Breast Cancer Female
Treating Women’s Pain: Rose Oil, Yoga and MusicJanuary 21, 2015
Women, when it comes to pain, don’t just grin and bear it. Plenty of treatments have been shown to work.
A new research review found that many remedies were available for all kinds of pain. Some problems that are specific to women — such as pain after childbirth or breast cancer surgery — could be helped by a variety of therapies that include music, yoga and rose oil.
The American Society of Anesthesiologists (ASA) conducted this review of pain management techniques to raise women’s awareness on the subject.
“I can’t tell you the number of women I see who have been told they just have to live with the pain,” said review author Donna-Ann Thomas, MD, a member of the ASA’s Committee on Pain Medicine, in a press release. “It’s just heart breaking because many of these women have been suffering a long time. Women, especially older women, are less likely to speak up and seek treatment for their pain."
Dr. Thomas noted that women who have phantom pain — pain that occurs after a body part like the breast is removed — may not receive appropriate treatment.
“It’s fairly clear-cut when someone has phantom pain after a limb amputation, but it’s often overlooked when a woman has the same pain after a mastectomy or lumpectomy and she suffers unnecessarily,” Dr. Thomas said.
Doctors who specialize in pain management include anesthesiologists, and they are specially trained in many therapies that could include medications, injections, biofeedback, acupuncture or herbal medicine. Pain management specialists try to get pain under control so patients can be more active and manage their daily activities.
Dr. Thomas and team assessed several studies on pain in women. In some cases, alternative therapies — like a rose oil massage for menstrual pain and yoga for — worked well.
In one study, women who had menstrual pain massaged their stomachs. One group used almond oil, one used rose oil and one used no oil. By the second session, the women using rose oil reported less pain.
Another study found that 12 weeks of yoga helped women with back pain. After the 12-week program, the women reported nearly three times less pain than when they started the program.
One of the studies Dr. Thomas and colleagues reviewed found that certain types of anesthesia were more effective for women than others.
Women who had a nerve block (which blocks nerves' ability to relay pain to the brain) and regional anesthesia for breast cancer surgery did better than women who had general anesthetic. Regional anesthesia is targeted to one part of the body and doesn't usually cause a loss of consciousness. General anesthesia targets the whole body and usually causes the patient to lose consciousness. The first group had less pain after surgery and took less pain medication. They were also less likely to feel nauseous or vomit, and they left the hospital earlier.
Music may play a part in pain management for women, too. One of the studies Dr. Thomas and team reviewed found that women who listened to music during labor had less pain — and their babies had better heart rates.
Opioid pain medications like morphine and codeine are often used for pain. However, when you’re pregnant, opioids should be a no-no, as they’re not good for the baby, Dr. Thomas and team noted. These researchers found that 1 in 7 women received opioids while pregnant, usually for back pain.
The ASA published this review in January on the ASA website.
The ASA did not note funding sources for the various studies or comment about conflicts of interest.
Finding Breast Cancer Early a Lifesaver for All RacesJanuary 21, 2015
No matter who you are, finding and treating breast before it gets too far may save your life. Some races and ethnicities, however, may face a bigger fight against cancer than others.
A new study found that biological differences among races and ethnicities may play a major role in when breast cancer is diagnosed and survival after this diagnosis.
Over the last few decades, overall breast cancer survival rates improved. Black women, however, had a lower survival rate.
Several factors may be contributing to this lower survival rate. Some women many not be following recommendations for clinical breast examinations, breast self-examination or mammogram breast cancer screenings. Some may not be seeking or getting appropriate care if they notice a breast mass, which can indicate breast cancer. Black women may also tend to have more naturally aggressive breast cancer, the authors of this study noted.
Javaid Iqbal, MD, of the Women’s College Research Institute at the Women’s College Hospital in Toronto, led this study.
“In our study, survival was associated with biological differences in tumor characteristics, but factors such as socioeconomic status, access to and use of health care, adherence to treatment, and [the presence of another chronic disease] might also contribute to breast cancer disparities,” Dr. Iqbal and team wrote.
These researchers followed nearly 400,000 patients with invasive breast cancer for an average of about 40 months. The races and ethnicities of these patients varied.
Dr. Iqbal and colleagues observed that black women were less likely to be diagnosed at the first stage of their cancer than other groups. Among black women, 37 percent were found to have breast cancer in its first phase — compared to about 56 percent of Japanese women and about 51 percent of white women. This meant that more black women were being diagnosed with cancer at later stages — when the cancer can be harder to treat.
These researchers found signs that tumors in black women were biologically more aggressive. Compared to other groups, black women were more likely to have breast cancer that had spread to other parts of the body.
Black women were also more likely to have triple-negative cancer, a type of breast cancer that tends to be more aggressive and likely to spread beyond the breast.
Triple-negative breast cancer is curable when caught early on, according to the American Cancer Society. In an editorial about the current study, researchers from the University of Chicago indicated that some black women may not be getting the quality of breast cancer screening that could detect cancer at an early stage.
To catch breast cancer early on, the American Cancer Society advises women to have regular mammography screenings and clinical breast exams that are part of a regular health checkup. The organization also says breast self-examinations may play a role in finding cancer.
Editorial authors Bobby Daly, MD, and Olufunmilayo I. Olopade, MBBS, also wrote that some patients may not be receiving the appropriate, high-quality treatment they need, which can include chemotherapy and radiation therapy.
“For women with triple-negative disease, access to prompt diagnosis and initiation of chemotherapy can be lifesaving because these tumors [spread] early,” Drs. Daly and Olopade wrote. “Closing the survival gap will only occur once health care leaders initiate system changes that improve access to high-quality care along with a more comprehensive study of breast cancer biology through inclusion of a substantial number of minority patients …”
The study and editorial were published Jan. 13 in JAMA.
Dr. Iqbal received a Canadian graduate scholarship from the Canadian Institute of Health Research. Dr Olopade was member of the medical advisory board for CancerIQ.January 13, 2015JAMA, "Differences in Breast Cancer Stage at Diagnosis and Cancer-Specific Survival by Race and Ethnicity in the United States" JAMA, "Race, Ethnicity, and the Diagnosis of Breast Cancer" JAMA, "Breast Cancer Diagnoses, Survival Varies by Race, Ethnicity" Centers for Disease Control and Prevention, "National Vital Statistics"" BreastCancer.org, "How Triple-Negative Breast Cancer Behaves and Looks" American Cancer Society, "Breast Cancer" Image Courtesy of Monkey Business Images | DreamstimeJanuary 21, 2015
This Treatment Could Keep Breast Cancer AwayJanuary 21, 2015
The treatment of one type of breast may be getting a makeover — and it might keep cancer from coming back.
A new standard of treatment might be on the way to treat patients with small HER2-positive breast cancer tumors. A new study found that a combination of the medications paclitaxel (Taxol) and trastuzumab (Herceptin) prevented breast cancer recurrence over a four-year period.
"Women with small, HER2- positive ... breast tumors have a low, but still significant, risk of recurrence of their disease," said senior study author Eric P. Winer, MD, of the Dana-Farber Cancer Institute in Boston, in a press release. "This study demonstrates that a combination of lower-intensity chemotherapy and trastuzumab — which is associated with fewer side effects than traditional chemotherapy regimens — is an appealing standard of care for this group of patients."
HER2-positive tumors have high levels of human epidermal growth factor receptor type-2 (HER2). This receptor can speed up cancer cell growth. The medication trastuzumab can block the HER2 receptor. This can prevent tumor growth.
Large past trials have shown that patients with advanced tumors have improved outcomes when trastuzumab is combined with chemotherapy.
Chemotherapy is another anti-cancer treatment. It affects cancer cells throughout in the body and is beneficial in case the cancer has spread. However, because it can cause strong side effects, it is sometimes not used when the risk of cancer coming back (recurrence) is low. For patients with small node-negative HER2-positive tumors with a low risk of recurrence, there is not an agreed-upon standard of care when it comes to chemotherapy.
To look at the impact of combining lower-intensity chemotherapy with trastuzumab, Dr. Winer and team looked at 406 patients with small node-negative HER2-positive tumors. Patients received 12 weekly treatments of paclitaxel and trastuzumab, and an additional nine months of trastuzumab therapy alone.
Dr. Winer and team thought that this combined therapy could provide effective treatment with reduced side effects. After three years, 98.7 percent of patients were free from cancer.
This study is a promising step in reducing side effects by treating small tumors differently than big tumors, Dr. Winer and team said.
The study was published Jan. 7 in the New England Journal of Medicine.
Genentech funded this research. Conflict of interest disclosures were not available at the time of publication.January 7, 2015The New England Journal of Medicine, "Adjuvant Paclitaxel and Trastuzumab for Node-Negative, HER2-Positive Breast Cancer" Dana-Farber Cancer Institute, "Combined therapy can reduce chance of recurrence in women with small, HER2+ breast tumors" Image Courtesy of Sherry Young | DreamstimeJanuary 21, 2015
MRI and Mammogram Screenings Catch Cancer EarlyJanuary 21, 2015
Women with a condition called atypical hyperplasia may benefit from breast screening — which can help doctors and patients find and fight breast cancer early.
A new study from the Mayo Clinic found that women with atypical hyperplasia face a much higher risk of breast cancer than women without the condition. Based on their findings, the authors of this study said women with this condition should also be screened with magnetic resonance imaging (MRI).
These researchers added that these women may also want to consider anti-estrogen medications. These medications have been shown to lower the risk of developing breast cancer by 50 percent or more, according to the research.
Lynn C. Hartmann, MD, an oncologist at the Mayo Clinic in Rochester, MN, led this study.
"We need to do more for this population of women who are at higher risk, such as providing the option of MRI screenings in addition to mammograms and encouraging consideration of anti-estrogen therapies that could reduce their risk of developing cancer," Dr. Hartmann said in a press release.
A mammogram may detect excessive growth of cells in the breast called hyperplasia. Mild hyperplasia does not raise cancer risk, but moderate and abnormal hyperplasia may serve as a warning sign.
Dr. Hartmann and colleagues followed 698 women with atypical hyperplasia. They had been biopsied at the Mayo Clinic between 1967 and 2001. After an average follow-up of 12.5 years, 143 of these women, or about 20 percent, had developed breast cancer.
At 25 years after biopsy, 25 to 30 percent of these women had developed breast cancer.
Dr. Hartmann and team noted that cancer risk increased with the extent of the atypical hyperplasia. They measured the extent by lesions or foci found in biopsies. A focus is a breast lesion smaller than 5 millimeters. At 25 years after the biopsy, 47 percent of women with three or more foci of atypical hyperplasia had developed breast cancer. Among women who had only one focus, 24 percent developed cancer.
These researchers concluded that the estimated 100,000 women who are diagnosed each year with atypical hyperplasia are likely to benefit from intense screening and use of medications to reduce risk.
Hyperplasia is a benign overgrowth of cells that line the ducts or lobules (the glands that make milk) inside the breast. While a mammogram may show signs of this cell abnormal cell growth, a biopsy (taking a tissue sample) can confirm the condition. Hyperplasia itself isn’t cancerous, but in time these cells may keep dividing and become more abnormal and transition to cancer.
Many women with atypical hyperplasia, however, are not taking potentially helpful medications like tamoxifen (brand name Nolvadex), Dr. Hartmann and team noted. They indicated that this may be due to doctors who have not had solid estimates of breast cancer risk to guide them.
The American Cancer Society also says patients who are high risk should undergo MRI screening.
“Breast cancer will not develop in the majority of these women [with atypical hyperplasia],” Dr. Hartmann and team said. “Even among those in whom breast cancer does develop, the diagnosis may occur at an age at which their risk of death from other causes is higher than their risk of death from breast cancer.”
This study was published Dec. 31 in the New England Journal of Medicine.
Grants from the National Cancer Institute and the National Center for Advancing Translational Sciences funded this research. The authors did not provide conflict of interest disclosures with the available study.December 31, 2014New England Journal of Medicine, "Atypical Hyperplasia of the Breast — Risk Assessment and Management Options" Mayo Clinic, "Mayo Clinic: Women with atypical hyperplasia are at higher risk of breast cancer" Mayo Clinic, "Atypical Hyperplasia of the Breast" American Cancer Society, "Hyperplasia" American Cancer Society, "What are the risk factors for breast cancer?" Cancer, "Significance of Breast Lesion Descriptors in the ACR BI-RADS MRI Lexicon"January 21, 2015
Cancer Screening May Benefit Diabetes PatientsJanuary 18, 2015
Diabetes patients may need to take extra precautions to lower their risk for or catch it early.
A new study found that cancers of the pancreas, liver and esophagus were more common in people with diabetes. Women with had a higher risk of developing cancer than men with diabetes.
Diabetes patients can take extra precautions to prevent cancer. For instance, they can avoid smoking and use sunscreen whenever they go out to prevent melanoma, recommends the Mayo Clinic. They can also see a doctor for regular checkups and ask about preventive screening like mammograms and colonoscopies. Keeping blood sugar under control by following diet, exercise and medication recommendations may also lower cancer risk.
The authors of the current study recommended routine cancer screening in all people with diabetes.
“Using one of the largest diabetes registries in the world, we show that both type 1 and are associated with an excess risk of incidence and mortality for overall and a number of site-specific cancers," the authors of this study wrote. "Screening for cancers, according to standard protocols for the general population, in diabetic patients should be emphasized in clinical practice, as early detection is key to preventing premature mortality.”
Jessica L. Harding, of the Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute in Melbourne, Australia, led this study. The research team used data from the National Diabetes Registry in Australia to study whether type 1 and type 2 diabetes were linked to an increased risk of cancer.
In , people produce little or no insulin, the hormone that regulates blood sugar. In type 2 diabetes, the cells are not sensitive to insulin the body produces.
Dr. Harding and team studied 953,382 patients who were entered into the diabetes registry between 1997 and 2008.
The incidence of any kind of cancer was about 2 percent greater in men with type 1 diabetes and 1 percent greater in women with type 1 diabetes than in the general population, these researchers found.
Women with diabetes had a higher risk of developing cancers of the pancreas, liver, esophagus, colon and rectum, stomach, thyroid, brain, lung, ovaries and endometrium. However, women with diabetes had a decreased risk of developing melanoma.
Women with type 2 diabetes were more likely to develop breast cancer than women with type 1 diabetes.
Men with diabetes had an increased risk of developing the same cancers as women when compared to the general population. When compared to women with diabetes, however, men with diabetes had a slightly lower risk of cancer.
Men with diabetes had a lower risk of than men in the general population, Dr. Harding and colleagues found.
The highest cancer risk for both men and women with diabetes was for cancers of the pancreas and liver.
This study was published Dec. 8 in Diabetes Care.
The National Health and Medical Research Council, the Australian Government Department of Health and Ageing and the Victorian OIS scheme funded this research. The authors disclosed no conflicts of interest.December 15, 2014Diabetes Care, “Cancer Risk Among People With Type 1 and Type 2 Diabetes: Disentangling True Associations, Detection Bias, and Reverse Causation” Mayo Clinic, "Cancer prevention: 7 tips to reduce your risk"January 18, 2015
Low-Fat Diet May Help Some Women Live Through Breast CancerJanuary 13, 2015
A simple change in diet could make a world of difference for women with certain types of breast cancer.
Among women with early-stage breast who ate a low-fat diet for 5 years after their diagnosis, survival rates were significantly improved in those who had breast cancers unrelated to hormone levels, according to findings from a recent study.
In other words, eating less fat reduced deaths from any cause among women with estrogen receptor-negative and progesterone receptor-negative breast cancers.
"Overall, while the death rate was somewhat lower in the [low-fat diet] group compared with control group (13.6 percent vs 17 percent, respectively), the difference was not statistically significant," said lead researcher Rowan Chlebowski, MD, PhD, medical oncologist at the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center.
"However, in exploratory subgroup analyses, in women with estrogen receptor-negative cancers, a 36 percent statistically significant reduction in deaths was seen in women in the [low-fat diet] group," Dr. Chlebowski said in a press statement. That reduction was even greater for women with both estrogen receptor-negative and progesteron receptor-negative cancers — these women had a 56 percent reduction in deaths.
A hormone receptor-positive breast cancer means that the cancer cells may receive signals from hormones like estrogen or progesterone that promote cancer cell growth. A hormone receptor-negative cancer does not receive such hormone signals.
In this study, the women who seemed to benefit most from the low-fat diet intervention were those with hormone receptor-negative cancers.
Dr. Chlebowski and colleagues came to their conclusions through studying data from the Women's Intervention Nutrition Study (WINS).
WINS was a trial that included 2,437 women ages 48 to 79 receiving standard care for early-stage breast cancer. Of these women, 1,597 had estrogen receptor-positive breast cancer, 478 had estrogen receptor-negative breast cancer, and 362 had estrogen receptor-negative and progesterone receptor-negative breast cancer.
Within 6 months of being diagnosed with breast cancer, these women were randomly assigned to eat a low-fat diet or to no diet.
After 5 years, the women on the low-fat diet reduced fat calories by 9.2 percent and cut body weight by nearly 6 pounds, compared to the women who did not eat the low-fat diet.
These findings were presented at the 2014 San Antonio Breast Cancer Symposium.
This research was funded by the National Cancer Institute and the American Institute of Cancer Research. Dr. Chlebowski has received consulting support from Pfizer, Novartis, Amgen, Genomic Health and Novo Nordisk, as well as honorarium from Novartis.
Migraines Not Tied to Breast CancerJanuary 13, 2015
They're painful and can put patients out of commission for hours or even days, but aren't likely associated with breast — despite past research that suggested they might be.
In a new study, women with migraines were not more likely to have breast cancer than those without migraines.
The authors of this new study also didn't find a connection between migraines and female sex hormones, which health professionals have thought might be associated with migraines. Past studies showed inconsistent results in migraine-breast cancer connections.
“In summary, results from this large ... study do not support an inverse association between migraine and incident breast cancer," wrote the study authors, led by Rulla M. Tamimi, ScD, of Brigham and Women's Hospital and Harvard Medical School in Boston. "In addition, women with migraine do not have different premenopausal ... sex hormone levels compared with women without migraine.”
Migraines, which can cause debilitating headaches, nausea and vomiting, are more common in women than men. What exactly causes migraines is unknown. Research on migraines and breast cancer has turned up inconsistent findings, but some research had indicated a possible link between migraines and breast cancer. Researchers theorized the connection could be based on female sex hormones, especially estrogen.
Dr. Tamimi and team used data from a large, ongoing research project called the Nurses’ Health Study II (NHSII). The NHSII provided data over a 20-year period on 115,378 women. Those women were 25 to 42 years old when the study began.
Of the women in the study, 17,696 said a doctor had diagnosed them with migraines. Dr. Tamimi and colleagues had access to data from the NHSII that included hormone levels in women who had not yet reached menopause. They reviewed medical records from 90 percent of the women who developed breast cancer during the 20 years of the NHSII study.
The team found that 3,924 women had been diagnosed with breast cancer. Of these, 833 had in situ cancer — cancer which had not spread beyond the breast tissue. The remaining 3,091 had invasive cancer, which had spread from the original site.
Dr. Tamimi and colleagues found that migraines did not increase the risk of breast cancer — with one exception. Women who had migraines were 1.54 times more likely to develop a type of cancer called ductal-lobular breast cancer than other types of cancer.
These researchers did not find a link between female sex hormones, migraines and breast cancer.
After completing their own study, Dr. Tamimi and team looked at four past studies on the same subject, as well as their own — a process called a meta-analysis. They looked for connections between migraines, breast cancer, and female sex hormones like estrogen and progesterone. This meta-analysis did not find a link between migraines and breast cancer.
This study was published Dec. 12 in the Journal of the National Cancer Institute.
This research was funded by grants from the National Institutes of Health (NIH) and by funds from Washington University School of Medicine, the Barnes-Jewish Hospital Foundation and the Siteman Cancer Center.
Dr. Tobias Kurth received research funding from the French National Research Agency, the NIH, Merck, the Migraine Research Foundation and the Parkinson’s Disease Foundation. He received honoraria from Allergan and the American Academy of Neurology for educational lectures, and from the BMJ and Cephalalgia for editorial services. Dr. Tamimi was a consultant and advisory board member for Pfizer. Some of these companies produce medications used in migraine and breast cancer treatment.
Many Didn't Get Shorter, Cheaper Breast Cancer TreatmentJanuary 13, 2015
Not all breast treatment methods are created equal — and many patients may not always get the shortest, most cost-effective option.
Women with early-stage breast cancer who have breast-conserving surgery may receive shorter, less costly radiation treatment. Most who qualify for this treatment, however, may not be getting it, a new study found.
The use of this shorter-term treatment has grown, but a large number of women who could be getting it were not, this study found.
“Hypofractionated whole-breast irradiation increases convenience, reduces treatment burden, and lowers health care costs while offering similar cancer control and [cosmetic outcomes] to conventional whole-breast irradiation,” wrote the study authors, led by Justin E. Bekelman, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia. “Furthermore, patients prefer shorter radiation treatment regimens.”
Breast conservation surgery is a common treatment for early-stage breast cancer. Also called breast-sparing surgery, it removes the cancer but not the breast itself. Radiation therapy is typically given following surgery to help lower the chance that the cancer will come back in the breast or nearby lymph nodes.
Conventional radiation treatment (whole-breast irradiation) can involve daily radiation treatments for five to seven weeks. Radiation using fewer treatments but given in larger doses — called hypofractionated whole-breast irradiation — has been shown to be just as effective. It can be given in three to five weeks.
In 2011, the American Society for Radiation Oncology (ASRO) said that hypofractionated whole-breast irradiation was equally effective for in-breast tumor control and comparable in long-term side effects for many women with early-stage breast cancer. The ASRO has endorsed this treatment for patients 50 years old or older without prior chemotherapy (medications used to destroy cancer cells) or cancer of the lymph nodes in the underarm.
In this study, a total of 8,924 patients were categorized as being hypofractionation-endorsed, according to the ASRO's guidelines. And 6,719 were hypofractionation-permitted. The patients who were "permitted" did not meet the ASRO's standards for endorsement — meaning they might have been younger than 50 or had cancer in the lymph nodes — but were still allowed to have the treatment.
Dr. Bekelman and team reviewed the usage and costs of hypofractionated whole-breast irradiation between 2008 and 2013. They referenced claims from 14 commercial health care plans. In total, these plans covered 7.4 percent of US adult women in 2013.
The women studied had early-stage breast cancer treated with lumpectomy. Lumpectomy is the removal of the breast cancer tumor, or the "lump.” This common type of breast conservation surgery also removes some of the normal tissue surrounding the cancer.
Among women in the hypofractionation-endorsed group, hypofractionated whole-breast irradiation increased from over 10 percent in 2008 to over 34 percent in 2013.
In the hypofractionation-permitted group, this shorter-term type of treatment rose from 8 percent in 2008 to 21 percent in 2013.
Although more women were getting hypofractionated whole-breast irradiation in 2013, the great majority of those who might be receiving this therapy were not getting it, Dr. Bekelman and colleagues said.
“The [ASRO] guidelines stopped short of recommending hypofractionated whole-breast irradiation as a care standard to be used in place of conventional whole-breast irradiation,” Dr. Bekelman and team wrote. “The absence of a clear recommendation may have contributed to slower uptake of hypofractionation in the United States than in other countries.”
In both groups, health care costs were higher for those who received conventional whole-breast irradiation. In the hypofractionation-endorsed patients, mean health care expenditures at one year after diagnosis were $28,747 for hypofractionated — versus $31,641 for conventional whole-breast irradiation. In the hypofractionation-permitted group, those costs were $64,273 for hypofractionated and $72,860 for conventional whole-breast irradiation.
This study was published Dec. 10 in JAMA to coincide with the San Antonio Breast Cancer Symposium. Dr. Bekelman received support from a grant from the National Cancer Institute.December 10, 2014JAMA, "Uptake and Costs of Hypofractionated vs Conventional Whole Breast Irradiation After Breast Conserving Surgery in the United States, 2008–2013" JAMA, "Many Breast Cancer Surgery Patients Do Not Receive Shorter, Less Costly Radiation Treatment" American Cancer Society, "Radiation therapy for breast cancer" Journal of Surgical Technique and Case Report, "Breast Conserving Therapy: A surgical Technique where Little can Mean More" National Cancer Institute, "breast-conserving surgery"January 13, 2015
Radiation Not Always Needed for Breast Cancer PatientsJanuary 7, 2015
Radiation may not always be necessary to treat breast — but some patients were still receiving it, along with two other treatments that worked just as well without radiation.
A new study found that most elderly women with early breast cancer received radiation along with hormone therapy and surgery.
Past studies found that radiation treatment may not affect how often breast cancer recurs in older women if they receive surgery and hormone therapy as well, the authors of the current study noted. Still, many women received all three treatments.
"Our findings highlight the fact that it may be challenging for practitioners to incorporate clinical trial data that involves omitting [radiation, which] was previously considered standard of care," said study author Rachel Blitzblau, MD, PhD, of Duke University in Durham, NC, in a press release.
"It has been found that the triad of treatments given to patients with early stage breast cancer — lumpectomy, radiation treatments and hormonal therapy — are not always all necessary in the elderly population," said Alexis Harvey, MD, Medical Director for the New Jersey Region of 21st Century Oncology.
"Depending on the performance status of the patient, it is possible to eliminate the radiation treatments and possibly the hormonal treatments, too. If the patient has an estimated survival of more than 5 years, it is quite often beneficial to give the treatments. If, however, there are many medical issues, it is reasonable to eliminate the daily radiation, and it will not have any impact on their survival," said Dr. Harvey, who was not involved in this study.
"If, however, the patient has a good performance status and wants all treatment, then it is reasonable to treat, possibly with a shorter course than the standard 6-7 weeks," she said. "Each patient is evaluated on an individual basis."
A past study — called the Cancer and Group B (CALGB) study — found that patients aged 70 and older who were treated with lumpectomy and a breast cancer medication called tamoxifen (brand names Soltamox and Nolvadex) had about the same rate of cancer recurrence (4 percent) as women who also had radiation treatments (1 percent). A lumpectomy is a procedure in which a surgeon removes a breast cancer tumor but not the whole breast. Tamoxifen is a medication used to treat breast cancer tumors that have certain proteins called estrogen receptors on their surface.
Ten years later, there was no difference in survival between the women who received lumpectomy and tamoxifen and those who received the surgery, medication and radiation. In other words, the CALGB study found radiation may not be a necessary treatment for some older breast cancer patients.
Dr. Blitzblau and colleagues looked at whether women's early-stage cancer was treated differently based on the findings of the CALGB study.
Early breast cancer was defined as having a cancer tumor that was less than or equal to 2 centimeters in size and had not spread.
Dr. Blitzblau and team looked at how often radiation was given to elderly women along with surgery and tamoxifen between 2005 and 2009. They compared this frequency with that of the years 2000 to 2004. Results of the CALGB study were published in 2004.
These researchers found a small decrease in the use of radiation in these women during 2005 to 2009 — compared to the years before the CALGB findings. Before the CALGB study was published, about 69 percent of these older breast cancer patients received radiation. Between 2005 and 2009, about 62 percent received it.
Despite the decrease in use of radiation, many women over 70 with early breast cancer still received radiation as a breast cancer treatment.
Dr. Blitzblau and team said too much treatment can be hard on older patients' health. Leaving radiation out of treatment when possible could improve patients' treatment.
These researchers called for more educational materials to help patients make decisions about their cancer treatment.
This study was published online Dec. 8 in Cancer.
The authors disclosed no funding sources or conflicts of interest.December 5, 2014Cancer, "The Use of Adjuvant Radiotherapy in Elderly Patients with Early-Stage Breast Cancer: Changes in Practice Patterns after Publication of Cancer and leukemia Group B 9343” Cancer, “Most Elderly Women with Early Stage Breast Cancer Receive a Treatment that May Not Be as Effective”January 7, 2015
Gene Testing May Identify Effective Cancer TreatmentsDecember 28, 2014
The term "genetic mutation" may sound a little scary, but some gene mutations may reveal lifesaving alternative treatments — and show who is at risk for cancer in the future.
A new Mayo Clinic-led study recommended that triple-negative breast cancer patients undergo genetic testing. This testing may reveal gene mutations that determine the risk of cancer returning after treatment and the risk of it affecting a family member.
This genetic testing may also find mutations that make patients more likely to respond to some new treatments, the authors of this study said.
“Clinicians need to think hard about screening all their triple-negative patients for mutations because there is a lot of value in learning that information, both in terms of the risk of recurrence to the individual and the risk to family members,” said Fergus J. Couch, PhD, laboratory medicine and pathology expert at the Mayo Clinic in Rochester, MN, in a press release. “In addition, there may be very specific therapeutic benefits of knowing if you have a mutation in a particular gene.”
About 15 percent of all breast cancers are triple-negative, according to the Triple Negative Breast Cancer Foundation. Triple-negative tumors lack three receptors: estrogen, progesterone and HER2. These are proteins found inside or on the surface of breast cells. Some effective cancer therapies target these receptors and prevent cancer growth. Commonly used breast cancer treatments — such as hormone therapy or therapies that focus on HER2 receptors — don’t work for triple-negative breast cancer.
Dr. Couch and colleagues analyzed DNA (genetic material) from 1,824 triple-negative breast cancer patients seen at 12 cancer clinics in the US and Europe. They found harmful mutations in almost 15 percent of these patients.
Of these, 11 percent had mutations in the BRCA1 and BRCA2 genes. These genes suppress cancer tumors, and mutations can stop them from functioning. These mutations can be inherited and may increase family members’ risk of breast cancer.
The other triple-negative breast cancer patients had harmful mutations in 15 other genes that could raise cancer risk. Some of these other genes included ones that repair DNA.
Many types of breast cancer respond to hormonal therapy — such as tamoxifen (brand names Soltamox or Nolvadex) or aromatase inhibitors (Arimidex or Femara) — or therapies that target HER2 receptors, such as trastuzumab (Herceptin). Dr. Couch and colleagues said triple-negative breast cancer patients might have gene mutations that make them more likely to respond to alternative treatments.
Cisplatin (Platinol) may be one such alternative treatment. Platinum-based agents, such as cisplatin, have emerged as possible treatments for triple-negative breast cancer, according to the National Cancer Institute.
PARP inhibitors — cancer-fighting agents that inhibit the poly ADP-ribose polymerase (PARP) family of enzymes — have also shown potential in fighting cancer. Several forms of cancer depend on PARP enzymes to survive. Some studies have found that inhibiting these enzymes may make chemotherapy more effective and could stop cancer growth, according to BreastCancer.org. Chemotherapy refers to cancer treatment with multiple powerful medications.
Dr. Couch and team noted that patients with gene mutations that may cause cancer were diagnosed at an earlier age and had higher-grade tumors than those without mutations. Higher-grade cancers tend to grow and spread faster than lower-grade tumors, according to the National Cancer Institute.
Obtaining information about patients' gene mutations through testing could help doctors determine the best course of cancer treatment, Dr. Couch and colleagues noted.
These researchers said that their study offers additional support for the National Comprehensive Cancer Network (NCCN) guidelines for genetic testing of triple-negative breast cancer patients. These guidelines call for genetic screening when a patient has a family history of cancer or a diagnosis under age 60.
“Other studies have suggested that [triple-negative breast cancer] might be associated with some defect in DNA repair, and our study verifies that,” Dr. Couch said. “Our findings generate a whole new set of hypotheses about how triple-negative breast cancer might be arising, which could give us better ideas for prevention or new therapies for this disease.”
This study was published online Dec. 1 in the Journal of Clinical Oncology.
The research was funded by the National Institutes of Health, the Breast Cancer Research Foundation and the David F. and Margaret T. Grohne Family Foundation. Conflict of interest information was not available at the time of publication.December 3, 2014Journal of Clinical Oncology, "Inherited Mutations in 17 Breast Cancer Susceptibility Genes Among a Large Triple- Negative Breast Cancer Cohort Unselected for Family History of Breast Cancer" Mayo Clinic News Network, "Triple-Negative Breast Cancer Patients Should Undergo Genetic Screening" American Cancer Society, "Breast Cancer" National Breast Cancer Foundation, "Triple Negative Breast Cancer" BreastCancer.org, "Treatment for Triple-Negative Breast Cancer" Triple Negative Breast Cancer Foundation, "TNBC Foundation® is Funding Breakthrough Research to Support the Discovery of Promising New Treatments for TNBC Patients" BreastCancer.org, "Research on New Treatment for Triple-Negative Breast Cancer" National Cancer Institute, "Tumor Grade" National Cancer Institute, "Breast Cancer Treatment"December 28, 2014