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  • Cancer Screening May Benefit Diabetes Patients
    December 18, 2014

    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.

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    December 18, 2014
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  • Low-Fat Diet May Help Some Women Live Through Breast Cancer
    December 18, 2014

    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.

     

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  • Migraines Not Tied to Breast Cancer
    December 18, 2014

    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.

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  • Many Didn't Get Shorter, Cheaper Breast Cancer Treatment
    December 18, 2014

    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.

    Don Rauf
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  • Radiation Not Always Needed for Breast Cancer Patients
    December 18, 2014

    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.

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  • Gene Testing May Identify Effective Cancer Treatments
    December 18, 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.

    Don Rauf
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  • 3-D Mammograms Found Cancer More Often
    December 18, 2014

    A mammogram can be a useful tool for finding breast in women, but sometimes getting a standard mammogram may not be enough. A new study suggests that 3-D mammography may detect cancer more often than a mammogram alone.

    Past research has shown that women with dense breasts were more likely to develop breast cancer. However, mammogram machines have some difficulty detecting cancer in dense breasts.

    The authors of this new study found that, for women with dense breasts, adding 3-D images to a normal mammogram identified more cases of breast cancer.

    This research was conducted by Per Skaane, MD, PhD, of the Department of Radiology at Oslo University Hospital in Norway, and colleagues.

    "Our results show that implementation of tomosynthesis might indicate a new era in breast cancer screening," Dr. Skaane said in a press release.

    Dr. Skaane and co-authors studied tomosynthesis — also called 3-D mammography. Tomosynthesis creates a 3-D picture of the breast using X-rays.

    Dr. Skaane said that tomosynthesis should be considered an improvement to the current mammogram used in most hospitals today.

    The US Food and Drug Administration has approved tomosynthesis, but it is not yet considered the standard of care for breast cancer screening.

    These researchers studied the mammograms of 25,547 women between the ages of 50 and 69. They compared cancer detection using full-field digital mammography (FFDM) versus FFDM plus tomosynthesis. FFDM is a mammography unit that captures an electronic picture of the breast in digital format.

    The authors measured breast density using the American College of Radiology's Breast Imaging-Reporting and Data System (BI-RADS). The BI-RADS scale runs from 1 to 4, with 1 being the least dense and 4 being most dense.

    Dense breasts have less fatty tissue and more glandular tissue than breasts that aren't dense. Glandular tissue makes and drains breast milk. One way to measure breast density is the thickness of tissue on a mammogram.

    Standard mammograms often have a hard time detecting breast cancer in dense breasts, Dr. Skaane and team noted. Breast cancer tumors (which appear white) are easier to see on a mammogram when they're surrounded by fatty tissue (which appears dark).

    These researchers found a combined total of 257 malignancies in patients using both FFDM by itself and FFDM plus tomosynthesis.

    A tumor can be benign (not dangerous to health) or malignant (could be dangerous).

    Of the women with malignancies, 105 were in the BI-RADS density 2 group and 110 were in density 3 group, noted study authors.

    Women in the BI-RADS density 2 group had a few small pockets of glandular tissue within their breasts. Women in the BI-RADS density 3 group had more areas of glandular tissue throughout the entire breast. These areas can make it hard to see small cancer masses on a standard mammogram machine.

    Dr. Skaane and team indicated that, of the 257 patients who had malignancies, 211 (82 percent) of the cancer masses were detected using FFDM plus tomosynthesis. These researchers identified 63 percent of the cancer masses using only FFDM.

    "Our findings are extremely promising, showing an overall relative increase in the cancer detection rate of about 30 percent," Dr. Skaane said.

    Dr. Skaane and colleagues noted that 3-D mammography found a total of 80 percent of the malignancies in women with dense breasts — versus 59 percent using FFDM alone.

    This study was presented Dec. 2 at the annual meeting of the Radiological Society of North America in Chicago.

    The authors disclosed no funding sources or conflicts of interest.

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  • Blood Pressure Rx May Not Pose Cancer Threat
    December 16, 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.

    Don Rauf
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  • More Women Opting for Mastectomies
    December 16, 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.

    Don Rauf
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  • Many Breast Cancer Patients Had Repeat Surgeries
    December 15, 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.

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