New Research Findings Enable More Reliable Prognoses For Breast Cancer

Researchers at Umea University in Sweden have shown that the length of telomeres in blood cells in newly diagnosed breast cancer patients is tied to survival rates. The study, published in the journal Cancer Research, was carried out by a research team headed by Professor Goran Roos at the Department of Medical Bioscience, Pathology.


The study shows that the telomere length in blood cells is associated with prognosis for breast cancer. The blood cells of the cancer patients in the study had somewhat longer telomeres than those of controls. It is interesting to note that within the tumor group patients with longer telomeres (= longer than the mean length of telomeres) had a significantly poorer prognosis than did patients with shorter telomeres. This difference in survival was above all seen in patients with more advanced disease, that is, with larger tumors and metastases in local lymph glands.


It is particularly important that the telomere length in these blood cells proved to be a prognostic marker that is independent of other well-known prognostic markers (tumor size, tumor metastasis). In other words, this new biological marker appears to be able to tell us more about the future prospects of cancer patients than previously known markers can.


The tips of chromosomes, telomeres, are important for the genetic stability of our cells. In normal cells, telomeres are shortened each time cells divide, whereas cancer cells usually have stable telomere length. This stability helps provide cancer cells with eternal life. The length of a cell's telomeres is determined by the balance of positive and negative factors, many of which are unknown.


Just why breast cancer patients with longer telomeres in normal blood cells have poorer prognoses than other patients is unclear at present. A number of explanations are under discussion. One probable hypothesis is that patients' telomere lengths are a reflection of presently unknown functions of the immune defense system. Preliminary unpublished data from the research team show that this biological marker can provide prognostic information for other tumor diseases as well. This makes it even more important to understand the mechanisms behind the observed differences in telomere length.


The study was performed in collaboration with colleagues at the oncology and medical clinics at Norrland University Hospital and Malmo Academic Hospital. The study comprises 265 patients who gave blood samples directly after they were diagnoses with breast cancer and 446 controls.


Reference:


Svenson U, Nordfjäll K, Stegmayr B, Manjer J, Nilsson P, Tavelin B, Henriksson R, Lenner P, Roos G. Breast cancer survival is associated with telomere length in peripheral blood cells. Cancer Research 2008, published May 15.


Vetenskapsradet (The Swedish Research Council)

vr.se

Less Invasive More Accurate 'Seed' Therapy For Breast Tumor Removal

Physicians at UT Southwestern Medical Center are the first in Texas to use a new technique in which a small radioactive pellet, or "seed", is implanted into a mass or suspicious lesion in the breast to pinpoint its exact location for surgical removal.



During the procedure, a radiologist uses a needle to insert a small radioactive seed, about the size of a grain of rice, into the mass. Once lodged, surgeons use a wand that detects radioactivity to locate the mass and find the best pathway for removal.



"The new technique is less invasive for the patient and allows us to be more precise when removing possible breast-cancer tumors," said Dr. Roshni Rao, a surgical oncologist who specializes in breast cancer.



Dr. Rao, an assistant professor of surgery, teamed up with Dr. Michael Ulissey, an associate professor of radiology at UT Southwestern, to use this new procedure at Parkland Memorial Hospital. The procedure is offered at only two other U.S. medical centers. Dr. Rao said the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern also will soon begin offering the procedure.



Previously, a radiologist would lance a thin, hooked wire into the breast to help guide the surgeon to the location of the mass. While one end of the wire was lodged at or near the mass, the other end protruded from the patient's skin.



Often, Dr. Rao said, the entry site of the wire was distant from the ideal site where a surgeon would prefer to make an incision. The wire also did not always take a direct path to the lesion.



The seed procedure pinpoints the location of a nonpalpable tumor more accurately than the wire and it is more efficient, Dr. Rao said. The wire method, on the other hand, requires patients to undergo the pre-operative procedure just hours before surgery because if left in longer, the wire could become dislodged.



"With the seed technique, the patient can have the seed inserted up to five days before surgery, any time of day," Dr. Ulissey said. "The seed procedure also increases efficiency in the radiology department since we are not locked into a two-hour window to insert the wire on the day of the surgery."



For patient Joan Hollers, 58, the pre-operative procedure was quick, easy and painless, she said.



After a mammogram had detected a suspicious mass in her left breast, Ms. Hollers consulted with Dr. Rao who decided on the seed procedure.



Dr. Ulissey numbed Ms. Hollers' breast before inserting the radioactive seed, which gives off less radiation than the amount emitted by a standard X-ray.



"I felt the prick of what felt to me like a tiny needle," said Ms. Hollers. "I went home with a small Band-Aid and went to work the next day." Several days later, the Rowlett resident returned to the hospital so that Dr. Rao could remove the suspicious mass.



While the mass in the left breast has been eliminated, Ms. Hollers will undergo chemotherapy for a cancerous tumor that was found in her right breast and can't be surgically removed until the therapy is complete.



Despite the surgery and long road ahead, Ms. Hollers is optimistic.



"When I got the news that I didn't have cancer anywhere else in my body I told myself, 'I'm not dying from this disease,'" said Ms. Hollers, a mother of three grown children and grandmother to eight grandchildren.







October is National Breast Cancer Awareness Month.



Dr. Roshni Rao


Dr. Michael Ulissey



Source: Connie Piloto


UT Southwestern Medical Center

New Breast Cancer Dictionary For Doctors

A new 'breast cancer dictionary' is being created to help bridge the gap between patient terminology and complicated medical language, announced The French League Against Cancer at the European Breast Cancer Conference (EBCC-5), today.


Most patients want to know as much as possible about their disease however they often feel unhappy with the information provided by their doctor. Patients frequently turn to other information sources but the medical language can be difficult to comprehend and very confusing.


To maximise patient understanding, French universities collaborated with the French League Against Cancer to build a patient oriented dictionary of terms. The idea was to create a resource that converted medical jargon into every day speech.


The researchers analysed hundreds of information resources used by patients to discover how patients wrote and talked about their cancer experience. They looked at health websites and followed breast cancer discussion forums. The terms were then analysed and the meanings defined. Similar words were then grouped together into one concept and then the concepts were structured into groups of words that had a relationship.


It was discovered that patients and doctors used very different words and expressions to talk about breast cancer. Patients used an incredible 3,000 different words and phrases to talk about their condition.


R. Messai who presented the findings said, "We really hope that doctors make use of this research and begin to use common words and phrases used by patients. By talking in a language patients understand doctors can make the breast cancer experience slightly easier."


It is hoped that the complete French dictionary will be available next year. The French team then hope to work with the UMLS (Unified Medical Language System) in the Unites States to create the first bilingual (French and English) patient friendly terminology for breast cancer.


The French Universities hope to work with the two major centres of excellence for terminology in the medical field: UMLS (Unified Medical Language System) and CHV (Consumer Health Vocabulary). UMLS is an initiative by the National Library of Medicine in the USA which aims at establishing links between medical classifications. Whilst the UMLS is oriented towards health professionals, the CHV is patient focussed. By analysing about 10 million health queries on the web the CHV have extracted 90,000 expressions which they are currently linking to UMLS concepts.


The French League against Cancer is a public service association and a federation of 102 departmental committees and 30,000 volunteers. Founded in 1918, the league leads the fight against cancer on three levels: research, information and prevention, and psycho-social assistance for patients. ligue-cancer















Catalognr: 441

ED6 Should advocates be involved in the design of clinical trials?

A breast cancer terminology for lay people


- R. Messai - Albert Bonniot, TIMC - IMAG laboratory. Faculty of Medecine. Unive, La tronche, France

- M. Simonet - Albert Bonniot. University of Joseph Fourier, TIMC - IMAG laboratory.TIMC - IMAG laboratory. Faculty of Medecine., La tronche, France

- M. Mousseau - Faculty of medecine., CHU of Grenoble. Oncology service, La tronche, France


Many studies show that patients want to get more information about their illness, and to participate in the decision relating to their treatment. Some studies indicate that from 79% to 96% cancer patients prefer to know as much as possible about their illness. Another study showed that only 19% of 232 patients were satisfied with the information they received from the physicians. The Internet is becoming an important resource for patients seeking health information. Despite the increasing availability of medical information, lay people often encounter barriers in health information seeking. Studies have identified some of the obstacles. The main obstacle being the differences in language used between patients and health professionals.


In order to improve information retrieval for breast cancer patients the TIMC laboratory and CHU of Grenoble collaborated with the French League against Cancer to build a patient oriented terminology. The latter relates every day expressions about breast cancer to technical terms or jargon used by health professionals. It will be used like an interpretative layer to help people understand the information retrieved and write accurate queries with the proper concepts and terms.


We used a corpus of texts to extract terms and expressions used by lay people to speak about breast cancer. This corpus collected from online health information web sites targeted to patients and web-based discussion forums on breast cancer n-Grams have then been automatically extracted from the corpus (a n-gram is a sequence of non consecutive words). We then analyzed the terms extracted to decide which should be kept in the terminology. Since the terminological properties of discourse on medical topics are not well characterized, this work has been done manually using a concordancer. A concordancer is a tool which makes it possible to view the occurrences of the terms in the texts and therefore specify the meanings. Expressions having the same meaning were grouped into one concept, and concepts were structured using different relationships.


We identified over 1,300 concepts expressed by over 3,000 terms. Patients use a language different from the one used by health professionals. Building such terminologies will help to bridge the gap between the two languages.


fecs.be/emc.asp?pageId=611&Type=P

Pre-op Mammogram Reduces The Need For Mastectomy In Women With DCIS

Over 60 per cent of women who have a form of breast cancer in the milk ducts (DCIS*) are spared a mastectomy, according to latest research published today in the British Journal of Cancer.


Researchers for the Sloane Project** examined how the size of the DCIS - measured by both imaging and pathology - related to the surgeon's decision of whether to conserve or remove the breast.


They found that, out of 2,500 women who had DCIS detected by breast screening, around 70 per cent of patients had conservation surgery to remove the disease and save the breast.


Of those who had conservation surgery, 71 per cent only needed one operation to remove the cancer, 19 per cent needed a further operation and 10 per cent went on to have a mastectomy.


In situ (non-invasive) breast cancer is confined to the ducts or lobules of the breast and has not spread to the surrounding tissues of the breast or other parts of the body. It is therefore curable if removed completely, but if left untreated may become invasive breast cancer.


This research is part of a large review of screen-detected DCIS and its treatment over the past five years through the Sloane Project, investigating the best treatment methods for DCIS.


Dr Jeremy Thomas, study author and consultant pathologist from the Western General Hospital, Edinburgh said: "This study shows that comparing the size of tumours as measured by imaging to the actual size of the tumour removed at surgery, gives a clear indication of where to focus improvements in practice. The results are very encouraging showing that 90 per cent of patients offered breast conservation for DCIS have a successful surgical outcome, usually from one operation, and avoid mastectomy.


"Deciding the best surgery option for patients with in situ breast cancer is difficult and requires very careful pre-operative assessment to define the extent of disease. A mastectomy would almost always cure the disease but where possible we want to conserve the breast and only remove the tumour. In the future we would hope to see that, with improvements in imaging and pre-operative assessment, more women could avoid having mastectomies."


Professor Stephen Duffy, Cancer Research UK's professor of screening at Queen Mary University of London, said: "In the screening era, large numbers of breast cancers are diagnosed at the DCIS stage. We have a responsibility to see that these cancers are not overtreated. Therefore it is good to see that the vast majority do not get a mastectomy. There is clearly room for improvement in that we can further reduce the need for re-operation. This problem can and doubtless will be reduced by high-quality pre-operative imaging."


Sara Hiom, director of health information at Cancer Research UK, said: "In the past treatment for DCIS was nearly always mastectomy so it's really encouraging to see that now around 60 per cent of women with DCIS have only the affected area removed, along with a border of healthy tissue around it.















"It's important that women go for breast screening when invited. The programme is very successful at detecting early stages of the disease which means treatment can be much more effective."


Reference


Dr Jeremy Thomas et al Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project British Journal of Cancer nature/bjc/journal/vaop/ncurrent/abs/6605513a.html



Notes


*Ductal Carcinoma In Situ - In situ (or non-invasive) breast cancer is confined to the ducts or lobules of the breast and has not spread to the surrounding tissues of the breast or other parts of the body. It may, however, develop into invasive cancer if left untreated.
For more information go to cancerhelp.uk


**The Sloane Project aims to record the present situation in the UK regarding the management of in situ breast disease, and to provide a guide to the optimal radiological assessment, pathological handling and reporting (including the features of greatest prognostic and clinical importance), surgical treatment and adjuvant therapy.


The Sloane Project was established in memory of the late Professor John Sloane, Professor of Pathology, Liverpool University who had a special interest in this area. The Sloane Project is led by Mr Hugh Bishop, Consultant Breast Surgeon, Royal Bolton Hospital. He is supported by a steering group representing all the main medical specialties with considerable support for data handling and interpretation from the West Midlands Cancer Intelligence Unit under the leadership of Dr Gill Lawrence.


The Sloane Project has been running for six years with more than 7000 patients entered - the project is voluntary, however over 80% of UK Screening Units contribute cases to this important audit - estimated about 50% of all relevant cases are now entered into the audit.


The Sloane Project is now funded by the National Health Service Breast Screening Programme (NHSBSP).


- Between 1st April 2007 and 31st March 2008, 16,792 breast cancers were detected within the NHS Breast Screening Programme (NHSBSP), of whom 3,311 (20%) had in situ/non-invasive breast cancer.


- There has been a marked increase in the incidence of in situ breast cancer since the NHSBSP started in 1988. The reason being that the trademark characteristic of microcalcification present in the majority of in situ breast cancers can be easily visualised radiologically on a mammogram.


- The invasive potential of in situ breast cancer is uncertain and accordingly the optimal method of treatment for every case is ambiguous and unclear. A mastectomy would almost always be curative, however this approach would be extreme in cases where breast conserving surgery would suffice. Identifying the optimal method of treatment can therefore be difficult.

Source
Cancer Research UK

CAD Useful In Finding Cancers Missed By Radiologists, But It Leads To Higher Patient Recall Rate

Computer aided detection (CAD) increases the breast cancer detection rate and decreases the false negative rate, but it comes at the cost of a higher recall rate, according to a recently released prospective study.


The study included 5,016 screening mammograms. The radiologists detected 43 of the 48 cancers in the study without the use of CAD, said Priscilla Slanetz, MD, an author of the study, now at Boston University Medical Center in Boston, MA. With the addition of CAD, two additional cancers both ductal carcinoma in situ that presented as microcalcifications -- were detected, she said. The cancers were stage 0 and stage 1 tumors, Dr. Slanetz added. CAD also marked one mass that was dismissed by the radiologist, but later shown to be cancer (categorized as a false negative).


The radiologist alone detected 90% of malignant asymmetry or masses and 89% of microcalcifications. CAD alone marked 67% of asymmetry or masses and 100% of microcalcifications. "CAD is best suited to detect microcalcifications, and in reality faint microcalcifications are the most commonly overlooked finding by most radiologists," Dr. Slanetz said. Neither the radiologist or CAD was perfect, but the false negative rate was reduced when both were employed, she said.


The study examined the recall rate as well and found that the use of CAD resulted in an additional 89 women (from 607 to 696 patients) being recalled. Of those, six women were biopsied; and two had cancers, she said.


"We continue to routinely employ CAD in the interpretation of screening mammograms. The tradeoff of earlier detection for a slight increase in recall rates seems reasonable and is well accepted by most patients," she added.


CAD is a useful addition to any practice, particularly in light of the ongoing shortage of breast imagers in the U.S., but it cannot and should not replace the radiologist, Dr. Slanetz said. It is important for each radiologist to be aware of what CAD can detect well, and what it tends to miss, she addded.


The study appeared in a recent issue of the American Journal of Roentgenology, which is published by the American Roentgen Ray Society.


American Roentgen Ray Society (ARRS)

44211 Slatestone Ct.

Leesburg, VA 20176-5109

United States

arrs

Delaware Breast Cancer Awareness Efforts Target Black, Hispanic Women

The Wilmington News Journal on Tuesday examined efforts in Delaware that seek to raise breast cancer awareness among black and Hispanic women. While black and white women are diagnosed with breast cancer at similar rates, historically black women have had higher mortality rates from the disease, according to the state Department of Public Health. From 2000 to 2004, black women were 34.6% more likely than white women to die from breast cancer in the state. The five-year survival rate for blacks was 77%, compared with 90% for whites during that time period. The American Cancer Society earlier this year found that U.S. death rates from breast cancer have slowed among black and white women, but blacks still have a 36% higher mortality rate than white women.

Black women often are diagnosed with breast cancer at later stages, begin treatment later, are more often indigent or uninsured, and "may see a doctor only sporadically and in places where the latest treatments are unavailable," according to the News Journal. Black women also are more likely to be diagnosed with a more aggressive and difficult to treat type of breast cancer known as triple-negative.

While Hispanic women are about 40% less likely than white women to be diagnosed with breast cancer, they often are diagnosed at later stages of the disease, according t0 ACS. Hispanic women also have a lower five-year survival rate than white women, at 83%. They also often have difficulty obtaining access to care and health care screenings, according to Susan Troyan, director of the Breast Care Center at Beth Israel Deaconess Medical Center in Boston. She added that language barriers sometimes lead Hispanic women to forego health care.

Various local programs have aimed to improve access to care for both black and Hispanic women. Efforts include no-cost or low-cost mammograms, educational programs, wellness efforts at churches and senior centers, support groups, and offering patient navigators. In addition, a program targeting Hispanic women trains volunteers to be medical interpreters.

At the Henrietta Johnson Medical Center, where 80% of the patients are black and 61% are women, staff members have taken steps to ensure that patients receive recommended mammograms and make routine phone calls to remind them to come in for exams.

"A doctor may give the prescription (for a mammogram) but they may not tell them how important it is. It does take the patient navigator's role to come and bring that extra education," Rosa Rivera, the center's CEO, said, adding, "Knowing the health disparities that exist, breast cancer is one of [the] things we've really pushed" (Bothum, Wilmington News Journal, 10/7).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.В  All rights reserved.

Brain Screenings Offered To Breast Cancer Patients During Breast Cancer Awareness Month

Women diagnosed with HER-2 positive Stage III or Stage IV breast cancer are eligible to participate in a clinical trial investigating early detection of brain metastases from advanced breast cancer through education and screening.


The trial will take place on Friday, October 26th, from 1 to 9 p.m. and Saturday, October 27th, from 8 a.m. to 5 p.m. The location is the Neurologic and Orthopedic Institute of Chicago, 4501 N. Winchester, Chicago: neuro-ortho. The brain MRI is free of charge to the patient.


HER2 is a breast cancer that tests positive for a protein called human epidermal growth factor receptor-2 (HER2), which promotes the growth of cancer cells. Studies have shown that as many as 30 percent of patients with breast cancer have it spread to the brain. As part of the screening protocol, participants will undergo a MRI of the brain. The cost of the MRI is covered by the clinical trial.


Patients who qualify must have an initial primary diagnosis of high risk and/or HER-2 positive breast cancer. They must be at least 18 years and should not participate if they are pregnant.


The Chicago Institute of Neurosurgery and Neuroresearch (CINN) Medical Group will use information from the screening to determine the potential benefit(s) of screening for brain metastases in patients with advanced breast cancer. More information about the study's Principal Investigator, Dr. Gail Rosseau, can be found here.



The study selection and enrollment criteria stipulate that women must be within three to twenty-four months of first metastases of Stage IV diagnosis or within 12 to 24 months of initial diagnosis of HER-2 positive Stage III disease. They must sign a written consent form approved by the CINN Institutional Review Board (IRB).


The exclusion criteria stipulate that patients with a prior diagnosis of brain metastases or who are unable to be safely exposed to MRIs cannot participate. Most common exclusions include, but are not limited to, pacemakers, implanted defibrillators, neurostimulators, aneurysm clips, cochlear devices, or any other institution contraindications. Additionally, women who are pregnant are also ineligible.


The Neurologic & Orthopedic Institute of Chicago is the country's first freestanding acute care hospital dedicated exclusively to neuroscience and orthopedic services. It utilizes breakthrough technology and minimally invasive techniques as well as advanced procedures for neurosurgery, orthopedics, pain management, neuro-oncology, sports medicine, and rehabilitation.


neuro-ortho/

Researchers Identify Potential Target For Metastatic Cancer

The deadliest part of the cancer process, metastasis, appears to rely on help from macrophages, potent immune system cells that usually defend vigorously against disease, researchers at Albert Einstein College of Medicine of Yeshiva University report.


In a new study published online in PLoS ONE, Einstein cancer research specialist Jeffrey W. Pollard, Ph.D., and seven colleagues analyzed the movement of breast cancer cells in mice to show that a distinct population of macrophages helps malignant cells set up shop at distant sites. This process, known as metastasis, is the main reason cancer patients die.


Dr. Pollard and his colleagues propose that their discovery offers a potentially useful new target for anti-cancer therapy. What they've found is a vulnerable step in the cancer process that might be blocked by drug treatments. In three different ways, the scientists showed that metastatic tumor growth is inhibited if these unusual macrophages are killed.


They also showed that even after breast cancer cells have lodged in the animals' lungs and started aggressive growth, erasing the special macrophages dramatically slowed growth of the metastasized tumors. "This suggests that anti-macrophage therapy will have an impact in patients even with metastatic disease," Dr. Pollard said.


Based on this new work, he added, "macrophages themselves, or their unique signaling pathways, represent new therapeutic targets that may be efficacious in reducing cancer mortality."


Ordinarily, macrophages are vital for maintaining health as an integral arm of the immune system, one of the body's main lines of defense. Their assigned tasks include cleaning up debris in the wake of disease or injury, alerting other immune system cells when an infection begins, and helping identify viruses and bacteria that need to be killed.


The findings of this study build on earlier cancer research by Dr. Pollard and his team that shows macrophages can act at the primary tumor site to enhance tumor progression and malignancy. Thus, they've now shown that macrophages can become traitors, enhancing the worst aspect of the disease metastatic tumor growth.


"This new study is important because it definitively shows the effects of macrophages at distant sites, as well as the identity of the macrophage population," Dr. Pollard explained. "This is the first proof that they have impact at this location, at the site of metastatic tumor growth."


Dr. Pollard noted that "metastatic disease is the major cause of cancer mortality," in part because the distant tumors tend to resist chemotherapy and radiation treatments. Unfortunately, "the biological mechanisms that underlie metastatic disease are poorly understood," so continuing research is needed. And if metastasis can somehow be blocked particularly through influencing cells of the metastatic microenvironment the impact on cancer mortality would be enormous.















The paper, "A Distinct Macrophage Population Mediates Metastatic Breast Cancer Cell Extravasation, Establishment and Growth," was published August 10 in PLoS ONE, a journal of the Public Library of Science. The lead author is post-doctoral fellow Binzhi Qian, Ph.D., Einstein. Other co-authors are Yan Deng and Yiyu Zou, Einstein; Jae Hong Im and Ruth J. Muschel, University of Oxford Churchill Hospital in England; and Richard A. Lang, Children's Hospital Research Foundation, in Cincinnati, Ohio.


Dr. Pollard is the director of the Center for the Study of Reproductive Biology and Women's Health, deputy director of the Albert Einstein Cancer Center, professor of developmental and molecular biology, and of obstetrics & gynecology and women's health. He is also the Louis Goldstein Swan Chair in Women's Cancer Research at Einstein.


About Albert Einstein College of Medicine of Yeshiva University


Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. It is home to 2,775 faculty members, 625 M.D. students, 225 Ph.D. students, 125 students in the combined M.D./Ph.D. program, and 380 postdoctoral research fellows. In 2008, Einstein received more than $130 million in support from the NIH. This includes the funding of major research centers at Einstein in diabetes, cancer, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Through its extensive affiliation network involving eight hospitals and medical centers in the Bronx, Manhattan and Long Island which includes Montefiore Medical Center, The University Hospital and Academic Medical Center for Einstein the College of Medicine runs one of the largest post-graduate medical training programs in the United States, offering approximately 150 residency programs to more than 2,500 physicians in training.


Source: Einstein College of Medicine of Yeshiva University

WHO To Call For Public Smoking Bans Worldwide Based On CalEPA Report Linking Secondhand Smoke To Increased Breast Cancer Risk

The World Health Organization on Thursday at the 13th World Conference on Tobacco or Health in Washington, D.C., plans to recommend smoking bans in workplaces and public grounds worldwide based on a California Environmental Protection Agency report released in January, USA Today reports (Ritter, USA Today, 7/13). The report, which was conducted by the CalEPA Office of Environmental Health Hazard Assessment, looks at more than 1,000 studies on the effects of secondhand smoke and finds the exposure to secondhand smoke increases young women's risk for breast cancer by 68% to 120%. The report also finds that secondhand smoke can cause preterm deliveries and low birthweights. The report's findings on breast cancer were the first ever to be made by a government agency in the U.S. (Kaiser Daily Women's Health Policy Report, 1/27). A WHO policy report due in September will use the CalEPA report as the scientific root of its recommendations, according to USA Today. The two reports will be published together, Yumiko Mochizuki, director of WHO's Tobacco Free Initiative, said. Only a few countries, including Ireland, have instituted complete smoking bans similar to what WHO plans to recommend (USA Today, 7/13).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

16 Common Myths About Breast Cancer

One in seven women will develop breast cancer in her life. But how much do most women really know about this disease?


Breast cancer specialists from the University of Michigan Comprehensive Cancer Center say that misconceptions often cause women more anxiety than necessary. And in some cases the fear paralyzes women and prevents them from seeking the care that could lead to successful treatment.


Here, experts debunk some of the most common myths about breast cancer:


1. You only get breast cancer if you have a family history. I don't have a family history, so I don't need to worry about it.


Eighty percent to eighty-five percent of women with breast cancer have no family history of the disease. Even if no one in your family has ever been diagnosed, that's no excuse to skip your yearly mammogram. "It's important all women over 40 years old be screened for breast cancer," says Mark Helvie, M.D., U-M's director of breast imaging.


2. I'm too young to worry about breast cancer.


Breast cancer can affect women of any age. The disease is more common in post-menopausal women, but 25 percent of women with breast cancer are younger than 50. Younger women should have a yearly breast exam by their doctor and begin mammographic screening at age 40. While a breast mass in a younger woman is much less likely to be cancer than a lump in an older woman, it still needs to be checked out. At the same time, you're never too old to get breast cancer. If you feel a lump - at any age - have it checked out.


3. If I'm diagnosed with breast cancer, it means I'm going to die.


Doctors are doing quite well at treating breast cancer, with 10-year survival rates currently at 85 percent to 90 percent. When caught early, up to 98 percent of women survive at least five years. Breast cancer that has metastasized, or spread to other parts of the body, poses the greatest challenge, although women with metastatic breast cancer often live for years with their disease.


4. I've made it five years as a survivor, so my breast cancer won't return


Breast cancer can recur at any time, although it is more likely to happen within the first five to 10 years: 75 percent of women who will get a recurrence see it within six years, and 25 percent recur in the 10 years after that. New hormonal therapies, including tamoxifen and aromatase inhibitors, may be delaying recurrence, so that the cancer is more likely to return after the woman stops taking those drugs.


5. Chemotherapy will make me nauseated and I will be vomiting all the time.


Chemotherapy does cause nausea and vomiting. But in the last 10 years, new drugs have become available that can almost completely control nausea, and very few people have persistent nausea and vomiting from chemotherapy.















6. If I have a breast lump, it's cancer.


Most breast lumps felt are not cancer. They could by cysts or a benign condition called fibrocystic changes or fibroadenoma. Lumps could also be pre-cancerous conditions that will need some treatment. But don't let these facts lull you into complacency. All lumps should be checked thoroughly.


7. Herbal remedies and dietary supplements can help treat breast cancer.


No herbal remedy, dietary supplement or alternative therapy has been scientifically proven to treat breast cancer. Further, doctors do not know how these alternative medicines may interact with established medicines - if they cause their own side effects or interfere with the traditional therapy's effectiveness.


8. I eat a healthy diet, which will make me immune to breast cancer.


Diet does play a role in cancer development, but not by itself. No one food or vitamin will prevent breast cancer. At the same time, no one food is responsible for causing cancer. Eat a healthy, balanced diet and strive to get a variety of nutrients.


9. My mammogram was normal, so I don't have to worry about breast cancer.


While mammography does catch the vast majority of breast cancers, it is only one screening tool. One in five breast lumps is invisible on a mammogram. Women should also have a breast exam done by their health care provider each year. If you feel a lump, always get it checked out, even if your last mammogram was clear. Also, it's important to get a mammogram every year. "The power of screening comes with regular annual exams," Helvie says. Doctors will look at previous years' mammograms to assess changes in the breast over time.


10. I was called back for "extra views" after my mammogram. That must mean I have cancer.


Extra views may be necessary because there's a shadow on the image. A mass may turn out to be a benign cyst. Most of the time, no further tests are necessary once the new images are reviewed. About 90 percent of women called back for extra views do not have cancer.


11. Mammograms are painful.


Is it comfortable? No. But it doesn't need to be excruciatingly painful, and most women will say it's not. Pre-menopausal women should schedule their exam for the first two weeks of their menstrual cycle, when their breasts are less tender. If you find mammograms are painful, talk to the technologist performing it. The amount of compression used can vary, so the technologist can ease up on the squishing if it's unbearable. Just keep in mind that more compression leads to a better image for the radiologist to read - so there's a payoff to that bit of discomfort. Don't think having a digital mammogram will get you out of it either. Digital mammography works the same as standard mammography by requiring compression.


12. If I have a breast biopsy, the surgeon might continue during that operation to remove my entire breast without telling me.


Before the biopsy operation, you will sign an informed consent form that explains exactly what procedure will be performed. Many years ago, surgeons would remove a suspicious mass, biopsy it on the spot and proceed to mastectomy if it showed signs of cancer. Today, it does not happen that way. Women have many more treatment options and a surgeon will always discuss these options with patients after a biopsy.


13. My breast lump is painful, so it must not be cancer since cancerous lumps are supposed to be painless.


Generally breast cancers are painless, but pain alone cannot rule out cancer. Some women also believe that a painless lump must not be cancer. Again, not true. There's no correlation between whether the lump is painful and whether it's cancerous. Any lump should be checked by a doctor.


14. If cancer is exposed to air during surgery, it will spread.


Surgery will not cause the cancer to spread. "The only thing that will promote cancer spread is a delay in diagnosis and failure to treat the cancer," says Lisa Newman, M.D., MPH, director of the U-M Breast Care Center.


15. Radiation therapy is dangerous and will burn my heart, ribs and lungs.


Current radiation techniques are safe and effective for treating breast cancer, with few complications. Methods used today minimize exposure to the heart, ribs and lungs. Women may experience a darkening of the skin during the course of treatment or a sunburn-like reddening. This will clear up after treatment is through.


16. Participating in a clinical trial is fine for others but not for me.


Clinical research can offer high-quality care for everyone. In all clinical trials, the minimum any woman would receive is standard treatment. In some trials, participants receive standard treatment plus a new approach, such as a new drug or a new way to use an old drug. In other studies, researchers are seeking more answers about the biology of the cancer or the effects of the treatment, so that new ideas can be generated. In these cases, patients' participation may be as simple as having an extra tube of blood drawn or answering a survey.


"I think every woman should ask her doctor, 'What clinical trial can I be on?' At least they should hear the options. Through clinical trials, we will continue to take good care of patients today, and better care of their sisters and daughters in the future," says Daniel Hayes, M.D., clinical director of the U-M breast oncology program. "Studies have shown women who participate in clinical trials do better in the long run than those who do not."


Some 212,000 women will be diagnosed with breast cancer this year, and more than 40,000 will die from it, according to the American Cancer Society. For information about breast cancer, go to cancer.med.umich/cancertreat/breast/index.shtml or call the CancerAnswerLine at 800-865-1125.


University of Michigan Health System

2901 Hubbard St., Ste. 2400

Ann Arbor, MI 48109-2435

United States

University of Michigan

Mammography Facility Characteristics Associated With Accuracy Of Screening

Some characteristics of mammography facilities are associated with the accuracy of interpretation of screening mammograms, according to a study published online June 10 in the Journal of the National Cancer Institute.



Previous studies have suggested that patient characteristics, such as age, are associated with variations in the accuracy of screening mammograms. Similarly, characteristics of the radiologist who interprets the mammograms, such as his or her reading experience, are associated with variations in accuracy. The impact of the type of facility or its characteristics on mammogram accuracy was unknown, but the information could help identify better practices and better places to obtain a mammogram.



In the current observational study, Stephen Taplin, M.D., of the National Cancer Institute in Bethesda, Md., and colleagues surveyed 53 mammography facilities between 1992 and 2002 to look for associations between facility characteristics and interpretive accuracy. The researchers were able to analyze data from 44 facilities, which altogether performed 484,463 screening mammograms on 237,669 women. Of those, 2,686 women were diagnosed with breast cancer.



On average, the facilities identified cancer when it was present (sensitivity) in 79.6 percent of breast cancer cases that occurred within one year and correctly categorized a mammogram as cancer-free (specificity) 90.2 percent of the time. The likelihood of cancer in women who were referred for additional imaging or evaluation due to an abnormal mammogram was 4.1 percent. On average, 38.8 percent of the women referred for a biopsy from each facility were found to have cancer. The likelihood of cancer among the women with any additional evaluation, or those referred for biopsy, varied substantially between facilities. The likelihood that a mammogram was accurately read as cancer-free varied by facility but the likelihood that a cancer was identified when it was present did not.



Several facility characteristics were associated with a higher measure of accuracy that combines sensitivity and specificity, including those that offered screening mammograms alone versus those that offered diagnostic and screening mammograms, and those that had a breast imaging specialist reading the mammograms versus those that did not.



If these associations are validated in future prospective studies, the information could help both patients and mammography facilities. "Understanding how facility characteristics influence interpretive accuracy is important because it could allow women and physicians to choose a mammography facility based on characteristics that are more likely to be associated with higher quality. Radiologists could also change the facilities' structures or processes to include practices that improve interpretive accuracy," the authors write.







Citation: Taplin S, Abraham L, Barlow WE, Fenton JJ, Berns EA, Carney PA, Cutter GR, Sickles EA, D'Orsi C, Elmore JG. Mammography Facility Characteristics Associated With Interpretive Accuracy of Screening Mammography. J Natl Cancer Inst 2008; 100:876-887



The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Visit the Journal online at jnci.oxfordjournals/.



Source: Liz Savage


Journal of the National Cancer Institute