Awareness. Latest News.
Angelina Jolie has a preventive double mastectomy after discovering she had a faulty BRCA1 gene……(May 2013)
This week, the news has been dominated by reaction to US actress Angelina Jolie’s decision to have a preventive double mastectomy, after discovering that she had a faulty BRCA1 gene. She announced her decision in a thoughtful article published in the New York Times which is well worth a read.
The news of her decision has led to considerable worldwide interest in inherited breast cancer and the BRCA1 gene in particular. Therefore, we thought it would useful to discuss inherited breast cancer.
No two people are born the same. Because of this natural variation in our genes, we all have slightly different chances of developing diseases in our lifetimes. Most breast cancers arise from genetic damage that accumulates over a person’s lifetime, however, approximately one in five women who develop breast cancer have a significant family history of the disease and one in 20 have inherited a fault in a gene linked with breast cancer, such as BRCA1.
Roughly one in a thousand people inherit a damaged copy of a BRCA1 gene from one of their parents. The BRCA1 gene tells cells to make a protein that helps repair damage to DNA; people who inherit a faulty copy are therefore less able to repair damage that accumulates in their DNA over time and so are at higher risk of breast cancer and at a younger age. In the UK, the average woman has a 12.5% chance of developing breast cancer at some point in her life. However, a female BRCA1 carrier has between a 60 and 90 per cent chance of developing the disease, with the precise figure for an individual varying dependant on particular factors, such as age, the number of affected family members and the exact nature of the fault in the gene.
There are multiple options for people who carry a BRCA gene fault; each woman has to make the decision that’s right for her. Surgery is not the only option- women can choose to have extra screening, either with mammography or MRI scans.
Mutations in the BRCA genes cause particular patterns in cancer down the generations, with families that carry these gene faults usually having a long history of breast or ovarian cancer. According to National Institute for Health and Care Excellence (NICE), you may have a higher than average risk of breast cancer if you have any of the following down one side of your family (a close relative means parent, sibling, grandparent, aunt, uncle, nephew or niece) and they must be blood relatives:
- A mother or sister diagnosed with breast cancer before the age of 40
- A mother, sister or daughter and another close relative diagnosed with breast cancer
- Three close relatives diagnosed with breast cancer
- A father or brother diagnosed with breast cancer
- A mother or sister with breast cancer in both breasts; the first cancer diagnosed before the age of 50.
- One close relative with ovarian cancer and one with breast cancer (at least one must be a mother, sister or daughter)
Risks are also higher among people of Ashkenazi Jewish descent.
If you are worried about your family history, please talk to your GP. However, it is important to remember that only one in a thousand people inherit a faulty BRCA1 gene. With one in eight women experiencing breast cancer at some point in their life, the likelihood of a family experiencing the disease is unfortunately high.
The number of women under 50 diagnosed with breast cancer each year in the UK has exceeded 10,000 for the first time…… (May 2013)
New statistics from Cancer Research UK has shown that 10,068 women under the age of 50 were diagnosed with breast cancer in the UK in 2010. This was the first time the figure had exceeded 10,000 and represents an 11 per cent increase since 1995, when the number of diagnosed in the same age group was 7,712.
This rise in younger patients developing breast cancer contributed to an overall increase in diagnosis rates among women of all ages. The total number of women diagnosed each year is now approaching 50,000.
The reasons for the increasing rates of breast cancer in this group are not clear, but it’s thought that increasing alcohol intake and hormonal factors such as having fewer children, having them later in life and increased use of the contraceptive pill may be playing a role.
However, the statistics also show that fewer women under 50 than ever before are dying from the disease. In the early 1990s, the mortality rate from breast cancer in women under the age of 50 was nine per 100,000 women in the UK. By late 2000, this had fallen to 5 in every 100,000. More than eight in 10 women diagnosed with breast cancer before the age of 50 now survive their disease for at least five years. This is thought to be due to better treatment.
Sara Hiom, Cancer Research UK’s director of health information, said: “Breast cancer is more common in older women but these figures show that younger women are also at risk of developing the disease. Women of all ages who notice anything different about their breasts, including changes in size, shape or feel, a lump or thickening, nipple discharge or rash, dimpling, puckering or redness of the skin, should see their GP straight away, even if they have attended breast cancer screening. It’s more likely not to be cancer but if it is, detecting it early gives the best chance of successful treatment.
“The number of cases in women under 50 diagnosed with breast cancer is increasing slowly, but thanks to research, awareness and improved care more women than ever before are surviving the disease”.
Tara Beaumont, Clinical Nurse Specialist at Breast Cancer Care said: “The increasing incidence of breast cancer in women under 50 reflects the growing incidence overall.
“Though it is not fully understood why the rates of breast cancer in this age group are rising, it is extremely encouraging to see a continuation of the downward trend in breast cancer mortality.”
Research has found that women with breast cancer from poorer homes areas are less likely to be diagnosed quickly than more affluent women….. (May 2013)
Researchers from the University of Leicester have found that poorer women with breast cancer are less likely to be diagnosed quickly than women from affluent homes.
The study looked at nearly 21,000 women diagnosed with breast cancer and found that fewer women in the more affluent groups were diagnosed in the later stages, across all ages. As early diagnosis greatly increases the likelihood of surviving the disease, they estimated that 454 deaths could have been postponed beyond five years by eliminating differences in the stage at which breast cancers were diagnosed.
The researchers suggested that one reason for the different survival rates might be that women from deprived backgrounds delay reporting symptoms to their doctors. This may reflect differences in awareness, but could also be due to psychological barriers, such as fear of wasting doctors’ time and fear of dying, or impressions of cancer incurability.
Jayant Vaidya, reader in surgery at UCL and a consultant surgeon who specialises in the diagnosis and treatment of diseases of the breast, said: “If all women were diagnosed earlier, it would also mean they would need less-aggressive treatment, with fewer side effects. We know that radiotherapy, for example, can adversely affect the heart, an effect that is particularly important when cancers are diagnosed early.
“I don’t believe access to the treatment is different between classes in the UK, but it may be a combination of factors. The less deprived are generally more health-conscious – eg take more exercise, eat sensibly, and have a more disciplined lifestyle – and this could affect the outcome from cancer.”
Nick Ormiston-Smith, statistics manager at Cancer Research UK, said: “This research provides further evidence that deprivation affects a woman’s chance of surviving breast cancer. More needs to be done to tackle this inequality to ensure everyone has the same chance of surviving breast cancer, no matter where in the country they live.
“Diagnosing and treating the disease earlier is key to improving a woman’s chance of surviving, and we must ensure this is a reality for all”.
Further research has indicated that drugs, including tamoxifen, could be used to prevent breast cancer developing in women with a high risk of developing the disease….. May 2013
A study published in the Lancet has shown that tamoxifen and three similar drugs used for osteoporosis can significantly reduce the incidence of breast cancer in women at risk from the disease.
Researchers considered medical records for 83,000 women taking the pills, monitoring the effect of taking the drugs for five years and then for a further five years after the treatment was stopped. Known as selective oestrogen receptor modulators, these drugs work by interfering with the action of proteins known as oestrogen receptors, and, in doing so, prevent oestrogen from encouraging cells to divide. They are currently used to treat some cases of breast cancer, but are not available to women who have not yet been diagnosed because of concerns about treating patients unnecessarily.
This study found that during five years of treatment, the incidence of breast cancer among women using the drugs was 42 per cent lower than in a similarly high-risk group who were not treated. Women in the treated group were also 25 per cent less likely to develop breast cancer in the five years after they stopped taking the pills.
Lead researcher Professor Jack Cuzick, of Queen Mary, University of London, said: “These are very encouraging results and pave the way for more widespread use of these drugs in high-risk women in a manner similar to the way statins and blood pressure-lowering drugs are used to reduce the risk of heart disease and stroke.”
The study also showed that all four drugs significantly increased the risk of blood clots, and Tamoxifen was also associated with an increase in the rate of womb cancers.
The National Institute for Health and Clinical Excellence (Nice), which examines the cost-effectiveness of new treatments, provisionally recommended that tamoxifen should be given to women at high risk of breast cancer. Nice is due to issue its final guidance later this year.
Hazel Nunn, head of health information at Cancer Research UK, said: “These results provide some of the clearest evidence to date of the ability of these drugs to prevent breast cancer. The study also offers clarity on the frequency of side-effects that can be expected from these drugs. Breast cancer is the most common cancer in the UK, and research like this has the potential to reduce the number of women diagnosed with the disease in future.”
Dr Caitlin Palframan, from Breakthrough Breast Cancer, said: “Draft guidelines from Nice recently took the historic step of recommending drug treatment to reduce the risk of breast cancer in women with a significant family history of the disease. Importantly, this may provide women with an alternative to risk-reducing surgery and we’re pleased to see that the findings of this study further support this recommendation.”
Nice’s final guidelines are expected to be announced in June.
For more information, please see Cancer Research UK, t
Study shows late-stage breast cancer survival is lower in the UK than other high-income countries……(March 2013)
Research published last week in the British Journal of Cancer has suggested women with late-stage breast cancer have lower survival rates in the UK than five other high-income countries. In this study, “early stage” is classified as stage 1 or 2, before the disease has spread.
The study, carried out by the International Cancer Benchmarking Partnership, investigated whether international differences in survival could be explained by delay in diagnosis. Researchers considered data on over 250,000 women from Australia, Canada, Denmark, Norway, Sweden and the UK, who were all diagnosed between 2000 and 2007.
In the UK, 28% of women with the most advanced cancers survived for three years, compared with 42% in Sweden.
Dr Sarah Walters, lead author, said: “…In the UK, we should now investigate whether the treatment of women with later-stage breast cancer meets international standards.”
However, an explanation for the UK’s poorer survival rates at stages 3 and 4 could be the current assumption that classification of stages is identical in all countries. To find out how advanced a breast cancer is, doctors use tests and scans to work out whether it has spread to the lymph nodes or other parts of the body. If doctors in some countries are more likely to send breast cancer patients for these tests, we might expect these countries to be more likely to find evidence that cancers had spread than a country that did not do the same tests.
For example, if the doctors in country A are less likely to send breast cancer patients for bone scans than doctors in country B, in country A some patients with breast cancer that had spread to the bones (stage 4) would be diagnosed instead as stage 3 (spread to the lymph nodes but not the bones) because the bone scans weren’t done. Therefore, a breast cancer classified in country B as stage 4 could be called stage 3 in country A. This could explain why UK stage 4 cancers have particularly poor survival, as those stages 4s with the best outlook have been instead classified as stage 3, leaving only those with the very worst prognosis in the remaining stage 4 category. Previous research has suggested that UK doctors are less likely to do these staging investigations, with NICE guidance indicating women without symptoms should not undergo staging investigations such as whole body bone and CT scans for metastatic disease.
However, these international discrepancies could be instead due to how we treat late stage breast cancer in the UK, or because breast cancer patients in the UK may, on average, have more additional health problems than their counterparts in other countries, which mean they would be less likely to be offered certain treatments or tolerate or complete this treatment, lowering their chances of survival.
What is clear is that even more detailed studies of breast cancer staging procedures, treatment access and the health of UK breast cancer patients is needed. As Eluned Hughes, head of Public Health at Breakthrough Breast Cancer says: “If [UK] breast cancer survival rates matched the best in Europe, 1000 extra lives would be saved in England alone, so work to bridge the gap is crucial.”
10-year follow-up results show that a lower total dose of radiotherapy, delivered in fewer, larger treatments, is just as safe and effective at treating early breast cancer….. (December 2012)
Last week, the 10-year follow-up results of a major Cancer Research UK trial were presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium. They found that a lower total dose of radiotherapy, delivered in fewer, larger treatments, is as safe and effective at treating early breast cancer as the international standard dose. Nearly 4,500 women across the UK took part in the trails. The initial five-year results also showed that lower total dose radiotherapy over fewer, larger treatments was just as safe and effective for patients, and offered important benefits for patients, including fewer trips to hospital and cost savings for the health service. As a result, a shorter treatment course of 15 treatments was adopted in the UK in 2008 (far less than the 25-dose international standard).
This latest 10-year follow-up, funded by Cancer Research UK, confirms these benefits. They found that very few women (around six per cent) experience a relapse of cancer within the same breast, regardless of whether or not they have a shorter course of radiotherapy after surgery. Professor John Yarnold, chief investigator and professor of clinical oncology at The Institute of Cancer Research, said: “We have shown conclusively that less can be more in breast cancer radiotherapy. Three weeks of radiotherapy is as good as five weeks – as well as being more convenient and less tiring for patients and cheaper for the health service.”
“The risk of breast cancer recurring continues beyond five years, and side-effects of radiotherapy can often develop many years after treatment, so these long-term results provide a very important reassurance that the shorter treatment course is definitely the best option for patients. Some doctors may have been hesitant to change their practice on the basis of five-year results, but these long-term findings should convert those sceptics.”
The same team is now investigating whether even fewer doses of radiotherapy could be just as effective, as part of a new Phase III randomised controlled trial of 4,000 women. The trial will compare the new UK-Standard 15 dose course of radiotherapy treatment, delivered over three weeks, with an even shorter 5-day course, delivered over one week.
Cancer Research UK’s director of clinical research, Kate Law, commented: “What’s really exciting is that, as a result of this trial, women are already benefiting from the added physical and emotional well-being of needing fewer hospital visits for their treatment. Minimising the long-term side effects of treatment is becoming increasingly important as cancer patients live longer. We hope that women around the world will now be able to benefit from this improved standard of care.”
Well-publicised study that suggests women in certain professions may face a higher risk of breast cancer has several drawbacks….. (November 2012)
A study suggesting that women in “chemical jobs” may face a higher risk of breast cancer has had a lot of media coverage this week.
The headlines were based on a new study published in the journal Environmental Health, which considered how likely women in different jobs are to develop breast cancer. The researchers compared 1,006 women with breast cancer and 1,146 women without to see whether those with breast cancer were more likely to work in particular jobs, and the findings were reported as showing that women working in certain jobs, including chemical exposures and bar/gambling work, had a higher risk of breast cancer. However, there were a number of limitations with the study which meant there was no justification for these headlines.
Firstly, as so many different occupations were considered, the number of women in each group was very small. This means it is much harder to generalise to the whole population when the result is based on only a few people. For example, in automotive plastics manufacturing, a job where women appeared to have a higher risk, only 26 women with breast cancer were included. This number is far too small to start drawing firm conclusions from.
A second problem is a serious case of misreporting, not by the newspapers, but by the study authors themselves. Some of the most alarming headlines were about bar work or gambling, including stories such as “Women who work in bars, factories or casinos face higher risk of cancer due to exposure due to ‘toxic soup’ of chemicals” in the Daily Mail.
The researchers did say that women in these jobs had a higher breast cancer risk. However, the result they found (as well as being based on only 16 women with breast cancer) was not statistically significant – the researcher s were not able to be confident that this result was real and it could just have happened by chance.
To conclude, these drawbacks mean it is difficult to conclude anything particularly meaningful from the study. As Sally Greenbrook, Senior Policy Officer at Breakthrough Breast Cancer, says: “No solid conclusions can be drawn from this research and there is little evidence to suggest that exposure to occupational chemicals increases breast cancer risk. This is a small study with some serious limitations, including making the assumption that women will recall specific details about their exposure to chemicals. We urge women who work in these industries not to worry.”
Study shows that acupuncture can alleviate fatigue and improve quality of life for former breast cancer patients….. (November 2012)
This week, the results of a large-scale clinical trial into how effective acupuncture is in treating former breast cancer patients has been published in the Journal of Clinical Oncology.
The study, led by the University of Manchester and funded by Breakthrough Breast Cancer, with significant support from Walk the Walk, has found that acupuncture alleviated both mental and physical fatigue and improved overall quality of life.
Fatigue affects up to 40% of breast cancer patients, with few recognised treatments available. It can have a severe impact on quality of life, causing a range of problems including depression, memory loss and a severe lack of energy. These symptoms can then lead to sufferers being unable to return to work, participate in social activities or even enjoy watching the television.
The trial involved 302 patients and was conducted at ten hospitals and support centres across the country. Of these, 227 patients were given weekly acupuncture sessions, with follow-up checks for another 18 weeks and the remaining 75 were given normal care. They were then assessed for physical and mental fatigue, activity, motivation, anxiety, depression and quality of life. Under all of these assessments, acupuncture was shown to have significant benefits. While the researchers acknowledged that a placebo effect was possible, they believe the results are too significant to be viewed as a result of the placebo effect alone.
Professor Alex Molassiotis, who led the trail, said: “Fatigue is a blight on the lives of thousands of former cancer patients and this trial proves acupuncture can help them. We were delighted to see so many patients getting substantial benefit from this treatment, particularly as they currently have limited options available.”
Dr Julia Wilson, Head of Research at Breakthrough Breast Cancer, said: “More people are surviving breast cancer than ever before which means quality of life after treatment is becoming increasingly important. These are very promising results which suggest acupuncture could reduce fatigue symptoms and improve the quality of life of may former breast cancer patients”.
The panel for the Independent Breast Screening Review have published their findings……(November 2012)
In response to the debate about the effectiveness of breast screening, and criticism of the information given to women, an independent review of breast screening published its report last week.
The purpose of screening is to advance the time of diagnosis so that prognosis can be improved by earlier intervention. However, a consequence of earlier diagnosis is to increase the apparent incidence of breast cancer in a screened population and to extend the average time from diagnosis to death. Therefore, the appropriate measure of benefit was decided as the reduction in mortality from breast cancer in women offered screening compared to women not offered screening.
The report focused on the UK setting, where women aged 50-70 are invited to screening every three years. To provide estimates of the level of benefits and harms, the Panel used findings from 11 randomised trials of breast cancer screening that involved over 600,000 women, comparing women invited to the screening with control women not invited. However, these trials were conducted at least 20 to 30 years ago, and so observational studies were used to provide contemporary estimates of the benefits of breast cancer screening.
They found that while 1,300 lives a year are saved by the national breast cancer screening programme, a further 4,000 women are “over-diagnosed”- where a cancer was detected through screening that might not have caused a problem in the woman’s lifetime – and may undergo unnecessary treatment. However, as it is not possible for either the woman or her doctor to know which screen-detected cancers are potentially fatal and which represent over-diagnosis, all will usually be treated, with the accompanying impact on quality of life and psychological well-being.
Putting together benefit and over-diagnosis, the Panel concluded that the UK breast screening programmes confer significant benefit and should continue. Evidence from a focus group conducted by Cancer Research UK and attended by two panel members was that this was “an offer many women will feel is worth accepting: the treatment of over-diagnosed cancer may cause suffering and anxiety but that suffering is worth the gain from the potential reduction in breast cancer mortality”.
Study indicates that by 2040, more than one million women over the age of 65 in the UK will be living with breast cancer….. (November 2012)
Research funded by Macmillan Cancer Support has indicated that by 2040 there will more than one million women in the UK living with breast cancer aged 65 and over. This is almost quadruple the 340,000 older women currently living with the disease.
The research, conducted by King’s College London and published in the British Journal of Cancer reveals that by 2040, nearly three quarters of breast cancer survivors will be 65 and over; an increase from 59% today to 73% in 2040.
The study used existing information about trends in cancer rates, cancer survival and changes in the population in the UK to create a model to predict how these numbers would change over the next three decades.
Ciaran Devane, Chief Executive of Macmillan Cancer Support, said: “The NHS needs to take heed of these figures. It is already struggling to provide adequate care for older breast cancer patients. We need to change the way we care for older breast cancer patients now – so we are prepared for such a dramatic increase in numbers.”
The research also showed that the projected increase in breast cancer among the over-65s is almost double the increase for younger age groups. This increase in the older age groups seems to be mostly due to people surviving longer with cancer, and the corresponding expected increase in the elderly population.
The model used by the researchers is based on the assumption that current trends in breast cancer will remain the same, which may not be the case. Changes in screening, risk factors or treatments could affect number of cases, or rates of diagnosis and survival.
Jane Hatfield, Director of Policy and Research and Breakthrough Breast Cancer, said: “we know that our aging population, better diagnosis and advances in treatment mean that more people will be living with breast cancer in the future.”
“However, today’s prediction that this could rise to over one million people by 2040 is a startling wake-up call for the scale of care and support that will be needed by so many… This report is the latest clear demonstration of the need for breast cancer treatment and support for older patients now and in the future to be seriously addressed.”
The first trial of whole-genome scans to select breast cancer treatment has been carried out in France….. (October 2012)
The first clinical trial in which the entire DNA ‘genome’ of breast cancer patients’ tumours was scanned to help select the best treatment, has been carried out at the Institute Roussy in Villejuif, France. The study biopsied secondary tumours in patients, before analysing the genetic code of the tumour samples using a technique called array CGH, which scans the genome for gains, losses or changes in the genetic material. This gives information about genes likely to be driving the disease, which was then used to choose treatments targeted at the specific cancers they had.
Several drugs have been developed to target specific genetic alterations that cause cancer, with doctors already using genetic tests for some tumours – including breast cancer – to work out which treatment a patient will respond to yet. However, in most cases, only a limited number of genes are examined. A total of 402 patients took part in the trial; the researchers were able to map the full genome in 248 samples. This resulted in 172 patients being given drugs that were designed to target a specific genetic change. The study found 20 per cent of the of the patients were found to have extremely uncommon genetic changes, and the tumours shrank in 18 out of 48 patients whose treatment was selected based on the results of a genome scan.
Dr Fabrice Andre, who led the research, said: “This study suggests that the time has come to bring personalised medicine to the cancer field.”
Kate Law, Cancer Research UK’s director of clinical research, said: “Routine whole-genome sequencing of tumours is on the horizon for cancer patients, but we’re not there yet.”
“The fact that genetic results weren’t generated for all patients highlights the need to improve technical aspects of the tests. And before such genome tests are available in the clinic, we absolutely need further good-quality clinical trials to show they help to improve treatment for cancer patients.”
Study into the causes of male breast cancer has found a gene that can increase the risk of the disease by up to 50%…..(October 2012)
A study published this week in Nature Genetics has found a gene that can increase the risk of developing the disease by up to 50 per cent.
Around 350 men are diagnosed with breast cancer in the UK each year, making it rare compared with the 48,000 women who develop the disease. These results, the work of scientists from the Breakthrough Breast Cancer Research Centre at The Institute of Cancer Research (ICR), were drawn from the Male Breast Cancer Study, the world’s largest study into the causes of male breast cancer. This particular project, named the Genome-Wide Association Study (GWAS) involved 823 male breast cancer patients, and investigated 447, 000 genetic changes. The results were then confirmed in a further 438 patients.
They found that changes in the RAD51B gene, involved in the repair of damaged DNA, can raise a man’s breast cancer risk by as much as 50 per cent. However, the absolute risk of breast cancer in men with this faulty gene remains low. Changes in a different part of RAD51B have been shown to raise the risk of breast cancer in women.
Study author Dr Nick Orr said: “This study represents a leap forward in our understanding of male breast cancer. It shows that while there are similarities with female breast cancer, the causes of the disease can work differently in men. This raises the possibility of different ways to treat the disease specifically for men.”
Professor Anthony Swerdlow, co-leader of the Male Breast Cancer Study, said: “Male breast cancer is rare, which makes it difficult to study. Through drawing on many hundreds of patients from this country and abroad, we can now start to unravel its causes. We will be continuing this research to try to find more genes that raise the risk of male breast cancer, in order to better understand the causes of this disease in men, and in women.
Largest ever study conducted into Hodgkin lymphoma and breast cancer….. (August 2012)
The Institute of Cancer Research (ICR) conducted a study in collaboration with doctors across England and Wales, finding that women who have been treated for Hodgkin lymphoma at a young age have up to a 50% chance of developing breast cancer over the 40 years after treatment.
The study, funded by Breakthrough Breast Cancer, was the world’s largest study of its kind, looking at over 5000 women, all who had been treated for Hodgkin lymphoma under the age of 36, over a 50 year period. They found that the risk of breast cancer increased fivefold for women who had received radiotherapy to their chest as part of their treatment for Hodgkin lymphoma. Although it was already known these women were at increased risk of breast cancer, this research was able to indentify the effect of specific factors, such as the age a women received her treatment, the type of treatment and the length of time that has elapsed since then. This allows the prediction of an individual’s likelihood to develop cancer based on their individual circumstances.
The study shows that women who had radiotherapy treatment to their chest between the ages of 10- 14 have the greatest risk, being 22 times more likely to have the disease than the general population of their age. These risks have been shown to remain for at least 40 years, with women in their 50s and 60s also at greater risk.
Professor Anthony Swerdlow, from the ICR notes that ‘by following such a large group of women over such a long time period, we have created the most detailed picture yet of the risks these women face. Importantly, our study enables this group of women to receive clear information about their personal breast cancer risk…It takes us a step closer to more-personalised medical plans.’
New study into breast conserving surgery…..(July 2012)
Of the 45,000 women diagnosed with breast cancer in the UK each year, 58 per cent will chose to have breast conserving surgery rather than a mastectomy. This involves having part of the breast, rather than the entire breast, removed. Results show that, when combined with radiotherapy, breast conserving surgery has similar survival rates to those achieved by treatment through a mastectomy alone. However, as it can be difficult to fully define certain tumours with current imaging techniques, this kind of surgery can result in not all cancer cells being removed and therefore a second operation.
The results of a new study recently published in the British Medical Journal show that one in five women with primary breast cancer who chose breast conserving surgery will go on to have a second operation. Examining data of 55,297 breast cancer patients who had the surgery at 156 NHS trusts in England between April 2005 and March 2008, researchers found that 11,032 needed a second breast operation within three months. Roughly 40 per cent underwent a mastectomy during reoperation. Of those who needed a second operation and elected to have breast conserving surgery again, one in seven required a further operation.
Commenting on the study, Cancer Research UK Breast Cancer Surgeon, Mr Ramsey Cutress, said: “This is a very interesting and important study on a large group of UK women, and previous studies, in the UK and elsewhere, have shown similar results. It is standard practice to discuss the possibility of further surgery and it’s important for patients to fully understand the pros and cons of this. Rates of breast cancer recurrence are also reduced by other treatments such as radiotherapy, hormone therapy and chemotherapy where appropriate. There’s an ongoing need to better identify those at high risk of breast cancer recurrence, and to carefully select those who would benefit the most from further surgery.”
Threat of cancer fails to reduce obesity….. (July 2012)
A new report published by Cancer Research UK shows that, despite knowing the increased cancer risk obesity carries, overweight Britons are failing to find the drive to lose the extra pounds. Earlier Cancer Research UK studies found that after smoking, being overweight or obese is one of the most important avoidable cancer risks. Scientists estimate that, in the UK, the number of people who are overweight and obese could lead to around 19,000 cases of cancer a year and that more than four in ten cases of cancer could be prevented by different lifestyle changes. However, the new report, based on the results of a recent survey, has found that even though many overweight people are aware of the risks, major barriers to weight loss still persist.
Of those surveyed, 87 percent of overweight people stated they wished to lose weight. Results showed that 68 percent of overweight women and 60 percent of overweight men felt that lack of willpower was the biggest barrier in trying to do so. Others reported that ‘having too many other things to do’ and ‘trying it before and not being successful’ also prevented them from shedding excess weight.
Professor Jane Wardle, from the Health Behaviour Research Centre at University College London, said: “…We know that the modern day environment makes it very hard for people to lose weight especially when they are bombarded by advertising and easily tempted by cheap readymade meals and fast food instead of a balanced diet with plenty of fresh fruit and vegetables. But for both men and women being overweight is, after smoking, the most important risk factor for cancer. What many people don’t realise is that extra fat around the middle – their ‘muffin top’ – is surprisingly active, releasing hormones and other chemicals that can make cells in the body divide far more often than usual, which can increase the risk of cancer.”
Dr Susan Jebb, head of diet and population health at the Medical Research Council, said: “Research shows that to make sustained changes in diet and physical activity people need tangible support from family, friends or health professionals. In the longer term, it’s important that the places we live and work make the healthier choice the easier choice, so healthy living becomes a way of life, not a matter of personal willpower.”
More support for women with breast cancer recurrence….. (June 2012)
The results of the first UK study into the number of breast cancer patients who develop the disease for a second time has prompted calls for the NHS to do more to help women with a recurrence. The study, conducted by researchers at St James’s Institute of Oncology in Leeds, has found that over one in five breast cancer patients will see their cancer return within ten years.
Researchers looked at 1,000 consecutive patients diagnosed with breast cancer in Leeds between January 1999 and March 2002. They monitored their health over a period of ten years after their first diagnosis. Excluding 54 patients who could not be followed up, 214 patients, or 22.6 percent, developed recurrent disease. Preliminary results show that, of these patients, 51 percent lived for over three years disease-free before their recurrence and on average survived for at least one year after their recurrence, with five percent living for at least ten years after.
Jane Maher, Macmillan’s chief medical officer, said of the results: “Far too many [patients with recurrent breast cancer] are given little practical or emotional support, the assumption being that they know what to expect from the first time they were treated. The NHS is focusing a lot of attention on people who don’t have problems and not enough on people who do. Women who have recurrent disease don’t get the same support and care as people who have had a primary diagnosis of breast cancer.”
In response to the study, Cancer Research UK warned that Macmillan’s figures were ‘crude’. Prof Peter Johnson, of Cancer Research UK, said: “The chance of cancer coming back for any particular woman is influenced by several factors such as whether they have passed the menopause, the size and grade of the tumour, whether it has spread to lymph nodes and whether it has hormone receptors, so crude figures for large numbers are not helpful to individual women. In fact, for many women the chance of cancer coming back is much lower than one in five.”
Dr Rachel Greig, Senior Policy Officer at Breakthrough Breast Cancer says: “We welcome this study as a useful first step towards knowing how many breast cancer patients might experience a recurrence of their disease. It is vital to know how many patients’ breast cancer are likely to return to allow the NHS to better plan and provide for their needs. We may need further studies from different parts of the country before we can accurately say what the true rate of breast cancer recurrence is nationally.”
Reduce alcohol to prevent cancer…..(June 2012)
A new study conducted by researchers at the University of Oxford and published in the BMJ Open medical journal suggests that the UK population should drastically reduce its alcohol intake to prevent cancer, liver disease and other drink-related conditions. According to the group of researchers, if drinkers reduced their daily consumption of alcohol to just half a unit per day, it could prevent 4,600 deaths every year, including 2,600 from cancer. Half a unit is the equivalent of one quarter of a pint of lager.
The study looked at how reducing alcohol intake would impact upon death rates for 11 conditions – five types of cancer, coronary heart disease, stroke, high blood pressure, diabetes, cirrhosis and epilepsy. The researchers gathered results from other studies and used figures from the 2006 General Household Survey to establish the weekly level of alcohol consumption of 15,000 English adults. By calculating the impact of reducing alcohol intake and increasing the proportion of non-drinkers, they concluded that three per cent of deaths from the 11 conditions could be prevented if daily consumption was reduced to half a unit.
Peter Scarborough, a researcher in the department of public health at Oxford University, and his three co-authors said: “The optimum level of reduced chronic disease mortality in England would be achieved at an average alcohol consumption level of around five grammes a day, which should be taken into account in the formulation of health guidance. It is likely that government recommendations would need to be set at a much lower level than the current ‘low-risk’ drinking guidelines in order to achieve this level.” The government’s current recommended daily limit is three or four units for men and two or three for women. These guidelines are currently under review by Dame Sally Davies, England’s Chief Medical Officer, who has been urged to include at least two drink free days a week in any revised recommendations.
Response to the study’s suggestion that the government should recommend only half a unit a day has been deemed by some as unrealistic. A representative of charity Alcohol Concern, which campaigns for effective alcohol policy and improved services for people who are affected by alcohol-related problems, said: “Although the findings of this study will be valuable for the Department of Health working group currently reviewing the drinking recommendations, the focus of the guidelines must be to gain the maximum acceptance by the drinking public, and to offer a realistic way of reducing the risks associated with drinking.” A Department of Health spokesman said Davies “will review the evidence on alcohol and health risks including whether advice is needed on the maximum amount of alcohol that can be drunk in one session”.
Research into breast cancer in men…..(May 2012)
An interesting article has been published this week in US magazine Time, which draws on the results of new research into breast cancer in men. In the largest study yet into the male disease, the results of which were presented to the American Society of Breast Surgeons in Phoenix, US, researchers found that while breast cancer is much rarer in men, those who do develop the disease will not survive as long as their female counterparts. Researchers have suggested that this is due to a lack of awareness about the disease amongst men, as many do not know that they both sexes are susceptible to the disease.
The researchers, lead by Dr. Jon Greif, a breast cancer surgeon in Oakland, California, examined and analysed data from breast cancer cases in the US over a ten year period from 1998 to 2007. Of those included in the study, there were a total of 13,457 male patients and 1.4 million female patients diagnosed with breast cancer. The database used contained data on about 75 percent of all breast cancer cases in the US during that period. The study found that, on average, women with breast cancer lived two years longer than men with breast cancer. It was also found that men’s breast tumors were larger at diagnosis, more advanced and more likely to have spread to other parts of the body. Men were also diagnosed later in life. Men were diagnosed at an average age of 63 whilst women were diagnosed at 59.
Dr Grief stated that many men have no idea that they can get breast cancer, and that some doctors are unaware as well, “dismissing symptoms that would be an automatic red flag in women.” The causes of male breast cancer are not well researched but it is thought that, as in women, risk factors include age, genetic mutations, a family history, and heavy drinking.
A new study into alcohol and breast cancer…..(April 2012)
The link between alcohol consumption and breast cancer risk is a topic frequently discussed by the media. It is know that a causal link between the two exists, with recent studies suggesting that even small amounts of wine, beer or spirit consumed regularly increase the risk of developing the disease. A review of research into alcohol and breast cancer published this week suggests that just one alcoholic beverage a day can increase risk significantly.
Researchers at the University of Heidelberg in Germany and the University of Milan in Italy analysed the results of 113 studies into breast cancer risk and alcohol. Their report was published in the journal Alcohol and Alcoholism. They found that women who drank one alcoholic drink a day had an increased risk of five percent. They found that the higher the consumption of alcohol, the higher the risk of breast cancer. The review suggested that women who drank heavily, meaning three or more drinks a day, were up to 50 percent more likely to develop the disease than those who did not drink. A drink was defined as 10 to 12 grams of ethanol, equivalent to 1.5 units, or to one 125ml glass of average strength red wine or a pint of lager. The review was not able to establish whether there is a safe threshold of low level alcohol consumption, under which the amount of alcohol has no effect on breast cancer risk.
The review stated: “Since several populations show a high prevalence of light drinkers among women, even the small increase in risk we reported — in the order of five per cent — represents a major public health issue in terms of breast cancers attributable to alcohol consumption.” Lead author Prof Helmut Seitz wrote: “Since there is no threshold level of ethanol for breast cancer risk, the breast is one of the most sensitive organs for the carcinogenic action of alcohol. Healthy women should not exceed one drink a day (equivalent to 10–12g of ethanol). Women at an elevated risk for breast cancer such as those with a positive family history, or conditions associated with an increased breast cancer risk should avoid alcohol or consume alcohol only occasionally.”
In response to the review, Sarah Williams, health information officer at Cancer Research UK, said: “Research has already shown that the risk of breast cancer increases the more alcohol a woman drinks. But this new study adds to the evidence that drinking even small amounts of alcohol – about one drink a day – can slightly increase the risk of breast cancer. Women can help reduce their risk of breast cancer by reducing the amount of alcohol they drink, keeping a healthy weight, and being physically active.”
Aspirin and cancer risk explained…..(March 2012)
Over the last few years, evidence has been building that taking a daily dose of aspirin may help to reduce cancer risk. The results from three new studies into the effects aspirin has on cancer risk and cancer spread, published this week in the Lancet and the Lancet Oncology Journals, suggest that the drug can not only help to reduce the risk of developing cancer in healthy individuals, it can also help to reduce the risk of cancer spreading in those who have the disease. However, anyone considering taking aspirin regularly is advised to discuss the drug with their GP as there are other associated risks, such as internal bleeding.
Each of the three new studies was led by Professor Peter Rothwell, Professor of Clinical Neurology at Oxford University and a world expert in aspirin research. They looked at data from several large trials of aspirin, where small daily doses were taken and the drug’s effect on heart disease and cancer risk was monitored. Earlier studies had suggested that aspirin specifically affected the risk of bowel cancer and other cancers of the digestive system, but the new research found that, after three years of taking low dose aspirin daily, the risk of all cancers decreased significantly in both men and women. In the study, there were nine cases of cancer per thousand people taking aspirin and twelve cases per thousand who were not, with the risk most significantly reduced in oesophageal, stomach, bowel and lung cancer.
The research also unexpectedly revealed the possible benefits of aspirin in helping to reduce the risk of cancer spread. It found that regular aspirin takers were less likely to be diagnosed with cancer that had already spread and that in those diagnosed with early localised cancers it was less likely to spread later on. This is a significant finding as cancer that has spread to other parts of the body is much more difficult to treat and it suggests that aspirin may be useful for certain people who have already been diagnosed with cancer. Overall, because of aspirin’s suggested effect on reducing cancer risk and preventing cancer spread, the research also suggested that aspirin taken for over five years reduced the risk of dying from cancer by nearly 40 per cent.
The studies also looked at the balance of the benefits and harms of taking aspirin regularly, in order to decide whether the drug does more good than harm overall. Aspirin is known to have serious side-effects such as internal bleeding in certain people. Researchers found that the benefit of reduced cancer risk increased over time but that the risk of internal bleeding was significantly increased in the first three years of taking aspirin before reducing over time to the same as those not taking aspirin after 5 years. Overall, the combined risk of cancer, serious internal bleeding and major heart and circulatory problems was lower in those taking aspirin, suggesting its benefits may outweigh its risk.
Red meat and cancer risk…..(March 2012)
A new study conducted by scientists at Harvard Medical School in the US claims that a diet high in red meat can shorten life expectancy and can significantly increase the risk of dying from heart disease and cancer. The results, published in the Journal Archives of Internal Medicine, also suggest that swapping red meat with healthier alternatives can help to lower this risk.
Scientists looked at the diets of over 120,000 people in the US over a period of more than 20 years. They analysed data collected from 37,698 men between 1986 and 2008 and from 83,644 women between 1980 and 2008. They recorded 23,926 deaths in this time, including 5,910 from heart disease and 9,364 from cancer. After taking into account known chronic disease risk factors such as age, body, weight, physical activity and family history, scientists concluded that there was a significant association between red meat consumption and premature death, and heart disease and cancer mortality. They found that each additional daily serving of unprocessed red meat, such as a helping of beef, lamb or pork about the size of a deck if cards, increased the mortality rate by 13 percent and a portion of processed red meat, such as burgers or sausages, increased it by 20 percent. When looking at cause of death, eating any kind of red meat increased the risk of dying from heart disease by 16 percent and from cancer by 10 percent. Processed meat increased this to 21 percent for heart disease and 16 percent for cancer.
Senior author Professor Frank Hu, of Harvard School of Public Health in Boston, US, said: “This study provides clear evidence that regular consumption of red meat, especially processed meat, contributes substantially to premature death. On the other hand, choosing more healthful sources of protein in place of red meat can confer significant health benefits by reducing chronic disease morbidity [illness] and mortality.” The study found that cutting red meat our altogether offered significant benefits and that halving red meat consumption could have prevent the deaths of 9.3 percent of men and 7.6 percent of women taking part in the study. Replacing red meat with healthier alternatives such as fish, chicken and plant-based protein was also found to make a significant difference. Nuts for example were found to reduce the mortality rate by 20 percent.
Victoria Taylor, a dietician at the British Heart Foundation, said: “This study links red meat to deaths from CVD [cardiovascular disease] and cancer. Red meat can still be eaten as part of a balanced diet, but go for the leaner cuts and use healthier cooking methods such as grilling. If you eat processed meats like bacon, ham, sausages or burgers several times a week, add variation to your diet by substituting these for other protein sources such as fish, poultry, beans or lentils.”
HRT and breast cancer….. (March 2012)
In January, the wide spread press coverage of hormone replacement therapy (HRT) and breast cancer risk. Previous research has indicated that the most common form of HRT, containing the hormones oestrogen and progesterone, increases the risk of developing the disease. However, new research published this week in The Lancet Oncology journal suggests that, for certain women, a different kind of HRT may actually help to protect against breast cancer. Women taking oestrogen-only HRT to manage menopausal symptoms following a hysterectomy were found to enjoy protection against the disease long after they stopped taking the drug.
The claims are the conclusion of a major US study of postmenopausal women called the Women’s Health Initiative, launched in 1993. The study monitored the progress of 7,500 women who took either oestrogen-only HRT or a placebo for around six years and then stopped. Five years after stopping treatment, 151 women taking oestrogen-only HRT developed breast cancer, while 199 women taking a placebo developed the disease, a difference of 23 percent. Women in the HRT group with breast cancer were also found to be 63 percent less likely to die from the disease than those in the placebo group.
Despite these potential benefits, the researchers have highlighted that they are counterbalanced by the increased risk of blood clots and strokes associated with HRT. Oestrogen-only HRT can also only be given to women who have had a hysterectomy as it has known links with cancer of the womb. Furthermore the study found that oestrogen-only HRT did not seem to offer any protection against the disease to those with a family history of breast cancer.
Professor Jack Cuzick, epidemiologist at Queen Mary, University of London, said of the results: “This is the first randomised controlled trial of oestrogen-only HRT and breast cancer risk, and is well designed. So although this study contradicts some research showing that oestrogen-only HRT moderately increases the risk of breast cancer, it shouldn’t be ignored. We need further research to clarify exactly how oestrogen-only HRT affects breast cancer risk in women of different ages and family histories. If a woman is considering starting or stopping HRT, or using it for a long time, she should discuss it with her doctor who can help weigh up the benefits and risks of different types of HRT and make the right choice based on her own circumstances. There are different types of HRT, and it’s clear that combined types increase the risk of breast cancer and other health problems. For women who’ve had a hysterectomy, oestrogen-only HRT is an effective short-term treatment for menopausal symptoms. But women taking it should use the lowest dose possible for as short a time as they need it.”
Treatment for menopausal symptoms after breast cancer….. (February 2012)
Between 65 and 85 percent of women who undergo treatment for breast cancer will experience menopausal symptoms such as hot flushes and night sweats. Hormone replacement therapy (HRT) can be prescribed to menopausal women as a means of managing such symptoms but they are not usually given to women who have had breast cancer as the treatment can increase the risk of cancer recurrence and the symptoms can return when HRT is stopped. Research published this week in The Lancet Oncology journal has found that cognitive behavioural therapy (CBT) may offer a safe and effective alternative to breast cancer patients.
Scientists at the Institute of Psychiatry at King’s College London recruited 96 women from breast clinics in London who were suffering with symptoms such as night sweats and hot flushes. The women were split into two groups: one group received ‘usual care’, comprising access to nurses and oncologists and to telephone support programmes and other cancer support services; the other group received usual care plus CBT, consisting of one 90 minute session a week for six weeks. The sessions included psycho-education, paced breathing and cognitive and behavioural strategies for managing side-effects. During the study, women were asked to rate the extent to which their symptoms negatively impacted upon their lives. Those in the group receiving CBT had significantly reduced ratings for hot flushes and night sweats after nine weeks compared with the group receiving usual care only and improvements remained after 26 weeks.
Professor Myra Hunter, lead author of the study, said: “Our findings show that group CBT can reduce the effect of hot flushes and night sweats for women who have had breast cancer treatment. These reductions were sustained and associated with improvements in mood, sleep, and quality of life. Group CBT seems to be a safe, acceptable, and effective treatment option which can be incorporated into breast cancer survivorship programmes and delivered by trained breast cancer nurses.” Martin Ledwick, Head Information Nurse at Cancer Research UK, said of the study: “We know that many women can have problems with hot flushes and night sweats following treatment for breast cancer and that this can be distressing, particularly when they have not previously suffered from these symptoms. Although certain drugs can help, many women prefer to seek alternatives where possible. We hope this new approach will provide these women with a more acceptable way of managing these symptoms.”
Genetic testing for triple negative patients…..(February 2012)
A report published this week in the British Journal of Cancer has called for more women diagnosed with triple negative (TN) breast cancer to be tested for the BRCA1 gene. Women with the gene mutation have a much higher risk of developing breast cancer and of developing it at a much younger age. Research shows that those who carry the mutation have up to a 65 per cent chance of developing breast cancer by the time they reach the age of 70. If breast cancer is caused by a BRCA1 gene mutation, it will influence which treatment a patient is given.
Researchers at the Institute of Cancer Research looked at over 300 women with TN breast cancer and found that almost one in five women diagnosed under the age of 50 carried the BRAC1 mutation.
However, based on their findings, they estimate that more than one in three women would not have been tested under current NICE (National Institute for Health and Clinical Excellence) guidelines. Due to the cost of genetic testing, NICE guidelines recommend that women should only be offered genetic testing if the likelihood of them carrying BRAC1 is over 20 per cent. To be eligible for testing, a patient must fulfil a range of critieria determined through various methods. However, lead author of the report, Professor Nazneen Rahman at the Institute of Cancer Research and the Royal Marsden Hospital, said: “Using a simple age criteria for testing will provide a clear and understandable guide for doctors and women to follow, and should result in many more women benefitting from the optimised care that genetic information makes possible.”
Professor Peter Johnson, chief clinician at Cancer Research UK, said of the issue: “It’s important that we identify women and their families who carry BRCA1 mutations. They’re more likely to develop breast and ovarian cancer, so armed with this knowledge doctors can offer targeted screening and tailored treatments to these women.”
Controlling your cancer risk…..(December 2011)
Our risk of developing cancer is based on a mixture of factors – our genes, our environment and our lifestyle choices, some of which we are able to control. Research has shown that leading a healthy lifestyle helps to reduce our cancer risk. Cancer Research UK (CRUK) this month published a ‘landmark’ review, led by Professor Max Parkin, into the latest evidence behind the preventable causes of cancers in the UK, producing some interesting results.
The review looked at 14 lifestyle and environmental risk factors, including tobacco, being overweight, a diet low infruit and vegetables, alcohol, occupation, sunlight and sunbeds, and analysed the proportion of different cancers that could be prevented through changes to these factors. Based on predicted cases of cancer in 2010, it found that a third of all UK diagnoses each year were caused by smoking, diet, alcohol and obesity. For all cancers, the biggest preventable risk factor was tobacco. For breast cancer specifically, the biggest, in order of significance, were: being overweight, alcohol, occupation, hormone replacement therapy, inactivity, not breast feeding, radiation. CRUK has produced a fascinating infographic which displays the findings for each cancer type and the proportion that could be prevented through changes to the various lifestyle factors. To see it, please visit their website.
Writing in its science blog, CRUK was quick to highlight that sharing these results was in no way about blame but was aimed at equipping the public and policy-makers with the best possible information. Every person diagnosed with cancer has a unique set of circumstances that led them to develop the disease, some of which could have been controlled, some which could not. Furthermore, leading a healthy lifestyle is not a guarantee against cancer. In both instances however, there are factors that we can control and ways that we can reduce our risk, to ‘stack the odds in our favour.’ In terms of policy-makers, information is vital in planning public health interventions. For example, decades of research into the risks of smoking has led to the implementation of successful policies to encourage people to give up, the effects of which can now be seen in the decreasing rates of lung cancer in UK men.
The link between drinking alcohol and breast cancerhas been strengthened by a new study…..(November 2011)Researchers from the US said women who drank two glasses of wine a day raised their risk of the disease by 50%. The study showed even women who drank only one glass a day increased their risk of breast cancer by 15%. They also said women who drank 2.5 units a day for five years during their twenties and thirties, but decreased their alcohol intake when they got older, were still a third more likely to develop the disease.
The researchers examined the records of 105,896 women aged 30-55 who had filled in surveys about their drinking and monitored which women were diagnosed with breast cancer over a thirty year period. Women who drank four units a day had 50% more risk of the disease than non-drinkers, while those who consumed 2.5 units a day had 28% more risk.
Drinking a small amount of alcohol has been found to lower the risk of heart disease in men of 40 and older, and in post-menopausal women.
The researchers wrote: “An individual will need to weigh the modest risks of light to moderate alcohol use on breast cancer development against the beneficial effects on cardiovascular disease to make the best personal choice regarding alcohol consumption.”
Sarah Williams, health information officer at Cancer Research UK, said: “This study adds to already strong evidence that drinking even small amounts of alcohol increases the risk of breast cancer.”
“Researchers found a small increased risk for low alcohol intake but the risk increases the more people drink. And the study re-confirmed that all types of alcohol – beer, wine and spirits – increase the risk of cancer.”
New test predicts chance of breast cancer return….. (October 2011)
A new test has been developed by Breakthrough Breast Cancer scientists that helps identify whether women diagnosed with ER positive breast cancer are at risk of the disease returning. This type of cancer is the most commonly diagnosed form of the disease, accounting for over three quarters (37,000) of all cases a year in the UK.
When a patient is diagnosed with ER positive breast cancer, their tumour is removed through surgery and they are then treated with hormone therapy to kill any remaining cancer cells and to reduce the risk of recurrence. Based on an assessment of the tumour, they may also be given chemotherapy to further reduce the risk. In around 12,000 cases, it is not possible to clearly determine whether a patient should or should not receive chemotherapy. Rather than run the risk of not giving a patient treatment that is actually needed, chemotherapy will be given in this situation.
While effective at preventing a return of the cancer, chemotherapy is known for its unpleasant side effects, including hair loss, lethargy, and risk of infection and blood clots. The newly developed test may be able to save many women who fall into the ‘unclear’ category from undergoing unnecessary and unpleasant chemo, by allowing doctors to make a much more certain decision on the treatment they require. The test measures the levels of four key proteins in ER positive breast cancer (ER, PR, HER2 and Ki67) to determine the risk of recurrence. It uses technology already available in almost all NHS laboratories and should cost a tenth of the only existing alternative, Oncotype DX, which is only available in one US lab and costs £1,600 for private UK patients.
Professor Mitch Dowsett from the Institute for Cancer Research and the Royal Marsden said: “I think it will help about 8,000 women a year make a much more certain decision about their treatment. It will allow us to say about a third of the 12,000 probably do need chemo and about a third probably don’t […] It is a major step towards more personalised and targeted treatment of breast cancer, which will mean that women can avoid unnecessary chemotherapy and its toxic side effects.”
Breast cancer risk over 70….. (October 2011)
A third of the 48,000 breast cancer diagnoses made a year in Britain fall within the over 70′s age category. Increasing age is the most significant risk factor for developing breast cancer but is often the risk most overlooked by women. A poll by Breast Cancer Campaign has revealed an alarming number of older women are unaware of their risks of developing breast cancer.
The survey revealed that only 1 in 50 women aged over 70 realised they are the age group with the highest risk. Many wrongly thought that women aged 40 to 59 are at greatest risk of developing the disease. It also found that only half of those over 70 were aware that although they do not get routinely invited to an NHS breast screening appointment, they are entitled to request one. According to the poll only 1 in 7 women had attended a screening since turning 71.
Baroness Delyth Morgan, chief executive of Breast Cancer Campaign, stressed that better awareness and education is needed about age as an increasing risk factor and about breast screening programmes. She said: “We read daily about different risk factors for breast cancer including alcohol and weight. While these are important, age is the most significant risk factor of all and yet women, including those most likely to be affected, remain in the dark about this [...] It is absolutely vital that women of this age are better informed about their risk and the steps they can take to ensure their breast health is a priority.”
Linking alcohol and breast cancer…..(September 2011)
Much is written about the links between alcohol consumption and breast cancer risk. New findings from a US laboratory study published in Alcoholism: Clinical and Experimental Research reveal how the breakdown of alcohol in human cells may result in DNA damage linked to a number of cell changes that cause cancer. This breakthrough is particularly important to breast and liver cancer susceptibility and emphasises that groundbreaking research into alcohol and cancer is progressing quickly. An article from Cancer Research UK helpfully outlines the laboratory study that is building upon our previously limited knowledge of the effects of alcohol as a carcinogen within human cells.
The study shows that when alcohol or more specifically ethanol, the type of alcohol found in alcoholic beverages, is converted within human cells to a chemical called acetaldehyde the resulting DNA damage directly affects a collection of proteins called the ‘FA-BRCA network (Fanconic anemia-breast cancer).’ Previous studies have shown that the FA-BRCA network is particularly important in protecting against breast cancer. Laboratory results confirmed that when the ethanol is converted into acetaldehyde it causes increased levels of DNA damage as well as switching on the cell’s DNA repair genes.
The study’s author Philip J Brooks explains: “Although the link between drinking alcohol and certain types of cancer was first established in the 1980’s the existence of such a relationship did not prove that alcohol itself caused the cancers. More recent evidence however has confirmed that alcohol, or more specifically ethanol, is carcinogenic to humans at several sites in the body.” He concludes that this research brings us a step closer to understanding the ways in which alcohol contributes to the development of breast and liver cancers. As a result of these finding, further research into the relationship between alcohol metabolism, the FA-BRCA network and human health will become increasingly important in the future.
Significant discovery in male breast cancer…..(September 2011)
Breast cancer is often thought of as a condition that only affects women. It is important to highlight however that men can also develop the disease. Around 48,000 women are diagnosed with breast cancer in the UK each year, and although it is far less prevalent in men, there are around 300 cases of male breast cancer each year. There is a limited amount known about male breast cancer, whether it is similar to breast cancer in women, or whether it is something different altogether.
In an attempt to find out more about the genes implicated in the disease, Breakthrough Breast Cancer and The Institute of Cancer Research (ICR) have been collaborating on research into male breast cancer and have discovered similarities with the female disease. Using data taken from the Male Breast Cancer Study, the research team studied 433 male breast cancer cases and looked at the 12 most common genes that contribute to the risk of female breast cancer. They learned that five of the genes also significantly affected risk in men. However, the extent of the risk was different between males and females. One of the first of its kind, the study’s results have been published in the journal PLoS Genetics.
Whilst this study is still in its early stages and there is still much more to learn, Dr Nick Orr from the Breakthrough Breast Cancer Research Centre hopes that these results could potentially lead to tailored treatments for male breast cancer patients. The team also believe it will improve knowledge of the genetic factors of female breast cancer.
Breast cancer screening debate…..(September 2011)
As you may well be aware, recent claims over the effectiveness of breast cancer screening programmes have unleashed fierce debate within the scientific community about whether or not women should take up their invitation to have a mammogram once every three years. Whilst the NHS states their programme is responsible for saving around 1300 lives a year, recent research claims that women may be being misled about the health benefits of screening.
In response, there has been lively discussion of the claims in the press. If you are interested in reading more, The Guardian , The Daily Mail and The Independent all examine the claims made by the recently published research in more detail.
Breast density and cancer risk explained….. (September 2011)
An interesting article on breast density was recently posted on the Komen for the Cure website. Research has shown that breast density is linked to breast cancer risk but it is still unclear exactly how the two are linked. This article helpfully outlines what we know about breast density as well as highlighting what remains to be investigated.
As the article tells us, the breast is made up mostly of fat and breast tissue. Breast tissue itself is the network of lobules and ducts that produce and carry milk to the nipple when a woman is breastfeeding, all held in place by connective tissue. Breast density is a measure of the composition of the breast, taken by comparing the area of breast and connective tissue to the area of fat as seen on a mammogram. The greater the area of breast and connective tissue in comparison with fat, the higher the breast density. This is currently measured by visual assessment of the mammogram by a radiologist through a variety of methods. The issue here is that such assessments are subjective and the best way to measure breast density remains an active area of research.
We know that women with very high breast density are at a higher risk of developing breast cancer. Those with a high density are four or five times more likely to develop breast cancer that those of a low density. It is not yet known, however, why this is related to breast cancer. Many factors affecting the disease also affect breast density, which may help to explain how density increases breast cancer risk: We know that some breast cancers are due to genetic predisposition, and breast density also seems to runs in families. There are studies being conducted into specific genes that may be linked to density. We know that pregnancy decreases breast density as well as decreasing breast cancer risk. The more children a woman has, the less dense her breasts are and also the lower her risk of developing the disease. Age is also an influencing factor – hormone changes during menopause cause a decrease in density and younger premenopausal women generally have denser breasts. However, we also know that breast cancer risk increases with age. Both density and risk are also related to body weight. Women with a higher body weight in adolescence and adulthood tend to have a lower breast density. A higher weight before menopause may help decrease breast cancer risk, but after menopause obesity or being overweight increases risk. The influence of age and weight are both topics currently under study.
Dense breast tissue poses problems in terms of breast screening. Breast fat appears dark on a mammogram and denser breast and connective tissues look light grey or white. Tumours can also appear white, making mammograms more difficult to assess when breast tissue is dense. Digital mammography on a computer screen makes images easier to examine in more detail, making them better at finding tumours in women with dense breasts. MRI and Ultrasound are also being investigated as potential tools for screening women with high density breasts.
Personalised medicine for those with breast cancer gene….. (August 2011)
An increasing amount of research is being done into targeted cancer treatments that depend on the genetic makeup of a patient and that of their cancer. This approach is known as personalised medicine. One such trial was launched this week at the Oxford Experimental Cancer Medicine Centre at the University of Oxford. The team of researchers based at the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre are leading the study into cancer drug 6MP, to find out if it may benefit those with hereditary breast and ovarian cancer. If successful the drug could offer important extra treatment options for patients with certain breast and ovarian cancers caused by faults in the BRCA1 and BRCA2 genes. These genes are known to significantly increase the risk of developing breast and ovarian cancer, with 15 out of every 100 breast and ovarian cancers being caused by BRCA1 and BRCA2 genetic faults.
The study will look at cancer drug 6MP, which belongs to a class of drugs known as thiopurines and is currently used to treat leukaemia patients, often given alongside another chemotherapy drug called methotrexate. Earlier laboratory studies into thiopurines have suggested that the drugs are effective at killing cancer cells lacking BRCA genes. The lab studies showed that the drugs may also be effective when cancer cells have developed resistance to other treatments such as PARP inhibitors and cisplatin. If the new study into 6MP and its possible benefits is successful, it will lead to a larger phase III trial in the future.
Trial leader Dr Shibani Nicum, a gynaecology specialist based at the Oxford Experimental Cancer Medicine Centre (EMCM) and a researcher in Oxford University’s Department of Oncology, said of the trial: “PARP inhibitors are a powerful new class of drugs developed specifically to target tumours caused by BRCA 1 and BRCA2 faults, but drug resistance remains a problem. We hope that the very encouraging results we have seen in early laboratory studies involving 6MP will lead to increased treatment options for these patients in the future.” Professor Mark Middleton, director of the Oxford ECMC at Oxford University, added: “It’s exciting to see drugs being developed for specific groups of patients who share the same underlying genetic faults in their cancer. Targeted treatments are at the cutting edge of cancer care and we’re proud to be involved in bringing such drugs a step closer to the clinic.”
Height linked to Cancer…..(July 2011)
New research has found that women who are 5ft 9in tall or over are more than 33 per cent more likely to be diagnosed with cancer than those who are just 5ft. The study, carried out at Oxford University, found that the risk of cancer increases by about 16 per cent for every four inches of height. This is thought to be because being tall increases the levels of hormones known to trigger tumours.
Researchers studied the link between height and ten of the most common forms of cancer, including breast, bowel, kidney, womb, ovarian and leukaemia by looking at the medical records of more than one million British women. They now think that this link may explain why cancer rates have risen so much in the last few decades, when our average height has also steadily increased.
In the last century, the height of adults in Europe has risen by more than 1cm every ten years. Figures show that cancer rates have increased by about 3 per cent every decade. Scientists now believe that the increase in height can explain up to 15 per cent of the rise in cancer rates seen in the last century. They believe that one reason for this is that tall girls tend to start puberty earlier and this is when their bodies start to produce large amounts of the hormone oestrogen, known to trigger the growth of tumours.
Also, taller people have more cells in their bodies, so there is a higher chance that one of them will become cancerous. Sara Hiom, director of health information at Cancer Research UK said: “Tall people need not be alarmed. Most people are not a lot taller than average and their height will only have a small effect on their individual cancer risk.”
As this study only involved women, it is not yet clear whether tall men are also at risk. However, previous studies have linked height with an increased risk of prostate and testicular cancer.
Obesity is the biggest driving force behind the most common form of breast cancer in older women, say researchers…..(July 2011) Alcohol and then cigarettes are the next largest culprits, according to Cancer Research UK. One in eight women in the UK develop breast cancer in their lifetime, data shows, and the majority of these tumours are “hormone sensitive” meaning their growth is fuelled by hormones. Too much stored fat in the body raises the level of these “sex” hormones.
Studies show that post-menopausal women with high levels of oestrogen and testosterone have between two and three times the risk of breast cancer than women with the lowest levels. Experts have known for some time that factors that influence hormone levels – like pregnancy, the oral contraceptive pill and the menopause – can change a woman’s breast cancer risk. This latest work, published in the British Journal of Cancer, suggests obesity should go at the top of this list, not least because it is a lifestyle factor that women can have some control over.
The Oxford University team, funded by Cancer Research UK, studied the health records of nearly 6,300 post-menopausal women, looking for factors that might explain why some developed hormone sensitive breast cancer when others did not. A woman’s weight had the greatest bearing on a woman’s sex hormone levels, shortly followed by smoking and alcohol consumption.
Women who are overweight or obese – meaning they have a body mass index of 25 or more – had high levels of hormones like oestrogen and progesterone. So too did women who drank more than two and a half units of alcohol a day or smoked more than 15 cigarettes daily. Experts say women should be made aware of these modifiable risk factors.
Dr Julie Sharp, of Cancer Research UK, said: “This is an important study as it helps to show how alcohol and weight can influence hormone levels. Understanding their role in breast cancer is vital and this analysis sheds light on how they could affect breast cancer risk. ”We know that the risk of the disease can be affected by family history and getting older, but there are also things women can do help reduce the risk of the disease. Maintaining a healthy body weight and reducing alcohol consumption are key to reducing breast cancer risk.”
Fad foods and breast cancer – how to read the headlines…..(July 2011) There are many articles out there that focus on the links between food and cancer, with headlines often promoting the cancer-fighting benefits of certain foods. Very often though, it can be difficult to decipher whether the headlines are indeed fact or fiction. A recent article on website ‘Koman for the Cure’ helps to give greater insight into how to ‘read between the lines’ when it comes to articles about foods and breast cancer.
When reading about possible links between diet and cancer, it can be helpful to look at whether the results come from studies of cells, animals or people. Whilst findings from cell studies may be interesting, they indicate a very early step in the research process, and may not necessarily translate to human health. Similarly, whilst animal studies can add to our understanding of how and why some factors may affect breast cancer risk in people, there are many differences between animals and people, and so human studies are needed before deciding whether certain foods are actually linked to the prevention, treatment or risk of breast cancer in people.
Another interesting factor to look out for when reading articles about food and breast cancer is the number of people used in a study. The more people used in a study, the more information or evidence it gives us, as results from a small study can sometimes be due to chance rather than a true effect. Important to also consider is how many other studies have been done on the same topic with similar outcomes as this can help us to have more confidence in the results. In other words, the more human studies is with large numbers and with similar findings there are, the more we can trust whether a food is linked (or not linked) to breast cancer. So next time you read about the link between a certain food and breast cancer, investigate whether the study was done with people, whether it was a large study and supported by other research – armed with this knowledge you will be better able to ‘read between the lines’ and properly interpret the headlines
Potential new treatment for oestrogen-negative breast cancers…..(1 July 2011)
Of the 48,000 women diagnosed with breast cancer in the UK each year, five percent of these will have a specific type of tumour known as an oestrogen-receptor-negative molecular apocrine tumour. Oestrogen-receptor-negative breast cancers such as these can be difficult to treat as they do not respond to hormone treatments like tamoxifen and aromatase inhibitors. In more common oestrogen-positive tumours, oestrogen receptors in the cancer cells are switched on by the hormone, fuelling their growth. Oestrogen negative tumours do not have the protein receptors required by hormone to be effective, leaving these women with fewer treatment options.
Scientists at Cancer Research UK’s Cambridge Research Institute have discovered that patients with this kind of difficult to treat tumour could in fact benefit from prostate cancer treatments which target a different receptor. Androgen receptors, a key trigger of prostate cancer, are fuelled by the androgen hormone, testosterone, in a similar way to which oestrogen receptors are fuelled by oestrogen. Researchers found that in oestrogen-receptor-negative molecular apocrine tumours, androgen receptors can also switch on genes that are usually switched on by the oestrogen receptor, fuelling breast cancer growth. As the research is still in its early stages, it is not yet known what fuels the androgen receptor, whether it is testosterone or testosterone, or if the receptor fuels cancer growth independently without the presence of a hormone.
Lead author, Dr Ian Mills, at Cancer Research UK’s Cambridge Research Institute, said of the research: “This important discovery suggests that patients with a type of oestrogen-receptor-negative breast cancer may potentially benefit from therapies given to prostate cancer patients, which could transform treatment for this patient group in the future. But at the moment this laboratory research is still at an early stage. We don’t know if oestrogen or hormones from the androgen family such as testosterone also have a role to play in fuelling the disease in this patient group. The challenge is to pin down these answers through further laboratory and clinical research.”
New research into body’s defence against cancer……(5th April 2011)
Cancer Research UK’s science blog this week discussed the ways in which the body defends itself against the development of cancer. A fascinating new piece of research into these processes, reported in Science Journal Medicine, has discovered a way in which cells protect themselves that could potentially offer opportunities for the development of new methods of breast cancer diagnosis and treatment.
As explained in the blog, there are a number of processes that allow the body to locate and destroy cancerous cells. We generate tumour-prone cells everyday and in order to prevent these from developing into cancer, injured cells produce ‘tumour suppressor’ proteins which kill or stop the division of such cells. In addition to this, they are targeted by white blood cells produced by the immune system.
A team of US researchers, led by Professors Mina Bissell and Wen-Hwa Lee, have now identified a protein also produced by the immune system that kills breast cancer cells whilst leaving healthy cells unharmed. Whilst examining the relationship between breast cancer cells and their healthy counterparts, they found that the protein interleukin-25 (IL-25) exclusively killed cancerous cells but had no effect on healthy ones. Further investigation revealed that cancer cells often have a protein known as IL-25 Receptor (IL-25R) on their surface, which causes the cell to die when it comes into contact with IL-25. Healthy cells do not produce IL-25R so are protected from this process.
Researchers believe that cancer cells produce IL-25R during the development of breast cancer as a means of distinguishing themselves. IL-25 is then produced by healthy cells to keep the cancerous cells in check. Although much more research needs to be done into the process, scientists think it could provide the basis for diagnostic tests and treatments for breast cancer in the future which target IL-25R. As the blog points out, similar studies into the protein HER2/neu led to the development of the now widely used breast cancer drug Herceptin.
Diabetes drug as breast cancer treatment…….(21st April 2011)
Breakthrough Breast Cancer has announced a new test to identify patients with aggressive breast cancer who could benefit from the drug metformin, currently used for the treatment of diabetes. By examining how cancer cells feed, the test could help identify patients who will have a poor prognosis who could then be prescribed the low-cost diabetes drug.
Teams of scientists at the Breakthrough Breast Cancer research unit at the University of Manchester and at the Thomas Jefferson University in the US developed the test by looking at what it is that cancer cells eat. First they fed cancer cells in the laboratory with high-energy foods known as ketones and lactate. Looking at 219 breast cancer patients, researchers then examined which cancer cells fed on these foods. They found that cells feeding off these high-energy foods, which come from surrounding healthy cells, were more likely to be aggressive and harder to treat. For patients with cancer cells consuming high levels of ketones and lactate, there was a higher chance of breast cancer recurrence, cancer spread and mortality. It is thought that such patients could benefit from metformin as it acts by cutting off the supply of food to the cancer cells.
Professor Michael Lisanti, who worked on the study, said: “There is more work to do but this test could be an important new way of tailoring treatments to a patient’s needs, across a range of cancers.” Professor Anthony Howell, Director of the Breakthrough Breast Cancer Research Unit in Manchester, said: “We have discovered important new insights into how cancers feed themselves. It is a step towards having each patient get the right treatment for them – what we call personalised medicine. We are looking at a new way to separate patients based on who should respond well to the treatments we have, and who might need something different. It is particularly encouraging that some of those treatments might already be in the doctor’s drug cabinet, and cheap to prescribe. We have some way to go but we hope that drugs like metformin will be saving lives of breast cancer patients over the next few years.”
Breast cancer prevention drugs ‘should be prescribed’….(28 March 2011)
Women at high risk of developing breast cancer should be given preventative drugs, according to an international panel of cancer experts. Writing in the Lancet Oncology, they said drugs such as tamoxifen could reduce the chances of developing breast cancer. Such a policy would be similar to prescribing statins to patients at risk of heart disease, they suggest.
However, tamoxifen has been linked with womb cancer, blood clots and stroke. In the UK, 46,000 women are diagnosed with breast cancer each year. Two drugs, tamoxifen and raloxifene, have been approved in the US for the prevention of breast cancer. However, they are not available as a preventative measure in the UK. Professor Jack Cuzick, who chaired the panel and is an epidemiologist at Queen Mary, University of London, told the BBC: “The two drugs should be approved in the UK. The evidence for them is overwhelming.” He estimates that for every 1000 women given tamoxifen there would be 20 fewer breast cancers, but there would also be three more womb cancers and six more cases of deep vein thrombosis. To balance the risks, the panel agreed that women who had a greater than 4% chance of developing breast cancer in the next 10 years should be offered preventative therapy.
In heart disease, there are well-known risk factors such as blood pressure and cholesterol, which can inform treatment. The challenge for any preventative breast cancer treatment would be identifying similar “markers” of risk. The panel suggests breast density. They say patients with more than 75% “dense breast tissue” had at least four times the risk of developing breast cancer than patients with mainly non-dense tissue.
Professor Cuzick said: “Increased breast density is one of the leading risk factors for breast cancer and early trial results suggest that where tamoxifen is shown to decrease density, the risk of cancer decreases. ”If this is confirmed in long-term studies, breast density could become a powerful way to identify high-risk women who could benefit from preventive treatments.” He suggests the risk of getting breast cancer should be determined during cancer screening.
Dr Lesley Walker, from Cancer Research UK, said: “Our scientists were behind some of the first trials showing the long term benefits of tamoxifen for preventing breast cancer in women with a greater than average risk of the disease. ”Being able to accurately predict breast cancer risk and who will respond to preventative drugs like these is a crucial step in ensuring women get the most suitable treatment.”
Meg McArthur, senior policy officer at Breakthrough Breast Cancer said: “It is vital that we find effective ways to prevent breast cancer, especially in women with a high risk. However, as preventative therapy may have negative side effects it would not be appropriate for everyone.
“We welcome studies investigating the best treatments to be used for breast cancer prevention. It’s also crucial to identify those at high-risk who would benefit the most from this form of therapy.”
Information supplied by Cancerkin