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Do Household Products Cause Breast Cancer?

August 4, 2010

Lending some credence to the widely circulated rumors you've likely heard, the first published report on conventional household product use and breast cancer links cleaners and air fresheners to an increased risk of the disease. Environmentalists have long theorized that household products may contain hormone-disrupting chemicals or carcinogens that contribute to breast cancer development.

Researchers from Boston University School of Public Health and the Silent Spring Institute in Newton, MA questioned more than 1,500 women about their product use and other risk factors for a study published in the journal Environmental Health. Roughly half were diagnosed with breast cancer and half weren't.

The investigators found that mold/mildew control products containing bleach as well as solid and spray air fresheners were linked with a higher risk of breast cancer. In fact, the risk was doubled among subjects who had the highest product usage compared with those who used them the least. However, general surface cleaners, oven cleaners, and most pesticides—which are also often implicated in breast cancer development—were not associated with a higher breast cancer risk.

Acknowledging that women with breast cancer may overestimate their past product use, the study authors note that further research is needed to confirm this early association. In the meantime, you may have more peace of mind by turning to gentler, "green" cleaning products.

Household products with the Environmental Protection Agency’s (EPA) "Design for the Environment" product label are deemed safer for consumers. Here's a short list of mold and/or mildew cleaners that have met the EPA's rigorous standards.

  • Global Green Technology's Mold and Mildew Stain Remover
  • Behr Process Corporation’s 62-N Premium Mildew Stain Remover
  • HAZfree's Odor & Mildew Remover

To remove unpleasant odors, try one of these tips from Penn State University's College of Agricultural Sciences:

  1. Place baking soda in closed areas such as the refrigerator and closets.
  2. Put 2 to 4 tablespoons of baking soda or vinegar throughout rooms that need deodorizing.
  3. Boil cinnamon, cloves, or your favorite spice.

Sources: Zota, Aschengrau, Rudel and Brody. "Self-reported Chemicals Exposure, Beliefs About Disease Causation, and Risk of Breast Cancer in the Cape Cod Breast Cancer and Environment Study," Environmental Health, July 20, 2010. doi:10.1186/1476-069X-9-40;
Environmental Protection Agency; and
"Alternative Household Cleaning Solutions," a publication of the College of Agricultural Sciences at Penn State University

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FDA Panel Says No to Avastin® for Breast Cancer

August 4, 2010

The days of using bevacizumab (Avastin®) to treat metastatic breast cancer may be numbered, as an advisory panel to the U.S. Food and Drug Administration (FDA) has recommended that it no longer be approved for this purpose. That's because Avastin, which is also approved for colon, lung, and kidney cancer, has failed to show a significant benefit for breast cancer in two large clinical trials.

Avastin had been granted an accelerated approval in 2008 for metastatic breast cancer to be used with the chemotherapy drug paclitaxel (Taxol, Abraxane). The special approval was based on early positive findings from a pharmaceutical-sponsored study that Avastin halted tumor growth for five-and-a-half months compared to treatment with only paclitaxel.

But the two trials submitted for the next step of standard approval have failed to confirm these results. In these studies, the progression-free period lasted from less than a month to almost three months, which was deemed not to outweigh potentially life-threatening side effects including high blood pressure (hypertension) and bleeding.

The FDA will make its decision by September 17—though it looks probable that using Avastin for this purpose will be nixed, as the agency usually follows the recommendation of its advisory committee.

Sources: FDA;
American Cancer Society; and

Breast Cancer Survivors: Get Moving

July 7, 2010

If you've had breast cancer or are still in the midst of treatment, of course you need to rest so that your body can recuperate and heal. You also need to get moving. That suggestion may sound a bit surprising and even unrealistic.

But what if you knew that exercise would improve your quality of life, ease fatigue, and help fend off physical decline? After reviewing extensive evidence, that's exactly what a panel of cancer and exercise specialists assert. New guidelines just released from the American College of Sports Medicine recommend that cancer survivors should exercise the same amount as the general population, about 2 and ½ hours a week.

One of the researchers on the panel, Wendy Demark-Wahnefried, Ph.D., conducted a study on 641 overweight breast cancer survivors and found that muscle strengthening exercises performed at home plus an improved diet could deter physical decline. Otherwise, in one year these women could experience muscle deterioration to fat that is the equivalent of 10 years of normal aging.

The panel acknowledges that breast cancer patients still in treatment shouldn't exercise as much as survivors, but they should avoid becoming too sedentary. The message: be as active as you can.

Source: Medicine & Science in Sports & Exercise July 2010; 42 (7):

Longer Treatment is More Effective for Early Stage Disease

June 14, 2010

A chemotherapy regimen of drugs given sequentially over six months is more effective for early stage breast cancer than taking the drugs all together for a three-month span says a new large-scale study just published in The New England Journal of Medicine.

Most doctors already favor sequential treatment, so the news comes as more of a confirmation than a surprise. But an interesting finding from the study was that younger breast cancer patients who began menopause early due to chemotherapy were more likely to live longer—regardless of whether their cancer was fueled by estrogen or not.

Researchers randomly assigned nearly 5,400 women with early stage breast cancer that had spread to at least one lymph node to one of three chemotherapy groups: a sequential group which took doxorubicin, cyclophosphamide, and docetaxel one after the other for six months, or one of two concurrent groups which took two or three of these medications at the same time for three months.

After eight years, 83% of the women who were on sequential treatment had survived compared with 79% of those who had concurrent treatment. There were also more women who had survived disease-free in the sequential group: 74% versus 69% of both concurrent groups.

An accompanying editorial pointed out that for many women, this small survival advantage may not outweigh the side effects more common with the longer program. Treatment is a very personal decision and both patient and doctor should consider all options.

Source: Swain SM, et al. New England Journal of Medicine June 3, 2010; 362; 22: .

Counseling Boosts Survival for Breast Cancer Patients

June 14, 2010

For women who’ve had breast cancer, stress-reducing techniques don’t just improve quality of life—they can significantly decrease the risk of the cancer returning and increase chances of surviving.

Researchers at Ohio State University had already shown that breast cancer patients who received psychological counseling had a 45% reduced risk of recurrence after an average of 11 years. The intervention was aimed at helping the women understand and reduce stress caused by cancer and adhere to and follow up with treatment, as well as facilitate recovery, enhance communication with health care providers, and improve overall health.

Then, in a follow up study published in Clinical Cancer Research, 227 women with newly diagnosed stage II or III breast cancer were randomly assigned to receive either psychological counseling or just an assessment. Sixty-two patients had their cancer recur during follow-up; of those women, the ones that received psychological counseling had a 59% lower risk of dying from cancer recurrence.

These results are important because they provide hard, scientific evidence that stress reduction can have significant physical benefits—oftentimes the proof is anecdotal or only suggests a link.

Source: Andersen BL, Thornton LM, Shapiro CL, Farrar WB, Mundy BL, Yang HC, Carson III WE. Clinical Cancer Research 2010; 16 (12); 3270-8.

Predicting Breast Cancer Spread

May 14, 2010

Women with the most common and less serious form of breast cancer, known as ductal carcinoma in situ (DCIS), may have a new way of determining their chances of developing more invasive tumors down the road. Researchers say they have found two factors—namely, the way women are diagnosed and the expression of several biomarkers—that can predict future risk, according to a study published in the Journal of the National Cancer Institute.

The investigators analyzed the medical records of 1,162 women with DCIS aged 40 and older who had undergone a lumpectomy to remove the tumor. They found that the women whose cancer was found through a manual examination instead of mammography had a significantly higher risk of developing invasive breast cancer in eight years. Subjects with high levels of the biomarkers p16, cyclooxygenase-2, and Ki67 were also more likely to develop invasive breast cancer.

The study authors point out that while only 1–2% of women with DCIS die of breast cancer within 10 years of being diagnosed, many choose aggressive treatment because they don't completely understand their risk of developing invasive breast cancer later on. These new understandings from this study could help doctors and patients more accurately determine their risk.

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Is Breast Cancer an Occupational Disease?

May 14, 2010

Several years ago, night-shift work was declared a probable cause of breast cancer by the World Health Organization's International Agency for Research on Cancer, based on studies of nurses and flight attendants. In response, Denmark granted breast cancer the status of occupational disease and awarded financial compensation to women with breast cancer who had no other risk factors. However, a new study by U.S. and Chinese researchers on more than 70,000 women in Shanghai found no association between breast cancer and shift work.

Previous research suggested that disturbances in the light-dark cycle from working at night could knock hormones like estrogen and melatonin off balance and increase breast cancer risk. But in the latest study, published in the American Journal of Epidemiology, the risk of developing breast cancer was no higher among women who worked nights—even for those who had done so for more than 25 years.

However, several factors should be taken into account. This is the first study on breast cancer and shift work from a non-Western country, so genetic and environmental differences could play a role. The specific type of shift work, whether regular or rotational, could also make a difference. The World Health Organization isn't changing its classification as of now, but more research on the subject is underway.

Better to Be Larger Early, Thin Later?

April 26, 2010

With all the talk about how being overweight increases breast cancer risk, it seems almost shocking to hear that thin girls may be at higher risk of the disease later in life. But that's the skinny from a new study published in the journal Breast Cancer Research.

Scientists examined the links between childhood body size and tumor characteristics among 2,818 Swedish breast cancer patients and 3,111 women without the disease. They found that having a large body type at age 7 was associated with a decreased risk of postmenopausal breast cancer regardless of other significant factors like breast density, adult body mass index (BMI), and age of first menstruation.

Being heavier as a child also protected specifically against estrogen receptor negative tumors, which are generally more serious and difficult to overcome.

The study authors concede that they are unsure of precisely what is behind this protective effect. They note that since weight and related hormonal exposures are controllable factors, women may decrease their breast cancer risk by altering their dietary habits and hormone intake at different points in their life.

How Many Breast Cancers Are Overdiagnosed?

April 26, 2010

About a quarter of all breast cancers found through mammograms are overdiagnosed, meaning they are detected and treated but if they were left alone, they would not progress to cause symptoms or death. Researchers came to this conclusion in a review that examined overdiagnosis of cancer overall published in the Journal of the National Cancer Institute.

The authors point out that the number of breast cancer cases has gone up over the past 30 years but mortality from them has not, and that an increase in screening tests is responsible for the surge in diagnosis. And while early detection helps some people, it hurts others if they wind up undergoing treatment they really didn't need.

A review of randomized trials also found that half of chest x-ray and/or sputum detected lung cancers and 60% of PSA detected prostate cancers were also overdiagnosed. Hopefully, doctors can work to develop clinical strategies to help minimize overdiagnosis of all cancers.

Avoiding Radiation After Mastectomy

April 12, 2010

Too many breast cancer patients who have had a mastectomy are not receiving follow-up radiation therapy that could potentially save their lives, according to researchers at the University of Michigan Comprehensive Cancer Center.

Radiation after mastectomy is advised for women who have very large tumors or cancer in four or more nearby lymph nodes, as the risk of the cancer returning can exceed 30%. Radiation treatment can reduce this risk by two-thirds.

In a study of more than 2,000 women, only 78% of those who had a mastectomy and who would benefit from radiation received the treatment compared with 95% of those who had breast-conserving surgery (lumpectomy).

How much the patient's physician was involved in the decision to have radiation seemed to strongly affect whether it was performed. Women who wanted to avoid radiation were still likely to receive it if their doctor was very involved in the decision.

BRCA Mutations Linked With Contralateral Breast Cancer

April 12, 2010

Women under age 55 who get breast cancer are four times more likely to develop cancer in the opposite breast if they have certain gene mutations than breast cancer patients who don't have them, a new study shows.

Younger breast cancer patients with mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 were 4.5 times and 3.4 times respectively more likely to develop cancer in the other breast, according to research published in the Journal of Clinical Oncology.

Age also appeared to be a factor, as the younger these women were when they were diagnosed the greater their risk of developing cancer in the other breast. About 5% of all breast cancer patients in this country have BRCA mutations, which are linked to early-onset disease.

The researchers assert that the results underscore the need for women diagnosed with breast cancer at a younger age to consider genetic testing in order to prepare for a possible subsequent diagnosis of cancer in the other breast. If these women are found to have a BRCA mutation, they can consider more intensive strategies for prevention and surveillance of a recurrence.

Does Pregnancy Protect Breast Cancer Survivors?

March 29, 2010

Challenging the widely held view that getting pregnant is not a good idea if you've had breast cancer, new research presented at the European Breast Cancer Conference in Barcelona, Spain has found that pregnancy may actually improve survival among women with the disease.

An analysis of 14 studies published from 1970–2009 including about 20,000 women discovered that those who became pregnant after being diagnosed with breast cancer had a 42% lower risk of dying than women with breast cancer who didn't become pregnant.

Researchers suggest that pregnancy may have a protective effect against breast cancer due to the antibodies a mother produces. And while estrogen, which is high in pregnant women, is known to fuel breast cancer tumors, it may protect against the disease above a certain level.

The issue remains controversial, as other studies find that pregnancy has a damaging effect for women who've had breast cancer. The timing of the pregnancy may be a crucial factor. A study of 3,000 breast cancer patients found that women who had a baby and then developed the cancer within a year afterwards were 50% more likely to die.

A third study regarding pregnancy and breast cancer found that chemotherapy administered during pregnancy does not harm the baby, which is reassuring news for potential mothers. Further studies that explore the effect of pregnancy and hormones on breast cancer will continue to be a priority for researchers to provide women with more definitive answers.

Beta-Blockers: A New Breast Cancer Treatment?

March 29, 2010

Popular heart medications known as beta-blockers may have another surprising use as a breast cancer treatment. Researchers in England, who are the first to examine the effect of beta-blockers in breast cancer patients, have found that women who were taking a beta-blocker drug for high blood pressure experienced less spreading and recurrence of breast cancer tumors and had a 71% lower risk of dying from the disease than those who took another medication for high blood pressure as well as those who did not have high blood pressure and took no medication.

The researchers assert that their results are due to the effects of the beta-blockers and not any protective effect of high blood pressure. Previous studies of beta-blockers in cell cultures have shown that the medications bind to a receptor on the stress hormones norepinephrine and epinephrine and keep them from activating cancer cells.

They speculate further that women without high blood pressure who have breast cancer would respond favorably to treatment with a beta-blocker. Further studies would need to examine what type of dose would be appropriate and the occurrence and frequency of side effects, as well as whether the medication could be used as a supplementary therapy in conjunction with an existing breast cancer treatment.

Osteoporosis Drugs May Lower Breast Cancer Risk

March 12, 2010

Here's good news if you take a bone-building drug for osteoporosis: You may have a lower risk of breast cancer. Researchers discovered that women who used popular medications such as alendronate (Fosamax®) and ibandronate (Boniva®) for more than two years had an almost 40% lower risk of breast cancer than women who didn't use them.

It is not entirely clear how the medications (known as bisphosphonates) may prevent breast cancer, though several factors may come into play. Bisphosphonates may affect cell growth and death; they also could prevent tumors from establishing a blood supply or keep cancer cells from binding to each other.

The study, published in the British Journal of Cancer, focused on a group of nearly 6,000 Wisconsin women ages 20 to 69. Participants who used the medications for less than two years also experienced a risk reduction of about 20 to 30%. The only women who took the bone-building drugs and did not experience a protective effect were those who were obese—perhaps because obese women often have elevated estrogen levels. Other breast cancer risk factors were accounted for, including family history and postmenopausal hormone use.

Keep in mind that this study does not show a direct cause and effect—only an association—so more research is needed to definitively conclude there is a benefit. Still, it is encouraging news on a medication that a lot of women take.

Start Radiation Treatment Swiftly

March 12, 2010

Women who have had surgery for breast cancer are sometimes waiting longer than the recommended four to six weeks to start radiation treatment—and that's a decision that could be costly. New research suggests that the longer women wait, the greater the chance of the cancer returning.

This finding is based on an analysis of cancer records for more than 18,000 American women diagnosed with early-stage breast cancer at age 65 or older between 1991 and 2002, published in BMJ. The study found that among the quarter of participants who began radiation therapy more than six weeks after surgery, 4% developed a recurrence within five years. The risk of recurrence also declined the sooner the radiation began.

Women who delayed starting radiation were more likely to be non-white or Hispanic, to have other health conditions, to have a lower income, to have affected lymph nodes, to reside outside of the southern states, and to be diagnosed more recently.

The authors of the paper stress that radiation therapy for breast cancer patients should begin as soon as possible after surgery, and efforts should be made to shorten times for women who are put on waiting lists for radiation due to rising breast cancer rates and higher demand for treatment.

Mammograms on the Decline

March 1, 2010

In just three months since new, controversial guidelines for breast cancer screening from the U.S. Preventive Services Task Force recommended that most women have their first mammogram at age 50 instead of 40, access to mammograms for women ages 40 to 49 has decreased.

The Avon Foundation for Women surveyed health educators and providers across the country and found that states including California, New York, Florida, Illinois, and Michigan cut some of their breast cancer screening programs since the guidelines were released and that fewer women were being screened. Other factors, like budget cuts, also played into the elimination of early breast cancer screening programs for women under 50 through state-administered breast cancer screening programs.

A quarter of the facilities surveyed also reported that fewer women under 50 were making appointments for mammograms and that those who were already reluctant to be screened are using the new guidelines to put off having the test done.

The new guidelines have been the subject of much debate and have not been endorsed by the medical establishment on the whole, including major groups like the American Cancer Society that stick to the screening at age 40 guideline. What's concerning is that some women may simply accept the new guidelines and not question whether it's the right thing to do for them. If you are nearing age 40 and unsure of whether you should have a mammogram, be sure to discuss it with your doctor.

Overcoming Tamoxifen Resistance

March 1, 2010

British researchers have made headway in figuring out why some breast cancers don't respond to the most common long-term chemotherapy treatment, tamoxifen (Nolvadex, Soltamox). Their findings, published in Cancer Research, show that when there is too much of a certain gene in breast cancer cells, it causes resistance to tamoxifen and other hormone treatments.

Breast cancer patients are usually given tamoxifen for about five years after being diagnosed to help prevent recurrence. But women whose breast cancers have too much of the FGFR1 gene—approximately 10% of patients—are more likely to have their cancer return after initial treatment.

In the study, scientists used a drug to turn off FGFR1 and block its function in cancer cells with too much of the gene. Once the gene was switched off, they discovered that tamoxifen was able to work again and destroy breast cancer cells.

The next step for researchers is to set up a clinical trial to see whether the drug can counteract resistance in actual patients. Confirmed results could lead to the development of a new treatment for breast cancer as well as a test that can measure gene activity.

Shorter Radiation Treatment May Be Better

February 15, 2010

For women with early-stage breast cancer, a shorter course of radiation therapy can eradicate the growth and prevent cancer recurrence just as well as standard five-week treatment, says a new study from The New England Journal of Medicine.

Three weeks of more intense treatment—known as accelerated hypofractionated whole-breast irradiation—was found to be as effective and safe as the longer course of radiation typically used after tumor removal surgery.

More than 1,200 Canadian women were randomly assigned to receive either accelerated or standard radiation and were followed for 12 years to track breast cancer recurrence. The cancer actually returned in slightly more of the standard group—6.7%—compared with 6.2% of the accelerated radiation group. Both groups experienced a low occurrence of side effects.

The authors of the study assert that these results will change standard treatment for breast cancer, since shorter more intense treatment is desirable for most patients. Further research is examining even shorter, more intensive therapy.

Will Tamoxifen Drain Your Brain?

February 15, 2010

One of the most popular treatments for breast cancer, tamoxifen (Nolvadex®), may impair memory and cognitive functioning in postmenopausal women.

A new study published in the Journal of Clinical Oncology found that women with breast cancer who did not receive chemotherapy and who took tamoxifen for a year had poorer memory function in some aspects than those who took another breast cancer drug, exemestane (Aromasin®) and healthy women.

Tamoxifen-takers scored significantly worse on tests of verbal memory and executive functioning (such as being able to shift attention between different parts of a task) than healthy participants and on information processing speed compared with those on Aromasin. Functions including visual and working memory, verbal fluency, reaction speed, and motor speed remained unaffected.

The researchers weren't clear on how tamoxifen adversely impacts cognitive function but suggest that it may counteract the possible beneficial action of estrogen on the brain.

In response to the study, the U.S. National Cancer Institute emphasizes that tamoxifen's benefits as a lifesaving breast cancer treatment still outweigh its risks. It should also be noted that the research was funded by Pfizer, makers of Aromasin.

Going Digital

January 29, 2010

In addition to concerns about whether women under 50 should have mammograms due to the risk of false positive results, there is also an issue of repeated radiation exposure. But new research shows that digital mammography significantly reduces the amount of radiation exposure compared with standard film mammography—and it is digital mammography that is becoming the new standard.

As published in the American Journal of Roentgenology, data on more than 5,000 women showed that those who underwent digital mammography received 22% less radiation than patients who underwent conventional film mammography. The reduction could be even greater among women with denser, larger breasts.

Earlier research on digital mammography also found that it is more accurate than film mammography, as digital screening can detect up to 28% more breast cancers in women under 50 and women with dense breast tissue.

Digital mammograms are now being used at more than 60% of breast imaging centers in the United States and that will probably continue to increase.

Tea and Exercise May Thwart Depression

January 29, 2010

Having breast cancer can take its toll on any woman's outlook on life, but breast cancer patients who exercise and drink tea regularly may be less likely to suffer from the blues. That's the assertion of a new study published in the January issue of the Journal of Clinical Oncology.

Nearly 1,400 women who were enrolled in the Shanghai Breast Cancer Survival Study reported their diet and exercise habits six months after being diagnosed with breast cancer. A year-and-a-half later, they were interviewed again to assess their mental health, and 26% were found to be depressed.

The researchers found that participants who exercised for two to three hours a week were less likely to be depressed than those who did not exercise. Women who increased their amount of physical activity during the follow-up period were 42% less likely to be depressed. Tea drinkers also suffered from depression less often among those studied than those who didn't drink tea, and it was green tea that was usually consumed.

This study only shows a link between exercise, tea consumption, and lower rates of depression—not a direct cause and effect—so more research is needed to determine the true effect of these lifestyle habits.

Gene Test Can Pinpoint Treatment

January 19, 2010

An available gene test can foresee how certain breast cancer patients will respond to chemotherapy and enables them and their doctors to make better treatment decisions.

Intended for women with estrogen receptor-positive breast cancer that has not spread to the lymph nodes, Oncotype DX examines 21 genes from a tumor sample to see how active they are and thus predict how likely the cancer is to return after treatment. Patients with low scores are not recommended to undergo chemotherapy. New research asserts that the gene test can more accurately pinpoint an appropriate breast cancer treatment strategy.

In a study of 89 women with breast cancer, published in the Journal of Clinical Oncology, doctors changed their treatment recommendations for 31.5% of them based on results from the Oncotype DX. Twenty participants were advised after taking the test to switch their treatment plans from hormone therapy plus chemotherapy to hormone therapy alone. The physicians also reported that the gene test increased their confidence in their recommendations in more than three-quarters of cases.

Oncotype DX has been on the market since 2004, and 120,000 women with breast cancer have taken it. While expensive—it costs $3,910—the test is usually covered by insurance.

Physical Therapy Eases Swelling Post-Surgery

January 19, 2010

Women who undergo breast cancer surgery that includes removing the lymph nodes often experience fluid retention and swelling of the arms as a result, known clinically as secondary lymphedema. But physical therapy, including massage and shoulder exercises, may reduce or even prevent secondary lymphedema, says a new study in the journal BMJ.

One hundred twenty women with breast cancer who had their lymph nodes removed were randomly assigned to one of two groups for three weeks of treatment soon after the surgery: One group received educational materials and physical therapy including lymph drainage, scar tissue massage, and shoulder exercises, while the other group only received education. Participants were followed up 1 month after surgery and again three, six, and 12 months after surgery.

After one year, only 7% of women who had physical therapy developed secondary lymphedema compared with 25% who received education only, and the condition was diagnosed four times earlier.

The results are promising, and the study authors suggest that further research is needed to determine whether physical therapy following lymph node surgery for breast cancer may be effective in the long term.

On Pins and Needles

January 5, 2010

Hot flashes and night sweats are common, uncomfortable side effects for women with breast cancer undergoing anti-estrogen therapy. Venlafaxine (Effexor®) is the standard treatment to offset these symptoms, but the antidepressant can also cause its own array of side effects, including nausea, anxiety, and dizziness.

Patients may have another treatment option. Scientists assert that acupuncture, in which the tips of needles are inserted into the skin at specific pressure points throughout the body for therapeutic effect, can reduce hot flashes and night sweats as effectively as Effexor with fewer side effects. This makes sense, since acupuncture has already been shown to reduce hot flashes in menopausal women.

Researchers conducted a randomized, controlled trial—considered the most accurate and trustworthy in medical research—on 50 breast cancer patients who received either acupuncture or Effexor for 3 months. Both groups experienced similar reductions in hot flashes and improvements in depression.

But while there were 18 incidents of adverse effects among Effexor-takers, there were none in the acupuncture group. The results, published in the Journal of Clinical Oncology, also showed that acupuncture could increase a woman's sex drive and sense of well-being.

The Breast Cancer-Infertility Link

January 5, 2010

Infertility is associated with elevated breast cancer risk as well as ovarian cancer risk. Now, new research gives a possible reason for that link: mutations in a gene known as BRCA1.

Investigators found that women with breast cancer and BRCA1 mutations have a higher rate of infertility as measured by early loss of egg reserves. BRCA1 mutations have already been linked to early onset breast cancer and ovarian cancer.

In a study published in the Journal of Clinical Oncology, researchers performed ovarian stimulation on 126 women with breast cancer. In patients who possessed BRCA1 mutations, low ovarian response was 30% higher than in subjects without mutations. However, women with related BRCA2 gene mutations did not similarly produce lower numbers of eggs.

These findings may partially explain why women with BRCA1 gene mutations not only have a greater risk of breast and ovarian cancer but also greater rates of infertility. Researchers estimate that one in every 1,000 women in the United States has BRCA gene mutations, and that number is as high as 2.5 in every 1,000 women in certain ethnic groups, such as Ashkenazi Jews.

Soy Linked to Lower Breast Cancer Recurrence

December 22, 2009

Soy foods like tofu and soymilk are heavily promoted as an alternative to higher fat products like beef and cow's milk for a variety health benefits. Soy has been thought to reduce breast cancer risk due to a group of plant-based estrogens it contains known as isoflavones. But for women who have already had breast cancer, concerns exist that the estrogen-like effect of soy could be harmful.

A new, large-scale study published in The Journal of the American Medical Association might reduce those fears and extend the joy of soy, finding it not only to be safe but linked with a lower risk of breast cancer recurrence and death.

Researchers analyzed data from The Shanghai Breast Cancer Survival Study on more than 5,000 female breast cancer survivors ages 20–75 in China. Women who consumed the highest amount of soy (up to 11 grams of soy protein) had a 32% lower risk of breast cancer recurrence and a 29% lower risk of death than those who consumed the least soy. This link held true for individuals with either estrogen-receptive positive (ER+) or estrogen-receptive negative (ER–) breast cancer, as well as for those with early and late stage cancers and regardless of menopausal status.

This study only shows an association (not hard evidence) and suggests that eating moderate amounts of soy could be beneficial for breast cancer survivors—but it is not a ringing endorsement to eat a lot of soy. A balanced diet is always healthiest, and your healthcare practitioner can help guide your dietary choices.

Fewer Complications with Core Needle Biopsy

December 22, 2009

When an abnormality is spotted on a mammogram or other screening test, a follow-up biopsy can be performed through several methods including open surgery or a core-needle technique, which is minimally invasive. In most of these biopsies, the tissue is found to be cancer-free.

A review of more than 100 studies in the January 5 issue of the Annals of Internal Medicine (published in advance online) asserts that there is less chance for scarring and other complications with core needle biopsy than open surgery, and it is nearly as effective in diagnosing breast cancer. For the majority of women who will be deemed cancer-free and won't need any further treatment, the lower risk of scarring with a needle biopsy is a significant benefit.

After examining data on more than 57,000 breast lesions, investigators found that the complication rate for open surgery biopsy was 2–10%, while for core needle biopsy it was less than 1%. A surgical biopsy is performed under either general or local anesthesia, and a scalpel is used to cut the skin and remove a tissue sample. In contrast a core needle biopsy uses a large needle with a hollow center to draw out the sample under local anesthesia.

If you are referred for a breast biopsy, be sure to explore all of your options and discuss with your doctor which one is best for you.

Women in their 40s Still Want Mammograms

December 8, 2009

Despite the recommendation change from the U.S. Preventive Services Task Force (USPSTF) that women with average breast cancer risk hold off on mammography until age 50, sparking a firestorm of controversy, most American women ages 40–49 plan to continue with annual mammograms according to a recent online poll.

Out of a nationwide sample of 454 women in their 40s who were polled by Harris Interactive, 67% said they will get an annual mammogram, and 23% said they would get the test even if their insurance didn't cover it and they had to pay out-of-pocket. Only 4% of respondents said they wouldn't have a mammogram in their 40s due to the new recommendations, while 17% reported they wouldn't have one regardless of the guidelines.

While the USPSTF has changed its recommendations, the American Cancer Society and the American College of Radiology are sticking with their recommendation of annual mammograms starting at age 40. Many doctors are also speaking out about how invaluable mammograms are for all women in their 40s and that routine testing for this age group shouldn't be discouraged in any way.

If you are uncertain about when you should start or continue getting mammograms, be sure to discuss the issue with your gynecologist to help make a decision that's right for you.

Secondhand Smoke Linked to Breast Cancer Risk

December 8, 2009

Whether exposure to secondhand smoke increases the risk of developing breast cancer remains a debated topic, but new research adds to evidence that it does.

A study published in the December issue of Cancer Epidemiology, Biomarkers & Prevention investigated breast cancer risk among women who had never smoked cigarettes but had been exposed to secondhand (or passive) smoke, whether in social settings, at work, or at home.

Researchers from the Northern California Cancer Center followed more than 57,000 women from the California Teachers Study for 10 years. Questionnaires helped determine whether certain factors of secondhand smoke exposure, including age when exposed and the setting or amount of exposure, affected breast cancer risk.

They found that women exposed to moderate to high levels of secondhand smoke as adults had a higher risk of developing breast cancer post-menopause—and that the risk increased as total exposure increased. Individual exposure in household, work, or social settings did not have a statistically significant effect on breast cancer risk, but cumulative exposure did.

Of course, the safest course of action is to avoid secondhand smoke in all settings to protect not only against breast cancer but other health risks as well.

Yes Mammogram? No Mammogram?

November 24, 2009

The new guidelines for mammograms, issued by an independent panel of government advisers called the U.S. Preventive Services Task Force (USPSTF), have caused a storm of controversy.

The USPSTF is advocating: Regular mammograms every two years for women ages 50 to 74 and no teaching of breast self-examination (BSE). Furthermore, they state that there is not enough evidence to assess whether a clinical breast examination (CBE)—an in-office breast exam by a doctor—does more harm than good for women 40 years or older. And they cannot assess if digital mammography and/or MRI imaging of the breast produces more accurate diagnosis than a conventional x-ray mammogram.

The change in mammogram recommendations to a new, less frequent schedule is what has caused all the debate. The opposition looks at the decline in breast cancer deaths and the increase in diagnosis of early-stage breast cancer in the past 20 years as a sign that the old standard—an annual mammogram from age 40 on—is beneficial. And they fear that these new guidelines will simply make it easier for more women to avoid mammograms—and risk their lives.

"Mammography is not a perfect test, but it has unquestionably been shown to save lives—even in women aged 40-49," says Carol H. Lee, M.D., from Sloan Kettering Cancer Center and chair of the American College of Radiology Breast Imaging Commission. "If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women." W. Phil Evans III, M.D., president of the Society of Breast Imaging (SBI) echoes her sentiments: "At least 40 percent of the lives saved by mammographic screening are of women aged 40–49."

But the recommendations did not arise without consideration of solid medical evidence. A review of previous studies and a randomized controlled trial showed that the risk reduction for women age 40 to 49 does not outweigh the problems associated with false positives, unnecessary treatments and the risk associated with x-rays screening for women of all ages. Furthermore, in the November 17 issue of the Annals of Internal Medicine, a comprehensive analysis of various mammography screening schedules suggests every other year for women 50 plus is the right decision.

So what's a woman to do? Talk with your doctor, assess your individual risk factors and pay attention to the continuing debate. And remember whatever schedule you and your doctor decide is best for you, stick to it. Don't skip a recommended mammogram.

Pain Relief Backfires

November 24, 2009

Morphine has been used to quell severe pain for centuries—but recently doctors have observed that it may also promote the growth of cancer cells. This means that using this powerful drug—at least without changing how it operates in the human body—may be dangerous for cancer patients.

Fortunately, there seems to be a way to allow morphine to reduce pain effectively while muting its cancer-stimulating effects. Patrick A. Singleton, Ph.D., assistant professor of medicine at the University of Chicago Medical Center and principal author of two studies on morphine's cancer-stimulating effects, has discovered that shielding lung cancer cells from opiates reduces cancer cell aggressiveness in both cell-culture and mouse models.

Cancer patients have also been seen to benefit from reduced exposure to morphine: Researchers have observed that those in palliative care, receiving a drug to help counter morphine's gastro-distressing effects, lived twice as long as expected. And other doctors have written about the improved outcomes of breast cancer and prostate cancer patients who had regional instead of general anesthesia.

How Breast Density May Affect Cancer Recurrence

November 13, 2009

It has long been suspected that women with dense breast tissue are at increased risk of developing breast cancer, but there wasn't much data on whether or not the increased risk persists after a lumpectomy to remove cancerous tissue. So researchers from Women's College Research Institute in Toronto reviewed the medical records of 335 patients who had undergone lumpectomy for breast cancer.

Comparing breast densities, as seen on mammograms, they monitored the patients for breast cancer recurrence. What they found was that over 10 years the women with the highest breast density had a 21 percent chance of cancer recurrence, compared with a 5 percent chance among women with the lowest density tissue.

The difference in the recurrence rates at 10 years after lumpectomy was even greater for the subgroup of women who did not receive radiation. Among those women, 40 percent with high-density breast tissue had a recurrence compared with none of the patients with low density.

New Treatment Option for Early Stage HER-2 Positive Cancer

November 13, 2009

The Food and Drug Administration (FDA) has just approved the use of trastuzumab (Herceptin) for the treatment of early-stage HER-2 positive breast cancer. Herceptin has been used to treat advanced HER-2 positive cancer for the past decade. (HER-2 is a protein that appears on about 15 to 20 percent of breast cancer cells and HER-2 positive breast cancer is a more aggressive form of the disease.)

The approval for extended use of trastuzumab comes as a result of mounting evidence that women who are diagnosed with early stage HER-2 positive breast cancer are at heightened risk for recurrence of the disease following their initial treatment.

Edward Romond, M.D., a cancer researcher at the University of Kentucky's Markey Cancer Center, analyzed the findings of two large clinical trials of early-stage breast cancer patients who received chemotherapy and trastuzumab. The results indicated a 52 percent decrease in the risk for breast cancer recurrence compared with patients who received the same chemotherapy without trastuzumab.

In terms of a leap forward in breast cancer treatment, "this is probably the most dramatic one we've had in a long time," says Dr. Romond. In fact, this study has changed the outcome for women with early stage HER-2 positive cancer from worrisome to one that has a much better prognosis, he adds emphatically.

Stopping the Spread of Breast Cancer

November 6, 2009

A new, potent chemotherapy drug cocktail has been developed that may stop the spread of breast cancer to other parts of the body (metastasis).

By dosing breast cancer cells with a leukemia drug—dasatinib—and a common breast cancer drug , doxorubicin, that is used to treat early-stage or node-positive breast cancer, HER-2 positive breast cancer, and metastatic disease, researchers from Northwestern University Feinberg School of Medicine say they can inhibit breast cancer cell invasion by half.

Up to now there have only been drugs that could try to stop cancer cells in breast ducts from dividing. There were none that could effectively target the spread of the cells from the ducts to other organs. "Perhaps this drug could be given to prevent invasion from happening in the first place," says lead researcher, Dr. Seth Corey. "This might keep the disease in check and prevent it from progressing."

Early, Conservative Treatment for Lymphedema Works Wonders

November 6, 2009

Lymphedema, a swelling of the arm(s) and sometimes leg(s), after breast cancer surgery that removes lymph nodes, can develop even if a woman is in sustained remission from the cancer itself.

Now, physical therapists have shown, in a study published in Cancer, that if they evaluate patients before surgery using infra-red measurement of limb volume and then see the patients regularly after surgery, they can detect the onset of lymphedema—and stop it in its tracks.

The physical therapists recommend daily use of a light-grade compression sleeve and a so-called hand gauntlet to reduce early swelling. This lymphedema treatment contrasts to the standard approach: Usually doctors suggest more aggressive and time-consuming techniques, such as complete decongestive therapy, explains the study's lead author, Nicole Stout, PT, MPT. Complete decongestive therapy requires the patient to attend daily therapy sessions for weeks and wear bulky compression bandages.

"This study clearly demonstrates the fact that lymphedema can be managed with a more conservative treatment option when diagnosed in its earliest stages," Stout says.

"We hope physicians, surgeons, oncologists, and other physical therapists will make early intervention and conservative treatment of lymphedema the standard of care in breast cancer treatment."

Discoveries in Breast Cancer Diagnosis & Treatment

October 13, 2009

The recent 2009 Breast Cancer Symposium, hosted by the American Society of Clinical Oncology, presented the latest discoveries about breast cancer diagnosis, breast cancer prevention and treatment of breast cancer.

A large retrospective study found that three-quarters of breast cancer deaths occur among women who don't get mammograms regularly—making it crystal clear how important this breast cancer screening test is for a woman's health.

Women diagnosed with ductal carcinoma in situ (a pre-invasive form of breast cancer) before age 44 have double the risk of recurrence following breast-conserving surgery and radiation as women with the same diagnosis who are ages 45 to 50. The implication, the researchers say, is that these younger women should receive more aggressive treatment than they now do.

Often women with early-stage breast cancer find they must have two surgeries to remove underarm (axillary) lymph nodes—one following initial diagnosis and another once more data accumulates, through biopsy and/or analysis of extracted nodes. Research shows that if doctors use ultrasound to examine the nodes before the initial breast-conserving surgery, nearly one-third of women can be spared a second axillary node surgery.

Taxol® (paclitaxel) has been a cornerstone of treatment for both early stage and metastasized breast cancer. But now a new technique—using what is called a microarray—identifies breast cancer subtypes and predicts response to adjuvant paclitaxel (Taxol) chemotherapy. As a result, doctors are better able to know before administering the drug which women will benefit from it and which ones will not. This lets oncologists offer women treatment that is tailored to work with their bodies' unique responses to medications and to spare them unnecessary side effects.

In Treatment? Check Your Vitamin D Levels

October 13, 2009

A recent study of 166 women with breast cancer, reported at the American Society of Clinical Oncology Breast Cancer Symposium, found that nearly 7o percent of these patients had notable vitamin D deficiency. This didn't surprise researchers, since previous studies found that nearly half of all men and women in the general population are deficient in the nutrient. But it does cause concern since there are other studies that indicate that women with low levels of vitamin D have poorer outcomes post-breast cancer treatment than those with optimal levels of the vitamin.

At last year's meeting of ASCO, researchers from the University of Toronto reported that women with vitamin D deficiency at the time of breast cancer diagnosis were 94 percent more likely to experience cancer spread and 73 percent more likely to die over the next 10 years, compared to women with adequate vitamin D levels.

What does it take to boost those levels—which were even lower in non-Caucasian women and those who had late-stage breast cancer? According to Luke Peppone, Ph.D., professor of Radiation Oncology, at Rochester's James P. Wilmot Cancer Center, weekly supplementation with 50,000 international units or more of vitamin D will improve blood levels.

If you have your vitamin D levels tested, The U.S. Institute of Medicine says 32 nanograms per milliliter is adequate—but 70 percent of women in the study had only 27 nanograms per milliliter.

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