Research has shown the risk of heart disease after breast cancer radiotherapy is less than previously thought….. (April 2013)

A study published in the New England Journal of Medicine has, for the first time, calculated by how much radiotherapy for breast cancer increases the risk of heart disease. While, it has been known for a long time that radiotherapy often reduces the risk of breast cancer reoccurring after surgery, the heart often receives some incidental radiation exposure during this treatment. This is particularly true if the cancer is in the left breast or if the lymph nodes inside the chest are irradiated.

However, until now, doctors have been uncertain as to whether modern radiotherapy still increased the risk of heart disease, and, if it did, how big the risk was. This study, carried out by scientists at the University of Oxford and in Scandinavia, considered over 2,000 women treated with radiotherapy in Denmark and Sweden and found that while the risk of radiation-related heart disease was real, for most women it was small. It has also, for the first time, produced a dose-response relationship for ischaemic heart disease, the most common form, which means that doctors will now be able to use these findings to help treat patients by predicting the size of the risk for each individual.

The amount of radiotherapy given to patients is measured in Gray (Gy). For women with right-sided breast cancer, most radiotherapy regimes expose the heart to one or two Gy. The amount varies widely for left-sided breast cancer but is usually higher.

However, the study found the increased risk of heart disease after radiotherapy was modest. For example, a 50-year old woman with no cardiovascular risk factors has a 1.9 per cent chance of dying of heart disease before she turns eighty. After radiation treatment for breast cancer, in which the heart received 3 Gy, the risk increased to 2.4 per cent. This is outweighed by the benefit from radiation treatment, which can halve the recurrence rate and lower the death rate from breast cancer by about one-sixth.

The study also found that there are a few women who would have a substantial increase in the risk of heart disease if radiotherapy is given the usual way. This includes women who are already at increased risk of heart disease and women for whom the distance between the heart and the chest wall is very small.

Professor Sarah Darby, study author based at the University of Oxford, said: “We carried out this work because doctors could not reliably estimate the risk of heart disease in women treated with radiotherapy for breast cancer.  Doctors can now estimate the risk and know that in most cases it will be very small so that they can reassure their patients.  In addition, the few women for whom radiotherapy poses undue risk can now be identified, so that alternative techniques can be considered.”

Dr Carolyn Taylor, another study author at Oxford University’s Clinical Trial Service Unit, added “Already our work is being used in cancer centres throughout the world and we’ve heard it’s making a difference to patients. It’s important to remember that for most women treated today the benefits of breast cancer radiotherapy far outweigh the risks.”

The Royal Free Hospital has become the first hospital in the UK to use breast PET……(Feb 2013)

The Royal Free has become the first hospital in the UK, and only the fourth in the world, to introduce breast PET, a new imaging technology to diagnose breast cancer.

Breast PET (positron emission tomography), or Mammi, produces a 3D image of the breast that clearly shows the metabolic activity of cancerous masses. A small amount of radioactive glucose is injected, to see how the cells react to it. Cancerous cells take up more glucose than regular cells, and so the cancerous area lights up on the image. The high metabolic activity of cancerous cells shows up on the image as a bright spot, making it easy to diagnose.

As the technology shows the metabolic activity going on in the breast, it can be used to diagnose breast cancer and determine the treatment in difficult cases, particularly in the case of younger women with dense breasts.

The use of the machine is being pioneered by a multidisciplinary team, including consultant oncological surgeon Mo Keshtgar.  Mr Keshtgar said: “We use a range of imaging methods to help us diagnose breast cancer, including mammography, ultrasound and MRI, with breast PET being the latest weapon in our armoury.”  “It will be an especially useful tool in younger patients with dense breasts, when it is often harder to detect cancer using a mammogram and we also know that breast density is associated with increased breast cancer risk…complex cases such as these usually result in the patient having to undergo further imaging tests, such as an ultrasound or MRI and sometimes more invasive biopsies.”

“Breast PET, on the other hand, allows us to study the metabolic activity going on in the breast… For this reason, breast PET will also be key in diagnosing cancer when previous scans have proved inconclusive in terms of identifying whether a mass is cancerous or benign.”

In certain patients, the breast PET can also be used to monitor their response to treatment. Results can be seen as early as after one cycle of chemotherapy, whereas with an MRI the response can usually only be determined after two or three cycles. This means that if the patient is not responding to treatment, alternative therapies can be considered.  Mr Keshtgar also added: “Another benefit of this technology is improved comfort for patients; there is no compression involved like traditional mammography, the patient simply has to lie face down.”

Royal Free Hospital, Pond Street, London NW3 2QG

Women in England and Wales with a strong family history of breast cancer could be offered medication on the NHS to try to prevent the disease….. (Jan 2013)

The National Institute of Health and Clinical Excellence has launched a consultation on whether tamoxifen could be given for up to five years.

If approved later this year, the draft guidelines would be the first of their kind in the UK.  NICE says not enough is being done to help healthy but high-risk women, who include women with a sister and a mother or aunt diagnosed with breast cancer before the age of 50.  Taking tamoxifen for five years could cut their own risk of the disease.

Breast cancer is the most common cancer in the UK, with about 50,000 women and 400 men diagnosed with the condition each year with most cases occur by chance and with increasing age.  But having a family history of breast or ovarian cancer can significantly increase the risk of developing breast cancer and at a younger age, although most women with a relative with breast cancer are not at a substantially increased risk themselves.  NICE says under 1% of women over 30 fall into the high-risk category.

Based on research findings, experts estimate that for every 1,000 women given tamoxifen, there would be 20 fewer breast cancers.  But this would have to be balanced against the risks associated with taking the drug, such as blood clots.  Currently, both tamoxifen and raloxifene, a similar breast cancer drug, are not licensed for this indication in the UK, although they are in some other countries.  Final NICE guidance is expected this summer. Professor Mark Baker, director of the centre for clinical practice at NICE, said: “The causes of cancer are complex and not fully known.  “However, we do know that having a family history of breast, ovarian or a related cancer can significantly increase the risk of developing breast cancer, including developing the cancer at a younger age.

The results of an international study show that taking Perjeta in combination with chemotherapy and Herceptin can significantly cut death rates over a three-year period….. (December 2012)

Data presented at the San Antonio breast cancer conference last week showing that Perjeta (pertuzumab) can prolong the lives of people with advanced HER2-positive breast cancer.

The study found that Perjeta significantly cut death rates over a three-year period, when used in combination with chemotherapy and another drug called Herceptin. Among patients with advanced breast cancer, the chance of dying over that time frame dropped from 50 per cent to 33 per cent – a relative reduction of a third.

Both Herceptin and Perjeta are only suitable for women with HER2-positive breast cancer, as they both work by blocking signals that HER ‘receptors’ send out to make cells divide uncontrollably. HER2-postive breast cancer accounts for approximately a quarter of all breast cancer cases.

Clinical Director at Breast Cancer Care, Emma Pennery, commented: “These results highlight the potential gains that can be achieved from developing new ways to treat HER2-positive advanced breast cancer.”

“Using two HER2-targeted drugs together could offer an effective new treatment option and will be welcomed by patients with HER2-positive breast cancer and their families.”

Dr Rachel Greig, from Breakthrough Breast Cancer, said: “This is very promising data and good news for treatment of this type of advance breast cancer.”

“Although it is not a cure it can help women survive longer and significantly extend the time a patient is able to control the growth of their disease. We hope it can be made available to UK patients as soon as possible.”

Research is underway to develop a new blood test to detect breast cancer…… (October 2012)

Researchers based at Leicester University and Imperial College London are developing a new blood test designed to spot breast cancer early.

The study, funded by Cancer Research UK, is developing a blood test that scans for tell-tale warning signs in DNA and early indications suggest the test could be even more accurate in spotting breast cancer than in identifying lumps by x-ray.  Professor Charles Coombes, from Imperial College London, notes: “When a woman has breast cancer, we can tell by the DNA in their blood. But what we’re trying to find out in our study is how early the signs of breast cancer show up on a blood test.”

A trial is now underway at Charing Cross Hospital, on women who have been asked back after shadows were discovered on their mammogram. The researchers will then compare the DNA in the blood of the women who go on to be diagnosed with breast cancer with those found to be free of the disease, to see what DNA markers are consistent. They have already found some DNA markers that indicate when breast cancer is present.

If this first human trial is successful, a second trial will be started to see whether the blood test could be used as a breast cancer screening tool for all middle-aged and older women.

Dr Jacqui Shaw, principal investigator from Leicester University, said: “This exciting research means we could one day have a blood test that detects the very early signs of cancer, meaning women could have an annual blood test rather than breast screening.”  If everything went well, she suggested this test could be available in five years, commenting: “I think this approach has the potential to impact significantly on screening in quite a short time.”

However, as Dr Rachel Greig, Senior Policy Officer at Breakthrough Breast Cancer, notes: “We welcome new tests that could be used to detect initial changes associated with the development of breast cancer as we know early diagnosis saves lives. However, this study has only just begun so more work is needed before we’ll know if a routine blood test like this can become a reality for patients.”

Rates of people dying from cancer in the UK are projected to fall 17 per cent by 2030…..October 2012

Figures released last week by Cancer Research UK predict the rates of people dying from cancer in the UK will have fallen by 17 per cent by 2030.

For all cancers, adjusting for age, 170 people in every 100, 000 died from the disease in 2010, which is predicted to fall to 142 in every 100, 000 by 2030. This is largely due to better survival rates, thanks to earlier diagnosis and improved treatments. However, it also reflects the reduction in smoking-related cancers, leading to fewer deaths.

Whilst ovarian cancer will see the biggest fall in people dying, with death rates expected to reduce by over 40 per cent, breast cancer in women is also predicted to have huge reductions in the number of people dying. Rates have already decreased from 40 deaths per 100,000 women in 1990 to 24 deaths per 100,000 women in 2010, but this is set decrease further, to 18 deaths per 100,000 women in 2030, a further reduction of 28 per cent.

Professor Peter Sasieni, Cancer Research UK epidemiologist at Queen Mary, University of London, said: “Our latest estimations show that for many cancers, adjusting for age, death rates are set to fall dramatically in the coming decades. And what’s really encouraging is that the biggest cancer killers – lung, breast, bowel and prostate – are part of this falling trend.”

“Because old age is the biggest risk factor for cancer, and more people are living longer, they have a greater chance of developing, and unfortunately, dying from the disease. But, overall, the proportion – or rate – of those who die from cancer is falling.”

Advice on preventing cancer is empowering ….. (April 2012)

An interesting blog on the Cancer Research UK website has discussed why it is so important to conduct research into and provide information on the relationship between leading a healthy lifestyle and cancer prevention. In response to different attitudes towards the link between the cancer and lifestyle, the blog explains that understanding and advising on the causes of cancer empowers people by giving them the information they need to reduce their risk, and that there is a moral duty to communicate this information to the wider public.

As the blog points out, some people may ask, what is the point of healthy living if it is no guarantee against cancer? Because by leading a healthy lifestyle, we can help to ‘stack the odds in their favour.’ Here an analogy of wearing a seatbelt when driving is introduced. Just as wearing a seatbelt considerably reduces but does not eliminate our risk of being hurt in a traffic accident, not smoking and staying active can help us to significantly reduce but not eradicate our cancer risk. Others may feel the media’s focus on the links between lifestyle choice and cancer leads to ‘the finger of blame’ being pointed at those who already have the disease. At this point it is emphatically stated that attempting to apportion blame would be both unscientific and insensitive. Again, just as studies into the use of seatbelts in traffic accidents are about trying to protect future drivers, research into how lifestyle can affect cancer risk is about preventing future cancer cases, as prevention is always better than cure.

Communicating the results of this research to the public can help to change public behaviour for the better, the blog explains. For example, the message that smoking causes cancer has worked its way into the public conscience, changed laws and has lead to a huge reduction in the number of lung cancer cases. Beyond smoking, however, the media often confronts us with conflicting information on diet, lifestyle and cancer, which gives the incorrect impression that when it comes to cancer risk, the evidence base is constantly changing. This is not true. The evidence to support lifestyle changes that can reduce cancer risk has been established from decades of research. These key changes are: maintaining a healthy body weight; reducing alcohol intake; eating a balanced diet; staying active and staying safe in the sun.

The blog goes on to discuss that, while we know certain cancers are caused by certain lifestyle choices and that we can reduce our risk by avoiding these, there is no way to definitively say who will develop the disease and who won’t based on their lifestyle. Cancers are caused by faulty or damaged genes, and this damage comes from different sources, not just from lifestyle. Faulty genes can be inherited or damage can occur following exposure to carcinogens like tobacco and ultraviolet light from the sun or just by chance. Epidemiological research allows us to estimate how many people in a population will get cancer, but we are currently unable to predict what will happen to individuals. However, the knowledge we have about the causes of cancer and what we can do to reduce our risk is a powerful tool in beating the disease.

New research reclassifies breast cancer…..(April 2012)

A major study by scientists at Cancer Research UK and the BC Cancer Agency Vancouver in Canada has reclassified breast cancer into ten separate diseases, based on the genetic fingerprint of breast cancer cells. The results were published this week in Nature Journal and are the culmination of the largest global study of the genes of breast cancer tissue ever performed. After decades of research, scientists now believe doctors will in the future be able to better tailor treatment and more accurately predict survival for each individual breast cancer patient based on the subtypes of the disease.

Researchers analysed the DNA and RNA of 2,000 tumour samples taken from women diagnosed with breast cancer between five and ten years ago.  They made three important discoveries. They were able to classify the disease into at least ten different categories. The subtypes were grouped by common genetic features that correlate to survival. This could change the way drugs are tailored to breast cancer patients. Scientists also discovered several completely new breast cancer genes. These are genes that drive the disease and are potential targets for developing new treatment. Furthermore they uncovered the relationship between these genes and the networks that control cell growth and division, known as cell signalling pathways.

Study co-lead author, Professor Carlos Caldas, at the University of Cambridge, said: “Our results will pave the way for doctors in the future to diagnose the type of breast cancer a woman has, the types of drugs that will work, and those that won’t, in a much more precise way than is currently possible. This research won’t affect women diagnosed with breast cancer today. But in the future, breast cancer patients will receive treatment targeted to the genetic fingerprint of their tumour. We’ve drilled down into the fundamental detail of the biological causes of breast cancer in a comprehensive genetic study. Based on our results we’ve reclassified breast cancer into 10 types – making breast cancer an umbrella term for an even greater number of diseases. Essentially we’ve moved from knowing what a breast tumour looks like under a microscope to pinpointing its molecular anatomy – and eventually we’ll know which drugs it will respond to. The next stage is to discover how tumours in each subgroup behave – for example do they grow or spread quickly? And we need to carry out more research in the laboratory and in patients to confirm the most effective treatment plan for each of the 10 types of breast cancer.”

Gene Test may bring safer chemotherapy…..(March 2012)

Doctors have fiscovered a way of identifying breast cancer oatients likley to suffer life-threatening side effects of chemotherapy.  Their research could eventually lead to safer treatments adapted to individual patients.

The study of almost 1,100 breast cancer patients found 17 percent needed hospital care for fatal infections after treatment with three widely used chemotherapy drugs.  But it also found 15 percent of women in the study had a gene variant linked to the worse side effects.  Around 48,000 women in the UK develop breast cancer every year and at least 20,000 will be offered chemotherapy.

Leas researcher Dr Christof Vulsteke said “We found that genetic variations in one gene was highly correlated with chemotherapy side effects.  Investigating this gene before starting chemotherapy would allow us to support the patients with either growth factors to increase the patient’s immmunity or dose modification’s, or a different chemotherapy regimen better adapted to the patient, or a combination of these”.

Patients currently receive a standard six cycles of treatment and side effects can range from minimal to severe, which are mainly caused by immune system depression.  These can result in potentially life-threatening fever and infections that need immediate hospital treatment.

UK breast cancer deaths set to continue to fall….. (March 2012)

New research published this week in the Annals of Oncology journal has found the proportion of women dying from breast cancer in the UK has dropped by more than 10 per cent in the last five years. Ten years ago, the UK had the highest rates out of six major European countries – France, Germany, Italy, Spain, Poland and the UK – but the report suggests that death rates have fallen to a similar rate as those in France and Germany.  Encouragingly, the research predicts that the rate will continue to fall, particularly among women under 50.

Scientists in Italy and Switzerland looked at World Health Organisation data for cancer death rates across Europe. From this, they have predicted that breast cancer death rates will fall by nine per cent to 14.9 per 100,000 EU women overall in 2012. In the UK, they predict rates will fall by 13 percent to 15.95 per 100,000 in 2012, compared with 18.39 per 100,000 women in 2007. They further predict that deaths in the EU among women aged 20 to 49 will fall by 13 per cent to 6.3 per 100,000 women.

The study authors attribute their findings primarily to advancements in treatment for breast cancer. Having found significant decreases in death rates amongst women under the age of 50, they suggest that screening for the disease has not played such a significant role as women in this age group do not generally receive mammograms. Study leader Professor Carlo La Vecchia, from the University of Milan, said of the findings: “The fact that there will be substantial falls in deaths from breast cancer, not only in middle age, but also in the young, indicates that important advancements in treatment and management are playing a major role in the decline in death rates, rather than mammographic screening, which is usually restricted to women aged 50 to 70 in most European countries.”

Dr Rachel Greig, of the charity Breakthrough Breast Cancer, said in response to the findings: “Whilst we know breast cancer incidence is on the increase, it’s reassuring to see positive indications that the rate of breast cancer deaths could decrease in 2012.”

Genetic breast cancer code unravelled….. (February 2012)

Around ten percent of all breast cancer cases are hereditary. They account for around 4,500 cases of the disease in the UK each year and are most commonly caused by a fault in the BRCA1 gene. Women who carry this gene mutation are at an increased risk of developing breast cancer by up to 85 percent, and cancers caused by the mutation are often aggressive and do not respond to targeted treatment such as tamoxifen and herceptin.  Scientists have this week made exciting progress in cracking the genetic code behind cancers caused by BRCA1 mutations. They have fully sequenced the DNA of two BRCA1 breast cancers and have identified three new breast cancer genes in the process. It is hoped this new information will lead to the development of better treatments for patients with this type of hereditary breast cancer.

Scientists at the Breakthrough Breast Cancer Research Centre at the Institute of Cancer Research looked at two tumours caused by a faulty BRCA1 gene. One tumour was classified hormone receptor negative, the other, hormone receptor positive. They tracked all the genetic mutations in each tumour and found the tumours shared only one similar alteration in addition to the initial BRCA1 fault and that all further changes were different. The hormone receptor negative tumour was found to have twice as many mutations. Scientists compared their findings to another group of breast cancers and identified three genes – DAPK3, TMEM134 and GATA4 – that were also altered in a number of other tumours, suggesting they the may be involved in causing the disease or driving its growth.

Study co-author, Professor Jorge Reis-Filho, said of the findings: “This research has big implications for how we treat hereditary breast cancer in the future. We often consider patients with a faulty BRCA gene as one group but our work shows that each tumour can look very different from each other genetically. Now we understand this, we can start to identify the best treatment strategies to save more lives of hereditary breast cancer patients.” Dr Rachael Natrajan, also a study co-author, added: “It is exciting to find new genes which could be involved in causing and driving breast cancer. Now these have been identified we have to do more work to find out the role that they play. Ultimately, this knowledge could help us develop new treatments that target the specific defects of each patient’s disease.”

Source: Cancerkin

Other Facts……..

• Survival rates are improving and on average 74 % of women are still alive after five years later
• Deaths have reduced to 12,000 a year
• 82% of patients survive 5 years
• 66% of patients survive 20 years
• The screening programme is having an impact
• But we still have the lowest number of specialist consultants per 100,000 patients compared with the USA and Europe

Since peaking in the late 1980s breast cancer death rates in the UK have fallen by a third.  In the last ten years alone the death rates for breast cancer have fallen by almost a fifth.  This remarkable achievement is the result of several contributory factors; the development of new drugs, better organisation of cancer services, and earlier detection as a result of breast screening and public awareness.  Together we can continue to improve everyones chances of either getting or recovering from breast cancer.