given" for this type of cancer, which
is notoriously hard to treat, said Dr. C. Kent Osborne of Baylor
College of Medicine in Houston, who had no role in the study.
However, for women whose cancers are fueled by
hormones _ the vast majority of breast cancer patients _ the diet
change seemed to make little difference in the risk of recurrence or
survival. Questions remained about whether those who did benefit
truly were helped by cutting fat or by the weight loss that
"Maybe it raises as many issues as it
answers," said John Milner, chief of nutrition science research
for the National Cancer Institute, which paid for the first phase of
Initial findings from the study were reported at a
cancer conference in 2005 and will appear in this week's Journal of
the National Cancer Institute. Updated results with longer follow-up
on many of the original participants were presented Saturday at the
San Antonio Breast Cancer Symposium.
The mixed results were a surprise because doctors
had expected all women to benefit, said Dr. Rowan Chlebowski of the
University of California at Los Angeles, who led the work.
Hormones might play such a strong role in some
cancers that dietary changes have only weak impact on future risk,
The study involved 2,437 women with early stage
breast cancer, average age 58, at 39 sites around the country. All
had surgery followed by chemotherapy and five years of tamoxifen if
their tumors were hormone-fueled.
At the start of the study, 29 percent of their
calories came from fat _ 10 percent to 12 percent lower than the
typical American diet. Doctors told 1,462 of them to continue their
normal diets. The other 975 had counseling with dietitians to cut
fat to around 20 percent of daily calories.
The diet group averaged 33.3 grams of fat a day
compared to 51.3 grams for the others, and lost five to six pounds
during the study.
Five years later, cancer had returned in 9.8
percent of the diet group and 12.4 percent of those on standard
diets, which translated to a modest 24 percent lower risk for the
group as a whole.
But the result barely reached statistical
significance, meaning that the difference almost could have occurred
by chance alone. The new results, with longer followup, put the
difference for the overall group at 21 percent and even weaker
Researchers' ability to study the women beyond the
first five years was hampered by the federal grant running out. Two
charities _ the Breast Cancer Research Foundation and the American
Institute for Cancer Research _ gave money so they could resume.
Ten of the original 39 study sites have provided
complete information on their participants for an additional two
years, and information on deaths is available for all women in the
study, Chlebowski said.
The new results: 14 percent of women on low-fat
diets and 17 percent of the others have had a recurrence or second
cancer. About 8 percent of dieters and 10 percent of the others have
However, there was a huge difference in the
subgroup of women whose tumors were fueled by neither estrogen nor
progesterone. Only 6 percent on low-fat diets died compared with 17
percent of the others. That translated to 66 percent lower risk of
death for those who trimmed fat.
Was the benefit due to weight loss, eating more
fruits and vegetables or something else? Researchers do not know.
"When you change the diet, you're probably
changing thousands of circulating proteins that could interact with
other targets," like insulin, that might impact cancer risk in
different ways depending on hormones, Chlebowski said.
"Excess calories, be they fat or otherwise,
are associated with cancer risk," Milner said.
Some earlier studies did not find low-fat diets to
reduce breast cancer risk. The new one's conclusion that some may
benefit from substantially cutting fat "suggests that getting
below a certain threshold of fat intake may be important," said
Dr. JoAnn Manson, a women's health expert at Harvard-affiliated
Brigham and Women's Hospital.
Chlebowski will help lead a new study in the
United States and Canada that will start next year and test weight
loss and increased exercise in addition to low-fat diets to try to
reduce cancer risk in women whose tumors are helped to grow by
On the Net:
Breast cancer meeting: http://www.sabcs.org
Cancer institute: http://www.cancer.gov
Cancer Drop Tied to Hormones
The millions of women who quit taking menopause hormones after a big
federal study found that the pills raised the risk of breast cancer now
have more reason to be glad they stopped.
new analysis reveals that U.S. breast cancer rates plunged more than 7
percent in 2003 and strongly suggests that the reason is less hormone
a big deal ... amazing, really," said one of the researchers, Dr.
Rowan Chlebowski of Harbor-UCLA Medical Center in Los Angeles.
"It's better than a cure" because these are cases that never
occurred, he said.
14,000 fewer women were diagnosed with the disease than had been
expected, researchers reported Thursday at the San Antonio Breast Cancer
take years to form, so going off hormones would not instantly prevent
new tumors. But tumors that had been developing might stop growing,
shrink or disappear, so they were no longer detected by mammograms,
dropped most among women 50 and older _ the age group taking hormones.
The decline was biggest for tumors whose growth is fueled by estrogen _
the type most affected by hormone use.
fact, when both factors were combined _ older women with
estrogen-positive tumors _ the drop was 12 percent.
decline was seen in every single cancer registry that reports
information to the federal government, and no big change occurred with
any other major type of cancer. These are strong signs that the breast
cancer decline is no statistical fluke or error.
separate study by the American Cancer Society, currently in press with a
medical journal, also documents the drop in cases. Lead author Ahmedin
Jemal attributes two-thirds of it to a decline in hormone use and the
rest to mammography use leveling off, resulting in fewer tumors being
are really trying to look at the big picture," he said. "You
cannot rule out the effect of screening."
cancer is the most common major cancer in American women and the second
leading cause of cancer deaths in women. About 213,000 new cases are
expected to occur in the United States this year and more than 1 million
in the United States rose almost 2 percent per year from 1990 to 1998,
then began to slightly decrease, said Dr. Peter Ravdin of the University
of Texas M.D. Anderson Cancer Center in Houston, who led the analysis
presented at the Texas conference.
July 2002, the federal Women's Health Initiative study was stopped after
more breast cancers and heart problems occurred among women taking
led to new warning labels on the drugs and doctor groups urging women to
use the lowest dose for the shortest time possible for hot flashes and
other menopause symptoms.
a year, about half of women who had been taking hormones stopped.
Prescriptions had been steady at around 22 million each quarter, but
plummeted to 12.7 million in the last quarter of 2003, according to IMS
Health, which tracks drug sales.
cancer rates declined, too. In 2002, there were roughly 134 cases per
100,000 women _ a 2.5 percent drop from about 137 the previous year. In
2003, there were only 124 cases per 100,000 women _ about a 7 percent
drop over 2002. That is the most significant decline in the breast
cancer rate since records have been kept beginning in the 1970s.
saw an even stronger trend when they looked month-to-month. Cases
dropped 6 percent in the first half of 2003 and 9 percent in the second
across the entire year, there appeared to be a trend toward
decrease," Ravdin said.
tumors declined twice as much as tumors that are not fueled by estrogen.
The decline in incidence among women ages 50-69 was three times that of
other age groups.
numbers come from the National Cancer Institute's surveillance database,
which uses cancer registries around the country to project national
incidence and death rates.
the 2003 numbers were first released a few months ago, they were grouped
with 2001 and 2002 and portrayed as a leveling off of breast cancer
after decades of steady rise. The big single-year drop was not pointed
don't want to overinterpret one point" without knowing whether it
is a trend, said Kathy Cronin, a National Cancer Institute statistician
who worked on the new analysis.
major health organizations have been cautious because of not wanting to
call attention to something of this much interest to everyone
prematurely," said Dr. Michael Thun of the cancer society.
doesn't have to be a trend to be real," he said. "Such a rapid
effect is most consistent with the idea that cancers that were already
there ... were actually being stopped in their growth to the point where
they would not be detected."
is not known whether these tumors will regress and never become a
problem or just take longer to show up, he said.
doctors already know that withdrawing hormones causes tumors to shrink.
If a woman with estrogen-sensitive breast cancer has her ovaries
removed, "her tumor will stop growing immediately," Ravdin
JoAnn Manson, a women's health expert at Harvard-affiliated Brigham and
Women's Hospital in Boston who has a new book out on hormones and
menopause, thinks the big drop in breast cancer cases could be due to
hormones, "especially a reduction in long duration of use."
also possible that a trend toward lower doses of hormones has played a
role," she said.
and other doctors are continuing to study women in the big federal study
who had been on hormones and then quit.
statistics for 2004 are expected in April. Information from one large
registry, California's, published recently in the Journal of Clinical
Oncology, hints that the trend is continuing.
Pharmaceuticals, which makes the hormone pills Prempro and Premarin, may
not be much affected by the new data, said Deutsche Bank analyst Barbara
Ryan. Most women are already aware of the drugs' risks and those that
choose to use them do so only for a short time, she said.
wouldn't expect a big impact."
Antonio Breast Cancer meeting: http://www.sabcs.org
study: http://www.nhlbi.nih.gov/whi/index.html%emph_ off(%)
2006-11-30 Scientists used the abortion
drug RU-486 to keep tumors at bay in mice bred with a gene destined to
give them breast cancer.
No one is suggesting women use the abortion pill
that way. But the provocative experiment helped illustrate how the
notorious breast cancer gene BRCA1 does its dirty work, by spurring
a hormone called progesterone that RU-486 happens to block.
If researchers could create a safer hormone
blocker, it might offer a long-awaited alternative for women with
the bad gene. They have few good options today to prevent breast
"All of us have to be cautious," said
cell biologist Eva Lee of the University of California, Irvine, who
led the research published in Friday's edition of the journal
Science. "But I do think if there is a better anti-progesterone
available, hopefully there will be other options in the future for
Cancer specialists not involved with the
experiment praised the work, even as they cautioned women not to get
their hopes up yet.
"This is an avenue worth pursuing on a
research level," said Dr. Claudine Isaacs, an oncologist at
Georgetown University Hospital who works closely with carriers of
BRCA1 and a related gene.
"This is work in a mouse," she said.
"It's clearly too early to start recommending use of this
Dr. Len Lichtenfeld, the American Cancer Society's
deputy chief medical officer, said researchers and patients will
"take interest in this topic and explore it further."
He called the paper "elegant research,"
but stressed that "it would not be appropriate in any way,
shape or form that women start taking RU-486 for this purpose."
Long-term use of RU-486 could suppress the immune
system and cause other side effects.
Some 212,000 women in the United States will be
diagnosed with breast cancer this year. Only 5 percent to 10 percent
will have a hereditary form. Women who inherit mutations in the
BRCA1 gene are at far greater risk of cancer than the average woman.
By age 70, more than half of those gene carriers develop either
breast or ovarian cancer.
Their options today include:
_Frequent cancer screening, in hopes of catching
_Removing both breasts while they are still
_Taking the anticancer drug tamoxifen, which helps
_Removing the ovaries before age 50, cutting the
risk of both cancers.
These are anxiety-provoking options. Hence the
push to determine exactly how BRCA1 triggers tumors, so maybe
doctors and women could fight its bad effects more easily.
Particularly puzzling, BRCA1 mutations occur in
every cell of the body, raising questions about why the defect would
trigger cancer just in reproductive organs.
In their research, Lee and colleagues created mice
whose mammary glands only harbor the BRCA1 mutation.
The scientists found that the bad gene caused
breast tissue to have too-high levels of progesterone receptors.
That means the hormone sticks around longer than it should, in turn
sparking excess cell growth. In fact, the mice's breast tissue
looked like it should have during pregnancy, when temporarily high
progesterone levels cause breast growth as the gland prepares to
The final evidence came from RU-486, also called
mifepristone. It causes human abortions by suppressing progesterone,
a hormone crucial to sustaining pregnancy.
Instead of a human pill, Lee implanted some of the
cancer-prone mice with an RU-486 pellet designed to slowly emit the
drug into their bodies over two months.
By 8 months of age, each of the untreated
gene-defective mice had developed tumors. But none of the mice given
RU-486 had developed tumors by 12 months, when the study stopped.
Lee cautioned that RU-486 is not a good candidate
for such long-term use in people. She said more targeted
progesterone blockers already are being developed.
2006-08-21 As lawyers argued over which evidence should be
allowed, a judge Monday delayed jury selection in the first trial of
4,500 lawsuits filed nationwide that challenge Prempro, a
hormone-replacement therapy that some women say causes breast cancer.
Linda Reeves of Benton sued drug maker Wyeth, claiming she
developed breast cancer after taking Prempro for eight years. Helene
Rush of Little Rock has argued similar claims in a federal suit
against the drug maker. Rush has an Oct. 10 court date.
Prempro is a widely prescribed estrogen-progestin combination used
to treat premenopausal symptoms, such as hot flashes.
While plaintiffs say Wyeth was more worried about money than
patient safety while developing the drug, the drug company wants
jurors to see its request _ made to the Food and Drug Administration
in 1983 _ for a study about the effects of combining estrogen and
progestin. Reeves' lawyers want the evidence limited, saying jurors
could be overwhelmed by such a huge file and miss its key portions.
Lawyers for both sides argued about the evidence before U.S.
Magistrate Judge Henry L. Jones Jr. on Monday as Jones filled in
temporarily for U.S. District Judge William R. Wilson, who will
preside over the trial. Jones pushed back jury selection to Tuesday.
A Women's Health Initiative study found that women who took Prempro
had a higher risk of breast cancer, stroke and coronary heart disease.
Wyeth recently reached more than $21 billion in settlements for
lawsuits over another drug combination, fen-phen, which was prescribed
as a diet drug. Analysts have said they don't think Wyeth's
hormone-replacement therapy settlements will be nearly as high as the
2006-07-24 Older women who take hormone pills that combine
estrogen and testosterone more than double their risk of breast
cancer, according to a study of more than 70,000 nurses.
"This type of hormone therapy may help with mood, libido and
bone mineral density, but the possible risk of breast cancer may
outweigh these benefits," said study co-author Rulla Tamimi of
Harvard Medical School.
The findings, published in Monday's Archives of Internal Medicine,
add to the evidence that certain types of hormone supplements, such as
estrogen-progestin pills, increase women's risk of breast cancer,
strokes and heart attacks. Earlier research also found a greater
breast cancer risk in women with higher natural levels of
The overall risk of breast cancer among the participants in the
latest study was small, with 17 cases of the disease among the 500 or
so women who took the estrogen-testosterone combination.
Women's natural levels of estrogen and testosterone decline with
Only about 2 percent of women taking hormones in the study in 2000
used a form that included testosterone. But usage climbed during the
24 years of the study as evidence appeared linking the hormone
combination to better bone density, improved mood and greater sexual
Estrogen-testosterone pills are sold under the brand names
Estratest and Estratest H.S. by Solvay Pharmaceuticals of Marietta,
Ga. Those brand names appear on a Washington-based advocacy group's
"Worst Pills" list because of breast cancer risk.
"We strongly urge women not to use this product or similar
products from compounding pharmacists," said Dr. Sidney Wolfe,
director of Public Citizen's Health Research Group, which produces the
Worst Pills list.
The Food and Drug Administration has asked Solvay for evidence the
drug eases hot flashes in menopausal women, as the label claims. The
company has requested a hearing on the matter.
The drug was approved 30 years ago, before such evidence was
The new study used data from the long-running Nurses' Health Study.
The women who took estrogen and testosterone after menopause had a 2
1/2 times higher risk of developing breast cancer than women who never
took hormones. Most of the women taking the combination used Estratest.
"The company has not yet had the opportunity to review the
details of the study or the content of the article," said Solvay
spokesman Gabrielle Braswell.
The researchers took into account other breast cancer risk factors,
such as family history, weight and age at menopause and still found an
increased risk associated with estrogen-testosterone pills.
On the Net:
Last update: 2006-07-24
By Craig Joseph
With the combined efforts of three West Virginia University professors,
a device was created that will serve as an early detector for various
types of cancer.
Dr. Peter Gannett of the WVU School of Pharmacy, Dr. Daniel Flynn,
associate director for basic research at the Mary Babb Randolph Cancer
Center, and Dr. David Lederman, WVU physics professor, are awaiting
patent protection on a nanodevice that tests a patient's biological
fluid for a cancer marker protein called Vascular Endothelial Growth
The amount of VEGF produced in the body is correlated with whether a
person has many types of common cancers, such as breast or lung cancer,
The device is about the size of an eraser tip on a pencil but elongated
with a sharp point on one end called a cantilever, Flynn said.
Antibodies (proteins that identify harmful antigens, or toxins), called
anti-VEGF, are attached to the tip of the cantilever to capture the
When the cantilever coated with the antibody runs into VEGF, the VEGF
sticks and the weight of the cantilever increases, Gannett said.
"So we have a very small cantilever, which sort of resembles a
diving board. Flick it, and it will vibrate. Flick it again, it'll
vibrate the same weight. This is its natural vibration frequency. Now,
add weight to it, flick it, and it will vibrate more slowly. If a sample
has VEGF, it will bind to the anti body, increase the weight, and there
will be a change in frequency," Gannett said. "It is actually
a very simple device except for the size."
Flynn said when the VEGF protein binds to the antibodies, the tip of the
cantilever bends by one angstrom or more, which can be measured using a
An angstrom is a unit of length equal to 100-millionth of a centimeter.
"Initial discussions of how to make this were started in December
during finals week. The physicists calculated how to make it and the
probability that it would work. The prototype device was ready for
testing in April," Flynn said.
In addition to Gannett, Flynn, and Lederman, additional research and
development for the device has been carried out by graduate student
Jarod Kabulski, post-doctoral student Dr. Jianhua Gu, undergraduate
student Cristina Pastuch and research assistant Odille Meyers, PhD.
Funding for development of the apparatus has come from the West Virginia
Nanotechnology Initiative, which has recently been expanded by a $13.5
million state-wide grant from the National Science Foundation and
Governor Joe Manchin.
Additional funding has been given by the Mary Babb Randolph Cancer
The group has also requested $250,000 in funding from the National
Institutes of Health. The application is pending, Gannett said.
"A prototype device has an estimate cost of $40,000-$50,000, and
this is doing all the work on campus (as inexpensive as it gets). A
production device may be simpler than what we are constructing and might
cost less to make, but this also depends on how many get made,
etc," Gannett said.
Including the equipment required to connect the cantilever device to the
real world and measure its vibration frequency, everything could fit
into a small suitcase, according to Gannett.
The device will be used on patients for the first time this summer when
the group will begin screening stage IV lung cancer patients in attempts
to show that VEGF can be detected in their sputum (the biological fluid
used in tests), Flynn said.
"The idea is this; most lung cancers are found by accident, say by
an x-ray obtained because someone thinks they may have pneumonia,"
If instead a tumor is found, it will likely be 1-2 centimeters in size
and therefore probably be closer to stage III. At stage III, a patient
has about an eight percent chance of living more than five years,
"What we hope is that the cantilever based device can be used in
routine screening of all patients as part of an annual check-up and that
if a person has cancer, the method will detect it as stage I or II where
the odds of living more than five years are nearly 50 percent,"
Gannett said the cost of screening to patients will be quite low and in
the vicinity of many standard blood tests.
2006-06-24 A multiyear study of elevated breast cancer
rates in several Long Island communities found no environmental
factors contributing to the spike, the state Health Department
"The results of the investigation found nothing unusual,"
the agency said in a statement released in Albany.
"We hope that our findings will ease concern among residents
in Suffolk County about breast cancer and the local environment,"
said Health Commissioner Antonia C. Novello. "This investigation
represented the largest and most thorough examination of environmental
risk factors that may be related to cancer in a particular geographic
Despite Novello's comments, a breast cancer advocate immediately
derided the findings.
"I totally do not agree," Karen Joy Miller, president and
founder of the Huntington Breast Cancer Action Coalition, said in a
telephone interview. "We definitely know genetics alone does not
cause diseases. To say there are no environmental causes is totally
The study sought to identify unusual environmental factors to
explain elevated breast cancer rates _ sometimes as high as 50 percent
above average _ between 1993 and 1997 in Coram, Mount Sinai, Port
Jefferson Station, Miller Place, Port Jefferson, Sound Beach and East
Setauket. The communities are on the north shore of Long Island in
eastern Suffolk County.
Researchers met with residents to learn about possible
environmental exposures and then obtained data from state and local
agencies. The study found the higher than expected breast cancer rate
was not significantly different after risk factors about age, race,
income and educational level were considered, the health department
Also, the study found that the levels of contaminants and other
possible environmental exposures in the area were similar to, or lower
than, levels in the rest of the state for the majority of those
Rep. Timothy Bishop, D-N.Y., said in a statement that further study
of the issue is required.
"While no one wants cancer-causing agents to be found in their
community, everyone wants to know what is causing such alarmingly high
rates of breast cancer," he said. "The finding of `nothing
unusual' in these communities does not mean we should give up; it
means we should work that much harder to determine the truth."
2006-05-08 Women who take estrogen-only pills for at least
15 years run a markedly higher risk of developing breast cancer,
according to a study of nearly 29,000 nurses. But no increased danger
was found among those who took the hormone for less than 10 years.
Researchers said the findings should be reassuring for women who
want to use estrogen for a short time to relieve menopausal symptoms
such as hot flashes and vaginal dryness.
Hormone supplements were once thought to help postmenopausal women
postpone age-related ills. But the government's Women's Health
Initiative study in 2002 contradicted those beliefs for estrogen-progestin
supplements, finding an increased risk of breast cancer, strokes and
heart attacks. That led millions of American women to stop taking
Later, a WHI study of estrogen alone _ an option only for women who
have had a hysterectomy _ linked the supplements to strokes and memory
problems. But it found that using estrogen alone for seven years does
not raise the risk of breast cancer.
The new findings came from the less-rigorous but longer-running
Nurses' Health Study, overseen by Harvard-affiliated researchers.
It found no increased risk of breast cancer in women who had taken
estrogen for less than 10 years. But for women who had been on
estrogen for at least 15 years, the risk of hormonally driven breast
cancer (the most common type in the United States) climbed 48 percent.
At the 20-year mark, the risk of any type of breast cancer rose 42
"This says at least for the shorter-term users, you don't need
to panic" about breast cancer, said lead author Dr. Wendy Chen,
an oncologist and epidemiologist at Brigham and Women's Hospital and
the Dana-Farber Cancer Institute in Boston. "But for the
longer-term users, you need to think about why am I still taking
estrogen for this long of time, and are there are alternatives I could
The risk of breast cancer also appeared to rise between 10 and 15
years of use, but the increase was not statistically significant, the
The study, published in Monday's Archives of Internal Medicine,
involved 28,835 women who were postmenopausal, had had a hysterectomy
and reported their estrogen use every two years. Just 3.2 percent of
the women, or 934, developed breast cancer during the study.
The researchers said it is unclear how many American women are
taking estrogen for 15 or 20 years, especially in light of the WHI
findings and doctors' recommendation since then that women who want to
use the pills take them for the shortest possible duration.
Dr. Carolyn D. Runowicz, president of the American Cancer Society,
said a few women in her practice have chosen to remain on estrogen for
a long time because they feel the improvement in their quality of life
outweighs the risks.
Runowicz called the study reassuring for short-term estrogen use
but also said it underscores the need for patients to regularly
"justify every medication" they take with their doctors.
"Is it estrogen forever? That's what we thought in the
1970s," said Runowicz, director of the Cancer Center at the
University of Connecticut Health Center, "but we've completely
reversed our thinking on that."
Estrogen-alone supplements are given only to women who have had
their uteruses removed, because the hormone can spur uterine cancer.
Other women get estrogen plus progestin, to counteract the risk of
The Women's Health Initiative was a clinical trial in which women
were randomly assigned estrogen pills or placebos. Scientists consider
that approach the gold standard. The new study relied on nurses who
reported on their own health every two years.
Runowicz said nurses could differ somewhat from women in the
general population _ perhaps they are healthier, for instance _ but
she said she had no reason to doubt the validity of the data,
especially because its conclusions regarding short-term estrogen use
are backed up the WHI findings.
Wyeth, which produces the estrogen pill Premarin, considers the
Nurse's Health Study a well-respected study and the most recent
research a "fairly reasonable trial," said Dr. James Pickar,
assistant vice president for clinical research and development.
Pickar said he sees the results as good news for women because they
back up the WHI findings that found no increased breast cancer risk
for short-term estrogen users.
"I think it's very important for women to talk to their
physician and review on a regular basis whether they need to continue
therapy," Pickar said. "Each patient has an individual risk
profile that only they and their physician can evaluate."
2006-03-27 Weightlifting appears to improve breast cancer
survivors' outlook on life, suggests one of the first studies to
scientifically measure the effects of such exercise.
About 80 percent of women who took up twice-a-week weight-training
saw improved scores on a quality-of-life survey, researchers said, in
a study to be published in an upcoming issue of the journal Cancer.
In contrast, 51 percent of participants in a control group did.
The physical and psychological benefits of exercise are
well-documented. But this study is the first to apply scientific
methodology to looking at how weight-training helps women who have had
"This may seem like common sense to most folks, but there's
really been no literature or science where researchers tried to
quantify and verify the effect," said Dr. Len Lichtenfeld, deputy
chief medical officer for the American Cancer Society.
Researchers recruited 86 women from the Minneapolis-St. Paul area
in late 2001 and early 2002. Each of the women had completed
successful treatment of breast cancer within the previous three years.
Half the women were assigned to an exercise group. For three months
they met twice a week with personal fitness trainers to develop a
weightlifting regimen. They were then encouraged to follow it for
another three months.
The second group had no such regimen.
Researchers asked women in both groups a series of questions about
physical well-being, marital happiness, sexual activity and other
aspects of life.
Women in the exercise group had a modest improvement over members
of the non-exercising group, Lichtenfeld noted.
However, the women in the exercise group said they felt they had
more strength, speed and self-confidence as a result of the workouts.
It appears the weightlifting helped them regain a feeling of control
of their bodies, researchers said.
The more women improved on bench press, the better they said they
felt overall. That may be because breast cancer treatment can reduce
the ability to lift and carry things, said Kathryn Schmitz, a
University of Pennsylvania researcher who co-authored the study.
The study also tried to observe weight-training's effect on
depression. The researchers didn't measure any significant effect, but
they said that might be because such a small number of women were
deemed to suffer from depression at the outset of the study.
Last update: 2006-03-27
D May Cut Breast Cancer Risk
2006-04-04 Women who get lots of vitamin D are less likely to
develop breast cancer, suggests a pair of studies that add to the
already strong evidence that the "sunshine vitamin" helps
prevent many types of cancer.
levels of vitamin D translated to a 50 percent lower risk of breast
cancer, one study found. Even modestly higher levels resulted in 10
percent less risk, which would translate to 20,000 fewer cases a year if
it were true of all American women.
second study, by Canadian researchers, found that women who spent time
outdoors or got a lot of vitamin D from their diets or supplements _
especially as teens _ were 25 percent to 45 percent less likely to
develop breast cancer than women with less of the nutrient.
to vitamin D at the time breasts are developing, particularly around
adolescence, might be important," said lead researcher Julia Knight
of Mount Sinai Hospital in Toronto.
studies were presented Tuesday at a meeting of the American Association
for Cancer Research.
body makes vitamin D from sunlight, but sun exposure is controversial
because of the risk of skin cancer. Many health experts see little harm
in 15 minutes several times a week.
D is found in salmon, tuna and other oily fish, and is routinely added
to milk, but diet accounts for very little of the nutrient that actually
makes it into the bloodstream.
contain the nutrient, but most contain an old form, D-2, that is less
potent than the harder-to-find D-3. Multivitamins typically contain
little D-2 and include vitamin A, which offsets many of D's benefits.
getting enough D safely and effectively is tough, but important, as the
new studies show.
led by Cedric Garland of the University of California in San Diego,
involved more than 120,000 women participating in two studies at Harvard
University and Saint George's Hospital Medical School in London. Blood
samples were obtained from 701 with breast cancer and a similar group of
724 healthy women.
with the highest blood levels of vitamin D had a 50 percent reduced risk
of breast cancer, but very few women are at this level. It would require
taking 1,000 international units of vitamin D a day, and most Americans
get only about 320, Garland said.
advisers can't agree on an RDA, or recommended daily allowance, for
vitamin D but say "adequate intake" is 200 international units
a day up to age 50, 400 IUs for ages 50 to 70, and 600 IUs for people
and many other scientists have been advocating 1,000 IUs a day, but warn
people not to overdo it because too much can cause a dangerous buildup
of calcium in the body.
"it's becoming clearer now that we can take higher doses than
people used to think," said Knight, who led the Canadian study.
involved about 1,000 women with breast cancer and a comparison group of
healthy women randomly selected through phone calls.
without breast cancer were less likely to cover up whenever they were
outside and more likely to get dietary sources of vitamin D or to have
had cod liver oil, which is rich in the nutrient, as children.
is one of the few factors women can modify to affect their risk of
developing breast cancer, so the vitamin D evidence is important, said
Dr. William Nelson, a cancer specialist at Johns Hopkins School of
Public Health who had no role in the studies.
are looking for guidance" on what foods can help protect against
cancer, he said.
2006-04-13 Britain's health service broke the law when it
refused to pay for a woman's breast cancer treatment with a
potentially life saving drug, an appeals court ruled Wednesday.
Herceptin is not licensed for treating early stage breast cancer in
England and Wales and is only authorized for use on patients in
advanced stages of cancer.
The case began when a local branch of the National Health Service
denied Ann Marie Rogers, 54, the drug, saying her circumstances were
not so exceptional she should be offered the drug in contravention of
Rogers challenged the decision, but a lower court found the Swindon
Primary Care Trust acted appropriately.
But Wednesday, Britain's Court of Appeal ruled the Swindon Primary
Care Trust acted unlawfully when it refused her request for the drug.
"I couldn't have asked for a better verdict, I did this for
all women battling this dreadful disease," Rogers said, as she
wept and hugged supporters.
Yogi Amin, one of Rogers' lawyers, said the judgment means hundreds
of women in Britain may now be eligible for treatment with the drug,
funded by their health authority.
Rogers' lawyers told the court that she considered the decision to
deny her Herceptin to be a virtual "death sentence."
Some patients in Britain have paid for the drug themselves when
denied the treatment by the health service, believing it offers them
better prospects than conventional treatment.
Herceptin is thought to cut in half the chances of a recurrence of
the HER-2 early form of breast cancer, Rogers' lawyers said.
Jan Stubbings, chief executive of the Swindon trust, said it had
provided Herceptin for Rogers as her case went through the courts.
The Swindon trust had operated a policy of offering treatment with
Herceptin in cases where a doctor considered there to be exceptional
circumstances, she said.
Rogers' attorneys argued that it was wrong for the trust to
discriminate between cases in such a way.
In his ruling, judge Sir Anthony Clarke _ one of three judges who
decided on the case _ said the policy "in this particular case
was irrational and therefore unlawful."
Lawyers for the health authority had argued that Britain's National
Institute for Clinical Excellence _ which regulates use of
prescription drugs in Britain _ has not yet determined if Herceptin
was safe or effective.
Last update: 2006-04-13
of Breast Cancer Victims Studied
2006-04-15 When Gina Gordick heard her younger sister had
breast cancer, she wanted to do something more than just make her soup
and run errands. Gordick, 55, of Fayette, says watching someone you love
fight breast cancer is a "painful, miserable, awful"
"My sister's diagnosis sent the whole family into a tizzy,"
Gordick said. "It's a helpless feeling. You want to do something,
but there isn't anything to do."
finally found a way to help through the Sister Study, a national effort
centered on women whose sisters have had breast cancer. Conducted by the
National Institute of Environmental Health Sciences, investigators hope
to determine how environment and genes in families affect the chances of
getting breast cancer.
of someone who has breast cancer have twice the risk of developing
breast cancer than women whose sisters don't have the cancer, not only
because they share genetic factors but also because they likely have
been exposed to similar potential carcinogens, said Dr. Dale Sandler,
chief of the epidemiology branch of NIEH.
they've grown up together, they ate the same, maybe lived next to the
same factory, perhaps have the same tendency to gain weight,"
Sandler said. "Sisters will be more identical in those sorts of
things, even if as adults they have very different lives."
hope to find 50,000 women aged 35 to 74 who will agree to fill out four
questionnaires, complete two one-hour phone interviews and donate blood,
urine, toenail and household dust samples. After that, participants are
asked to update investigators at least once a year for the next 10 years
on any health-related issues.
information will be compared between women who do and do not get breast
cancer, in hopes of finding common factors.
the study began in October 2004, 26,000 women from across the country
have signed up. Investigators are making a strong effort to include
women from all economic and racial backgrounds so the eventual results
apply to everyone, Sandler said.
need variation to pick up the subtle signals," she said. "No
one has found the one big environmental factor for breast cancer. There
hasn't been a link made like smoking to lung cancer."
the variations, Sandler said the volunteers generally are motivated by
the same things.
fear of getting breast cancer may be a motivation. But we're finding
that people really do this more out of a love for their sisters,"
Sandler said. "And they say it may not help them avoid cancer, but
maybe we'll learn something so their daughters don't get breast
were the motivations for Susan Meilink, 48, of St. Charles County, a
nurse whose sister was diagnosed with breast cancer 10 years ago at the
age of 32. Her sister, also a nurse, has been through several other
health crises but currently is doing well and is pregnant.
the most phenomenal person I know," Meilink said. "She was
only 32, we had no family history of breast cancer. We thought 'Where
did this come from?'"
Meilink or Gordick can think of any particular environmental factor in
their pasts that may have caused their sisters to get cancer and both
believe researchers will eventually find a range of risk factors that
women will need to avoid.
Meilink's sister was the first in the immediate family to get breast
cancer, the disease has haunted Gordick's family. Since her sister was
diagnosed, her mother, aunt and sister-in-law have been diagnosed.
are currently healthy, but the cancers made Gordick and other family
members quit their jobs to move within 20 minutes of each other, and to
become deeply involved in educating women about preventing breast
sister, Patricia Broeckling, of Columbia, said she participated in
several clinical trials while fighting breast cancer, mostly to help her
three daughters and other young women arm themselves against the
she and her sister say they push women who are eligible to participate
in the Sister Study.
is the easiest thing a woman can do to help," Gordick said.
"The answer to cancer is going to be in the research. That's where
they are going to find out what factors contribute to a majority of this
and, hopefully, researchers will be able someday to prevent it from