Thursday, June 30, 2011

The Breast Cancer Update: July 1

Today in breast cancer news, we'll wrap up the week's big story by looking at what's next for Avastin. We'll also look at a UK decision to deny cost coverage for Tykerb or Herceptin plus hormone therapy for some metastatic patients and surgical scar treatment and prevention advice.

What's next for Avastin?

There's been a great deal of activity on the Avastin (bevacizumab) news page this week. Earlier this week, an FDA advisory panel held hearings on the risks and benefits of Avastin for metastatic breast cancer. In the end, the panel voted 6-0 against the use of Avastin for breast cancer. The FDA Commissioner will make the final decision, which will likely follow the panel's recommendation.

So, what's next for Avastin?

First, because Avastin will still be available for other cancers, doctors may continue to prescribe it off-label for metastatic breast cancer. At a cost of about $8,000 a month, the real question is if insurance will continue to pay.

According to the New York Times, Medicare will continue to cover Avastin for metastatic breast cancer even if the FDA revokes approval. This may eventually change, but such a change in policy "would take at least a year and involve public input." Representatives from several private insurance companies indicated that they would review coverage after the FDA final decision. A UnitedHealthcare representative told the New York Times that it would continue to base chemotherapy coverage on National Comprehensive Cancer Network (NCCN) guidelines.

A Reuters story noted that Roche is "undeterred" and is planning another breast cancer trial for early 2012. The new trial will include a biomarker to try to identify which patients may benefit from Avastin.

Both the New York Times and Reuters mentioned that Europe expanded its approval for Avastin for breast cancer to allow it to be combined with a second type of chemotherapy, Xeloda (capecitabine). Avastin "can be used for breast cancer in more than 80 countries."

UK won't pay for Tykerb or Herceptin plus hormone therapy for some patients

In foreign regulatory news, Bloomberg reports that the UK National Institute for Health and Clinical Excellence has denied cost coverage for Tykerb (lapatinib) or Herceptin (trastuzumab) in combination with aromatase inhibitor therapy for older, HER2 positive, metastatic patients. Unlike the recent Avastin hearing, the UK decision was based on a cost/benefit analysis. Both Tykerb and Herceptin have previously been approved in the UK for use in "certain other patients."

Breast cancer surgical scar prevention and treatment

According to a recent Cure Today article, surgical scars "can be managed and minimized." Breast surgeries, such as breast conserving surgery (lumpectomy) and mastectomy, are "associated with a high incidence of scarring." The International Advisory Panel on Scar Management recommends silicone gel sheeting be used as the "first-line preventative measure" for the first month after surgery. For more severe cases, intralesional corticosteroid injections are recommended as second-line treatment. Pressure wrapping may also be an option. In some cases, surgical excision may be necessary.

Please check back on Monday for more breast cancer news updates from You may find all the news and research on any breast cancer test or treatment option, including complementary therapies on our website anytime.

The Breast Cancer News Update: June 30

With all the coverage of the Avastin hearing, yesterday was the most one-sided breast cancer news day we can remember.

But if you're following this story you might find it worthwhile to quickly see how different respected news organizations like The New York Times, Washington Post, LA Times, US News and World Report and others all covered it by accessing all their links from our single Avastin news page.

I should mention one interesting take on the Avastin: a blog entry by Dr. Debu Tripathy on the CureToday site (link). Dr. Tripathy calls the Avastin hearings "the end of an era in drug discovery." He does a nice job summarizing the situation and then links it to drug companies' need to do more research to identify predictive tests for new drugs.

If such a test existed for Avastin (in the same way that HER2 testing identifies patients who should receive Herceptin) then those Avastin patients who testified at the hearing wouldn't have to pit their own personal clinical benefit against the large number of patients who get no benefit, only side effects.

As Dr. Tripathy stated: "It is now necessary to define predictive factors at the same time a drug is initially being developed. Not only is FDA approval in jeopardy, but drug companies can no longer afford the cost of huge trials to show a tiny difference in outcomes. The FDA hearings mark a milestone in this turn - the end the old era of cancer drug development."

...and another step toward the inevitable: truly personalized medicine.

Anyway, regarding other stories yesterday, we won't waste your time. All were either repeats of stories we've already mentioned or weren't of broad relevance.

More tomorrow.

Tuesday, June 28, 2011

The Breast Cancer News Update: June 29

There were two dominant breast cancer stories yesterday: day 1 of the 2-day Avastin FDA hearing requested by Genentech, and new results from a Swedish study that reaffirm the value of screening mammography.

Avastin appeal hearing, Day 1
Can Genentech and activist patients convince the F.D.A. to reverse its December 2010 decision to revoke the drug’s approval for treatment of advanced breast cancer? All day yesterday I was getting minute-by-minute tweets live from the hearing. Most of the news coverage yesterday was about the passion of patients and doctors who believe they are benefiting from the anti-angiogenic drug. Genentech is on their side. But the FDA believes, based on several studies published since the provisional approval, that the drug's side effects and risk are real while the benefits are not. Day 2 is today. The story continues. Check out our Avastin page for all of yesterday's coverage by the respected news sources that we track.

Mammography: New data from a 30 year Swedish study
Breast screening recommendations issued in 2009 by the U.S. Preventive Services Task Force caused an uproar among medical professionals and women in their 40s. Yesterday, new results from a large, ongoing Swedish study suggested that the benefits of screening mammography increases the longer you follow women. This includes women in their 40s. So while screening mammography has risks and benefits, particularly in this age range... and while decisions about screening should be made by women and their physicians, these results point to a larger long-term benefit in terms of reduced deaths than was earlier appreciated. There are several articles listed at the top of our screening mammography page.

As always, more tomorrow.

HER2 Part 6: Agendia's TargetPrint Test

Bottom line: TargetPrint is a quantitative mRNA test that can be used as a second opinion to IHC or FISH testing or as a first line test to measure HER2, ER and PR.

There are three situations where it would be reasonable to consider some of the next generation, "non-standard-of-care" tests, like TargetPrint, that assess a breast tumor's HER2 status:

1) The first situation is when a basic IHC (immunohistochemistry) test like Dako's HercepTest gives an "equivocal" result (a score of 2+). Today FISH is most commonly used in this case. But other tests could be considered. Or multiple different tests could be used.

2) The second situation is where neither IHC or FISH deliver a clear positive or negative result, or if they give conflicting ("discordant") results.

3) Finally, if a tumor is designated HER2-negative but the disease is progressing faster than expected, then consider rechecking with another kind of test.

Agendia's TargetPrint test looks quantitatively at the amount of HER2 mRNA in tumor cells. This is different than standard IHC tests (like Dako's HercepTest) that look at the amount of protein on the tumor cell surface semi-quantitatively, or FISH tests (like Abbott's' PathVysion or Dako's HER2 FISH PharmDx) that look at the amount of DNA amplification.

Why might looking at mRNA be useful? Consider the biology. Within the cancer cells, a portion of chromosome 17 (home of the HER2 gene) is being amplified. Instead of the normal double helix of chromosome 17 DNA, the cell has aberrantly made many double helixes. There are too many HER2 genes so the cell naturally produces too much HER2 mRNA. These HER2 mRNAs float around the cell and are used to creates too many HER2 proteins.

In theory, the amount of DNA amplification, mRNA and protein should coincide. But biology is complex and scientists always have an imperfect picture of what's going on inside of the cell. In addition, there are strengths and weaknesses associated with different tests and lab techniques. Some tests are more subject to laboratory error, for example. So the idea of using different techniques to measure different aspects of biology (DNA, mRNA and proteins) and to cross check one against the other is a reasonable strategy.

In addition, analyzing mRNA as a means of understanding what's happening inside cancer cells has become important in recent years. mRNA analysis is the basis of Genomic Health's popular Oncotype Dx test and Agendia's better known test, MammaPrint test, both for assessing recurrence risk. So it is a growing diagnostic approach.

Back to TargetPrint. Yes, it analyzes HER2. But it also analyzes estrogen receptor (ER) and progesterone receptor (PR), also by looking at mRNA. Normally both are analyzed by IHC. Several recent studies show that ER testing is far from perfect. For example, a Yale study that just came out this week found that 10-20% of patients who are told they have ER-negative tumors really have ER-positive tumors. Another recent study found that patients test negative for ER by IHC more often on Fridays and Saturdays! So, as mentioned before, IHC is subject to lab and lab technician variability.

TargetPrint costs $1200 and it is covered by Medicare.

Monday, June 27, 2011

The Breast Cancer News Update: June 28

Most of the press attention yesterday was given to a study out of MD Anderson showing that many physicians are not following medical guidelines related to delivery of radiation after mastectomy. In another story with big treatment implications a Yale study that found a very high rate of ER-positive women misclassified as ER-negative. Finally, the Avastin battle continues at a Genentech-requested FDA hearing this week.

Who needs radiation after mastectomy?
Researchers at MD Anderson found that many physicians are wrongly omitting radiation therapy after mastectomy to older breast cancer patients. Multiple guidelines call for radiation treatment after mastectomy in cases of high risk, advanced disease patients. Stories appear on both the Mastectomy and Radiation therapy pages.

ER (falsely) negative
Accurately determining hormone receptor status is absolutely critical for planning breast cancer treatment. Yet a Yale study found that between 10-20% of women who were told their tumors are ER negative (and thus not candidates for hormonal therapies like tamoxifen and aromatase inhibitors) were in fact ER positive and so should have received those drugs. Click on the first (most recent) news story listed on or ER (Estrogen Receptor) testing page.

Avastin battle rages on
The FDA's Center for Drug Evaluation and Research (CDER) is holding a hearing this week at the request of the drug's maker, Roche/Genentech, to reconsider its decision to rescind the drug's breast cancer indication. Several articles can be found under the News tab on our Avastin page.

Thursday, June 23, 2011

The Breast Cancer News Update: June 24

In the news today the FDA says silicone implants appear to be safe. Also, a possible shortage of a mainstay breast cancer chemotherapy, and the possibility of a topical gel form of tamoxifen that might eliminate side effects that keep some patients from using the drug.

Silicon Implants: So Far So Good

Silicone breast implants were banned in 1992 based on health concerns but then were reintroduced into the market in 2006. Yesterday FDA officials claimed that, based on research performed since 2006, their decision to reintroduce the products seems to have been the right one. The research was performed by the manufacturers. Last year 60% of breast implants were silicone-based rather than saline-based. You can find all of these stories on our Breast Implant page.

A Possible Shortage of Taxol (paclitaxel)

Taxol is one of the most commonly used breast cancer chemotherapeutics. It's used to treat early stage, locally advanced and metastatic disease. A report from claims that some hospitals are finding it difficult to get enough of the drug. The degree of the shortage is unclear, as is the reason. Find the article on our Taxol page.

Tamoxifen the Gel

Researchers at Northwestern University are conducting a clinical trial of a gel form of tamoxifen that might very well avoid some of the major side effects of the tablet: namely, blood clots, uterine cancer and hot flashes. In theory, a gel would concentrate the drug in the breast and minimize exposure to the rest of the body. This could be very good news, especially for the many women at high risk who choose not to take the drug based on their concerns about these side effects. The article does not say when the drug might be available assuming positive trial results. The article will be the first News Article listed on's Tamoxifen page.

Next update: Monday June 27. Enjoy the weekend!

The Breast Cancer News Update: June 23

Today in the news, more reason to be concerned about bisphenol A (BPA) exposure, a new kind of radiation treatment that could minimize exposure to other tissues, and the growing legislative movement to require doctors to inform women with dense breasts about their higher risk of breast cancer.

Risk of breast cancer and exposure to BPA and other chemicals

A new report released by three organizations including the EPA warns that early life exposure to common chemicals such as plastics (including BPA) and canned foods can affect breast development, which can later disrupt the secretion of breast milk and increase susceptibility to breast cancer. The problem is that today safety testing of these chemicals does not specifically look at effects on mammary gland tissue. Mammary tissue can be more sensitive than other tissues to these chemicals, and so dangers associated with exposure currently could be missed. The report authors recommend testing specifically on mammary gland tissues. Two articles in US News and World Report and in Environmental Health News.

A new type of radiation: proton beam

Proton beam radiation therapy has been around for decades. It is mainly used for radiation treatments that require high precision such as treating brain cancer and prostate cancer. Now a team in Southern California is using the technology to treat women with early stage breast cancer, in an effort to minimize side effects caused by unwanted radiation exposure to surrounding tissues. Another advantage: the treatment takes 2 weeks instead of six. The treatment is available in the context of a clinical trial at Loma Linda University Medical Center.

Should states requires doctors to warn women with dense breasts?
Dense breast tissue is a risk factor for breast cancer. As awareness grows, more states are either debating or creating laws that will require doctors to warn women with dense breasts about their higher risk and to discuss risk reducing strategies. A new law called Hendra's Law passed this week in Texas (link). In California, however, there has been opposition by medical professional societies about a law there (link).

Please check back on Friday for more news and research updates from

Monday, June 20, 2011

The Breast Cancer News Update: June 21

Today in breast cancer news, we'll look at a potential new treatment for lymphedema, two stories about breast cancer risk and the use of OncotypeDX in the UK.

Potential new surgery to treat lymphedema

Lymphedema can be an uncomfortable side-effect of axillary lymph node dissection. According to a story in the New York Times, a randomized trial of an experimental surgical procedure to treat lymhpedema is being launched. The procedure, called autologous vascularized lymph node transfer, involves clearing scar tissue and transferring a lymph node from another location. Half of the patients in the study will receive the lymph node transfer. The other half will undergo a "dummy surgical procedure." Patient progress will be followed for two years. To date, the few patients who have been treated with the surgery have experienced improvement. Hopefully, the randomized trial will confirm these results.

BREVAGen risk assessment test launched in the US

BREVAGen, a new breast cancer genetic risk assessment test has been launched in the US. The assessment uses a cheek-swab genetic analysis and individual risk factors to predict 5-year and lifetime breast cancer risk. According to the press release, women's health clinics will begin using the BREVAGen test in the coming months.

Childhood body size may affect breast cancer risk

Typically, higher body mass is associated with an increased risk of breast cancer. The opposite may be true when it comes to childhood body size. An NBC News affiliate reported that a recent Swedish Breast Cancer Research study discovered that a "large body size" at age seven was associated with a 27 percent reduction in risk of postmenopausal breast cancer. The researchers concluded that women who had a larger body size at age seven may have a "decreased risk of developing postmenopausal breast cancer." Body size at age seven may be "a useful contribution" to estimating breast cancer risk.

OncotypeDX use in the UK

An interesting story in The Telegraph (UK) discussed the use of the OncotypeDX test in the UK. OncotypeDX is a genetic assay that predicts the risk of recurrence to determine whether an early-stage patient with estrogen receptor positive cancer would benefit from chemotherapy. It is used "extensively" in the US, but is only available privately in the UK at a cost of about $4,000 US Dollars. The UK National Institute for Health and Clinical Excellence is expected to reach a decision about the use of OncotypeDX in the NHS late next year.

Please check back Wednesday for more news and research updates from

The Breast Cancer News Update: June 20

This weekend's breast cancer news was about the risk of dying from breast cancer.

Cancer death rates are falling

On Friday, US News & World Report and the Los Angeles Times reported on the American Cancer Society release of 2011 statistics, facts and figures. Overall, death rates from any type of cancer fell about 22% for men and 14% for women from 1997 to 2007. Since 2000, death rates have fallen about 1.9% for men and 1.5% a year for women. For women, the decline is attributed to lower rates of death from breast and colorectal cancers due to earlier detection and better treatment.

People who are less educated are more likely to die from cancer

In another piece, the Los Angeles Times looked further into the American Cancer Society findings that people with less education were more likely to die from cancer. Cancer death rates are "almost three times higher" for those who didn't finish high school than for college graduates." The article explored a University of Wisconsin study which found that women who did not finish high school were almost 40% more likely to die of invasive breast cancer than college grads. The disparity remained even after adjusting for lifestyle factors and income.

Heart disease is the leading cause of death for older breast cancer patients

A story in The Telegraph (UK) examined a University of Colorado study printed in Breast Cancer Research which looked at 60,000 women diagnosed with breast cancer between 1992 and 2000 at age 66 or older. They were followed for a median of about 9 years. About half were still alive at the end of the study. Those who died lived on average to age 83. Of those who died, only about a third of them died from breast cancer. The "biggest" cause of death was heart disease. According to Jennifer Patnaik, one of the researchers, "breast cancer is not necessarily a death sentence and patients need to take care of their health to reduce their risk of dying from heart disease and other age-related diseases."

This story raised questions. What were the stages at diagnosis? What treatments were given? Could the heart disease have been related to treatment? Looking at the full text of the study provides further insight.

On page 13, we learn that heart disease was the primary cause of death for women diagnosed with stage I breast cancer. Women with stage I or II cancer were more likely to die from causes other than breast cancer. Also, for all stages of breast cancer, the likelihood of dying of causes other than breast cancer increased as women aged.

Interestingly, on page 15, only 25.5% of the women who died of cardiac disease during the study were diagnosed with cardiovascular disease at the time of breast cancer diagnosis. The authors explain that this may be due to cardiac disease developing during the long study follow-up or from cardiac disease being under diagnosed in the Medicare population. They also note that chemotherapy "has been shown to be associated with cardiac toxicity in breast cancer patients, particularly in older patients."

At, we don't just read media coverage of breast cancer news. We look at the studies behind the stories. Our website provides access to the latest news and research for all of your breast cancer treatment options.

Friday, June 17, 2011

The Breast Cancer News Update: June 17

Today in breast cancer news, we'll look at the disappointing results from the phase III iniparib trial for metastatic triple-negative patients, whether mastectomy or lumpectomy plus radiation is better for early-stage triple-negative patients and a test of the cardiac side-effects of Omnitarg.

Disappointing results from the phase III iniparib trial for triple-negative cancer

In January 2011, a phase II trial of iniparib for metastatic triple-negative breast cancer in the New England Journal of Medicine concluded that adding iniparib to chemotherapy improved clinical benefit and survival without added toxicity. (All related news and research may be found on the iniparib (BSI-201) page of our website.)

Yesterday, an Internal Medicine News story covered the disappointing results of the current phase III trial. In phase III, adding iniparib to the same chemo combination, "provided an insignificant survival advantage." For first-line patients, there was no difference in progression-free or overall survival. For second and third-line patients, progression-free survival increased from 2.9 months to 4.2 months with the addition of iniparib, and overall survival increased from 8.1 to 10.8 months.

The researchers are analyzing the results. Factors being considered include the variety of molecular subtypes that can be classified as triple-negative breast cancer, the number of BRCA mutation patients, the length of disease-free survival between surgery for the primary and the detection of metastasis and the role and function of iniparib.

Increased risk of recurrence for early triple-negative cancer treated with mastectomy

A June 13 Canadian study published in the Journal of Clinical Oncology discovered that early-stage patients with triple-negative breast cancer had a "significant increased risk" of local recurrence if they were treated with modified radical mastectomy compared with those treated with breast conserving surgery (lumpectomy) plus radiation.

Low risk of cardiac side-effects with Omnitarg (pertuzumab)

Finally, a June 10 study in the Annals of Oncology examined the cardiac safety of Omnitarg (pertuzumab). Patients treated with Omnitarg alone "experienced relatively low levels" of asymptomatic left ventricular systolic dysfunction or symptomatic heart failure. There was "no notable increase in cardiac side-effects" when Omnitarg was given in combination with other anticancer drugs.

As always, all of this news and research can be found and filtered on our website. Please check back Monday for the weekend research wrap-up.

Thursday, June 16, 2011

The Breast Cancer News Update: June 16

Today in breast cancer news, we'll look at two studies of how socioeconomic factors affect MRI and radiotherapy use rates and four recent papers on axillary lymph node dissection.

Use of diagnostic MRI and adjuvant radiotherapy vary with socioeconomic factors

A May 17 study in The Journal of Surgical Research examined diagnostic MRI rates for Medicare patients from 2003 to 2005. Overall, diagnostic MRI use increased from 3.9% of eligible patients in 2003 to 10.1% in 2005. Women who were younger, Caucasian, living in metropolitan areas or living in wealthy areas were more likely to receive MRI.

A June 15 study in Cancer acknowledged the benefits of radiation therapy after breast conserving surgery and looked at factors influencing the use of radiation in Kentucky. The rate of radiotherapy use was "drastically lower" for women older than 70 and those living in rural Appalachian areas. It was "modestly lower" for African Americans, those with DCIS and the uninsured. The 10 year survival rate for those who received breast conserving therapy plus radiation was 79.7% compared to 67.6% for those who received surgery alone.

Four June research papers on axillary lymph node dissection

So far this month, there have been four research papers on the use of axillary lymph node dissection (ALND).

Characteristics of patients who were spared ALND

A June 1 study in the Canadian Journal of Surgery found that, in British Columbia, patients who had sentinel lymph node biopsy (SLNB) rather than complete axillary lymph node dissection (ALND), had more sentinel lymph nodes (SLN) removed, a lower percentage of positive SLNs and lower pathological stage than those who had complete ALND. Most of the SLNB group received radiation to the axilla. Complications, including lymphedema, were 21% in the ALND group and 7% in the SLNB group. Recurrence rates were similar for both groups.

Diminishing rates of ALND use over the last 10 years

Researchers from Memorial Sloan-Kettering Cancer Center in New York examined 10 year trends in ALND use in a June 7 study in the Annals of Surgical Oncology. Over that time, ALND rates diminished for patients with "low-volume" sentinel lymph node metastasis. According to the authors, the "trends suggest a more nuanced approach to axillary management." If current selection criteria had been applied during the entire 10-year period, 48% of ALND would have been avoided, "sparing 13% of all patients the morbidity of ALND."

Micrometastases and the risk of axillary lymph node metastasis

This month, two studies examined the association between sentinel lymph node micrometastases and axillary metastasis.

The first, a June 2 study from Korea in the Annals of Surgical Oncology concluded that "[m]icroinvasive breast cancer is associated with a low rate of lymph node metastases." Some patients with micrometastasis at "low likelihood" of lymph node metastases "may be spared lymph node evaluation."

The second study, from Spain, published in the Revista Espana de Medicina Nuclear examined axillary lymph nodes which had been dissected from early-stage patients with micrometastases in the sentinel lymph nodes. 79.1% of the dissected axillary nodes were negative, 8.3% had micrometastasis and 12.5% had macrometastasis. The authors concluded that for patients wtih micrometastasis in the lymph nodes, the "low percentage of further axillary invasion. . . may open up the possibility of avoiding" complete ALND "in favor of other adjuvant treatments (chemotherapy, radiotherapy)."

I wanted to mention two unique elements of today's news update. First, all of this news has been sorted and organized for you on the website. For example, all four axillary lymph node studies are on our ALND page. We hope that makes it easy to see the latest research all in one place. Also, all of today's news comes straight from actual research abstracts. We don't just read media headlines. Although we do follow media coverage of breast cancer news, we also read hundreds of breast cancer research abstracts a week. Both are added to our website daily and can easily be found on the treatment pages of our site.

Please check back tomorrow for more breast cancer news and research updates.

Wednesday, June 15, 2011

The Breast Cancer News Update: June 15

Today's breast cancer news involves vitamin D, Epogen and a new HER2 test.

Exposure to solar vitamin D reduces breast cancer risk

A new study in the American Journal of Epidemiology examined the association between sunlight exposure, vitamin D production factors and breast cancer risk. A "solar vitamin D score" was "significantly associated with reduced breast cancer risk." According to a article on the study,

Compared with women who had 6 hours per week spent outdoors, those who spent 21 hours or more per week during adolescence were 29 percent less likely to develop breast cancer. The risk reduction was 26 percent, 39 percent and 50 percent when the time was counted in the 20s to 30s, in the 40s to 50s, and in the 60s to 74 years, respectively.
Both the study abstract and the story may be found on the Vitamin D page of our website.

Complications associated with Epogen for older metastatic breast cancer patients

Epogen, an erythropoietin-stimulating agent, is used to treat cancer-induced anemia. A new study in Cancer examined the complications associated with erythropoietin-stimulating agent use in metastatic breast cancer patients older than 65. Thromboembolic events, such as deep vein thrombosis, blood clots and stroke were "common" among this group of patients. "Therefore, caution is recommended when using these agents."

New HER2 test, the Inform Dual ISH, receives FDA approval

This week, the FDA granted approval to a new HER2 test, the Inform Dual ISH test. The test is similar to the fluorescense in situ hybrid (FISH) test, but the slides can be read using a standard light microscope. Both the FDA news release and a US News and World Report story can be found on the Inform Dual ISH page of our website.

For more on HER2 testing, please check-out Scott Cole's blogs - How Doctors Determine if You're HER2 Positive and The HERMark Test.

Please check back tomorrow for more breast cancer news updates from In the meantime, please consult our website for all the news and research on every breast cancer test, treatment option and complementary therapy.

Tuesday, June 14, 2011

The Breast Cancer News Update: June 14

Today's breast cancer news addresses hypnosis, breast conserving surgery and radiation.

Hypnosis during breast cancer surgery

Most of the news and research on hypnosis for breast cancer relates to managing hot flashes or pain. This week, the Toronto Sun reported on a Belgian study about hypnosis during breast cancer surgery. Of the 78 women in the study, 18 received a local anaesthetic plus hypnosis. The rest were given a general anaesthetic. Although the women who were hypnotized spent "a few minutes more" in the operating room, the time spent in recovery and in the hospital were "greatly diminished." In addition, according to one of the researchers, local anaesthesia can "block the body's stress response to surgery and could therefore reduce the possible spread of metastasis." At the UCL Hospital in Brussels, a quarter of all breast cancer surgeries are performed under local anaesthetic with hypnosis.

Multiple re-excisions are a safe alternative to mastectomy

According to a study in the Annals of Surgical Oncology, multiple re-excisions to obtain clear margins after breast conserving surgery (lumpectomy) are a safe alternative to mastectomy. In the study, 70 of 3,737 lumpectomy patients over a 10 year period had more than one re-excision. Of those 70, 49 eventually achieved clear margins. All 49 also received radiation. At a median follow-up of 64 months, 1 of the 49 patients had a local recurrence and 1 had a distant recurrence. The authors concluded that there was "an acceptably low risk" of recurrence "when negative margins are ultimately achieved."

Whole breast radiation when no breast mass is detected

Sometimes, when there is axillary metastasis, breast cancer will be diagnosed even with no palpable, mammographic or sonographic evidence of a breast tumor. This is called an occult primary. A UK study published in the European Journal of Cancer concluded that an occult primary should be treated with breast conserving surgery plus whole breast radiation or mastectomy. Although patients who did not receive radiation after lumpectomy experienced worse 5 year local recurrence and relapse free survival rates, there was no difference in overall survival rates. Also, the study suggested that it is "not necessary to irradiate the breast to more than 50Gy in 25 fractions." Higher doses made no difference in local recurrence rates.

Please check back tomorrow for more breast cancer news from, the only place on the web where you may personalize your research to your diagnosis.

Sunday, June 12, 2011

How to Keep Track of Breast Cancer News and Research

Breast cancer is in the news just about every day. Stories trickle in from press releases, medical conferences and published research papers. Headlines flash on Google, Twitter and various websites all day long. How do you keep track of all of these developments? What if you want to refer to something later? What if you miss something important?

At, we read news reports and medical journals every day. We not only share the latest developments as they appear, we organize and store them for you. We can even personalize your research. You don't have to take notes, print stories or keep files. Everything you need can be found in three places.

For daily news highlights: The Breast Cancer News Update

Every weekday we highlight the latest breast cancer headlines here in our Breast Cancer News Daily Update. It's a place to check in to see the most recent breast cancer news all in one place. Think of it as a daily paper.

For 2 years of breast cancer news and research organized by topic: The website

We don't just read news and research. We code it, sort it and store it by treatment option for easy future reference. Basically we "clip" a link to the story and "file" it by test or treatment option.

For example, let's say you are interested in the aromatase inhibitor Arimidex. To see all the latest news and research, just visit the Arimidex (anastrozole) page of the website.

Under the News tab, you'll see 5 pages of news stories about Arimidex, organized in reverse chronological order. Over the last two months, you'll see a Washington University in St. Louis news report about how neoadjuvant Arimidex therapy reduces mastectomy rates, a video about the effect of body mass index on Arimidex therapy and a Reuters report on how co-pay amounts affect aromatase inhibitor use. There's a press release about a new study of entinostat and Arimidex for triple negative cancer and a story of how Zometa plus Arimidex reduces breast cancer recurrence rates.

Under the Medical Journal Abstracts tab, you'll find 10 pages of research paper abstracts about Arimidex. Often, you'll find the study that relates to a recent news item. For example, there's a link to the May 9, 2011 Journal of Clinical Oncology abstract about the effect of body mass index on Arimidex therapy.

In addition to news and research, you'll find several overviews of Arimidex under the Descriptions tab and the FDA product label under the FDA tab.

For personalized news and research: News and Journals for subscribers

Everything mentioned above is free on our website. Subscribers who create a personal profile have two additional benefits.

First, the test and treatment options and news and research are filtered so subscribers only see what's applicable to them. For example, if you will only see Arimidex as a treatment option if your cancer is hormone-receptor positive. If your cancer is early-stage, you will only see news and research relevant to early-stage cancer. Instead of 10 pages of research abstracts, you may see only one or two.

Also, subscribers have access to the News and Journals tab of our website, where information may be sorted by date and treatment category. For example, in the News and Journals section, you may search for all surgery news in the last month for patients with your diagnosis. For more on how to use the site as a subscriber, please visit our Quick Start Guide.

Our goal is to sort and store breast cancer news and research so you don't have to. We always welcome comments and suggestions. Please let us know what we can do to make breast cancer research easier for you.

Friday, June 10, 2011

The Breast Cancer News Update: June 10

It's time for the Friday breast cancer news weekly research wrap-up. Today we'll highlight some of the abstracts from medical journals we added to the database this week.

Another study on radiation therapy for DCIS

Recently, several studies have shown that radiation therapy after surgery for DCIS reduces the risk of recurrence. (See the March 15 study in Cancer, March 16 study in the Journal of the National Cancer Institute and the May 2 report on a study presented at the American Society of Breast Surgeons meeting. All may be found on the External Whole Beam Irradiation (WBI) journal abstract and news pages of our website.)

This week, an Australian study published in the Annals of Surgical Oncology looked at 5 and 8 year recurrence and survival rates in a group of older women. Most did not receive radiation. Of 422 DCIS patients, 373 were treated with surgery alone and 27 were treated with surgery plus radiation. The study did not distinguish between those who received radiation and those who did not. For the group, at 8 years, the breast cancer survival rate was 99.3% and the local recurrence rate was 17.1%. The authors concluded that "breast cancer mortality was very low in this cohort of older patients." The "moderate rate" of recurrence "could usually be salvaged with breast conservation." They recommended that decisions about radiotherapy for DCIS "take these findings into account."

Zoladex (goserelin) or tamoxifen, but not both for adjuvant therapy

A Swedish study published in Breast Cancer Research and Treatment found that both Zoladex (goserelin) and tamoxifen reduced the risk of recurrence in hormone receptor positive premenopausal breast cancer. Women with "strongly ER-positive tumors may benefit more from goserelin treatment." The combination of the two together "was not superior" to either alone.

Fareston (toremifene) better than Arimidex (anastrozole) in terms of serum lipids and bone markers

A Japanese study published in Breast Cancer Research and Treatment compared serum lipid numbers and serum bone turnover or metabolism markers of postmenopausal women with early breast cancer treated with Fareston (toremifene) or Arimidex (anastrozole). Women on Fareston experienced decreased serum lipid numbers, such as triglycerides and cholesterol, and decreased serum markers of bone metabolism. By contrast, lipid numbers were stable for women on Arimidex and bone metabolism marker numbers increased.

In May, another Breast Cancer Research and Treatment study found Fareston to be a safe and effective alternative to tamoxifen for adjuvant hormonal therapy for peri- or postmenopausal women.

Please check back Monday for the weekend breast cancer news.

Thursday, June 9, 2011

The Breast Cancer Update: June 9

Today's only breast cancer news story addressed depression and survival rates for metastatic patients.

Changes in depression associated with differences in breast cancer survival

Today, Internal Medicine News ran a interesting story and video about depression and survival rates for women with metastatic breast cancer. According to the Stanford study, published in the Journal of Clinical Oncology, patients who experienced a decrease in depression over a one year time period lived a median of 2 years longer than patients who experienced an increase in depression. Change in depression levels over the first year had a "significant effect" on survival out to 14 years later.

In the study, some patients received "supportive-expressive group therapy." Others received educational materials. The type of treatment received was not associated with differing survival rates - only whether the depression increased or decreased.

Although further research is needed to confirm the findings and causation cannot be assumed, Dr. David Spiegel, one of the study authors, recommends that cancer patients be screened and treated for depression. According to an Internal Medicine News quote from Dr. Spiegel, it is "reasonable to raise the possibility that treating depression . . . may not only help people live better, but may help them live longer."

Please check back tomorrow for the weekly research wrap-up.

Wednesday, June 8, 2011

The Breast Cancer News Update: June 8

Just two breast cancer news updates today.

Another Phase II study of the NeuVax vaccine for HER2 positive patients

Yesterday, there was a Boston Business Journal story on positive Phase II results for the NeuVax vaccine for HER2 positive breast cancer patients not eligible for Herceptin. Today, a Business Wire press release revealed positive results of another Phase II NeuVax study. In today's study, none of the patients who received Herceptin (trastuzumab) plus NeuVax experienced a recurrence, while 12.5% of those who received Herceptin alone did. At, we'll continue to keep an eye on this one. Any news or research will be posted on the NeuVax page of our website.

Paraplatin adds no benefit or toxicity to chemo combo for basal-like cancer

Internal Medicine News reported on a study which found that adding Paraplatin (carboplatin) to standard chemotherapy for basal-like (similar to triple-negative) breast cancer added no benefit or toxicity. Paraplatin is a DNA-damaging agent. The authors speculate that the lack of benefit may have been due to the fact that patients were also exposed to Ellence (epirubicin), another DNA-damaging agent.

Please check back tomorrow for more breast cancer news updates from

Tuesday, June 7, 2011

The Breast Cancer Update: June 7

Today in breast cancer news - a bone metastasis drug, a vaccine for HER2 positive patients and generic letrozole.

Alpharadin for breast cancer bone metastasis

This morning, a story in Reuters revealed positive preliminary phase IIa trial results for Alpharadin for the treatment of bone metastasis from hormone-therapy resistant breast cancer. In the study, Alpharadin reduced two markers of bone involvement, and it was found to be safe and well-tolerated. Larger trials are needed to confirm the results.

NeuVax vaccine for HER2 positive breast cancer recurrence prevention

According to a story in the Boston Business Journal, a three-year phase II study of the NeuVax vaccine for HER2 positive breast cancer showed promising results. Women in remission treated with the vaccine had no recurrences 36 months later. There was a 22 percent recurrence rate among those not treated with the vaccine, "which is consistent with historical norms." A Phase III trial is planned for 2012.

Generic aromatase inhibitors

In late May, a study revealed that women with high insurance co-pays were more likely to discontinue the recommended five years of aromatase inhibitor therapy. (See the Femara (letrozole) news page.) As aromatase inhibitor patents expire, the costs are expected to drop with the release of generic versions. In late April, Mylan launched a generic version of Femara. Today, it was announced that APP Pharmaceuticals will begin marketing its own generic version.

This weekend, the news was abuzz with stories about Aromasin (exemestane) to lower breast cancer risk. Interestingly, both the New York Times and Los Angeles Times noted the April 2011 patent expiration and expected decrease in cost.

Please check back tomorrow for more news updates from

Monday, June 6, 2011

The Breast Cancer News Update: June 6

This weekend, there were several interesting breast cancer research developments from the American Society of Clinical Oncology (ASCO) meeting in Chicago.

Aromasin for breast cancer prevention

Perhaps the biggest news from ASCO this weekend was the study which found that Aromasin (exemestane) reduces the risk of breast cancer for post-menopausal women without the potentially lethal side effects of tamoxifen or Evista (raloxifene). The Los Angeles Times, New York Times, Reuters and others covered the story. (I even saw coverage on my local TV news station this morning.) In the study, hot flashes, fatigue, insomnia and bone stiffness were slightly more common among women on Aromasin. Pfizer's patent on Aromasin expired on April 1, which is expected to reduce the cost of treatment.

Zometa plus hormone therapy reduces the risk of breast cancer recurrence

Austrian researchers discovered that, for premenopausal women with early-stage, hormone receptor positive breast cancer, adding the osteoporosis drug Zometa (zoledronic acid) to tamoxifen or Arimidex (anastrazole) reduces risk of recurrence more than taking tamoxifen or Arimidex alone. The joint pain, bone pain and fever side-effects were relatively mild.

Axillary radiotherapy reduces the risk of breast cancer recurrence

For women with early-stage breast cancer with one to three positive lymph nodes, a Canadian study found that radiation therapy to the breast and axillary lymph nodes reduced the risk of distant recurrence more than radiation to the breast alone. The Globe and Mail and Medical News Today covered the story. Side effects included lymphedema and lung inflammation.

NKTR-102 shows clinical benefit as a second or third-line for metastatic patients

Positive results from a phase II trial reveal a clinical benefit for NKTR-102 as second or third-line therapy for metastatic patients. Neuropathy and alopecia were minimal. Phase III studies are planned.

Flaxseed is not effective against hot flashes

Finally, not all news from ASCO this weekend was good. According to a Mayo Clinic study, flaxseed is not an effective remedy for hormone therapy related hot flashes.

At, we'll continue to follow breast cancer news developments daily. As always, we welcome feedback and comments.

Friday, June 3, 2011

HER2 Part 5: The HERmark test

Note: This is the blog of, where you can get personalized information about the latest in breast cancer treatment.

Bottom line: HERmark is a powerful new test for patients who need to resolve an unclear HER2 result.

There are situations in which the standard ways of analyzing HER2 fail to provide a clear positive or negative result, leaving it uncertain as to whether or not to prescribe Herceptin (trastuzumab).

If this describes your situation, realize that it is critical that you accurately determine your tumor's HER2 status. Patients who are HER2-positive have a significantly worse prognosis. On the other hand, Herceptin is a powerful drug that essentially neutralizes the survival disadvantage caused to HER2 overexpression. In other words, if your tumor will respond to Herceptin, you need to know that.

So regarding HER2 testing, there are two situations to avoid. The first is wrongly diagnosing a patient as HER2-negative and not giving her Herceptin. The second is wrongly diagnosing a patient as HER2-positive and subjecting her to possible side effects without providing any benefit.

Today there isn't enough clinical evidence to recommend using HERmark instead of IHC. There might be in the future. So in what situation might a patient consider asking about HERmark?

1) If IHC gives an "equivocal" result (a score of 2+). Today FISH is commonly used in these cases, but HERmark is another option. Given the importance of knowing HER status with certainty, another reasonable but more expensive option in this situation might be "do both."

2) If neither IHC or FISH deliver a clear positive or negative result, or if they give conflicting ("discordant") results.

3) If a patient is determined to be HER2-negative but their disease is progressing more rapidly than expected, then consider rechecking HER2 with HERmark to make sure that the situation can't be reversed with Herceptin.

So how does HERmark differ from IHC and FISH? Remember that IHC analyzes the amount of HER2 protein on tumor cells in a "semi-quantitative" way. FISH looks at amplification of the HER2 gene, which is what causes the overabundance of HER2 protein.

HERmark, like IHC, looks at the protein. It actually looks at total HER2 protein and it looks at the extent to which HER2 proteins are paired up with each other ("homodimers"). To quantitatively assess both, it uses a method that is more sophisticated than IHC. So you get more quantitative information about HER2 status. For example, instead of knowing that your HER2 result was a "3", you might see that it was barely a three (really almost a 2). Or you might see that it was a strong 3. This might make a difference with regard to treatment approach or decisions about the value of additional HER2 testing. The point is, IHC only delivers 4 results: 0+, 1+, 2+ and 3+. HERmark tells you the real, numerical result.

As I mentioned, HERmark also does something tricky. Remember that HER2 only sends a grow signal when it is paired with either another HER2 (called a "homodimer") or with a different HER (called a "heterodimer"). HERmark tells you to what extent HER2 is found as active homodimers on the cell.

Today, the company that developed HERmark doesn't emphasize the homodimer information on the lab report. I spoke to someone at the company--Dr. Weidong Huang, an MD/PhD in their clinical research group--about this. Apparently the homodimer information isn't yet providing much value beyond the quantitative total HER2 information in the test report. The company is developing next-generation versions of the test that will look at all of the possible HER2 pairings and Dr. Weidong believes that those tests could provide key information that could bear upon treatment strategy in the future.

In a nutshell, HERmark is a powerful option for patients who need to resolve an unclear HER2 result. This is no small issue, given the importance of correctly identifying patients who will receive a drug as potent as Herceptin. The technology behind the test has strong validation. The company that developed the test, Monogram Biosciences (South San Francisco, CA) was recently purchased by LabCorp, the largest testing lab in the United States. So the experts at LabCorp obviously see great promise in the HERmark technology.

A few other details: the test takes seven days to perform, it requires a standard FFPE breast biopsy sample (FFPE is an acronym describing the way biopsy samples are most commonly stored), and it is performed at a single lab in South San Francisco. The price is $3,350. Assistance with insurance reimbursement is provided by the company.

Thanks to Dr. Weidong Huang and Bruce Nita, both of whom work for Monogram Biosciences (LabCorp).

The Breast Cancer News Update: June 3

Today in breast cancer news, there are developments in imaging, prognostic testing and radiation therapy. Many of today's developments will be presented at the American Society of Clinical Oncology (ASCO) meeting this week.

Breast cancer imaging: screening, risk and impact on surgical decisions

The FDA considers mammography to be the most effective breast cancer screening method. According to a press release in PR Newswire, women should not substitute breast thermography for mammography for breast cancer screening. The FDA is "unaware of any valid scientific evidence" supporting thermography alone as a breast cancer screening method.

In addition to breast cancer detection, breast cancer risk may be assesed at a screening mammogram. According to a UCSF study published in Cancer Epidemiology, Biomarkers & Prevention, measurements of the volume of breast density at mammogram predict breast cancer risk more accurately than current risk models.

According to a study in the Journal of Surgical Oncology, the routine use of diagnostic MRI increases mastectomy rates. MRI is more sensitive to multifocal disease than mammography. MRI detection of multifocal disease is "highly correlated with pathology results," and appears to "justify the performance of mastectomies" in those circumstances.

Breast cancer prognostic testing: C-reactive protein, PAM50 and taxane response

A study in Denmark discovered that women who have high levels of C-reactive protein at diagnosis may have worse outcomes. However, researchers cautioned that their findings may be limited to the Danish population tested and that other known markers were not included in the study.

According to a Business Wire press release, several papers on the utility of the PAM50 assay will be presened at ASCO this week. The PAM50 test provides a subtype classification and prognostic score based on breast tumor biology.

Also, positive study results of a test to predict a patient's response to taxane therapy will be presented. The latest results corroborate an earlier study published in the May 11 issue of JAMA.

Breast cancer radiation: trends for women over 70 and therapy for liver metastases

Presentations on radiation therapy will also be made at ASCO this week.

Researchers Thomas Jefferson University will present data on radiation therapy use by women over 70 with stage I cancer. More women are choosing brachytherapy radioactive implants, such as MammoSite, Contura or Savi, and more women with estrogen positive tumors are opting out of radiation therapy. Researchers also discovered that women with estrogen negative tumors were 91 percent more likely to die from breast cancer if they did not receive radiation after lumpectomy, and that "radiation is currently being underutilized in these women."

For metastatic patients, an Italian study which concluded that SIR-Spheres radioactive microspheres for breast cancer liver metastases were "effective and well-tolerated" will also be presented.

Please check back on Monday for highlights of the weekend breast cancer news. Until then, all of the latest news and research on breast cancer tests and treatment options can be found on the website.

Thursday, June 2, 2011

The Breast Cancer News Update: June 2

Today in breast cancer news, there is advice relating to hormone replacement therapy after ovary removal, progress for two treatments for advanced disease and two lab discoveries which may lead to new treatments for triple-negative breast cancer.

Hormone replacement therapy is safe for BRCA mutation carriers after ovary removal

Researchers from the University of Pennsylvania recommend that women with BRCA1/2 gene mutations have prophylactic oophorectomies (surgical ovary removal) after childbearing to decrease cancer risk. Some women resist this option due to concerns about menopausal symptoms after surgery. According to a recent study, short-term hormone replacement therapy after oophorectomy for menopausal symptom relief does not increase breast cancer risk for young patients.

Progress in the development of tesetaxel and etinostat for advanced breast cancer

Early results of a study of tesataxel as first-line therapy for recurrent or metastatic breast cancer are promising. To date, 60 percent of the patients in the study have attained an average 55% reduction in tumor size. Tesetaxel, an oral taxane, "has been generally well tolerated," with "no substantial neuropathy or alopecia (hair loss)." Tesetaxel has been previously studied as second-line therapy with a 38% response rate. An expert panel will be convened to explore registration strategies for the drug.

A US patent has been issued for etinostat in combination with aromatase inhibitors for metastatic breast cancer. According to a statement from the company, entinostat is expected to extend the benefit of hormone therapy and delay the start of chemotherapy. Phase III studies are planned.

Lab discoveries may lead to new treatments for triple-negative or basal breast cancer

Researchers from the Dana-Farber Cancer Institute have identified a network of growth-spurring genes called the Jak2/Stat3 pathway, which drives triple-negative breast tumors. In animal studies, drugs to block the pathway halted tumor growth. Jak2/Stat3 inhibitor drugs are already in advanced clinical trials for other cancers. It "should be possible to begin testing them in breast cancer patients soon."

Australian researchers have discovered a "hedgehog" molecule, with a "spiky structure" responsible for the spread of basal breast cancer. In animal studies, blocking the molecule results in smaller tumors which don't spread as far. Readily available "hedgehog" blocking drugs have been studied in other cancers. Researchers are hopeful that they will be effective in tests on breast cancer patients.

Please check back tomorrow as we highlight the research abstracts added to the database this week.

Wednesday, June 1, 2011

The Breast Cancer News Update: June 1

Today in breast cancer news, there were two studies about beta-blocker use and an overview of the chemotherapy side-effect neutropenia.

Beta-blocker use associated with breast cancer survival

Late yesterday, Reuters Health covered two Journal of Clinical Oncology studies which found an association between beta-blocker use and breast cancer survival.

In the first study, from MD Anderson, breast cancer patients who took beta-blockers, mainly metoprolol and atenolol, seemed to "fare better." Even though there were no differences in the tumors after surgery, three years later, 87 percent of the women on beta-blockers were alive and cancer free, compared to 77 percent women not on beta-blockers. The findings were "even more striking" for women with triple-negative breast cancer.

The second study, from Ireland, found that women who took the beta-blocker propranolol in the year before diagnosis were less likely to present with advanced breast cancer and had a "significantly lower" risk of mortality than those who took no beta-blockers. However, the use of the beta-blocker atenolol did not appear to confer similar benefits.

Although beta-blockers are inexpensive and readily available, both of these studies are considered early. Further research is needed to identify or confirm a causal relationship.

Neutropenia from chemotherapy

Today, Cure Today published an overview of chemotherapy side-effect neutropenia, or low white blood cell count. Because neutropenia results in a compromised immune system, the article recommended that patients "take precautions to prevent infections," such as washing hands, avoiding crowds, sick people and raw or uncooked foods. Medications such as granulocyte colony stimulating factors (G-CSFs) and antibiotics were also addressed. The latest news and research on Neulasta (pegfilgrastim) and Neupogen (filgrastim), two forms of G-CSFs, can be found on our website,

Please check back tomorrow for more daily breast cancer news updates.