Testing It Up

A study published in the journal The Lancet Oncology shared that a simple blood test may help save the lives of patients suffering from breast cancer.

The blood test can help doctors diagnose if a patient with early breast cancer is likely to succumb to the disease, or to relapse after treatment. Researchers from the MD Anderson Cancer Center of the University of Texas shared that tumor cells in a blood sample taken at the early stages of breast cancer may accurately predict a patient’s chances for survival.

The researchers said: “The presence of one or more circulating tumor cells (CTCs, in the blood) predicted early recurrence and decreased overall survival.”

The study analyzed data from tests conducted on 302 patients who received treatment at the cancer center between February 2005 and December 2010. The study participants suffered from early stage breast cancer, a phase of the disease where the cancer has not spread to other parts of the body, and had not received chemotherapy.

The analysis indicated that a quarter of the group had CTCs, and of those who had CTCs, one in seven relapsed after treatment, while one in ten died during the test period. On the other hand, those who did not have CTCs had a 3 percent relapse rate and a 2 percent death rate.

A press release that accompanied the study reads: “For patients with a higher concentration of CTCs, the correlation with survival and progression rates was even more dramatic, with 31 percent of these patients dying or relapsing.”

Two reports published in the Annals of Internal Medicine indicate that the benefits of having mammograms may outweigh the risks for women in their 40s who have a higher than average risk of developing breast cancer.

One of the studies, which was conducted by researchers led by Dr. Heidi Nelson of Oregon Health & Science University in Portland, consisted of a review of 66 studies that looked at women’s risk for developing breast cancer based on their family history, weight, drinking and smoking habits, as well as if they had given birth or breastfed.

Based on the study, women who have a mom or sister who have breast cancer or very dense breasts may be twice as likely to develop the disease as well. Dr. Nelson and her team of researchers concluded that knowledge of risk factors associated with breast cancer may assist doctors and patients in coming up with a more personalized screening strategy.

The second study, on the other hand, was led by Nicolien van Ravesteyn from Erasmus Medical Center in Rotterdam, the Netherlands. Some of the researchers actually worked on both studies, including Nelson and van Ravesteyn, and its results mirrored those determined by the first study.

In a commentary accompanying the new reports, Dr. Otis Brawley, Chief Medical Officer at the American Cancer Society, wrote that making screening decisions based on the individual cancer risk of a woman “has the potential to save more lives than our current practice… Risk-based screening can refocus efforts onto the women who are most likely to benefit from screening.”

A false positive mammogram may not necessarily mean that one is out of the woods when it comes to developing breast cancer.

A Danish study indicated that women who had false positive mammograms were more likely to develop breast cancer later in life, when compared against women who had negative mammograms.

The study analyzed data from more than 58,000 women, and was published in the Journal of the National Cancer Institute.

It determined that women who had false positive mammograms (those whose results suggested breast cancer even though there was none) had a 67 percent higher risk of developing breast cancer.

The study authors wrote: “The excess breast cancer risk in women with false-positive tests may be attributable to misclassification of malignancies already present at the baseline assessment … or to a biological susceptibility for developing breast cancer in some women without malignancies at baseline.”

Dr. Susan Love, president of the Dr. Susan Love Research Foundation, shared that women who have a family history of breast cancer are also more likely to have a false positive. She also talked about the decision of a radiologist to order a biopsy after a suspicious mammogram. Dr. Love shared: “It’s so subjective… If you had a mother with breast cancer, the radiologist and … probably you yourself would be more aggressive in following up any slightly suspicious abnormality in a screening mammogram.”

She shared further that cancer risk may be increased by surgery or needle biopsies, which may cause a local inflammatory or wound-healing reaction. The extra radiation from the workup due to the false positive may also increase breast cancer.

As the debate over the significance of breast cancer screening rages on, the results of a new study supports the notion that undergoing screening may do more harm than good, citing, among others, the possibility that false positives may lead to unnecessary surgery for some women.

Women are more likely to be harmed and undergo unnecessary surgery in the first decade of undergoing screening, and that during this time period, the “harms” that a woman may experience offsets the benefits that may be derived from the screening.

The study involves a re-examination of data from the 1986 Forrest report, which triggered the introduction of NHS screening. James Raftery, professor of health technology assessment at the University of Southampton, and his colleague, Maria Chorozoglou, updated the Forrest report by conducting an analysis of the outcome for 100,000 women, aged 50 and above, who are still surviving up to 20 years after undergoing screening for the first time.

An inclusion of the “harms” associated with breast cancer screening, according to the researchers, brought down initial estimates in terms of number of lives saved by half. On average, the new study determined that women were more likely to be harmed in the first few years of screening; the study determined further that women aged 60 to 70 could benefit the most from the screening.

Prof. Raftery shared: “There are lots of women who have had surgery who believe their lives were saved when in fact only around one in ten have had their life saved… There should be a fundamental overhaul of the screening programme – what’s the right time frame and how cost-effective is it? We need trials to look at who is most likely to benefit from surgery and for measuring the levels and duration of the harms from surgery.”

In 2009, the United States Preventive Services Task Force recommended against routine mammograms for women in their 40s, a move that eventually became the subject of debate and controversy. Now, a Canadian task force also arrived at the same recommendation: no routine screening for women of average risk, aged 40 to 49.

The recommendations of the Canadian task force, which were published in the Canadian Medical Association Journal, were based on their assessment of evidence, on a population level. They determined that the risks associated with screening mammograms outweigh the benefits that may be derived from them, for this particular age group.

Popular notion dictated that screening mammograms are important for the early detection of breast cancer, which, in turn, increases one’s chances for survival should one develop the disease.

The task force noted that for women in the 40 to 49-year old age group, breast cancer is a lot rarer. The task force shared further that among that age group, 690 will receive a false positive on a mammogram, while 75 may have an unnecessary biopsy.

The task force recommends, however, that women aged 50 to 74 years undergo mammograms very 2 to 3 years. The current recommendation in Canada is every two years.

Other recommendations from the Canadian task force include a recommendation against MRIs for women of average risk. In addition, they also recommended against the conduct of routine breast self-exams and clinical breast exams for women with no symptoms, as there is said to be no evidence that these procedures help in the reduction of death risk, among others.

Sometimes, the last thing on women’s minds is performing breast self-exams. Constantly overlooking these exams, however, may have consequences for some women, in terms of detecting breast cancer. There is a new smart phone app, though, that will help you remind you of this simple but important task.

The soon-to-be released app called Your Man Reminder will provide ladies with a virtual man of their choice, who will appear on their smart phone to remind women to conduct breast self-exams. Ladies can choose between six “dream men” – from “the boy-next-door” to “the business man” – who appear with cheerful messages such as “show your breast some TLC” (which stands for touch, look, check), and “any man would be lucky to have you.”

The app, which is coming next month, was created by Canadian charity Rethink Breast Cancer.

Tracie Snitker, who works for the public relations term that promotes the app, says that it targets young women to think about breast cancer detection. Snitker shared: “It’s not a lot of fun to remind yourself to do a self exam, and a busy woman has so many reminders in her phone for all kinds of things. With this app, you can have a cute guy to remind you to do it.”

Rethink Breast Cancer is known for doing “provocative” marketing campaigns that stir up controversies.

When asked whether the app will offend women, Snitker answered: “He’s not going to do it for you. It’s about touching yourself, about knowing how your breast feels when it’s normal. So later if there’s a change, you’ll know.”

The free app will be released in October, coinciding with National Breast Cancer Awareness month. It is compatible to both iPhone and Android smart phones, and it will have information on signs and symptoms to be aware of during exams.

Andrea Mitchell, veteran correspondent for NBC, revealed on her MSNBC show “Andrea Mitchell Reports” that she has been diagnosed with breast cancer.

She did say, however, that the malignancy has not spread, and that her prognosis was excellent. “I had planned to be hiking in Wyoming last week,” Mitchell shared. “But instead discovered that I am among the one in eight women in the country – incredibly, one in eight – who have had breast cancer.”

She shared further that the disease was detected during a routine screening, so she is now urging women to undergo screening: “Screening works… Do it.”

The effectiveness of breast cancer screening, specifically mammography, had been called into question in a 2010 study. The study, which was published in the New England Journal of Medicine, categorized a nationwide screening program as only marginally effective: “We conclude that our results supported the evidence that screening mammography reduces the rate of death from breast cancer… However, the magnitude of this benefit seems modest.”

The American Cancer Society (ACS) recommends that women should undergo annual mammograms for as long as they are in good health. Younger women in their 20s and 30s, the ACS said, should have their breasts examined by a doctor every three years; while women aged 40 and older need to undergo the same exam annually.

Mitchell did not share any details as to her treatment, although she is currently working. Based on what other breast cancer patients experience, however, the days ahead may be rather challenging for the 64-year-old correspondent.

A survey conducted by the University of Massachusetts Medical School in Worcester determined that more than 80 percent of women felt that the recommendation against having women under the age of 50 undergo breast cancer screening is unsafe.

Reuters featured the results of the study, and shared the following quote from the article published in the American Journal of Obstetrics and Gynecology: “Indeed, they have been exposed to consistent and high profile media campaigns, endorsed by medicine and a variety of interest groups, that have indoctrinated them into the concepts that mammograms lead to early detection and early detection saves lives.”

Most women, however, overestimate their risk for developing breast cancer.

In late 2009, a group of independent experts funded by the government changed the recommendation regarding screening mammography. The U.S. Preventive Services Task Force (USPSTF) recommended that women should only start undergoing routine screening upon reaching the age of 50. Furthermore, women between the ages of 50 and 74 are advised to undergo mammograms every two years.

The decision to undergo screening mammography among women under the age of 50 is left to the discretion of the individual woman concerned, and her attending physician.

The survey involved the distribution of questionnaires to 247 women in their 40s who underwent annual well-woman exams. Of these respondents, Dr. Autumn Davidson and her colleagues determined that more than eight out of ten women preferred to undergo annual mammograms. They also incorrectly assessed the lifetime risk of developing breast cancer among women in the US at 37 percent; scientists indicate that 12 percent, or one in eight women, will develop breast cancer in their lifetime.

A feature on Bloomberg Businessweek shared the results of a study, which indicated that doctors may be able to predict outcomes for women with breast cancer better, through tissue analysis.

An analysis of what was described as “highways” of connective tissue in breast cancer tumors was conducted by the researchers, according to the feature. They eventually determined that the way collagen fibers are arranged may help in making a diagnosis for a patient, and arrive at a suitable treatment plan. Collagen fibers are the main component of connective tissue.

Serving as senior author for the study is Patricia Keely, an associate professor of cell and regenerative biology at the University of Wisconsin-Madison School of Medicine and Public Health, shared the following through a university news release: “We think the cancer cells start to pull on the collagen and straighten it out, forming a track or highway on which the cells can migrate… We have identified a novel collagen-signature system that may become a very useful addition to the tools clinicians use to determine a breast cancer patient’s prognosis.”

Dr. Priscilla A. Furth, a professor of oncology and medicine at Georgetown University’s Lombardi Comprehensive Cancer Center, commented on the study, describing it as an example of “valid basic research.” Furth, who was not involved in the study, shared: “before any new prognostic test can go into practice it must be extensively validated. This publication is a first step that might trigger additional research to examine the utility of this type of analysis in different settings and by different groups… From the basic science perspective, this is an interesting observation and should trigger additional studies.”

The study was published in the March issue of the American Journal of Pathology.

There is a lot of debate going on regarding when a woman should submit oneself to routine mammograms, along with doubts as to whether the procedure brings as much good as it should.

At this time, the American Cancer Society (ACS) has the following recommendation: “Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.” There have been other groups, however, who are pushing for changing the recommended age to 50.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, was quoted in a feature on Bloomberg Business Week: “I have tremendous difficulty in not recommending an intervention [mammography] that a number of clinical trials suggest is beneficial… That’s where we stand.”

The results of a recently-released Swedish study support the recommendation of the ACS. The study revealed that women in their 40s who regularly undergo mammograms can reduce the risk of dying from breast cancer by 29 percent. The research, touted as one of the largest such studies to date, analyzed data from more than a million women; researchers, however, did not     take into account other potential harms related to screening, such as unnecessary biopsies.

Dr. Daniel Kopans, senior radiologist in the breast imaging division of the Massachusetts General Hospital and a member of the American College of Radiology Breast Imaging Commission, offered the opinion that mammography for women in their 40s saves lives. He said: “The Swedish study, to me, should be the nail in the coffin [of the debate]… This whole business of we don’t know if works for women in their 40s that should end. Randomized controlled trials show a benefit beginning at age 40.” Kopans is also a professor of radiology at Harvard Medical School.