Breast Cancer Female
Blood Pressure Rx May Not Pose Cancer ThreatNovember 20, 2014
A blood pressure medication once considered a threat to women's health may not be as bad as researchers thought.
Calcium channel blockers have been linked to increased odds of developing breast cancer. A new study found that the risk of getting breast when using these medications may be smaller than previously thought.
Calcium channel blockers are widely used to treat (high blood pressure). Last year, the Fred Hutchinson Cancer Research Center in Seattle published a study that said breast cancer risk more than doubled for women who took these heart medications.
Jeffery L. Anderson, MD, a cardiologist and researcher at the Intermountain Medical Center Heart Institute in Salt Lake City, UT, and colleagues wrote the study.
These researchers reviewed medical records on more than 3,700 women from two groups at the Intermountain center. One group of 2,612 consisted of general patients. Another group of 1,106 patients was undergoing coronary angiography. This is a procedure that uses dye and special X-rays to view the insides of coronary arteries to look for heart disease.
The women were all ages 50 to 70 at the start of the study and had no history of breast cancer.
In each of the two groups, Dr. Anderson and colleagues compared women who were prescribed calcium channel blockers to similar women who weren't prescribed the medications.
After five years or less of follow-up, Dr. Anderson and team observed that women in the general patient group who were taking calcium channel blockers were 1.6 times more likely than those who were not taking them to develop breast cancer. On the other hand, patients in the angiography group who were taking channel blockers had a 50 percent reduction in their risk for breast cancer.
Because of these contrasting results, the study authors concluded that it was unlikely that the medication caused the changes in breast cancer risk.
“Given the important role of calcium channel blockers in clinical medicine, further studies are warranted, including randomized trials to assess calcium channel blocker safety with respect to breast cancer risk,” Dr. Anderson and team concluded.
Calcium channel blockers work by blocking calcium from moving into heart cells and blood vessel walls. This widens blood vessels and makes it easier for the heart to pump — which can reduce blood pressure. A few common calcium channel blockers are amlodipine (brand name Norvasc), felodipine (Plendil) and isradipine (DynaCirc).
This study was presented Nov. 19 at the American Heart Association Scientific Sessions 2014 in Chicago. Research presented at conferences may not have been peer-reviewed.
The authors disclosed no funding sources or conflicts of interest.November 20, 2014Intermountain Heart Institute, "Long Term Use of Calcium Channel Blockers and Risk of Breast Cancer Development" Intemountain Medical Center, "Common blood pressure medication does not increase risk of breast cancer, new study finds" Acta Physiologica, "Functional and pharmacological consequences of the distribution of voltage-gated calcium channels in the renal blood vessels" Mayo Clinic, "Calcium channel blockers"November 20, 2014
More Women Opting for MastectomiesNovember 20, 2014
Women with breast are often faced with a choice between partial or complete breast removal. More and more have been opting for the complete removal, new research suggests.
The authors of a new report, led by Kristy L. Kummerow, MD, of Vanderbilt University Medical Center in Nashville, reviewed data on more than 1.2 million women being treated for breast cancer.
The report found that higher proportions of women who qualify for breast conservation surgery were choosing mastectomies instead of less invasive breast conservation surgeries.
Breast conservation surgery is an operation to remove breast cancer but not the entire breast. It typically involves removal of a cancerous lump (lumpectomy) and some of the tissue surrounding the tumor. Mastectomy involves removing the breast.
“We hope our data will increase awareness of current trends and prompt efforts to better understand what is driving decisions for mastectomy in early breast cancer," Dr. Kummerow told dailyRx News.
"At the end of the day, the operation that a women undergoes for early breast cancer should be determined by that individual woman and her provider. That said, the onus is on us as healthcare providers to take the time to make sure patients are truly informed of the risks and benefits of available treatment options and able to make decisions that incorporate good information with an understanding of outcomes that matter most to them."
Dr. Kummerow added that more research is needed to understand factors that influence patients and providers with respect to surgical treatment of early breast cancer.
“We need to better understand the drivers of these decisions in order to develop tools for high-quality decision making,” she said.
Dr. Kummerow and team analyzed 14 years of data from the National Cancer Data Base. They found that the proportion of women with early-stage breast cancer who qualified for breast conservation surgery but chose mastectomy rose from 34.3 percent to 37.8 percent between 1998 and 2011.
The sharpest increase occurred in women who had cancer “in situ.” This is an early-stage cancer in which the tumor is still confined and has not spread to surrounding tissue or other organs in the body. Women with in situ tumors were 200 percent more likely to have a mastectomy in 2011 than they were in 2003.
The size of a tumor may be a deciding factor in choosing mastectomy over lumpectomy. Dr. Kummerow and colleagues found that younger women opted for mastectomy more often than breast conservation surgery — regardless of tumor size. Older women were more likely to choose mastectomy if the tumor was larger than 0.78 inches.
The authors also noted that reconstructive procedures in women undergoing mastectomy climbed from 36.9 percent to 57.2 percent between 1998 and 2011. Reconstructive procedures for mastectomy patients involve rebuilding the breast mound so that it is similar in size and shape to the breast before it was removed.
Also, the rate of bilateral mastectomy (removal of both breasts) for cancer in one breast went up from 1.9 percent in 2003 to 11.2 percent in 2011. Some women may choose to have the healthy breast removed due to fears of developing breast cancer in that breast, too. The Susan G. Komen Breast Cancer Foundation says, however, that the risk of getting cancer in the healthy breast is fairly low.
In an editorial, Bonnie Sun, MD, and Michael E. Zenilman, MD, of Johns Hopkins Medicine in Baltimore, wrote that this study “reveals a surprising rise in the rate of mastectomy for early-stage cancers.”
Drs. Sun and Zenilman write that "Existing guidelines are in place to ensure that patients are offered the appropriate options." They added that the study by Dr. Kummerow and team "should at least serve as a wake-up call that as we fulfill that responsibility, and use every type of care to give patients the best quality of life and survival advantage, the guidelines may need to change again."
The study and editorial were published online Nov. 19 in JAMA Surgery.
The study was based on research funded by the Office of Academic Affiliations, Department of Veterans Affairs and Veterans Affairs National Quality Scholars Program. The authors disclosed no conflicts of interest.November 19, 2014JAMA Surgery, "Nationwide Trends in Mastectomy for Early-Stage Breast Cancer" JAMA Surgery, "The Swinging Pendulum" JAMA Surgery, "Study Examines National Trends in Mastectomy for Early-Stage Breast Cancer" National Cancer Institute, "NCI Dictionary of Cancer Terms: breast-conserving surgery" Breastcancer.org, "Mastectomy vs. Lumpectomy" Susan G. Komen Breast Cancer Foundation, "Why Are Rates of Bilateral Mastectomies Rising?"November 20, 2014
Many Breast Cancer Patients Had Repeat SurgeriesNovember 20, 2014
Many breast patients have surgery to remove the cancer, but several types of surgery are available. A new study suggests that one type of surgery may lead to more operations down the road.
The study found that almost a quarter of patients who had breast conservation surgery had another operation later.
According to the American Cancer Society, most women with breast cancer will have surgery, but several different surgical options are available. For instance, in breast conservation surgery, only part of the breast is removed. In mastectomy, the entire breast is removed.
The authors of this new study, led by Lee G. Wilke, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, wanted to explore the nature of repeat surgeries after breast conservation surgery.
To do so, Dr. Wilke and team used data from the National Cancer Data Base to identify 316,114 breast cancer patients who had breast conservation surgery. The patients all had stage 0 to 2 breast cancer.
Of these patients, 23.6 percent — almost one quarter — had at least one additional surgery.
Of the patients who had repeat surgeries, 62.1 percent had a "completion lumpectomy" — another breast conserving surgery removing only a portion of the breast. The remaining 37.9 percent had a mastectomy. Both of these surgery types suggest that the patients underwent a repeat operation due to their cancer coming back.
Over the course of the study period, the rate of repeat surgeries slightly decreased — from 25.4 percent of patients in 2004 to 22.7 percent in 2010.
Younger patients and those with larger tumors were more likely to have repeat surgery, the study authors found. Only 16.5 percent of patients older than 80 had repeat surgery — compared to 38.5 percent of patients between the ages of 18 and 29.
The rate of repeat surgeries also differed in different regions of the US and types of facilities. Certain types of tumors were tied to higher rates of repeat surgeries, including ductal carcinoma in situ (cancers that started in the milk ducts without spreading) and invasive lobular carcinoma (cancer that began in the milk-producing lobules and spread to surrounding tissue). Larger tumors were also tied to higher rates of repeat surgeries.
Further research is needed to better understand how these factors might affect repeat surgery, the authors noted.
"These findings can be used by surgeons to better inform their patients regarding repeat surgery rates and how patient or tumor characteristics influence these rates," Dr. Wilke and colleagues wrote.
In an editorial accompanying the study, Julie A. Margenthaler, MD, from the Washington University School of Medicine in St. Louis, and Aislinn S. Vaughan, MD, of the Sisters of St. Mary's Breast Care in St. Charles, MO, wrote that they hoped these findings would affect how breast cancer surgery is approached.
"... [Additional] operations increase health care costs, misuse of resources, patient anxiety, and delay in [early] therapy," Drs. Margenthaler and Vaughan wrote. "With more than 200,000 new invasive breast cancers diagnosed each year, a staggering number of women are undergoing procedures that are unnecessary and simply wasteful."
The study and editorial were published Nov. 12 in JAMA Surgery.
The authors disclosed no funding sources or conflicts of interest.November 11, 2014JAMA Surgery, "Repeat Surgery After Breast Conservation for the Treatment of Stage 0 to II Breast Carcinoma: A Report From the National Cancer Data Base, 2004-2010" American Cancer Society, "Surgery for breast cancer" JAMA Surgery, "Breast Conservation Surgery and the Definition of Adequate Margins: More Is Not Better…It’s Just More"November 20, 2014
Meditation and Yoga May Ease Breast Cancer AnxietyNovember 20, 2014
Chemotherapy, radiation and surgery are all common ways to fight breast cancer. While complementary therapies may not directly treat , many may relieve related worry and stress.
Newly published guidelines provide a report on the safety and effectiveness of more than 80 “alternative” therapies. Meditation, yoga and relaxation with imagery received the highest marks.
In an interview with dailyRx News, Peter Strong, PhD, a professional mindfulness-based psychotherapist offering online therapy via Skype and author of "The Path of Mindfulness Meditation," explained why meditation specifically may be a useful tool for breast cancer patients.
"Meditation, at its core, describes a process of changing the relationship that we have toward our thoughts and emotions," said Dr. Strong. "When we develop a conscious and compassionate relationship with the emotions associated with a diagnosis of cancer, we are less likely to become embroiled in the uncontrolled negative thinking and rumination that exacerbates anxiety."
Many breast cancer patients use complementary therapies along with their standard cancer care to manage symptoms and improve quality of life. There are scores of options, such as meditation, yoga, massage, music therapy, acupuncture, hypnosis, tai chi and botanicals. Some patients may have trouble deciding which techniques to use.
The Society for Integrative Oncology issued the new report. The research was done by investigators at several institutions, such as Columbia University's Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center in New York City.
"Most breast cancer patients have experimented with integrative therapies to manage symptoms and improve quality of life,” said report author Heather Greenlee, ND, PhD, professor at Columbia's Mailman School of Public Health and president of the Society for Integrative Oncology, in a press release. “But of the dozens of products and practices marketed to patients, we found evidence that only a handful currently have a strong evidence base.”
"These guidelines provide an important tool for breast cancer patients and their clinicians as they make decisions on what integrative therapies to use and not use,” Dr. Greenlee added.
The guidelines authors looked at results from 203 studies of complementary treatments paired with standard cancer therapies. Based on their assessment, meditation, yoga and relaxation with imagery earned an “A” grade for routine treatment of anxiety and mood disorders common to breast cancer patients.
Relaxation with imagery is a way to use the imagination to create calm, peaceful images in the mind.
Those three techniques received a “B” grade for reducing , and fatigue. Massage and music therapy also earned a “B” in this category. Acupuncture received a "B" grade for controlling chemotherapy-induced nausea and vomiting. All therapies that received a “B” were still recommended for most patients.
Dr. Greenlee and team assigned a "C" grade to 32 therapies. These treatments had weaker evidence of benefit but could still help. For instance, acupuncture had mixed results in improving quality of life. Healing touch received a “C” for improving mood in patients undergoing chemotherapy. Healing touch is a therapy said to focus on touch to restore energy and promote healing.
A “D” grade was assigned to seven therapies. These treatments were deemed unlikely to provide any benefit. For instance, soy extracts could not be recommended to prevent or treat hot flashes in breast cancer survivors. Hot flashes happen to some breast cancer patients who enter menopause early due to chemotherapy. Aloe vera gel could not be endorsed to help soothe skin reactions from radiation therapy.
Dr. Greenlee and colleagues did find one treatment to be harmful. Acetyl-l-carnitine, which is sold to prevent a type of neuropathy, was found to increase neuropathy. Neuropathy is a nerve disorder that causes weakness or numbness.
Over 80 percent of breast cancer patients in the US use some type of complementary therapy following a breast cancer diagnosis, the study authors wrote.
The report was published online Nov. 5 in the Journal of the National Cancer Institute Monograph.
The Society for Integrative Oncology funded the research. The authors disclosed no conflicts of interest.November 6, 2014JNCI Monographs, "Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer" Columbia University's Mailman School of Public Health, "Report card on complementary therapies for breast cancer"November 20, 2014
Depression Common Among Women With Breast CancerNovember 20, 2014
Being diagnosed with a potentially deadly disease like breast can come as an emotional shock. And a new study found that women diagnosed with breast cancer had a raised risk for depression.
A recent Danish study found that many women sought mental health care in the first year after breast cancer diagnosis, and many more started taking antidepressants. This was especially true for women who had other health problems in addition to breast cancer, and for women whose lymph nodes tested positive for the cancer — meaning the disease had spread beyond the breast.
The study authors said all women diagnosed with breast cancer should be screened for depression.
Nis P. Suppli, MD, of the Danish Cancer Society Research Center in Denmark, wrote this study with colleagues.
Past studies on the relationship between breast cancer and lacked important information or only followed women for a short period of time, the authors noted.
The authors studied almost 2 million women who were cancer-free and did not have a major psychiatric disorder. From this group, 44,494 women developed breast cancer between 1998 and 2011.
The study authors found that, in the first year after a breast cancer diagnosis, women were 1.7 times more likely to seek treatment for depression and three times more likely to start taking antidepressants than women who did not have breast cancer.
The researchers followed up with the women who had breast cancer three and eight years after they received the news. Even years after the diagnosis, more of these women started using antidepressants or contacted a hospital for depression treatment than women who did not have breast cancer. However, the number of patients who sought hospital treatment for depression or began taking antidepressants was highest within the first year of diagnosis.
Factors that may make a woman with breast cancer more likely to be depressed included having other health problems, having cancer that had spread to the lymph nodes, being 70 years old or older, living alone or having limited education, the authors found.
The study authors suggested that doctors keep these factors in mind when they see patients with breast cancer.
“In conclusion, women with breast cancer are at long-term risk for depression, and clinicians should be vigilant for signs of this condition,” they wrote.
This study was published online Oct. 27 in the Journal of Clinical Oncology.
The Danish Cancer Society and the Health Foundation, Denmark, funded the research. Study author Lars V. Kessing received funding from Lundbeck and AstraZeneca.
Girls Treated for Wilms Tumor May Be at Risk for Breast CancerNovember 20, 2014
Sometimes, radiation can be a lifesaving treatment. But radiation may also increase the risk for developing another cancer — and new research suggests this might have happened to some children years after radiation treatment.
Treatment of Wilms tumor, a rare childhood , can include radiation treatments to the chest. Because radiation is thought to increase the risk for other cancers, a group of researchers studied girls with Wilms tumor to see whether they were more likely to develop breast cancer.
Girls treated with radiation directed at the chest had a greatly increased risk for breast cancer as young women — compared to those who did not receive radiation.
Norman E. Breslow, PhD, of the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle, and colleagues wrote a paper on the research findings.
Advancements in the treatment of Wilms tumor have raised the cure rate to nearly 90 percent, the study authors wrote. Treatments can include radiation to the chest or stomach.
Dr. Breslow and team reviewed data on 2,492 girls with Wilms tumor. The patients ranged in age from newborn to 19 years old. The study authors noted whether the girls received radiation therapy for their cancer.
The team continued to collect data on patients who lived past age 15 to see whether they developed breast cancer.
"I applaud the authors of this important study analyzing the long-term risks of developing a well-known secondary malignancy, breast cancer, in pediatric cancer patients who undergo thoracic radiation," said Brian Lawenda, MD, National Director of Integrative Oncology and Cancer Survivorship, 21st Century Oncology and Founder of Integrative Oncology-Essentials. "For many years, oncologists have been aware of the increased risk of developing breast cancer in adult survivors of pediatric lymphomas who received thoracic radiation therapy as part of their treatment."
Dr. Breslow and his team found 29 cases of breast cancer among the patients. Twenty-five of the cancers were in women younger than 40.
The researchers calculated that the risk of getting breast cancer by age 40 for the women in this study was more than 27 times that of the average woman.
Most of the breast cancer was in women who had chest radiation. Of the 369 patients who received chest radiation, 16 developed breast cancer.
"Follow-up guidelines have generally recommended breast imaging (i.e. mammography) starting at the age of 25 years or 8 years after thoracic [chest] radiation therapy in those who received a radiation dose of 20 Gy or higher. Thanks to this study, we now know that thoracic radiation therapy doses as low as 12 Gy are associated with a significant increase in the risk of developing breast cancer in adult survivors of pediatric Wilms tumor," said Dr. Lawenda.
"Furthermore, any diagnosis of WT appears to increase the risk of developing breast cancer as an adult even without having received prior radiation therapy to the chest. It is believed that this increased risk of breast cancer in those without prior radiation therapy is due to associated chromosomal [genetic] abnormalities often co-existing with a diagnosis of WT that predispose to the eventual development of breast cancer.
In a related editorial, Jennifer B. Dean, MD, and Jeffrey S. Dome, MD, PhD, of Children's National Health System in Washington, DC, said "The take-home message is that [doctors who treat childhood cancer] should closely evaluate their female survivors of [Wilms tumor] for risk factors for the development of breast cancer."
Drs. Dean and Dome noted that only about half of cancer survivors at risk for breast cancer are screened as recommended. They urged better education for survivors and health care providers to increase screening.
"[Dr. Breslow and colleagues] have provided us important information that should prompt changes to the follow-up guidelines for patients with a history of Wilms tumor (with or without prior thoracic radiation therapy to doses less than 20 Gy). Breast cancer screening should be implemented in all patients in this high-risk population," Dr. Lawenda said.
This study and editorial were published online Oct. 27 in Cancer.
The National Institutes of Health funded the research. The authors disclosed no conflicts of interest.October 23, 2014Cancer, “Breast Cancer in Female Survivors of Wilms Tumor: A Report From the National Wilms Tumor Late Effects Study” Cancer, “Chest Radiation to Treat Childhood Cancer Increases Patients’ Risk of Developing Breast Cancer” Cancer, “Breast Cancer in Wilms Tumor Survivors: New Insights Into Primary and Secondary Prevention” CA: A Cancer Journal for Clinicians, “Cancer statistics, 2013”November 20, 2014
Standard Medication for HER-2 Breast Cancer Remained Top RxNovember 17, 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.October 3, 2014Mayo Clinic, “Data From Worldwide Trial of Two HER2-Positive Breast Cancer Drugs Shows That Trastuzumab Should Remain as Standard of Care” European Society for Medical Oncology, “Disease-free survival (DFS) in the lapatinib alone arm and expanded results of the phase III ALTTO trial (BIG 2-06; NCCTG (Alliance) N063D) in the adjuvant treatment of HER2-positive early breast cancer (EBC)”November 17, 2014
Most Breast Cancer Patients Happy with Choice to Remove Non-Cancerous BreastNovember 12, 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.October 3, 2014Annals of Surgical Oncology, “Impact of Reconstruction and Reoperation on Long-Term Patient-Reported Satisfaction After Contralateral Prophylactic Mastectomy” Mayo Clinic, “Most Breast Cancer Patients Who Had Healthy Breast Removed at Peace with Decision”November 12, 2014
'Angelina Effect' May Have Boosted Screening for Breast CancerNovember 11, 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.September 23, 2014Breast Cancer Research, “The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services” BioMed Central, “The ‘Angelina Effect’ was not only immediate, but also long-lasting” National Cancer Institute, “BRCA1 and BRCA2: Cancer Risk and Genetic Testing”November 11, 2014
Breast Cancer Screening May Be Riskier for Women Over 70November 10, 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.September 17, 2014The BMJ, "Effect of implementation of the mass breast cancer screening programme in older women in the Netherlands: population based study"November 10, 2014