Use of a Tamoxifen Indication Score (TIS). Decisions about whether or not to prescribe tamoxifen have been simplified by the introduction of TIS, a simple grid system that awards points for such factors as age, surgical history, general medical history, etc. Adding the points provides a total score that guides the physician’s decision. The TIS was developed by Dr. L. Rahman and colleagues at U Mass Memorial Health Care in Worcester. (Abstract 1053, San Antonio Breast Cancer Symposium)

Breast density helps predict risk of breast cancer. Two recent studies suggest that rating breast density using mammography may help in the prediction of breast cancer risk. The Gail model, used to assess risk, has been extended to include breast density (as well as weight, age at first live birth, previous benign breast biopsies, first-degree relatives with breast cancer, etc.) One problem is that breast density reporting is not standardized. This failing must be addressed. (J Natl Cancer Inst 2006;98:1172-1173 &1204-1226)

Bisphenol-A and breast cancer. Bisphenol-A, a plasticizer widely found in food packaging, can accumulate in breast cancer cells. According to in vitro studies, BPA can accumulate in breast cancer cells because it is a pseudoestrogen (also known as a xenoestrogen). There are many other compounds that have the potential to be similarly problematic, according to the principal researcher. (Chem Biol 2006;13)

Red meat intake increases risk for breast cancer in premenopausal women. According to results of a prospective study, women eating red meat more than three times a week have an increased risk of hormone positive breast cancer. The research notes that “cooked or processed red meat is a source of carcinogens, such as heterocyclic amines, N-nitroso-compounds, and polycyclic aromatic hydrocarbons (PAHs) that increase mammary tumours in animals and have been hypothesized to increase breast cancer risk.” (Arch Intern Med 2006;166:2253-2259)

Oral contraceptive use increases risk of premenopausal breast cancer. According to a recent study in the Proceedings of the Mayo Clinic, exposure to oral contraceptives – particularly by women who have never been pregnant – leads to an increased risk of breast cancer prior to menopause. The duration of use did not significantly affect the risk of developing the disease. (Of studies that provide data on any use of oral contraceptives, 29 demonstrate an increased risk for breast cancer, while eight show a protective effect.) (Mayo Clinic Proc 2006;81: 1287, 1290-1302)

Digital mammography better than film for detecting premenopausal breast cancer. Both digital and conventional mammography were used to screen more than 42,000 women with no signs of breast cancer. The only group in which digital mammography was statistically an improvement over standard mammograms was for pre- or perimenopausal women (younger than 50) with dense breasts. Studies continue to establish what groups of women should be directed toward digital mammography. (RSNA 92nd Scientific Assembly, Abstract SSA 15-02, November 2006)

Adverse effects of chemotherapy. Women with breast cancer who receive chemotherapy are more likely to be hospitalized or visit emergency rooms as compared to woman who do not receive che-motherapy (61% vs. 42%). Complaints due to chemotherapy include: fever, infections, low blood counts, dehydration, nausea, vomiting, diarrhea, anemia, or deep-vein blood clots. This report warns that adverse effects are often not evident in clinical trials because they tend to exclude women with other illnesses and/or they do not include enough participants to reveal the extent of adverse effects. (J Natl Cancer Inst 2006;98:1826-1827)

Exposure to DDT and risk of breast cancer. An analysis of blood samples collected from young women who had just given birth indicates that high levels of DDT in the blood predict a five-fold increased risk of breast cancer. The women at risk were under age 14 when DDT came into widespread use in 1945 and under 20 when DDT use peaked. This study has enormous implications for the controversy surrounding the reintroduction of DDT in Africa for malaria control. (Environ Health Perspect 2007;115(10): 1406-1414)

Is Breast Cancer Ever Cured? An examination of yearly mortality rates for breast, ovarian, and colorectal cancers follow clearly different patterns. Yearly mortality rates for ovarian and colorectal cancer are initially steep but then decline. Those who survive their initial cancer are unlikely to subsequently die from cancer. Breast cancer mortality rates are lower than for either of the other two but, even after ten years of follow-up, yearly mortality rates resemble rates observed in the first few years after diagnosis. It is hypothesized that late recurrence after apparent cure of breast cancer may be a manifestation of slow-growing micrometastatic disease. (Br J Surg 2007;94:957-965)

Breast Cancer Risk and NSAIDs. The risk for breast cancer tends to decrease with increasing duration of nonsteroidal anti-inflammatory drug use and was generally lowest after seven years or more of daily use. NSAIDs (i.e., aspirin or ibuprofen) are often used to alleviate chronic pain or inflammation, such as arthritis. (Am J Epidemiol 2007;166:709-716)

Older Breast Cancer Patients and Anthracyclines. Older women (over 65) with breast cancer who receive anthracycline chemotherapy have significantly increased rates of congestive heart failure, as compared to matched patients given other forms of chemotherapy. The investigators emphasize the need for studies to define chemotherapy regimens with the best therapeutic ratio for this age group. (J Clin Oncol 2007;25:2808-3815)

Bone Health and Chemotherapy. The bones of breast cancer patients tend to age prematurely as a result of their treatment. Bone health of patients administered chemotherapy and/or prescribed aromatase inhibitors should be evaluated as if they were much older, according to a report presented at the American Society for Bone and Mineral Research in Honolulu, September 2007. The report was the work of Dr. Pauline M. Camacho and colleagues at Loyola University of Chicago.

Cognitive function and chemotherapy. High-dose cyclophosphamide, thio-tepa, and carboplatin (CTC) is a treatment for high-risk breast cancer patients. Now CTC has been associated with a drop in cognitive performance over time. As compared with healthy controls and with patients treated with another chemo (FEC), about one quarter of CTC patients showed a decrease in cognitive function six months after treatment. (J Natl Cancer Inst 2006:98:1742-1745) The phenomenon of “chemo brain” was confirmed by a comparison of PET scans of breast cancer patients who had received chemotherapy five to ten years previously. As compared to controls, these women’s brains were working harder to recall the same information. The findings support the use of PET to monitor brain activity in cancer patients. (Breast Cancer Res Treat 2006)

Discovery of interval cancers. Interval cancers are cancers found during the period between routine breast cancer screenings (often every two years). A survey of women who had had interval cancers diagnosed reveals that they were much more likely to occur in women with a previous history of breast cancer and that they were found either by the woman herself or during a routine clinical breast examination. (Ann Fam Med 2006;4:512-518)

Treatment for inflammatory breast cancer. This form of breast cancer in likely to affect younger patients (under age 50) and, while relatively rare, is considered the most aggressive form of breast cancer. A new experimental drug, laptinib (Tycerb), has been found useful in preventing occurrences and may be more useful – and less cardiotoxic – than Herceptin. The drug is available from GlaxoSmithKline. (ESMO 31st Congress, abstracts 1400 & 1420, October 2006)

Second opinions lead to changes in treatment for half of patients. When women with a diagnosis of breast cancer and a recommended plan of treatment were seen by a multidisciplinary board for a second opinion, the recommendation for surgery was changed in over half of the cases (77 of 149 patients). The board consisted of surgeons, oncologists, radiologists, pathologists, radiation oncologists, and nurses. Many of the changes were made after the mammograms were reviewed. Eleven patients avoided mastectomy after getting this second opinion. (Cancer 2006;107:2346-2351)

High body mass index (BMI) linked to lower risk. A longitudinal study found that a high BMI at age 18 was predictive of lower risk of breast cancer in premenopausal women. After following over 100,000 women in the Nurses Health Study, over a period of 14 years, the authors write that, “Body size during the early phases of adult life seem to be particularly important in the development of premenopausal breast cancer.” (Arch Intern Med 2006;166:2395-2402)

Hormone therapy linked to ovarian cancer risk. Researchers examined the association between menopausal hormone use and the risk of ovarian cancer using data from over 97,000 women who completed questionnaires between 1995 and 1997. They conclude that risk of ovarian cancer is increased in women who take estrogen for ten years or more, and in those taking estrogen + progestin for five years or more. (J Natl Cancer Inst 2006;98:1397-1405)

Radiation helpful in older women with ductal carcinoma in situ (DCIS). Using data of 3,409 women aged 66 years or more who had had a lumpectomy for DCIS, this study sought to determine if additional radiation conferred a significant benefit. Results indicate that women who had radiation had a 68% lower relative risk for recurrence of DCIS, invasive breast cancer, and/or mastectomy. The study suggests that radiation should be a standard of care for older women treated for DCIS. (J Natl Cancer Inst 2006;98:1302-1310)

Family history of breast cancer affects risks of ovarian cancer. A detailed family history was taken of almost 50,000 women; of these, 362 ovarian cancers were identified during follow-up. Having a first- or second-degree relative, or two or more first-degree relatives with breast cancer led to significantly increased risk for ovarian cancer. This was even more true of women with a personal history of breast cancer. Knowledge about breast cancer history in one’s immediate family can be useful in assessing risk for ovarian cancer. (Cancer 2006;107:1075-1083)

HRT no help against tamoxifen-related hot flashes. Researchers examined data from a study of 7,100 women at high risk of breast cancer. Half of the women were taking tamoxifen and half were on placebo. The tamoxifen group reported more hot flashes than the placebo group (70.6% vs. 57.1%) but HRT was not effective in reducing hot flashes. The explanation is that tamoxifen almost completely saturates the estrogen receptor, so that increasing HRT has no effect. (J Clin Oncol 2006;24:3991-3996)