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Herckleperckle
Member
11-20-2003
| Thursday, July 06, 2006 - 11:40 pm
Source: breastcancer.org Invasive Ductal Carcinoma (IDC) Invasive ductal carcinoma, or IDC (also called 'infiltrating ductal carcinoma'), accounts for about 80% of all breast cancers. Invasive means that it has "invaded" or spread to the surrounding tissues. It is ductal because the cancer began in the milk ducts—which are the "pipes" that bring milk from the lobules to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs—such as breast tissue.
Normal breast with invasive ductal carcinoma (IDC) in an enlarged cross-section of the duct Breast profile: A Ducts B Lobules C Dilated section of duct to hold milk D Nipple E fat F pectoralis major muscle G Chest wall/rib cage Enlargement A Normal duct cell B Ductal cancer cells breaking through the basement membrane. C Basement membrane
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Herckleperckle
Member
11-20-2003
| Friday, November 03, 2006 - 4:57 pm
Source: Ivanhoe.com Reported November 2, 2006 Birth Control ups Breast Cancer Risk By Vivian Richardson, Ivanhoe Health Correspondent ORLANDO, Fla. (Ivanhoe Newswire) -- Premenopausal women who take oral contraceptives have an increased risk of breast cancer, according to a new analysis of a decade of research. Lead author Chris Kahlenborn, M.D., from Altoona Hospital in Altoona, Penn., extracted data from 34 studies to come up with his findings. He told Ivanhoe 21 out of 23 retrospective studies suggested women who took oral birth control before having their first child have a 44-percent increased risk of developing breast cancer. "What's scary about is that no one has really heard about it until now, and it's been in the literature for the last decade," said Dr. Kahlenborn, who has also written about the link between abortion and oral contraceptives. The estimated risk for breast cancer in the general population is about one in eight over a lifetime, according to the National Cancer Institute. A 44-percent increase of this risk would equal out to about one in five, but Dr. Kahlenborn says it's too soon to judge whether the increased risk associated with oral contraceptives will last over a lifetime. Dr. Kahlenborn says many women do not know about all the risks associated with hormonal birth control, and the medical community is partly to blame. "There's tremendous vested interest -- drug companies with a lot of money, government agencies who give a lot of money for contraception. It doesn't make people look good when a study like this comes out," he said. Length of contraceptive use did not have an affect on the risk level for women who had not had children yet. Among women who have had children, however, use of oral contraceptives for more than four years did increase their risk over those who used them for a shorter duration. The increased risk of breast cancer is probably the same or higher with other forms of hormonal birth control, like the patch, rings, or IUDs with hormones, according to Dr. Kahlenborn. "I would expect a higher risk, but a lot of these things just came out five years ago. And what the companies will say is there is not much increased risk because it takes 40 years," he said. "Like with the pill, we're hearing about this now? This was invented in 1960, and here we are in 2006, and that's 46 years to hear about this?" Dr. Kahlenborn is an internist and doesn't usually work on family planning with his patients. He does, however, recommend the Billings method when his patients ask. This method is based on changes in cervical mucus when a woman is fertile. When women recognize a change in their natural lubrication, they know they are close to ovulation and it's possible they will conceive if they have sex. In an editorial accompanying Dr. Kahlenborn's study, James Cerhan, M.D., from the Mayo Clinic of Epidemiology in Rochester, Minn., raises a few questions about this research. While he agrees the evidence shows there is some kind of link between breast cancer and contraceptives, he writes all risks and benefits of oral contraceptives must be weighed against one another. SOURCE: Ivanhoe interview with Chris Kahlenborn, M.D., Altoona Hospital, Altoona, Penn.; Mayo Clinic Proceedings, 2006;81:1290-1302:1287-2189
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Herckleperckle
Member
11-20-2003
| Sunday, November 19, 2006 - 12:04 pm
Source: Ivanhoe.com Reported November 15, 2006 Red Meat Raises Risk for Breast Cancer By Lucy Williams, Ivanhoe Health Correspondent ORLANDO, Fla. (Ivanhoe Newswire) -- If you're a woman, you may want to trade your burger for chicken or fish. Red meat consumption could put premenopausal women at risk for hormone receptor-positive breast cancer, reveals a new study. "There was a two-fold increase for a woman who ate more than one-and-a-half servings of red meat per day compared to those who ate less than three servings of red meat per week," study author Eunyoung Cho, Sc.D., of Brigham and Women's Hospital and Harvard Medical School, told Ivanhoe. Researchers reviewed diets of 90,659 premenopausal women who participated in the Nurses' Health Study II between 1991 and 2003. Participants completed food-frequency questionnaires and reported incidence of breast cancer. During the 12 years following the initial survey, women who reported the highest intake of red meat had the highest risk of developing hormone receptor-positive breast cancer. Breast cancer is classified as hormone receptor-positive if estrogen and progesterone can bind to surface proteins on the tumor. Researchers are unable to precisely determine why red meat is linked to higher cancer incidence. Dr. Cho said several components of red meat could contribute to higher cancer risk, including: * Cancer-causing chemicals in cooked or processed red meat * Growth hormones given to cattle * Iron in red meat Further research is needed to determine which, if any, of these are responsible for the increased risk of cancer. Dr. Cho said women should not reduce red meat consumption simply because of this study, but there are other benefits of eating less red meat. "Red meat has been associated with other chronic diseases, including colorectal cancer, so I think our study provides another reason for a woman to reduce red meat intake," she said. SOURCE: Ivanhoe interview with Eunyoung Cho, Sc.D., Brigham and Women's Hospital and Harvard Medical School; Archives of Internal Medicine, 2006;166:2253-2259
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Herckleperckle
Member
11-20-2003
| Sunday, November 19, 2006 - 1:01 pm
Source: Ivanhoe.com Reported November 10, 2006 Reducing Breast Cancer Risk in Offspring (Ivanhoe Newswire) -- A new study reveals eating whole wheat during pregnancy could reduce the risk of breast cancer. The research was done in rats, but researchers say the results suggest it might be beneficial for pregnant women to try to include whole wheat in their diets. Previous research has suggested daughters of mothers who ate a high-fat diet were at a greater risk of breast cancer. This new study, done at Georgetown University in Washington, D.C., looked at what dietary factors could reduce the risk of breast cancer in offspring. For the study, investigators fed rats a diet with 6 percent fiber from whole wheat flour, oat flour, defatted flax flour or cellulose. The cellulose was used as a control. The offspring were given a breast cancer inducing chemical. Researchers report the rats that had been fed whole wheat were less likely to develop breast tumors. They also found the rats given defatted flax flour were at an increased cancer risk. The oat flour had no effect. Researchers say it appears whole wheat somehow improves the animals' ability to repair DNA damage. SOURCE: International Journal of Cancer, 2006;119:2279-2286
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Herckleperckle
Member
11-20-2003
| Sunday, November 19, 2006 - 2:21 pm
Ivanhoe.com Reported November 9, 2006 Breast Cancer Risk for Younger (<40) Black Women (Ivanhoe Newswire) -- There has been an overall decline in the rate of invasive breast cancer, but the rate has not declined in young black women, according to new research. Researchers studied the changed in breast cancer rates in the United States between 1975 and 2002. In 2006, breast cancer will account for nearly one out of every three cancer diagnoses in women in the United States, according to the American Cancer Society. White women have the highest overall breast cancer incidence rates when compared to all other ethnic groups. However, a closer look at the figures reveals black women younger than 40 have an even higher incidence of breast cancer and a higher rate of death than white women. Researchers from the University of Pittsburgh Cancer Institute (UPCI) Center of Environmental Oncology analyzed breast cancer rates over 27 years. They report the chance of getting breast cancer is about 21-percent higher in white women and 41-percent higher in black women compared to previous generations. Study authors hypothesize this increased incidence is because of better detection. But why are young African American women at such a greater risk of breast cancer? Study authors are now researching if environmental factors could play a role. Researchers point out that many black women may use personal care products that contain estrogen and other hormone-mimicking compounds. They suggest this could be involved with the development of breast cancer. In their paper, researchers call for public disclosure by manufacturers of personal care products so research can move forward. SOURCE: The American Public Health Association Annual Meeting in Boston, Nov. 4-8, 2006
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Herckleperckle
Member
11-20-2003
| Sunday, November 19, 2006 - 3:02 pm
Source: Ivanhoe.com Reported November 7, 2006 Breast Cancer Return Gauged by Computer Tool (Ivanhoe Newswire) -- A new computer tool may soon be helping doctors determine which women are most likely to see a return of their breast cancer within 10 years. The tool might also be used to identify women who could benefit from radiation therapy following standard surgery to remove their cancer. The tool was developed by researchers at Tufts-New England Medical Center in Boston to assess future cancer risk in the same breast and the need for radiation therapy among women with early stage breast cancer who are initially treated with a lumpectomy. The tool takes multiple factors into consideration, like the woman's age, the size and grade of the tumor, whether or not the lymphatic system is affected, and whether or not the woman has undergone chemotherapy or hormone therapy. "Our tool provides physicians with information regarding the risk of breast cancer returning in the same breast for any individual patient, which can then help them evaluate the potential benefit of additional treatments needed to cure the cancer, including radiation therapy," reports study author Mona Sanghani, M.D. While Dr. Sanghani and her fellow investigators emphasize more study will be needed before their computerized tool is put into widespread practice, they believe it holds promise in guiding many of the tricky decisions that must be made following a diagnosis of breast cancer. SOURCE: Presented at the American Society for Therapeutic Radiology and Oncology's 48th Annual Meeting in Philadelphia, Nov. 5-9, 2006
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Herckleperckle
Member
11-20-2003
| Sunday, November 19, 2006 - 10:33 pm
Source: Ivanhoe.com Reported August 8, 2006 Note: This article is heavy on the medical jargon, so not an easy read. But there is good news here. Better Breast Cancer Treatment In-Depth Doctor's Interview Rebecca Moroose, M.D., explains a new drug combination for advanced breast cancer that is just as effective as chemotherapy but without the side effects. Ivanhoe Broadcast News Transcript with Rebecca Moroose, M.D., Oncologist, Florida Hospital Cancer Institute, Orlando, Florida What are the two drugs you are studying? Dr. Moroose: The first drug is Herceptin (trastuzumab) and the second is Avastin (bevacizumab). Why are you studying these drugs? Dr. Moroose: In the late 1980s and early 1990s, some scientists at UCLA discovered there were targets on cancer cells that not only played an important role in making the cancer more aggressive but also made an opportunity for targeting those proteins on the cancer cells as part of therapeutic intervention. So based on the scientific information then, researchers developed monoclonal antibodies that can target those important proteins on cancer cells. The first one that received an FDA label for treating breast cancer was Herceptin. About 20 percent or 30 percent of patients with breast cancer have a very aggressive sub-type, and it’s made aggressive because it has that protein expressed on its surface due to over-expression of genes inside the cell that make the cell grow more rapidly. This makes the cell resistant to standard treatment and significantly impacts the patients prognosis. So Herceptin isn’t used for all breast cancer patients? Dr. Moroose: No. Only those who have this specific target. And where does Avastin fit in? Dr. Moroose: The second drug that’s being studied is a drug that has FDA approval for other diseases but not for breast cancer. Again back to the scientist laboratory, it was shown that in patients who had every expression of HER2neu, the protein that is targeted by Herceptin, they were found to have higher levels of a protein that stimulated the growth of new blood vessels to the tumor and actually gave the tumor more nourishment and gave the tumor a highway so that it could spread through the body. So the second drug we’re studying targets the protein that stimulates blood vessel growth into the tumor. That process is called angiogenesis. The factor that is being targeted is vascular endothelial growth factor. It’s a protein that stimulates growth of blood vessels. So this study is not just targeting one protein, it’s targeting two proteins with two different antibodies. How do the two drugs work together? Dr. Moroose: They handle two realms of the cancer cells' biology. Not just the protein that stimulates the cancer cells to grow more rapidly and to resist chemotherapy but the protein that regulates blood vessel growth. So the drug combo hits both ends of the biology of the cancer cell. We know from experience you can use chemotherapy drugs and monoclonal antibodies, and it can work very well for a time being but then cells learn how to get around the treatment and start to escape the effectiveness of treatment. So by treating with two agents there may be a better probability of short-and long-term gain. How many breast cancer patients would be candidates for this therapy? Dr. Moroose: About 20 percent to 30 percent of patients with breast cancer have amplification of a gene that causes this abnormal protein HER2. That means extra copies are made in the cancer cell, and that leads to extra production of protein on the surface of the cell. This extra protein actually stimulates the cells to grow more rapidly, to resist chemotherapy, and to make the prognosis of the patient much worse. Those patients who have over-amplification of this gene have now been shown to have more stimulation of the development of blood vessels to grow into the tumor, nourish the tumor, and allow the tumor to spread. So part of the whole biology of what we learned about amplification of HER2 has now led to better understanding of why certain tumors have more blood vessels growing into them. The beauty of this trial is it’s going to use a double whammy approach to these aggressive cancers but will not have the same toxicity profile as what we would typically offer that type of patient, which would be very aggressive chemotherapy along with Herceptin. How effective is chemotherapy and Herceptin for these patients? Dr. Moroose: Traditionally, patients who have HER2 over-expressing tumors develop advanced disease, what we call metastatic disease, and they will often initially receive a very good response from chemotherapy and from Herceptin but they’re exposed to chemotherapy for a long period of time. The side effects can sometimes build up or be cumulative, and occasionally those patients who have lots of exposure to chemotherapy might have other unwanted side affects like heart damage. Herceptin has revolutionized the prognoses, however, of these patients. In the past these were the patients who often didn’t live very long if they had advanced disease. With the development of Herceptin, I personally see many, many lives being saved because we can combine Herceptin with chemotherapy in a very effective, synergistic way. Studies have shown when you add Herceptin to certain chemotherapy, instead of the situation being one plus one equals two, it is one plus one equals three or four. You get a synergistic effect of the interaction of these agents. What are the benefits of using this new drug combination for patients? Dr. Moroose: Well this is a clinical trial, so we really can’t promise any benefits until the studies are done. The goals are to look at effectiveness of the treatment in terms of response of the tumor, survival of the patient, and the side effect profile. Our goal in treating cancer patients, especially if the cancer has spread from the main site to other sites in the body, is to not only treat a patient effectively but to give them the best possible quality of life. We cannot promise if it will pan out, but our hope is that by using very effective, very logical combinations of treatment that do not have the side affects of chemotherapy that a patient will live and do well and have a better quality of life while undergoing cancer treatment. What does this mean for patients if it does prove to be as effective as standard chemotherapy? Dr. Moroose: The scientists at UCLA probably have the best experience with this and in talking to them, the side effect profile is relatively mild compared to side effects of chemotherapy. Sometimes patients get flu-like symptoms that are very temporary. They might have a low-grade fever or a little achiness. Now compare that to a patient who gets chemotherapy where she develops nausea, vomiting, fatigue, and a drop in their white blood cell count, which makes them highly susceptible to infections. With chemotherapy, they may develop the physical changes, hair loss, sores in their mouth, and sometimes skin changes depending on the drug. Also, there may be neurological changes like numbness and tingling in the fingers and the toes. So the host of side affects from chemotherapy is broader and more significant than the side affects from receiving monoclonal antibody therapy. How can that impact the patient’s life? Dr. Moroose: A patient who is fighting cancer still wants to live his or her life the best he or she can. That’s why they would even go through something like chemotherapy. It is because of that desire to live life and to meet certain goals in life. So a patient who doesn’t have to deal with the toxicity can have effective treatment and also live a much richer life, be more involved with her family, and continue the same normal activities that she enjoyed before the diagnosis of cancer. What did the phase I trial show as far as effectiveness of this drug? Dr. Moroose: The phase I trial treated a limited number of patients who had the same type of cancer with HER2 protein over- expression and gene amplification. A significant number of patients had either a complete or partial response to this combination. Because of that, the FDA gave this regimen the green light to go on to phase II. So in phase II, more patients are offered the opportunity to participate in this clinical trail. The goal of this study is to identify 50 patients around the country working with the UCLA research team who are well educated, advised, and understand the benefits and the down side of being in a clinical trail. So for this trial, we will watch the participants meticulously to make sure they tolerate therapy well, to see how their tumor will respond to therapy, and to look at that very important end point which is the quality of life. How many patients were studied in the phase I? Dr. Moroose: Ultimately 10, but nine were published in the abstract form at the San Antonio Breast Conference last year. How many did you see respond? Dr. Moroose: There was a significant number of patients who had a partial response, and there was one complete response that was in the publication. I know it’s a small group, but that’s a pretty good sign so far. How exciting is it for you to be involved in this research? Dr. Moroose: I have been practicing clinical oncology for 19 years, and this is just a whole new refreshing and exciting wave of the future that we’re just beginning to see. We are so thrilled not only to participate but most importantly to bring new hope, to bring new ideas, and to bring new therapeutic regimens to our cancer patients. We want to make cancer a chronic, not a fatal, disease. If this proves effective, how could it change the way oncologists treat breast cancer? Dr. Moroose: If this proves effective, I think it will stimulate scientists to look for more novel combinations of drugs that have low toxicity but high efficacy because the science of how the drug is working is really what’s leading the edge. It is great to look at individual patients' cancer cells to identify the profile in each individual patient’s cancer so that we understand in a very logical way which drugs have a higher chance of benefiting and which have a lower chance of benefiting that particular patient. Then we can use those combinations logically and effectively. In the past, treating breast cancer or any kind of cancer was a one-size-fits-all approach. Where if you had advanced breast cancer, you got this regimen, then that regimen, and the next regimen. Now we’re looking at the molecular signature, at the biological profile of each individual's cancer cell, and then selecting logical drugs that will target the proteins and the genes that are making that individual cancer cell behave in an abnormal way. So that what one patient gets with breast cancer might be entirely different than another patient with breast cancer. So it could possibly eliminate chemotherapy in some breast cancer patients? Dr. Moroose: It could eliminate or reduce the need, or the chemotherapy in combination with biological therapies may be much more effective. So even if the patient has to go through the sacrifice of being exposed to chemotherapy, she's more likely to hit a home run with her treatment and have a successful outcome. Is this the only treatment so far for breast cancer patients where there’s no hair loss? Dr. Moroose: Oh no. For many, many decades we have been using hormonal manipulations to treat the subset of breast cancer patients who have hormone-responsive breast cancer. So in the old days before we had drugs, we used to do things like remove a woman’s ovaries or remove her adrenal glands. Now we have medications that perform basically the same thing. By manipulating endocrine therapy, often we can deliver good therapeutic outcomes with less toxicity. There are many patients though who have aggressive cancers that are not responsive to hormone therapy in whom it’s necessary to utilize chemotherapy, and those combinations of agents have improved significantly. Then with the advent of the drug Herceptin, we’ve learned how to combine monoclonal antibodies with certain chemotherapy drugs for more efficacy than we used to see with either treatment alone. We also are combining monoclonal antibody therapy in certain situations with endocrine manipulation in those sub-set of patients who might be responsive to both. So the possibility of combinations is broad, the important thing is learning how to identify which makes the best sense for which individual patient. And scientific leaders have taught us a tremendous amount about how we can identify the sub-sets of patients who will do better or worse. So to me, it’s just wonderful and refreshing that I can offer a cancer patient hope and a better quality of life and also that we can learn and understand how cancer behaves the way it does and how it can eradicate that behavior. Is there any kind of metaphor that you can explain how these drugs work in the body? Dr. Moroose: I guess the best analogy I can think of is if you go duck hunting, you take your rifle, you go to the lake, and you shoot your rifle. If there are not ducks out on the lake, then you’re not going to bring a duck home from your duck-hunting adventure. You have to not only have the ammunition but you have to have the target too. So without the target, it’s like shooting blanks. So the best analogy here is that patients need to identify their targets, and then effective therapy that can aim at and impact that target needs to be developed. So if the target is not there it is a waste of the patient's time, effort and money to use targeted therapy. But if we can find a target and then develop therapy that will selectively impact that target then that’s going to lead to more effective therapy. END OF INTERVIEW If you would like more information, please contact: Jeni Hatter Florida Hospital 2520 North Orange Ave. Suite 200 Orlando, FL 32804 (407) 303-8213 jeniffer.hatter@flhosp.org
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