Researchers at Oregon Health & Science University's Advanced Imaging Research Center (AIRC) are developing a new imaging method that may provide a clearer diagnosis of breast cancer. The research is published in the latest issue of the journal Magnetic Resonance in Medicine. AIRC Director Charles Springer, Ph.D., is senior author, and AIRC Manager, Xin Li, Ph.D., is first author of the new paper, along with William Rooney, Ph.D., AIRC faculty. Professor Springer also holds appointments in OHSU's Cancer Institute and Department of Biomedical Engineering.
"This technique involves a new method for interpreting information gathered through MRI," explained Springer. "The technique involves recognizing that certain properties of MRI signals can change during the examination, much like the changing of a camera's shutter speed. On a camera, a fast shutter speed can make a speeding car look as if it is standing still. A slower shutter speed may result in a photo showing the car blurring past the camera. This principle, when correctly applied to MRI imaging, can provide more accurate information. In the case of MRI, the blurring is not of the actual image, but of the time courses of the MRI signals."
Magnetic resonance imaging technology combines the use of powerful magnets and radio wave pulses. The magnet influences the magnetization of the body's water molecules. The radio signals that are received from this can be converted into a visual representation.
The shutter speed concept allows researchers to adjust the mathematics of the computer program analyzing the signals to account for the movement of water molecules in and out of cellular compartments in diseased and healthy tissue. When the MR shutter speed increases, this movement appears to slow. In the case of tumors, using shutter speed analysis not only more clearly indicates the locations of tumors, it also allows researchers to distinguish between malignant tumors and benign tumors.
To conduct this research project, the scientists analyzed data from six patients identified as having breast tumors with mammograms (X-rays.) In procedures conducted by New York research collaborators Drs. Wei Huang, Alina Tudorica, and Thomas Yankeelov of Stony Brook University and Brookhaven National Laboratory, the patients were injected with a contrast agent, which acts like an MRI dye and provides clearer images. The patients received MRI scans as the dye passed through the tumors. The time courses of the MRI signals were analyzed with the shutter speed model. The results showed hot spots only in images of malignant tumors but not in the benign tumors (three of the cases). This complete distinction was not the case using the standard MRI technique, and there was no distinction using mammography. Pathology results on these tumors confirmed the accuracy of the new MRI testing.
"While continued research is required, we believe shutter speed analyzed MRI could become a powerful tool for the diagnosis and treatment of breast cancer and almost any other form of cancer, as well as many other pathologies," explained Springer. "The shutter speed is a very general concept and applies to a great many different MRI techniques."
"We are fortunate to have recruited Dr. Springer and his team to lead the imaging research activities at OHSU and the OHSU Cancer Institute." said Grover C. Bagby Jr., M.D., Director of the OHSU Cancer Institute. "His 'shutter-speed' model has the potential of changing our approach to cancer screening in general and may also play a role in determining the early effects of treatment. The findings also provide a unique opportunity for cancer researchers to unravel the basic molecular causes of the different image signatures."
Contact: Jim Newman
newmanjohsu
Oregon Health & Science University
четверг, 20 октября 2011 г.
понедельник, 17 октября 2011 г.
Rate Of Breast Cancer In Italy Significantly Higher Than Previously Reported
A new analysis of the incidence of breast cancer in Italy per 100,000 women between the ages of 0 to 84 from 2000 to 2005 shows a 72 percent spike above official estimates issued by the Ministry of Health, with the sharpest uptick of +28.6 percent found in the youngest group studied (ages 25 to 44).
The new results, which rely on hospitalization databases that track major breast surgeries rather than official estimations computed using statistical models, appear in The Journal of Experimental & Clinical Cancer Research.
"Our findings show that women under 45 who are not currently enrolled in secondary prevention programs, should be considered for receiving regular mammograms," says Prisco Piscitelli, Ph.D., of the CROM (Cancer Research Center) in Mercogliano, Italy, one of the study's authors. "The results also strongly suggests that measures for adopting primary preventative measures to investigate and eliminate dietary, behavioral and environmental causes of breast cancer, such as estrogen in food, hormone pills, smoking, dioxin and pollution."
The study was done by a multidisciplinary team of researchers (epidemiologists, oncologists, radiologists and surgeons) Antonio Giordano, M.D., Ph.D., Director of the Sbarro Institute for Cancer Research and Molecular Medicine and Director of the Center for Biotechnology at Temple University in Philadelphia, PA and 'Chiara fama' Professor in the Department of Human Pathology & Oncology, University of Siena, Siena, Italy.
Overall, the incidence of breast cancer from 2000 to 2005 among all age groups was 26.5 percent higher than official estimations. The incidence of breast cancer per 100,000 women aged 0 to 84 years was 141.80 in the year 2000 and 160.85 in 2005, a 13.4 percent increase. This is 72 percent higher than that provided by official estimations of the Ministry of Health (93 per 100,000 women aged 0 to 84). There was an increase among all groups studied: +9.4 percent in people aged 45 to 64; +11.7 percent in people aged 64 to 75 and +15.7% over 75 years old.
But the most important finding of the study reveals that the highest increase in the incidence rate per 100,000 was observed among women below 45: +28.6 percent in people 25 to 44.
The new analysis examines the number of major surgeries (mastectomies and quadrantectomies) attributed to breast cancer over six years and by age group. Their results show that over that period, 100,745 mastectomies and 168,147 quadrantectomies were performed. A total of 41,608 major surgeries due to breast cancer were performed in the year 2000, a figure that rose to 47,200 in 2005, signifying a 13.8 percent rise over the six years.
By comparison, official estimations from the Italian Ministry of Health tallied only 37,300 cases in the year 2005.
Until now, official epidemiological data concerning the incidence of breast cancer in Italy has been computed using a statistical model (MIAMOD --Morality-Incidence Analysis MODel) based on mortality and survival data. The newly published analysis relies on hospitalization databases that track major breast surgeries.
The current study notes that while use of MIAMOD may be justified in light of the need to evaluate the incidence of all tumors, the figures may underestimate the number of breast cancers, since many deaths that occur at home or in hospital settings might be attributed to cardiovascular causes on the statistical form filled out by physicians.
Source
Sbarro Health Research Organization
The new results, which rely on hospitalization databases that track major breast surgeries rather than official estimations computed using statistical models, appear in The Journal of Experimental & Clinical Cancer Research.
"Our findings show that women under 45 who are not currently enrolled in secondary prevention programs, should be considered for receiving regular mammograms," says Prisco Piscitelli, Ph.D., of the CROM (Cancer Research Center) in Mercogliano, Italy, one of the study's authors. "The results also strongly suggests that measures for adopting primary preventative measures to investigate and eliminate dietary, behavioral and environmental causes of breast cancer, such as estrogen in food, hormone pills, smoking, dioxin and pollution."
The study was done by a multidisciplinary team of researchers (epidemiologists, oncologists, radiologists and surgeons) Antonio Giordano, M.D., Ph.D., Director of the Sbarro Institute for Cancer Research and Molecular Medicine and Director of the Center for Biotechnology at Temple University in Philadelphia, PA and 'Chiara fama' Professor in the Department of Human Pathology & Oncology, University of Siena, Siena, Italy.
Overall, the incidence of breast cancer from 2000 to 2005 among all age groups was 26.5 percent higher than official estimations. The incidence of breast cancer per 100,000 women aged 0 to 84 years was 141.80 in the year 2000 and 160.85 in 2005, a 13.4 percent increase. This is 72 percent higher than that provided by official estimations of the Ministry of Health (93 per 100,000 women aged 0 to 84). There was an increase among all groups studied: +9.4 percent in people aged 45 to 64; +11.7 percent in people aged 64 to 75 and +15.7% over 75 years old.
But the most important finding of the study reveals that the highest increase in the incidence rate per 100,000 was observed among women below 45: +28.6 percent in people 25 to 44.
The new analysis examines the number of major surgeries (mastectomies and quadrantectomies) attributed to breast cancer over six years and by age group. Their results show that over that period, 100,745 mastectomies and 168,147 quadrantectomies were performed. A total of 41,608 major surgeries due to breast cancer were performed in the year 2000, a figure that rose to 47,200 in 2005, signifying a 13.8 percent rise over the six years.
By comparison, official estimations from the Italian Ministry of Health tallied only 37,300 cases in the year 2005.
Until now, official epidemiological data concerning the incidence of breast cancer in Italy has been computed using a statistical model (MIAMOD --Morality-Incidence Analysis MODel) based on mortality and survival data. The newly published analysis relies on hospitalization databases that track major breast surgeries.
The current study notes that while use of MIAMOD may be justified in light of the need to evaluate the incidence of all tumors, the figures may underestimate the number of breast cancers, since many deaths that occur at home or in hospital settings might be attributed to cardiovascular causes on the statistical form filled out by physicians.
Source
Sbarro Health Research Organization
пятница, 14 октября 2011 г.
New Law Requires Hospitals To Inform Breast Cancer Patients Of Breast Reconstruction Options
While breast reconstruction after a mastectomy is covered by insurers in New York, many poor, minority, and less educated women do not seek out the procedure. Now, NY Gov. David A. Paterson has signed into law a bill that is aimed at reversing this trend.
"A disproportionate number of women who are at a socioeconomic disadvantage do not get breast reconstruction surgery after a mastectomy for one of several reasons. Either they are unaware of it as an option, they do not know it is covered by Medicaid and Medicare insurance programs, they do not know where to gain access to the procedures, or it is never mentioned to them by their other doctors," said Evan Garfein, MD, the plastic and reconstructive surgeon at Montefiore Medical Center who authored the Bill.
He hopes that the new law (A10094B/S6993-B/Information and Access to Breast Reconstruction Surgery) will correct this disparity. It requires hospitals in New York to inform breast cancer patients about the availability of, and insurance coverage for, breast reconstruction before they undergo "mastectomy surgery, lymph node dissection or a lumpectomy."
While Congress passed the Women's Health and Cancer Rights Act in 1998, which guaranteed universal coverage for reconstruction after surgery, and New York soon passed comparable provisions into its laws, disparities in access remain.
"Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women who have been treated for breast cancer," said Dr. Garfein. "This new law will ensure that breast cancer patients from all socioeconomic groups are informed about their options regarding breast reconstruction and about where to get the procedure."
Why the Bill is Needed: Letitia Was Never Told About Reconstruction
Letitia M., a 39-year-old single mom of two who lives in the Bronx, was diagnosed with breast cancer in 2006. She had felt a lump in her left breast and her primary care physician confirmed her suspicions of cancer after he referred her for a mammogram and sonogram. Even though she consulted with three different doctors while planning her treatment, none of them mentioned reconstruction as an option.
Letitia first had a lumpectomy and then a full mastectomy. It was only later in the treatment process, while she was receiving radiation therapy at a Manhattan hospital, that she learned about reconstruction. It was at this time that she was referred to Dr. Garfein at Montefiore, who subsequently performed reconstruction two years after her cancer surgery. When Letitia was asked why she did not undergo reconstruction at the time of her mastectomy, she replied that no one had mentioned that it was an option.
Letitia is doing well and is on the road to recovery. While it is possible that she would have chosen to delay her reconstruction until after her cancer surgery and radiation therapy were complete, the standard of care in 2010 is to at least offer her the option of immediate reconstruction at the time of her mastectomy. The purpose of the Bill is to make sure that no woman ever says, "I didn't get reconstructed because no one mentioned it to me."
One-Third of Women With Breast Cancer Choose Reconstruction
Breast reconstruction is not for everyone. Each year, a quarter of a million women are diagnosed with breast cancer, according to the American Cancer Society. Of those who undergo mastectomy, 30-40 percent, depending on the study, receive breast reconstruction, according to Dr. Garfein.
"This percentage is much lower among poor, minority and less educated women. One reason for this disparity is that their breast surgeons are less likely to discuss it with them and they are less likely to receive treatment at a dedicated cancer center where reconstruction procedures are more readily available," said Dr. Garfein. "We feel strongly that all breast cancer patients, wherever they live and whatever their knowledge level should be informed that reconstruction may be an option and that, if it is, it will be covered."
Discussing Reconstruction Before a Mastectomy is Key
Today, there are many reconstruction options for patients who have breast surgery, including saline and silicone gel implants, and several types of reconstruction using the patient's own tissues from the abdomen, thigh, back or buttocks.
The new law underscores that patients should discuss this range of reconstruction choices before deciding between a mastectomy (the total removal of the cancerous breast) or a lumpectomy (removal of part of the breast), and that the discussion involve both the cancer surgeon, who removes the cancer from the breast, and the plastic surgeon, who would perform the breast reconstruction. The surgical team and the patient can then decide if reconstruction should be performed at all, and if so, whether that should happen at the same time as the cancer surgery (as is now the standard), or at a later date.
Many women who choose not to have reconstruction do so because of personal preferences, their overall health, the stage of their breast cancer, or to avoid the risks of additional surgery. Some women, however, don't receive reconstruction because it wasn't offered to them and they didn't know to ask about it. It is this group that the legislation targets.
Montefiore Medical Center encompasses 126 years of outstanding patient care, innovative medical "firsts," pioneering clinical research, dedicated community service and ground-breaking social activism. A full-service, integrated delivery system caring for patients in the New York metropolitan region and beyond, Montefiore is a 1,491-bed medical center that includes: four hospitals -- the Henry and Lucy Moses Division, the Jack D. Weiler Division, the North Division and The Children's Hospital at Montefiore; a large home healthcare agency; the largest school health program in the US; a 22-site medical group practice integrated throughout the Bronx and Westchester; and, a care management organization providing services to 179,000 health plan members.
Montefiore has been ranked by U.S. News & World Report as among the top 50 hospitals in the country in Geriatrics, Diabetes and Endocrinology, and Neurology and Neurosurgery. The Children's Hospital at Montefiore has been consistently ranked in the magazine's Best Children's Hospitals editions, and in 2010-2011, ranked among the top 10 in the nation in Kidney Disorders and among the top 25 in the nation in Neurology and Neurosurgery.
The Leapfrog Group lists Montefiore among the top one percent of all U.S. hospitals based on its strategic investments in sophisticated and integrated healthcare technology.
Montefiore is committed to meeting the healthcare needs of the future through medical education and manages one of the largest residency programs in the country. Montefiore is The University Hospital and Academic Medical Center for Albert Einstein College of Medicine and has an affiliation with New York Medical College for residency programs at the North Division.
Distinguished centers of excellence at Montefiore include cardiology and cardiac surgery, cancer care, tissue and organ transplantation, children's health, women's health, surgery and the surgical subspecialties. Montefiore is a national leader in the research and treatment of diabetes, headaches, obesity, cough and sleep disorders, geriatrics and geriatric psychiatry, neurology and neurosurgery, adolescent and family medicine, HIV/AIDS and social and environmental medicine, among many other specialties.
Source: Montefiore Medical Center
"A disproportionate number of women who are at a socioeconomic disadvantage do not get breast reconstruction surgery after a mastectomy for one of several reasons. Either they are unaware of it as an option, they do not know it is covered by Medicaid and Medicare insurance programs, they do not know where to gain access to the procedures, or it is never mentioned to them by their other doctors," said Evan Garfein, MD, the plastic and reconstructive surgeon at Montefiore Medical Center who authored the Bill.
He hopes that the new law (A10094B/S6993-B/Information and Access to Breast Reconstruction Surgery) will correct this disparity. It requires hospitals in New York to inform breast cancer patients about the availability of, and insurance coverage for, breast reconstruction before they undergo "mastectomy surgery, lymph node dissection or a lumpectomy."
While Congress passed the Women's Health and Cancer Rights Act in 1998, which guaranteed universal coverage for reconstruction after surgery, and New York soon passed comparable provisions into its laws, disparities in access remain.
"Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women who have been treated for breast cancer," said Dr. Garfein. "This new law will ensure that breast cancer patients from all socioeconomic groups are informed about their options regarding breast reconstruction and about where to get the procedure."
Why the Bill is Needed: Letitia Was Never Told About Reconstruction
Letitia M., a 39-year-old single mom of two who lives in the Bronx, was diagnosed with breast cancer in 2006. She had felt a lump in her left breast and her primary care physician confirmed her suspicions of cancer after he referred her for a mammogram and sonogram. Even though she consulted with three different doctors while planning her treatment, none of them mentioned reconstruction as an option.
Letitia first had a lumpectomy and then a full mastectomy. It was only later in the treatment process, while she was receiving radiation therapy at a Manhattan hospital, that she learned about reconstruction. It was at this time that she was referred to Dr. Garfein at Montefiore, who subsequently performed reconstruction two years after her cancer surgery. When Letitia was asked why she did not undergo reconstruction at the time of her mastectomy, she replied that no one had mentioned that it was an option.
Letitia is doing well and is on the road to recovery. While it is possible that she would have chosen to delay her reconstruction until after her cancer surgery and radiation therapy were complete, the standard of care in 2010 is to at least offer her the option of immediate reconstruction at the time of her mastectomy. The purpose of the Bill is to make sure that no woman ever says, "I didn't get reconstructed because no one mentioned it to me."
One-Third of Women With Breast Cancer Choose Reconstruction
Breast reconstruction is not for everyone. Each year, a quarter of a million women are diagnosed with breast cancer, according to the American Cancer Society. Of those who undergo mastectomy, 30-40 percent, depending on the study, receive breast reconstruction, according to Dr. Garfein.
"This percentage is much lower among poor, minority and less educated women. One reason for this disparity is that their breast surgeons are less likely to discuss it with them and they are less likely to receive treatment at a dedicated cancer center where reconstruction procedures are more readily available," said Dr. Garfein. "We feel strongly that all breast cancer patients, wherever they live and whatever their knowledge level should be informed that reconstruction may be an option and that, if it is, it will be covered."
Discussing Reconstruction Before a Mastectomy is Key
Today, there are many reconstruction options for patients who have breast surgery, including saline and silicone gel implants, and several types of reconstruction using the patient's own tissues from the abdomen, thigh, back or buttocks.
The new law underscores that patients should discuss this range of reconstruction choices before deciding between a mastectomy (the total removal of the cancerous breast) or a lumpectomy (removal of part of the breast), and that the discussion involve both the cancer surgeon, who removes the cancer from the breast, and the plastic surgeon, who would perform the breast reconstruction. The surgical team and the patient can then decide if reconstruction should be performed at all, and if so, whether that should happen at the same time as the cancer surgery (as is now the standard), or at a later date.
Many women who choose not to have reconstruction do so because of personal preferences, their overall health, the stage of their breast cancer, or to avoid the risks of additional surgery. Some women, however, don't receive reconstruction because it wasn't offered to them and they didn't know to ask about it. It is this group that the legislation targets.
Montefiore Medical Center encompasses 126 years of outstanding patient care, innovative medical "firsts," pioneering clinical research, dedicated community service and ground-breaking social activism. A full-service, integrated delivery system caring for patients in the New York metropolitan region and beyond, Montefiore is a 1,491-bed medical center that includes: four hospitals -- the Henry and Lucy Moses Division, the Jack D. Weiler Division, the North Division and The Children's Hospital at Montefiore; a large home healthcare agency; the largest school health program in the US; a 22-site medical group practice integrated throughout the Bronx and Westchester; and, a care management organization providing services to 179,000 health plan members.
Montefiore has been ranked by U.S. News & World Report as among the top 50 hospitals in the country in Geriatrics, Diabetes and Endocrinology, and Neurology and Neurosurgery. The Children's Hospital at Montefiore has been consistently ranked in the magazine's Best Children's Hospitals editions, and in 2010-2011, ranked among the top 10 in the nation in Kidney Disorders and among the top 25 in the nation in Neurology and Neurosurgery.
The Leapfrog Group lists Montefiore among the top one percent of all U.S. hospitals based on its strategic investments in sophisticated and integrated healthcare technology.
Montefiore is committed to meeting the healthcare needs of the future through medical education and manages one of the largest residency programs in the country. Montefiore is The University Hospital and Academic Medical Center for Albert Einstein College of Medicine and has an affiliation with New York Medical College for residency programs at the North Division.
Distinguished centers of excellence at Montefiore include cardiology and cardiac surgery, cancer care, tissue and organ transplantation, children's health, women's health, surgery and the surgical subspecialties. Montefiore is a national leader in the research and treatment of diabetes, headaches, obesity, cough and sleep disorders, geriatrics and geriatric psychiatry, neurology and neurosurgery, adolescent and family medicine, HIV/AIDS and social and environmental medicine, among many other specialties.
Source: Montefiore Medical Center
вторник, 11 октября 2011 г.
U.S. State Department Partners With Saudi Arabia, U.A.E., Other Countries For Breast Cancer Awareness, Research, First Lady Says
The U.S. State Department has collaborated with Saudi Arabia, the United Arab Emirates and other partners to expand breast cancer education and research in the Middle East, first lady Laura Bush said Monday, the AP/Forbes reports (Pickler, AP/Forbes, 6/12). As part of the U.S.-Middle East Partnership for Breast Cancer Awareness and Research, Johns Hopkins University researchers are helping the U.A.E. establish a breast cancer center, and the Houston-based MD Anderson Cancer Center plans to share information with the breast cancer unit at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. The Susan G. Komen Breast Cancer Foundation also plans to partner in the program (Hoover, Washington Times, 6/13). "This is the first major women's health campaign in the Middle East, and the [U.S.] is proud to be a part of it," Bush said during a speech at the Komen Foundation's 2006 Mission Conference, adding, "Together, these partners will develop awareness campaigns suited to each country; they'll increase research, training and community-outreach efforts; and [they will] help women build the knowledge and the confidence they need to be in charge of their own health" (White House release, 6/12). Bush also said, "By confronting the challenge of breast cancer together, this partnership, which represents the very best kind of public diplomacy, will also help build lasting friendships between our countries" (AP/Forbes, 6/12) Morocco and Jordan are involved in discussions to expand the program, which is organized by the State Department's public diplomacy office and the Middle East Partnership Initiative (Austein, Washington File, 6/12)
"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.
"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.
суббота, 8 октября 2011 г.
Computer Software Less Reliable Than Radiologists' Eyes In Detecting Cancerous Tumors Shown By Mammograms, Study Says
Radiologists using computer-aided detection software for mammograms are more likely to interpret a benign growth as potentially cancerous than "human reviewers using their eyes and experience," and CAD systems do not help detect more cancers, according to a study published in Thursday's New England Journal of Medicine, the Los Angeles Times reports (Gellene, Los Angeles Times, 4/5). CAD systems use complex algorithms to identify "suspicious" areas of a mammogram for a radiologist to review, according to the Wall Street Journal (Armstrong, Wall Street Journal, 4/5). The systems, which cost $50,000 to $175,000, were approved by FDA in 1998 and are sold by several companies, the New York Times reports. Medicare gives providers extra $20 more for administering mammograms that use CAD, and the systems are used in 30% of mammography centers, according to the National Cancer Institute. For the study, Joshua Fenton of the University of California-Davis and colleagues examined 429,345 mammograms performed at 43 medical centers from 1998 to 2002. During the study period, seven of the centers began using CAD (Kolata, New York Times, 4/5). The study found standard mammography detected 4.15 cases of cancer per 1,000 women screened, compared with 4.2 cases of cancer per 1,000 women screened using CAD (Wall Street Journal, 4/5). According to the study, CAD systems correctly identified which women had tumors and which did not 87.2% of the time, compared with 90.2% for standard screening. CAD systems also led to 31% more women being called back for more tests and 20% more biopsies, the study found. The researchers estimate that for every additional woman who was diagnosed with breast cancer using CAD, 156 had unnecessary additional tests and 14 had unnecessary biopsies. The researchers said that CAD systems did find more of a type cancer known as ductal carcinoma in situ, which tends to be less dangerous, the Washington Post reports. Wide use of the systems also would raise annual cost of mammography by 18%, or about $550 million, the study found.
Comments, Reaction
According to Fenton, the "goal of [CAD] systems was to make mammography better." He added, "Our study suggests that, if anything, they appear to be doing more harm than good" (Stein, Washington Post, 4/5). Suzanne Fletcher, an emerita professor of ambulatory care and prevention at Harvard Medical School, said, "With mammography, we have multiple studies showing what happens to mortality rates if you get [the screening] versus if you don't. With [CAD systems] we don't" (New York Times, 4/5). Some radiologists expressed caution about the study -- funded by NCI and the American Cancer Society -- saying that the technology continues to evolve and that larger studies are needed to confirm and expand upon the results. According to some radiologists, the performance of CAD also could be improved with better training of physicians using the technology. "We have a tool that helps us find smaller abnormalities and earlier indications of the disease," Rob Cascella -- president of Hologic, the maker of the best-selling CAD system, which was used in the study -- said (Wall Street Journal, 4/5). Ferris Hall -- a radiologist at Beth Israel Deaconess Medical Center in Boston who wrote an accompanying NEJM editorial -- said some mistakes might have been a result of inexperience with CAD because it takes radiologists several years to learn the technology. Nonetheless, the study is a setback for the technology, Hall said, adding, "This will have a major impact on radiology" (Los Angeles Times, 4/5).
The study is available online.
CBS' "Evening News" on Wednesday reported on the study. The segment includes comments from Katherine Lee of the Cleveland Clinic Breast Center and study co-author Joanne Elmore of the University of Washington (LaPook, "Evening News," CBS, 4/5). Video of the segment is available online.
NPR's "All Things Considered" on Wednesday also reported on the study. The segment includes comments from Elmore and Hall (Knox, "All Things Considered," NPR, 4/5). Audio and a partial transcript of the segment are available online.
"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.
среда, 5 октября 2011 г.
Breast Density, No Lobular Involution Increase Breast Cancer Risk
Women with dense breasts and no lobular involution were at a higher risk for developing breast cancer than those with non-dense breasts and complete involution, according to a study published online in The Journal of the National Cancer Institute.
Apart from age, family history, and age at menarche, two additional factors associated with breast cancer risk include mammographic breast density and extent of lobular involution. Lobular involution is the physiological atrophy of the breast epithelium and is known to increase with increasing age.
To determine whether these two factors are independently associated with breast cancer risk, Karthik Ghosh, M.D., of the Mayo Clinic, and colleagues investigated the factors' association with breast cancer risk in a cohort of 2666 women with benign breast disease, followed for a mean of 13.3 years; 172 (6.5%) women subsequently developed breast cancer.
The researchers took their cohort from the larger Mayo Breast Disease cohort, which included 9376 women between the ages of 18 and 85, with no history of breast cancer, who were diagnosed with benign breast disease between 1967 and the end of 1991.
The researchers found that breast density and extent of lobular involution were independent risk factors for breast cancer, and that combined, they pose an even greater risk. The authors write: "Our findings also reveal that having a combination of dense breasts and no lobular involution was associated with higher breast cancer risk than having non-dense or fatty breasts and complete involution."
The researchers write that one of the study's strengths is that it was conducted in a large, well-organized cohort of women; however, limitations include the fact that the study population was predominantly white and representative of the upper Midwest, pointing to the need to conduct research in diverse populations.
In an accompanying editorial, Gretchen L. Gierach, Ph.D., of the National Cancer Institute, and colleagues, describe lobular involution and mammographic breast density as factors that "hold promise for improving risk prediction, particularly because they reflect the cumulative interplay of numerous genetic and environmental breast cancer risk factors over time."
Future studies, they write, should include larger numbers of patients from diverse racial and ethnic backgrounds and aim to understand the relationship between involution and epidemiological risk factors such as body mass index. Furthermore, since neither lobular involution nor mammographic breast density are static processes, evaluating changes over time may improve their predictive value.
Source:
Kristine Crane
Journal of the National Cancer Institute
Apart from age, family history, and age at menarche, two additional factors associated with breast cancer risk include mammographic breast density and extent of lobular involution. Lobular involution is the physiological atrophy of the breast epithelium and is known to increase with increasing age.
To determine whether these two factors are independently associated with breast cancer risk, Karthik Ghosh, M.D., of the Mayo Clinic, and colleagues investigated the factors' association with breast cancer risk in a cohort of 2666 women with benign breast disease, followed for a mean of 13.3 years; 172 (6.5%) women subsequently developed breast cancer.
The researchers took their cohort from the larger Mayo Breast Disease cohort, which included 9376 women between the ages of 18 and 85, with no history of breast cancer, who were diagnosed with benign breast disease between 1967 and the end of 1991.
The researchers found that breast density and extent of lobular involution were independent risk factors for breast cancer, and that combined, they pose an even greater risk. The authors write: "Our findings also reveal that having a combination of dense breasts and no lobular involution was associated with higher breast cancer risk than having non-dense or fatty breasts and complete involution."
The researchers write that one of the study's strengths is that it was conducted in a large, well-organized cohort of women; however, limitations include the fact that the study population was predominantly white and representative of the upper Midwest, pointing to the need to conduct research in diverse populations.
In an accompanying editorial, Gretchen L. Gierach, Ph.D., of the National Cancer Institute, and colleagues, describe lobular involution and mammographic breast density as factors that "hold promise for improving risk prediction, particularly because they reflect the cumulative interplay of numerous genetic and environmental breast cancer risk factors over time."
Future studies, they write, should include larger numbers of patients from diverse racial and ethnic backgrounds and aim to understand the relationship between involution and epidemiological risk factors such as body mass index. Furthermore, since neither lobular involution nor mammographic breast density are static processes, evaluating changes over time may improve their predictive value.
Source:
Kristine Crane
Journal of the National Cancer Institute
воскресенье, 2 октября 2011 г.
Breast Cancer And Hormone Therapy - New Study Examines Whether Trends In Breast Cancer Incidence And Use Of HT May Be Directly Linked
The medical community has been debating for many years whether, and to what extent, postmenopausal hormone therapy (HT) use is associated with a higher risk of breast cancer, says Professor Amos Pines, President of the International Menopause Society. Although it is agreed that long-term HT slightly increases that risk, the definition of long-term use is still unclear, particularly in view of data showing that it may vary significantly by type of HT (estrogen-alone vs. estrogen-progestin, brand of progestin, dosage). A new study from the Kaiser Permanente health plan[1] raises the question whether trends in breast cancer incidence and use of HT over the past 25 years may be directly linked.
The Women's Health Initiative (WHI) trial was a landmark in menopause medicine since it provided information based on the best available study methodology[2]. By adopting its results as the ultimate source of information, many organizations, medical societies and health authorities actually declared that data derived from observations in the postmenopausal population are less valuable. Nevertheless, during the past few months, several studies have used databases on the incidence of breast cancer, on the one hand, and sales of HT on the other hand, in order to suggest a direct link between trends of hormone use and the number of newly diagnosed breast cancer patients. While such information, by itself, is very important and interesting, conclusions must be drawn with great caution. It is tempting to simplify the observed year-by-year figures on HT use and breast cancer incidence and establish a 'mirror glass' equation: the more postmenopausal hormone use, the more breast cancer, and vice versa. But human biology is far too complicated and the pathophysiology of breast cancer is far too complex to adopt such a mechanistic approach, as the authors of those studies and related Editorials rightly say.
The mere fact that the incidence of lung cancer is higher among people carrying a lighter in their pocket does not mean that lighters cause lung cancer. Thus, having two parallel time trends, for breast cancer incidence and for hormone use, still makes it necessary to investigate further in order to better understand if and how those trends could be linked. For example, a third important player has now been added, namely the rate of mammography screening, which has proved to have similar fluctuations as HT use and breast cancer incidence1. According to the Kaiser Permanente registry[1], the rate of women aged 45-59 undergoing screening mammography in 2002-2004 (post-WHI period) decreased from 48% to 44%. Thus, awareness of the need for periodic breast examinations may ease, and the likelihood of women coming to be examined may decrease in a population that uses HT less frequently, which could lead to under-diagnosis of breast cancer.
On the other hand, the 28% increase in breast cancer incidence between the early 1980s and the early 1990s observed in the Kaiser Permanente cohort probably reflects the outcome of implementation of the mammography screening program during that period. The largest group among HT users in most of the countries (excluding the USA) has always been women younger than 60 years. The Kaiser Permanente data show that, for women aged 45-59, the 70% drop in HT use (defined as dispensation of at least one hormonal prescription) in the year 2006 (post-WHI period) as compared to the year 2000 (pre-WHI period) was associated with a non-significant decrease of 4.9% in breast cancer incidence, which translates into a reduction of less than one case of breast cancer per 10,000 women per year. Furthermore, a welcome but unexplained fact is that, in younger women (age groups < 45 years and 45-59 years), the incidence of invasive breast cancer started to decrease before the year 2000 (see Figure 1 in Glass et al.[1]). The same has been shown for the incidence of localized cancers (Figure 2[1]) and the age-adjusted annual incidence rate of both estrogen receptor-positive and -negative breast cancers (Figure 3[1]). Therefore, the decrease of breast cancer incidence analyzed from different angles by Glass and colleagues cannot be attributed simply to the drop in HT use, which started after the publication of the WHI study. There must be another, non-hormonal and still unknown factor explaining, at least in part, these changes in incidence since 1998.
Professor Pines concludes that the new epidemiological data coming from the Kaiser Permanente study do have scientific merits, but may be confusing when interpreted for the lay public. Health-care providers should stay with the first-grade information coming from the WHI study when discussing this issue with their patients: breast-wise, in women younger than 60, HT (particularly estrogen-alone) is safe. Long-term use may be associated with a small increased risk, in the order of one extra case per 1000 women per year. Discontinuation of HT brings this risk back to the values for age-matched non-users after 3-5 years. Weighing the overall benefits and risks of HT in the younger postmenopausal population clearly favors the use of HT for symptomatic women.
References
1. Glass AG, Lacey JV Jr, Carreon D, Hoover RN. Breast cancer incidence, 1980-2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst 2007;99:1152-61
2. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321-33
THE INTERNATIONAL MENOPAUSE SOCIETY
The aims of the Society (IMS) are to promote knowledge, study and research on all aspects of aging in men and women; to organize, prepare, hold and participate in international meetings and congresses on menopause and climacteric; and to encourage the interchange of research plans and experience between individual members. The Society is a non-profit association, within the meaning of the Swiss Civil Code. It was created in 1978 during the first World Congress on the Menopause. In addition to organizing congresses, symposia, and workshops, the IMS owns its own journal: Climacteric.
For further information please go to: imsociety
Source: Jean Wright
International Menopause Society
The Women's Health Initiative (WHI) trial was a landmark in menopause medicine since it provided information based on the best available study methodology[2]. By adopting its results as the ultimate source of information, many organizations, medical societies and health authorities actually declared that data derived from observations in the postmenopausal population are less valuable. Nevertheless, during the past few months, several studies have used databases on the incidence of breast cancer, on the one hand, and sales of HT on the other hand, in order to suggest a direct link between trends of hormone use and the number of newly diagnosed breast cancer patients. While such information, by itself, is very important and interesting, conclusions must be drawn with great caution. It is tempting to simplify the observed year-by-year figures on HT use and breast cancer incidence and establish a 'mirror glass' equation: the more postmenopausal hormone use, the more breast cancer, and vice versa. But human biology is far too complicated and the pathophysiology of breast cancer is far too complex to adopt such a mechanistic approach, as the authors of those studies and related Editorials rightly say.
The mere fact that the incidence of lung cancer is higher among people carrying a lighter in their pocket does not mean that lighters cause lung cancer. Thus, having two parallel time trends, for breast cancer incidence and for hormone use, still makes it necessary to investigate further in order to better understand if and how those trends could be linked. For example, a third important player has now been added, namely the rate of mammography screening, which has proved to have similar fluctuations as HT use and breast cancer incidence1. According to the Kaiser Permanente registry[1], the rate of women aged 45-59 undergoing screening mammography in 2002-2004 (post-WHI period) decreased from 48% to 44%. Thus, awareness of the need for periodic breast examinations may ease, and the likelihood of women coming to be examined may decrease in a population that uses HT less frequently, which could lead to under-diagnosis of breast cancer.
On the other hand, the 28% increase in breast cancer incidence between the early 1980s and the early 1990s observed in the Kaiser Permanente cohort probably reflects the outcome of implementation of the mammography screening program during that period. The largest group among HT users in most of the countries (excluding the USA) has always been women younger than 60 years. The Kaiser Permanente data show that, for women aged 45-59, the 70% drop in HT use (defined as dispensation of at least one hormonal prescription) in the year 2006 (post-WHI period) as compared to the year 2000 (pre-WHI period) was associated with a non-significant decrease of 4.9% in breast cancer incidence, which translates into a reduction of less than one case of breast cancer per 10,000 women per year. Furthermore, a welcome but unexplained fact is that, in younger women (age groups < 45 years and 45-59 years), the incidence of invasive breast cancer started to decrease before the year 2000 (see Figure 1 in Glass et al.[1]). The same has been shown for the incidence of localized cancers (Figure 2[1]) and the age-adjusted annual incidence rate of both estrogen receptor-positive and -negative breast cancers (Figure 3[1]). Therefore, the decrease of breast cancer incidence analyzed from different angles by Glass and colleagues cannot be attributed simply to the drop in HT use, which started after the publication of the WHI study. There must be another, non-hormonal and still unknown factor explaining, at least in part, these changes in incidence since 1998.
Professor Pines concludes that the new epidemiological data coming from the Kaiser Permanente study do have scientific merits, but may be confusing when interpreted for the lay public. Health-care providers should stay with the first-grade information coming from the WHI study when discussing this issue with their patients: breast-wise, in women younger than 60, HT (particularly estrogen-alone) is safe. Long-term use may be associated with a small increased risk, in the order of one extra case per 1000 women per year. Discontinuation of HT brings this risk back to the values for age-matched non-users after 3-5 years. Weighing the overall benefits and risks of HT in the younger postmenopausal population clearly favors the use of HT for symptomatic women.
References
1. Glass AG, Lacey JV Jr, Carreon D, Hoover RN. Breast cancer incidence, 1980-2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst 2007;99:1152-61
2. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321-33
THE INTERNATIONAL MENOPAUSE SOCIETY
The aims of the Society (IMS) are to promote knowledge, study and research on all aspects of aging in men and women; to organize, prepare, hold and participate in international meetings and congresses on menopause and climacteric; and to encourage the interchange of research plans and experience between individual members. The Society is a non-profit association, within the meaning of the Swiss Civil Code. It was created in 1978 during the first World Congress on the Menopause. In addition to organizing congresses, symposia, and workshops, the IMS owns its own journal: Climacteric.
For further information please go to: imsociety
Source: Jean Wright
International Menopause Society
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