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)