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  • Standard Medication for HER-2 Breast Cancer Remained Top Rx
    October 22, 2014

    The approval of a new medication represents new options for patients. But the new option isn't always the best option. When it comes to treating HER-2 positive breast , the standard medication still appears to beat the newer option.

    A recent study found that, compared with a newer medication called lapatinib (brand name Tykerb), the older trastuzumab (brand name Herceptin) led to fewer disease events in those with HER-2 positive breast cancer when used in addition to standard chemotherapy.

    Disease events are cases of breast cancer recurrence anywhere in the body, a new cancer, or death from any cause.

    HER-2 positive breast cancer is when the cancer makes a protein called human epidermal growth factor receptor 2. This protein is known to promote growth of cancer cells. About one in five people with breast cancer has this type.

    Patients are usually treated for HER-2 positive breast cancer with chemotherapy and a medication that interferes with the HER protein receptor, such as lapatinib or trastuzumab.

    Edith Perez, MD, from the Mayo Clinic in Jacksonville, Florida, conducted this study with colleagues.

    The study, which lasted from 2007 to 2011, included 8,381 people with HER-2 positive breast cancer. These patients received either a combination of lapatinib and trastuzumab or one of the medications alone.

    When both medications were given together, the participants did not live longer disease-free than when taking either medication alone. The combination only led to more harmful effects because of the increased toxicity to their bodies.

    After four and a half years of follow-up, 14 percent of people who were given only trastuzumab had at least one disease event, and 18 percent of those who only took lapatinib had at least one disease event.

    In 2011, early results showed that lapatinib was inferior to trastuzumab. At that point, patients on lapatinib were offered trastuzumab. About 52 percent of people taking lapatinib took at least one dose of trastuzumab.

    In a press release, Dr. Perez said that her team showed that lapatinib was less effective than trastuzumab in stopping the cancer from spreading.

    "There was a trend for additional benefit if those patients were switched to trastuzumab, that cardiac safety was better than predicted, and that the number of brain metastases appeared similar for the patients who received either lapatinib or trastuzumab,” she said.

    The study results were presented at the European Society for Medical Oncology Congress in Madrid at the end of September.

    The study was funded by The Breast Cancer Intergroup of North America , the Breast International Group, the National Cancer Institute and Glaxo SmithKline; the company that makes lapatinib.

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  • Most Breast Cancer Patients Happy with Choice to Remove Non-Cancerous Breast
    October 22, 2014

    When a woman decides to get a cancerous breast removed, she may need to decide if the second, healthy breast should also be removed to reduce her risk of another cancer. In that moment, it can be hard for women to know if they made the right choice.

    A recent study has found that the majority of women who opted to have a mastectomy (surgical removal) of the healthy breast were happy with their decision a decade later.

    Those who had reconstruction — surgery to make the breast mound about the same size and shape as before the mastectomy — were surprisingly less likely to think they made the right decision compared with women who did not have reconstruction. The researchers believe this may be because 39 percent of women who had reconstruction needed another unplanned surgery.

    This study was done by Judy Boughey, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues.

    The researchers learnt how the women felt by sending out more than 600 questionnaires about 10 and 20 years after the women had the non-cancerous breast removed; a procedure called contralateral prophylactic mastectomy (CPM). All were women who had breast in one breast and chose to have a CPM.

    Of the 583 women who answered the first questionnaire about a decade after their surgery, 403 had undergone reconstruction of their breasts.

    Overall, 83 percent were happy with their decision to have a CPM.

    Women who had reconstruction were less satisfied with their decision than women who did not.

    Of the 269 women who answered the questionnaire about 20 years after their surgery, 92 percent said they would choose to have a CPM again.

    Some women who had chosen reconstruction reported more satisfaction with their appearance, higher self-esteem and feeling more feminine than those who did not have reconstructive surgery.

    Still, the vast majority of women were happy with the decision they had made earlier.

    “I think what this study does is adds some literature to the hands of the people counseling patients to say, ‘Whatever decision you make, you’re very likely to be happy with that in the long run, so listen to yourself, and make the decision that’s best for you,’” Dr. Boughey said in a press release.

    The study authors noted that there is mixed data on whether breast cancer patients with CPM live longer than those who do not choose to remove the healthy breast, though most studies show they do not.

    This study appeared in the September issue of the Annals of Surgical Oncology.

    The authors did not disclose any conflicts of interest.

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  • 'Angelina Effect' May Have Boosted Screening for Breast Cancer
    October 22, 2014

    The United Kingdom recently saw a spike in women seeking genetic screening for breast cancer. Researchers think the increase may be tied to a high-profile celebrity endorsement.

    In May 2013, actress Angelina Jolie had genetic screening that determined she was at a heightened risk for breast cancer. The actress then opted to have both of her breasts removed as a preventive measure.

    After Jolie announced her experience, referrals for breast screenings in the UK more than doubled. Researchers are calling this the "Angelina Effect."

    Jolie had a mutation to the gene BRCA1. The BRCA1 and BRCA2 genes produce proteins that fight cancerous tumors. Mutations to these genes are associated with an increased risk of breast and ovarian cancers.

    Dr. Gareth Evans, lead author on a recent study on the spike in cancer screening in the UK, said in a press statement that Jolie’s decision resonated with women “possibly due to her image as a glamorous and strong woman. This may have lessened patients’ fears about a loss of sexual identity post-preventative surgery and encouraged those who had not previously engaged with health services to consider genetic testing.”

    Breast cancer treatments include chemotherapy and radiation. In some cases, doctors perform a mastectomy, which is partial or total removal of one or both breasts.

    Some women, like Jolie, choose to have both breasts removed before cancer develops. That procedure is called an elective double mastectomy.

    Dr. Evans, a geneticist with the Genesis Breast Cancer Prevention Center in Manchester, UK, and colleagues collected data from 21 health centers for 2012 and 2013.

    In those health centers, total referrals for genetic screening went from 12,142 in 2012 to 19,751 in 2013.

    Compared to 2012, referral rates were 17 percent higher from January to April 2013, the study authors found.

    Then, when Jolie made her announcement in May, referrals increased by almost 50 percent.

    Referral rates were 32 percent higher than the previous year in November and December 2013.

    "These high-profile cases often mean that more women are inclined to contact centers … so that they can be tested for the mutation early and take the necessary steps to prevent themselves from developing the disease,” Dr. Evans said.

    In an interview with dailyRx News, Kevin Hughes, MD, Co-Director of Avon Comprehensive Breast Evaluation Center at Massachusettes General Hospital, explained which women are typically recommended for genetic screenings. Screening may be recommended, said Dr. Hughes, if a woman has "a strong family history of breast cancer, multiple relatives with breast or , a family member who had breast or ovarian cancer under the age of 45, a family member who had both breast and ovarian cancer, or a family member with bilateral breast cancer."

    According to Dr. Hughes, these family histories would prompt a physician to recommend a woman to genetic consulation with an expert who conducts genetic screening.

    Dr. Hughes said that if a woman is found to have a BRCA mutation, doctors "tend to give patients the option between close screening with MRI and mammography or profilactic mastectomy [removal of breast to prevent breast cancer]." The close screening, he explained, can detect breast cancer in its early stages, when it's easier to treat.

    The study by Dr. Evans and team was published online Sept. 18 in Breast Cancer Research.

    The Breast Cancer Campaign funded the study. The authors disclosed no conflicts of interest.

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  • Breast Cancer Screening May Be Riskier for Women Over 70
    October 22, 2014

    (dailyRx News) Mammograms can be a lifesaving tool, but older women undergoing this breast screening may be at a higher risk for misdiagnosis.

    A recent study looked at the effects of a breast cancer screening program that began testing women older than 70. The researchers found more early cases of cancer, but the fall in cases of advanced cancer was minimal.

    The authors of the study concluded that testing women older than 70 led to a risk of overdiagnosis and overtreatment. They suggested that women over 70 decide for themselves whether to continue screenings for breast cancer.

    "Talk to your family physician about what cancer screenings you need."

    Gerrit-Jan Liefers, a surgical oncologist at Leiden University Medical Centre, led the study.

    According to the authors, breast cancer is the largest contributor to cancer deaths among women. Current guidelines recommend that women receive regular mammograms to screen for breast cancer.

    This study focused on women in the Netherlands who were 70 or older.

    The Netherlands extended its breast cancer screening program to cover women up to 75 in 1998. Before, the program only covered women up to age 69.

    Researchers tracked cases of breast cancer among these older women from 1995 to 1997, 1998 to 2002 and 2003 to 2011.

    They found that diagnoses of new cases of breast cancer in its early stages rose after the screening expansion began — by about 116 cases per 100,000 women.

    However, diagnoses of advanced breast cancer decreased by 7 cases per 100,000 women.

    The researchers said more screening led to overdiagnosis. Some patients were diagnosed with breast cancer even though they did not have it.

    The authors of the study wrote that overdiagnosis and overtreatment could be costly and result in harmful side effects, especially in older women.

    They concluded that "the harms and benefits of screening should be weighed on a personalized basis."

    "This is a reasonable study where they found the incidence of advanced cancers decreased and the incidence of early cancers increased after the use of screening mammography in the age group 70-75," said Cary Kaufman, MD, FACS, a breast surgeon and specialist at Bellingham Regional Breast Center in Washington state. "That is a valid finding and supports the value of screening mammograms, yet the authors conclusions seem to misinterpret their data."

    Dr. Kaufman explained that screening mammograms find cancers sooner than routine physical exams. "Thus," he said, "mammograms will find a stage 3 cancer when it is stage 2, a stage 2 cancer when it is stage 1 and so on. This study found that larger (stages 2, 3 and 4) breast cancers decreased while smaller (stage 1 and stage 0) breast cancers increased. Their data supports screening mammography in that age group."

    Dr. Kaufman noted, though, that the authors of this study excluded stage 2 cancers — which he called "a very important group of cancers" — from their final statistics. "They excluded the very important finding of a dramatic lowering of stage 2 cancers in their final calculations in this study," he said.

    He explained that before screening, stage 2 cancers were 47 percent of cases. After screening, however, they were only 28 percent of cases. "That is a dramatic effect of down-staging by screening mammography," he said.

    Stage 2 cancers are 2 centimeters to 5 centimeters in size, while stage 1 cancers are less than 2 centimeters. "Essentially, screening mammography found cancers when they were half the size they were previously," Dr. Kaufman told dailyRx News.

    "The effect of screening created a 60 percent decrease in the number of stage 2 patients accompanied by a 70 percent increase in stage 1 patients. Changing from stage 2 to stage 1 increases the survival rate of these patients according to national survival statistics comparing stage 1 and stage 2," he said.

    "It is unfortunate that the authors didn't provide interpretations using all the data. The assumption that the 60 percent decrease in stage 2 patients was not worth including in the calculations and discussion seems erroneous," he said.

    This study was published Sept. 15 in The BMJ.

    The Alpe d'HuZes Foundation funded the research. The authors declared no conflicts of interest.

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    September 17, 2014
    October 22, 2014

  • New Breast Cancer Vaccine Tested
    October 22, 2014

    (dailyRx News) Efforts to fight include both treatment and prevention. And researchers recently tested a vaccine to prevent breast cancer recurrence.

    Results of a clinical trial of a breast cancer vaccine showed that, when women who had breast cancer were vaccinated, the cancer came back less often.

    The researchers also found that the vaccine was safe and well-tolerated in patients.

    "Ask your primary care physician about screening for breast cancer."

    Even with treatment, breast cancer returns in about 20 percent of cases.

    Targeting proteins on tumor cells has been the objective of drug therapy and vaccine development. One such protein is HER2. Trastuzumab (brand name Herceptin) is a type of immunotherapy medicine known as a monoclonal antibody that was developed to target HER2, a protein found in abundance in some breast cancers.

    Elizabeth Mittendorf, MD, PhD, from the M.D. Anderson Cancer Center, led a clinical trial of a new vaccine against GP2, a protein on tumor cells.

    Vaccines work differently than chemotherapy or immunotherapy. They do not kill cancer cells directly. The GP2 vaccine was developed to prime the immune system to look for the recurrence of any HER2 protein and destroy it.

    Dr. Mittendorf presented her team's research results Sept. 6 at the 2014 American Society of Clinical Oncology’s Breast Cancer Symposium in San Francisco.

    The researchers gave 89 breast cancer patients the vaccine combined with an agent to increase its effectiveness by stimulating the immune system (GM-CSF). Ninety-one women were given the GM-CSF alone.

    All the women in the study had HER2 protein on their breast tumors in different amounts.

    The patients received injections once a month for six months. From 12 to 36 months, they received boosters every six months. The researchers collected data on the women for up to five years.

    The main goal of this Phase II study was to find out if the vaccine was safe. The vaccine was found to be as safe as the GM-CSF alone. The women also tolerated the vaccine well.

    The researchers found that breast cancer recurrence decreased by 57 percent in women who got the GP2 vaccine, compared to those who received GM-CSF alone.

    Some of the women in the study had also been previously treated with trastuzumab. In this smaller group of women, those who also received the vaccine did not experience a recurrence of their breast cancer during the study.

    “This is an important and different avenue in immunotherapy research, in that we are investigating ways to prevent cancer recurrence by stimulating the immune system to treat cancer,” Dr. Mittendorf said in a press release.

    Galena Biopharma, Antigen Express and Norwell sponsored the clinical trials. M.D. Anderson receives funds when patients are enrolled in the studies.

    George Peoples, MD, a study author, had inventor rights to the GP2 vaccine.

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  • Call for Genetic Screening to Become New Norm
    October 22, 2014

    (dailyRx News) Gene mutations associated with higher rates of breast and may pose a serious risk to Ashkenazi Jewish (AJ) women, even those without a family history of cancer. This prompted a call for more genetic screening.

    As it stands now, genetic screening is usually only recommended to patients with a family history of cancer. In fact, the US Preventive Services Task Force recommended against population screening of the two genes.

    "Talk to an oncologist about cancer screening methods."

    Efrat Gabai-Kapara, a professor at the Hebrew University Medical School in Jerusalem, led a recent study of 8,195 AJ men.

    The authors focused on three mutations of the genes BRCA1 and BRCA2. These two genes produce a protein that helps the body fight cancer. Mutations, or changes, to the gene may increase the risk of breast or ovarian cancer.

    Of the patients, 91 had a BRCA1 mutation, 81 had a BRCA2 mutation and three had changes to both genes.

    The changes are equally common in men and women. Both mothers and fathers can pass them down.

    The authors first tested AJ men for the genetic mutations. From there, they screened female relatives of the men who had the mutated genes.

    For AJ women who carried the BRCA1 mutation, the combined risk of either breast or ovarian cancer was 60 percent by age 60 and 83 percent by age 80.

    For those with BRCA2 mutations, the risk was 33 percent by age 60 and 76 percent by age 80.

    Applied to all AJs in Israel, 11 percent of breast cancer and 40 percent of ovarian cancer cases could be due to the gene mutations, the authors found.

    Of the 167 families studied, 51 percent had little or no family history of cancer.

    The authors wrote that screening efforts should focus on "clearly damaging mutations" like BRCA1 and BRCA2 — not just family history.

    "We suggest that the time has come to apply our knowledge of these genes to consideration of a general screening program, with the aim of reducing the burden of breast and ovarian cancer," the authors wrote.

    "It is almost paradoxical that, as there is a major effort underway to reduce access for women to mammography for breast cancer screening, there are calls for more genetic screening," said Daniel B. Kopans, MD, Professor of Radiology at Harvard Medical School and Senior Radiologist of the Breast Imaging Division at Massachusetts General Hospital.

    "I certainly support anyone's decision to be tested to see if they have a BRCA1 or 2 gene mutation that carries a very high lifetime risk of developing breast cancer, but we should not lose sight of the fact that genetic mutations only account for approximately 10 percent of breast cancers," he said. "This may increase slightly as we find that there are more women (and men) who develop breast cancer who have unsuspected mutations, but the fact remains that most breast cancer occurs among women who have no known predisposition and none of the known risk factors."

    According to Dr. Kopans, "Mammography is not the ultimate answer, but no one has any idea how to safely prevent or cure all breast cancers. Early detection offers a lifesaving benefit for thousands of women."

    In an editorial about the study published Sept. 8 in JAMA, Mary-Claire King, PhD, and co-authors echoed that call for widespread screenings of the BRCA1 and BRCA2 genes.

    “It is time to offer genetic screening of these genes to every woman, at about age 30, in the course of routine medical care,” they wrote.

    Dr. King noted the limitations of using the study group to make general statements about a much larger group.

    She wrote that the study “has implications for public health and prevention strategies in the United States,” in part because “large-scale population screening for BRCA1 and BRCA2 mutations was feasible.”

    The study was published online Sept. 5 in PNAS.

    The Breast Cancer Research Foundation, National Institutes of Health, Israel Cancer Association and Israel National Institute for Health Policy Research funded the study. The authors disclosed no conflicts of interest.

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  • Wearing a Bra Not Linked to Breast Cancer
    October 22, 2014

    (dailyRx News) Some believe breast is more common in developed countries because more women wear bras. But new research may debunk that idea.

    Wearing a bra did not lead to breast cancer, according to Seattle researchers who interviewed breast cancer patients about bra use in a recent study.

    "Get screened for breast cancer regularly."

    Lu Chen, MPH, and colleagues tested the concern that breast cancer may be more common in women who wear bras.

    “Our study found no evidence that wearing a bra increases a woman’s risk for breast cancer,” Chen said. “The risk was similar no matter how many hours per day women wore a bra, whether they wore a bra with an underwire, or at what age they first began wearing a bra.”

    With the help of colleagues, Chen, a researcher in the Public Health Sciences Division at Fred Hutchinson Cancer Research Center, recruited 1,044 patients for the study.

    Of those, 454 had invasive ductal carcinoma and 590 had invasive lobular carcinoma — the two most common types of breast cancer. All were postmenopausal and between the ages of 55 and 74.

    Breast cancer screenings include regular mammograms, which are X-ray images used to detect cancer. Treatments include radiation, chemotherapy, and surgical removal of one or both breasts, called a mastectomy.

    The study authors interviewed the patients to find out lifetime patterns of bra use. They found no associations between wearing a bra and breast cancer.

    “The findings provided reassurance to women that wearing a bra does not appear to increase the risk for the most common histologic types of postmenopausal breast cancer,” the study authors wrote.

    The study was published online Sept. 5 in Cancer Epidemiology, Biomarkers & Prevention.

    The National Cancer Institute funded the study. The authors disclosed no conflicts of interest.

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  • Double Mastectomy Rates Increased
    October 14, 2014

    (dailyRx News) Double mastectomy hit the news last year when Angelina Jolie reported having the procedure. But new research suggests that the surgery has been on the rise for over a decade.

    The new study looked at rates of double, or bilateral, mastectomy in California between 1998 and 2011.

    During that time, rates of the procedure increased, but the study authors saw little improvement in patients' life spans.

    "Learn the risks and benefits of surgeries you may have."

    "This phenomenon has been seen only since 1998, which isn’t actually that long ago," said Cary Kaufman, MD, FACS, a breast surgeon and specialist at Bellingham Regional Breast Center in Washington state. "Even in 1998, young women with breast were anxious and had the reflexive response to have a bilateral mastectomy. Yet, calmer advice from physicians noting no survival advantage was accepted and most young women did not opt for contralateral prophylactic mastectomy (CPM) [removal of the noncancerous breast]."

    According to the authors of this new study, which was led by Allison Kurian, MD, of the Stanford University School of Medicine in California, double mastectomy — the removal of both breasts — has become more common, although much about its use is still unknown.

    The procedure is sometimes used in women who only have cancer in one breast, called unilateral breast cancer, as a preventive step.

    The authors wanted to better understand double mastectomy and how it compared to other treatments, including the removal of only one breast (unilateral mastectomy) and procedures that only remove part of a breast (breast-conserving surgery) combined with radiation therapy.

    To do so, the authors used the California Cancer Registry to identify 189,734 women diagnosed with unilateral breast cancer in the state between 1998 and 2011. The patients were followed for an average of 7.4 years.

    Dr. Kurian and team found that rates of bilateral mastectomy increased significantly — from occurring in 2 percent of patients in 1998 to 12.3 percent in 2011.

    Use of double mastectomy especially increased among women younger than 40. For these patients, the rate rose from 3.6 percent of patients in 1998 to 33 percent in 2011.

    "This study looking at the use of breast cancer surgery provides much data regarding these procedures," Dr. Kaufman told dailyRx News. "What is doesn’t provide is the answer as to why women choose one procedure over another when they have all options. We first look at reasons which may be related to the type of breast cancer or the likelihood that the patient will develop a second breast cancer in the future. Yet, these reasons do not seem to explain the marked increase in use of mastectomy and bilateral mastectomy in the last 10 years.

    "This is a trend that has been seen across the country, not just in California. Other studies have shown that this trend is not related to the type of breast cancer that is diagnosed, not related to the likelihood of carrying the breast cancer gene (BRCA1 or BRCA2), not related to the increased use of breast MRI in diagnosing breast cancer, and most importantly, not related to the medical indications necessitating unilateral or bilateral mastectomy," Dr. Kaufman explained.

    Despite the increase in double mastectomy, Dr. Kurian and team found that this procedure was not associated with lower death rates than breast-conserving surgery combined with radiation therapy. Ten years after surgery, 18.8 percent of double mastectomy patients and 16.8 percent of patients undergoing breast-conserving surgery plus radiation had died.

    Both of these rates, however, were lower than the 10-year death rates for unilateral mastectomy — which were 20.1 percent.

    "The underlying truth is demonstrated in this paper, that there is no survival benefit from CPM vs. breast conservation surgery (lumpectomy with radiation)," Dr. Kaufman said. "Yet women continue to be swayed by their peers to choose this more aggressive option. Like all pendulums, this trend will eventually swing back to a more medically reasonable option. We’ll just have to wait."

    This study only looked at patients from one state. Further research is needed to confirm these findings and better understand why rates of double mastectomy might be increasing, the authors noted.

    The study was published online Sept. 2 in JAMA.

    One study author reported receiving grants (not tied to this study) from the biotech corporation Genentech. The authors cited a number of funding sources for the research, including the National Cancer Institute and the Cancer Prevention Institute of California.

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    September 2, 2014
    October 14, 2014

Regular cancer screenings are widely regarded as an important part of preventive medicine, particularly for people in midlife. But those same screenings might cause more harm than good in older patients facing a limited life expectancy. I'm Erin White with your latest health news. New research found that elderly patients were often screened for cancer, which could result in unnecessary medical tests and costs. The study authors called for creating, quote, "simple and reliable ways" to estimate life expectancy to reduce unnecessary screenings. The researchers concluded that would put less strain on the patient both physically and financially. Discuss cancer screenings with your primary physician.

Some breast cancer survivors undergo reconstructive surgery after a mastectomy, the removal of all or part of the breast, but a majority do not. A new study sought to find out why. I'm Miranda Savioli with your latest health news. Many insurers cover breast reconstruction after a mastectomy, but most women do not get the surgery. Based on survey results of women who opted out of the reconstruction, most wanted to avoid more surgery or said it was not important to them. Others noted a fear of implants and concerns about interfering with future cancer screenings. Demographic factors such as being black, less educated, or older were also reflected in the study's findings. Talk to your doctor about potential risks of reconstructive surgery.


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