Friday, July 29, 2011

Breast Cancer News for July 29: Risk, Prevention and Screening

Breast cancer research news is not always about breast cancer treatment. Today, we'll examine the latest data on breast cancer in America and highlight the latest breast cancer research on risk and prevention.

U.S. breast cancer incidence rates vary by estrogen receptor status

Yesterday,, citing a Journal of the National Cancer Institute study, revealed that although American breast cancer incidence rates appear to be stable, rates of estrogen-receptor negative breast cancer are actually falling and rates of estrogen-receptor positive breast cancer are on the rise. The decline in ER-negative breast cancer, which is more difficult to treat, is good news. The rise in ER-positive tumors, however, is concerning, and will likely be the focus of future research on risk and prevention.

Three new risk studies: fiber, breast density and BRCA biology

According to Reuters, a Chinese study in the American Journal of Clinical Nutrition found that women who were in the top fifth of fiber consumers were 11 percent less likely to develop breast cancer than those who were in the bottom fifth. Reuters notes that the findings do not prove that fiber lowers breast cancer risk. Fiber consumers may just be healthier overall. Also, Dr. Linos, from Stanford, noted that the potential effect of fiber was "very small." More on diet and breast cancer can be found on the fruits, vegetables and nuts page of the website.

Medical News Today reports that a Harvard study in the Journal of the National Cancer Institute discovered that women whose mammograms reveal dense breasts have not only a greater risk of breast cancer, but a greater risk of developing more aggressive tumors. The women in the study were postmenopausal. Higher breast density was associated with larger tumors, higher-grade tumors, estrogen receptor-negative status and a higher risk of developing ductal carcinoma in situ (DCIS). This was the first study to link breast density with tumor characteristics.

From the biology labs, BRCA 1/2 gene mutations have long been associated with a higher risk of breast cancer. Yesterday, a EurekAlert! press release discussed a Spanish study which examined the chromosomes of BRCA carriers. It found that BRCA 1/2 carriers have chromosomes with short telomeres, which are complex structures that protect the end of chromosomes. Interestingly, it also found "genetic anticipation" of breast cancer in daughters whose telomeres were shorter than their mother's. According to the press release, "The significance of generational changes in telomere length has interesting potential clinical applications in the management of familial breast cancer, and could be extended to other hereditary cancer syndromes."

Low risk of some serious side effects when Tamoxifen is taken for prevention

According to a July 18 study in Cancer Treatment Reviews, women younger than 50 who take tamoxifen for breast cancer prevention have only a low risk of developing endometrial cancer, deep vein thrombosis and pulmonary embolism. The risk decreases from the active to follow-up phase of treatment. The authors note that education and counseling are "the cornerstones of breast cancer chemoprevention."

Please check back on Monday for the weekend breast cancer news highlights. Even though we don't write the daily news blog on the weekends, we continue to add the latest breast cancer news and research to the website and database.

Thursday, July 28, 2011

The Breast Cancer News Update: July 28

One of the most serious side effects associated with breast cancer surgery is lymphedema. In today's breast cancer news update, we'll discuss a white paper by an expert panel on a plan for early detection and treatment. We'll also
look at the latest news on computer-aided detection in mammography and an alternative to surgical nipple reconstruction. Links to today's news stories may be found on the treatment pages of the website.

The early detection of lymphedema

Lymphedema is a painful arm swelling caused by lymphatic fluid accumulation. It is most commonly associated with axillary lymph node dissection, but can be caused by any treatment which damages the lymphatic system. It is universally recognized that early detection and treatment yields the best results.

Yesterday, an expert panel convened by the Avon Foundation for Women, the Lymphatic Research Foundation and the National Lymphatic Network issued a white paper on lymphedema detection and care. Both the white paper and a PR Newswire press release may be found on the axillary lymph node dissection page of our website.

Typically, lymphedema is not detected until discomfort is present or swelling is visible. The white paper reviews the recent research and recommends pre-treatment baseline measurement and continuous monitoring post-treatment to detect lymphedema before visible swelling and discomfort. This is a novel recommendation. For example, the National Cancer Institute publishes a comprehensive summary of lymphedema (link), but the only preventative measure suggested is notifying your doctor if you notice signs of lymphedema such as discomfort and swelling.

In addition to early detection, the benefits of physical therapy, weight bearing exercise the compression sleeves are also discussed in the paper.

Breast cancer patients facing surgery or radiation may want to print the white paper and/or press release and discuss baseline measurements, post-treatment monitoring, exercise, compression sleeves and other lymphedema prevention techniques with their doctors. With proper monitoring, lymphedema may be detected and treated before obvious symptoms appear.

Computer-aided detection does not improve mammography

There's been some media buzz on a July 27 Journal of the National Cancer Institute study of computer-aided detection CAD) in screening mammography. Yesterday, both the Los Angeles Times and US News and World Report covered the study.

What is CAD? Basically, it's a software that scans a mammographic image to identify abnormalities. As defined by the American College of Radiology, it's a "computer-based process designed to analyze mammographic images for suspicious areas; in effect, it is a "second pair of eyes" for the radiologist." In the U.S., it is used in three out of four breast cancer screenings.

What did the study find? An analysis of 1.6 million screening mammograms revealed that CAD did not improve the detection of invasive breast cancer. It did improve the detection of DCIS, but not with statistical significance. In US News and World Report, study author, Dr. Joshua J. Fenton mentioned a "slightly increased chance" of unnecessary recall if a mammogram was read with CAD. "For every 200 women who are screened with CAD who have a second mammogram, one additional woman is called back unnecessarily for further testing," he said.

Tattoos as an alternative to surgical nipple reconstruction

What are nipple tattoos? The latest fad or fashion statement? No, nipple tattoos may be a realistic option to surgical nipple reconstruction for women who have had breast reconstruction after mastectomy. An interesting Philadelphia Inquirer story discusses the procedure and interviews a tattoo artist and her patients.

Please check back tomorrow for more news updates from

Wednesday, July 27, 2011

The Breast Cancer News Update: July 27

Today's breast cancer news update is brought to you by the letter "M". We'll look at the latest research on micrometastasis and mastectomy for multicentric breast cancer. (We hope you don't mind a little midweek humor.)

Lymph node micrometastasis is not prognostically significant

Breast cancer patients frequently ask about the significance of lymph node micrometastasis. Micrometastases are sometimes called "occult" metastasis because they were not seen during routine lymph node staging. Patients may be first diagnosed as node-negative, but upon more refined inspection of the tissue after biopsy are reclassified as having lymph node micrometastasis.

What does this mean? Well, according to recent research, not much.

A new Journal of the American Medical Association (JAMA) study found no association between occult lymph node metastasis and overall survival. In the study, 3,326 sentinel lymph nodes which were considered negative after stain testing underwent further immunohistochemical testing. 349 were found to contain occult metastasis. The authors concluded, "Among women receiving breast-conserving therapy and SLN dissection, immunohistochemical evidence of SLN metastasis was not associated with overall survival over a median of 6.3 years. . ."

If sentinel lymph node micrometastasis is not prognostically significant, is immunohistochemical testing necessary? The Los Angeles Times and US News and World Report suggest not. In an interview with JAMA News, study author Armando E. Giuliano, MD noted,

This study, along with other recent studies, argues against the routine examination of sentinel nodes with immunohistochemistry and argues against basing more extensive treatment on these micrometastatic findings.

Dr. Giuliano clarified that while immunohistochemical testing may be unecessary, sentinel lymph node biopsies are still important. He said,

Sentinel lymph node biopsy should still be performed for patients with early breast cancer as findings may change the use or type of adjuvant systemic therapy or reveal the need for axillary dissection. Sentinel node biopsy remains part of the standard management for early breast cancer.

Importantly, Dr. Giuliano notes that all women in the study were treated with breast conserving surgery, whole breast irradiation and systemic therapy - chemotherapy, hormone therapy or both. Micrometastatic lymph nodes may not require extra testing or treatment, but the standard of care for stage I or II breast cancer still applies.

Links to the study abstract and news stories may be found on the sentinel lymph node biopsy page of the website.

No scientific evidence to support mastectomy for multicentric breast cancer

The use of preoperative MRI has been associated with higher mastectomy rates. Just this year alone, studies in The Breast Journal (March 16), the Journal of Surgical Oncology (May 25) and Annals of Surgical Oncology (July 13) associated MRI use with higher mastectomy rates. Sometimes MRI reveals cancer in the opposite breast. Sometimes it reveals multicentric breast cancer in one breast.

Is a mastectomy necessary to treat multicentric breast tumors? A July 15 review in the Journal of the National Cancer Institute suggests not. After an "extensive examination" of the vast amount of material on the subject, the author concluded that aside from a large trial which demonstrated no statistically significant difference in disease-free survival or overall survival between lumpectomy and mastectomy, "there has been no information in any of the few recently conducted studies involving multicentricity to justify the current resurgence in mastectomy."

Links to all of these studies may be found on the mastectomy page of the website.

Please check back tomorrow for more breast cancer news and research updates from Until then, all the latest news and research for any breast cancer test or treatment option may be found on our website anytime.

Tuesday, July 26, 2011

The Breast Cancer News Update: July 26

Do doctors know when to refer a patient for genetic risk testing? Why do African American women with advanced breast cancer tend to have a worse prognosis than Caucasian women? Today in breast cancer news, we'll highlight recent studies that address these questions.

Not all doctors comply with BRCA 1/2 testing guidelines

Yesterday the Los Angeles Times, US News and World Report and Medical News Today covered a study published in Cancer which examined if doctors would refer hypothetical patients for BRCA 1/2 genetic testing according to recommended guidelines. Only 41% of the doctors would refer the hypothetical patients at high risk of breast or ovarian cancer for genetic counseling. 29% would refer a woman at average risk. Referral guidelines were more likely to be followed if a patient was 35 than if she was 51. Female doctors made proper recommendations more often than males. Ob-Gyn referrals were more compliant than those of internists or family practitioners. Urban doctors were more likely to make appropriate referrals than rural doctors. The authors recommended the development of simple risk assessment tools and further education to help doctors make appropriate recommendations.

Until then, be sure to discuss your personal family history of cancer with your doctor. Also, don't forget the July 13 Journal of the American Medical Association study which stressed the importance of updating your family history as you age. Changes in family history may result in changes in screening recommendations.

Researchers still don't know why African Americans with advanced breast cancer tend to have a worse prognosis

Several recent studies have failed to shed light on why African American women with advanced breast cancer tend to have a worse prognosis than Caucasian women.

Yesterday Reuters covered a Journal of Clinical Oncology study which hypothesized that the difference in prognosis may be due to differences in body weight. The study found that it is "unlikely that differences in obesity distributions between black women and white women account for the poorer survival of black women."

Also yesterday, Medical News Today covered a study in Cancer which hypothesized that African American women may have a worse prognosis because they are less likely to receive radiation therapy. The study confirmed higher breast cancer death rates for African Americans, but found that receipt of radiation therapy was not a factor.

A May 12 study in Clinical Breast Cancer tested whether the difference in prognosis may be due to a higher incidence of triple-negative breast cancer among African Americans. The study found that although African Americans were more likely to have estrogen receptor negative and progesterone receptor negative breast cancer, HER2 status did not differ by race. African American patients with advanced disease "exhibited an increased risk of death" independent of triple-negative status. Interestingly, no survival disparity was found among patients with local disease.

Please check back tomorrow for more breast cancer research updates from

Monday, July 25, 2011

The Breast Cancer News Update: July 25

Today in breast cancer research news, we'll look at recent studies on Herceptin plus chemotherapy and Ellence plus Taxotere for early breast cancer, the Doxil shortage, and a study on the risk of recurrence after a trauma or surgery. Links to the study abstracts may be found on the treatment pages of the website.

Herceptin benefits confirmed in long-term follow-up

In 2006, Herceptin (trastuzumab) received FDA approval in combination with chemotherapy for the treatment of early, HER2 positive breast cancer based on two large trials - the North Central Cancer Treatment Group (NCCTG) and National Surgical Adjuvant Breast and Bowel Project (NSABP). This week, a Journal of Clinical Oncology study published four-year follow-up data which confirmed the benefit of Herceptin. Consistent disease-free survival and overall survival advantages were observed during "the longest follow-up reported to date." "The clinical benefits continue to outweigh the risks of adverse effects."

Ellence followed by Taxotere is better than Ellence alone

Chemotherapy drugs may be given alone or in combination with other chemotherapy drugs. This week, a "relatively small" phase III trial in the Journal of Clinical Oncology compared survival, toxicity and quality of life of six cycles of Ellence (epirubicin) alone to three cylces of Ellence followed by three cycles of Taxotere (docetaxel) for women with postmenopausal, node-positive, early breast cancer. Both disease-free survival and five-year survival rates were better in the Ellence plus Taxotere arm. Ellence plus Taxotere was associated with "greater toxicity," but there was no difference in quality of life during follow-up. published a detailed video on this study for medical professionals. A link to the video may be found under the news tab on the Taxotere page of the website.

Chemotherapy drug Doxil is in short supply

Doxil (PLD), a chemotherapy approved for ovarian cancer, is in clinical trial or used off-label for breast cancer. It's a formulation of Adriamycin (doxorubicin) believed to reduce its cardiotoxicity, or heart-related side effects. According to Reuters, Johnson & Johnson has announced a Doxil shortage and advised doctors not to start new patients on Doxil. New supplies will not be shipped until late August.

Trauma or surgery after breast cancer not associated with increased risk of recurrence

According to a recent Annals of Oncology study, "Several lines of evidence suggest that cytokines released as a result of wound healing might reactivate dormant breast cancer metastases." To test this, British researchers examined recurrence rates 2 to 24 months after a non-cancer related trauma or surgery. They concluded that "[t]rauma was not associated with an increased rate of breast cancer recurrence in the 24-month window after the event in this large study." (Emphasis added.)

Please check back tomorrow for more breast cancer research news updates. Until then, all the latest news and research on any breast cancer test or treatment option may be found on our website anytime.

Friday, July 22, 2011

The Breast Cancer News Update: July 22

There's been a lot of buzz about a recent study which found that tall women have a higher risk of breast cancer. According to the story in the Los Angeles Times, breast cancer risk increased 17% with every 4 inches in height. While this may be interesting, it's not really useful. Height is not a modifiable risk. Today we'll look at recent studies on modifiable risk factors such as diet, exercise, and alcohol use. All of the studies below can be found on the complementary therapy and lifestyle pages of the website.

Diet and breast cancer risk: soy, omega-3s and vitamins

Breast cancer research does not always have a positive ending. This month, two studies found that soy and omega-3 fatty acids do not reduce the hormones associated with breast cancer risk. Another study found that while vitamin A may reduce risk, vitamins C and E do not appear to have an effect.

Dietary soy does not modify estrogen levels

A July 8 study in Cancer Epidemiology, Biomarkers & Prevention examined the effect of dietary soy on blood and nipple aspirate fluid estrogen levels to assess impact on breast cancer risk. The authors concluded that soy in the amounts typically consumed by Asians did not significantly modify blood or nipple fluid estrogen levels. They did observe a non-significant trend towards lower estrogen levels in nipple fluid during the high-soy diet, which "counters concerns about adverse effects of soy foods on breast cancer risk."

Omega-3 fatty acids do not reduce hormones associated with risk

A July 11 study in Nutrition and Cancer found, contrary to expectations, that omega-3 fatty acids did not reduce the hormones associated with breast cancer risk.

Retinol and vitamin A may reduce breast cancer risk

A July 15 review in Cancer Causes & Control analysed the research on retinol, vitamin A, vitamin C and vitamin E and breast cancer risk. The authors concluded that intake of retinol and vitamin A "could reduce breast cancer risk," but the association between vitamins C and E and risk "seem to be limited."

Lifetime exercise reduces precancerous benign breast disease

According to a July 12 study in Cancer Causes & Control, "exercise may be inversely associated with the risk of developing proliferative benign breast disease, one of the earliest steps in the development of breast cancer." The study followed over 40,000 women for four years. Women in the study reported on levels of physical activity during adolescence and adulthood. A significant inverse association was found between walking and the risk of benign breast disease.

Alcohol and breast cancer risk

This month there have been two stories on the use of alcohol and breast cancer risk.

First, a July 11 story in the Los Angeles Times reported that although government health agencies often publish recommended drinking limits, no amount of alcohol is safe in terms of breast cancer risk.

On July 19 and 20, BBC News and Cancer Research UK reported on a study which found that obesity has the greatest effect on the hormones associated with breast cancer risk, followed by alcohol use then smoking. Women who drank 2.5 units of alcohol a day had higher levels of all hormones. A large glass of wine is 3 units of alcohol.

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

Thursday, July 21, 2011

The Breast Cancer News Update: July 21

Today in breast cancer news, we'll look at the latest recommendations on screening mammography and two new studies on sentinel lymph node biopsy recurrence rates.

ACOG weighs in on the screening mammography debate

Another influential group, the American College of Obstetrics and Gynecology (ACOG), has weighed in on the debate over when to start and how often to have screening mammography. Reuters, US News and World Report and The Boston Globe covered the story.

In 2009, the US Preventative Services Task Force stirred up controversy when it noted that the benefit of screening mammography before age 50 was very small compared to the risk of false positives and unnecessary biopsies. Even after age 50, the Task Force recommended screening every two years. By contrast, the American Cancer Society and the National Comprehensive Cancer Network recommend annual screening mammography starting at age 40. The National Cancer Institute recommends screening every one or two years starting at age 40. The public has been vocal on both sides of the issue.

This week, the ACOG recommended that doctors offer annual screenings starting at age 40. Media coverage of the new guidelines varied in emphasis. The Reuters story highlighted the offering of a choice. Reuters quoted Dr. Jennifer Griffin, one of the authors of the new recommendation as saying, "We believe it is our job to help women make the best health decision for themselves. We believe that many women will choose to have a screening mammogram every year, (and) of course there are women that will choose not to." By contrast, the US News and World Report coverage highlighted the incidence of breast cancer among women in their 40s and also quoted Dr. Griffin,

"I think the main point we considered was that about 40,000 women every year in their 40s are diagnosed with breast cancer, and about 20 percent of them will die from it," said Griffin, an assistant professor of OB/GYN at the University of Nebraska Medical Center. "Screening mammograms reduce the risk of dying by 15 percent" in this population.

The ACOG guidelines only apply to women with average risk of breast cancer.

Sentinel lymph node biopsies for node negative and micrometastatic nodes

A sentinel lymph node biopsy (SLNB) is generally preferred over complete axillary lymph node dissection (ALND) due to the less severe side effects and better quality of life associated with SLNB. Back in February, a Journal of the American Medical Association study concluded that for women with one or two positive sentinel lymph nodes, the use of SLNB instead of ALND did not result in inferior overall survival.

This month, two studies evaluated the recurrence rates associated with SLNB without complete axillary dissection for women with negative or micrometastatic nodes.

A July 1 study in The Breast Journal assessed the incidence of recurrence in 481 patients from a hospital in Belgium who were treated with SLNB. In this study, the sentinel nodes were either negative or contained micrometastases. At a median follow-up of 4 years, only one patient (from the node negative group) experienced axillary relapse. The authors concluded, "This study confirms that the axillary recurrence rate after long-term follow-up of patients with a negative sentinel lymph node is very rare, provided that the selection criteria are judicious."

A July 9 study from China in Breast Cancer Research and Treatment reviewed recurrence and survival rates from 8 randomized controlled trials of SLNB and ALND. The authors concluded that "SLNB can be recommended as preferred care for SLN-negative patients and selected patients with SLN-micrometastasis."

Please check back tomorrow for more breast cancer news from

Wednesday, July 20, 2011

The Breast Cancer News Update: July 20

Today in breast cancer news there are stories on Trelstar (triptorelin) to prevent chemotherapy-related early menopause, the UK denial of cost coverage for Halaven (eribulin) for metastatic patients and the effect of body weight and alcohol consumption on breast cancer risk.

Trelstar may prevent chemotherapy-induced early menopause

Today's big story is a Journal of the American Medical Association study on Trelstar (triptorelin) to prevent chemotherapy-induced early menopause. Links to the JAMA study and media reports in the Los Angeles Times, US News and World Report and Internal Medicine News can all be found on the Trelstar (triptorelin) page of the website.

According to the study abstract, premenopausal women are at "high risk of premature ovarian failure" due to systemic treatments such as chemotherapy. In the study, the use of Trelstar to induce temporary ovarian suppression "reduced the occurrence of chemotherapy-induced early menopause."

In the comment section of the study, the authors cautioned that even though early menopause may be avoided, it has "not yet been confirmed" that Trelstar-induced ovarian suppression is "effective in preserving fertility." Embryo cryopreservation (freezing embryos) has been shown to be "relatively effective in achieving pregnancy." The authors note that embryo cryopreservation and Trelstar-induced ovarian suppression can be used together to increase the probability of preserving fertility.

Trelstar is a synthetic version of the body's luteinizing hormone-releasing hormone (LHRH). In May 2011, a Journal of Clinical Oncology study of another LHRH, Zoladex (goserelin), reached an opposite conclusion. In that study, the use of Zoladex to suppress ovarian function during neoadjuvant (before surgery) chemotherapy did not preserve ovarian function or prevent early menopause. In a Cure Today/Reuters article, the authors noted that fertility preservation strategies such as embryo freezing "might be preferred" to the use of Zoladex to suppress ovarian function.

UK denies cost coverage for Halaven

Halaven (eribulin), which is derived from a sea sponge, is used to treat metastatic breast cancer. The News tab of the Halaven (eribulin) page of the website reads like a high-society debutant announcement page. In the last several months, Halaven has made its international debut in the UK, Sweden, Denmark, Finland, Japan and Switzerland. All the news seemed to be good.

Today, however, a Reuters story announced that the UK healthcare cost watchdog the National Institute for Health and Clinical Excellence (NICE) determined that Halaven is not cost-effective. According to Reuters,

Although clinical data indicated the drug could potentially help patients live for a little longer, it also caused more negative side effects than other treatments and NICE said the effects on health-related quality of life had not been adequately assessed.

The NICE decision is a draft guidance, which is now open for public consultation. We'll continue to follow developments in this area.

Weight, alcohol and breast cancer risk

Also from the UK this morning, a British Journal of Cancer study discussed on the Cancer Research UK website found that for post-menopausal women, weight is the biggest factor affecting the hormones that increase breast cancer risk, followed by alcohol and cigarettes. Women with a high body mass index and those who drank a large glass of wine or more a day had increased estrogen levels. This may explain why obese women and regular drinkers are at increased risk of breast cancer.

Please check back tomorrow for more breast cancer news updates from

Tuesday, July 19, 2011

The Breast Cancer News Update: July 19

Herceptin (trastuzumab) is the treatment of choice for HER2 positive breast cancer. Today, we'll look at the latest news and research on Herceptin for metastatic patients. All of the news and research discussed below can be found on the Herceptin (trastuzumab) page of the website.

Herceptin improves survival in patients with brain metastasis

On July 18, Medical News Today covered a Clinical Cancer Research study which examined the survival benefit of three treatment options - Herceptin, chemotherapy and surgery - for breast cancer patients with brain or central nervous system metastasis. Each option was associated with a "significant improvement in overall survival." Overall survival averaged 17.5 months with Herceptin compared to 3.8 months without, 16.4 months with chemotherapy compared to 3.7 months without, and 20.3 months with surgery compared to 11.3 months without. According to Adam Brufsky, M.D., Ph.D., the lead researcher, "We clearly now know that these women should get trastuzumab and potentially chemotherapy, even if cancer spreads to the brain."

Herceptin after previous progression while on Herceptin

The continued use of Herceptin in metastatic patients whose cancer has previously progressed while on Herceptin is controversial. This month, two studies addressed the use of Herceptin beyond progression.

Overall survival analysis of Herceptin plus Xeloda

A July 7 phase III study from Germany in the European Journal of Cancer evaluated the overall survival benefit of Herceptin plus Xeloda (capecitabine) to treat HER2 positive metastatic breast cancer which had previously progressed on Herceptin. Preliminary study results showed a "significantly improved overall response rate and time to progression." However, "final overall survival analysis" did not demonstrate a significant survival benefit.

Post-hoc anaylsis, or looking back at the data for patterns, revealed that patients who continued anti-HER2 treatment with Herceptin or Tykerb (lapatinib) as third-line therapy, after a second progression while on Herceptin, experienced "better post-progression survival than those not receiving this targeted treatment." Post-progression survival in this group averaged 18.8 months compared to 13.3 months for those who did not receive third-line anti-HER2 treatment.

Clinical benefit of Herceptin plus Afinitor

A July 5 Journal of Clinical Oncology phase I/II study evaluated the combination of Herceptin plus Afinitor (everolimus) for patients with HER2 positive breast cancer who had progressed while on Herceptin-based therapy. 7 of 47 patients (15%) experienced a partial response. 9 of 47 (19%) experienced "persistent stable disease" lasting 6 months or longer. Combined, this reflects a clinical benefit of 34%. The authors concluded that the addition of the mTOR inhibitor Afinitor to Herceptin "results in clinical benefit and disease response."

According to a July 8 EurekAlert! press release about the study, "MD Anderson researchers are recruiting HER-2 positive breast cancer patients for BOLERO-3, a randomized multi-center trial of a regimen including the two agents and a chemotherapy drug (vinorelbine)."

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

Monday, July 18, 2011

The Breast Cancer News Update: July 18

This weekend, Omnitarg (pertuzumab), a monoclonal antibody for the treatment of HER2 positive breast cancer, made news as positive phase III study results were announced. Today we'll highlight the latest news and research on Omnitarg for HER2 positive breast cancer. All of the news articles, reviews and studies discussed below can be found on the Omnitarg (pertuzumab) page of the website.

Omnitarg: A little background and biology

For HER2 positive breast cancer, Herceptin (trastuzumab) has been the treatment of choice. Unfortunately, some HER2 positive breast cancers do not respond to Hercpetin and some develop a resistance to Herceptin over time. This has led to the development of new targeted drugs for HER2 positive breast cancer. A 2011 review in Swiss Medical Weekly overviewed the development of Herceptin and Omnitarg (as well as Tykerb (lapatinib), Trastuzumab DM-1, and Rexomun (Ertumaxomab)) for HER2 positive breast cancer. The full-text of the review is available free of charge, which is not always the case with journal reviews.

How does Omnitarg work? A short YouTube video posted by BusinessWire explains the biology behind Omnitarg. Basically, Omnitarg blocks the pairing (or dimerizing) of HER2 proteins with other HER proteins (HER1, HER2, HER3 and HER4). This is different than Herceptin, which attaches to HER2 receptors and blocks them from receiving growth signals. (See the summary for more on how Herceptin works.)

Omnitarg: The latest research

Positive phase III study of Omnitarg plus Herceptin and Taxotere

On Friday, Reuters and Medical News Today published articles covering the announcement of positive phase III trial results of Omnitarg plus Hercpetin and Taxotere (docetaxel) for metastatic breast cancer. Progression free survival was longer for those treated with all three drugs than for those treated with Herceptin and Taxotere alone. The study results are expected to be submitted for global regulatory approval later this year.

Recent cardiac safety study

One of the concerns with Herceptin is the risk of cardiac side-effects. Omnitarg may not raise the same concerns. A June 2011 study published in the Annals of Oncology concluded that patients treated with Omnitarg experienced "relatively low levels" of asymptomatic left ventricular systolic dysfunction (LVSD) and symptomatic heart failure (HF). "There was no notable increase in cardiac side-effects when pertuzumab was given in combination with other anticancer agents," such as Herceptin or non-anthracycline based chemotherapies, such as Taxotere.

Omnitarg: Other studies

Phase II studies for metastatic cancer

In March 2010, two phase II studies of Omnitarg for metastatic breast cancer were published in the Journal of Clinical Oncology . One from Spain found that the combination of Omnitarg and Hercpetin was "active and well tolerated in patients with metastatic HER2-positive breast cancer who had experienced progression during prior trastuzumab therapy." Both the Journal of Clinical Oncology abstract and a February 2010 Cure Today story can be found on the Omnitarg page of our website. The other study, from Italy, concluded that Omnitarg was not effective as a single agent in treating HER2 negative metastatic breast cancer.

Neoadjuvant studies

Omnitarg is not just being studied for metastatic breast cancer. In December 2010, Cure Today and Medical News Today reviewed the positive phase II study of Omnitarg plus Herceptin and Taxotere in the neoadjuvant (before surgery) setting for women with newly diagnosed breast cancer. A November 2010 review in Cancer Treatment Reviews also addressed the research on neoadjuvant Omnitarg.

Other research and reviews

In addition to the studies discussed above, the Omnitarg page contains links to research at the cellular level (December 2009 and February 2011 Cancer Research studies) and several comprehensive reviews of the development of Omnitarg for HER2 positive breast cancer.

We'll continue to monitor Omnitarg developments and add the latest news and research to our website and database. As always, our goal is to monitor and organize breast cancer research for you.

Friday, July 15, 2011

The Breast Cancer News Update: July 15

Today in breast cancer research news, we'll highlight recent studies on MRI for breast cancer screening, the accuracy of BI-RADS for women under 50, the use of contrast enhancement in CT scanning and a study on exercise to reduce breast cancer risk. As always, links to the research discussed today may be found on the treatment pages of the website anytime.

Eligibility for MRI breast cancer screening may change over time

Typically, MRI is only used for breast cancer screening for women with high risk due to a strong family history of known BRCA mutation. According to a July 13 study in the Journal of the American Medical Association, discussed in a story, eligibility for MRI screening may change as a woman ages and family history is updated. When new cases of cancer in the family are taken into account, a woman has a 4 percent chance that her eligibility for MRI screening will change between age 30 and 50. A US News and World Report article on the same study noted that more patients may be eligible for genetic risk assessment, such as BRCA mutation testing, if family histories are updated over time.

BI-RADS assessment not as predictive for younger women

Radiologists use a Breast Imaging-Reporting and Data System (BI-RADS) to classify mammogram or ultrasound findings. Basically, findings are categorized on a scale from 1 to 5, with one being negative and 5 representing a probable malignancy. A 6 means that malignancy has been proven with a biopsy. A zero means the results were inconclusive.

A July 12 study in Breast Cancer Research and Treatment assessed the predictive value of the BI-RADS classifications for women under 50. The researchers compared the accuracy of mammogram and ultrasound reports for women under 50 to the accuracy of the reports for women over 50. They concluded:

The [positive predictive value] PPV of the current screening modalities diminishes markedly in women under the age of 50 and even more below the age of 40. Calcifications and masses larger than 2 cm should be biopsied, but the current BI-RADS criteria may benefit from revision for other findings in young patients.

CT contrast enhancement not required to visualize known breast tumors

According to a July 7 study from The Netherlands published in Radiotherapy and Oncology, "a pre-operative CT scan with contrast enhancement (CE) has recently been proposed to improve tumorbed delineation in breast conserving therapy." The researchers compared contrast enhanced CT to CT without enchantment to determine if contrast enhancement was necessary to visualize known tumors. They concluded that contrast enhancement was not required in "most patients" with a known breast tumor. Visibility on mammogram was a "good parameter to decide on the use" of contrast enhancement.

Exercise may reduce the risk of benign breast changes

A July 12 study in Cancer Causes and Control followed over 40,000 women with no benign breast disease or cancer for four years. The study participants reported on their physical activity levels during adolescence and adulthood. Over the course of the study a "significant inverse association" was observed between walking and the incidence of benign breast disease. Risk was reduced by 9% per hour of walking per week. Risk of columnar lesions was inversely associated with hours of strenuous activity. The authors concluded:

This study suggests that exercise may be inversely associated with the risk of developing proliferative benign breast disease, one of the earliest steps in the development of breast cancer.

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

HER2 Part 7: DNAarray HER2 PRO

Bottom line: CombiMatrix's DNAarray HER2 PRO test offers a more complete picture of HER2 amplification than FISH and can avoid some false negatives. It also shows other important chromosomal problems beyond HER2.

Understanding a breast tumor's HER2 status is critical for treatment planning. But what to do if a pathology report describes HER2 status as "equivocal" (FISH result between 1.8 and 2.2; IHC result of 2+) or if IHC and FISH results contradict one another and so are "discordant?" Inconclusive HER2 results happen about 10-15% of the time. So this is not a rare situation.

As a side note: HER2 testing guidelines for gastic cancer now require dual IHC and FISH testing, an acknowledgement of both the importance of, and concerns over current HER2 testing methods.

In the past few blogs we've written about newer tests based on technologies different than the ones used in IHC and FISH that can be used to make the determination. Today we'll discuss CombiMatrix's DNAarray HER2 PRO.

First, what does this test "look at?" The answer: the entire chromosome 17 in breast tumor cells in your biopsy sample. The HER2 gene is on chromosome 17. But FISH also looks at chromosome 17. So what's the difference?

It's pretty simple. FISH looks at a specific gene (HER2) by attaching ("hybridizing"... the "H" in FISH) fluorescent molecules to it ("fluorescence" is the "F" in FISH). The more HER2 DNA there is, due to gene amplification, the brighter the fluorescence that's emitted.

FISH determines whether the HER2 gene has been amplified by comparing the amount of fluorescence at the HER2 gene with the amount at a different part of the chromosome that FISH also targets. So the pathologist looks at two points on the chromosome using a fluorescence microscope.

If the amount of fluorescence at the HER2 gene is much greater than the amount at the centromere (pronounced sen'-tro-mere and more technically called CEP17), then the assumption is that the gene has been amplified. So the test is all about the ratio of fluorescence emitted at two different know points on chromosome 17. Pretty tricky.

Now DNAarray HER2 PRO. As previously mentioned, it looks at many more points on the chromosome using a technology you might have heard of in the news called a "DNA microarray" or "DNA chip." The generic term for the DNAarray test is array-based Comparative Genomic Hybridization, or aCGH. You don't have to know this. But I didn't want anyone to be confused if they happened to come across the term.

aCGH uses somewhat similar technology to FISH, but by using the DNA chip, it can simultaneously look at hundreds or thousands of points on the chromosome using fluorescence hybridization, not two. The chip is analyzed using an automated instrument. No one looks through a microscope, as with FISH.

Next question: Why does it matter to look at the whole chromosome? Mainly because one potential problem of FISH is that it can give a false negative result. This is a situation where the test says the tumor is HER2 negative even though there is amplification. This can occur if BOTH the HER2 gene and the centromere are amplified. Remember, FISH looks at the ratio between the two. If both are amplified, the amount of fluorescence signal could be about the same but the reason would be that they are BOTH amplified, NOT that neither is amplified! And centromere amplification is relatively common.

Second, and this goes beyond the issue of HER2, tumors that are more aggressive tend to have bigger problems than just HER2 gene amplification. They tend to have amplification elsewhere, changes in the numbers of chomosomes and other problems that can be summed up as "chromosomal chaos." Chromosomal chaos is easily visualized using aCGH. And if the DNAarray test shows big chromosomal problems on chromosome 17, then there's little doubt that the same thing has happened on other chromosomes. Knowing this, and thus that the tumor is aggressive, might alter treatment decisions.

DNAarray HER2 PRO costs $1,500. Reimbursement not certain, as it is with IHC and FISH. But for patients who either don't have a clear-cut HER2 status or who might be willing to pay for a high-tech method that might provide additional insights into the tumor's characteristics, then it's worth a look.

Thursday, July 14, 2011

The Breast Cancer Research Update: July 14

Today in breast cancer research news, we'll highlight recent studies in two controversial areas - nipple-sparing mastectomy and treatment for small, node-negative breast tumors.

Nipple-sparing mastectomy can be safe in properly selected patients

As the name implies, the intent of a nipple-sparing mastectomy is to remove breast tissue and spare the natural nipple area. As noted in a July 5 study published in Plastic and Reconstructive Surgery, the procedure "remains controversial and its adoption has been slow because of oncologic and surgical concerns."

The Georgetown University researchers evaluated the safety of nipple-sparing surgery in 48 women who had 49 mastectomies to treat a current breast cancer and in 80 women who had 113 mastectomies to prevent breast cancer.

In the treatment group, 80% (39/49) of the procedures included subareolar biopsies. 10% (4/39) revealed DCIS, resulting in the later removal of the nipple area. Four breasts had ischemic (blood supply) complications in the nipple area. One of those resulted in excision. On follow-up, an average of two and a half years later, no patients developed cancer in the nipple area.

In the prevention group, 71% (80/113) of the procedures included subareolar biopsy. One biopsy revealed LCIS. No DCIS or invasive cancer was found. Two nipple areas which developed ischemic complications were later excised. On follow-up, an average of three and a half years later, no primary cancers developed in the nipple area.

The authors concluded that nipple-sparing mastectomies "can be safe in properly-selected patients." Subareolar biopsies can effectively identify cancerous cells and ischemic complications can be minimized.

Treatment of early breast cancer

The treatment of early stage (small, node-negative) breast cancer often involves difficult decisions. Options included mastectomy, breast conserving surgery plus radiation and the possible addition of chemotherapy to either surgical option. Two recent studies shed light on when radiation and chemotherapy should be considered. Both can be found on the breast conserving surgery (lumpectomy) page of the website.

Breast conserving surgery plus radiation for early triple-negative breast cancer

A June 13 study in the Journal of Clinical Oncology, discovered that women with early stage(T1-T2, node-negative) triple-negative breast cancer treated with mastectomy alone had a "significant increased risk" of local recurrence when compared with those treated with breast conserving surgery plus radiation. The authors concluded that future studies of radiation therapy after mastectomy for triple-negative breast cancer are warranted.

Chemotherapy should be considered for young patients with early breast cancer

A July 5 MD Anderson study published in The Breast Journal noted that some patients with small, node-negative tumors who only undergo local therapy, such as breast conserving surgery, experience recurrences. The researchers analysed data from 273 patients to identify prognostic factors. They discovered that age at diagnosis was a significant factor in predicting recurrence. They concluded that "adjuvant systemic therapy," such as chemotherapy, "should be discussed with and considered for young patients" with small, node-negative invasive breast cancer.

Please check back tomorrow for more updates from As always, all the latest news and research on any breast cancer test or treatment option may be found on our website anytime.

Wednesday, July 13, 2011

The Breast Cancer News Update: July 13

Today in breast cancer news, we'll highlight recent studies on molecular breast imaging and a study of molecular changes in tamoxifen resistant breast cancer recurrences.

Two Molecular Breast Imaging (MBI) studies

This week we added two studies on molecular breast imaging (MBI) to the website and database. MBI is also knowsn as breast-specific gamma imaging (BSGI).

Molecular breast imaging of invasive cancer

A June 28 study from George Washington University published in The British Journal of Radiology evaluated the sensitivity of BSGI in 139 women with invasive breast cancer. BSGI was found to have "a high sensitivity for the detection of invasive breast cancer." The authors concluded that BSGI "can reliably detect invasive breast cancers and is a useful adjunct imaging modality for the diagnosis of breast cancer."

Molecular breast imaging of DCIS

A July 8 study in the Annals of Surgical Oncology compared BSGI to MRI for the detection of DCIS. 18 patients recently diagnosed with DCIS were enrolled in the study. One tumor was not seen on either MRI or BSGI. One was seen on MRI only. In all, the sensitivity was 94% for MRI and 89% for BSGI. The authors concluded that "BSGI is equally as sensitive as MRI at detecting newly diagnosed DCIS." Future studies are needed due to the "limited number of patients enrolled" in this study.

Biomarker changes in tamoxifen resistant recurrent breast cancer

Sometimes even though a primary breast tumor was responsive to tamoxifen therapy, a recurrent tumor will be resistant to tamoxifen. A July 6 British study published in Endocrine-Related Cancer examined the molecular changes in tamoxifen resistant recurrent tumors to try to determine why. The study confirmed that some tamoxifen resistant tumors lose estrogen or progesterone receptor status and gain HER2 positive status. IGF1R gain, PTEN loss and PI3KCA mutations did not appear to contribute to tamoxifen resistance. This study confirms the importance of hormone receptor and HER2 status testing of recurrent breast cancer to determine the best course of treatment.

Please check back tomorrow for more breast cancer news and research highlights from

Tuesday, July 12, 2011

The Breast Cancer News Update: July 12

Today in breast cancer news, we'll discuss alcohol and breast cancer risk, increased risk of blood diseases after radiation therapy and survivor awareness of diagnosis and treatments received. As always, all of the news and research discussed below can be found on the relevant pages of the website.

No amount of alcohol safe when it comes to breast cancer risk

Back in early May, the Cancer Council Australia increased its estimates of the number of breast cancers caused by alcohol. The Council's chief executive, Ian Olver, told the Sydney Morning Herald that although the National Health & Medical Research Council still recommended alcohol be taken in moderation,

[P]eople should also be told there was no evidence of a safe alcohol dose below which cancer-causing effects did not occur - either from direct DNA damage, increased oestrogen levels or excessive weight gain. ''If you want to reduce your cancer risk as far as possible [abstinence] would be the option you have,'' he said.

Well, it's not just Australians who recommend no alcohol to lower breast cancer risk. Yesterday, the Los Angeles Times reported on an article in the Canadian Medical Association Journal, in which French researchers cautioned health authorities "against telling consumers that any amount of drinking is truly safe, at least, when it comes to cancer risk." According to the authors,

It can be concluded that there is no level of alcohol consumption for which the cancer risk is null. . . Thus, for cancer prevention, the consumption of alcoholic beverages should not be recommended.

Some women treated with radiation may have an increased risk of blood diseases

According to a story in HemOnc Today, some women younger than 65 treated with radiation for breast cancer may be at an increased risk of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML), two blood disorders. (For more on myelodysplastic syndrome, please see the National Cancer Institute overview.) Although breast cancer patients were four times more likely to be diagnosed with MDS or AML than non-patients, the overall risk only affected a small percentage of patients (0.29%). Among patients, women younger than 65 and those who were treated with surgery and radiation or surgery, radiation and chemotherapy had a higher risk than those treated with surgery and chemotherapy with no radiation. Overall, 30% of the MDS cases and 71% of the AML cases were fatal.

Not all breast cancer survivors are aware of their diagnosis details or treatment history

Because I work in the medical information field, the breast cancer patients I meet are typically very aware of the details of their diagnosis. I was surprised to read a recent study in the Journal of Cancer Survivorship (see the Adriamycin link below) which found that 40% of breast cancer survivors were unable to identify the stage of their disease. 7% did not know if they had positive nodes and 42% did not know their estrogen or progesterone receptor status.

It's very important for survivors to be aware of the breast cancer treatments they received. Future health care providers will need to know if a patient has previously been treated with drugs such as Adriamycin (doxorubicin) or tamoxifen. According to the study, only 43% of those treated with Adriamycin could correctly identify it. Fortunately, more than 90% of those on tamoxifen or aromatase inhibitors could identify the correct drug. This may be because hormone treatment typically lasts for five years. Logically, accurate recollection of diagnosis and treatment declined with patient age.

The study authors suggest written treatment summaries to help cancer patients obtain the best future medical care.

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

Monday, July 11, 2011

The Breast Cancer News Update: July 11

Afinitor, also known as everolimus or RAD001, has been making breast cancer news lately. Today, we'll look at the latest news as well as the biology and the history of development of Afinitor for the treatment of breast cancer. All news and research may be found on the Afinitor (everolimus, RAD001) page of the website.

Afinitor: A little biology

Basically, Afinitor targets the mammalian target of rapamycin (mTOR), a protein kinase. According to a nice summary on Inhibiting the PI3K/Akt/mTOR Signaling Pathway from the National Cancer Institute, "mTOR is a critical regulator of several normal cell processes." Essentially, mTOR receives growth signals and regulates cell division, metabolism and blood vessel growth. In cancer cells, the signalling pathway that includes mTOR can become "highly active," resulting in a poor prognosis and increased likelihood of resistance to many types of therapy. Afinitor treats breast cancer by inhibiting mTOR.

The latest Afinitor news: Two studies for metastatic breast cancer

Last week, there were two announcements of positive study results of Afinitor for metastatic breast cancer.

Afinitor plus Aromasin for hormone therapy resistant breast cancer

On July 5, Reuters and RTT News covered results from a phase III study of Afinitor plus Aromasin (exemestane) to treat advanced cancer that had progressed on hormone therapy. The study was halted when its primary endpoint of progression free survival was met ahead of schedule. For women with resistance to hormonal therapy, the addition of Afinitor "has the potential to extend the time until chemotherapy is needed."

Aromasin plus Herceptin for Herceptin resistant breast cancer

On July 8, MD Anderson announced, via EurekAlert!, positive results of a phase I/II study involving the addition of Afinitor to Herceptin (trastuzumab) for HER2 positive metastatic breast cancer that had been resistant to previous Herceptin-based therapy. Despite the fact that most of the women in the study had received "multiple chemotherapy regimens," this "chemotherapy-free option" offered "additional clinical benefit and less toxicity for many" of the patients. Thirty-four percent of the women in the study benefited from the combination.

Afinitor Research History

One of the really unique features of the website is that it's very easy to see the entire history of the development of a drug. Afinitor is a good example. The development history can be seen under both the News Articles and Medical Journal Abstracts tabs.

Early research of Afinitor plus Aromasin or Herceptin

To learn more about the history of Afinitor plus Aromasin, we may look under the News tab to see a December 2010 Medical News Today story about the phase II study.

To see the early, pre-clinical research on Afinitor plus Herceptin, a December 2009 Clinical Cancer Research study, found the combination to be effective for the treatment of HER2 positive breast cancer in mice.

Afinitor plus Taxol and Herceptin

Both of the combinations above are chemotherapy-free options. Afinitor is also being studied in combination with Taxol (paclitaxel), a chemotherapy. Under the News tab, we see links to December 2008 and October 2009 Medical News Today coverage of early studies of the combination of Afinitor, Taxol (paclitaxel), and Herceptin. The October 2010 Journal of Clinical Oncology abstract of the phase I study can be found under the Medical Journal Abstracts tab.

Neoadjuvant (before surgery) therapy

Looking under the Medical Journal Abstracts tab, it is clear that Afinitor is not just being studied for advanced breast cancer. An April 2009 Journal of Clinical Oncology phase II study discovered that the addition of Afinitor "significantly increased" the efficacy of Femara (letrozole) in neoadjuvant therapy in postmenopausal women with operable breast cancer.

Similarly, an October 2010 Breast Cancer Research and Treatment study gave a small number of postmenopausal women with early breast cancer Afinitor alone once a day for 14 days before surgery. The treatment "significantly decreased proliferation," particularly for HER2 postitive cancer and tumors with high Ki67 and p-AKT.

Reviews of the history and future of Afinitor

Not all medical journal abstracts are studies. Often, scientists review all of the research on a treatment or type of treatment. Reviews often explain the biology, history and future potential for a new drug. Several such reviews exist for Afinitor. Under the Medical Journal Abstracts tab, we see reviews published in The Oncologist, Clinical Breast Cancer, the American Journal of Health-System Pharmacy, Breast Cancer Research, the Annals of Oncology, Current Opinion in Obstetrics and Gynecology and Seminars in Oncology.

At, we'll continue to follow developments in Afinitor for breast cancer. All future news and research will be added to the Afinitor page of our website. Please stay tuned.

Friday, July 8, 2011

The Breast Cancer News Update: July 8

Today in breast cancer news, we'll share the latest research on the accuracy of diagnostic ultrasound. As always, all of the research discussed below can be found on the diagnostic ultrasound page of the website.

After a screening mammogram is read by a radiologist, it's not uncommon for a woman to be recalled for a diagnostic ultrasound to further examine a suspicious finding. Understandably, it can be a stressful event. Even after a negative ultrasound where no malignancy is found, some women continue to worry and wonder about the accuracy of the ultrasound. Three recent research papers addressed these concerns.

BI-RADS assessments are consistent among experienced radiologists

Ultrasound findings are classified using a Breast Imaging Reporting and Data System known as BI-RADS. Using something like the American College of Radiology BI-RADS form, a radiologist can check boxes to reflect ultrasound findings on mass size and shape, margins, vascularity, surrounding tissue, echo patterns, etc. At the bottom of the form, radiologists assign a number to classify their findings. Scores range from Category 1, meaning the findings are benign to Category 5, almost certainly malignant. A Category 0 is an inconclusive result. Category 6 means that malignancy has been confirmed by biopsy.

Because the assignment of a BI-RADS score involves a certain amount of subjectivity, some may question the accuracy of the score. In a June 6 study from China published in the European Journal of Radiology, 12 radiologists reviewed 60 ultrasound images (two images of thirty lesions) and assigned each a BI-RADS score. The researchers found that among experienced radiologists, BI-RADS assessments were accurate and consistent. However "diagnostic agreement" decreased as breast imaging experienced decreased.

Diagnostic ultrasound false-negatives

An Australian study published June 29 in Clinical Radiology examined ultrasound false-negative rates and factors. The researchers examined the records of 646,692 women who received screening mammograms over a 10 year period. From a group of 34,533 women recalled for further assessment, 46 patients who received a diagnostic ultrasound were diagnosed with cancer within the next 24 months. Of these, 10 were true false-negatives, meaning that the cancer existed at the time of ultrasound, but was erroneously classified as benign. 15 were true interval cancers, which did not exist at the time of diagnostic ultrasound. For 21 women, the ultrasound assessment was correct, but cancer diagnosis was delayed either due to a delay in obtaining a biopsy or a "non-diagnostic initial biopsy." Based on these findings, the authors conclude that a "normal ultrasound examination should not deter the radiologist from proceeding to stereotactic biopsy, if the index mammographic lesion is suspicious of malignancy."

Ultrasound of clustered microcalcifications

A June 30 study from Taiwan published in Breast (Edinburgh, Scotland) examined the accuracy of diagnostic ultrasound when clustered microcalcifications are found on screening mammography. The study evaluated the diagnostic ultrasound findings of 142 cases with clustered microcalcifications on mammogram. The authors found that ultrasound "was significantly more sensitive for the identification of malignant cases but biopsy of clustered microcalcifications is still warranted when targeted-ultrasound revealed negative findings."

At, we don't just provide access to the latest news and research on a breast cancer test or treatment option. We also provide links to helpful descriptions, videos or overviews. For example, under the Descriptions tab of the diagnostic ultrasound page, you'll find links to 11 overviews of diagnostic breast ultrasound.

Please check back Monday for more news and research highlights. In the meantime, feel free to explore the latest news and research on all breast cancer test and treatment options on the website anytime.

Thursday, July 7, 2011

The Breast Cancer News Update: July 7

Today in breast cancer news, we'll highlight the latest news and research on exercise for breast cancer treatment side effects. As always, all news and research can be found on the exercise page of the website.

Exercise mitigates common breast cancer treatment side effects

A July 2 review in Breast Cancer (Tokyo, Japan) examined the recent research on exercise. According to the authors,

Overall, current research evidence indicates that regular participation in physical activity after breast cancer diagnosis may mitigate common side effects of breast cancer adjuvant therapy, including fatigue, depression, impaired quality of life, decreased muscular strength, decreased aerobic capacity, and weight gain.

Interestingly, the authors noted that future research may examine the influence of exercise on the effectiveness of breast cancer treatment.

Individualized exercise and counseling programs have a greater impact on quality of life than group-based programs

A July 1 study in Psychooncology compared the quality of life benefits of individual-based exercise and counseling and group-based exercise and counseling to the usual standard of care. It was a small, early study, but "preliminary results" suggest that a combined exercise and counseling program was feasible and acceptable to breast cancer survivors. Although both the individual and group-based plans improved quality of life, only the individual plan made a statistically significant difference when compared to no intervention at all.

Physical therapy and massage reduces pain and pressure hypersensitivity

A June 23 Clinical Journal of Pain study from Spain found that an 8-week program of physical therapy based strengthening exercise and massage reduced neck and shoulder pain and "widespread pressure hyperalgesia," or hypersensitivity, in breast cancer survivors.

Inconsistency in breast cancer exercise studies

While these studies are interesting and helpful to the extent that they demonstrate the positive effects of exercise, from a scientific standpoint, they may be difficult to replicate at home or in future studies. Basically, we don't always know the "dose" of exercise. What specifically did the patients do, for how long and how often?

A June 10 review in the British Journal of Sports Medicine addressed this problem. None of the 29 studies reviewed by the authors "applied all principles of exercise training" or "reported all components of the exercise prescription." The authors concluded that "[i]ncomplete reporting of the exercise prescription and adherence to the prescription limits the reproducibility of the intervention, and the ability to determine the dose of exercise received by participants."

Today, we've highlighted some of the latest research on exercise for breast cancer treatment side effects. For news and studies on exercise to reduce breast cancer risk, please visit the exercise page of the website.

Wednesday, July 6, 2011

The Breast Cancer News Update: July 6

Today in breast cancer news, we'll look at a successful study of Afinitor (everolimus) for advanced cancer. We'll also look at recent developments in breast cancer complementary therapies, including vitamin D, acupuncture and tumeric (curcumin).

Positive phase III study results for Afinitor (everolimus)

In a phase III randomized, double-blind, placebo-controlled study known as BOLERO-2, Afinitor (everolimus) plus Aromasin (exemestane) significantly extended progression-free survival for post-menopausal women with estrogen-receptor positive locally advanced or metastatic breast cancer when compared to placebo plus Aromasin. The study was halted when its goals were reached ahead of schedule. According to a statement from Novartis published in Reuters, the results suggest that the Afinitor/Aromasin combination "has the potential to extend the time until chemotherapy is needed for these patients." The results will be presented at a future medical conference. Regulatory submissions are planned by the end of 2011. Marketing approval is possible in early 2012. For more details, please see the link to the RTT News story on the Afinitor page of our site.

Vitamin D for aromatase inhibitor induced bone loss

Looking at the vitamin D page of our website, most studies this year involve breast cancer risk or prognosis. The June 21 Breast Cancer Research and Treatment study is different. As explained in a July 5 Internal Medicine News story, which can be found under the vitamin D page News tab, aromatase inhibitor induced bone loss was "significantly slowed with increasing supplements of vitamin D." "The magnitude of bone-loss prevention correlated with incremental increases" in serum vitamin D concentrations. According to the Internal Medicine News story,

The findings suggest that vitamin D supplementation at doses higher than standard of 400 to 800 IU/day might be useful to minimize bone loss in women starting out on aromatase inhibitors and who are not eligible for bisphosphonate therapy according to current guidelines.

Acupuncture for breast cancer fatigue

Looking at the acupuncture page of our website, acupuncture has been studied for breast cancer related joint pain, hot flashes and lymphedema. According to the latest study, published on June 25 in BMC Complementary and Alternative Medicine, acupuncture may also be useful to treat breast cancer fatigue. Although it was a small study due to recruitment problems, education on exercise and nutrition plus acupuncture seemed to reduce fatigue. Researchers concluded that the "very promising effect" warrants larger studies to confirm the findings.

Another tumeric (curcumin) study on cancer cells

Breast cancer patients are often interested in tumeric (curcumin) as a complementary therapy. Unfortunately, as our curcumin page shows, there haven't been any significant studies in humans. (There was one promising phase I French study in January 2010.) However, several studies on breast cancer cells have demonstrated anti-cancer activity. Curcumin has been tested as a chemosensitiser or radiotherapy sensitiser to make chemotherapy and radition more effective. The latest study from Germany, dated June 26, demonstrated curcumin's effect on cell growth and survival factors. We'll continue to follow developments in curcumin research and hope to see advanced trials in humans someday soon.

Please check back tomorrow for more breast cancer news and research updates. Until then, all breast cancer news and research for any test or treatment option, including complementary therapies, may be found on our website anytime. We update content daily.

Tuesday, July 5, 2011

The Breast Cancer News Update: July 5

Today in breast cancer news, there are studies about the long-term impact of BRCA1/2 testing, surgery for metastatic cancer and personalized screening mammogram guidelines.

BRCA1/2 testing "likely to have a favorable effect" on breast cancer outcomes

Women with a family history of breast cancer often wonder if they should undergo BRCA1/2 gene testing to evaluate their personal risk of breast cancer. A June 29 study published in Cancer looked, long-term, at the actions taken by women who were tested. At an average of 5.3 years after testing, more than 80% of the carriers had chosen prophylactic mastectomy, ovary removal (oophorectomy) or both, suggesting that the testing "is likely to have a favorable effect on breast and ovarian cancer outcomes."

Surgery does not improve survival for stage IV breast cancer

Standard treatment for stage IV breast cancer involves systemic therapy, such as chemotherapy, but not surgery to remove the breast tumor. There has been some suggestion that removing the primary tumor may improve overall survival. A study in Breast Cancer Research and Treatment, which can be found on our breast conserving surgery (lumpectomy) page, compared a group of 236 patients who did not receive surgery to 54 patients who had. When patients were matched for the various cancer types, "surgery was not shown to improve survival."

Study suggests personalized screening mammography guidelines

Lately, there's been a lot of activity on the screening mammography page. The controversy involves when to start and how often a woman should have a screening mammogram. Today, the Los Angeles Times reported on a new study which suggests a more individualized approach. Instead of a "one-size-fits-all" guideline, the study presents a method for personalizing a screening schedule based on breast density and other risk factors. Under the proposed plan, a baseline mammogram at age 40 would be used to craft an individual screening schedule. As wise as this plan appears, practically speaking, it is uncertain if doctors are currently willing or able to invest the deliberation needed. A change in approach may not materialize until formal guidelines are altered.

Please check back tomorrow for more updates. Until then, all the latest news and research on any treatment option may be found on the at any time.

Monday, July 4, 2011

The Breast Cancer News Update: July 4

Happy Fourth of July from Today we'll look at the latest breast cancer news and research on breast cancer side effects including risk of infection, scarring, quality of life, sleep disturbance, pain and nausea and vomiting.

Mastectomy side effects: risk of infection, scarring, insomnia, quality of life and pain

All the latest breast cancer news and research on the potential mastectomy side effects of infection, scarring and pain may be found on the Mastectomy page of our website.

Under the News tab, you'll find a July 1 Cure Today article about the risk of infection after mastectomy or chemotherapy. According to the story, the body's "immune function often decreases in the hours immediately following surgery and may take many months to fully recover." Patients who receive chemotherapy before surgery, known as neoadjuvant chemotherapy, are at "greater risk" of infection. The article includes preventative tips such as preoperative antibiotics, frequent hand washing and influenza vaccines for patients and people in close contact. Port-site infection risk and prevention is also addressed.

Also under the News tab, you'll find a June 1 Cure Today article about mastectomy scar prevention and treatment. Available treatment options include silicone gel sheeting and intralesional corticosteroids.

Under the Medical Journal Abstracts tab, three June 2011 studies address long-term mastectomy side effects.

A June 1 Sleep Medicine study from Norway examined the relationship between insomnia and arm/shoulder problems years after surgery, radiation and hormone therapy for stage II or III breast cancer.

A June 8 European Journal of Surgical Oncology study from Taiwan found that quality of life improved significantly two years after surgery for all patients, with the greatest improvement for patients who received mastectomy with reconstruction. The authors concluded that factors other than surgery type, including age, chemotherapy, radiation, hormone therapy and preoperative functional status affected quality of life.

A June 9 Breast Cancer Research and Treatment study from San Diego examined long-term pain reporting in breast cancer survivors. Over a four-year period, a "slight but significant increase in pain was reported." The authors found that an increase in pain symptoms was associated with medical factors, such as surgery type and tamoxifen use, and psychological factors such as stress and depression. Interestingly, exercise "at baseline had a beneficial effect on pain recovery."

Triple therapy including Aloxi for nausea and vomiting

Finally, a June 28 study on a triple therapy approach for treating chemotherapy-related nausea and vomiting can be found on our Aloxi (palonosetron) page. According to the study, the combination of Aloxi, which is a 5-HT(3) receptor antagonist, plus dexamethasone plus either EMEND (aprepitant) or EMEND for Injection (fosaprepitant) resulted in a lower risk of uncontrolled nausea and vomiting than a triple therapy with other 5-HT(3) receptor antagonists.

For more news and research on drugs to treat breast cancer side effects, please visit that section of the website anytime.