Re: BCO NEWS-HIGHLIGHTS FROM 2007 SAN ANTONIO BREAST CANCER CONFERENCE

December 29, 2007

> HIGHLIGHTS FROM 2007 SAN ANTONIO BREAST CANCER CONFERENCE

>

> Vitamin D Supplementation Reduces Fatigue and Muscle Pain in Women With

> Early-Stage Breast Cancer: Presented at SABCS [Doctor's Guide]

> [NOTE: For the full article, please follow the supplied link.]

> SAN ANTONIO, TX- December 17, 2007 - Treatment of low levels of vitamin D in

> women with early stage breast cancer appears to reduce fatigue and muscle

> pain associated with aromatase inhibitor therapy, researchers reported here at

> the 30th San Breast Cancer Symposium (SABCS).

> The preliminary results involving 40 women out of planned enrollment

> of 60 women were presented in a poster presentation here on December 16 by

> Qaram Khan, MD, Assistant Professor of Hematology/Oncology, University of

Kansas

> Medical Center, Kansas City, Kansas. Although the study showed that

> vitamin D insufficiency was already present in 75% of women at the start of

> adjuvant aromatase inhibitor therapy, when vitamin D supplementation was added

to

> treatment, there was a decrease in fatigue and muscle pain, Dr. Khan

> reported.

> Men Unaware of Their Risk of Cancer When Female Family Members Test Positive

> for Cancer-Causing Gene Mutation [Fox Chase Cancer Center] SAN ANTONIO (Dec.

> 2007)

> Men whose mothers, sisters or daughters test positive for a

> cancer-causing gene mutation also have an increased risk of developing the

disease but

> are unaware of that risk. That is the conclusion of a study at Fox Chase

> Cancer Center exploring how families communicate genetic test results.

> Like their female relatives, fathers, sons or brothers can also harbor

> a mutation in the BRCA 1 or 2 genes. Male carriers of these mutations, more

> commonly called the " breast cancer genes, " face a 14 percent lifetime risk of

> developing prostate cancer as well as a 6 percent lifetime risk of developing

> breast cancer.

> " Despite these health implications, we have found a lack of

> understanding of genetic test results among men in these families, " said

B. Daly,

> M.D., Ph.D., senior vice president for population science at Fox Chase and

> lead author of the new research presented at the San Breast Cancer

> Symposium today.

> Daly and her colleagues interviewed 24 men, each with a first-degree

> female relative who tested positive for having a BRCA1 or BRCA2 mutation. The

> women reported telling the results of their genetic test result to the male

> relative in the study, though only 18 of the men remember receiving the

> results.

> Daly said what they learned demonstrates a level of cognitive and

> emotional distance that men experience from the genetic testing process.

> Nearly half of the men (seven) who remembered receiving results did not

> believe that the test results increased their own risk of cancer. Only five

> (28 percent) could correctly identify their chance of being a mutation

> carrier.

> " We devote a significant amount of time learning how best to

> communicate genetic test results to women, but this study shows we also need

to help

> them communicate the information to their male family members who may be

> impacted by the test results, " concluded Daly.

> Fourteen of the 18 men who recalled receiving the results expressed

> some level of concern about the meaning of the test result, but most (11)

> directed their concern toward other family members, primarily daughters and

> sisters.

> " Based on the responses, we were not surprised to learn that the level

> of interest in genetic testing was relatively low. Of the six men who did

> express interest, half said they'd do it for their children's sake. "

> Even Tiny Breast Tumors Can Be Aggressive and May Require Maximum Therapy [

> Eureka News Service] SAN ANTONIO

> Breast tumors that are 1 centimeter in size or smaller - no more than

> 0.4 inch in length -can still be very aggressive and may require more

> intensive therapy than is routinely offered today, say researchers at Mayo

Clinic in

> ville, Fla.

> The study, which is being presented at the San Breast Cancer

> Symposium, is one of the few that has looked at outcomes of women who have

tiny

> tumors that have not spread to the lymph nodes. The findings suggest that

> outcome of two types of breast cancer ? those classified as HER2 positive

> (HER2+) and triple negative ? may not depend on size alone.

> " This is a small study and so we can't make treatment recommendations

> from it, but it appears that biology and not only size matters when it comes

> to selecting therapy for small, invasive tumors, " says the study's lead

> researcher, Surabhi Amar, M.D., a fellow in Hematology/Oncology at Mayo Clinic

in

> ville.

> Currently, there are no definitive treatment guidelines for tumors less

> than 1 centimeter in size because clinical trials are usually conducted on

> women whose tumors are larger or are associated with lymph node involvement,

> Dr. Amar says. " We just don't have extensive data on tumors this small, so

> treatment becomes a matter of physician discretion. "

> Researchers at all three Mayo sites - ville; sdale, Ariz.;

> and Rochester, Minn. ? participated in the study, which examined 401 women

> who were treated for breast cancer between 2001 and 2005 at the breast cancer

> clinics in ville and sdale.

> The vast majority (87 percent, or 350 women) had tumors that were

> classified as ER/PR positive and HER2 negative (in short, HER2

negative/ER/PR+).

> Twenty-seven women (6.7 percent) had tumors that were HER2+ and 24 patients

> (5.9 percent) were diagnosed with triple negative cancer ? that is, ER/PR

> negative and HER2 negative. These classifications refer to receptors present

on

> the outside of the tumor cell that are fueling growth, and cancer that is

> ER/PR+ is considered the least aggressive of the three categories. Generally,

> studies have shown that in all patients diagnosed with breast cancer, 15 to 20

> percent of breast cancers are HER2+ and about 10 to 15 percent are triple

> negative.

> Patients were followed for an average of almost three years, and so far

> researchers have data on all patients with HER2+ and triple negative cancers

> and on 219 women with HER2 negative/ER/PR+ cancer. Researchers found that:

> There were many more grade 2 and grade 3 tumors in women with the two rarer

> subtypes ? 92 percent in HER2+ cancer and 91 percent in triple negative

> cancer ? compared to HER2 negative/ER/PR+ cancer (36 percent). Tumors are

graded

> 1-3, and higher grade tumors are more likely to grow faster and be more

> difficult to treat than lower grade tumors.

> Cancer came back more frequently in HER2+ tumors (7.4 percent of patients

> relapsed) and triple negative cancers (12.5 percent), compared to HER2

> negative/ER/PR+ cancer (1.3 percent).

> Although the overall outcome of these small, lymph-node-negative tumors was

> excellent (overall survival 97.4 percent, disease free survival 95.1

> percent), these outcomes were different in the three subgroups studied. The

death

> rate was higher in triple negative breast cancer: there was one death in the

24

> patients with triple negative tumors, none in the HER2+ group of 27 women,

> and one death related to relapse in 219 women with HER2 negative/ER/PR+

cancer.

> Although only small numbers of women have the rarer cancer subtypes included

> in this study, the findings suggest that women with HER2+ and triple

> negative tumors should receive as much treatment as possible in order to

prevent

> cancer relapse, Dr. Amar says. Researchers found that only 35 percent of women

> with triple negative cancer were treated with adjuvant chemotherapy

> (chemotherapy after surgery) despite the higher grade of the tumors.

" Chemotherapy

> may not work as well as we would like in these tumors, but, still, physicians

> who treat patients with triple negative cancer should be aware of the higher

> risk of relapse, even if tumors are quite small, " she says. Adjuvant

> chemotherapy was offered to 28 percent of patients with HER2+ tumors, and only

4

> percent received the targeted therapy Herceptin, which has been designed

> specifically to treat this class of tumors. " Should Herceptin be offered to

such

> small node-negative tumors? There is not enough data currently to answer this

> question, " Dr. Amar says. " But this study definitely highlights the fact that

> HER2 positive tumors, even if very small, may warrant more aggressive

> therapy. "

> Only 3.9 percent of patients with HER2 neg/ER/PR+ cancer were treated

> with chemotherapy. " So although the rates of adjuvant chemotherapy use were

> significantly higher in the HER2+ and triple negative subgroups, these groups

> still showed a higher relapse rate, " she says. The study's senior investigator

> is Edith A. , M.D., director of Mayo Clinic's Multidisciplinary Breast

> Clinic in ville. Other researchers contributing to the study include

> Ann E. McCullough, M.D.; Xochiquetzal J. Geiger, M.D.; B. McNeil,

> Ph.D; Winston Tan, M.D.; E. Coppola; Beiyun Chen, M.D.; and Judy C.

Boughey,

> M.D.

> Drug May Reduce Breast Cancer Recurrence [Eureka News Service]

> The drug anastrozole reduced the risk of breast cancer recurrence among

> postmenopausal women who took it for three years following treatment with

> tamoxifen.

> A previous clinical trial showed that breast cancer patients who were

> still disease-free after taking tamoxifen for five years had their risk of

> recurrence further reduced if they received five additional years of treatment

> with the drug letrozole. Both anastrozole and letrozole are in the same class

> of drugs, known as aromatase inhibitors.

> Raimund Jakesz, M.D., of Vienna Medical University and colleagues

> conducted a similar trial-the Austrian Breast and Colorectal Cancer Study

Group

> trial-by randomly assigning breast cancer patients who had taken five years of

> tamoxifen to receive either three years of anastrozole or no further

> treatment.

> After more than five years of follow-up, women who received anastrozole

> had a 38 percent reduction in the risk of recurrence compared with women who

> received no further treatment, but there was no difference in overall

> survival between the two groups. No unexpected side effects occurred in these

> women.

> " The more manageable side effect profile of anastrozole compared with

> tamoxifen may allow the duration of adjuvant treatment to extend beyond the

> 5-year period recommended for tamoxifen, " the authors write.

> In an accompanying editorial, Tatiana Prowell, M.D., and Vered Stearns,

> M.D., of s Hopkins University School of Medicine in Baltimore compare

> this trial with similar breast cancer trials of aromatase inhibitors and

> discuss the factors that are important for deciding which drugs to give

patients

> and for how long.

> " Results: from both completed and ongoing studies should not only help

> to identify women who can safely forego adjuvant therapy as well as those who

> are best treated with short-term and long-term adjuvant hormone therapy but

> also provide a rationale for the selection of the most appropriate drug or

> drugs to incorporate in adjuvant therapy, " the editorialists write.

> Patients More Likely to be Diagnosed with Cancer Soon after Blood

> Transfusions [Eureka News Service]

> Blood transfusion recipients have a slightly increased risk of cancer in

> the months immediately after the transfusion, but this may be due to the

> need for blood transfusions in patients with undiagnosed cancer.

> Some researchers have speculated that blood transfusions could increase

> the recipient's risk of cancer through transmission of biologic agents or

> effects on the immune system. To investigate this, Henrik Hjalgrim, M.D.,

> Ph.D., of Statens Serum Institut in Copenhagen and colleagues identified

nearly

> 890,000 individuals who were cancer-free when they received blood transfusions

> after 1968 in Sweden and Denmark. The researchers tracked the patients to

> determine whether they were at increased risk of subsequent cancer.

> Among this group, 80,990 cancers were diagnosed, whereas only 55,788

> cancers were expected. During the first six months after a transfusion,

> patients had more than a fivefold increase in overall cancer risk compared

with the

> general population, but after this period, the risk declined rapidly to

> levels approaching those of the general population .

> " There has been speculation that blood transfusions promote tumor

> growth and this could precipitate incipient cancers. However, we speculate

that

> other mechanisms unrelated to blood transfusion could account for the observed

> increased incidence of cancer at early times after blood transfusion, " the

> authors write.

> ______________________________________________________

> Recurrence Score Assay Predicts Adjuvant Therapy Benefit in Women With

> Node-Positive, ER-Positive Breast Cancer

>

http://clinicaloptions.com/Oncology/Conference%20Coverage/Breast%20Cancer%20Dec%\

202007/Tracks/Prognosis/Capsules/10.aspx

> According to the results of a study presented at the 2007 San

> Breast Cancer Symposium, the Oncotype DX? test may help guide chemotherapy

> decisions among women with node-positive, estrogen receptor-positive breast

> cancer.

> Although chemotherapy is recommended for many women with early-stage

> breast cancer, the benefit of chemotherapy varies. Identifying in advance

those

> women who are most likely to benefit from chemotherapy may allow for more

> individualized treatment. This would allow women who are unlikely to benefit

> from chemotherapy to avoid the toxic effects of treatment.

> Oncotype DX is a genomic test that predicts the likelihood of a cancer

> recurrence, the likelihood of benefit from chemotherapy, and the likelihood

> of survival in patients with newly diagnosed breast cancer that has not spread

> to their lymph nodes (node-negative) and is estrogen receptor (ER)-positive.

> Oncotype DX evaluates the activity of 21 genes from a sample of the

> patient?s cancer to determine the patient?s Recurrence Score. The Recurrence

> Score ranges from 0 to 100, with a higher score indicating a greater risk of

> recurrence.

> In addition to its established role among women with node-negative

> breast cancer, Oncotype DX may also help predict recurrence risk and

chemotherapy

> benefit among women with node-positive breast cancer.

> To explore the use of Oncotype DX among postmenopausal women with

> node-positive, ER-positive breast cancer, researchers evaluated information

from

> a Phase III clinical trial. Information was available for 367 patients; 148

> patients had been treated with tamoxifen alone, and 219 had been treated with

> chemotherapy plus tamoxifen.

> Forty percent of the study participants were classified as low risk

> (Recurrence Score less than 18), 28% were classified as intermediate risk

> (Recurrence Score 18-30), and 32% were classified as high-risk (Recurrence

Score 31

> or higher).

> In the women treated with tamoxifen alone, higher Recurrence Scores

> were linked with worse disease-free survival.

> Among women with a low Recurrence Score, disease-free and overall

> survival were not significantly improved by the addition of chemotherapy.

Ten-year

> disease-free survival was 60% among women treated with tamoxifen alone and

> 64% among women treated with chemotherapy plus tamoxifen.

> Among women with a high Recurrence Score, disease-free and overall

> survival were significantly improved by the addition of chemotherapy. Ten-year

> disease-free survival was 43% among women treated with tamoxifen alone and 55%

> among women treated with chemotherapy plus tamoxifen.

> These results suggest that Oncotype DX may help guide decisions about

> the need for chemotherapy among patients with node-positive, ER-positive

> breast cancer. The addition of chemotherapy significantly improved outcomes

among

> women with a high Recurrence Score. Furthermore, the researchers note: A low

> [Recurrence Score] may define a group of women with positive nodes who do not

> appear to benefit from anthracyline-based adjuvant chemotherapy.

>

> Reference: Albain K, Barlow W, Shak S et al. Prognostic and predictive value

> of the 21-gene recurrence score assay in postmenopausal, node-positive,

> ER-positive breast cancer (S8814,INT0100). Presented at the 30th Annual San

> Breast Cancer Symposium. San , TX, December 13-16, 2007.

Abstract

> #10.

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December 29, 2007