Breast Cancer
Aspirin may slow down breast cancer.
Feb 19th
Scottsdale – A report seen on CBS news says breast cancer patients who take aspirin regularly may be able t cut their risk of dying by 50 percent, according to a study by Harvard Medical School and published Tuesday in the Journal of Clinical Oncology.
Most of the women taking the aspirin to reduce their risk of stroke or cardiac problems may find an additional benefit when it comes to breast cancer recurrence and mortality, according to the study. In the survey, from 1976 to 2006 of more than 4,000 registered nurses showed that women who took aspirin regularly (two to five days a week) cut their risk of having the cancer spread by 60 percent and reduced their risk of dying from breast cancer by 71 percent.
Breast cancers produces inflammatory chemicals when compared to normal breast cells. Lab tests show that aspirin keeps breast tumor cells from growing and invading other tissue. Researchers theorize that aspirin may help control cancer by fighting inflammatory chemical or signal produced by cancer cells.
The medical investigators said more study is needed and they caution that aspirin therapy can thin blood and can cause stomach bleeding or ulcers, even in healthy women.
UC system taking on breast cancer: the creation of the ATHENA Breast Network
Oct 15th
Fight Breast Cancer
Scottsdale – University of California medical centers are putting their heads together in an effort to study breast cancer like it has never been studied before. All UC medical center are participating in an unprecedented statewide collaboration to improve care for breast cancer by designing and testing new research, technology and health care delivery systems. The program is called the ATHENA Breast Health Network, and will initially involve 150,000 women throughout California who will be screened for breast cancer and followed for decades through the five UC medical centers.
“ATHENA is a model of multi-institutional collaboration and demonstrates the enormous potential in shared systems,” said Dr. John D. Stobo and UC senior vice president for health sciences and services. “This is a great example demonstrating that the total of what can be accomplished by UC functioning as a system far exceeds the sum of contributions by the individual campuses. ATHENA represents an unprecedented opportunity to play a leadership role in driving critical changes in health care. The public nature of the UC institutions make them uniquely positioned to study the appropriateness and effectiveness of treatment. It also allows for the applied use of new scientific evidence, much of which has been developed in the UC medical centers, to truly change the delivery of care.”
The plan has a very ambitious goal – to generate a large amount of data that can be used later to improve breast cancer care! All women undergoing screening and treatment will be asked to contribute information about themselves, risk factors they have, health status, and other related lifestyle behaviors, such as diet, tobacco and drug use, environmental factors, gynecological history and family risk.
“The ATHENA Breast Health Network provides a first-time opportunity for the five UC cancer centers to leverage their collective research strengths in tackling important scientific and clinical questions in breast cancer,” said Dr. Dennis Carson the director of the Moores UCSD Cancer Center. This exciting news was reported through the UC San Diego News Report and the UCSD Moores Cancer Center.
After the information is gathered it will be used to help improve treatment but also to target prevention services. The UC system is particularly well-positioned for a project of ATHENA’s magnitude because the medical centers annually screen as many as 80,000 women, and diagnose 2,500 patients with breast cancer.The project is expected to generate a rich collection of data and knowledge that will shape breast cancer care in the way the renowned Framingham heart study changed the care of patients with heart disease.
While ambitious – this type of study has been needed for a long time. I believe that once the data is analyzed- the infromation will have the potential to change the face of breast cancer prevention and treatment.
Menopause, breast tenderness and Hormone Replacement – relationship may imply a higher risk of breast cancer.
Oct 13th
Fight Breast Cancer
Scottsdale – This morning’s Reuters Health section reports the findings of a study of hormone replacement therapy (HRT), post-menoupausal women and the relationship with breast cancer. According to the research, those women whose breasts became tender after taking hormone replacement therapy had nearly twice the risk of developing breast cancer than women who did not develop tenderness of the breasts while on these drugs.
The research published in the Archives of Internal Medicine involved 8,506 patients taking estrogen plus progestin and 8,102 individuals taking placebo pills. The investigators said that breast tenderness may identify women who have a higher risk of developing breast cancer while taking hormone replacement therapy to treat menopause. The study findings only applies to this patient group and not to younger individuals. Overall, more than 16,000 women who took estrogen-plus-progestin as part of the Women’s Health Initiative were analyzed. The research was halted in 2002 when researchers found healthy menopausal women who took the drugs were more likely to develop breast cancer.
“We report that an increase in breast tenderness, easily detected by physicians or patients, identifies a population at particular risk for breast cancer,” Dr. Carolyn Crandall of the University of California Los Angeles. The investigators said that while the findings are intriguing, the exact relationship between breast tenderness and breast cancer risk was not completely clear. Breast tenderness is not an established risk factor for breast cancer.
Doctors currently recommend hormone replacement therapy for women suffering from severe menopause symptoms, but caution that they should use the lowest dose possible for the shortest period of time to minimize risks. “We need to figure out what makes certain women more susceptible to developing breast tenderness during hormone therapy,” Dr. Crandall said.
Based on the data analysis, the research found that women who took hormone treatments had 3-times the risk of developing breast tenderness. Those with breast tenderness after taking the HRT were at 48 percent higher risk of invasive breast cancer than women who took hormone replacement therapy but did not develop tenderness.
“It may be that hormone therapy is causing breast-tissue cells to multiply more rapidly, but the team could not tell that by the study,” Dr. Crandall said.
This report may represent the first evidence in the relationship between breast tenderness and the development of breast cancer in postmenopausal women taking HRT. However, without more research and more more data we cannot make too much of the findings until the evidence is confirmed. In general, breast tenderness is not considered a risk factor for breast cancer. Additionally, the results of this study would only apply to tenderness in this select group of patients.
Based on previous medical studies, we know that estrogen consumption can predispose to certain medical conditions, including breast cancer. It would be a great help to find such a simple risk factor, such as, breast tenderness in identifying which patients should be monitored more closely for the development of breast cancer. We will not be able to use this evidence until more confirmation is obtained.
Girls! Get your mammogram – it might save your life!
Oct 11th
Fight Breast Cancer.
SCOTTSDALE – This week, Reuters reported alarming new findings from clinicians at the Harvard Medical School. The researchers reported that women who never got mammograms were far more likely to die of breast cancer than women who are regularly screened using mammography.
“The most effective method for women to avoid death from breast cancer is to have regular mammographic screening,” said Dr. Blake Cady of the Cambridge Hospital Breast Center and Harvard Medical School in Massachusetts.
The researchers reviewed data on 6,997 Massachusetts breast cancer patients between 1990 and 1997. They separated patients into two groups, those who got regular mammograms and those who did not. They followed their outcomes clinically until 2007 before analyzing the data.
The study found that 75 percent of the women who died of breast cancer never had a mammogram or were diagnosed after their first mammogram. On the other hand, 25 percent of the women they studied who died of breast cancer had received more than one mammogram.
“Women who are in screening programs have only a 4.7 percent mortality. Women who are not screened have a 56 percent mortality,” added Dr. Cady. These numbers represent a very alarming difference. A mammogram is a simple x-ray examination of the breast and is inexpensive and readily available in the U.S. cities. Mammography can detect most breast cancers when the only signs of the disease are minuscule calcium deposits, which would otherwise not be detectable until many months or years.
“That is the same as the overall mortality (56 percent) we used to see in breast cancer up to 1970, prior to the onset of wide mammography screening”, stated Dr. Cady. According to the investigators, it was not clear why some patients did not receive mammograms as part of their regular healthcare. The National Cancer Institute recommends first mammogram beginning at age 40 and then yearly.
In the past, there has been some debate about the value of mammograms. Many recommend that women be screened regularly but a few studies have shown that mammograms may have false positives, in which a woman may have to undergo biopsy for a mammographically detected lesion, which ultimately is found not to be cancer.
Over the years, I have seen patients who resist having a mammogram. In some cases I have declined to perform breast surgery in patients who do not want to obtain a mammogram before routine breast surgery. This study is important because it shows the general value of mammography in improving survival with breast cancer. Not only is it logical to obtain a mammogram before breast surgery in patients over 35 years of age, but it may actually save a life, if early breast cancer is found.
The bottom line is that these findings support the revolutionary effect mammography has had on improving survival from breast cancer.
More women choose to have unaffected breast removed when diagnosed with breast cancer
Oct 10th
Fight Breast Cancer.
Scottsdale – A recent report detailed on Fox News reports that more women undergoing mastectomy for breast cancer are choosing to have the unaffected breast removed at the same time in an effort to reduce the risks of recurrence. The original report which appears in the medical journal Cancer, was formulated using data from New York State hospitals between 1995 and 2005. During that time the prevalence of preventive mastectomy in women with a history of cancer in one breast more than doubled.
While this is an impressive trend, the study showed that just over 4 percent of the women choose the prophylactic option in 2005. That is significant, however, because in 1995 only about 2 percent of women diagnosed with breast cancer chose prophylactic mastectomy.
The senior investigator on the study, Dr. Stephen Edge, said that a controversial issue with prophylactic mastectomy is that there is no evidence that removing the unaffected breast improves long-term survival. It is believed that prophylactic mastectomy likely reduces the chances of breast cancer developing in the second breast.
Dr. Edge did note that among women who are not at risk for genetic cancer (95 percent of all breast cancer patients) the odds of developing cancer in the second breast are between 10 and 20 percent over 20 to 30 years. This is important because many patients can survive breast cancer for that length of time with the newer treatment regimens currently available.
“Women need to be carefully counseled on the issues of the risks of developing a second cancer, and the largely minimal or no impact this may have on their survival,” Edge said. Later he added that, “The large majority of breast cancers are detected early and effectively treated.” The article concluded by saying that women need to consider the uncertain long-term benefits of prophylactic mastectomy and the risk of complications including bleeding, infection and nerve damage.
As a plastic surgeon, I have seen the number of bilateral mastectomies increase over the last few years. The underlying factors are complex, however, many of these patients decide to proceed with breast reconstruction after mastectomy. It is well known that much better symmetry is achieved when both breast are reconstructed than when trying to match a reconstructed breast to a non-reconstructed one. As the options for reconstruction of the breast have improved significantly since 1995 it makes sense to see more patients choosing these techniques. In particular, the autologous techniques which use the person’s own tissue can create some of the most-natural looking breast reconstructions available.
Advances in using these techniques have lowered the risks for may patients. Since only 4% of the study population had the prophylactic mastectomy, it makes me believe that plastic surgery education and the reconstructive options are not as widely known.
Exercise improves well-being after breast cancer
Oct 9th
SCOTTSDALE – Researchers report in the American Journal of Epidemiology that among Chinese women diagnosed with breast cancer, those reporting even low levels of regular exercise were more likely to report better physical, mental, and social well-being than those reporting no exercise. The study was carried out by Dr. Xiaoli Chen of Vanderbilt University Medical Center in Nashville, Tennessee.
According to the study, the women who exercised at levels recommended by the U.S. Department of Health and Human Services fared best, reporting the highest capacity for daily living and work or study, less distress, better body image, and higher quality relationships. Additionally, the benefits of exercise were still evident 36 months after breast cancer diagnosis, Chen noted via email to Reuters Health.
Recommended exercise include taking about a 45-minute walk 3 days a week, or a 20-minute brisk walk daily, yoga for about 40 minutes 3 times a week or 20 minutes daily, and any aerobic exercise for about 30 minutes 3 times a week or 12 minutes daily.
These positive findings provide strong evidence that regular exercise plays an important role in improving quality of life for breast cancer survivors, the researchers concluded.
Tiny computer chip may help detect breast and other cancers
Oct 8th
Fight Breast Cancer.
Scottsdale – Canadian researchers have developed a tiny computer that may allow doctors to check a woman’s breast cancer risk. The investigators said the pocket sized device can use just droplets of blood or breast tissue to measure the levels of estrogen. These are far smaller samples than used with conventional methods which can quickly screen breast cancer risk (World News). The diagnosis can be made via less invasive methods and the manufacture of the device is less costly than other diagnostic methods. The chip is also being studied to diagnose other types of cancers.
The University of Toronto investigators said, “the new device is compatible with extremely small samples – around 1,ooo times smaller than the amount needed for conventional analysis”. Dr. Mousa of the University of Toronto, who also worked on the study said the device can also be used to check on the effectiveness of breast cancer drugs (Reuters).
While the device is experimental, it is estimated that the technology will be available within the next 5 years. Such a device could be come a “pocket” diagnostic tool that can be transported and utilized with greater ease. It is exciting to see the future development of such technology that can reduce and simplify the diagnosis of complicated medical conditions (model used in illustration).
Perforator flap breast reconstruction may offer more options for patients.
Sep 2nd
Fight Breast Cancer.
Scottsdale – An article in the September (2009) issue of Plastic and Reconstructive Surgery, suggests that a relatively new technique, using perforator flaps, can offer patients with difficult reconstructive scenarios better results after breast cancer treatment. The article includes an overall experience with almost 4000 breast flaps performed for breast reconstruction. The success rate was 99 percent. The researchers concluded that perforator flap breast reconstruction is an accepted surgical option for breast cancer patients electing to restore their body image after mastectomy.
A “perforator flap” is quite different from traditional tissue flaps used in plastic surgery. Previously, tissue flaps would depend on oxygen and nutrition derived via the blood vessels in muscles and fascias, called musculocutaneous or fasciocutaneous flaps. While use of these techniques is important, transfer of the tissue would inevitably removed the underlying muscle or fascia from the donor region for good. The perforator tissue flaps only use the blood vessels that penetrate muscle and fascia and supply oxygen and nutrition to the skin and fat tissue being harvested. Perforator flaps allow the reconstructive surgeon to provide tissue while preserving underlying muscular structures, such as the rectus muscles of the abdominal wall, seen with dissection of the Deep Inferior Epigastric Perforator flap. The muscle can left intact, while the tissue for breast reconstruction, the skin and fat, is transferred to reconstruct the breast.
With the introduction of the deep inferior epigastric perforator flap, microsurgical techniques have evolved to support a 99 percent success rate for a variety of flaps with donor sites that include the abdomen, buttock, thigh, and trunk. With this experience, the authors are tackling more difficult cases and scenarios. They concluded that the current trends for the use of perforator flaps suggest an application of these techniques in patients previously felt to be unacceptable surgical candidates with a focus on safety, aesthetics, and increased sensitization. Moreover, recent experience highlights the use of perforator flaps as a proven solution for patients who have experienced failed breast implant-based reconstructions or those requiring irradiation in the treatment of breast carcinoma.
