Wednesday, August 31, 2011

The Importance of Radiation for Triple-Negative Breast Cancer

Radiation therapy, which is standard treatment for many breast cancers, may be especially important for triple-negative breast cancer.

Triple-negative breast cancer, by definition estrogen-receptor, progesterone-receptor and HER2 negative, does not have as many treatment options as other breast cancers. Hormonal therapy and Herceptin (trastuzumab) for HER2 positive cancer are not effective.

Two recent studies highlighted the importance of radiation for triple-negative breast cancer.

Lumpectomy plus radiation better than mastectomy alone

A July 20 study in the Journal of Clinical Oncology found that women with small, node-negative, triple-negative breast cancer treated with mastectomy alone had a "significant increased risk" of local-regional recurrence compared to women treated with lumpectomy (breast conserving surgery) plus radiation. The authors noted that future studies are warranted to investigate the benefit of radiation after mastectomy in triple-negative breast cancer.

After mastectomy, chemotherapy plus radiation better than chemotherapy alone

Almost on cue, an August 16 study in Radiotherapy and Oncology evaluated the benefit of radiation after mastectomy in triple-negative breast cancer. (Link may be found on the postmastectomy radiotherapy (PMRT) page of our website.)

For women with early-stage triple-negative breast cancer treated with a mastectomy, chemotherapy plus radiation was "more effective" than chemotherapy alone. Recurrence rates and overall survival rates were significantly better in the group treated with radiation.

In both studies, women with triple-negative breast cancer treated with radiation fared better than those not treated with radiation.

Triple-negative breast cancer is a special situation. At our website, subscribers may create a profile based on their personal diagnosis to see the latest breast cancer news and research applicable to them. Our goal is to make internet research more efficient, and less overwhelming, for women with breast cancer.

Monday, August 29, 2011

Lumpectomy for Large, Lobular Breast Tumors? Treatment before surgery may make it possible

Is lumpectomy an option for breast cancer patients with large lobular tumors? According to two new studies, shrinking the tumors with chemo or hormonal therapy before surgery may allow some women to opt for a lumpectomy instead of a mastectomy.

If lumpectomy ends up being an option, how do you know if it's right for you? MD Anderson has developed an index to predict recurrence after chemotherapy followed by lumpectomy. Today we'll share a recent study on its effectiveness.

Links to all studies and a news story may be found on the breast conserving surgery (lumpectomy) page of the website.

Annals of Surgical Oncology: "Neoadjuvant Chemotherapy Increases the Rate of Breast Conservation in Lobular-Type Breast Cancer Patients"

A July Annals of Surgical Oncology study from Vienna evaluated whether neoadjuvant (before surgery) chemotherapy resulted in more lumpectomies for women with lobular breast cancer.

The study leader, Dr. Florian Fitzal was quoted by,

"Up until now it had been the view that neoadjuvant chemotherapy hardly had any benefits in cases of lobular breast cancer due to the poor response rate of the cancer, however no one had yet examined the question of the breast preservation rate."
The study found that after neoadjuvant chemotherapy, 45% of the women originally scheduled for mastectomy were able to have breast conserving surgery instead.

In addition, there was no difference in local recurrence between lobular and ductal cancers treated with breast conserving surgery, or between lobular patients treated with lumpectomy or mastectomy.

Breast Cancer Research and Treatment: "Invasive lobular carcinoma: response to neoadjuvant letrozole therapy"

Femara (letrozole) is an aromatase inhibitor used to treat hormone receptor positive breast cancer in post-menopausal women. An August 26 study in Breast Cancer Research and Treatment examined the effectiveness of Femara alone as neoadjuvant therapy in women with "estrogen receptor rich" lobular breast cancer. Women were considered for treatment if they had large operable or locally advanced breast cancer or were unfit for surgery. There was no control group. All study participants received Femara.

After 3 months of Femara, the average reduction in tumor volume was 61%, measured by ultrasound. At the time of publication, 40 of 63 patients underwent surgery, 31 of those were breast conserving surgeries. 21 patients continued with Femara alone, and 19 remained controlled at a median of 2.8 years.

The authors concluded that there is a "high rate of response" to Femara in post-menopausal women with estrogen receptor rich invasive lobular carcinoma.

The Risk of Local Recurrence After Breast Conserving Therapy in Patients Receiving Neoadjuvant Chemotherapy

Even if neoadjuvant chemotherapy can reduce tumor size, is a lumpectomy the right choice for you?

MD Anderson has developed a prognostic index to evaluate the risk of recurrence for patients treated with breast conserving surgery after neoadjuvant chemotherapy. (Link to the original study.) A score from 0 to 4 is calculated based on four factors. For each factor, a zero or one is assigned. For example,

Solitary tumors = 0; Multifocal = 1
Tumors less than or equal to 2cm = 0; Greater than 2cm = 1.
Initial lymph node status of N0 or N1 = 0; N2 or N3 = 1
Lymphovascular space invasion = 1; No invasion = 0.

The numbers are totalled to reach the prognostic index score.

An August 26 Annals of Surgical Oncology study evaluated the index in 551 patients treated from 2001 to 2005 with chemo, surgery (mastectomy or lumpectomy) and radiation. (The study does not distinguish between lobular or ductal breast cancer.)

For patients with a prognostic index score of 0, 1 or 2, the 5-year local-regional recurrence (LRR) free survival rates were similar between women treated with mastectomy and lumpectomy. However, when the score was 3 or 4, the 5-year LRR-free survival was significantly lower for patients treated with lumpectomy (69%) compared to mastectomy (93%).

The authors concluded, "The prognostic index can be used to identify patients at high risk for LRR who may be considered for more extensive surgery or enrollment into clinical trials evaluating novel strategies for local-regional control."

In addition to the prognostic index score, MD Anderson publishes several prognostic calculators to aid in the neoadjuvant chemotherapy decision process. Individual treatment decisions are based on many factors. Tools such as the prognostic index and calculators are factors to be considered, but ultimate decisions are made between a patient and her doctor.

Today's summary only highlights the most recent research on breast conserving surgery and neoadjuvant therapy. Two-years worth of news and research on every breast cancer test and treatment option may be found on the treatment pages of the website. Subscribers may create a profile based on their personal diagnosis to personalize their research.

Friday, August 26, 2011

The New Breast Cancer News Blog

Variety is the spice of life. Over the next few weeks, we're going to experiment with some different approaches to our breast cancer news blog. We'd love your input.

What we do now

At, we read breast cancer research journals and news reports every day. We share what we learn in two ways.

The website

First, we add links to latest news and research to our database and website - The links are sorted by breast cancer test or treatment option. You may explore the latest research on any option under the Treatments tab.

For example, the tamoxifen page of our website has links to medical journal abstracts, news reports, general descriptions and FDA information, all in reverse chronological order. Every time we find a new study on tamoxifen, a link is added to the page.

The blog

We use this blog to highlight some of the news and research we add to the website. Until now, the blog discussed the latest developments on an almost daily basis. It was akin to a daily newspaper. We are starting to wonder if this is the most efficient (or interesting) way to share the news.

What we plan to do over the next few weeks

Over the next few weeks, we are going to try a variety of formats for the news blog. We'll continue to highlight the latest developments. However, instead of a daily run-down of headlines, we'll sort the data to present it in a more meaningful way.

Future news blogs will be sorted by topic, such as complementary therapies or side-effects, and by patient, with blogs for the newly-diagnosed, triple-negative or metastatic patients.

Don't worry, we'll continue to share media headlines. Our plans include -

News Alerts - Important studies making headlines. Issues you may want to discuss with your doctor now.

Buzzworthy - A weekly round-up of studies that garnered media attention. (Note, the studies that generate headlines are not always clinically relevant now. Some interesting discoveries are made in biology labs or animal studies. These will not make a difference in humans for some time.)

We're also going to share research you may not hear from other sources. Topics will include -

Under the Radar - Important studies that did not make headlines, but may make a difference in your treatment decisions.

The Cutting Edge - News and research on fresh, new options, available now.

Up-and-Coming - News and research on options not currently available, but making progress in clinical trials.

How you can help

We want this news blog to be interesting and meaningful. To be our best, we need your input and feedback. As we experiment with new styles, please let us know what works and what doesn't. If there's something you'd like to see, we'd love to hear about it. If you miss the daily news update, we want to know that too.

To share your feedback, please leave a comment, send an email, make a comment on our Facebook page or send us a tweet (@ann_latestbc).

The new blog will start this week. We're looking forward to keeping you posted.

Wednesday, August 24, 2011

Breast Cancer News (8/24): Aromatase Inhibitors and Tamoxifen

Tamoxifen or aromatase inhibitors? It's a treatment decision for postmenopausal women with hormone-receptor positive breast cancer. Three recent studies compared tamoxifen to aromatase inhibitors in terms of survival, toxicity and tumor activity. Links to all studies and media coverage may be found on the Arimidex page of the website.

Adjuvant therapy: Aromatase inhibitor toxicity and overall survival

When used as adjuvant therapy to prevent recurrence, aromatase inhibitors (AIs) are associated with improvements in disease-free survival, but not overall survival. A review in the Journal of the National Cancer Institute, first published online July 8, examined whether differences in toxicity explain the difference in overall survival. Yesterday, Medical News Today and covered the results.

The review included 7 trials and 30,023 patients. Longer use of AIs was associated with increased odds of cardiovascular disease and bone fractures, but decreased odds of venous thrombosis and endometrial cancer. Five years of AIs was associated with an increase in the odds of death without breast cancer recurrence compared to 5 years of tamoxifen or 2-3 years of tamoxifen followed by AIs. However, the difference was not statistically significant.

The authors concluded that when used alone, "cumulative toxicity" of AIs may explain the lack of overall survival benefit despite improvement in disease-free survival. Switching from tamoxifen to AIs "reduces this toxicity and is likely the best balance between efficacy and toxicity."

Advanced breast cancer: Aromatase inhibitors vs. tamoxifen

A review in Clinical Breast Cancer, first published online July 7, compared aromatase inhibitors to tamoxifen as first-line therapy to treat advanced breast cancer. The review included 6 trials with 2,560 patients. Aromatase inhibitors had a significantly better overall response rate and clinical benefit. There was a trend towards improved overall survival, but it was not statistically significant. Toxicities did not differ significantly, except vaginal bleeding and thromboembolic events.

The authors concluded that AIs "appeared to be effective and feasible compared with tamoxifen as first-line hormonal therapy in postmenopausal women with advanced breast cancer." They noted that further, randomized, controlled trials are necessary.

PET scanning reveals differences in anti-estrogen activity

How effective is hormonal therapy in blocking estrogen activity?

A July 15 Clinical Cancer Research study used PET scanning to monitor how tumors in metastatic patients responded to tamoxifen, Faslodex (fulvestrant) and aromatase inhibitors such as Arimidex, Aromasin or Femara. This week, DOTMed News and Medical News Today covered the study.

Thirty women with metastatic breast cancer underwent PET scan imaging. Uptake of an estrogen-containing contrast agent was used to assess estrogen binding. A decline in uptake meant less estrogen binding. Tumor uptake "declined more markedly" with tamoxifen and Faslodex than with aromatase inhibitors. Tamoxifen was more effective than Fulvestrant in complete tumor blockade of estrogen.

The authors concluded that PET scanning "can assess" the pharmacodynamics (what a drug does to a body) and "give insight" into the activity of estrogen-receptor targeted agents. "Imaging revealed significant differences between agents," including differences in blockade.

Dr. Hannah Linden, a study author, was quoted in both media stories to say, "What we're suggesting in the paper . . . is if estrogen is incompletely blocked you're not getting a good outcome for the patient."

We'll continue to follow hormone therapy research. We review medical journal abstracts and media sources daily. All the latest news and research on any breast cancer test or treatment option may be found on the treatment pages of the website anytime.

Monday, August 22, 2011

Breast Cancer News (8/22): Drug Shortage, Hot Flashes and Gifts for Mastectomy Patients

Today in breast cancer news, there are stories on the government response to the drug shortage, the use of hormone replacement therapy to treat hot flashes and a great piece on gifts for mastectomy patients. Interestingly, all of today's stories are from the New York Times.

The US considers interventions in response to the drug shortage

The chemotherapy drug shortage is real. A subscriber recently shared that she was unable to receive her last infusion of Taxol (paclitaxel). She was given another, similar drug instead. (She shares her experience in her blog.)

Last week, USA Today ran a story on price gouging due to the shortage.

On Friday, the New York Times wrote about government plans for intervention. (Link may be found on the Taxol page of our website.) Proposals include a national stockpile of cancer drugs, a nonprofit to manage drug import and manufacture, mandatory early warnings of shortages and increased inspections of foreign plants.

In the meantime, concern and prices are soaring. Dr. Michael Link, president of the American Society of Clinical Oncology, was quoted in the New York Times, "These shortages are just killing us." “These drugs save lives, and it’s unconscionable that medicines that cost a couple of bucks a vial are unavailable.”

Hot flashes, hormone replacement therapy and breast cancer risk

Is hormone replacement therapy, which has been associated with an increased risk of breast cancer, still an option to treat hot flashes during menopause?

An August 15 blog in the New York Times suggests it should be for some. For women with severe symptoms, hormone replacement is effective. Alternative remedies such as soy and flaxseed have been disappointing in clinical trial.

According to the article, some doctors are frustrated by the message that women must seek alternative treatment. They believe risk of breast cancer should be factored into the decision like any other treatment side-effect. For some women, the benefits of hormone replacement would outweigh the risks.

Back in May, the Los Angeles Times ran a similar piece. Dr. Richard Santen, the endocrinologist interviewed, clarified that studies on breast cancer risk have involved women in their 60s. For women in their 50s, who have had a hysterectomy, estrogen alone may be taken to treat symptoms of menopause. For women with a low personal risk of breast cancer, taking estrogen and progesterone results in a potential breast cancer risk which is "also quite low." On the other hand, women with a family history of breast cancer and high personal risk should not take estrogen plus progesterone. He concluded, "We've got to individualize the therapy to the individual patient."

Gifts for mastectomy patients

"What gifts bring the most comfort to breast surgery patients?" Last week, the New York Times shared an entry from the Losing My Boobs blog with terrific suggestions for gifts for mastectomy patients. It's a must read for women facing surgery and her friends and family.

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

Friday, August 19, 2011

Breast Cancer News (8/19): Taxotere (docetaxel)

In the last few days, there have been two studies on Taxotere (docetaxel) for breast cancer. Links to these and other studies may be found on the Taxotere (docetaxel) page of the website.

Taxotere, Navelbine and Herceptin for Metastatic Breast Cancer

According to an August 9 Breast Cancer Research and Treatment phase II study, "The combination of trastuzumab, docetaxel, and vinorelbine is effective as first-line chemotherapy in HER2-positive MBC [metastatic breast cancer] with minimal toxicity. One-year survival estimates are among the highest reported in this population."

Androgen receptor status and response to Taxotere

A pathological complete response (pCR) occurs when a tumor disappears after treatment. Studies often evaluate how different factors, such as estrogen or progesterone receptor status affect pCR in response to treatment.

An August 12 study from Germany in Breast Cancer Research and Treatment considered the effect of androgen receptor status on pCR and overall survival in patients treated with Taxotere/Adriamycin/Cytoxan (TAC) chemotherapy before surgery (neoadjuvant). Patients with androgen receptor (AR) positive tumors had a lower chance of achieving pCR than patients with AR negative tumors, but "better survival, especially if they did not achieve a pCR."

Additional research, news, general information and FDA product information on Taxotere may be found on the website. We update our website and database daily.

Thursday, August 18, 2011

Breast Cancer News (8/18): Survival and Vitamin D, Exercise and CYP2D6 Variations

Recent studies suggest a worse prognosis for breast cancer patients with low blood levels of vitamin D. Do vitamin D supplements improve prognosis? A recent review asked that very question. Today, we'll also share the latest research on how CYP2D6 variations and exercise affect survival. As always, links to the studies below may be found on the treatment pages of the website.

Vitamin D supplementation for cancer patients

Should breast cancer patients take vitamin D supplements to improve prognosis? An August 11 review in The Oncologist evaluated 25 studies involving several cancers. For breast cancer, the two studies reviewed reached opposite conclusions about the prognostic importance of vitamin D. Three prostate cancer trials showed no survival benefit of vitamin D supplementation. The authors concluded that even though low vitamin D was associated with worse prognosis in some cancers, the "currently available evidence is insufficient to recommend vitD supplementation in cancer patients in clinical practice."

Does this mean that breast cancer patients should not take vitamin D? Not necessarily.

First, The Oncologist study reviewed only two breast cancer studies. Recent studies suggest that low serum vitamin D at diagnosis may be associated with a worse prognosis. An April 29 University of Rochester Medical Center study (under the News tab) linked low vitamin D with more aggressive tumors and a worse prognosis. A July 27 Breast Cancer Research study found that low serum vitamin D "may be associated with poorer overall survival and distant disease-free survival in postmenopausal breast cancer patients." These recent studies were likely not considered in The Oncologist review. (The Breast Cancer Research study also noted that the only two previous studies were inconclusive.)

Also, even though vitamin D supplementation is not yet proven to improve prognosis, recent studies suggest it may be beneficial for breast cancer patients to preserve bone mineral density (Annals of Oncology, April 2 and Breast Cancer Research and Treatment, March 8) and to reduce bone and joint pain associated with aromatase inhibitors (Breast Cancer Research and Treatment, June 21).

The bottom line is that breast cancer patients with low serum vitamin D should discuss vitamin D supplementation with their doctors.

CYP2D6 variations do not affect risk of recurrence

Variations in CYP2D6 genes affect how tamoxifen is metabolized. Some women metabolize tamoxifen well. Some do not. Do variations in CYP2D6 affect the risk of recurrence? According to a August 5 study in Cancer, no. Researchers from MD Anderson found that variations in CYP2D6 genes "had no significant effect" on the risk of recurrence in women with early breast cancer treated with adjuvant tamoxifen.

Exercise after breast cancer diagnosis may improve survival

Studies have associated exercise with improved quality of life, but can exercise affect breast cancer survival? An August 12 study in Breast Cancer Research and Treatment revealed that exercise after a breast cancer diagnosis may affect the regulation of tumor suppressor genes, which have "favorable impacts on survival outcomes of breast cancer patients."

Please check back tomorrow for more breast cancer research news from

Wednesday, August 17, 2011

Breast Cancer News (8/17): Race, Risk, Exercise and Music Therapy

Why do African Americans have a greater risk of ER/PR negative breast cancer? What's the minimum amount of exercise needed to improve survival? How can music help cancer patients? Today's top news stories address these questions.

Childbirth and breastfeeding linked to the risk of ER/PR negative breast cancer in African Americans

Recent research has revealed a higher incidence of estrogen receptor (ER) negative and progesterone receptor (PR) negative breast cancer subtypes among African Americans. (A May 12 study in Clinical Cancer Research found a "2-fold greater frequency".)

Yesterday, a Cancer Epidemiology, Biomarkers & Prevention study, covered by the Los Angeles Times and US News and World Report, asked, "Why?"

The answer may relate to childbearing and breastfeeding. Comparing pathology reports to Black Women's Health Study questionnaires, researchers found that African American women who gave birth to more children were more likely to develop ER/PR negative breast cancer, and had a reduced risk of ER/PR positive cancer. However, among women who breastfed, having more children was "no longer associated" with a higher incidence of ER/PR negative cancer, and the reduced risk of ER/PR positive cancer remained. The authors conclude that the higher incidence of ER/PR negative breast cancer in African Americans may be explained in part by a higher number of childbirths and lower prevalence of breastfeeding relative to Caucasians. "Increased breastfeeding may lead to a reduction in the incidence of this breast cancer subtype."

15 minutes of exercise a day reduces cancer risk and improves survival

Can just 15 minutes of exercise a day reduce cancer risk and improve survival? According to an August 16 study from Taiwan in The Lancet, yes. The study and a Reuters news story may be found on the exercise page of the website.

The study explored the minimum amount of exercise needed to reduce mortality and increase life expectancy for all people, healthy or not. It found that compared to inactive people, those who had 15 minutes of moderate exercise a day had a 14% reduced risk of all-cause mortality and a 3 year longer life expectancy. According to the Reuters story, "Daily exercise was also linked to a lower incidence of cancer, and appeared to reduce cancer-related deaths in one person in ten."

More exercise was associated with more benefit. Every additional 15 minutes of daily exercise beyond the minimum reduced all-cause mortality by 4% and all-cancer mortality by 1%.

Music therapy reduces pain and anxiety for cancer patients

It seems obvious that music can be comforting to cancer patients. Are there any scientifically proven benefits? An August 10 Cochrane Library study reviewed the recent research on music therapy for cancer patients. Music was found to have beneficial effects on anxiety, pain, mood and quality of life. It may have "a small effect" on heart rate, respiratory rate and blood pressure. The evidence did not support a benefit on fatigue or physical status.

According to Reuters, "it is not entirely clear" what type of music therapy helps patients most. Debra Burns, a music therapist, said she suspects that visits with a music therapist help more than listening to CDs.

Please check back tomorrow for more breast cancer news and research highlights. Until then, all the latest news and research on any breast cancer test, treatment option or complementary therapy may be found on the treatment pages of the website.

Tuesday, August 16, 2011

Breast Cancer News (8/16): A little something for everyone

Today's breast cancer news update has a little something for everyone. For women in treatment, there's a story on tamoxifen, an overview of DCIS treatment options and an update on a vaccine in development. For women who have completed treatment, there are stories on fatigue and post-trauma survival. Of general interest, there are pieces on the biology of cancer cells and breast cancer statistics in South Chicago.


Tamoxifen affected by genetic mutations and anti-depressants

Yesterday, CBS News Miami published a story and video explaining why tamoxifen may not be effective in some women. Mutations in CYP2D6 genes and anti-depressants, such as Zoloft and Prozac, may interfere with tamoxifen metabolism. Interestingly, the story notes that a "hint" that tamoxifen may not be working is the absence of hot flashes.

An overview of DCIS treatment options

In a commentary, "Management of DCIS - A Work in Progress," reviewed the latest treatment options for DCIS. In addition to standard options such as breast conserving surgery (lumpectomy) or mastectomy, the article addresses prognostic factors and a future role for molecular markers, such as HER2 status.

Plans for phase III vaccine trial make progress

In a GlobeNewswire press release, RXi Pharmaceuticals announced progress in its plans for a phase III trial of its NeuVax vaccine to prevent recurrence in early-stage, node-positive breast cancer with low to intermediate HER2 expression. A principal investigator has been named, conditional site approvals have been received, an organization has been selected to manage international centers and manufacturing approvals have been submitted. The trial is expected to commence in the first half of 2012.


Stress and growth after the trauma of breast cancer

After the stress of breast cancer diagnosis and treatment, some women experience post-traumatic stress disorder (PTSD). provides an overview of symptoms and management suggestions.

Yesterday, an article in the Philadelphia Inquirer explored studies on "the positive side of trauma and grief." For some women, experiencing a trauma such as breast cancer results in personal growth. The "key quality" for post-traumatic growth appears to be "expressive flexibility," the ability to express or suppress emotions as necessary. Experts caution that it is "bad to expect growth." The last thing patients need is more pressure.

Biofield therapy to treat fatigue in breast cancer survivors

Breast cancer survivors often battle fatigue. HemOnc Today wrote about a recent study in Cancer on the complementary therapy known as biofield healing. Basically, a biofield is believed to be the energy or aura that surrounds a person. In the study, biofield healing and mock healing both significantly reduced fatigue compared to wait-list controls. Only biofield therapy made a significant difference in cortisol slope. Because both biofield and mock therapy improved fatigue, the results may be partially due to "nonspecific factors," such as scheduled rest, touch and clinical intervention. However, because biofield healing had a greater effect on general and mental fatigue, the authors note that further study is warranted.


How breast cancer cells evade natural killer cells

In a healthy immune system, natural killer (NK) cells exhibit anti-tumor activity. In breast cancer, tumor cells and the surrounding microenvironment develop the ability to escape NK cell antitumor immunity. The biological process is explained in a GEN: Genetic Engineering & Biotechnology News story on a recent study in The Journal of Clinical Investigation.

Breast cancer mortality rates in South Chicago

Yesterday, a story in the Chicago Sun Times revealed that Chicago's south and southwest side neighborhoods are the "unhealthiest in the city." Those areas had the highest breast cancer mortality rates and few breast health services. Neighborhoods in the north and northwest have more breast health resources and the lowest breast cancer mortality rates. Dr. Bechara Choucair, Chicago's commissioner of health, noted that black women are less likely to get breast cancer, but more likely to die from it. He said the focus "needs to be on making sure black women have more access to mammography, better quality mammography and more timely treatment."

Please check back tomorrow for more breast cancer news highlights from

Monday, August 15, 2011

Breast Cancer News (8/15): 3D Mammography, Risk and Vision Side Effects

What's new in breast cancer news? This weekend, 3D mammography and a study on risk made headlines. From the research world, there were studies on the vision side effects of treatment and the use of breast cancer social media to identify treatment side effects. As always, links to the studies and stories below may be found on the treatment pages of the website.

Is 3D mammography a breakthrough in breast cancer?

On August 14, The Boston Globe asked if 3D mammography, which earned FDA approval in February, and is now available in at least 9 states, is really a breast cancer breakthrough. The comprehensive story addressed the history of the mammography debate, the benefits of 3D mammography in terms of sensitivity and specificity, the risk of increased radiation exposure and the financial cost. It noted that definitive research on overall survival is years away, meaning that 3D mammography may be outdated by the time we know if it improves breast cancer survival.

Aromatase and breast cancer risk

Researchers continue to explore the factors which increase a woman's risk of breast cancer. On August 12, Cancer Research UK covered a Cancer Research study which linked the overproduction of aromatase in breast tissue to breast cancer risk. Although it was an early animal study, the results suggest that aromatase inhibitors, such as Arimidex (anastrazole), may be "a better choice for cancer prevention in postmenopausal women" than tamoxifen. A Cancer Research UK study of Arimidex for breast cancer prevention in postmenopausal women at risk, called IBIS-II, is already underway.

How does breast cancer treatment affect vision and eye health?

A review in Current Eye Research analyzed how treatment for early breast cancer affects vision and eye health. Chemotherapy, hormonal therapy and drugs for side-effects were included. According to the review, Taxotere (docetaxel) can cause epiphora, an overflow of tears onto the face, due to duct narrowing. Tamoxifen can cause cataracts, affect the optic nerve, and alter the perceived color of flashed light. Arimidex may lead to vision reduction, and bisphosphonates for bone loss may cause inflammation within the eye. The authors note that doctors should be aware of these types of side effects and suggest avenues for future research.

What can researchers learn from breast cancer social media?

Finally, an interesting study in the Journal of Biomedical Informatics suggests that researchers monitor breast cancer online social media to learn more about breast cancer treatment side effects. The authors note that medical message boards contain a large number of posts, where patients share "opinions and experiences that would be potentially useful to clinicians and researchers." The authors monitored message boards for information on the side effects of tamoxifen, Arimidex, Aromasin and Femara. 75 to 80% of the side effects discussed were documented on the drug labels. Some side effects were "previously unidentified." The authors conclude that breast cancer chat rooms and message boards become a source of "medical hypothesis generation."

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

Friday, August 12, 2011

Breast Cancer News (8/12): Insomnia and anemia

Feeling tired? Insomnia and anemia are problems for many breast cancer patients, and both cause fatigue. Today we'll look at the latest breast cancer research on insomnia and anemia.

Insomnia in breast cancer patients and survivors

Three recent studies and a Reuters news story addressed insomnia in breast cancer patients and survivors. All may be found on the mastectomy page of the website.

Insomnia before and after surgery for early-stage cancer

An August 8 Journal of Clinical Oncology study from Canada periodically assessed insomnia in early-stage cancer patients from before surgery to 18 months later. Before surgery, insomnia levels were high. Women with breast or gynecologic cancers had higher rates than men with prostate cancer.

Over time, insomnia declined, but remained pervasive even 18 months later. The authors suggest that "[e]arly intervention strategies, such as cognitive-behavioral therapy, could prevent the problem from becoming more severe and chronic."

Carol Enderlin, a sleep researcher not involved in either study, told Reuters the findings indicate that sleep is "a really big problem for cancer patients." She advised patients to report changes in sleep before the problems become more severe. "When people are faced with stress, when they are faced with challenges, they do much better on a good night's sleep," she said. "It's very important, never more so than with cancer patients."

Insomnia, fatigue and depression after treatment for early breast cancer

Also on August 8, a Journal of Clinical Oncology study from UCLA assessed fatigue, sleep disturbance and depression among women who completed surgery, radiation and/or chemotherapy for early breast cancer. More than 60% reported "clinically significant problems with fatigue and sleep, and 25% reported elevated depressive symptoms." Women treated with chemotherapy reported higher levels of all symptoms. The authors associated the symptoms with elevated blood levels of markers of inflammation, suggesting that inflammatory signaling contributes to fatigue.

Insomnia may be due to arm and shoulder pain from breast cancer treatment

A June study from Norway in Sleep Medicine evaluated insomnia a median of 4 years and again 7 years after surgery and radiation for stage II/III breast cancer. Arm and shoulder pain at 4 years was significantly associated with insomnia at 4 and 7 years on simple analysis. In multivariate analysis, however, only the use of sleep aids remained associated with insomnia at 4 years. Only insomnia at 4 years remained associated with insomnia at 7 years. Nevertheless, the authors concluded that arm and shoulder problems, particularly pain, are factors to consider in breast cancer survivors with insomnia.

Anemia develops immediately after treatment for advanced cancer

One potential side effect of chemotherapy is anemia, a low red blood cell count. An August 3 study in Breast Cancer Research and Treatment analyzed the blood of advanced breast cancer patients one hour after chemotherapy with Adriamycin (doxorubicin) or Taxol (paclitaxel). Just one hour after chemotherapy, anemia and oxidative stress were already evident. The authors conclude that this is a new perspective on the aggravation of chronic anemia in women with advanced breast cancer.

Please check back Monday for the weekend breast cancer research news update. Until then, all the latest news and research for any breast cancer test or treatment option may be found on the website anytime.

Thursday, August 11, 2011

Breast Cancer News (8/11): Cardiotoxicity

Breast cancer treatment side effects are in the news again. Earlier this week, we shared the recent research on nausea and thromboembolic events. Today we'll review the latest studies on cardiotoxicity, the heart damage caused by some breast cancer treatments. As always, the news stories and studies discussed below may be found on the treatment pages of the website.

Herceptin-induced cardiotoxicity in elderly patients

The big story was a small study from Spain in the Annals of Oncology which assessed the cardiotoxicity of Herceptin (trastuzumab) in women older than 70. Twelve of the 45 women in the study developed Herceptin-related cardiotoxicity. According to Medical News Today, "Earlier clinical trials in younger, healthier women revealed a slightly lesser rate."

Cardiotoxicity was more prevalent in women with cardiovascular risk factors. It developed in 33% of the women with cardiac disease and 33.3% of the women with diabetes. By contrast, only 9.1% of those without cardiac disease and 6.1% of those without diabetes developed heart damage.

The cardiotoxicity induced by Herceptin was reversible in most. According to US News and World Report, "When the women with heart problems stopped taking Herceptin, all but one recovered fully and five were able to re-start treatment with the drug."

In conclusion, Dr. Cesar Serrano, who conducted the study, was quoted in Medical News Today, "We think that it is reasonable to refer elderly breast cancer patients to a cardiologist if one or more cardiovascular risk factors are present before or during treatment with trastuzumab. Moreover, a closer surveillance of early symptoms and cardiac function is highly recommended."

Exercise and Adriamycin-related cardiotoxicity

Can aerobic exercise prevent or reduce the heart damage associated with
Adriamycin (doxorubicin)? Researchers from the NASA Johnson Space Center asked that very question in a review in Circulation, a journal of the American Heart Association. To lay the preliminary groundwork, the authors reviewed the molecular mechanisms of chemotherapy-induced cardiotoxicity and the effects of exercise on heart tissue. Their early findings "have implications for future research regarding the application and effectiveness of exercise and doxorubicin treatment in humans."

Sutent and the risk of congestive heart failure

Sutent (sunitinib) is approved for renal cell carcinoma and gastrointestinal stromal tumors, and is in clinical trials for breast cancer. A Journal of Clinical Oncology review of phase II and phase III trials found Sutent to be associated with an increased risk of congestive heart failure in cancer patients.

A story and video from provides more detail. The review included 16 studies of renal cell carcinoma and other cancers, involving almost 7,000 patients. Patients treated with Sutent had about a 3-fold higher relative risk of developing high-grade congestive heart failure. The authors concluded that "clinicians need to be aware of the risk of CHF with sunitinib treatment to provide early intervention and balance therapeutic benefit with this potentially life-threatening adverse effect."

Tomorrow, we'll review the latest breast cancer research on another treatment side effect - insomnia. Please stay tuned.

Wednesday, August 10, 2011

Breast Cancer News (8/10): Exercise, Avastin and Soy

In today's breast cancer news update, we'll share the latest media headlines on exercise, Avastin and soy. As always, links to the news stories discussed below may be found on the treatment pages of the website.

The New York Times: "The Benefits of Exercise After Cancer"

Yesterday, The New York Times shared a recent report on the benefits of exercise during and after cancer treatment. In the report, "The importance of physical activity for people living with and beyond cancer:
A concise evidence review," Macmillan Cancer Support (UK) reviewed 60 studies on exercise during and after cancer treatment. Exercise was found to reduce the risk of breast-cancer mortality and recurrence. It also improved physical function, fatigue, well-being, body composition and bone health. For women with advanced breast cancer receiving chemotherapy, exercise affected quality of life and fatigue. The Macmillan Cancer Support webpage is full of additional information on physical activity for cancer patients and healthcare providers.

Bloomberg: "Roche Seeks ‘Middle Ground’ in U.S. Appeal of Avastin Breast Cancer Ruling"

The Avastin (bevacizumab) regulatory saga continues. According to a story in Bloomberg, Roche has appealed the recent FDA withdrawal of approval of Avastin for metastatic breast cancer with a "middle ground proposal." Roche asked the FDA to allow patients with advanced, aggressive cancer with few treatment options to use Avastin with Taxol (paclitaxel). The proposal includes an offer to provide doctors with a "risk-evaluation strategy" and additional information on Avastin effectiveness and risks. Roche also plans a 480 patient follow-up trial. Trial failure would trigger an "immediate voluntary withdrawal of Avastin for breast cancer." The trial is to include a test of a protein biomarker (VEGF-A) to identify patients who may benefit from Avastin.

The Los Angeles Times: "Study indicates soy won't fight bone loss after menopause"

After breast cancer treatment, some women turn to natural remedies, such as soy, for menopausal symptoms such as hot flashes and bone loss. According to a story in yesterday's Los Angeles Times, a recent study in the Archives of Internal Medicine has found that soy tablets do not reduce bone loss in post-menopausal women. Further, the women who took soy experienced more hot flashes and constipation. The women in the study were not breast cancer survivors, but the effects of soy on menopausal symptoms should still apply.

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

Tuesday, August 9, 2011

Breast Cancer News (8/9): Platinol, anemia drugs and the risk of thromboembolic events

A thromboembolic event (TEE) is an event (blood clot in the lungs (pulmonary embolism), deep-vein thrombosis (DVT) or stoke (blood clot in brain)) related to a blood clot loose in the blood stream. According to a recent Anticancer Research study, for patients with advanced breast cancer a TEE is associated with a worse prognosis, although a causal relationship is not yet clear. Today we'll look at recent studies which have linked breast cancer drugs (Platinol chemotherapy and Procrit, Epogen, Aranesp for anemia) to thromboembolic events.

"Unacceptable" rate of thromboembolic events in patients treated with Platinol

An August study in the Journal of Clinical Oncology found an "unacceptable incidence" of thromboembolic events in patients treated with Platinol (cisplatin) based chemotherapy. According to the story and video on, "nearly 1 in 5" (18.1%) have a TEE during treatment or within a month of ending it. Age, patient performance status and presence of a central venous catheter were associated with a higher risk of TEE. Until a "more applicable predictive model is available," the authors suggest that all patients on Platinol-based chemotherapy be considered for "thrombophrophylaxis, unless there is a contraindication." Both the study and news story may be found on the Platinol page of the website.

Drugs to treat anemeia associated with thromboembolic events

Erythropoietin-stimulating agents (ESAs) treat anemia by stimulating bone marrow to produce red blood cells. Back in February, a study in Cancer evaluated the risk of thromboembolic events in patients older than 65 with metastatic breast cancer treated with chemotherapy and ESAs, such as Epogen (epoetin alfa), Procrit (epoetin alfa) and Aranesp (darbepoetin alfa). In this group, TEEs were found to be a "common event" and caution was recommended.

Interestingly, an August 1 study in the Journal of Clinical Oncology found "widespread variablity" in the prescription of ESAs for patients older than 65 on chemotherapy. Some doctors under use and some overuse ESAs. The use and duration of ESA prescriptions varied with doctor experience, specialty and gender. The authors concluded, "Policies to discourage inappropriate use of cancer therapies are needed."

At, we'll continue to highlight studies on breast cancer drug side effects, including thromboembolic events. Please stay tuned.

Monday, August 8, 2011

Breast Cancer News (8/8): Aloxi for nausea

Nausea and vomiting are perhaps the most unpleasant potential side-effects of chemotherapy to treat breast cancer. This year, several studies have shown Aloxi (palonosetron) to be effective in the prevention of chemotherapy-induced nausea and vomiting for breast cancer patients. All of the studies discussed today may be found on the Aloxi page of the website.

Single dose of Aloxi plus dexamethasone for moderately emetogenic chemotherapy

A May 2011 study in the Italian journal Tumori examined the effectiveness of Aloxi to control nausea and vomiting associated with moderately emetogenic chemotherapy, meaning chemotherapy with a moderate risk of vomiting. A single IV administration of Aloxi (.25 mg) plus dexamethasone (8 mg) before the administration of chemotherapy adequately controlled nausea and vomiting "during the entire period of emetic risk."

Aloxi plus dexamethasone for repeated cycles of Platinol, AC or EC chemotherapy

An August 2011 Japanese phase III study in Supportive Care in Cancer tested Aloxi with repeated cycles of Platinol (highly emetogenic), Adriamycin/Cytoxan (AC) and Ellence/Cytoxan (EC) chemotherapy combinations. Aloxi (.75 mg) was administered 30 minutes prior to chemotherapy. Dexamethasone was administered on days 1 through 3. The authors found an "extraordinary safety profile and maintenance of efficacy . . . throughout repeated chemotherapy cycles."

Two studies show Aloxi to be superior to other, similar drugs

Biologically, Aloxi is a 5-hydroxytryptamine receptor antagonist (5-HT(3) RA). It blocks the action of seratonin at 5-HT(3) receptors in the central nervous system and gastrointestinal tract. Other 5-HT(3) RAs are available for the supression of nausea and vomiting. Two recent studies found Aloxi to be superior to other 5-HT(3) RAs.

A May study in Supportive Care in Cancer compared Aloxi to other 5-HT(3) RAs in breast cancer patients treated with Cytoxan based chemotherapy and lung cancer patients on Paraplatin (carboplatin) or Platinol (cisplatin). The patients on Aloxi had a "significantly lower risk" of nausea and vomiting associated with hospital admission compared to those treated with other 5-HT(3) RAs.

Similarly, a June 2011 study in Expert Reviews of Pharmacoeconomics & Outcomes Research compared different 5-HT RAs in combination with aprepitant/fosaprepitant and dexamethasone for highly emetogenic chemotherapy. Patients on Aloxi had a lower risk of uncontrolled nausea and vomiting events than patients on other 5-HT(3) RAs.

At, we'll continue to add the latest news and research on medications to treat side effects to our database and website. Please stay tuned.

Friday, August 5, 2011

Reducing Chemo Side Effects by Exploiting Tumor Cell "Doors"

Results from the DoD's Era of Hope Conference

Yesterday we looked at the challenges of delivering next generation peptide drugs to breast tumors. Today we'll continue to talk about the importance of drug delivery, but in the context of chemotherapeutics, by looking at more research coming out of this week's Era of Hope conference in Orlando.

Drs. Andras Lacko and Nirupama Sabnis from the University of North Texas Health Science Center in Fort Worth showed a technology that could potentially improve the efficacy and decrease the side effects of any chemotherapy drug.

Chemotherapy drugs are by definition poisons. So ideally you want them to enter tumor cells and not healthy cells where they can do things like cause hair loss and worse. But how to accomplish this?

Here's how: find a molecular "door" that only exists on tumor cells -- or that exists in much greater abundance on tumor cells compared to healthy calls.

This is what our featured research team did.

They found that a certain cell surface receptor called "scavenger receptor type B1" (SR=B1) is much more prevalent on tumor cells. This receptor's function on healthy cells is to extract a portion of circulating HDL cholesterol molecules needed for normal cell processes. But since tumor cells grow and proliferate much more rapidly than normal cells, they need much more of this HDL cholesterol element. So tumor cells put many more of these HDL-grabbing SR=B1 receptors on their surface.

So there it is! Our door!

The researchers exploit this door by creating so-called "rHDL nanoparticles" containing drugs of interest. A nanoparticle is an aggregate (a grouping) of defined molecules. In this case, the main component of the nanoparticle is rHDL. The "r" stands for "reconstituted." The other component is the drug of interest. The goal is to trick the cell's SR-B1 receptors into pulling the drug-containing nanoparticles into the cell.

And that's what happens. In Drs. Lacko and Sabnis' research they tricked tumor cells in mice to pull in a drug that isn't a standard chemotherapeutic. But as they said at the conference, "This novel drug delivery system has the potential to be compatible with most of the commonly used chemotherapy agents."

You might recognize that this drug delivery model has similarities with Abraxane, the "nanoparticle albumin-bound" version of the chemotherapeutic Taxol (paclitaxel) that is FDA-approved for the treatment of breast cancer. In the case of Abraxane, the protein used in the nanoparticle is albumin, which tends to attach to albumin receptors in blood vessels around tumors.

So this concept of creating protein-chemo nanoparticles seems to be gaining momentum.

Next the University of North Texas researchers are going to look at replacing the rHDL with a smaller protein, or peptide, that is known to mimmick HDL and which is currently used and approved for the treatment of arteriosclerosis. This would make any future drug easier to get through regulatory approval and likely less expensive.

My thanks to Dr. Sabnis for speaking with me yesterday about her research.

Breast Cancer News (8/5): Risk studies from the Era of Hope

This week, the Era of Hope conference in Orlando, Florida is highlighting research funded by the Department of Defense Breast Cancer Research Program. Yesterday, Scott Cole shared his interview with one of the researchers working on new drug delivery methods. Today, we'll review the Era of Hope presentations on breast cancer risk. For more details, please see the press release page of the Era of Hope website.

Young adult daughters of BRCA mutation carriers have "little knowledge" and "intense anxiety" about their own risk

A study from the Dana-Farber Cancer institute questioned women, ages 18 to 24, whose mothers were BRCA gene mutation carriers, about their own breast cancer risk. The young women "exhibited a limited understanding" of screening and risk reduction options. Worry about hereditary cancer was high. Dr. Andrea Farkas Patenaude noted the need for "targeted educational materials to reduce that anxiety and ultimately improve participation in effective screening and risk-reducing interventions that can improve survival and quality of life for these young women."

Vitamin D and risk for women of European and African descent

A study from Roswell Park Cancer Institute, Buffalo evaluated the association between vitamin D levels and breast cancer risk for women of European and African descent. In the study, all women with breast cancer had lower levels of vitamin D than those without. Women with premenopausal triple-negative breast cancer had the lowest levels of vitamin D. Severe vitamin D deficiency "was almost six times higher in African American women than . . . in European American women (34.3 percent vs 5.9 percent)." The researchers also identified two genetic variants (SNPs) which may partly explain the higher risk of estrogen-receptor negative cancer in African American women. The authors concluded that low vitamin D levels are inversely associated with breast cancer risk, particluarly triple-negative cancer, which is more common in African Americans. Future studies to investigate if maintaining sufficient levels of vitamin D can mitigate risk for African Americans are warranted.

Progress in understanding genetic risk for African Americans

Genetic studies of breast cancer risk have been conducted "almost exclusively" in in women of European descent. Researchers from the University of Southern California (USC) initiated a genetic study of breast cancer risk in women of African descent. To date, genetic mapping has identified markers which will "allow for an improved ability to predict the risk of breast cancer development for African Americans over previously-reported markers." Future research is planned.

Two animal studies on pregnancy diet and future breast cancer risk for daughters

Two early animal studies examined the affect of diet during pregnancy on future breast cancer risk for offspring. Although animal studies are not yet applicable to humans, it's interesting to peek at the future of research on breast cancer risk and prevention.

A study from Marshall University found a "reduced incidence" of mammary gland cancer in offspring whose mothers consumed canola oil, rich in omega 3, compared to offspring of mothers who consumed corn oil, rich in omega 6.

Similarly, a study from North Dakota State University found a decrease in tumor incidence and growth in offspring whose mothers consumed a diet supplemented with methyl nutrients (methionine, choline, folate and vitamin B12) compared to offspring of mothers in the control group.d

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

Thursday, August 4, 2011

Opening Up the Potential of Peptide Drugs -- A New Delivery Method

Results from the DoD's Era of Hope Conference

Scientists are teasing apart the molecular causes of breast cancer so that they can develop more targeted drugs. But applying this new model of personalized, targeted treatment depends as much on developing new technologies to deliver drugs as developing the active components of the drugs.

Why is drug delivery is so critical? To explain, today we'll look at research results presented yesterday at the Era of Hope conference in Orlando, which featured research funded by the Department of Defense's Breast Cancer Research Program (BCRP). Today I spoke to Dr. Gene Bidwell of the University of Mississippi Medical Center who presented findings on a new "thermally-targeted" approach to delivering peptide drugs. (Press releases from the conference can be found here.)

Dr. Bidwell's research was performed in an animal model and is years away from the bedside. But it is an exciting approach. It also underscores several larger trends in cancer research and future treatment. So let me explain the context and relevance before describing his new system.

First, peptides. What are they? The term "peptide" simply refers to a small protein. While a typical protein is a chain of hundreds of amino acids, peptides are tens or teens. Dr. Bidwell's H1 peptide, the focus of this research, is 16 amino acids long.

Peptides have the potential to be fabulous drugs. Most of the molecular activity in cells is about proteins interacting with other proteins. So peptides (being proteins themselves) are a natural in terms of interacting with, changing or inhibiting proteins gone awry.

In addition, today we have machines that make peptides to order. You just type in any series of amino acids you want, and out pops the peptide. So researchers can make a peptide, try it out, adjust it a bit (maybe switch one of the 16 amino acids), make that one, try that out and iterate little by little to create the perfect drug. This process is called "rational drug design."

Today, some drugs are large proteins called monoclonal antibodies (for example, Herceptin), which work well if the target lies on the surface of the tumor cell. But most drugs are "small molecules" -- chemicals.

Pharmaceutical companies make enormous collections (libraries) of millions of random chemicals that they then robotically test. The process of finding a good small molecule drug is literally like throwing the entire library against a wall (actually against the molecule they're targeting) and seeing which "stick," or attach to that molecule. If one or more do stick, they still have to figure out if it sticks such that it interrupts the molecule's function. If not, they move on. This process doesn't allow the research team to iterate small changes to perfect the drug nearly as easily as with peptides. So there are big advantages to peptides in terms of a rational drug design approach.

But today there are no peptide cancer drugs. Why? First, small peptides degrade in the bloodstream. So they need to be attached to another molecule (sometimes just larger peptides) for protection until they arrive at the tumor. Second, peptides need to get inside tumor cells to do their thing. That doesn't happen naturally.

Many research teams are trying to solve this problem and Dr. Bidwell's research provides a great and an exciting example. He created a three part peptide drug. All three parts are peptides. Together create a larger and more stable molecule. It's really tricky. Here's how it works.

- The first part is the peptide drug itself, called H1. It targets a growth signaling protein in cancer cells called c-Myc.

- The second part is called elastin-like peptide (ELP). The ELP enables the drug to remain soluble and stable in the bloodstream. But right at the tumor site a mild heat is applied (according to Dr. Bidwell, "about 5-10 degrees hotter than body temperature... like a high fever") using ultrasound. The focused heat changes the shape of the ELP, and causes the drug to aggregate and accumulate where it's needed.

- The third part is called cell-penetrating peptide (CPP). When the drug aggregates at the tumor cell, the CPP provides entry into the cells.

This is a powerful approach. All three parts of the drug have distinct functions. Mild heat is used to aggregate the drug to where it's needed at the tumor and to avoid exposure of other tissues.

According to Dr. Bidwell, there are other approaches being developed to deliver peptides to breast tumors, including synthetic polymers and liposomes. But those aren't thermally-targeted, which provides not only stability, but also (potentially) increased effectiveness and fewer side effects.

So cross your fingers. Let's hope that Dr. Bidwell's thermally-targeted delivery mechanism, or a variant of it, will open up the full potential of next-generation peptide drugs against cancer. And thanks again to Dr. Bidwell for taking the time to speak with me today.

Breast Cancer News (8/4): Is it safe to delay treatment?

After a breast cancer diagnosis, there's a natural sense of urgency to start treatment immediately. How long is it safe to wait? Today, we'll look at three recent studies on treatment delays for women with early, node-negative breast cancer.

Short delays before surgery not associated with significant changes in tumor size

In April, an MD Anderson study in the Annals of Surgery evaluated whether delays before breast cancer surgery affected tumor size for 818 clinically node-negative women. The median time from imaging to surgery was 21 days. The median difference in tumor size from mammogram to surgery was 0 cm, and from ultrasound to surgery was .1 cm. The researchers concluded, "Modest time intervals from imaging to surgery are not significantly associated with change in tumor size; thus, patients may undergo preoperative work-up without experiencing significant disease progression."

Senior researcher Dr. Funda Meric-Bernstam told Reuters Health, "Clearly, rapid treatment is desireable. However, taking a few weeks to coordinate care is safe. It's very unlikely there will be tumor progression."

Two studies on delays between surgery and radiation

Also in April, a study in Clinical Breast Cancer evaluated how delays between breast conserving surgery and the start of radiation affect local recurrence rates. 387 women with node-negative, early breast cancer were divided into four groups based on how long after surgery radiotherapy started - less than 60 days after surgery, 61 to 120, 121 to 180 and more than 180 days later. Five years later, "a delay in administering radiotherapy after breast-conserving surgery was not associated with an increased risk of local relapse." The authors did, however, acknowledge conflicting results from other published studies and noted that "a larger evaluation of this issue is warranted."

A Korean study in the May/June issue of Tumori evaluated the local recurrence rates for two groups of women with node-negative breast cancer treated with breast conserving surgery. The first group started radiation therapy within 6 weeks of surgery. The second group started more than six weeks after surgery. The eight-year "local control," meaning no local recurrence, rates were 94.5% in the less than six week group and 92.7% in the more than six week group. For women less than 40 years old, starting radiotherapy within six weeks of surgery was associated with "a higher local control rate." There was no statistically significant difference for older women. Also, the interval between surgery and radiation "had no impact on overall and distant metastasis-free survival." The authors concluded, "Early radiotherapy within 6 weeks of breast-conserving surgery is associated with increased local control in patients with node-negative breast cancer not undergoing chemotherapy."

The topic for today's blog was inspired by a recent Twitter chat where a breast cancer survivor advised the newly diagnosed not to rush to treatment, but to take time to explore options and seek second opinions. Twitter can be another valuable resource for breast cancer patients and survivors. Currently, a group of survivors, patients and medical professionals participate in a weekly chat under the #bcsm (breast cancer social media) hashtag. Conversations take place on Mondays at 9pm Eastern/6pm Pacific time. Recent topics have included "Advice for the Newly Diagnosed," and "How Breast Cancer Affects Families." To learn more, search for #bcsm on Twitter. I tweet under the name @ann_latestbc. I hope to see you there.

At, we'll continue to add breast cancer research on delays in treatment to our website and database. The studies discussed today can be found on the radiation and breast conserving surgery pages of our website.

Wednesday, August 3, 2011

Breast Cancer News (8/3): Mammography, Hercpetin and the NCCN Guide for Patients

Today in breast cancer news, we'll highlight a study on the radiation damage caused by screening mammography, two studies on the neoadjuvant (before surgery) use of Herceptin and the new patient-friendly guidelines from the National Comprehensive Cancer Network (NCCN).

DNA damage from screening mammography

Once concern in the screening mammography debate is the exposure to radiation. A July 29 study in the International Journal of Radiation Biology assessed mammography induced DNA damage, in the form of double-strand breaks, in cells of women with high and low risk of breast cancer. DNA double-strand breaks were induced by mammography in all patients, and the effects were "exacerbated" in high-risk patients. The researchers concluded, "These findings may lead us to re-evaluate the number of views performed in screening using a single view (oblique) in women whose mammographic benefit has not properly been proved such as the 40-49 and HR [high risk] patients."

Neoadjuvant use of Herceptin

Herceptin (trastuzumab) is used to treat HER2 positive breast cancer. This week, two studies addressed the use of Herceptin in the neoadjuvant setting, to shrink tumors before surgery.

A July 25 study in the Journal of Clinical Oncology found that the neoadjuvant combination of Herceptin plus chemotherapy resulted in a high rate of pathological complete response (pCR), "defined as no residual invasive tumor in breast and lymphatic tissue." Women with pCR who continued Herceptin after surgery had "an improved long-term outcome." On the other hand, patients "without a pCR had an increased risk for relapse and death."

A July 25 review of five trials (515 patients) in Breast (Edinburgh, Scotland) found the addition of Herceptin to chemotherapy in the "neoadjuvant setting improves the probability of achieving higher pCR with no additional toxicity."

NCCN Guidelines for Breast Cancer Patients

For doctors, the NCCN publishes Clinical Practice Guidelines in Oncology, which outline a recommended standard of care for the treatment of cancer. This week, the NCCN released a patient-friendly version for breast cancer called the NCCN Guidelines for Patients. It's a terrific starting point for the newly diagnosed, covering breast cancer development, detection, staging, and standard-of-care treatment options by type. It even addresses side effects, complementary therapy and caregiver issues.

Our website,, is an additional resource for breast cancer patients. Patients may explore the latest news and research on the standard-of-care treatment options mentioned in the NCCN Guidelines and up-and-coming tests and treatment options in development. In addition, subscribers may personalize their research to their pathology reports to see the test and treatment options applicable to them.

Tuesday, August 2, 2011

Breast Cancer News (8/2): Vitamin D and Exercise

There's more to breast cancer care than surgery, radiation and drugs. Complementary therapies and lifestyle choices can affect risk, recovery and quality of life. It's an aspect of prevention and care that women can control. Today we'll look at the latest breast cancer research on vitamin D and exercise.

Vitamin D for breast cancer side effects, risk and prognosis

The vitamin D page of the website is full of links to news and research on breast cancer side effects, risk and prognosis. Today, we'll discuss the most recent studies.

Vitamin D for aromatase inhibitor muscle and joint pain

A June 21 study in Breast Cancer Research and Treatment found that high doses of vitamin D reduced the muscle and joint pain associated with aromatase inhibitor therapy. On July 26, Washington University in St. Louis released a detailed written news story and video about the study.

Does exposure to solar vitamin D decrease breast cancer risk?

Recent studies on vitamin D from sun exposure and breast cancer risk are contradictory. On one hand, a June 6 study in the American Journal of Epidemiology determined that exposure to solar vitamin D during adolescence resulted in a lower risk of breast cancer. A June 28 article on the UK National Health Service Choices website provides a detailed analysis of the study.

On the other end of the spectrum, (no pun intended), the findings of a July 23 study in the European Journal of Cancer "contradict that vitamin D production through extensive sun exposure has any protective effect on internal cancer but emphasise the increased risk for skin cancer." In that study, the risk of breast and other internal cancers was calculated for Swedish women with basal cell carcinoma (BCC), which is typically associated with extensive sun exposure. The authors found that women with BCC had an increased risk of other forms of cancer, including breast cancer, prior to the BCC diagnosis.

Why are study results inconsistent? The answer may be that people are genetically different. Much as tamoxifen only treats hormone receptor positive breast cancer, vitamin D may only reduce risk in those with specific genetic characteristics. A June 21 study in Cancer Epidemiology, Biomarkers & Prevention evaluated whether genetic variations might explain why vitamin D is associated with breast cancer risk reduction in some but not others. The study concluded, "Variation in vitamin D-related genotypes may help to explain inconsistent results from previous epidemiologic studies and may lead to targeted prevention strategies."

Serum vitamin D levels and breast cancer prognosis

Recent studies suggest that low serum (blood) levels of vitamin D at diagnosis may be associated with a worse prognosis.

A July 26 Breast Cancer Research study found that low concentrations of serum vitamin D before the start of chemotherapy "may be associated with poorer overall survival and distant disease-free survival in postmenopausal breast cancer patients." In the study, 1,295 German postmenopausal breast cancer patients were followed a median of 5.8 years after diagnosis.

Back on April 29, US News and World Report covered a similar study which was presented at the annual meeting of the American Society of Breast Surgeons. In that study, "[r]esearchers from the University of Rochester Medical Center found an association between low vitamin D levels (less than 32 milligrams per milliliter of blood) and poor scores on every major biological marker used to predict a breast cancer patient's outcome."

Exercise and breast cancer side effects and survival

Exercise to reduce side effects

Most of the links on the exercise page of our website associate exercise with the reduction of breast cancer treatment side effects for survivors.

A recent Evidence-Based Complementary and Alternative Medicine study found that core stability exercise and massage reduced "fatigue, tension and depression and improved vigor and muscle strength" for breast cancer survivors.

A July 11 study in Medicine and Science in Sports and Exercise concluded that resistance training alone improved physical self esteem, which is based on conditioning, attractiveness and strength. Aerobic exercise improved physical conditioning. However, a combination aerobic and resistance program did not improve physical self esteem any greater than single modality programs.

Additional studies on exercise and breast cancer side effects were discussed in the July 7 issue of our blog.

Exercise to improve survival

We know there is evidence that exercise can improve quality of life for survivors, but does exercise after diagnosis affect breast cancer survival? The findings of a July 27 study in Cancer Prevention Research "suggest that exercise after breast cancer diagnosis may improve overall and disease-free survival." This is an exciting area of research that we will be sure to follow.

Please check back tomorrow for more breast cancer research news highlights. Until then, please check our website for the latest news and research on other breast cancer complementary therapies and lifestyle options.

Monday, August 1, 2011

Breast Cancer News (8/1): Tamoxifen, Screening and Race

Deja vu in breast cancer news? Didn't we discuss tamoxifen, screening mammography and race last week? Although the topics seem familiar, today's studies approach these issues from different directions.

Long-term efficacy of tamoxifen to prevent recurrence

Last week, we highlighted a study on the side effects of tamoxifen when used to prevent breast cancer (July 29 blog.) Today, we'll look at the latest research on adjuvant tamoxifen to prevent breast cancer recurrence. Links to the studies and news below may be found on the tamoxifen page of our website.

Back in March, a Journal of Clinical Oncology study found that, for women over 50, 5 years of tamoxifen reduced the risk of recurrence 15 years after starting treatment. It also reduced the risk of cardiovascular disease and death. US News and World Report/HealthDay, Vancouver Sun and Medical News Today all covered the study.

On Friday, a review in The Lancet Oncology analyzed patient data from 20 trials of tamoxifen. The simple conclusion was that "5 years of adjuvant tamoxifen safely reduces 15-year risks of breast cancer recurrence and death" for women with estrogen receptor positive breast cancer. Media coverage included stories in US News and World Report/HealthDay and Medical News Today and a written story and video by ABC News.

The study, however, was anything but simple. It was a complex statistical analysis, which considered the risk of fatal side effects, variations in estrogen receptor status, risk by time period and absolute risks without tamoxifen.

Kathleen Kolb, author of the blog, read the full text of the study with a critical eye. Her piece, Tamoxifen Efficacy Revisited: Behind The Hype delves into the details of the statistical findings in search of practical meaning. For those interested in adjuvant tamoxifen, her analysis is an additional resource.

More fuel in the screening mammography debate

Last week, we looked at a study on mammography and the use of computer-aided detection (July 28 blog). This week, a British Medical Journal study evaluated whether screening mammography affects mortality, adding more fuel to the debate on when to start and how often to have a screening mammogram.

What's the issue? In one corner, advocates of yearly screening starting at age 40 argue that early detection saves lives. In the other corner, opponents argue that for women in their 40s with average risk, the benefits of annual screening mammography are small and not worth the exposure to radiation and high rates of false positives, which result in higher anxiety and unnecessary follow-up procedures. They question the relationship between screening mammography and breast cancer mortality.

There is research to support both sides. The screening mammography page of our website has many pages of news and study links. Recently, a June 28 Swedish study in Radiology found that an invitation to screening mammography resulted in a "highly significant decrease in breast cancer-specific mortality."

The July 28 British Medical Journal study reached an opposite conclusion. (Follow the link for the full text of the study.) The study compared breast cancer mortality rates for pairs of European countries which implemented breast cancer screening programs at different times. Using World Health Organization (WHO) data, the analysis suggested that "screening did not play a direct part in the reductions of breast cancer mortality." US News and World Report/HealthDay and Reuters both covered the study.

We'll continue to follow the controversy and highlight the latest research.

Racial differences in receipt of breast cancer treatment

On July 26, we discussed three studies which failed to explain why African American women with advanced breast cancer tend to have a worse prognosis than Caucasian women. On July 29, Reuters covered a July 15 study in Cancer which approached this issue from a different angle.

The study authors acknowledged the racial difference in mortality rates and examined if there were racial differences in treatment received by women with the same health insurance. The women in the study were all covered by the Department of Defense Military Health System. Results showed no statistical difference in type of surgery received - mastectomy or breast conserving surgery plus radiation. For women with "local stage tumors," African Americans were just as likely as Caucasians to receive chemotherapy and hormonal therapy. However, for women with "regional stage tumors," or advanced breast cancer, African Americans were significantly less likely than Caucasians to receive chemotherapy and hormonal therapy.

Questions remain as to why the treatments were different. Were the options not offered? Were they offered and rejected? Further studies are needed to address the disparity.

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