Ultrasound results in relation to tumour characteristics. The American College of Radiology (ACR) has published reference guidelines to the categorization of breast tumours according to their ultrasound characteristics. In order to more precisely evaluate the relation of ultrasound findings to biological characteristics in breast cancer, ultrasound data from 315 breast masses were collected and analyzed based on a number of factors. The research revealed a variety of ultrasound features characteristic of certain types of cancer which can potentially be enormously helpful in diagnosis. On the other hand, some breast cancers tended to possess criteria usually associated with benign masses. Because false-negative diagnoses may result in serious consequences for the patient, knowledge about variations will help the examiner to avoid false classification of breast lesions. The authors suggest that sonographers should be well aware of potential variations in the ultrasound morphology of breast tumours. (Wojcinski S, Stefanidou N, Hillemanns P et al. The biology of malignant breast tumors has an impact on the presentation in ultrasound. BMC Women’s Health. 2013;13(47))
Chemoprevention of breast cancer. Growing evidence indicates that chemoprevention with aromatase inhibitors [e.g., letrozole (Femara), anastrozole (Arimidex) or exemestane (Aromasin)] and selective estrogen receptor modulators (SERMS, e.g., tamoxifen, raloxifene or toremifene) can significantly reduce the risk of breast cancer for certain women, yet few women embrace this strategy. One well-known expert on aromatase inhibitors identifies key points to help patients decide whether to opt for this kind of chemoprevention. If a woman carries an inherited BRCA-1 or BRCA-2gene mutation, has had an abnormal biopsy (considered precancerous or carrying a strong risk for cancer, whether premenopausal or postmenopausal), has had an abnormal mammogram or has found a lump or thickening in the breast (detected by self-examination or by a physician), then a discussion with her doctor may be warranted. Being Caucasian and of middle or upper socioeconomic status or education are other risk factors. (Paul E. Goss, Co-Director, Breast Cancer Disease Program, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts, as reported in “Doc, Should I Take This Pill or Not?” Medscape. Feb 20, 2014)
Multiple Sclerosis linked to higher cancer risk in Taiwan. A nationwide population-based cohort study from Taiwan suggests that persons with multiple sclerosis (MS) may have an increased risk of developing cancer, particularly breast cancer. Previous studies have found no such association. The researchers admit that information on lifestyle and behaviours is lacking in the database (1292 people with MS) used for this study, making it impossible to adjust for well-recognized risk factors such as smoking and alcohol consumption. Also, MS is relatively rare in Taiwan -- suggesting that underlying genetic and environmental factors might play a role. Further large-scale studies are required to help improve understanding in this area. (Sun L-M, Lin C-L, Chung C-J et al. Increased breast cancer risk for patients with multiple sclerosis. Eur J Neurol, 21(2);238-244February 2014)
Sentinel lymph node (SLN) staging. It is unclear if sentinel node staging is valuable for patients with estrogen or progesterone positive breast cancer who receivechemotherapy prior to surgery. To examine this, the American College of Surgeons Oncology Group designed a multicentre, prospective study to determine the false-negative rate for SLN biopsy following chemotherapy. In this study, to ensure accuracy, SLN was followed by standard axillary lymph node dissection (ALNS). A total of 751 patients were enrolled and 649 underwent chemotherapy followed by both SNL and ALNS. Results suggest that, for this population, preventing an unacceptable rate of false positives requires SLN of at least three lymph nodes.(Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: The ACOSOG Z1071 (Alliance) Clinical Trial.. JAMA. 2013;310(14):1455-1461)
Bisphenol-A and supermarket receipts. BPA – the endocrine-disrupting chemical found in canned food liners – is also present in the thermal receipt paper spewed out by ATMs, automated gas stations, and supermarkets. When 24 volunteers were asked to act as cashiers, printing and handling receipts for two hours, urinary levels of BPA were found to increase to over three times baseline levels, although peak BPA level remained at roughly one quarter that observed after consumption of a canned soup. The researchers suggest that, when cashiers regularly handle supermarket receipts, they should wear gloves. (Ehrlich S, Calafat AM, Humblet O, et al. Handling of thermal receipts as a source of exposure to bisphenol-A. JAMA. 2014;311(8):859-860)
Trastuzumab (Kadcyla)and radiosurgery. A small number of patients being treated for HER2+ breast cancer with a combination of a chemo drug (trastuzumab emtasine, brand name Kadcyla) and radiation developed brain edema, i.e., excess accumulation of fluid in the brain. Radiation had been ordered for some patients with this form of breast cancer and a few of these then developed brain metastases. Because Kadcyla is relatively new, doctors were unaware of the potential interaction. Symptoms of brain edema included headaches, nausea, vomiting, speech impairment and short-term memory deficits. Steroids were administered to remedy the condition. (Carlson JA, Nooruddin Z, Rusthoven C, et al. Trastuzumab emtansine and stereotactic radiosurgery: An unexpected increase in clinically significant brain edema. Neuro-oncology 16(2); online Feb. 3, 2014)
Vitamin D linked to enhanced breast cancer survival. Women with high levels of vitamin D in their blood when diagnosed with breast cancer are almost twice as likely to survive. A meta-analysis looked at five studies involving 4443 patients and found that, over an average of ten years, breast cancer mortality was 44% lower in patients with the highest levels of D as compared to those with very low levels. A previous study had found that those with very low levels of vitamin D when diagnosed were more likely to have aggressive disease. According to Mayo Clinic recommendations, for cancer prevention, 400 to 1100 IU of vitamin D should be taken by mouth daily. However, this latest study advises doctors to measure vitamin D levels in their breast cancer patients and, if deficient, to start them immediately on 40,000 IU of vitamin D daily. (Mohr SB, Gorham ED, Kim J, et al. Meta-analysis of Vitamin D sufficiency for improving survival of patients with breast cancer. Anticancer Res. 2014;34(3):1163-1166)
Black/white disparities widening in U.S. breast cancer deaths. In the 50 largest cities in the U.S., death rates from breast cancer have dropped across the board over 20 years, but far less so for black women than whites. Although hypertension, diabetes and other health problems that worsen cancer outcomes are more common among blacks, and black women are more likely to have aggressive breast tumours that don't respond to the most effective treatments, it is thought that the widening survival gap is more likely due to differences in the quality of and access to healthcare. (Hunt BR, Whitman S, Hurlbert MS. Increasing black/white disparities in breast cancer mortality in the 50 largest cities in the United States. Cancer Epidemiology 38(2);118-123 April 2014)
Minorities vulnerable to financial slide after breast cancer. Based on surveys of 1500 U.S. women diagnosed with early-stage breast cancer, researchers found that up to one quarter were struggling financially as a result of their disease. As compared to white women, black and Latina breast cancer patients were more than twice as likely to have lingering medical debt and to skip treatments because of costs. Of the women living in Los Angeles and Detroit who were surveyed, 35% reported spending $2,000 or more on cancer treatments, and 17% spent more than $5,000. Moreover, 12% reported medical debt four years after the end of treatment. (Jagsi R, Pottow JAE, Griffith KA, et al. Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol, Apr 20, 2014: 1269-1276)
Chemo brain is an area of intense research. Ofgrowing importance in oncology, cognitive dysfunction was the subject of an oral presentation by Elizabeth Kvale, MD, of the Supportive Care and Survivorship Clinic, Birmingham, at a recent meeting of the National Comprehensive Cancer Network (NCCN). Much of the research into chemo brain has centred on women with breast cancer, with chemotherapy-associated cognitive dysfunction affecting 20% to 30% of all cancer survivors. Effects typically last either months or a few years but, in some cases – primarily older and less educated patients -- they may persist. Despite significant media attention, there is limited evidence to guide medical management of this condition. Clinicians working with patients who complain of cognitive problems should inquire about their ability to pay attention, find words, remember things, think clearly, and perform daily activities. Patients appreciate having their symptoms validated.(Chemo brain is top of mind at NCCN Meeting. Medscape. Mar 21, 2014)
Breast cancer mortality declined in most EU countries. Breast cancer mortality declined in 31 European countries from 1989 to 2010, but there are still notable differences between countries, and variations cannot be explained simply by the resources devoted to cancer care in each country. For instance, rates declined sharply in Norway and Italy but less so in France and Sweden, despite the fact that the latter two countries had screening programs in place much earlier and their citizens have access to the best treatment. Overall, women under age 50 had the greatest reduction in mortality while the smallest decreases were observed in women 70 years and older. (Autier P. Deaths from breast cancer fall in Europe, but unexplained differences between countries remain. 9th European Breast Cancer Conference, Glasgow, March 20, 2014)
Radiation improves odds after mastectomy. For women with just a few positive lymph nodes, radiation improves outcome after mastectomy. Although it has been clear for some time that women with healthy lymph nodes do not benefit from radiotherapy, it was unclear what the benefit is for women with one, two or three positive lymph nodes. The new findings are based on data from over 8,000 women who were randomly assigned to either receive radiation or not after having unilateral or bilateral mastectomy. For women with one to three positive nodes, there was a noticeable difference in cancer recurrence and death. Women with positive lymph nodes had a 46% risk of recurrence during the ten years after mastectomy as compared to 34% among women who received radiation. Also, 47% of women who did not receive radiation died of breast cancer as compared to 37% of women who received radiation. (Darby S. Radiation improves odds for some women after mastectomy. The Lancet, early online publication, 19 March 2014)
Could Half of All Breast Cancers Be Prevented? According to two experts, if girls and women of all ages adopted healthier lifestyle behaviours and the highest-risk women took preventive drugs (tamoxifen or raloxifene), fully half of breast cancers might be avoided. Women can slash their breast cancer risk by avoiding alcohol or drinking very moderately; maintaining a healthy weight; being physically active; eating plenty of fruits, vegetables and whole grains; and, if they have children, breastfeeding them. The risk associated with lifestyle factors begins to accumulate in early life, and there is evidence that the time between a girl's first period and her first pregnancy may be particularly important in determining breast cancer risk. For example, research has found that teens who don't drink may reduce the future risk of breast cancer by 20% to 30% compared to those who had at least one drink in the past 30 days. Moreover, physical activity has the most breast-cancer-preventing benefit when women sustain it throughout a lifetime. For many higher-risk women in their 50s and 60s, the benefits of chemoprevention outweigh the risks. According to these experts, strategies for preventing breast cancer have received far less attention than efforts to improve treatment and early detection of the disease. (Colditz GA, Bohlke K. Priorities for the primary prevention of breast cancer. CA – Cancer J Clin : published online March 19, 2014)
Breast cancer in lesbians and bisexual women. A systematic review investigated evidence on whether there is, or is likely to be, higher rates of breast cancer among lesbian/bisexual (LB) women. Online databases, unpublished research and specialized websites were searched, as were citation lists of relevant papers. A total of 198 references were found. None provided incidence rates; two showed higher prevalence estimates, four showed no differences, one showed mixed results, one had no comparison group and one gave no sample size. All studies were small with poor methodological and/or reporting quality. Although there is a high degree of uncertainty surrounding this question, the balance of evidence suggests a higher incidence. The only realistic way to establish this will be to collect sexual orientation information within routine statistics, including cancer registry data, or from large cohort studies. (Meads C, Moore D. Breast cancer in lesbians and bisexual women: systematic review of incidence, prevalence and risk studies. BMC Public Health 2013, 13:1127 (5 December 2013))