Breast Cancer and Radiation - New Study

Breast Cancer Recurrence Rates Appear Different When Radiation Used
Early finding shows fewer local recurrences in short term, more invasive recurrences in long run.

(our note on this) Most women think that radiation is a must when getting a lumpectomy, but here is another study that shows radiation is not without side effects. We highlight some sentences here that we think are worth considering and will comment again at the bottom.)


FRIDAY, April 29 (HealthDay News) -- Patients with early stage breast cancers are commonly treated with surgery or surgery plus radiation, and radiation is widely believed to cut local recurrence rates by about half.

Now, researchers report that they have found that surgery plus radiation does cut local recurrences, but appears to increase the risk of invasive breast cancers later.

"I don't want people to think radiation is bad," said study author Dr. Janie Weng Grumley, a fellow in breast oncology at the University of Southern California Keck School of Medicine. "We know there is less recurrence with radiation."

Grumley's team evaluated 1,014 patients with early breast cancer, known as ductal carcinoma in situ. Of these, 651 had surgery alone while 363 had surgery plus radiation.

The 10-year probability of any recurrence at the same site was 30 percent for the surgery group and 18 percent for the combination group. However, when cancer does return in those who get the combination treatment, her study showed the patterns are different.

"The patients who got radiation recurred a lot later than the patients who didn't," she said. The average time to the cancer recurring in the same site was 7.5 years for those who had radiation plus surgery and 4.4 years for those who had surgery only.

However, "surgery plus radiation had more invasive recurrence," she said. Thirty-seven percent of the surgery group had an invasive recurrence at the same site, but 57 percent of the combination group did, she said.

While 28 percent of the recurrences were in different quadrants of the breast for the combination patients -- essentially new cancers -- only 10 percent of the recurrences in surgery-only patients were in new quadrants.

The survival rate among the surgery group at 10 years was 99.7 percent, compared to 98.3 percent for the combination group, the study found.

The study leaves many questions unanswered. "Is the radiation causing more new cancers?" Grumley wondered.

The research also has several limitations: The average follow-up for the surgery group was six years, while the average follow-up for the combination group was a little over nine years. "One could say the follow-up is longer, and maybe we would find the same thing if we followed the surgery-only group," Grumley said.

The findings were slated to be presented Friday at the American Society of Breast Surgeons meeting, in Washington, D.C.

The finding should be considered very preliminary, said Dr. Otis Brawley, chief medical and scientific officer for the American Cancer Society and professor of oncology and epidemiology at the Emory University School of Medicine, in Atlanta.

"I would say you have to look at all abstracts from scientific meetings with a grain of salt," Brawley said. The research has not yet been exposed to rigorous review and critique by the researchers' colleagues, he said. If a study is the first of its kind, it must be replicated by others to confirm the finding.

Grumley said the message for now is that women should be aware of the different patterns found. "Really, the message should be we should monitor these patients beyond the [typical] five years," she added.

SOURCES: Otis Brawley, M.D., chief medical and scientific officer, American Cancer Society, and professor, oncology and epidemiology, Emory University School of Medicine, Atlanta; Janie Weng Grumley, M.D., fellow, breast oncology, University of Southern California Keck School of Medicine; April 29, 2011, presentation, American Society of Breast Surgeons meeting, Washington, D.C.

(did you see the difference in survival rates! That really what we wanted to draw attention to here. The surgery only group had higher survival rates!!! Most women don't realize with DCIS the chance of recurrence is small. Still respecting individual choices to take more or less treatment, just wanting those choices to be INFORMED choices...)

Weightlighting after Breast Cancer Surgery - It's a YES!

Charlene Laino

Freelance writer for Medscape.
From WebMD Health News
Weight Lifting May Be OK After Breast Cancer Surgery

Charlene Laino

December 10, 2010 — Contrary to what’s been thought, a program of weight lifting may not increase the risk for arm swelling caused by lymphedema in breast cancer survivors. This is according to a new study performed by the same researchers who previously found that weight lifting may help breast cancer patients who already have lymphedema in their arms to gain strength.

Lymphedema is buildup of fluid that causes swelling. It can be a lasting side effect of removing lymph nodes during breast cancer surgery.

To avoid developing the condition or making it worse, the vast majority of the 2.4 million breast cancer survivors in the U.S. are typically advised against lifting children, heavy bags, or anything else weighing more than 5 pounds.

But the studies challenge such advice.

The findings "do not mean women can just go out, buy a set of weights and start their own rehabilitation program," says researcher Kathryn Schmitz, PhD, MPH, associate professor of epidemiology and biostatistics at the University of Pennsylvania School of Medicine.

What "breast cancer survivors should do is go to their physician and insist on getting a prescription for physical therapy. The physical therapist can evaluate them and develop a safe weight lifting program," Schmitz tells WebMD.

The new study was presented at the San Antonio Breast Cancer Symposium and published online in the Journal of the American Medical Association.

Weight Lifting and Lymphedema

The study involved about 150 breast cancer survivors who had their cancer diagnosed one to five years previously. All had two or more lymph nodes removed, and none had signs of lymphedema when they entered the study.

Arm measurements were taken throughout the one-year study. A woman was considered to have lymphedema if her affected arm swelled by 5% or more.

Eleven percent of 72 women in the weight lifting group had their affected arm swell by 5% or more vs. 17% of 75 women who did not change their normal physical activities.

Among women who had five or more lymph nodes removed during breast cancer surgery, 7% of 45 women in this group had arm swelling of 5% or more, compared with 22% of 49 women who did not lift weights. This translates to a 70% reduction in risk, Schmitz says.

Women in the weight lifting group were given a one-year membership to a local fitness center. For 13 weeks, they attended small, twice-weekly, 90-minute classes led by certified fitness professionals who taught them safe techniques for weight lifting using both free weights and machines. Weight was increased slowly for each exercise if the women had no arm symptoms including swelling, pain, tingling, or numbness.

For the remainder of the study, the women exercised on their own while being monitored for any change in symptoms.

The rest of the women weren't asked to start weight training, and they got a one-year pass to a health club only when the study ended.

Any woman who developed lymphedema was given a custom-fitted compression garment for their affected arm and was required to wear it if performing weight lifting exercises.

Some Breast Cancer Survivors Still Get Arm Swelling

Some women are going to develop lymphedema even if they follow a well-designed weight lifting program, Schmitz cautions. "A reduction in risk does not mean total prevention."

Alphonse Taghian, MD, PhD, chief of breast radiation oncology at Massachusetts General Hospital in Boston, tells WebMD that he thinks the study will have "a great impact."

"This will change the way we counsel women, who are usually afraid of using their affected arm. They don't have to be afraid," says Taghian, who was not involved in the study.

That said, "women have to be careful so [lifting] won't cause harm," he says.

But another expert in cancer and exercise cautions that further study is needed before any advice to avoid lifting heavy objects can be changed.

Lee W. Jones, PhD, scientific director of the Duke Center for Cancer Survivorship at Duke Comprehensive Cancer Center, tells WebMD that while the study is "a step in the right direction," the number of women studied was "small and the number of patients who actually developed lymphedema was especially small," he says.

Lymphedema: What's at Risk

Studies have shown that the one-third of breast cancer survivors who have had multiple lymph nodes removed are at greatest risk of lymphedema, with as many as 47% of these women developing the condition.

Of the 61% of women who undergo less invasive sentinel lymph node biopsies and have only one or two nodes removed, up to 7% develop lymphedema.

"This is a real-life concern that often limits their ability to work, play with their kids, even lift up all those holiday bags this season," Schmitz says.

Insurance co-pays generally cover the cost of five to 10 physical therapy sessions, Schmitz says. If you don’t have insurance, cost varies widely, but is typically in the range of $75 to $100 per session.

SOURCES:

San Antonio Breast Cancer Symposium, San Antonio, Dec. 8-12, 2010.

Kathryn Schmitz, PhD, MPH, associate professor of epidemiology and biostatistics, University of Pennsylvania School of Medicine, Philadelphia.

Lee W. Jones, PhD, scientific director, Duke Center for Cancer Survivorship, Duke Comprehensive Cancer Center, Durham, N.C.

Alphonse Taghian, MD, PhD, chief of breast radiation oncology, Massachusetts General Hospital, Boston.

Schmitz, K. Journal of the American Medical Association, published online Dec. 8, 2010.

WebMD Health News © 2010 Medscape, LLC

To Mammogram or not to Mammogram

We get a lot of questions about this so here is an attempt to clarify some things. The recent task force recommendation AGAINST mammography screening in women 40 - 50 year old women is stirring up a lot of confusion.

What the panel actually said is that it does not make FINANCIAL sense to screen these women. The numbers they issued are as follows. Of the 250,000+ women in this age group who are screened every year. 80,000 of those women are called back for further screening and or biopsy. Of those 80,000 only 1,200 will be diagnosed with breast cancer. Those are the numbers, here come the emotions....

Getting a call back for a mammogram is scary, really scary. Getting a biopsy is horrible. There is no way around it, either lying face down totally uncomfortable while a core needle biopsy or the small needle and then the surgical biopsy. I would not wish either of these things on my worst enemy. 80,000 women have to walk thru this. That is nearly one third of the women who get mammograms!!

On the other hand, i know sooo many women between 40 and 50 who found their cancer thru a mammogram. What do we say to these women?!?

I think the choice is personal, intensely personal. If you know these numbers, make your choice and trust your self. No one can tell you what to do. Most of the arguments we hear are so based in fear that they do not even make sense. Some story of someone who did or did not get help from a mammogram is not what you should base your decision on.

More to follow....

Study shows promise against Breast Cancer

We love the company and the products. I personally take breast defend, what higher recommendation can I give!?! - I have no connection financially to the company, i do sell and recommend it to my clients but there is no incentive for me to sell it to you.

Indiana University Study Shows Blend of 6 Mushrooms Fight Breast Cancer

Researchers at Indiana University and Methodist Research Institute publish the dramatic effects of a unique medicinal mushroom formula against breast cancer

Santa Rosa, Calif. (Nov. 11, 2010) – Researchers at Indiana University and Methodist Research Institute studied an innovative medicinal mushroom formula against breast cancer. The impressive results are found in the December issue of the International Journal of Oncology. Lead investigator Dr. Daniel Sliva says, “The formula inhibits growth of highly metastatic human breast cancer cells, and suppresses metastatic potential of these cells.” The all-natural, doctor-designed formula is a blend of six potent varieties of medicinal mushrooms grown on immune enhancing and cancer fighting botanicals that work together to provide breast protection and immune support. Dr. Sliva adds, “These cultivation conditions help naturally increase the amount of biologically active components in these medicinal mushrooms.”

Breast cancer is one of the most common cancers affecting women and may lead to more than 38,000 deaths this year in the U.S. Despite significant advances in breast cancer treatment, available treatments for advanced stage breast cancer offer little hope. However, as the study shows, this potent mushroom formula can be beneficial in the fight against highly invasive breast cancer. Medicinal mushrooms have been extensively researched for their anti-tumor and immune-modulating effects, and are essential for the maintenance of overall vitality and cellular health. “This unique mixture of ingredients produced positive and promising results,” says Isaac Eliaz, M.D., whom the study authors acknowledge for his development of the formula. Dr. Eliaz explains, “These compounds support breast health through cellular protection, and vital immune enhancement.”

Cancer metastasis is a complex process consisting of cell adhesion, cell migration, and cell invasion, and the inhibition of some of these events is crucial for the suppression of cancer metastasis. “Fortunately, the formula we studied inhibits all of these processes, without side effects, which are associated with cancer chemotherapy,” explains Dr. Sliva.

Source: International Journal of Oncology

Jiahua Jiang, Daniel Sliva, Novel Medicinal Mushroom Blend Suppresses Growth and Invasiveness of Human Breast Cancer Cells

Hear us interviewed on the radio!

We were interviewed last week by Jan Janzen author of Breast Health Revolution.

Listen to internet radio with Jan Janzen on Blog Talk Radio

Breast Cancer Prevention Comes With Increasing Evidence

This Article from Kansas City talks about the typical woman who has breast cancer in her family and what her choices are. However here they lay out some interesting research about prevention thru three main strategies. Weight Loss, Exercise and Nutrition. One study mentioned from University of Kansas put 25 women on a 1,200 calorie-a-day diet and an exercise regimen of six hours or more of walking every week.

The women not only lost weight, they ended up with fewer precancerous cells in their breasts.

Exercise reduces inflammatory chemicals in the body that seem to make it easier for pre-cancerous cells to survive.

The other things mentioned were flax seeds and vitamin D. We talk about other flax seed studies here, it is right under the recipe.

We will be interviewing an expert about Vitamin D in November.

Read the entire article here: http://www.kansascity.com/2010/10/02/2270033/research-is-emphasizing-prevention.html#ixzz11LkW0fh5

Breast Cancer Spreads from Stress

Stress accelerates breast cancer progression in mice
Chronic stress acts as a sort of fertilizer that feeds breast cancer progression, significantly accelerating the spread of disease in animal models, researchers at UCLA's Jonsson Comprehensive Cancer Center have found.

Researchers discovered that stress is biologically reprogramming the immune cells that are trying to fight the cancer, transforming them instead from soldiers protecting the body against disease into aiders and abettors. The study found a 30-fold increase in cancer spread throughout the bodies of stressed mice compared to those that were not stressed.

It's long been thought that stress fuels cancer growth in humans. This study provides a model that not only demonstrates that stress can speed up cancer progression, but also details the pathway used to change the biology of immune cells that inadvertently promote the spread of cancer to distant organs, where it is much harder to treat.

The study appears in the Sept. 15, 2010 issue of the peer-reviewed journal Cancer Research.

"What we showed for the first time is that chronic stress causes cancer cells to escape from the primary tumor and colonize distant organs," said Erica Sloan, a Jonsson Cancer Center scientist, first author of the study and a researcher with the Cousins Center for Psychoneuroimmunology. "We not only showed that this happens, but we showed how stress talks to the tumor and helps it to spread."

In addition to documenting the effects of stress on cancer metastasis, the researchers were also able to block those effects by treating stressed animals with drugs that block the nervous system's reprogramming of the metastasis-promoting immune cells, called macrophages.

Beta blockers, used in this study to shut down the stress pathways in the mice, are currently being examined in several large breast cancer databases for their role in potential prevention of recurrence and cancer spread, said Dr. Patricia Ganz, director of cancer prevention and control research at UCLA's Jonsson Comprehensive Cancer Center. If preliminary findings indicate benefit, early phase clinical trials are being considered at the Jonsson Cancer Center testing beta blockers as a means of preventing breast cancer recurrence. Other healthy lifestyle behaviors may also influence the biological pathways described in the study, such as exercise and stress reduction techniques.

"We're going to be focusing on younger women, because they may have a multitude of things weighing on them when they're diagnosed with breast cancer. Younger women have more significant life demands and typically are under more stress," Ganz said.

Ganz said her proposed research will focus on "host factors," or things affecting the patient, that may be aiding the cancer progression and could help explain why a group of patients with the same type and stage of disease have varying rates of recurrence and cancer spread.

"This study provides evidence for a biological relationship between stress and cancer progression and identifies targets for intervention in the host environment," Ganz said. "Because of this study, we may be able to say to a patient in the future that if you follow this exercise regimen, meditative practice or take this pill every day it will help prevent recurrence of your cancer. We can now test these potential interventions in the animal model and move those that are effective into the clinic."

In Sloan's study, mice with breast cancer were divided into two groups. One group of mice was confined in a small area for a short period of time every day for two weeks, while the other group was not. The breast cancer cells were genetically engineered to include the luciferase gene, which is the molecule that makes a firefly glow. The growth and spread of the cancer in the mice was monitored using sensitive cameras that can pick up the luciferase signal and allowed Sloan and her team to observe both the development of primary tumors and the spread of metastases throughout the body, said Steven Cole, an associate professor of hematology/oncology, a Jonsson Cancer Center researcher and senior author of the study.

What was interesting, Cole said, was that the primary tumors did not seem to be affected by stress and grew similarly in both groups of mice. However, the stressed animals showed significantly more metastases throughout the body than did the control group. The cancer, in effect, acted differently in the stressed mice.

"This study is not saying that stress causes cancer, but it does show that stress can help support cancer once it has developed," Cole said. "Stress helps the cancer climb over the fence and get out into the big, wide world of the rest of the body."

Cole said Sloan detailed the biology of the stress-induced changes in the cancer cells along every step of the pathway, providing a road map by which stress promotes cancer metastasis. Additionally, she proved that using beta blockers in stressed mice prevented the same cancer progression seen in the stressed mice that did not receive medication.

When cancer occurs, the immune system sends out macrophages to try to repair the tissue damage caused by uncontrolled growth of cancer cells. The macrophages, in an attempt to help, turn on inflammation genes that are part of the normal immune response to injury. However, the cancer cells feed on the growth factors involved in a normal immune response. Blood vessels that are grown to aid healing instead feed the cancer the oxygen and nutrients it needs to grow and spread, and the extra cellular matrix, which provides structural support for normal cells, is attacked during the immune response, In Sloan's study, mice with breast cancer were divided into two groups. One group of mice was confined in a small area for a short period of time every day for two weeks, while the other group was not. helping the cancer cells escape from the primary tumor and spread to distant parts of the body.

"Many of the genes that promote cancer metastasis get turned on during the immune response by macrophages," Cole said. "This study shows that stress signaling from the sympathetic nervous system enhances the recruitment of macrophages into the primary tumor, and increases their expression of immune response genes that inadvertently facilitate the escape of cancer cells into other parts of the body."

Sloan showed that the beta blockers prevented the macrophages from hearing the signals sent by the sympathetic nervous system, and stopped them from infiltrating the tumor and encouraging cancer spread.

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The study was funded by the National Institutes of Health, the Department of Defense and the Jonsson Cancer Center.

UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2010, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 10 of the last 11 years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu .