Breast Cancer News Weekly Wrap-Up (Aug. 28 to Sept. 1)

What's new in breast cancer news? Today we'll share the week's headlines and the studies behind them.

US News and World Report: "Some Older Breast Cancer Patients Can Skip Hormone Therapy: Study"

This headline sounds encouraging. For hormone receptor positive breast cancer, hormonal therapy is typically prescribed for five years and associated with unpleasant side effects. Who wouldn't want to skip it?

However, there is some fine print. (Links to the US News and World Report/HealthDay story, the underlying study and related Memo to the Media may be found on the Arimidex (anastrozole) page of our website.)

The August 31 Journal of the National Cancer Institute (JNCI) study evaluated mortality (death) rates for women in Denmark with early-stage, node-negative, hormone-receptor positive breast cancer. Women over 60, with small tumors (up to 10mm), who received no hormonal therapy or chemotherapy were not at an increased risk of death compared with women the same age in the general population.

In an accompanying editorial, the authors noted that even if there is no benefit in terms of mortality, hormonal therapy reduces the risk of recurrence in the same or opposite breast, and many "will continue to take it for that reason." (See the JNCI Memo to the Media under the News tab.)

For women in this subset, this study is another factor to be considered in the decision on whether to take hormonal therapy. According to the Memo to the Media, "patient preferences regarding risks and benefits play a critical role" in the decision. In US News and World Report, Dr. Jennifer Griggs, a study co-author, suggested a three month trial of hormone therapy to gauge side effects before deciding whether to continue.

Reuters: "New breast cancer gene may help predict risk"

The gene at issue, known as CHEK2, is not really new. The CHEK2 genetic test is available, but not generally offered. Instead, BRCA 1/2 genetic tests are typically used to assess hereditary risk. (More on the test and links to the study and story below may be found on the CHEK 2 gene testing page of our website.)

The August 29 Journal of Clinical Oncology study from Poland estimated breast cancer risk in women with CHEK2 mutations and family histories of breast cancer. Baseline lifetime risk was assumed to be 6%. Women with a CHEK2 mutation and no family history had an estimated lifetime risk of 20%. Risk increased with family history. A second-degree relative with breast cancer raised the risk to 28%, one first-degree relative to 34% and both a first- and second-degree relative to 44%.

An August 29 story in Reuters noted that the study may not be "ready for prime time yet." According to Reuters, Dr. James P. Evans, editor-in-chief of Genetics in Medicine, called the study a "nice start," but said it would be "premature" to recommend CHEK2 testing for everyone with a family history now. Dr. Diana Petitti, of Arizona State University in Phoenix, said the study is "an important breakthrough," but more research is needed, noting that "this is a field where replication is critical."

One of the concerns is that the Polish women in the study may be different than Americans. In America, the lifetime risk of breast cancer is about 12% (1 in 8). According to the study authors, that number is only about 6 percent in Poland.

ScienceDaily.com: "Breast Cancer Risk Drops When Diet Includes Walnuts, Researchers Find"

A recent study in Nutrition and Cancer found that walnut consumption reduced breast cancer risk in mice. Study leader Elaine Hardman, Ph.D was quoted in ScienceDaily.com to say, "The results of this study indicate that increased consumption of walnut could be part of a healthy diet and reduce risk for cancer in future generations." (Link on the the Fruits, Vegetables and Nuts page of our website.)

Animals studies such as this one are often interesting, but the applicability in humans has not yet been proven in human trials.

Toronto Sun: "Smoking after menopause could increase risk for breast cancer: Study"

This week, the Toronto Sun, US News and World Report/HealthDay and WebMD covered an August 10 study in The Journal of Endocrinology and Metabolism which found higher androgen and estrogen levels in smokers.

According to the study, because hormone levels dropped with smoking cessation, "hormone related disease risks could potentially be modified by changing smoking habits."

Next week, we'll share the latest research on soy for breast cancer survivors. Until then, all the latest news and research on any breast cancer test or treatment option may be found on the treatment pages of the LATESTBreastCancer.com website.

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 LATESTBreastCancer.com 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 medpagetoday.com 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 LATESTBreastCancer.com website anytime.

The Breast Cancer News Update: June 6

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

Aromasin for breast cancer prevention

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

Zometa plus hormone therapy reduces the risk of breast cancer recurrence

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

Axillary radiotherapy reduces the risk of breast cancer recurrence

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

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

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

Flaxseed is not effective against hot flashes

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

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