Breast Cancer Survivor

01/18/00. Serendipity and Hope in War on Cancer, New York Times, by Gina Kolata. (Article mostly about colon cancer but has similar breast cancer science). Over the years, researchers have found hundreds of drugs to slow the growth of cancer. But they have found virtually nothing that can prevent cancers from forming. The goal is not just a drug to stop cancerous cells from growing. It must also be safe enough to be taken for years by healthy people, most of whom will never get cancer. Now, however, scientists at the National Cancer Institute say they have a promising candidate, an aspirinlike drug, known as a selective cox-2 inhibitor, that is commonly used to treat arthritis pain. By accident, scientists found that such drugs might also prevent cancer. Until recently, the only known drugs that inhibited production of cox-2, an enzyme involved in inflammation, also had a troublesome side effect. The drugs, which include aspirin and the anti-inflammatory drug sulindac, can cause bleeding, particularly in the gastrointestinal tract. But new cox-2 inhibitors are essentially free of this problem. And so the cancer institute, working with Searle, is beginning large studies involving thousands of Americans, asking whether people at risk for cancers of the colon, skin, esophagus or bladder can protect themselves by taking the new drugs. Merck is starting a similar study on its own, with its cox-2 inhibitor, asking if it can prevent colon cancer. The studies are not the first to look at drugs that prevent cancer. The institute has studied beta-carotene and vitamin A, for example, but has failed to find anti-cancer effects. It also has another major prevention initiative under way, comparing two drugs, tamoxifen and raloxifen, for the prevention of breast cancer. Both drugs can block estrogen, which often promotes breast cancer growth. But both drugs can also lead to potentially fatal blood clots, and tamoxifen doubles a woman's risk of developing uterine cancer. The cox-2 story is more of a medical mystery. In theory, it makes little sense that blocking this enzyme should prevent cancer. Scientists have competing hypotheses to explain it. But they also have more than two decades of accumulating research, with animals, with cells grown in the laboratory and with human populations, all supporting the idea that blocking the cox-2 enzyme might prevent cancer. "Everything is crystallizing," said Dr. Marcia Bertagnolli, a colon cancer specialist at the Brigham and Women's Hospital in Boston. "What you really look for is that all the avenues of information are giving you the same information. Not just the epidemiology, not just the molecular biology, not just the genetics. Everything is converging on the same answer." But the researchers temper their enthusiasm with strong words of caution. The only way to know if cox-2 inhibitors can prevent cancers is to test them in large studies in which some people take the drugs and others take a dummy medication for comparison. In a way, this story begins in the late 1970's, in the office of Dr. William R. Waddell at the University of Colorado Health Sciences Center in Denver. One of Dr. Waddell's patients had a rare inherited condition known as familial adenomatous polyposis, or F.A.P.. People with F.A.P. eventually develop hundreds or thousands of polyps in their colons -- too many to excise one by one. Since colon cancers start out as polyps, the only way to protect these patients is to remove their colons. Dr. Waddell had removed the woman's colon when she was 23 but by August 1978, at the age of 31, she had developed another common consequence of F.A.P.: noncancerous scarlike tumors in her abdomen. In addition, polyps were starting to grow in her rectum and Dr. Waddell expected that they would proliferate until she would have to have her rectum removed as well. For the time being, however, Dr. Waddell had to treat the tumors in her abdomen. He prescribed indomethacin, an anti-inflammatory drug that often makes such tumors shrink. Two years later, in July 1980, the woman began to complain that the drug upset her stomach, so Dr. Waddell switched her prescription to another anti-inflammatory drug, sulindac. To his amazement, the drug seemed to make the tumors disappear. Year after year, she was polyp-free. Dr. Waddell decided to prescribe the drug for three of the woman's relatives who also had the disease. One was a 21-year-old man whose colon had been removed but who had 15 polyps in his rectum. Within a year, he had none. Another, a 42-year-old man, had 50 polyps in his colon when he began taking the drug. A year later, he had four very small polyps. A 16-year-old girl had 25 polyps in her colon. A year later she had three small ones. Dr. Waddell thought he had stumbled upon something amazing, but few of his colleagues believed him and major medical journals rejected his findings. He finally published them in The Journal of Surgical Oncology in 1983. "No one paid any attention to that paper," Dr. Waddell said. But he continued to give sulindac to patients with F.A.P., to gather data and to publish results, though they got little attention. "Very few people believed it," said Dr. Bert Vogelstein, a cancer researcher at the Johns Hopkins University School of Medicine. "I was intrigued by it, but I asked my clinical colleagues and they said it was unlikely to be valid." But by 1989, Dr. Francis M. Giardiello, a colon cancer specialist at Johns Hopkins, had heard of the sulindac findings and decided to test them in 22 patients, 11 of whom took the drug and 11 a placebo. His results were not as striking as Dr. Waddell's: patients who took sulindac had 44 percent fewer polyps after a year and the diameters of their polyps had decreased by a third. No patients saw all their polyps disappear. Still, Dr. Giardiello considered the results "astounding." His paper was published on May 6, 1993, in The New England Journal of Medicine; this time, the sulindac story got national attention. About the same time, Dr. Raymond N. DuBois, the director of the cancer prevention program at Vanderbilt University Medical Center, noticed studies indicating that people who used aspirin regularly for, say, arthritis, contracted colon cancer at only about half the rate of people over all. At first, he said, he and his colleagues doubted that the finding was a matter of cause and effect. But the evidence continued to accumulate. Some studies were enormous, like one involving 104,217 elderly people who were part of the Tennessee Medicaid program and a study of 47,900 health care workers. Dr. DuBois became so intrigued that he decided to test the idea that anti-inflammatory drugs could inhibit colon cancer by testing cells in the laboratory and by conducting studies in animals. Other researchers took up the search, and more and more studies were done. By now, said Dr. Ernest Hawk, who is chief of the gastrointestinal cancer research group in the institute's division of cancer prevention, about 50 studies show that blocking cox-2 can prevent premalignant and malignant tumors in animals, and not just colon cancers. The drugs appear effective for bladder, skin, and esophageal cancers as well. All these cancers make greatly increased quantities of cox-2. "There are very consistent results across investigators, across sites, across agents," Dr. Hawk said. But, Dr. Hawk said, until recently there were two problems with taking the next step and testing the cox-2 hypothesis in large groups of people at risk for these cancers: first, the only drugs available then were ones, like aspirin or sulindac, that could cause bleeding; and second, sulindac's patent had run out and aspirin was sold over the counter, so drug companies had no incentive to invest in research on them. The situation changed a few years ago with the discovery and development of Celebrex by scientists at Searle. Like Merck, which has a similar drug, Searle was interested in the compound because it might help the huge group of arthritis patients who needed an anti-inflammatory drug without gastrointestinal side effects. But scientists at the National Cancer Institute managed to pique the interest of Dr. Philip Needleman, co-president of Searle, on the compound's potential as a cancer preventive. Dr. Needleman decided to put the cox-2 hypothesis to a test, giving the Searle drug to patients with F.A.P.. If it squelched polyp formation in these patients, he reasoned, it would make sense to go on to test it in people in the general population who had had one or two polyps -- and so were at risk for colon cancer. If it failed in the F.A.P. patients, Dr. Needleman said, "we would have stopped all trials of cox-2 in cancer." The study, he added, "was the proof of concept in every way." The study, conducted by Searle with the cancer institute, included 83 patients and lasted six months. It found that patients who took Celebrex had a 28 percent reduction in the number of polyps, compared with a 5 percent reduction in those taking a placebo. The Food and Drug Administration approved the drug late last year for F.A.P. patients. The investigators are continuing to study Celebrex to see if cancers as well as polyps are prevented in F.A.P. patients. In the meantime, however, they stress that F.A.P. patients will still need surgery. "It is not good enough to replace surgery," said Dr. Bertagnolli, the colon cancer specialist at Brigham and Women's Hospital. Dr. Bertagnolli, who will lead the new study seeking to prevent colon cancer in the general population, is also a consultant to Searle. She added: "Perhaps you can do a lesser surgery or perhaps you can take a young person who has the gene and see if you can prevent them from having polyps. We have 15- and 16-year-old kids with this disease. They're in high school, they're trying to do sports. Maybe you could give them a few years." For Dr. Needleman, the important thing now is to conduct studies of people in the general population at high risk of cancers of the colon, bladder, skin or esophagus. But he and Dr. Hawk of the cancer institute say they have one big concern: people will refuse to enter trials because they will want to start taking cox-2 inhibitors. "It doesn't do anybody any good if they're overzealous," Dr. Needleman said. Dr. Hawk agreed. "We feel it's important to get answers by science, not by personal opinion," he said.

01/07/00. UK Defends Breast Cancer Screening...are mammograms necessary??? By Ross Colvin, LONDON (Reuters) - Britain Friday defended its breast cancer screening program in response to a controversial new Danish study that says screening may do more harm than good. The government's Department of Health said the program was worthwhile, detecting more than 8,000 cancers in 1997/98 alone. Figures published in November 1999 showed a 14 percent drop in deaths from breast cancer between 1989 and 1998, it said. "The NHS (National Health Service) breast screening program is a success and around one million women are screened each year," the department said in a statement. The screening program's top official, Dr Muir Grey, went on a media offensive, concerned that the study's findings, published in The Lancet medical journal and given wide publicity Friday, may dissuade women from having mammogram screenings. Mammography uses a series of X-rays to detect abnormalities, such as tumors, in breasts. "It is very important that we say to women this is just another bit of evidence and if they are offered an invitation (for a mammogram) they should accept," said Grey, director of the National Screening Committee. "We designed the breast screening program to be the best in the world, and the UK breast screening program is the best in any large industrial country," he told BBC radio. The Danish researchers said mammography, long considered the biggest weapon against breast cancer, which kills more British women than any other form of cancer, was a waste of time as it did not reduce the death rate from the disease. "There is no reliable evidence that screening decreases breast cancer mortality," Dr Peter Gotzsche and Ole Olsen of the Nordic Cochrane Center in Copenhagen said in the latest issue of The Lancet.

INITIAL STUDIES FLAWED

The Danish study re-examined major trials of breast cancer screenings in Sweden, Scotland, Canada and the United States that involved 500,000 women. The researchers found that only two trials -- conducted in Canada and Sweden -- met widely accepted criteria for an adequate randomization process, where women were randomly assigned either for mammographic screening or to an unscreened control group. "These two trials did not find an effect on breast cancer mortality," Gotzsche said. "We have doubts about whether the benefits that might be there outweigh the harm," he said, adding that some false alarms led to healthy breasts being removed. Grey said: "I will be asking our specialist breast cancer group to look at this (the study) in detail. But at the moment this is not something that makes me say I'm going to phone the minister today and say let us change the policy.

01/04/00. Lymph node number tied to risk of dying from breast cancer, By Suzanne Rostler, NEW YORK, Jan 04 (Reuters Health) -- By counting the number of lymph nodes under a woman's arm after surgery to remove a breast tumor, doctors can predict her risk of dying from breast cancer in the next 5 years, even when there is no evidence that the cancer has spread to the nodes, US researchers report. Their study in the January issue of the journal Cancer is the first to demonstrate the importance of total number of lymph nodes to survival in breast cancer patients. Doctors currently gauge survival after breast cancer surgery by counting the number of axillary (armpit) lymph nodes to which cancer has spread. However, about 10% to 15% of women will die from the spread of cancer when there appears to be no axillary lymph node involvement. "In women with no evidence that cancer has spread, a major problem is that we don't have a good indicator of which women will ultimately die of metastatic breast cancer," lead author Dr. Robert L. Camp, a post-doctoral fellow in the department of pathology at the Yale University School of Medicine in New Haven, Connecticut, told Reuters Health. "Our study indicates that a high number of axillary lymph nodes in patients with lymph node negative breast carcinoma is of significant predictive value in determining patient survival," the research team concludes. Camp said there is actually little variation in the total number of lymph nodes between women. However, more aggressive tumors cause lymph nodes to swell, giving the appearance that more exist. The investigators found that "the 5-year survival rate for patients with 20 or more tumor-free lymph nodes was 84.7%, compared with 96.3% for patients with fewer than 20 tumor-free lymph nodes." Camp and colleagues looked at the medical records of 290 women who had breast resection surgery and whose disease did not spread to their lymph nodes. The majority of patients underwent modified radical mastectomies, or removal of most of the breast. Some patients underwent lumpectomies in which only the tumor was removed. Women with a total count of 20 or more axillary lymph nodes were 4.33 times more likely to die from the spread of their cancer than women with fewer than 20 lymph nodes in the first 5 years after surgery. Over the longer term, the size of the tumor was also found to correlate with the risk of death from the spread of cancer. "Lymph node number was the only independently predictive factor in the 5-year analysis, and tumor size was the only other factor that retained long-term significance," the authors write. Camp said the finding may stimulate research in the area of lymphatic drainage to help researchers determine how to stop tumors from spreading to lymph nodes. Breast cancer is the most common cancer among women and the second leading cause of cancer death. According to the American Cancer Society, in 1999, an estimated 175,000 women in the US were diagnosed with breast cancer and there were 43,300 deaths from the disease. SOURCE: Cancer 2000;88:108-113.

12/07/99. Cholesterol drugs also regrow bone.<<Important to survivors because most anti-osteoporosis drugs are estrogen replacements....first time a new drug has shown to provide growth of new bone rather than just slowing bone loss..... may be very important to bone met survivors>>WASHINGTON, D.C. Dec. 2 (UPI) A family of drugs used to lower cholesterol also can stimulate bone regrowth, creating hope for a more effective way to treat the bone loss that comes with aging. Researchers at the University of Texas and their colleagues found that the drugs, called statins, have a desirable side effect of stimulating bone protein growth in rats. Hormone replacement therapy and other drugs now used to treat osteoporosis, or bone mass loss, typically only stop the progression of bone loss, but do not thicken the remaining bone. They report their findings in Thursday's issue of Science. "It is now possible to rebuild bone with statin drugs, which are well known," Dr. Gregory Mundy, lead author of the Science paper, told United Press International. Munday is professor of medicine at the University of Texas Health Science Center in San Antonio and scientific director of Osteoscreen Inc., the company that found the bone-building activity of statins by screening 30,000 drug candidates. Statins work by blocking the action of an enzyme in the liver that turns fatty foods into cholesterol. Statins are marketed under the names of Mevacor, Zocor and Prevachol. Rats receiving oral doses of statins experienced growth of 39-94 percent after one month in the type of bone found at the end of bones like the femur, Munday said. Physicians studying and treating osteoporosis say the discovery is exciting because statins can grow bone and because they are common drugs used by an estimated three million Americans to lower cholesterol and prevent heart attacks. There are at least half a dozen statins on the market and a dozen or so under development, Mundy said. However, doctors advise osteoporosis sufferers to exercise caution, because the doses of statins in humans still aren't known, nor is it known which statin or statins will work the best for bone growth. "This is potentially a big discovery, because all the treatments we have now prevent bone resorption, but do not really build bone," said Dr. Doug Bauer, a clinical researcher at the University of California at San Francisco. "But it is too early to tell the doses and how this will translate into people." Dr. C. Conrad Johnston, president of the National Osteoporosis Foundation in Indianapolis, agreed. "This is exciting, and it's totally unexpected," he said. "But people shouldn't use statins for osteoporosis on the basis of this evidence. We don't know the right statin to use nor the dose," he said. Johnston said upwards of 10 million people in the United States have osteoporosis, most of them women. Another 20 million suffer from low bone mass. As many as 1.5 million fractures a year are related to osteoporosis, he added. Osteoporosis in particular occurs in postmenopausal women and the elderly population. Mundy said those patients suffer as their bones lose crucial minerals like calcium and phosphorous and become thin and fragile. Osteoporosis patients often lose 50-60 percent of their bone mass in areas such as the hip and spine, so rebuilding bone is key to their recovery, he said. After hearing a preliminary report from Munday last year, Bauer conducted three studies on a total of 17,500 women with osteoporosis and found that about 50 percent of those who have been taking statins to lower cholesterol also suffer fewer hip fractures. "However, people taking sta

12/12/99. (UP) BENEFIN, THE shark cartilage, has NOT been proven to treat cancer, the Food and Drug Administration said in seeking a permanent injunction against New Jersey-based Lane Labs-USA’s sales of the product.
The FDA complaint also names a Lane skin cream called SkinAnswer that claims to treat skin cancer, and a rice-bran extract called MGN-3 that claims to treat both cancer and AIDS. FDA officials also warned cancer patients Friday to beware of the products’ claims. “People should not be misled into thinking bogus remedies are going to be effective,” said Dr. Janet Woodcock, the FDA’s drug chief. “We have a very vulnerable population of cancer patients and their families out there that are really looking for hope. We are not going to let companies promote products that have not been adequately tested and are not shown to be effective.” The FDA filed its complaint in U.S. District Court in Newark, N.J. Lane has 20 days to file a response before a judge could decide the issue. “We have no comment at this time except to say we believe we’ve done nothing wrong,” said Joyce Steel, a spokeswoman for Allendale, N.J.-based Lane. Doctors have estimated that 50,000 U.S. cancer patients have tried some form of shark cartilage, a product whose popularity resulted in part from William Lane’s book “Sharks Don’t Get Cancer.” Lane Labs is headed by Lane’s son, Andrew. But shark cartilage proved worthless in the first careful scientific study of such products last year. That study did not use the Benefin brand, and the FDA in fact has given Lane permission to perform a small study of Benefin in cancer patients. That study is not affected by Friday’s court filing — it can continue — but companies cannot claim their experimental drugs treat disease until the studies actually prove it, Woodcock said. Other companies that sell shark cartilage merely as a dietary supplement also are not at issue as long as they do not claim the product cures or treats a disease, she said. The FDA says it has warned Lane Labs since 1997 about illegally touting its products as cancer treatments in articles and on the Internet. One Internet search for Benefin turned up a Web page listing that said, “If you are a cancer patient, this could save your life.”

tins shouldn't assume that they don't have to worry about osteoporosis," Bauer cautioned. Bauer said the medical cost to society for osteoporosis fractures is $10 billion per year in the United States. Calcium, exercise and other measures to stave off bone degeneration have had mixed results, he added. Several decades ago fluoride was shown to grow bone, but that bone was not as strong as original bone, Bauer said. Another promising new approach has been parathyroid hormone, but that requires injections. Statins can be taken orally. The take-home message to consumers is cautious optimism. "This study is way ahead of other forms of therapy," said Dr. Steven Teitelbaum, professor of pathology at Washington University School of Medicine in St. Louis. "But consumers have to be cautious." Mundy said the cost to take statins into human trials is too much for his company, and he hopes someone else will continue the studies. He said Osteoscreen will keep screening for statins that target bone rather than cholesterol.

12/06/99. New test for estrogen-like compounds in food. <<Important from standpoint of breast cancer patients>>.By Merritt McKinney, NEW YORK, Dec 06 (Reuters Health) -- Researchers in England have developed a test that tells whether foods and other products contain phytoestrogens, estrogen-like chemicals that may have harmful health effects. A number of foods and chemicals contain compounds that mimic the female sex hormone estrogen. All of these phytoestrogens may not be created equal, however. According to Heather A. Lee, of the Institute of Food Research in Norwich, UK, the effects of phytoestrogens on human health are uncertain. While some of these compounds, such as those in certain pesticides, have been shown to be harmful to animals, other estrogen-mimicking chemicals, such as those in soy products, may lower the risk of breast and prostate cancer. Measuring levels of phytoestrogens has been difficult, but Lee and her colleagues have developed a less complicated method of detecting the chemicals. Using the test, the researchers detected high levels in soy products and moderate levels in licorice, beans and chickpeas. Fruits and vegetables as well as both black and green tea also contained detectable amounts of phytoestrogens. While the current study only tested foods, Lee told Reuters Health that the test could also be used to test levels of synthetic phytoestrogens in pesticides and other chemicals. It is no big surprise that soy products contain high levels of estrogen-like compounds, according to Dr. Bertold Hock and Martin Seifert, of the Technical University of Munich in Freising, Germany. But detecting noticeable levels of phytoestrogens in tea was unexpected, they note in an editorial that accompanies the study. Screening foods and chemicals in the environment using this type of test is important for understanding which substances are harmful and which might have health benefits, they conclude. SOURCE: Nature Biotechnology 1999;17:1162-1163, 1219-1222.

11/30/99. Breast cancer in elderly undertreated, By ED SUSMAN, CHICAGO, Nov. 29 (UPI) Doctors said Monday elderly women who develop b

12/28/99. Discovery helpful for women with benign breast disease, NEW YORK, Dec 28 (Reuters Health) -- A newly discovered biological marker should help make it easier to determine which women with benign breast disease are at risk for developing breast cancer later in life. Dr. William Dupont, of Vanderbilt University in Nashville, Tennessee, and colleagues have found that by measuring levels of a certain protein in biopsy samples, they can help predict breast cancer risk in women with a condition known as epithelial hyperplasia lacking atypia (EHLA). EHLA is found in one quarter of benign breast biopsy samples, but is usually not treated because there is only a very small chance it will develop into cancer. The protein that Dupont and his team evaluated, transforming growth factor beta (TGF-b) receptor, helps regulate cell growth by instructing cells not to divide. The researchers studied levels of TGF-b receptor in samples of breast tissue from 54 women with EHLA who developed cancer many years after the sample was taken, and from 115 women with EHLA who did not develop cancer. Low levels of TGF-b receptor were a warning sign, Dupont's team discovered. If fewer than 25% of cells in a EHLA biopsy sample contained TGF-b receptor, a woman's risk of breast cancer was 3 times higher than if 75% or more of the cells contained TGF-b receptor. The team's report appears in the December 15th issue of the Journal of the National Cancer Institute. It appears that TGF-b helps put the brakes on uncontrolled cell growth, the researchers says. Once a cell loses the ability to bind to the molecule, the risk of cancer goes up. If there is a low level of TGF-b in breast cells, tissue that is already abnormal but not yet malignant can more readily become cancerous, because the growth of that cell is less well controlled. It is of "great importance to be able to reassure women who are at low risk of breast cancer and to initiate preventive measure in women who are at high risk of this disease," the authors conclude. Levels of TGF-b receptor may help identify women who should receive cancer-preventing treatment with the drug tamoxifen, according to an editorial by Drs. Matthew Ellis and Daniel Hayes, of Georgetown University Medical Center in Washington, DC. SOURCE: Journal of the National Cancer Institute 1999;91:2067-2068,2096-2101.

11/18/99. Thalidomide Found to Slow a Bone Cancer, NY Times, (Indirectly related to breast cancer, but the science is the same), (By SHERYL GAY STOLBERG WASHINGTON -- In a serendipitous discovery that grew out of the pleas of a New York woman whose young husband was dying of cancer, scientists will report Thursday that thalidomide, the notorious sedative that caused the deformation of thousands of babies in the 1960's, can slow the course of a deadly bone cancer. Some experts say it may become the most effective new drug for the disease in decades.
In a study of 84 patients with advanced forms of the disease, multiple myeloma, Dr. Bart Barlogie, an oncologist at the University of Arizona, and his colleagues found that one-third were helped by thalidomide, and two went into complete remission. While the numbers are not high, experts say the results are startling because the patients had not responded to other therapies and the disease is notoriously difficult to treat. "This is very significant," said Dr. Philip Griepp, a myeloma expert at Mayo Clinic in Rochester, Minn. In an editorial in The New England Journal of Medicine, which is publishing Barlogie's findings Thursday, two experts at the Dana-Farber Cancer Institute in Boston wrote that, given the condition of the patients, "the effect of thalidomide is indeed remarkable." Thalidomide was banned from pharmacy shelves worldwide in the early 1960s, after the birth of thousands of deformed babies, mostly in Europe, Canada and Japan, whose mothers took it for morning sickness. In recent years, it has been experiencing a revival, however, and scientists are studying it for everything from AIDS to breast cancer. Last year, the Food and Drug Administration approved it in the United States for the first time, for treatment of leprosy. The drug is being marketed by Celgene Corp. of Warren, N.J., which provided the medicine for Barlogie's study and helped analyze the data, but did not otherwise contribute to the research. One of the 12 co-authors of the article is a Celgene employee and two others said they owned stock in the company. Celgene spokesman Bruce Williams said Wednesday that the company intended seek approval to market the drug for myloma. No one was investigating thalidomide for multiple myeloma until Barlogie was pushed into it by Beth Wolmer, a Manhattan lawyer whose husband, Ira, had received a diagnosis of multiple myeloma in 1995, at the age of 35. Dr. Ira Wolmer, a cardiologist, underwent three bone marrow transplants and tried an experimental vaccine, his wife said, but nothing worked. "I was always looking for something new," said Mrs. Wolmer in a telephone interview Wednesday. "I would routinely call scientists in their labs to find out what they were working on." But they had nothing to offer. One of them, however, told Mrs. Wolmer about Dr. Judah Folkman, a researcher at Harvard Medical School who has theorized that cancer may be treated by retarding angiogenesis, the growth of blood vessels that feed tumors. One of the substances under study in Folkman's laboratory was thalidomide. A researcher there, Dr. Robert D'Amato, said Wednesday that he has been pursuing the idea that drugs that caused severe side effects, like birth defects, would also inhibit blood vessel growth. He said his experiments show that the drug inhibits tumors in rabbits and mice. Folkman could not be reached Wednesday because he was traveling. He referred questions to D'Amato. But Mrs. Wolmer said that when she called him, late one Saturday night in his laboratory, and asked him if he thought thalidomide might work against multiple myeloma, "it was like a light bulb went off." Mrs. Wolmer told Barlogie to call Folkman. By the fall of 1997, Barlogie said, he had obtained permission to test thalidomide in Wolmer. The drug did not work for Wolmer; he died in March 1998. But when Barlogie tested it on a second patient, he said, the man "went into almost a complete remission." Despite Folkman's theory about angiogenesis, the researchers who conducted the myeloma study are not certain precisely how thalidomide works against the disease. Inhibiting the growth of blood vessels is only one possibility; the drug may also work by stimulating the immune system's reaction against myeloma cells, or it might limit the growth of the cells, either directly or by restricting other factors in the bone marrow that enable them to grow. The study measured the success of thalidomide by looking at the level of a certain protein produced by the cancer causing cells. In analyzing the patient's urine, they found that the protein levels were reduced by at least 90 percent in eight patients, including the two who went into remission. The levels dropped at least 75 percent in six patients; at least 50 percent in seven patients; and at least 25 percent in six patients; in all, 32 percent of the 84 patients were helped. Most of the patients experienced the known side effects of the sedative, including constipation, weakness, sleepiness and tingling or numbness in their extremities. But because the side effects are different from those of standard chemotherapy, experts said they were encouraged that thalidomide might be used in conjunction with other drugs to treat myeloma and offer relief to patients in earlier stages of the disease. The American Cancer Society estimates that 13,700 people in the United States will be diagnosed with multiple myeloma this year; 11,400 patients with the disease will die. Griepp of the Mayo Clinic said the median survival time of those with the disease is three and a half years. Experts say new treatments are urgently needed; the five-year survival rate for patients treated with chemotherapy has remained unchanged, at 29 percent, for more than four decades. Dr. Joseph Michaeli, a myeloma expert at Memorial Sloan-Kettering Cancer Center in New York, said it would be especially important for researchers to learn how thalidomide worked, particularly because some patients responded while others did not. "It's a clue," Michaeli said. "Once we figure out why some patients show sensitivity to thalidomide while others do not, I think we will gain some valuable insight into the biology of myeloma." He said Barlogie's work provides "an important lesson," adding, "Here is someone who apparently had no rationale to use this drug on these particular patients, but he did go this extra mile, and he sort of hit the jackpot, in a way." As for Mrs. Wolmer, she is credited at the end of the New England Journal for her persistence. "I didn't save the person I was doing this for," she said. "But I'm glad it helped everyone else."

11/18/99. Scientists Link a Single Gene to Longer Life in Mice (Not directly related to breast cancer, but interesting). NY Times, By NICHOLAS WADE, In a finding that may yield a sharp insight into the genetic reasons for death, a team of Italian scientists Wednesday reported discovery of a gene that exerts major control over the life span of mice. The effects of the corresponding gene in humans is unknown, but experts in aging called the findings a milestone that could someday lead to drugs that postpone the effects of aging. The new gene fits into a pattern of other recent findings about aging that highlight the role of oxygen damage to the tissues as a major driver of the aging process. Oxygen may be the breath of life, but in the body it creates chemical byproducts, free radicals, that can corrode the cell's working parts and corrupt the information in its DNA data bank. If the damage is too severe, cells are genetically programmed to self-destruct, a fail-safe mechanism to prevent damaged cells turning cancerous. The gene studied by the Italian team makes a protein that triggers the self-destruct process in response to oxygen damage. Mice genetically engineered to lack the trigger protein turned out to live 30 percent longer than normal, with no apparent harm. The gene's effect was discovered by Dr. Pier Giuseppe Pelicci of the European Institute of Oncology in Milan, together with scientists at the Institute of Pathology in Perugia, Italy, and the Memorial Sloan-Kettering Cancer Center in New York. Their findings are reported in the journal Nature. Experts in aging described the report as a significant step forward, although all said the finding needed to be better understood, and extended to different strains of mice, before it could be considered decisive. "This is a fascinating start on what could prove an incredibly exciting pathway for research," said Dr. Steven N. Austad of the University of Oregon. "I think it is a milestone that we can alter a single gene in a mouse and make it live longer, without any obvious side effects," said Dr. Leonard Guarente of the Massachusetts Institute of Technology. Guarente described the Italian research as "proof of principle that we will be able to dissect the aging process in mammals," and said that whether this or some other gene is the key to increasing longevity, "at least this says there is hope." Despite the obvious differences, mice are quite similar to people at the genetic level and provide valuable insights into their fellow mammal. The new gene's role in protecting cells from oxygen-related damage is particularly striking because it fits in with findings from lower laboratory organisms like fruit flies and roundworms. Biologists who have made these animals live longer by genetic manipulation have found that their cells are less likely to die after oxygen-related damage. Also, the single known treatment that makes ordinary mice and rats live much longer -- severe restriction of the calories in their diet -- is one that cuts down on their cells' metabolism of glucose and the associated oxygen-related damage. The gene studied by the Italian researchers makes a protein that forces the cell to die when oxygen damage is detected. The mice that were genetically incapable of making the trigger protein presumably lived longer because their cells, even though suffering some degree of oxygen damage, were no longer being zapped by the hair-trigger self-destruct mechanism. Pelicci said the trigger belongs to a class of proteins for which many inhibitory drugs are known, and that it should not be too difficult to tailor a drug to block it. Dr. Pier Paolo Pandolfi of Memorial Sloan-Kettering, who helped genetically engineer the mice, said that such a drug applied in the form of a cream might reverse the aging skin's wrinkles and blemishes. Other biologists said the discovery, if confirmed, offered the hope of more important interventions. Caloric restriction seems to impede a whole set of aging processes, and drugs that inhibit the trigger protein might produce the same wide range of benefits as caloric restriction but without the pain, these experts said. Few people are able to maintain a diet with 30 percent fewer calories than a normal diet. Should caloric restriction prove to increase life span in primates as well as mice -- monkey studies are in progress -- a drug that mimicked the effects of caloric restriction would be valuable. A surprising aspect of Pelicci's work is that so far he has found no downside in blocking the manufacture of the trigger protein. In all other laboratory animals whose longevity has been enhanced, there have severe penalties, usually in the form of reduced fertility. Calorically restricted mice do not breed at all. Surprisingly, the fertility of Pelicci's mice appears to be normal. There must be some deficit, however, because genes that do not benefit their owner are soon lost. Both Pelicci and other scientists expect he will find some adverse effect of losing the gene, perhaps a fertility effect too mild to have shown up yet, or some disadvantage not evident in the protected conditions of a laboratory. The expected downside is likely for evolutionary reasons to occur in the young. Experts on aging believe that if the gene works the same way in humans, with luck the downside of inhibiting it would not be a problem in treating older people.

11/05/99. Bone marrow transplant may "transmit" asthma. NEW YORK, Bone marrow donors with asthma can pass the lung disease to the recipient, according to US researchers. Donors with asthma should be excluded from donating bone marrow to non-asthmatic recipients, the research team advises. At the 65th annual international scientific assembly of the American College of Chest Physicians, an Atlanta researcher described two cases of asthma "transmitted" via bone marrow transplantation. Dr. A. Gal and colleagues at Emory University reviewed the cases of two bone marrow recipients who did not have a history of asthma but who subsequently developed asthma following transplantation. Both of the bone marrow recipients were female patients with leukemia, aged 18 years and 43 years. Neither patient had any history of allergy or asthma prior to the transplant. In each case, the patient received marrow donated from a sibling with a history of asthma. One marrow recipient developed shortness of breath with fever and cough 17 months after transplant, and the other patient developed wheezing about 6 weeks after transplant. Lung function tests revealed abnormal breathing patterns in both patients. The Emory team eventually diagnosed asthma on the basis of the examination of lung tissue taken from these patients. Both women responded to treatment with asthma medications. Transmission of cytomegalovirus, herpes viruses, HIV and toxoplasmosis infections has been reported in organ transplantation. Some cancers such as lymphoma have been transmitted from donor to recipient. A case of peanut allergy in a liver recipient was reported in 1997 in The New England Journal of Medicine.

11/04/99. Tamoxifen cuts breast cancer risk most in young women. NEW YORK, Nov 04 (Reuters Health) -- Tamoxifen therapy is most effective in preventing breast cancer in young women at high risk for the disease, experts report. The findings, gleaned from a trial involving over 13,000 women, may "assist healthcare providers and women in weighing the risks and benefits of tamoxifen for reducing breast cancer risk," write a team of researchers led by Dr. Mitchell Gail of the National Cancer Institute (NCI) in Bethesda, Maryland. The NCI's Breast Cancer Prevention Trial (BCPT) -- focusing on the risks and benefits of tamoxifen therapy in women at high risk for breast cancer -- found that tamoxifen use was associated with an average 49% reduction in breast cancer risk. Tamoxifen use was also associated with reductions in risk for bone fracture. But the NCI study also showed that women taking the drug had double the risk of developing endometrial (uterine lining) cancers, and up to 3 times the risk for clot-related cardiovascular events, compared with women not receiving tamoxifen. In their latest effort, Gail's team re-examined the trial data to give women and their doctors clearer guidelines in deciding on whether or not to initiate tamoxifen therapy. The investigators explain that health risks linked to tamoxifen use "increase with age," largely due to the fact that heart disease risks increase significantly after menopause. Based on these findings, the authors suggest that "tamoxifen is most beneficial for younger women with an elevated risk of breast cancer." Any decision on tamoxifen use should be based on each patient's personal health profile and "on a weighing of the various risks and benefits" associated with the drug, according to the report. In an accompanying editorial, Dr. Anne Taylor of Case Western Reserve University in Cleveland, Ohio and colleagues point out that just 220 of the 13,388 women in the BCPT trial were African-American. For this reason, they say, the new guidelines "can clearly be used with more confidence for white women than for African-American women.... In fact, with the available data, it is not possible to assess the magnitude of additional risk, if any, of tamoxifen use in African-American women." According to Taylor's group, there is a "desperate need" for studies focusing on the risks and benefits of tamoxifen use in black women at high risk for breast cancer. SOURCE: Journal of the National Cancer Institute 1999;91:1792-1793, 1829-1846.

10/30/99. Tamoxifen may help in genetic cancers (UPI) Dutch researchers said Friday that the anticancer drug tamoxifen may help prevent the spread of breast cancer among women with a common genetic mutation. In an article to be published in the November issue of the Journal of Clinical Oncology, doctors reported that women with the gene known as BRCA2 tend to develop breast cancers that would be sensitive to tamoxifen. Presently, doctors have few choices for preventing further bouts of breast cancer for women with the genetic mutation: They can offer the women more aggressive screening with mammography or they can offer prophylactic mastectomy removal of the breast not yet affected. Dr. Johannes Klijn of the Family Cancer Clinic at Daniel den Hoed Klinick, Rotterdam, said, "These findings lead us to suspect that tamoxifen might prevent breast cancer in women with BRCA2 germline mutations but not in women with BRCA1 mutations." The mutations in the BRCA genes are known to increase the lifetime risk of breast cancer in women carriers by as much as 80 percent. About 5 percent to 10 percent of all breast cancer occurs in these germline _ hereditary mutations. Klijn said his study revealed that women with the BRCA2 most frequently develop tumors that depend on hormones such as estrogen for growth. Tamoxifen, an anti-estrogen drug, is used in treatment and prevention of breast cancer for women at high risk of the disease. Tamoxifen deprives the tumors of estrogen. Although tamoxifen is used in prevention of breast cancer in general, scientists have not been able to determine exactly what the drug's role would be in women with specific mutations. "In the United States, tamoxifen is being used by some physicians to treat women with the breast cancer mutations," said Mary Lynn Carver, a spokeswoman for Zeneca Pharmaceuticals of Wilmington, Del., the manufacturer of tamoxifen. "The implications of the Dutch study make sense," she said. Ongoing studies in the United States are attempting to further define the use of tamoxifen in patients with these mutations, she said. In the study, Klijn and colleagues examined 28 breast cancer patients in 14 families with eight different BRCA2 inherited mutations. The researchers found that tumors associated with BRCA2 are "steroid receptor positive," therefore sensitive to the hormone estrogen. In contrast, Klijn said cancers arising from BRCA1 gene are more likely to be "steroid receptor negative," and so less affected by hormone. The researchers also found that women with BRCA2-associated cancers have a similar prognosis compared to women whose breast cancer arises either spontaneously or is due to BRCA1 mutations. After five years, 52 percent of both the BRCA2 patients and the other breast cancer patients were disease free; overall survival was 74 and 75 percent, respectively. The only significant difference between the groups was that tumors occurring in both breasts occurred five times more frequently in the BRCA2 group, Klijn said.

10/27/99. FDA OKs Taxol For Early Breast Cancer, Maker Says WASHINGTON (Reuters) - Taxol, the world's most widely used cancer drug, has won federal approval for treating patients with early-stage breast cancer, maker Bristol-Myers Squibb Co. said Wednesday. Taxol already had the Food and Drug Administration's blessing for fighting some advanced breast cancers and lung and ovarian cancers. The drug had 1998 sales of $1.2 billion. The FDA has now approved Taxol as part of chemotherapy following surgery for patients with breast cancer that has spread to the lymph nodes but no further, according to Bristol-Myers spokesman John Kouten. "It will have a significant impact on how women with this stage of cancer are treated," Kouten said. Breast cancer is one of the top cancer killers of women in the United States, second only to lung cancer. Taxol, known generically as paclitaxel, was originally developed from compounds found in the Pacific yew tree. The drug's possible side effects include neutropenia, a potentially dangerous drop in some white blood cells. Drug industry analysts said the expansion of approved uses would help strengthen Taxol's position as the number one cancer drug but was not expected to have a major sales impact. "This approval again adds to the depth and breadth of Taxol," Gruntal and Co. analyst David Saks said. "... The drug has become ubiquitous in chemotherapy."

10/25/99. Study: prayer helps patients heal KANSAS CITY(UPI) A study of nearly 1,000 heart patients in a Kansas City hospital concluded the patients did better when someone was praying on their behalf. Researchers at the Mid-America Heart Institute at St. Luke's Hospital determined patients who were the unknowing subjects of prayers from strangers generally needed less medication and recovered faster. The findings were published Monday in the Archives of Internal Medicine. Led by heart disease researcher William Harris, the team studied 990 patients suffering a range of life-threatening cardiac conditions, such as heart attacks or severe coronary heart disease, the Kansas City Star reported. The team chose five prayer group volunteers to pray daily for each of 466 of the patients. The volunteers knew nothing about the patients other than their first names and the fact they were sick, while neither the patients nor their doctors were told of the prayers. The other 524 patients served as a control group. Harris told the Star, "The patients who were prayed for just did better." The team qualified the results by reviewing 35 medical measurements, such as the number and type of medicines used, the length of hospital stays, the need for pacemakers, the speed of recovery and whether the patient died. On average, those who were prayed for did 11 percent better in terms of the 35 considerations. James Dalen, the Archives of Internal Medicine's editor, told the Star he felt the study was well-designed and well-written. He said of prayer, "If this was a medication, the conclusion would be that this medication helped." Physician Harold Koenig of the Duke University School of Medicine called the study "very significant" but also "highly controversial." Koenig, who has conducted several studies on spirtuality and health, said, "I'm not sure how many doctors are going to embrace this." The Harris results match the findings of a similar study conducted in the late 1980s by Randolph Byrd at San Francisco General Hospital. That study involved 393 patients. Other larger studies on the effects of prayer on the sick reportedly are being conducted by researchers at Harvard University and Georgetown University Medical Center.

10/25/99. Pharmacia Wins FDA Approval For Breast Cancer Drug PEAPACK, N.J. (Reuters) - Pharmacia & Upjohn said Friday it was cleared by U.S. regulators to market Aromasin, a new treatment for advanced breast cancer in postmenopausal women.
Aromasin, Pharmacia's second breast cancer drug to win approval this year from the Food and Drug Administration, works by inhibiting the enzyme aromatase. It was tested among patients with advanced breast cancer whose tumors stop responding to the conventional treatment tamoxifen. Aromasin was generally well-tolerated in clinical trials. The most common drug-related adverse events were hot flashes, nausea, fatigue, increased sweating and increased appetite, Pharmacia said. In September, Pharmacia was given FDA approval to market Ellence for treating early node-positive breast cancer after surgery.

10/25/99. Exercise fights effects of stress (Reuters Health) -- Regular exercise can help fight the negative effects of stress on the body, according to Colorado researchers.
Investigators led by Dr. Monika Fleshner of the University of Colorado studied the effects of stress in rats. Looking at how physical activity affects the brain, rats ran for exercise for 8 weeks prior to 90 minutes of stress exposure and then were compared with rats that had not exercised before being exposed to stress. The rats that exercised had lower levels of a particular protein in stress-related parts of their brains than their sedentary counterparts. This theory of a beneficial effect of exercise on stress circuits in the brain was put to the test in a second study that found that rats who exercised regularly released less norepinephrine, a stress hormone, when exposed to stress. In a third study, exercise before exposure to stress appeared to help rats recover more quickly from infections with E. coli bacteria. "An analogy might be a sedentary person on a challenging mountain hike cutting his hand on a sharp rock and introducing bacteria into the wound," Fleshner said in a statement. "That person's body probably would not be able to 'clean up' the infection site as quickly or efficiently as an experienced, active mountain climber's body." "Our goal is to understand how regular, moderate physical activity alters the stress response by examining the entire system, from the brain to the individual cells," added Fleshner. "We think we have the pieces mapped out, but we still need to show how one leads to another."

10/23/99. Breast cancer radiation therapy not linked to heart disease (Reuters Health) -- Radiation therapy after mastectomy does not appear to increase the risk of heart disease in breast cancer patients, according to Danish researchers reporting in The Lancet this week. Lead researcher Dr. Inger Hojris of Aarhus University Hospital, Denmark, told Reuters Health that "the most important message from our study is that postmastectomy irradiation can be given without injury to the heart, if appropriate treatment techniques are used." Hojris and colleagues in the Danish Breast Cancer Cooperative Group analyzed data from more than 3,000 women enrolled in two Danish trials to determine whether radiation therapy would impact on the development of ischemic heart disease in women identified as high-risk for breast cancer recurrence. As to why ischemic heart disease might be a consequence of radiotherapy, the researchers explain that in patients with cancer of the left breast, one of the arteries supplying blood to the heart "receives a substantial radiation dose because the artery lies within or near the target (area)." The investigators found that "the cumulative survival at 12 years (of follow-up) was significantly better among women in the (radiation therapy) group than those in the no-radiotherapy group." And, there was apparently no discernible difference in the occurrence of ischemic heart disease between the two groups, suggesting that concerns about a heightened risk of eventual cardiac problems in the radiotherapy group were unfounded. In contrast, earlier research had indicated that death from cardiac causes was, in fact, influenced by receipt of radiation therapy. In an e-mail reply to a query from Reuters Health, Hojris noted that "the number of patients suffering from ischemic heart disease in the radiotherapy group compared with the no-radiotherapy group did not increase with time (since) treatment, and there was no increase among patients treated for left-sided breast cancer compared to patients treated for right-sided breast cancer." Hojris noted that her team's study "gives further support for the use of postoperative radiotherapy in patients with high risk of (disease) recurrence." Although "further follow-up is necessary to rule out harmful effects on the heart after more than 12 years," Hojris emphasizes that "the follow-up period was long enough to show a significant survival benefit from systemic treatment plus irradiation compared with system treatment (chemotherapyhormonal therapy) alone." The authors also point out that "the total time patients were followed up was longer in the radiotherapy group than in the no-radiotherapy group because significantly more patients in the no-radiotherapy group died from cancer (recurrence)." According to Hojris, she and her team "are now planning to investigate the occurrence of ischemic heart disease among patients given radiotherapy after breast-conserving treatment and apart from this, we are currently investigating other treatment-related complications." SOURCE: The Lancet 1999;354:1425-1430.

10/22/99. Many women overestimate mammography's accuracy. SOURCE: Journal of Epidemiology and Community Health 1999;53:716-720. NEW YORK, Oct 21 (Reuters Health) -- Many women may place too much faith in the ability of mammography to catch breast cancer at its earliest stages, results of an Australian study suggest.
In a survey of 115 women that asked them to estimate the accuracy of mammograms, one-third believed screening detected at least 95% of breast cancer cases -- an "unrealistically high expectation," according to researchers led by Dr. Alexandra Barratt of the University of Sydney, Australia. Reporting in the current issue of the Journal of Epidemiology and Community Health, the researchers added that 40% of women thought the breast x-rays "should realistically" detect all cancers. In actuality, Barratt's team notes, mammography detects between 75% and 94% of breast cancer cases, depending on age -- the failure rate is higher for women younger than age 50 because of their more dense breast tissue. Just 35% of survey respondents made estimates within the correct range. The women's tendency to overestimate the reliability of mammography was coupled with the common belief that women should be financially compensated when the test initially fails to detect cancer, but further screening catches it at a later stage. Forty-five percent favored financial compensation if the failure was due solely to mammography's inherent failure rate; nearly all -- 93% -- favored compensation if someone involved in the screening made an error. While the investigators note that they are unaware of anyone in Australia who has successfully sued for an inaccurate cancer screening, there remains the concern that if such claims are successful in the future, the financial burden "could render breast and cervical screening programs in Australia unsustainable." Similar concerns, they add, have been expressed in the United States. In the US, the National Cancer Institute (NCI) recommends that women at average risk for breast cancer have a mammogram every 2 years beginning at age 40, and every one to two years after age 50. Women at high risk, such as those with a personal or family history of breast cancer, should discuss their screening needs with their physician. According to the NCI, a new technique called digital mammography is likely to improve the test's accuracy in coming years. Currently under study, this technology produces clearer images of breast tissue and allows computer-assisted diagnosis of cancer.

10/21/99. 'Vaccine' pits immune system against prostate cancer. NEW YORK, Oct 21 (Reuters Health) -- By injecting prostate cancer patients with a genetically engineered 'vaccine,' researchers have activated the immune system to do battle against the disease. The technique "could have implications in the treatment of many kinds of cancer," according to a statement issued by Johns Hopkins Oncology Center in Baltimore, Maryland, where the research team is based. "Such a complete and thorough activation of the immune system against prostate cancer has never before been seen," said study senior author Dr. William G. Nelson, of the Johns Hopkins University School of Medicine. His team published their findings in the October 15th issue of the journal Cancer Research. Prostate cancer is the second leading cancer killer of men after lung cancer, taking the lives of over 40,000 US men each year. Conventional prostate cancer treatment usually involves radiation therapy, surgery, or hormone therapy. In their study, the Johns Hopkins researchers focused on eight prostate cancer patients whose cancers had spread throughout the body despite surgical removal of the prostate. Using cells taken from these patients, the researchers grew prostate cancer cells in the laboratory. They then injected a potent anti-cancer gene, GM-CSF, into these cells. Finally, they reintroduced the cancer cells back into the patient, 'piggybacked' onto an inactivated, harmless retrovirus. The cells were irradiated prior to injection to eliminate the possibility that they might trigger new cancers. According to the authors, within a month after injection, the cancer 'vaccine' had placed each patient's immune T-cells on 'high alert' against prostate cancer cells. The researchers "were not surprised to see T-cell activation," Nelson explained in the Johns Hopkins statement, since this T-cells are naturally 'turned on' by the presence of retroviruses such as the one carrying the vaccine. More surprising was the fact that the vaccine "also stimulated new high-level antibody production," he said. These antibodies, produced by immune cells called B-cells, targeted roving prostate cancer cells, while T-cells attacked tumors. The investigators are continuing to study the effectiveness of the technique in treating prostate cancer patients. They note that side effects were minimal, mostly itching at the injection site and flu-like symptoms, and that the therapy does not require hospitalization. The authors believe the therapy holds promise as a new method of attacking metastatic (spreading) cancers. "Using gene therapy, we re-educated the immune system to recognize prostate cancer cells as a potential infection and attack," explained study lead author Dr. Jonathan Simons. He believes that enetically-engineered vaccines "could make a real difference when used as (secondary) therapy to 'mop up' microscopic cancer cells left behind following surgery, chemotherapy, and radiation therapy." Larger trials focused on the use of vaccines obtained without the need for surgery are currently underway. Patients with advanced prostate cancer who are interested in taking part in the trials can get further information by writing Johns Hopkins Oncology Public Affairs, c/o Dr. Jonathan Simons, 550 North Broadway, Suite 801, Baltimore, MD, 21205, or e-mailing to cancerquestions+jhmi.edu. WEBMASTER>>>>This was put on our breast cancer site because of the implications it has to breast cancer. By techniques such as this, it will be found that secondary microscopic breast cancer cells can likewise be destroyed.

10/21/99. Breast cancer study eyes pesticide link. NEWTON, Mass., Oct. 21 (UPI) A new study suggests higher breast cancer rates among affluent women in the Boston suburb of Newton may be due to environmental factors and more frequent screenings.
Researchers found women with higher rates in more affluent neighborhoods more frequently used pesticides and other toxic chemicals than those in poorer areas, but cautioned the findings are not conclusive and more studies are needed. "We still have a lot to learn," said Julia Brody, executive director of the Newton-based Silent Spring Institute, which released the study. She said in Thursday's Boston Herald the study "takes us a step further in understanding breast cancer." The researchers said the findings have implications far beyond Newton because the highest rates of breast cancer in Massachusetts are generally in affluent communities. Lower rates were found among those living in less affluent areas. The researchers studied 1,350 women and found possible environmental risk factors associated with higher income and education, such as the more frequent use of vaginal spermicides, professional lawn services and dry cleaning. This, the study suggested, exposed more affluent women to possible cancer-causing substances than poorer women. Nancy Maxwell, an epidemiologist who headed the study, said in the Boston Globe, however, "We don't know that any of these are breast cancer risks at this point." Another key factor in higher rates among the wealthier and more educated women appeared to be more frequent mammograms and breast self- examination. Silent Spring is conducting similar studies in other communities in Massachusetts where breast cancer rates are elevated.

10/16/99. U.S. Air Force Plucks Sick Doctor From South Pole WELLINGTON (Reuters) - A ski-shod U.S. Air Force LC-130 aircraft briefly touched down at the U.S. scientific base at the South Pole Saturday and evacuated the base's ill physician, who needs treatment for a lump in her breast. The LC-130 from the New York National Guard's 109th Airlift Wing landed at 12:33 p.m., picked up Jerri Nielsen and dropped off her replacement, then took off again at 12:55 p.m., said U.S. Air Force spokesman Captain Vic Hines, in Christchurch. The plane will have a three hour trip back to the staging base at McMurdo Sound, on the edge of the Antarctic. The turboprop aircraft landed in conditions of minus 60 degrees Fahrenheit, Hines said. There was no immediate update on the condition of Nielsen. Her employer, the U.S. National Science Foundation, has previously said she requires treatment in the United States for the lump but has been reluctant to elaborate out of respect for Nielsen's privacy. The mission was held up for three days because of extreme cold at the South Pole. The U.S. Air Force has a policy of not landing in temperatures below minus 58 F. At very low temperatures critical hydraulic systems on the aircraft become sluggish and it might not be able to take off again. Also snow becomes sticky as it becomes colder, making it harder for the aircraft to achieve take-off speeds on its skis, Hines said.

10/14/99. Scientists Develop a Mouse that Resists Some Cancers. By NICHOLAS WADE (NY Times, October 14, 1999) In a striking demonstration of the reach of a new anticancer technique, scientists have developed a strain of mouse that is immune to certain types of cancer, surviving injections of malignant cells that quickly raise lethal tumors in normal mice. A new technique that may prove useful to humans. The technique is based on the idea of starving tumors by cutting off their blood supply. Several compounds that inhibit the sprouting of new blood vessels -- a process called angiogenesis -- are at various stages of testing and may or may not prove clinically useful. The new strain of mice, which is genetically incapable of making many new blood vessels, shows how effective an anti-angiogenesis therapy might be if someone could develop a drug that worked as well in people as the genetic manipulation does in mice. A team led by scientists at the Memorial Sloan-Kettering Cancer Center in New York developed the mice by deleting two genes that appear to control the process of angiogenesis. Their work is described in the issue of the journal Nature that is being published on Thursday. Experts on angiogenesis said that the new finding would help explain the genetic mechanisms that underlie the formation of new blood vessels and the that discovery of the mechanisms would provide a new set of targets against which anti-angiogenesis drugs could be developed. Directing drugs against blood vessels rather than the tumor itself is regarded as particularly promising because cancer cells, being genetically unstable, can quickly develop resistance to a drug. But new blood vessels, which are composed of the body's normal cells, cannot. "It's very compelling and exciting work," said Dr. David A. Cheresh of the Scripps Research Institute in San Diego. "It gives you a gold mine of potential targets." Dr. George Yancopoulos, chief scientific officer at Regeneron Pharmaceuticals, described the new work as a "fabulous story" because it explained a range of previous observations about angiogenesis, including the fact that blood vessels that sprout new branches seem in some respects to be reverting to an embryonic state. Indeed, the new work springs from a study of genes that control the development of the embryo and in particular a process by which the versatile cells of the embryo take up their mature and final form. In 1990, Dr. Robert Benezra discovered a family of genes that postponed the maturation of muscle cells, a process known as differentiation. He called the genes I.D. genes, for inhibitors of differentiation. With David Lyden, Alison Z. Young and colleagues at Memorial Sloan-Kettering and elsewhere, Dr. Benezra then created strains of mice that lacked the genes. Creating these "knock-out" mice is a laborious though standard way of trying to learn what role a new gene plays by seeing what deficiencies a mouse develops. To Dr. Benezra's surprise he found that although the proteins produced by the ID genes are important in the embryo, they also have a role in adult life, that of orchestrating the changes involved in creating new blood vessels. "I wanted to figure out how these proteins worked," Dr. Benezra said. "I had no idea we would be thrown into the angiogenesis world." The Sloan-Kettering team found that mice lacking all copies of the I.D. genes died in the womb, but if just three of the four copies were knocked out, the mice were born healthy and apparently normal. The deficiency of I.D. genes showed up only when the animals were injected with malignant cells. When either lymphoma or breast cancer cells were injected, the mice formed transient tumors that failed to establish a blood supply and quickly regressed. The mice did not develop cancer and lived a normal life span. After an injection of lung cancer cells, tumors did develop but did not spread to other sites in their usually aggressive way. The mice died, but not until much later than normal mice treated the same way. The mice's resistance to cancer, Dr. Benezra and his colleagues believe, arises because their lack of I.D. genes makes them incapable of building the new blood vessels that tumors must have to survive. To grow beyond a certain size, tumors must induce a nearby blood vessel to sprout new branches that will supply them with oxygen and nutrients. Presumably, the tumors send out some signal that forces the blood vessel cells to switch on their I.D. genes. In mice that lack the I.D. gene, the cells are deaf to the tumors' deadly siren call. Dr. Benezra said he had already identified a chemical that inactivates the protein produced by the I.D. genes and is working with Angiogenex, a biotechnology company in Seattle, to evaluate it. Because the I.D. genes seem to play no role in human adults except when new blood vessels are being formed, therapy that inhibits the gene should have no serious side effects. The broader significance of the Sloan-Kettering work is that the I.D. genes seem to lie at the top of the cascade of genes that direct new blood vessel growth. Each of these genes could offer a point at which to disrupt the angiogenesis induced by tumors. Exploration of the role of these subsidiary genes may also lead to better understanding of the substances now being tested as anti-angiogenic agents. Dr. Cheresh, for example, has found that angiogenesis is inhibited by substances that attack a protein called integrin, which studs the surface of new blood vessel cells and helps them bore into the tissues they are irrigating. Dr. Benezra found some evidence that the integrin gene is switched off in cells that lack their I.D. genes. He also hopes to determine whether angiostatin and endostatin, two angiogenesis antagonists developed by Dr. Judah Folkman of the Harvard Medical School, work through the I.D. gene pathway.

10/14/99. Coping with Fear: Keeping Breast Cancer in Perspective. By JANE E. BRODY (NY Times, October 12, 1999) What descriptions come to mind in connection with breast cancer? The ones I've heard often include tragic, terrifying, horrific, devastating, terrible, monstrous and "a woman's worst nightmare." But how accurate are these words and phrases for the vast majority of women diagnosed with breast cancer? And haven't we induced an unrealistic fear -- indeed, a paralyzing terror -- in many women in our efforts to stimulate research into this disease and raise awareness of the need to be vigilant and conscientious about checkups? Elaine Ratner, a breast cancer survivor and author of a newly published book, "The Feisty Woman's Breast Cancer Book" (a $14.95 paperback by Hunter House), maintains that all the publicity given in recent years to this disease has created the impression that it is far more common and more deadly than it really is, and the resulting fear has caused many women to avoid rather than seek the examinations that could save their lives. Ms. Ratner wrote: "The fear of breast cancer among American women has reached epidemic proportions, not because the number of deaths is on the rise but rather because breast cancer has moved into the spotlight and is now a public issue. "Negativity and morbidity prevail. In all the talk about breast cancer you rarely hear the fact that most women who get it deal with it and go on to live out normal, healthy lives. You also rarely hear that fear itself, and a pessimistic attitude, can negatively affect a woman's ability to cope with the disease." As a breast cancer survivor myself, I think it's time to replace fear with facts. Here are some important facts about this disease: The vast majority of women never get breast cancer. The one-in-eight-women statistic is accurate, but only if you live to 85. And as you get older and remain free of cancer, the one-in-eight figure starts dropping because you have already lived out many of the at-risk years. If, for example, you are now 70 years old and still cancer-free, your chances have dropped to 1 in 20.

•Seventy percent of women who get breast cancer do not die from it. And the death rate has been dropping steadily throughout this decade. Furthermore, if more women adhered to current detection guidelines and cancers were found while still in their earliest stages, upward of 95 percent could survive this disease.

•The probability that an American woman who lives to age 90 will die of breast cancer is only 3.8 percent. Fifty percent will die of heart disease, yet this leading killer does not conjure up anything like the fear that breast cancer does.

•Lung cancer, not breast cancer, is the leading cause of cancer deaths in American women. This year, 68,000 women will die of lung cancer, 57 percent more than will succumb to breast cancer. Why are we not more terrified of lung cancer, which has a survival rate of only 12 percent?

•While it is true that breast cancer is the leading cause of death among American women in their 40's, it is also true that only 1 woman in 50 contracts breast cancer by age 50. These women are unusual and their cases are poignant; they are sick in the prime of life.

Yet, with modern treatments, even these younger women are more likely to survive. "It is time we turn some of our focus from the losers in the fight against breast cancer to the winners," according to Ms. Ratner. "I do not belittle in any way the pain or tragedy of those who have succumbed. But it is only part of the story. Our preoccupation with those who die of breast cancer has kept us from being encouraged and inspired by the many more who live -- long and well." Among the many breast cancer survivors I know, for example, there is a champion amateur ballroom dancer and artist, an editor/literary agent, a community volunteer who spearheaded the redevelopment of downtown Cleveland and a retired educator who cares for two grandsons when she is not traveling around the world. And there is me: writer, lecturer, athlete, gardener, cook and world traveler. If anything, having survived breast cancer has made every minute more precious, bringing me even closer to my friends and family and reminding me daily not to postpone doing anything I've been wanting to do. We are alive today because of improved methods of detection and treatment, combined with a willingness to participate in treatment decisions, a view that breast cancer was not the most terrible thing that could happen to us and a determination to beat the disease and get on with life. Ms. Ratner, who chose mastectomy over lumpectomy followed by radiation, put it this way: "I consider myself fortunate that my cancer was in my breast. If I had to choose a body part to sacrifice, a breast would be my first choice. No other body part is as expendable. A breast doesn't pump your blood or digest your food. You don't breathe with it or use it to walk or talk." In dealing with her disease, she wrote, "I decided that I would not let cancer take over my life. I decided to concentrate on continuing to feel fine. Maybe in the end cancer would get me and I would die, but for as long as I could, I would do everything possible to extend and enjoy my life." Worry, she insists, is a destructive force that can only make things worse. I don't share Ms. Ratner's views on modern methods of treatment; her discussions of radiation therapy, chemotherapy and tamoxifen, a drug that can help to prevent recurrence and second cancers, fail to give enough weight to the life-saving value of these procedures for many women. But I heartily endorse her emphasis on the importance of learning all you can about treatment options and not allowing doctors to make all the decisions for you. I agree, too, with Ms. Ratner's plea to share one's breast cancer experience and concerns with good friends and others who can provide understanding and support through cancer treatment and recovery. "Human contact and emotional support have a great deal to do with anyone's ability to deal with illness," she wrote, noting that breast cancer strengthened her ties to her family and close friends. Emotional support also aids survival. Dr. David Spiegel, a psychiatrist at Stanford University School of Medicine, demonstrated that even among women with advanced breast cancer, those who participated in support groups lived twice as long as other women with the same prognosis who were not in such groups.

10/12/99. Drug lowers fracture risk in women with osteoporosis. NEW YORK, Oct 12 (Reuters Health) -- Risedronate, a drug already approved for the treatment of Paget's disease and other metabolic bone disorders, appears to be highly effective in preventing fractures in postmenopausal women with established osteoporosis.
"We've already shown in earlier projects that this medication... is effective in reducing bone loss in women who do not yet have osteoporosis," study director, Dr. Steven T. Harris told Reuters Health. The study, published in the October 13th issue of The Journal of the American Medical Association, is the first to demonstrate a significant effect of the drug in women who have already experienced one or more vertebral fractures linked to osteoporosis. Harris, a researcher at the University of California, San Francisco, and colleagues elsewhere compared the 3-year medical histories of nearly 2,500 postmenopausal women given either risedronate or a 'dummy' placebo. Each of the women had suffered at least one vertebral fracture prior to entry to the study. All women also took 1,000 mg calcium daily, and a subset received vitamin D, as well. Both compounds are thought to help reduce fracture risks. After only 1 year of treatment, fracture risk was reduced by 65% in women taking risedronate compared with those on placebo. After 3 years, the number of new vertebral fractures was reduced by 41% and the incidence of nonvertebral fractures was reduced by 39% in the risedronate group compared with placebo users. "I think the most important message is that even in these women with established osteoporosis... it was possible actually to do something very important to help them," Harris told Reuters Health. He explained that there is a popular perception that once an individual has osteoporosis, there is no treatment that can improve the condition. Compared with placebo, risedronate therapy also resulted in significant increases in bone mineral density at the lumbar spine, and other bones in the legs and arms. And the drug was safe. "Risedronate treatment was well tolerated in this study, with an overall safety profile similar to placebo," the authors report. Although the drug is not yet approved for the treatment or prevention of osteoporosis, prior studies have already demonstrated that risedronate can reduce bone loss in women at risk of osteoporosis due to menopause and in patients taking corticosteroids. The Food and Drug Administration is currently reviewing data supporting the use of risedronate for these populations and in women with established osteoporosis. With respect to its pending approval, Harris commented that there is "great room for optimism." SOURCE: The Journal of the American Medical Association 1999;282:1344-1352.

10/12/13. Sent in by survivor...Jannah Lee. Seen in 'Contemporary OB/GYN' July 1999 issue: "Pregnacy After Breast Ca Does Not Affect Survival" In the follow-up of a case-control study, there was no increase in mortality among 53 women who became pregnant after a diagnosis of breast cancer, compared with women with the same diagnosis who did not become pregnant (Cancer.85;1999:2424-2432). However, miscarriages occured in 24% of the women who had breast cancer, compared with 18% of women of similar age without breast carcinoma. The accompanying editorial points out that the study is particularly timely because American women are choosing later childbirth and the incidence of breast cancer is rising (2301-2304). Reviewing the literature on this subject, the editorialists conclude that pregnancy does not have an adverse effect on the prognosis of patients with stage I or II breast cancer. But women who are diagnosed with stage III disease should consider deferring pregnancy at least 5 years after treatment, and those with stage IV disease should not considerconception. For a breast cancer survivor who is contimplating pregnancy, these authors recommend thorough counceling by a physician, nurses, psychologists, and other patients who have had the same experience.

10/08/99. Weight gain a problem for some breast cancer patients NEW YORK, (Reuters Health) -- Women diagnosed with breast cancer may experience a paradoxical complication: weight gain. Now, researchers at the University of California, San Diego, have identified factors contributing to this weight change. Dr. Cheryl Rock and colleagues explain in their report, published in the October issue of the Journal of the American Dietetic Association, that "contrary to a common assumption that all patients with cancer suffer weight loss and (a general body decline)," weight gain is a real concern for many breast cancer patients. The investigators used data obtained from the Women's Healthy Eating and Living Study to assess a variety of factors that could potentially impact on the weight gain phenomenon. These include "weight history, age at time of diagnosis, ethnicity... physical activity level,... primary treatment modalities, menopausal status, time since diagnosis and stage of cancer at diagnosis," the team explains. Of the over 1,000 study subjects, some 60% experienced weight gains averaging 2.7 kilograms (6 pounds), according to the study authors. More than a quarter of participants reported weight loss while the remainder seemed to experience no significant weight fluctuations. The researchers determined that several factors influence the likelihood of weight gain in this population. "Factors positively ...associated with weight gain were time since diagnosis,... chemotherapy, African-American ethnicity, current (caloric) intake, and postmenopausal status at time of... entry (into the study)," they write. The study results indicate that breast cancer patients who have undergone longer courses of chemotherapy are at greater risk for weight gain than those who had short courses of cancer drugs. Those women who walked or engaged in more strenuous exercise were found to gain less weight than their inactive peers. Upon statistical analysis of the data, "neither mild exercise other than walking, nor moderate exercise were significantly related to weight gain," Rock and colleagues point out. The authors conclude that "strategies to modify (increased caloric intake coupled with limited physical exertion) are likely to influence the long-term pattern of weight change (found in this patient group)." SOURCE: Journal of the American Dietetic Association 1999;99:1212-1218.

10/06/99. Clinical breast exam detects at least half of asymptomatic cancer. NEW YORK, (Reuters Health) -- Performed properly, clinical examination of the breast can detect at least 50% of asymptomatic cancers in women over the age of 40 and may help reduce mortality from breast cancer in older women who undergo screening, researchers report in the October 6th issue of The Journal of the American Medical Association.
The investigators also suggest that detection of early breast cancer can be improved if healthcare professionals are taught to perform the exam in a standardized way. Dr. Mary B. Barton and colleagues from Harvard Medical School, Boston, Massachusetts, and from the University of North Carolina in Chapel Hill, collected data from 110 articles published between 1966 and 1997 on the effectiveness of clinical breast examination (CBE) as a screening tool to detect breast cancer and what the best technique might be. According to the data analyzed, investigators found that clinical examination of the breast by itself detected anywhere between 3% and 45% of breast cancers missed on mammography. Although it was difficult to determine precisely how much clinical breast examination alone contributes to breast cancer detection, the authors note that in every study, "CBE contributed to cancer detection independently of mammography," they state. In one large trial, for example, mortality rates in women with breast cancer at 7 years were similar among those who had undergone clinical breast examination and those who had undergone both clinical examination of the breast and screening mammography. These results suggest that "mammography may not offer mortality rate advantages over a careful screening CBE, at least for women in their 50s," Barton and colleagues state. The investigators also suggest that if standardized examination techniques were more widely used, more breast cancers might be detected. Correct breast examination technique includes spending at least 3 minutes examining each breast, proper placement and movement of the fingers in a specific pattern, and the correct positioning of the patient. "Although the clinical breast examination is widely recommended and practiced, technique varies greatly. More studies are needed to determine whether the standard techniques can be taught and how effective they can be in improving the precision and accuracy of the clinical breast examination," said Barton in a statement issued by the Harvard Pilgrim Health Care Foundation, which funded the study. SOURCE: The Journal of the American Medical Association 1999;282:1270-1280.

10/03/99 New breast-cancer treatments here! By PETER DOWNS
WASHINGTON, Oct. 3 (UPI) A drug approved just last year for the treatment of osteoporosis in women also may be the most effective way yet to prevent breast cancer in women. Drug manufacturers, however, say they can do even better. The drug in uestion is raloxifene, manufactured by Lilly Co. and sold under the name Evista. Last year, the U.S. Food and Drug Administration approved the drug as a safe and effective therapy for osteoporosis in women. While the drug company conducted clinical trials for the FDA approval, "We also kept track of the number of women who got breast cancer," said Dr. Michael Draper, a spokesman for Lilly. An analysis of the results of the three-year study of 7,705 postmenopausal women with osteoporosis, published recently in the Journal of the American Medical Association, concluded that raloxifene decreased the risk of invasive breast cancer by 76 percent. That compares with estrogen supplements, "which slightly increase breast cancer," said Draper. It also compare favorably with tamoxifen, the most widely prescribed anti-breast cancer drug. In clinical studies completed last year, tamoxifen was found to decrease the risk of invasive breast cancer in healthy women by 49 percent. The National Cancer Institute was so impressed by Lilly's data that "it is recruiting for a 23,000 patient study to compare tamoxifen and raloxifene for the prevention of breast cancer in women," Draper said. Lilly, however, does not intend to pursue the question. "We have other drugs in the pipeline that we think will be even better," he said. Raloxifene and tamoxifen both are part of a class of drugs called selective estrogen receptor modulators, or SERMs. These are designer drugs that mimic estrogen in some parts of the body, but not others. Raloxifene, for example, mimics estrogen in maintaining bone health, but appears to block estrogen in women's breasts. Scientists in St. Louis for the annual meeting of the American Society for Bone and Mineral Research say they are learning how to more narrowly tailor drugs so the next generation of SERMs will be both more effective and have fewer side effects. In part, that follows from a recent discovery that there are at least two different types of estrogen receptors, so scientists can tailor drugs to interact with one or the other. Besides Lilly's scientists, researchers from Signal Pharmaceuticals said they are in preclinical trials with SERMs that hold promise for treating tamoxifen-resistant breast cancers, and prostate, endometrial and ovarian cancers. In poster presentations to the meeting, Signal researchers said the drugs have proven effective against cultured human cancer cells grown in the laboratory and are being tested now on mice and rats.

First Ever FDA-Cleared Breast Self-Examination Pad to Help Women Now Available in Drug Stores and Major Chains Nationwide
Tuesday, September 14, 1999 09:03 AM Nearly 3 Out of 4 Women Still Don't Conduct Potentially Life-Saving Breast Self-Examinations
FRANKLIN LAKES, N.J., /PRNewswire/ -- B-D Sensability(TM) Breast Self-Examination Aid*, the first FDA-cleared pad to help women conduct breast self-examinations (BSEs), is now available in drug stores and major chains nationwide. A study using the Sensability pad showed it provided a higher level of tactile awareness than a bare hand(1). The Sensability aid is a complete educational system, including the pad itself, an educational video and an instruction guide, all in a discreet storage case.

The American Cancer Society (ACS) recommends a three-pronged approach to breast health, which includes monthly BSEs, clinical exams by a healthcare professional, and annual mammograms for women over 40. According to recent studies, women who conduct monthly BSEs are diagnosed while in an earlier stage of breast cancer than those who do not conduct regular BSEs(2). Earlier diagnosis typically leads to earlier treatment and improved treatment outcomes. In fact, some studies estimate breast cancer mortality can be reduced by as much as 18 percent through increased use of BSE(3). "BSE is a simple test women can do to maintain breast health and statistics show women still don't do it on a routine basis," explains Katherine Alley, MD, Director, The Breast Center, Suburban Hospital, Bethesda, MD. "The Sensability aid can help women feel more confident in their ability to conduct exams by making it easier and more comfortable for them. Despite its importance in early detection, many women still do not practice BSEs on a regular basis(3). In fact, although 96 percent of women are aware of the need for BSEs, only 29 percent actually perform the exam on a regular basis. The Sensability aid may encourage the more than 71 million women nationwide who do not conduct regular exams to do so. ACS guidelines for successful early detection of breast cancer recommend breast self-examination, professional clinical breast examination, and mammography. Often reported reasons for not performing regular BSEs are lack of confidence at being able to do the exam correctly, not knowing what to look for, limited tactile sensitivity when conducting a BSE with a bare hand, fear of what they may find, and discomfort in touching one's own breasts. "When I first brought home the Sensability pad, I didn't use it for six months because I didn't feel confident that I would be able to detect a lump on my own," said Mary Gorman of Chevy Chase, MD. "Once I started using it, I was amazed at how the pad was able to enhance my sense of touch. The Sensability pad helped me to find a lump that both a mammogram and my doctor had missed." "Having a tool that makes women more comfortable conducting the exam and confident in their ability to detect lumps may influence them to conduct breast self-exams more regularly," said Dr. Alley. "Because lumps are frequently caught by women themselves, conducting frequent breast exams could increase cancer survival rates." The correct way to conduct a complete breast self-examination is to check your breasts while standing up, lying down and before a mirror. Women who conduct monthly BSEs often do so standing in the shower, and are, therefore, not giving themselves what the ACS calls a complete exam. Patients Used Sensability Pad as Effectively as Trained Healthcare Professionals

A clinical trial involving a group of 72 breast cancer patients showed that patients who used the Sensability pad (then known as Sensor Pad(R)) were able to use the product as effectively as nurses familiar with the proper breast examination technique(1). Another comparative study showed that with the Sensability pad a woman had higher tactile awareness than dry palpation (bare hand) or palpation with soapy water (simulating BSE in the shower)(1). The B-D Sensability Breast Self-Examination(TM) pad consists of two thin, round, latex-free plastic sheets that are 10-inch diameter (about the size of an oven mitt) with a liquid lubricant sealed between them. This design reduces friction, making it easier for the woman's fingers to glide smoothly across her breast during a self-exam. The pad makes it easier and more comfortable to conduct the exam.

08/17/99. Virus and Breast Cancer, By Maggie Fox, Health and Science Correspondent WASHINGTON (Reuters) The virus that causes glandular fever, also known as "kissing disease," may also play a role in many cases of breast cancer, European researchers said Tuesday. They said they found Epstein-Barr virus (EBV) in the tumors of about half of all the women with breast cancer they examined. Irene Joab and colleagues at France's medical research institute INSERM, as well as a team in Germany, looked at 100 tissue samples taken from women with breast cancer. In 30 cases they compared tumor tissue to tissue from healthy cells nearby. Genetic material from the virus was found in 51 of the 100 samples, and only three of the comparative samples of healthy tissue contained the virus. "Our results show the presence of EBV genome in a large subset of breast cancers," Joab's team wrote in the Journal of the National Cancer Institute. "Because it is more frequently associated with the most aggressive tumors, EBV may play a role in their development." Dr. Ian Magrath and Kishor Bhatia of the National Cancer Institute said just about everyone is infected with EBV. "At least 90 percent of the world's adult population, including people in the most remote corners of the world, are infected by the virus," they wrote in a commentary on the study. Normally it is harmless, not even causing mononucleosis -- the blood infection also known as glandular fever. "However, even the best of marriages have their ups and downs and EBV has been impugned in the causation of many serious illnesses, including malignant neoplasms (cancer), albeit in a tiny fraction of the population," they wrote. The virus was discovered because of its role in Burkitt's lymphoma, a form of cancer. It has also been associated with another kind of lymphoma, Hodgkin's disease, as well as stomach cancer. The virus infects immune cells known as B lymphocytes and, like all other viruses, stays in the body forever. But Magrath and Bhatia warned that finding bits of the virus in tumor cells does not mean it caused the cancer. They said it could be the virus can move into cells that are already damaged in some way, or might be drawn to cancerous cells. "If the virus were causative one would suspect that you would find the viral genome in every cell," Bhatia, a specialist in EBV, said in a telephone interview. Bhatia said that in the case of Burkitt's lymphoma, the virus is found in every single tumor cell. And he noted that five other studies have found no connection between the Epstein-Barr virus and breast cancer. "This is quite a preliminary finding," Bhatia said. "It is something that has to be treated with tremendous caution. All it does is open the door and suggest that one should walk into this room and check this out." But if it were shown to cause breast cancer "there would be strong grounds for speeding up efforts to develop an EBV vaccine, since breast cancer is the most common tumor of women worldwide, with approximately 800,000 new cases per year," Bhatia and Magrath wrote. A second study in the same journal found gene mutations that might make breast cancer more likely to spread. Peter O'Connell and colleagues at the University of Texas Health Sciences Center in San Antonio looked at tissue from 76 breast cancer patients and found that genetic damage at two sites was more common in those whose cancer had spread.

08/05/99 Two new cancer fighting proteins. WASHINGTON (Reuters) -By Maggie Fox, Health and Science Correspondent. Researchers said Thursday they had found two new cancer-fighting proteins they think will prove especially powerful in starving cancerous tumors. The proteins will join an arsenal of drugs being developed to fight cancer in a novel way -- by choking off the blood supply that cancers create to feed themselves. Human Genome Sciences Inc., a Rockville, Maryland-based company that specializes in searching the collection of human genes for useful new proteins, has named its discoveries METH-1 and METH-2. It said they work better than a highly publicized protein, called endostatin, developed by another Maryland company, Entremed. Entremed last month received permission from the U.S. Food and Drug Administration (FDA) to test endostatin on human volunteers. Huge attention has surrounded the development of endostatin and similar compounds, known as angiogenesis inhibitors. "The use of angiogenesis inhibitors is one of our most promising cancer-fighting strategies," Judith Gasson, director of Jonsson Cancer Center at the University of California Los Angeles, where the proteins were tested, said in a statement.

"By now everyone should be aware of the excitement surrounding the possible use of novel anti-angiogenic proteins as drugs to treat cancer," said Craig Rosen, senior vice president of research and development at Human Genome Sciences. He said the company would develop the proteins if they continue to work in laboratory trials.

Writing in the Journal of Biological Chemistry, molecular biologist Luisa Iruela-Arispe and a team at UCLA said METH-1 and METH-2 act by interfering with the growth of endothelial cells, which are key to blood vessel formation. "The discovery of two novel proteins that inhibit blood vessel formation is exciting, because both proteins were shown to be more potent than endostatin or thrombospondin in preventing new blood vessel formation," she said. Thrombospondin is an anti-tumor protein being developed by Blue Bell, Pennsylvania-based InKine Pharmaceutical Company Inc.. Iruela-Arispe said the proteins appear to be part of a larger family of proteins found in many life forms. Many companies are working to develop angiogenesis inhibitors. Whole proteins have been problematic to work with, though, because they are difficult to produce and because they are large molecules -- very hard for the body to absorb. One of the companies working on such drugs, Boston Life Sciences, Inc., said it may have tackled this problem by isolating a small part of one of the proteins that seems to work as well as the whole protein. Boston Life Sciences says it plans to test the protein, called Troponin I, in people with breast cancer and sarcomas, including melanoma, a form of skin cancer, soon.

07/28/99. Unlocking the secrets of cancer cells. LONDON (Reuters) - Scientists Wednesday said they had unlocked the secret of how normal human cells become cancerous in a breakthrough that could help the search for cures. "Until now, the human cancer cell has been a black box with unknown number of regulatory changes. Now we have been able to catalog the number of changes with precision," Robert Weinberg, of the Whitehead Institute at the Massachusetts Institute of Technology, said. Weinberg told Reuters in a telephone interview he and his colleagues were able to turn normal cells into cancer cells in a culture dish in the laboratory. "What (the scientists) show is that in order to get a tumor cell, there are four steps. If we can somehow rebuild one of these steps in the tumor cell, then we may stop the evolution of the tumor cell," Moshe Yaniv of the Institut Pasteur in Paris told Reuters. The research was published in Wednesday's issue of the science journal Nature and was reviewed by Yaniv and his colleague Jonathan Weitzman. Weinberg and his colleagues found that four regulatory changes -- or disruptions in the normal growth of cells -- need to take place for a cell to become cancerous. Scientists have been trying for 15 years to turn normal human cells into tumor cells in the laboratory. "They set out to determine the minimum number of defined genetic events required for tumor formation, and have brought an end to an endeavor that began more than 15 years ago," Yaniv and Weitzman wrote in Nature.

06/13/99 NY Times By DENISE GRADY (Interesting article) People who sign on to work at the Amundsen-Scott research station at the South Pole understand that they will not see home for a long time: from February to October, planes cannot even land. But an Air Force jet came close early Sunday morning, dipping low over the base to drop medical supplies for a woman, trapped there for the winter, who had discovered a lump in her breast and needed treatment. Her plight turns out to be even more complex than initial reports suggested. The woman herself is the only medical doctor at the station, said a cancer expert who was consulted in her case and who spoke on the condition of anonymity. Therefore, the patient must act as her own doctor, taking care of every aspect of diagnosis and treatment, which may include chemotherapy. If she was to become incapacitated, that would leave the 40 other members of the research team without a doctor at the remote Antarctic outpost. Dr. Karl Erb, director of the Office of Polar Programs at the National Science Foundation, which runs the base, declined to identify the woman or say whether she was the station's doctor. Dr. Erb said cancer experts in the United States had made a "working diagnosis," but he declined to reveal whether a biopsy had been performed. He said she would begin taking medication as soon as it was retrieved. The foundation said it was honoring the woman's request for confidentiality and would not reveal whether or not she had cancer. Mary Hanson, a spokeswoman for the foundation, said that despite the need to protect the patient's privacy, officials did not think the Air Force medical-drop mission itself could or should be kept secret from the public. "We knew it was going to get out sooner or later, so it seemed appropriate to explain as much as we could as soon as we could," Ms. Hanson said. Dr. Erb said it was adequate to have one doctor at an Antarctic station, backed up by people who had trained as paramedics, along with computer, video and telephone links to medical centers. In addition, he said, people who sign up for extended stays at the South Pole are carefully screened for medical problems. "Everyone there is sufficiently fit that he or she is carrying out assigned duties without any problem," he said. Ms. Hanson said the woman, who is 47, had been working at the station since December and had discovered the lump in her breast in June. The foundation sought advice on her behalf from doctors at the National Cancer Institute and other centers. The foundation said in a news release that "the patient and her physicians decided on a course of drug treatment that they consider appropriate to maintain her health and safety." But the release did not specify what the treatment would be. Dr. Erb said the drugs sent in included different treatment options. The jet dropped the equipment from an altitude of about 700 feet. "We have never landed a plane at the South Pole in midwinter," Ms. Hanson said. Winter temperatures at the base average 80 degrees below zero. Dr. Erb said that the equipment included a digital microscope and an ultrasound machine, which can be used to measure the size of tumors and to guide a doctor doing a biopsy. But, he said, "The preliminary report is that the ultrasound machine did not survive the drop." He also said that it took time to retrieve and open the packages that had been dropped and that because satellite communication with the base was possible for only a few hours a day he did not know about the condition of the other equipment. The consultant on the case said he thought the woman would be performing her own biopsy, or perhaps already had. Despite the difficulty of driving a needle into one's own breast, he said: "I would assume that somebody who chooses to go to the South Pole is a tough person, a strong character. It wouldn't shock me that somebody could do this."

Even without ultrasound, video conferencing with an ordinary camera, he said, might allow a radiologist to "walk her through" the procedure. She would then have to make microscope slides out of the cells from the biopsy and stain them so that the slides could be examined for cancer cells. The digital microscope would allow the images to be transmitted for diagnosis to a pathologist anywhere in the world. If cancer was found, chemotherapy could be started, and the woman could have surgery later, after leaving the South Pole. Although most women who need chemotherapy for breast cancer have surgery first, studies have shown that giving chemotherapy first and surgery later can work just as well, said Dr. Larry Norton, head of the division of solid tumor oncology at the Memorial Sloan-Kettering Cancer Center in Manhattan, who was not a consultant on the South Pole case. But the woman would need other drugs to treat chemotherapy's side effects. Another option, the consultant said, is that if the cells were malignant, and if proper staining materials had been sent to the base, it might be possible for the doctor to test her own cancer cells for sensitivity to the naturally occurring hormone estrogen. And if their growth was stimulated by estrogen, the doctor could be given hormonal therapy instead of chemotherapy. The consultant said the hormonal approach would have milder side effects than chemotherapy and could slow the growth of the tumor until the doctor could be flown out of the South Pole in October or November.

06/07/99. Vitamin A Derivative Kills Cancer Cells-US Study Updated 3:58 PM ET July 7, 1999 WASHINGTON (Reuters) - A chemical derived from vitamin A can kill cancer cells, even those that are resistant to other drugs, U.S. researchers said Wednesday.
It is one of several such vitamin A derivatives, known as retinoids, which have been found to act against cancer cells. But in a report in the Journal of the National Cancer Institute, Dr. Barry Maurer of Children's Hospital in Los Angeles and colleagues said they had figured out the mechanism, and said the chemical, known as fenretinide or 4-HPR, might be added to the mix of drugs given to some cancer patients. Fenretinide has already been shown to kill cancer cells, notably cervical cancer and myeloid leukemia. Maurer's team tested it in cells taken from children with neuroblastoma, a kind of cancer of the nervous system. They found the fenretinide killed cancer cells and raised levels of a fat-like molecule called ceramide. The more fenretinide they used, the higher the levels of ceramide and the more tumor cells died. Ceramide is known to kill tumor cells, but scientists have been unable, until now, the find a drug that raises ceramide levels enough in the cells to kill them. The researchers said fenretinide might be used along with other retinoids in treating neuroblastoma to maximize the number of cancer cells killed. "Therefore, should it be clinically tolerated, high-dose 4-HPR may form the basis for a new, ceramide-based chemotherapy," they wrote. Dr. John Reed of the Burnham Institute in La Jolla, California said fenretinide is already being tested in humans. In a commentary on the findings, he said knowing how fenretinide works may help scientists develop even more effective drugs based on its action.

06/18/99. Exercise may reduce breast cancer risk . TORONTO, June 18 (UPI) Exercising at least four hours a week for 12 years can reduce a woman's risk of breast cancer by 50 percent, a new study shows. "That's a lot of exercise," said University of Southern California medical professor Leslie Bernstein. "And the more you do, the better." But she said women don't have to run marathons: The exercises "doesn't have to be severe, but it does have to be consistent," she said at a research conference of the Canadian Breast Cancer Research Initiative in Toronto. Even four hours of brisk walking every week is enough to reduce the risk, she said, and the 12 years don't have to be consecutive. Earlier studies on pre-menopausal women had found beneficial effects of exercise during adolescence and the child-bearing years, she said. The study looked to see if exercise during those periods had any effect for post-menopausal women, but found nothing, Bernstein said. "The only thing that predicted your breast cancer risk relative to exercise was how much you did over your entire life," she said. Her study, which looked at 1,100 post-menopausal women who had been diagnosed with breast cancer and compared their history of exercise with 1,000 women who had not come down with the disease, is to be reported early next month in the British Journal of Cancer. But Bernstein added there are some women who did not show a benefit from exercise those who had gained more than about 17 percent of their body weight after their teenage years. There are two possible reasons for that, she said: The weight gain might make it hard to do enough exercise to show the benefit or heavier women might not be accurately reporting their exercise history. As well, Bernstein said, the benefits aren't absolute: "There will be some women who develop breast cancer who will have done everything right," she said. But she added that her advice would be to take regular exercise, because it's known to have other benefits, including reducing the risk of cardiovascular disease, Type II diabetes and osteoporosis.

Bernstein's results are confirmed by another new study, this one carried out in the Canadian province of Alberta, said researcher Christine Friedenreich of the Alberta Cancer Board. Friedenreich studied 1,240 women diagnosed with breast cancer between 1995 and 1997, and compared their exercise history to 1,238 women without the disease who were matched according to age, ethnicity and other variables. The results show that a high level of physical activity in all walks of life job, school, and leisure time and throughout the lifespan of a woman predicted a 20 percent reduction in risk of breast cancer. Friedenreich said the reduction appeared to be lower for her study because the exercise was averaged across the entire lifetime of the women being studied and because it lumped together all types of physical activity. Women whose jobs involved physical activity seemed to have the greatest benefit, she said. By MICHAEL SMITH

06/15/99. Osteoporosis Drug Fights Some Breast Cancers-Study By Andrew Stern
CHICAGO (Reuters) - An osteoporosis-fighting drug has been found to reduce the risk of breast cancer in women, but researchers said Tuesday they were not yet prepared to recommend it for that purpose. A three-year trial showed women with osteoporosis who took the drug, raloxifene, reduced by 76 percent their risk of developing the types of cancer associated with oestrogen, compared to women who took an inert placebo in the test. Millions of women take oestrogen supplements to ease the symptoms of menopause such as hot flashes and to battle post-menopausal conditions such as osteoporosis -- in which bones lose density, become brittle and break more easily. Oestrogen is also believed to cut women's risk of heart disease. But taking oestrogen has also been blamed for a slightly higher risk of breast cancer, creating a difficult decision for women, particularly those considered more susceptible to the cancer, such as those whose mothers or other family members had the disease. The study of raloxifene was funded by Eli Lilly and Co. which manufactures the drug under the brand name "Evista." It was published in this week's Journal of the American Medical Association. Of 5,129 post-menopausal women who took either 120 milligrams or the recommended daily dosage of 60 milligrams of raloxifene, 13 developed breast cancer. By comparison, 27 women out of 2,576 taking a placebo developed breast cancer.

The size of the dosage did not make a difference in preventing breast cancer, which killed 43,500 women in the United States last year. If the results hold up over an extended period, "we've got an intervention that reduces the risk of breast cancer over the very long term," study author Steven Cummings of the University of California at San Francisco said in an interview. Researchers are convinced that raloxifene prevents oestrogen-related breast cancers by occupying the same molecular "receptors" as the oestrogen molecule, blocking estrogen's carcinogenic effects on breast and endometrial tissue by changing the way proteins are synthesized. In other ways, raloxifene mimics oestrogen and has similar health benefits such as preventing bone loss and lowering blood levels of so-called bad cholesterol that can lead to heart disease. However, raloxifene did not lift levels of so-called good cholesterol, as oestrogen does. Unlike the drug tamoxifen, another fairly new drug that has been found to prevent bone loss and to cut women's risk of breast cancer in half, raloxifene does not carry an increased risk of endometrial cancer. Oestrogen also carries a higher risk of endometrial cancer. However, raloxifene has its own drawbacks and risks, Cummings and other researchers said. For one thing, it is only half as effective as oestrogen in slowing the loss of bone density, which may be the key factor in whether women suffer debilitating hip and back fractures later in life. Cummings said fractures will be the subject of a subsequent paper from his study, which will be continued for four more years to offer a longer time frame for results. Of greater concern, raloxifene increases the risk of potentially life-threatening blood clots in the lungs and legs and can cause recurring hot flashes. Cummings said the risk of blood clots was small, occurring in about 1 percent of his study's subjects. An editorial examining the study's results that appeared in the same journal said the findings were encouraging about raloxifene, but remained inconclusive.

"Raloxifene should not be considered suitable for use by most women at this time," wrote Adele Franks of Prudential Center for Health Care Research and Karen Steinberg of the Centers for Disease Control and Prevention. "I would agree with that," Cummings said. "I think the editorial is correct in saying post-menopausal women who have no special risk of disease may not need to take drugs, period. It may depend on women's risk factors for breast cancer."

06/12/99. Tamoxifen Lowers Risk Of Invasive Breast Cancer
LONDON (Reuters) - Tamoxifen, a drug used to treat and prevent breast cancer, can also lower the risk of invasive cancer in women with early signs of the disease, doctors said Friday. Ductal carcinoma in situ (DCIS) involves early cancerous changes in the cells of the milk ducts of the breast. Thousands of women each year are diagnosed with the condition which can be picked up on a mammogram. It is a non-invasive cancer because the cells have not migrated to the surrounding breast tissue. Doctors have found it difficult to treat because women with DCIS can develop invasive cancer but not all do. Until the 1980s mastectomy was the main type of treatment. Now most women with the disease have a lumpectomy and radiation therapy to reduce the risk of DCIS recurring or of it developing into invasive cancer. Researchers in the United States and Canada have found that tamoxifen can also help. "The combination of lumpectomy, radiation therapy and tamoxifen was effective in the prevention of invasive cancer," said Dr Bernard Fisher of Allegheny University of Health Sciences in Pennsylvania. In a report in The Lancet medical journal, Fisher and his colleagues said their study of 1,804 women with DCIS showed that the 902 women who had the triple treatment with tamoxifen had fewer invasive cancers after five years of treatment than those who had been given a placebo instead of the drug.

Tamoxifen, which is marketed by newly formed drug giant AstraZeneca Plc under the brand name Nolvadex, works by neutralizing the action of the female hormone oestrogen which stimulates breast tumor growth. Studies has shown it is effective in the treatment of early and advanced breast cancer. The U.S. Food and Drug Administration also approved it for use in preventing breast cancer in women with a high risk of getting the disease. Side effects linked to the drug are weight gain, hot flushes and irregular periods. It may also induce early menopause in older women and can increase the risk of cancer of the lining of the womb and blood clots in the lung.

06/09/99.PET Scans are better at detecting some cancers. LOS ANGELES (Reuters) - PET scans may be expensive, but they are better than other methods for detecting lung, breast and colon cancers, according to several studies released Tuesday. "PET is now having a major impact on the way we take care of patients," Dr. Edward Coleman, professor of radiology at Duke University's Medical Center and an expert in the use of the scans, said at the Society of Nuclear Medicine's annual meeting.

6/8/99. FDA votes for breast cancer drug. SILVER SPRING, MD, Jun 08 (Reuters Health). -- An advisory panel to the Food and Drug Administration (FDA) recommended on Monday that the federal agency approve the drug epirubicin hydrochloride (Ellence) to treat breast cancer that has spread to local lymph nodes, but has not spread to other sites in the body.
But the panel recommended against approving the drug as the first treatment of choice for breast cancer that had spread or metastasized to other parts of the body. The FDA often, but not always, follows the advice of such panels. Epirubicin has been approved in 80 countries. The manufacturer, Pharmacia & Upjohn, first applied for FDA approval in 1984, but was subsequently turned down because it did not have sufficient data, said the agency. After Upjohn merged with Pharmacia, the company reapplied in December 1998, using new data.

In new trials, seven of which were submitted to the FDA, epirubicin was studied in a regimen including cyclophosphamide and fluorouracil (CEF) and compared with a combination of cyclophosphamide, methotrexate, and fluorouracil (CMF) in breast cancer patients. In one Canadian trial, 62% of the patients taking epirubicin had a relapse-free survival of 5 years, compared with a 53% rate among CMF patients. Results were similar in a second study conducted at 20 sites in France between 1990 and 1993. The Canadian study also showed that 77% of the epirubicin patients survived 5 years, compared with 70% of CMF patients. The seven studies showed that there was a higher incidence of leukemia and heart side effects in patients taking epirubicin. In the early-stage study, 3.4% of the epirubicin group had a cardiac effect, compared with 1.1% of the CEF group. The effect was even more pronounced in metastatic patients -- 13% had cardiac toxicity, compared with 4% of the CMF group. The Oncologic Drugs Advisory Committee voted unanimously to back epirubicin as an additional treatment for breast cancer that had spread to lymph nodes after removal of the original tumor. But the group voted 6-3 against approving the drug as the first treatment for breast cancer that had metastasized. Although some patient advocates at the meeting argued for approval, others said they were not impressed with epirubicin. "I see it has some survival benefit, but with significant toxic effects, so I don't see what's so exciting to the patient," said Susan Zook-Fischler, the panel's patient representative.

6/8/99. Estrogen linked to curable cancer. CHICAGO, June 8 (UPI) , A study of women who take estrogen products after menopause finds they have a slightly higher risk of getting rare but generally curable breast cancers. The finding may fuel the controversy over whether the benefits of hormone replacement therapy are worth the risk. The study, published in Wednesday's Journal of the American Medical Association, said post-menopausal use of hormone replacement therapy _ generally estrogens for up to five years gives women a 1.81 greater chance of developing "invasive breast cancer with a favorable prognosis" than women who did not use it. For women taking the hormone longer than five years, the risk shot up to 2.65 times. Dr. Tom Sellers of the Mayo Clinic in Rochester, Minn., and a chief study investigator, said while past studies have "tended to see a slight increase in breast cancer risk" this is the first to break it down by breast cancer type and prognosis. "The bottom line is, yes, there is a slight increase, but primarily tumors with a favorable prognosis," Sellers said. The research did not find a link between estrogen products and the risk of more common breast cancers, including those that have not spread, but which carry less favorable outcomes.

The study was conducted by researchers from Mayo and from Northwestern University Medical School in Chicago. They analyzed results from more than 37,100 women who participated in the Iowa Women's Health Study designed to determine if use of hormone replacement therapy is associated with specific types of breast cancer. Post menopausal women often have to balance the risks of taking estrogen products against the benefits, which include reducing menopausal symptoms and the risk of osteoporosis, along with a potential for reducing the risk of heart disease. The study, however, did not resolve key questions for some researchers. Dr. Michele Blackwood, a breast cancer surgeon and founder of the Blackwood Breast Center in Stamford, Conn., said, "The question about breast cancer and hormone replacement therapy is still not answered." She said a randomized double blind study with a placebo group is needed to test the long-term impact of estrogen. But study author Sellers said, "I don't think the results are necessarily controversial or even inconsistent with other studies. I'm not sure this is going to change the minds of women who are already taking hormone replacement therapy. If anything, it is reassuring for them." Dr. Trudy Bush of the University of Maryland School of Medicine in Baltimore wrote the accompanying editorial in JAMA critical of continued research into an estrogen-breast cancer link. "I think this is an association we've been looking for, for an awful long time and we simply don't get consistent reports it's there," Bush said in an interview with UPI. "This is a really good group of people and it's a very good study and it's an example of how we look so hard for an association between hormone replacement therapy and breast cancer." Bush said researchers have known for 25 years estrogen increases the risk of uterine cancer but said years of studies have not produced compelling evidence of a link to breast cancer so it's time to move on. "That should be reassuring to women and a challenge to drop the estrogen-breast cancer blinders and look for something else," Bush said. That something else, Bush added, could well be a link between some type of "ovarian product" and breast cancer. She said there are reproductive factors linked to breast cancer and research needs to begin on identifying the ovarian codes for proteins to see if there is a connection. (Written by Ellen Beck in Washington)

6/08/99. New test prior to breast cancer surgery. LOS ANGELES (Reuters) -Breast or skin cancer patients who opt for a new test of their lymph nodes can avoid the pain, potential complications and cost of some surgery, according to studies released Monday. More and more surgeons are asking for the test called "lymphoscintigraphy," Dr. Robert Henkin, professor of radiology at Loyola University Medical Center in Chicago, said at the annual meeting of the Society of Nuclear Medicine in Los Angeles. A diagnostic procedure, lymphoscintigraphy uses a radioactive tracer to locate the "sentinel node," the first lymph node into which a malignant tumor drains. Henkin said the test is similar to a tuberculosis skin test, with the patient feeling only a stinging sensation. "The results are very easy to read. We are able to mark the exact spot for the surgeon to go in," he added. With the sentinel node identified, the surgeon can remove it instead of removing all the lymph nodes surrounding the tumor, Henkin explained. If no tumor is present in the sentinel node, remaining nodes may not need to be removed, he said. Conversely, lymphoscintigraphy could be employed to detect tumors in areas that appear normal, Henkin noted. Findings from several studies were presented at the meeting to support the effectiveness of the test. A study of 113 breast cancer patients at the Netherlands Cancer Institute found sentinel nodes in unexpected locations for 19 percent of the patients. Eighty percent of those nodes were detected by lymphoscintigraphy. In another study, Dr. Mohammad Keshtgar and colleagues in London found that lymphoscintigraphy saved around $500 in treatment costs per patient and reduced post-surgical complications. By Deena Beasley

6/4/99. Screening for breast cancer helps to reduce deaths from the disease in younger, as well as older women, according to two studies published Friday. LONDON (Reuters) - The mammogram has been an important tool in diagnosing breast cancer in women over 50 but researchers have been divided about its benefits for younger women because their breast tissue is much denser. Two studies in The Lancet medical journal showed that mammograms helped to detect cancer in younger women. "The results for younger women suggest benefit from introduction of screening before 50 years of age," said Dr Freda Alexander of the University of Edinburgh in Scotland. She followed the medical histories of more than 54,000 women for 14 years. Half were screened regularly and the other half had medical checkups, but no mammograms. Breast cancer death rates were 21 percent lower in the screening group. A similar study which compared women who were screened, those who attended breast self-examination education centers and others in a control group found that screening reduced the death rate by 27 percent in all age groups after a 16-year follow-up. The UK Trial of Early Detection of Breast Cancer involved more than 100,000 women in eight centers across the country. "The analysis of results by age at entry continues to suggest that screening of women aged 45-49 years is at least as effective as is that for women over 50 years," the researchers said in the report.

6/4/99. Federal advisers are set to review three drugs next week that could offer alternatives for patients suffering from breast and ovarian cancers or help beat the ravages of radiation therapy.. WASHINGTON (Reuters) - A Food and Drug Administration advisory panel Monday is scheduled to review Pharmacia & Upjohn Co.'s epirubicin for early or advanced breast cancer. Tuesday, the panel will turn to Alza Corp.'s Doxil for ovarian cancer and Ethyol, a drug that could protect healthy cells from harm during radiation therapy for cancer. Of the three drugs, Ethyol, which would be co-marketed with U.S. Bioscience, could offer the biggest benefit for both consumers and Palo Alto, Calif.-based Alza because it would provide a unique treatment, Gruntal and Co. analyst David Saks said. The FDA, which usually follows its panels' advice, has approved medications to protect the body during chemotherapy but none for radiation. The most serious side effect for the 500,000 Americans who undergo radiation treatment each year is severe dry mouth that affects chewing, swallowing and speaking. Ethyol could protect the salivary glands, allowing doctors to increase radiation levels to better fight cancer. "The impact would be quite significant to the U.S. market," Saks said. "There's no other drug on the U.S. market like it." Ethyol is currently approved for fighting kidney toxicity in chemotherapy patients. The other Alza drug, Doxil, will be considered for treating ovarian cancer victims who have not responded to initial therapies. The FDA is considering Doxil under priority review because women who do not benefit from initial ovarian cancer treatment have no other options. Priority review means the agency should make a decision on Doxil within six months after the application was filed last December.

About 25,000 U.S. women are diagnosed with the disease each year, and about 14,000 die annually. The FDA designated Doxil an orphan drug, which gives Alza seven years' worth of market exclusivity. The drug's 1998 worldwide sales were $48 million. The drug, known generically as doxorubicin, has FDA approval for treatment of AIDS-related Kaposi's sarcoma. Doctors already use it to treat ovarian cancer, Hambrecht and Quist analyst Corey Davis said, adding that those patients now comprise about 75 percent of Doxil's sales. "If it can do 75 percent of sales without having a formal indication, it should be able to do really well," Davis said. "We think it could be a $100 million product." Pharmacia and Upjohn's epirubicin has been sold abroad since 1984 in more than 80 countries for a variety of cancers. Used with other medicines as part of chemotherapy, epirubicin generated 1998 worldwide sales of $177 million.

In clinical trials involving breast cancer patients, epirubicin, cyclophosphamide and fluorouracil worked better than another three-drug cocktail in decreasing the risk of cancer recurrence and increasing survival, the company said. Epirubicin would offer a new alternative for breast cancer patients but would not have a huge impact on Pharmacia and Upjohn's revenues, analysts said.

6/4/99.Armed with a new understanding of how certain enzymes go haywire in the body, researchers may soon be able to tackle arthritis, as well as cancer, from a different angle. NEW YORK, Jun 04 (Reuters Health) -- Two separate groups of scientists report their latest findings on these enzymes, known as matrix metalloproteinases (MMPs), in the June 4th issue of the journal Science. The primary job of MMPs is to "chew up proteins," the author of an editorial in Science notes. They "remodel the entire body during embryonic development and help migrating cells, such as immune cells or the cells necessary for wound healing, move to where they are needed." But when the function of these enzymes goes awry, the result can be arthritis or cancer. Finding a way to control MMP activity is a goal of many scientists. By describing for the first time one MMP enzyme's three-dimensional structure, Dr. Karl Tryggvason and colleagues from the Karolinska Institute in Stockholm, Sweden, have made a step in that direction. This specific enzyme has been shown to help cancer spread, and also helps tumors to build supply lines of blood. Knowing the structure of MMP2 should help scientists develop agents to inhibit its action. In the second paper in Science, a group of scientists led by Dr. Mickey Tortorella of DuPont Pharmaceuticals Company in Wilmington, Delaware, report that they have identified a new family of MMP enzymes called aggrecanase 1 and aggrecanase 2.

These enzymes are thought to contribute to arthritis development because they "chew up" aggrecan, one of the major components of cartilage. When aggrecan levels are depleted, cartilage becomes dysfunctional. The result is pain in affected joints. "The fact that we have identified the enzymes responsible for aggrecan degradation, we now have the ability to design small molecules (that) are selective and potent, which would block these enzymes. So in theory, we should be able to slow down or more importantly stop the progression of the disease," Tortorella told Reuters Health. "Aggrecan also coats collagen, so by preventing aggrecan from degrading not only do we prevent aggrecan loss, but we prevent collagen loss, the two major components of cartilage. So we think that by targeting these two enzymes -- aggrecanase 1 and 2 -- we should be able to prevent the onset of diseases such as osteoarthritis and perhaps rheumatoid arthritis as well," Tortorella added. SOURCE: Science 1999;284:1600-1601, 1664-1669.

6/3/99. Breast Cancer Study on Alternative Therapy. Women with breast cancer who seek alternative therapies like herbs or acupuncture in addition to standard treatment may be unusually worried and depressed and in need of extra help in coping with their fears of the disease, a study says. The study, published in The New England Journal of Medicine, included 480 women with early stage breast cancer, 28% of whom began using alternative therapy for the first time ater their cancer surgery. The researchers found that women who began the alternative treatments, compared with women who did not, reported a lower qualtity of life, more depression, more fear of recurrence of cancer and less sexual satisfaction. They turned to alternative therapy for help in coping with their stress, the researchers suggested. The 480 women in the study were treated from 1993 to 1995 in Mass. hospitals. Three months and 12 months after the surgery, they filled out surveys that included questions about their emotional states before and after cancer was diagnosed and their use of alternative therapies like herbs, megavitamins, massage, homeopathy, special diets, relaxation techniques, self-help groups, spiritual healing and hypnosis. The women used those treatments in addition to standard therapy and not as a substitute for it. But three months after surgery, those who had tried the alternative methods for the first time were more depressed and fearful than those who had not. A year after surgery, all felt better, but those that use alternative methods still reported less sexual satisfaction and more fear of recurrence. The results came as a surprise, contradicting earlier perceptions of patients who use alternative therapy said Dr. Jimmie Holland, chairwomen of psychiatry and behavioral sciences at the Memorial-Sloan Kettering Cancer Center in New York. "I was not expecting this." Dr. Holland said, explaining that a previous study had found that patients who used alternative medicine were better adjusted than those who did not. Dr. Holland wrote that women in the study "were not psychologically strong" and that they "turned to alternative medicine to alleviate their stress." "We should be treating the whole person", she said. "The problem in health care today is that visits are so short with doctors that patients often don't tell a doctor how distressed they are and doctors have no time to ask."

The researchers hoped patients would not be offended by their conclusions. "We've been very concerned that some patients might feel this is pejorative or that we think somehow dysfunctional." "This is not a diagnosis, but an entree for doctors to start talking to patients." "Some patients are going to be furious, said Dr. Holland. They'll say, "How could you say such a thing about me? I'm fine. I'm not distressed." And that may be true. This is only one study. Fran Visco, pres. of National Breast Cancer Coalition, a patient's group, called the researchers conclusions "almost patronizing" and said they might backfire and lead women using alternative methods to hide it, to avoid being viewed as depressed or anxious. "It's very disturbing to me that scientists would automatically assume based on this small study that they know how to intervene with these women, " Ms. Visco said. "The only conclusion they should jump to is the distress come from the fact we don't know how to cure breast cancer." Partial article from the NY Times written by Denise Grady on June 3, 1999. Elizabeth/ David's Editorial Comment: This is only one study and I think the money would have been better spent if research were done to determine if various alternative treatments work. This article never mentioned the success or failure of alternative treatments. However, we do not advocate or dismiss alternative treatments as we just report studies for survivors to make up their own minds.

6/2/98. Chemo First for Breast Cancer. Traditional, chemotherapy is given after breast cancer surgery. But according to research for the University of Texas Anderson Cancer Center in Houston, having chemo before the operation can shrink and often eliminate breast tumors. For many, radical surgery is no longer necessary, says Dr. Henry Kuerer in an article published in the Journal of Clinical Oncology. Instead, a less invasive surgical procedure than orginally anticipated is sufficient. Reader's Digest World of Medicine. June 99.

5/26/99. Scientists are seeking 22,000 postmenopausal women at high risk of developing breast cancer for a study comparing the potential of two drugs to prevent the disease. NY Times Article. Washington, May 25 (AP), Researchers announced today that the women would be enrolled at 400 medical centers in the U.S. and Canada for the long-awaited study, comparing the drugs tamoxifen and raloxifene. Tomoxifen has long been considered a potent treatment for breast cancer andthe FDA approved it last year as a way to reduce the odds that women at particularly high risk of breast cancer will get the disease. But tamoxifen causes serious side effects: in research, it doubled women's risk of uterine cancer, tripled the risk of potentially fatal blood clots and increased chances of developing cataracts.

Raloxifene treats osteoporosis, but studies suggest that it could have similar protective effects against breast cancer. It, too, has side effects, particularly an increase in the risk of blood clots in the legs and the lungs, although it does not appear to increase the risk of uterine cancer. The new study, to be performed by a research group called the National Surgical Adjuvant Breast & Bowel Project and supported by the National Cancer Institute, will try to determine which drug is best. One feature of the study that has drawn criticism is that it does not include a placebo control group. Barbara Brenner, executive director of the advocacy organization Breast Cancer Action, in San Francisco, has urged healthy women to refuse to enter the trial until it has been redesigned to include a group that receives dummy pills.

5/21/99. British Medical Journal of Medicine Article. (Doctors should be reminded of this prior to surgery as it may make radiation unnecessary). Women who undergo localised breast surgery for the removal of a common form of non-invasive breast carcinoma may have their need for follow up radiotherapy eliminated if surgeons remove an extra centimetre of tissue around the cancer, according to a new study (New England Journal of Medicine 1999;340:1455-61). Ductal carcinoma in situ, an abnormal growth of cells inside milk ducts that is non-invasive and unlikely to recur if completely excised, was studied. Dr. Melvin J Silverstein (at the University of Southern California School
of Medicine) and colleagues followed 469 women with the cancer who were treated at two California facilities between 1972 and 1998. Just under half of them had no follow up radiotherapy. Among women whose lumps were removed along with a 1 cm margin of tissue, about 97% had no recurrence of cancer. When used, radiotherapy did not reduce recurrence rates. The study found that radiotherapy benefited only women who had had 1 mm or less of extra tissue removed around the cancer. Up to 80%of patients with ductal carcinoma in situ are eligible for lumpectomy rather than complete breast removal. Medical opinion has been divided on whether radiotherapy is necessary for all patients
with this type of cancer who have chosen to have a lumpectomy. The new findings suggest that there is a trade off: having more tissue removed might alter or disfigure
the breast but may also eliminate or delay the need for follow up radiotherapy.

Dr. Carolyn Kaelin, director of the Comprehensive Breast Health Center at
Boston's Brigham and Women's Hospital, said that the pathologists taking part in the study had used a meticulous procedure to measure how much tissue was removed from around the cancer. But in cases in which this approach is not adopted hospitals may not feel confident advising women not to have radiotherapy. In an accompanying editorial (New England Journal of Medicine 1999;340:1499-1500), Drs. David L. Page and Jean F Simpson of the Vanderbilt University School of Medicine in Nashville, Tennessee,
said: "What the report does not establish is that the excised lesion should have a 1 cm margin in all cases of ductal carcinoma in situ that are amenable to cure by local
excision. "This conclusion would be as overly simplistic and restrictive as the
paradigm it is replacing." © British Medical Journal 1999 (Article submitted by Scott Gottlieb, of New York.)

5/18/99. Magazine Article. Hi there - I have a few articles that may be of interest. From Ladies'Home Journal - March 1999: No More Surgery? Researchers have combined advanced imaging techniques and laser treatment to come up with a procedure that kills cancerous breast cells without surgery. In this technique, Drs insert a hollow needle into the breast. A laser is then threaded through the needle, and heat is applied for about ten minutes to kill the cancer cells. Fifteen women with early-stage breast cancer volunteered for the treatment. "We found we could accurately define the treatment zones with imaging and that we effectively killed the cells within the zones," says Steve Harms, MD., a radiology professor at the University of Arkansas for Medical Sciences, in Little Rock. However, researchers say it is too early for claims of a new, improved treatment.
It may seem a bit trite, coming from a mainstream journal, but I found it interesting. I also have a great newsletter from MD Anderson with some stuff I will post to the message board. Thanks for your hard work, this site has done a lot to help me and gives me the opportunity to give some back. God Bless - Jan (Submitted by Janice L. Workman).

5/16/99. Breast Cancer Research Update. Preliminary findings were released April 15, 1999 by the National Cancer Institute (NCI) on five separate clinical trials on breast cancer patients, comparing highdose chemotherapy with bone marrow or stem cell transplants (HDC/BMT) to lower-dose chemotherapy without transplants. In four of the five studies investigators found no difference in the survival between patients receiving HDV/BMT and those receiving lower-dose chemotherapy with transplants. Only one trial found a difference in favor of HDC/BMT. But this trial should not be disregarded, the NCI noted, since chemotherapy agents and approach used were different than in the other trials and may be responsible for the positive results. Ut was also noted that the following-up on all the trials was relatively short-term and the results might change in time. The findings apply only to patients whose breast cancer has spread to many nodes and other parts of the body. Lora Weiselber, M.D., Director of Breast Services at the Don Monti Cancer Center at North Shore University Hosptial/ Manhasset, comments: "There are many avenues of research in the prevention, detection and treatment of breast cancer. There has been progress in each of these areas, which has translated into an improved survival rate and a brighter outlook for the future." (Source - North Shore- Long Island Jewish Health System: HER-Health, Education and Review)