Breast Cancer Death Rate in USA Declines By 2% A Year

The breast cancer death rate in the United States continues to fall by around 2% a year, as it has since 1990, according to Breast Cancer Facts & Figures 2007-2008, a report on breast cancer statistics and trends produced every other year by the American Cancer Society. That's an impressive winning streak for an important indicator of success in the fight against cancer, made possible in large part, the report says, by advances in early detection and treatment.

Those advances have benefited women of some races more than others, data shows. For instance, the cancer death rate for white and HispanicLatina women fell by 2.4% between 1995 and 2004, but only by 1.6% for African-American women. And during the same time period, no change was seen in cancer death rates of Asian AmericansPacific Islanders or American IndiansAlaska Natives.

Also in this issue, authors note a decline in breast cancer incidence -- that is, the rate at which new cancers are diagnosed -- but suggest it may be due in part to fewer women getting mammograms.

Breast Cancer Death Rates Differ by Race

On whole, the report shows the continuation of a welcome trend -- a steady decrease each year in the rate of breast cancer deaths. Thanks to increased efforts at prevention, better methods of detecting cancers early, and treatment advances, American women today are less likely to die of breast cancer than they have been in decades, said Harmon J. Eyre, MD, chief medical officer of the American Cancer Society.

Looking at the issue of race -- and the socioeconomic and genetic factors associated with race -- it becomes clear that this good news is better for some groups of women than for others. Perhaps most troubling, said Eyre, is the striking divergence in long-term mortality trends seen between African-American and white females that began in the early 1980s and that by 2004 had led to death rates being 36% higher in African-American women.

Other key statistics about breast cancer included in the report

An estimated 178,480 new cases of invasive breast cancer in women will be diagnosed in 2007, and approximately 40,460 deaths will be recorded. Only lung cancer accounts for more cancer deaths in women.

In 2004 (the latest year for which figures are available), approximately 2.4 million women living in the US had a history of breast cancer. Breast cancer accounts for more than 1 in 4 cancers in US women.

On average, the breast cancer death rate decreased by 2.2% each year between 1990 and 2004. Younger women saw an even more significant decline during that period.

Breast cancer incidence among white women -- that is, the rate at which new breast cancers are diagnosed in this group -- fell by 3.7% a year during 2001-2004. Also declining during this time the use of mammography and hormone replacement therapy (HRT) by white women. There was no significant change in breast cancer incidence among African-American women during this time, coinciding with stable mammography rates and HRT use.

Among women 50 and older, incidence rates have been on a steep decline (by 4.8% per year) since 2001. Among women under age 50, incidence rates have remained stable since 1986.

Since 2000, the incidence rate of smaller tumors has declined by 3.8% per year. In contrast, the incidence rate of larger tumors (5.0 cm) has increased by 1.7% per year since 1992. (Larger tumor size at diagnosis is associated with decreased survival.) Both trends may be tied to an increase in obesity in postmenopausal women, HRT use, or both.

Risk Factors of Breast Cancer Detailed

The report details the major risk factors for breast cancer that women have some control over. These include

Weight Obesity increases a woman's risk of postmenopausal (but not premenopausal) breast cancer, as does weight gain during adulthood.

Alcohol use Women who drink just 2 alcoholic beverages a day face a 21% increase in their risk for breast cancer.

Secondhand smoke Although most studies have found no link between cigarette smoking and breast cancer, the link between secondhand smoke and breast cancer remains controversial.

Exercise Women can lower their risk of breast cancer by exercising vigorously for 45 to 60 minutes on 5 or more days per week. Postmenopausal women can lower their risk, according to one study, with any level of physical activity performed on a regular basis.

The report also takes note of groundbreaking breast cancer research, such as studies looking at the chemoprevention of cancer and at the development and testing of so-called rational therapeutics, drugs that are tailored to the unique characteristics of each patient and tumor. Also discussed are important investigative trials such as the Sister Study. Investigators are seeking to enroll 50,000 cancer-free women who have a sister with a history of breast cancer. They will follow these women for up to 10 years, collecting information about their genes, lifestyles, and environments and seeking to determine the impact of these factors on breast cancer risk.

Taken together, this report highlights the remarkable gains we've made in the fight against breast cancer, said John R. Seffrin, PhD, chief executive officer of the American Cancer Society. But it also puts into focus the challenge before us to close the gap so all Americans can reap the benefits equally, and to ensure that no American woman faces an increased risk of dying from breast cancer because of her race or ethnicity or because of lack of access to quality care.

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New Breast Scanner Can Detect Early Signs of Cancer

DURHAM, N.C. - Researchers at Duke University Medical Center have developed a new breast scanner that is designed to detect subtle changes in breast cells before a lump can be felt by hand or seen with X-ray mammography.

Such early detection should enable doctors to more successfully treat breast cancer before it has formed a tumor or spread to lymph nodes, said Martin Tornai, Ph.D., associate professor of radiology and biomedical engineering at Duke and developer of the device. The new camera has undergone extensive testing in artificial breasts and will begin testing in women this spring.

The camera uses nuclear medicine to pick up chemical changes to breast cells that signal the cells are becoming malignant, said Tornai. The camera should be particularly useful for detecting tumors in large or dense breasts, which are difficult to image using traditional mammography because X-rays often cannot penetrate them. Moreover, the geometry of the new device allows for imaging small breasts and the nearby chest wall. It can even image the axillary lymph nodes to look for evidence of metastasis, which traditional mammography cannot do. The new device works without any breast compression, and women may not be required to remove their bras.

Tornai will present results with the new device Dec. 4, 2003, at the 26th Annual San Antonio Breast Cancer Symposium.

The key to the new scanner is that it detects changes in the behavior of cancer cells rather than structural changes, such as tumor masses, which take much longer to develop, said Tornai.

Once you start seeing structural changes using mammography, that indicates the molecular process has been going on for awhile, he said. If we can detect subtle changes in cells before a tumor has developed, we have a better chance of treating the abnormal cells in their earliest stages of malignancy.

To use the device, a cancer-specific radioactive tracer is injected into the patient's bloodstream. The tracer, called sestamibi, is preferentially absorbed by cancer cells because they have large numbers of mitochondria, the cells' powerhouses. Cancer cells have more mitochondria than normal cells because they are more metabolically active and require more energy to grow and spread.

Next, the camera obtains an image by picking up gamma rays -- high energy photons or units of light -- that are emitted by the radioactive atom attached to sestamibi. The gamma rays easily penetrate the tissue and can be detected non-invasively by a gamma ray camera.

Nuclear imaging tracers like sestamibi show up in both pre-malignant and malignant breast cells as a little light bulb in the middle of a dim space, said Tornai. You really want a tracer to home in on small bits of cancer that may otherwise be too small for other scanners to detect.

Gamma ray tracers such as sestamibi have a short half-life and are broken down quickly by the liver and excreted. The amount of radiation exposure from a single diagnostic procedure is about the same as a year's exposure from the natural background radiation found in the environment, said Tornai, hence, they are relatively safe.

Early studies using existing clinical gamma cameras have been encouraging until now, said Tornai, but they have fallen short of being able to detect cancers smaller than a marble (one centimeter). The existing clinical nuclear medicine cameras are large whole-body scanners that take a single, two-dimensional image that cannot generally take multiple views of the breast. Furthermore, their cumbersome size makes it difficult to obtain a close image of the breast, which is critical to obtaining a complete, three-dimensional picture.

To overcome these limitations, Tornai developed a miniature gamma camera and rotating platform system that allows it to completely and closely orbit a breast, creating a high-resolution, three-dimensional image, called an emission or functional mammotomogram.

In early studies, Tornai and Duke colleagues Caryl Archer and James Bowsher, Ph.D., assistant research professor of radiology, optimized the imaging system using an artificial breast, which they implanted with small spheres that simulate cancerous growths. The spheres ranged from 4 millimeters, about the size of an early cancerous lesion, up to one centimeter. The researchers demonstrated that, in principle, it is possible to locate even a pinhead-sized lesion using the new device.

In clinical practice, the procedure would take 10 to 20 minutes per breast, and should be more comfortable for the patient than mammography, because the breast is not compressed during the procedure. Patients may not even need to remove their bra, since the device never touches the breast, noted Tornai.

As a screening device, functional mammotomography will not replace traditional mammography in most cases, said Tornai, but it could become a useful adjunct device in the mammography clinic.

This technology could potentially be applied to screening women who are at high risk for breast cancer, particularly younger women who have denser breast tissue that X-ray mammography can't easily penetrate, he said.

In addition, Tornai said the device could be useful to monitor the course of chemotherapy or radiation therapy in breast cancer patients because it could detect changes to the cancer cells.

During and after chemotherapy, if you take an X-ray mammogram of the same cancerous tissue, it looks identical to its pre-treatment size, says Tornai. But if you take a nuclear medicine image, the dead tissue doesn't take up the tracer, so you can see if the therapy is having an effect very early on, much sooner than waiting for tumor shrinkage.

Tornai plans to begin imaging studies with patients at Duke in spring 2004, and will begin studies with physicians to determine how small a lesion can actually be detected with the naked eye from the resulting images.

The next step in the development of the device will be combining the nuclear medicine image with a dedicated X-ray computed tomography (CT) scan, which will provide a structural mammotomogram. This information can be overlayed with the functional information on the same three-dimensional image.

One of the criticisms of nuclear medicine is that it is hard for physicians to read the grainy images, Tornai said. For example, an X-ray will exquisitely show the bones in my hand, and as an analogy, a nuclear medicine image will show the ring on my finger which will appear to be floating in space. We need an imager that will show where the ring sits on my hand, and we can achieve that with a dual imager.

Tornai is awaiting patent approval on the new device, including the combination device that overlays X-ray and nuclear medicine images.

The source of this article release: dukemednews.org

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Breast Cancer Fund Examines Causes, Effects Of Early Puberty

A variety of environmental factors could be responsible for early puberty among girls in the U.S., according to a recently released report commissioned by the San Francisco-based Breast Cancer Fund, the Sacramento Bee reports. According to the Bee, U.S. girls as young as age eight are beginning to menstruate, develop breasts, and grow pubic and underarm hair, all of which a few decades ago typically occurred at age 13 or older. Black girls are more likely than other girls to begin puberty at an early age.

The report -- titled The Falling Age of Puberty in U.S. Girls What We Know, What We Need To Know and written by biologist Sandra Steingraber -- examined factors such as obesity, family stress, inactivity, sexual imagery in the media and accidental exposure to chemicals that might prompt early puberty. The report concluded that early puberty can be best described as an ecological disorder resulting from different environmental factors.

According to Steingraber, rising childhood obesity has contributed to early puberty because puberty is triggered by leptin, a hormone produced by body fat. According to the Bee, blacks have higher levels of leptin than other groups. In addition, Steingraber found that exposure to household chemicals also contributes to early puberty. The report also linked early puberty with premature birth, low birthweight, consumption of formula as an infant, and excessive television viewing and media use. Steingraber said some of the shift in puberty age can be attributed to evolutionary factors, such as improved nutrition and infectious disease control.

Girls who have their first menstrual period before age 12 have a 50% higher risk for breast cancer than girls who have their first period at age 16, Steingraber said. Marion Kavanaugh-Lynch, an oncologist and director of the California Breast Cancer Research Program, said girls who menstruate early are exposed to higher levels of estrogen, which can cause breast cancer cells to spread. Early puberty also is linked to emotional and social problems, the report found. Steingraber noted that girls who experience early puberty are at higher risk of depression, early alcohol consumption, substance abuse, early first sexual encounter and unintended pregnancies.

Research, Diagnostic Efforts

According to the Bee, research into the reasons for early puberty is increasing. The Breast Cancer and the Environment Research Center in San Francisco, a federally funded project conducted by scientists at Kaiser Permanente and the University of California-San Francisco, is monitoring environmental exposure in 400 girls over several years to determine predictors of early puberty. In addition, the five-year, state-funded California Environmental Contaminant Biomonitoring Program will measure chemical exposure in blood and urine samples from more than 2,000 California residents, the Bee reports.

Charles Wibbelsman, a pediatrician with Kaiser Permanente and a member of the American Academy of Pediatrics committee on adolescents, said that many pediatricians are adjusting the way that they conduct routine check-ups among girls to identify signs of early puberty. Kavanaugh-Lynch said the report will advance research into early puberty and will allow researchers to think creatively about new areas of study.

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.orgemail . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Breast Cancer Survivors Treated To A Day Of Luxury

Ten special breast cancer patients from Howard County General Hospital will be treated to a day of luxurious spa services for free. Afterward, the patients and their sponsors in Survivors Offering Support (SOS), a program that teams up newly diagnosed breast cancer patients with women who've already undergone treatment, will be treated to a luncheon in their honor.

The women will be getting services including facials, pedicures, massages and reflexology treatments, at the acclaimed Pearl spa in Fulton, Maryland starting at 1000am. The catered luncheon, provided by oZ. Chophouse, will immediately follow the services in the spa's 'Akoya' party room. The women will also receive gifts from other local businesses including i.m.Wine, Bellisimo flowers, Calico Corners, Simply Divine Boutique, and Bra-la-la. Local girl scouts are making cards for the women.

We are delighted that the Pearl has offered to provide our patients with such a wonderful opportunity, says Tina Beerman, Clinical Program Manager of the Center for Breast Care at Howard County General Hospital. The hospital and 'Survivors Offering Support' provide our patients with practical information and emotional support during their journey through breast cancer treatment.

Pearl owner Kassi Buscher says, These women are fighting for their lives every day. It's the least we can do to make this one day extra special for them, to help them relax and feel good. We want to honor these women and the wonderful S.O.S Program that is making such a difference in the battle against Breast Cancer. The Pearl is also donating a portion of their proceeds this month to breast cancer research.

The Pearl spa was recently featured in The Wallstreet Journal, Washingtonian, Baltimore, and Howard Magazines for its exotic treatments, luxurious atmosphere and impeccable service.

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Breast Cancer Risk Higher In Women Living In Cities

Women who live in urban areas have denser breasts, making them more likely to develop breast cancer, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

Women living in cities need to pay more attention to having regular breast screening, said Nicholas M. Perry, M.B.B.S., F.R.C.S., F.R.C.R., director of The London Breast Institute at The Princess Grace Hospital in London, U.K. Currently, women who live in urban areas are known to have lower attendance for breast screening programs than women in outlying areas.

Breast tissue in women may be fatty or glandular or a mixture of both. Women with more glandular breasts show denser tissue on a mammogram and are known to have nearly four times the risk of developing breast cancer than women with fatty breasts. Dr. Perry and colleagues set out to determine if there was a relationship between breast density and area of residence.

The researchers analyzed digital mammograms of 972 women from urban, suburban and rural areas. They discovered that women who lived in London had significantly denser breasts than those living outside the city. The risk of increased density was twice as great in the 45- to 54-year-old group. Age-specific analyses suggested that overall differences by area were more pronounced in women under age 50.

Dr. Perry cautioned that more research is needed to determine the precise reason for this phenomenon, taking into account lifestyle factors, stress, workplace and other possible contributors, but he advised that all women maintain a recommended breast screening regimen, and that women with dense breasts be screened with digital mammography, which is more effective at detecting cancer in dense breast tissue.

Regular breast screening with mammography saves lives, Dr. Perry said. Access to breast screening for women living in cities must be prioritized.

Co-authors are P.C. Allgood, Ph.D., S.W. Duffy, M.D., S.E. Milner, B.Sc., and K. Mokbel, M.D.

Another study presented on Monday (Nov. 26) at RSNA 2007 looked at the influence of the Western lifestyle on breast composition. Miriam Sklair-Levy, M.D., and colleagues from Hadassah Medical Center in Jerusalem compared breast densities of Israeli women and Ethiopian women who immigrated to Israel. The study found that Ethiopian-born women who have immigrated to Israel had significantly lower breast density than did Israeli-born women. In addition, past Ethiopian immigrants who had begun to adopt a Western lifestyle (decreased number of children, change in diet or increased hormone use) had significantly higher breast density than recent immigrants.

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Importance of emotional needs among women with advanced breast cancer

Survey data also underscores dissatisfaction with breast cancer treatment experience, importance of internet as informational resource.

Psychosocial support in women with advanced or metastatic breast cancer (MBC) is as important as the need for disease- and treatment-related information, according to results of a survey presented here today at the 30th Annual San Antonio Breast Cancer Symposium.

The survey of 367 women with advanced breast cancer, which was conducted by Y-ME National Breast Cancer Organization, also underscores the growing importance of the Internet as an information resource for patients. The survey uncovered that patients with MBC feel that the Internet can be utilized more effectively by healthcare professionals and patient advocates.

“Despite the growing recognition of unmet medical, educational, and psychosocial needs among women with advanced breast cancer, there has been little information regarding which of these needs are most important to this patient population,” said Margaret C. Kirk, CEO, Y-ME National Breast Cancer Organization. “This survey identifies psychosocial support as a high priority for women with metastatic breast cancer, one that should be pursued in tandem with the search for more effective and better-tolerated treatments.”

Additionally, survey participants’ responses about treatment-related side effects, fears and anxieties, and the overall treatment experience suggest that healthcare professionals would benefit from more education.

Survey Highlights Negative Experiences with Disease and Treatment

The survey identified a host of challenges among women with MBC. A vast majority (94%) of respondents indicated that they had experienced weakness or fatigue while dealing with their disease; and nearly three-quarters (73%) said they had suffered from depression. Two-thirds (67%) noted they had experienced cognitive disorders associated with treatment (e.g., the so-called “chemo-brain” syndrome); and more than half (51%) complained of sexual dysfunction. When asked what has concerned them most about their treatment, nearly one-third of survey participants mentioned side effects (29%), fear that the treatment would not work (29%) and fear of the unknown (27%). Respondents noted that fatigue (30%) was the most impactful of side effects associated with standard treatment, followed by pain (21%) and hair loss (14%).

When the survey participants were asked who has given them the most support in dealing with MBC, family member (43%) was mentioned most often, followed by caregiver (16%), friend (14%), and medical oncologist (13%). Nearly as many respondents said they get most of their information about MBC from the Internet (39%) as from their doctors (42%), and 86 percent said Web-based MBC education and support materials would be most helpful to them.

The survey uncovered gaps in the treatment of MBC. Twenty-two percent expressed unhappiness with the care they have received for their disease; 73% were not offered entry into a clinical trial at diagnosis; 36% disagreed with the statement that women with MBC have a variety of treatment options available to them; 41% indicated that options were not clear to them at the time of diagnosis; and 52% said their healthcare provider does not offer a variety of treatment options or keep them informed of relevant drug approvals and clinical trials.

The survey also uncovered a strong desire for more patient advocacy groups to focus on MBC, as voiced by 82% of respondents. Nearly half of those polled (47%) expressed a wish for more monetary support in the area of MBC research to extend survival.

“Although the breast cancer advocacy communities have made great strides in developing and disseminating information about metastatic breast cancer, it is clear that we need to do a better job in these areas,” said Kirk. “The survey results should serve as a wake-up call to healthcare professionals and advocacy groups to step up and improve their communication and support to patients, caregivers, and families dealing with this devastating disease.”

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Black Women Have Higher Death Rates From Breast Cancer

Black women in Houston, Texas, have a 45% greater mortality rate from breast cancer than white women, according to a new study, the Houston Chronicle reports (Ackerman, Houston Chronicle, 24).

The study was presented at the Avon Foundation Breast Cancer Forum, which took place this month in Houston. Steve Whitman, director of the -=-->http://www.suhichicago.org/, led the study, which is similar to research he did on black women and breast cancer in Chicago (Avon Foundation release, 25).

According to the Houston study, for every 100,000 women, 40.8 black women and 28.2 white women died from breast cancer in 2004. In 2000, 34.3 black women and 30.4 white women for every 100,000 women died from breast cancer.

Whitman said that the study suggests that the disparity is related to access to care, including mammography and treatment. He added, The racial disparity in breast cancer mortality rates in Houston, like elsewhere, is a symptom of a broken health care system. The system delivers the benefits of recent advances in breast cancer treatment to white women, but not black women.

In response to the study's findings, local health experts are starting a task force, which will study the issue for about a year and then issue recommendations. The task force also will decide whether to expand the study to look at death rates from breast cancer among Asians and Hispanics, according to task force leader Lovell Jones, director of the Center for Research on Minority Health at the University of Texas M.D. Anderson Cancer Center. Jones said, Knowing the city, I expected these sort of figures. I'm more curious about what's accounted for the fluctuations in the rates over the years (Houston Chronicle, 24).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives, and sign up for email delivery at kaisernetwork.orgemail. The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Helping Women Cope With Breast Cancer Diagnosis

There are great racial and socioeconomic disparities that make some women more likely to lose their fight [against breast cancer] than others. This isn't just wrong; it's unthinkable, Hannah Linden and Carey Jackson, both physicians and associate professors of medicine at the University of Washington write in a Seattle Post-Intelligencer opinion piece.

They add, Beating breast cancer isn't a question of luck, but rather a matter of diagnosis and proper treatment. They note that delays in seeking and completing necessary medical care can affect the growth and spread of cancer and lead to poorer outcomes andor increases in treatment cost.

According to Linden and Jackson, In the best of circumstances, the experience of cancer diagnosis, treatment and survivorship is a gauntlet requiring help from many sources at many points in time. They write that many women who are poor or minorities have not had success in dealing with the health system. They suggest that patient navigators can help such women with appointments, paperwork and financial issues, as well as help patients to cope with medication side effects and find other sources of support.

Linden and Jackson note that officials in Washington state are beginning to invest in patient navigation programs, which are crucial to eliminate breast cancer among all women, regardless of race and economic class.

They conclude, Economic realities and cultural bias impact whether a woman lives or dies from this disease. But there are culturally competent alternatives. The current barriers to beating breast cancer are neither unique nor insurmountable (LindenJackson, Seattle Post-Intelligencer, 24).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives, and sign up for email delivery at kaisernetwork.orgemail . The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Breast Cancer More Prevalent In Hispanic Women

Among several U.S. racialethnic groups examined, Hispanic women were found to have the highest prevalence of the cancer-associated gene mutation BRCA1 at 3.5 percent, with Asian Americans having the lowest prevalence (0.5 percent), according to a study in the December 26 issue of JAMA.

Mutations in the tumor suppressor gene BRCA1 confer high risks of breast and ovarian cancer. Average cumulative risk by age 70 years has been estimated at 65 percent for breast cancer and 39 percent for ovarian cancer, according to background information in the article. Although mutations in BRCA1 are rare, they are more frequently present in individuals with multiple relatives having breast or ovarian cancer, early-onset breast cancer, or of Ashkenazi Jewish ancestry. Information on the prevalence of BRCA1 mutation carriers in racialethnic minority populations is limited.

Esther M. John, Ph.D., of the Northern California Cancer Center, Fremont, Calif., and colleagues examined the prevalence of BRCA1 mutations in Hispanic, African American and Asian American female breast cancer patients compared with non-Hispanic white patients with and without Ashkenazi Jewish ancestry. The patients, younger than 65 years at diagnosis, were enrolled at the Northern California site of the Breast Cancer Family Registry (n = 3,181) during the period 1996-2005.

In patients without reported Ashkenazi Jewish ancestry, estimated mutation prevalence was highest in Hispanic patients (3.5 percent), followed by non-Hispanic white patients (2.2 percent), African American patients (1.3 percent), and Asian American patients (0.5 percent). Those with Ashkenazi Jewish ancestry had a prevalence of 8.3 percent. Within each racialethnic group, prevalence estimates decreased with age at diagnosis and were higher in patients who reported a family history of breast or ovarian cancer than in those who did not.

The prevalence of BRCA1 mutations was particularly high in African American patients diagnosed before age 35 years (16.7 percent), compared with young Hispanics (8.9 percent), non-white Hispanics without Ashkenazi Jewish ancestry (7.2 percent), and Asian Americans (2.4 percent).

“The present study included multiple racialethnic groups, therefore allowing direct comparison of carrier prevalence estimates. Since certain mutations may be unique to specific populations, the full spectrum of mutations needs to be determined. Such information may facilitate mutation screening in a clinical setting and is needed to guide resource allocation for genetic testing, genetic counseling, and planning of preventive interventions in all population subgroups,” the authors conclude.
(JAMA. 2007;298(24)2869-2876. Available pre-embargo to the media at www.jamamedia.org)

Editor’s Note Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial Genetic Testing in Diverse Populations - Are Researchers Doing Enough to Get Out the Correct Message

In an accompanying editorial, Dezheng Huo, M.D., Ph.D., and Olufunmilayo I. Olopade, M.D., of the University of Chicago, comment on the findings regarding genetic testing for BRCA1.

“As documented by John et al, more than half of BRCA1 mutation carriers would be detected in female patients with breast cancer whose cancers are likely to be hereditary based on age at diagnosis and family history. The differences in BRCA1 mutation prevalence across populations should be used to more accurately calculate the pretest probability of having a mutation, rather than as evidence against genetic testing in minority populations. While there has been great debate about the role of raceethnicity in health research, clinicians interested in providing patients with personalized assessment of cancer risk must understand the contributions of BRCA1 and BRCA2 mutations in diverse populations, because potential modifying factors particular to patients’ raceethnicity, family history, ancestral country of origin, and environmental factors may work in concert to influence outcomes.”

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Improving Breast Cancer Treatment At Cardiff

Cardiff University research could improve breast cancer treatment for women who become resistant to drugs such as tamoxifen.

While drugs such as tamoxifen have been successful in treating breast cancer, for a significant proportion of sufferers the drugs either fail to work, or after an initial successful response, the patient relapses as the cancer acquires or possesses resistance to the drug.

However researchers from the Welsh School of Pharmacy’s Tenovus Centre for Cancer Research have discovered that inhibiting the activity of a certain protein in the cancer could prevent or even reverse the resistance to tamoxifen. The researchers noticed that when breast cancer cells grown in the laboratory develop resistance to tamoxifen, they show a large increase in the activity of a protein known as Src – and by stopping this activity resistance to tamoxifen can be prevented and even reversed.

Dr Stephen Hiscox of the Welsh School of Pharmacy, who led the research team and has just been appointed as one of the Cancer Research UK Cardiff University Research Fellows, explained “We have previously shown that when breast cancer cells become resistant to medicines such as tamoxifen in the laboratory, they become more aggressive with an invasive behaviour. These are characteristics that can be promoted by Src, a protein which we have recently shown to be more active in tamoxifen-resistant than tamoxifen-sensitive breast cancer cells.”

The collaborative research between Tenovus and AstraZeneca also found that the aggressive, invasive behaviour in the cells could be reduced by treating them with a specific inhibitor of Src activity, AZD0530, which also made the tamoxifen-resistant cells sensitive to tamoxifen again. In addition, the research found that co-treating the cells with a combination of tamoxifen and AZD0530 could actually prevent drug resistance occurring in the first place.

The Src inhibitor AZD0530 developed by AstraZeneca is currently in early clinical trials. If the results seen in the laboratory can be reproduced in the clinic, this approach could offer a substantial clinical benefit to a large number of women with breast cancer, as Professor Robert Nicholson, Director of the Tenovus Centre for Cancer Research, explains “Whilst little is known about the mechanisms used by breast cancers to become resistant to common therapies such as tamoxifen, it remains a significant clinical problem. Therefore the ability to restore sensitivity to therapy, or to even prevent resistance arising in the first place, could be of huge benefit to a large number of breast cancer patients.”

Medical and medical related research and education across the University’s School of Medicine, the School of Biosciences, Welsh School of Pharmacy and other academic schools is making a major contribution to tackling breast cancer.

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A 'Must Read' For Breast Cancer Patients

Patent 7,309,486 issued to NexGen Biomedical discloses a better way of using Genentech's drug Herceptin against breast cancer. The patent discloses that today's practice of concurrent administration of Herceptin with conventional phase specific chemotherapy results in antagonistic action between the two classes of drugs. In later stage cancers, these protocols only increase median survival by several months.

Patent 7,309,486 discloses novel protocols that allow the two classes of chemotherapeutics to function synergistically. The protocols are designed to provide a way of holding the cancer in check indefinitely.

All proliferating cells progress through 4 distinct phases termed G1, S, G2, and M. S-Phase cytotoxics, such as Pfizer's Camptosar or Eli Lilly's Gemzar, are capable of killing virtually all cells that are in the S-Phase, however, in the best case, only around one third of cancer cells are typically in the S-Phase during chemotherapy, explains Mark Zamoyski, the inventor.

The patented protocols boost the number of cells in the S-Phase by exploiting the cancer's unique mutation profile to establish a road block to aggregate a large number of cancer cells at a point prior to the S-Phase, the road block is then removed to allow the wave of cancer cells to enter the S-Phase during the administration time ofthe S-Phase cytotoxic chemotherapy, and then the road block is reestablished to start aggregating surviving cancer cells for the next administration of S-Phase cytotoxic chemotherapy.

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