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 AccidentalAmazon.com 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 LATESTBreastCancer.com. 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.
Showing posts with label screening mammogram. Show all posts
Showing posts with label screening mammogram. Show all posts
Monday, August 1, 2011
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,
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 LATESTBreastCancer.com.
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 LATESTBreastCancer.com.
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