Cancer No. 1 Killer of Asian-Americans, Hawaiians, Pacific Islanders: Study

Cancer No. 1 Killer of Asian-Americans, Hawaiians, Pacific Islanders: Study

Cancer is the leading cause of death among Asian Americans, Native Hawaiians and Pacific Islanders, even though overall cancer incidence and death rates in these groups are lower than among white Americans, a new study finds. There will be about 57,740 new cancer cases and nearly 17,000 cancer deaths among Asian Americans, Native Hawaiians and Pacific Islanders in 2016, the American Cancer Society report estimated.
However, the three leading causes of cancer death among Asian American, Native Hawaiian and Pacific Islander men are lung (27 percent), liver (14 percent) and colon/rectum (11 percent). Among women, they are lung (21 percent), breast (14 percent) and colon/rectum (11 percent), the findings showed.
Even though Asian Americans, Native Hawaiians and Pacific Islanders have cancer incidence and death rates that are 30 percent to 40 percent lower for all cancers combined than whites, their rates of stomach and liver cancers are nearly double those of whites. And they also have higher rates of nasopharynx (upper throat behind the nose) cancers.
The researchers also found that Asian Americans, Native Hawaiians and Pacific Islanders are less likely than whites to be diagnosed with cancer before it has spread. Within Asian American, Native Hawaiian and Pacific Islander subgroups, there are also wide variations in cancer incidence rates.
Study co-author Lindsey Torre, an epidemiologist in the surveillance research group at the cancer society said that the variations they see in cancer rates in [these groups] are related to risk factors, including lifestyle factors, use of screening and preventive services, and exposure to cancer-causing infections.
Between 2006 and 2010, incidence rates per 100,000 men ranged from about 217 among Asian Indians/Pakistanis to almost 527 among Samoans. The rate among white men was 554. Among Asian American, Native Hawaiian and Pacific Islander women, rates ranged from 212 among Asian Indians/Pakistanis to almost 443 among Samoans. The rate among white women was about 445, according to the report.
Among both men and women in this population, the highest rates after Samoans were among Native Hawaiians and Japanese, the study authors said.
In addition, Torre concluded that cancer-control strategies among this population include improved use of vaccination and screening; interventions to increase physical activity and reduce excess body weight, tobacco use and alcohol consumption; and research to get a more detailed understanding of differences in the cancer burden and risk factors between subgroups.

Could We Be Winning the War on Cancer?

Could We Be Winning the War on Cancer?

Deaths from cancer continue to decline in the United States, according to a new report from the American Cancer Society. Since peaking in 1991, cancer death rates have dropped by 23 percent, the ACS said in the report released Thursday.
Study author Rebecca Siegel, strategic director for surveillance information services for the American Cancer Society said that cancer death rates are continuing to decline by about 1.5 percent per year. The 23 percent drop in death rates occurred from 1991 through 2012 and that translates to more than 1.7 million cancer deaths averted.
The findings are included in Cancer Statistics, 2016, the American Cancer Society’s latest annual report on cancer incidence, mortality, and survival. The report was published online Jan. 7 in CA: A Cancer Journal for Clinicians.
The data was collected from the U.S. National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program and other sources. Over the past decade, the rate of cancer deaths has dropped by 1.8 percent a year in men and 1.4 percent in women, according to the report. The decline in the past 20 years has been driven by the continuous drop in deaths for four major cancer types: breast, colon, lung, and prostate, the report noted.
For 2016, the ACS estimates that there will be about 1.6 million new cancer cases and nearly 600,000 deaths in the United States.
Despite the progress, death rates for certain cancers are increasing, Siegel and her colleagues found. These include cancers of the liver, pancreas, and uterus. Thyroid cancers are the most rapidly rising, increasing more than 5 percent yearly in both men and women, the research revealed. However, some of that increase stems from overdiagnosis due to advanced imaging techniques, the experts said.
Dr. Steven Rosen is director of the City of Hope Comprehensive Cancer Center and Beckman Research Institute in Duarte, Calif. While saying “there was nothing surprising” in the new report, he added that “we should be very proud of all our accomplishments.”
Among the cancers that may be linked to obesity are breast, colon, endometrial, esophagus, gallbladder, kidney, pancreas, prostate, and thyroid, he said. Siegel agreed that obesity must be addressed head-on as a cancer risk factor. “For many of the cancers that are increasing, it’s related to obesity,” she said. The link between obesity and cancer is not well-known by many people, she added.

Regular Mammograms Worthwhile for Elderly Women

Regular Mammograms Worthwhile for Elderly Women

Regular mammograms benefit elderly women, a new study indicates. Previous research has shown that mammography screening reduces breast cancer deaths among women up to age 74, but there is little information about women older than 74, especially minority women, the Florida Atlantic University researchers explained.
They analyzed Medicare data from 1995 to 2009 on more than 4,800 black women and more than 59,000 white women, all of whom were aged 69 or older. Among women aged 75 to 84, those who had annual mammograms were less likely to die from breast cancer over a 10-year period than those who had irregular or no mammograms.
In addition, breast cancer patients aged 69 to 84 who had annual mammograms in the four years before their diagnosis had lower five- and 10-year death rates than those who had irregular or no mammograms.
Ten-year death rates among women aged 69 to 84 were three times higher among whites and more than two times higher among blacks who had irregular or no mammogram screening, compared with those who had annual mammograms.
The researchers also found that white women who died of breast cancer were more likely to be older, to have been diagnosed at a later stage and to have received chemotherapy. They were also less likely to have had surgery or have undergone radiation therapy.
Breast cancer is the second most common type of cancer in American women, affecting one in eight during their lifetime and killing one in 25. In 2010, 41 percent of breast cancer deaths occurred in women aged 65 to 84. Furthermore, regular mammography is recommended for women aged 65 to 74, according to the American Cancer Society and the U.S. Preventive Services Task Force.

Some Women Face Geographic Barriers to Breast Reconstruction

Some Women Face Geographic Barriers to Breast Reconstruction

Long distances to treatment centers are a significant obstacle for some women seeking breast reconstruction after a mastectomy, a new study finds.
The study’s authors, led by Dr. Evan Matros from Memorial Sloan Kettering Cancer Center in New York City wrote while greater patient awareness and insurance coverage have contributed to greater breast reconstruction rates in the United States, geographic barriers to access this service remain, particularly to academic centers
The researchers used the National Cancer Database to examine the association between breast reconstruction and the travel distance of more than 1 million American women who had a mastectomy between 1998 and 2011.
During this time period, the overall rate of immediate breast reconstruction jumped from about 11 percent to more than 32 percent, the investigators found. The upward trend may reflect the Women’s Health and Cancer Rights Act of 1998, which requires insurance companies to pay for breast reconstruction after mastectomy, the researchers suggested. Implant-based reconstructions increased the most, but breast reconstructions involving patients’ own tissue also rose, the study found.
The researchers found that treatment travel distances for patients having breast reconstruction increased from 1998 to 2011, but the same was not true for women who didn’t have the surgery.
The findings were published in the January issue of Plastic and Reconstructive Surgery.
“Patients who underwent mastectomy with immediate reconstruction had to travel significantly greater distances than patients who did not undergo reconstruction and the greater distance traveled by women undergoing breast reconstruction, as compared to mastectomy without reconstruction, suggests the presence of a geographic disparity” the study authors wrote in a journal news release.
Roughly 14 percent of the women who traveled less than 20 miles underwent reconstruction, compared to almost one-quarter of the women traveling between 100 and 200 miles, the study found. Women treated at academic hospitals were most likely to undergo breast reconstruction. The study revealed 26 percent of these women had the procedure, compared to 20 percent treated at comprehensive community hospitals and 10 percent treated at community hospitals.
The average travel distance for women treated at both types of community hospitals was about 20 miles, but women treated at academic hospitals traveled an average of 47 miles, the researchers found.
Moreover, travel distance for women who underwent reconstruction with their own tissue at high-volume hospitals more than doubled over the study period to 53 miles. The study authors said this reflects the concentration of specialized centers in metropolitan areas. The researchers suggested that more needs to be done to eliminate the barriers preventing women from accessing breast reconstruction after mastectomy.

Breast Ultrasound Might Work Just as Well as Mammography, Study Finds

Breast Ultrasound Might Work Just as Well as Mammography, Study Finds

Ultrasound and mammography appear equally likely to detect breast cancer, a new study says. The finding is good news, particularly for women who live in developing countries that typically have more access to ultrasound than to mammography, the researchers said.
While the detection rate with ultrasound was comparable to that of mammography, “it looks like ultrasound does better than mammography for node-negative invasive cancer,” said study leader Dr. Wendie Berg, professor of radiology at Magee-Womens Hospital of UPMC in Pittsburgh. Node-negative invasive cancer is cancer that hasn’t invaded the lymph nodes, but has grown past the initial tumor, according to the U.S. National Cancer Institute. At least one expert doesn’t expect this study to change current screening practice in the United States.
Dr. Lusi Tumyan, a radiologist and assistant clinical professor at the City of Hope Cancer Center, in Duarte, Cali said that for controlled study shows that, used as part of breast reconstruction, lipofilling is a safe procedure that does not increase the risk of recurrent or new breast cancers.
In addition, Tumyan said that at this time we do not have enough data to support or refute ultrasound as a screening tool for average-risk patients. The take-home message for women in the United States, she added, is to discuss their specific risks with their physician and decide together which screening test is best for them.
Ultrasound is generally used as a follow-up test once a potential breast tumor has been discovered through a mammogram or a physical exam, according to the American Cancer Society (ACS). The ACS says that ultrasound is a valuable tool that’s widely available and noninvasive.
The new study involved 2,600 women living in the United States, Canada and Argentina who had ultrasound and mammogram annually for three years. They had no symptoms of breast cancer at the study’s start, but they did have dense breast tissue — considered a risk factor for breast cancer — plus at least one other risk factor for breast cancer.
Separate radiologists interpreted each of the two scans the women received. At the end of the study, 110 women were diagnosed with breast cancer. Detection rates were similar between the two tests. Rates of false-positive results (where a scan erroneously suggests a tumor) were higher for ultrasound compared to mammography, the researchers reported.
Overall, the researchers found that 32 percent of more than 2,500 women without cancer were asked to come back for additional testing at least once after an ultrasound. That compared to 23 percent of women who’d had mammography, the study said.
The findings suggest that for women who don’t have a high risk of breast cancer but have dense breasts, “we find many more cancers if we do ultrasound in addition to mammography,” Berg said.
Berg said the cost of mammography and ultrasound are comparable in the United States. “The issue is: what are the cancers we most need to find,” she said. “The cancers you need to find are the invasive, node-negative ones. More of the cancers found with ultrasound were invasive and node-negative than those found with mammography.”
Moreover, guidelines about breast cancer screening vary among organizations. Current ACS guidelines advise women to consider beginning screening at age 40, depending on individual risk factors. They then recommend that women undergo annual screening with mammography from ages 45 to 54. At age 55, the ACS suggests continuing annual screening or switching to screening every two years, depending on risk factors. Some women, due to family history or other risk factors, should also be screened with MRIs, according to the ACS.
According to Tumyan insurance coverage for breast ultrasounds also varies and ultrasound coverage varies with different insurance companies and different state laws. California has passed a law that requires radiologists to inform patients if they have dense breasts. But California law does not require insurance companies to pay for supplemental screening. However, in other states, the dense breast law requires insurance companies to pay for supplemental screening.

If All Women Breastfed, 800,000 Lives Might Be Saved

If All Women Breastfed, 800,000 Lives Might Be Saved

If nearly all women worldwide breastfed their infants and young children, there would be about 800,000 fewer children’s deaths and 20,000 fewer breast cancer deaths a year, researchers report. That decrease in children’s deaths is equivalent to 13 percent of all deaths in children younger than 2 years of age, the study authors reported in a two-part series published online Jan. 28 in The Lancet.
The researchers also said that current breastfeeding practices cost the world’s economy hundreds of billions of dollars a year.
“There is a widespread misconception that the benefits of breastfeeding only relate to poor countries. Nothing could be further from the truth,” series author Cesar Victora, of Federal University of Pelotas in Brazil, said in a journal news release.
“Our work for this series clearly shows that breastfeeding saves lives and money in all countries, rich and poor alike. Therefore, the importance of tackling the issue globally is greater than ever,” Victora added.
Only one in five children in high-income countries is breastfed for 12 months, the researchers said. And, only one in three children in low- and middle-income countries is exclusively breastfed for the first 6 months.
This means that millions of children and women don’t receive the full benefits offered by breastfeeding, which has been shown to be healthy for both mothers and children, the study authors said.
In a detailed worldwide analysis, the researchers identified a number of benefits of breastfeeding. For example, breastfeeding lowers the risk of sudden infant death in high-income countries by more than one-third, they said. The study also found that breastfeeding could prevent about half of all cases of diarrhea and one-third of respiratory infections in low- and middle-income countries.
Breastfeeding reportedly also boosts children’s intelligence and may protect them against obesity and diabetes later in life, the researchers said. Among mothers, long-term breastfeeding reduces the risk of breast and ovarian cancer, the researchers added.
The investigators also estimated that poorer thinking skills among children who aren’t breastfed cost the global economy about $302 billion in 2012. The loss in high-income countries alone was $231 billion, the study concluded.
Increasing breastfeeding rates for infants younger than 6 months to 90 percent in the United States, China and Brazil, and to 45 percent in the United Kingdom, would lower treatment costs of common childhood illnesses—such as pneumonia, diarrhea, and asthma. This could save health care systems about $2.5 billion in the United States, $29.5 million in the United Kingdom, $224 million in China and $6 million in Brazil, according to the study.
Despite the many benefits of breastfeeding, rates are low, especially in high-income countries, the study showed.
Victoria explained that breastfeeding is one of the few positive health behaviors that is more common in poor than richer countries, and within poor countries, is more frequent among poor mothers. The stark reality is that in the absence of breastfeeding, the rich-poor gap in child survival would be even wider. Our findings should reassure policymakers that a rapid return on investment is realistic and feasible, and won’t need a generation to be realized.
Reasons for low breastfeeding rates include poor promotion and support of breastfeeding, and aggressive marketing and rising sales of infant formula, the study authors said.

With Early Breast Cancer, Targeted Radiation Shows Promise

With Early Breast Cancer, Targeted Radiation Shows Promise

Especially for women with early stage breast cancer, targeted doses of radiation therapy may be as effective as standard radiation treatment of the entire breast, a new British study suggests. The research only tracked women for five years, so it isn’t definitive. Still, “this contributes to a growing body of evidence that a large proportion of women over 50 years old with small breast cancers can avoid whole breast radiotherapy,” said study co-author Dr. John Yarnold. He is a professor of clinical oncology with the Institute of Cancer Research in London.

At issue: What is the best treatment for low-risk early breast cancer? Many studies have shown that surgery to remove the cancerous lump — but not the entire breast — followed by radiation of the whole breast reduces the chance of breast cancer returning, said Dr. Reshma Jagsi, who was not involved with the new study. Jagsi is an associate professor in the department of radiation oncology at the University of Michigan Health System.

Research also suggests that women who undergo this more intensive treatment survive somewhat longer, Jagsi added. But side effects can include breast shrinkage, firmness and tenderness, Yarnold said. That raises the question of whether partial radiation could be a better option. 

The researchers behind the new study randomly assigned just over 2,000 women with breast cancer in the United Kingdom to undergo one of three radiation therapy approaches after having small cancerous tumors surgically removed. Two of the approaches focused the radiation around the tumor, exposing the rest of the breast to little or no radiation. 

According to Yarnold, the study revealed that three weeks of partial breast radiation therapy produced fewer side effects but seemed just as effective as whole breast radiation over five years. Besides very low rates of relapse among all three groups, the rate of side effects from the target therapy was minimal, the study authors said.

On the other hand, Yarnold and Jagsi disagree over whether doctors should embrace the more limited form of radiation treatment now. He predicted that partial breast radiation treatment will become standard for large numbers of women with breast cancer over the next five years.

But he cautioned that the treatment isn’t appropriate for all patients. Physician opinions vary, he said, but in general, the treatment seems best for women over 50 with low- to medium-grade tumors who’ve had the entire primary tumor removed and didn’t show signs of the cancer spreading to axillary nodes (lymph nodes in the armpit region). The findings are promising, said Jagsi, who added that the technology to deliver partial breast radiation is available in the United States.

However, the study isn’t strong enough to warrant changing the traditional approach, at least for women with longer life expectancies, Jagsi said. More follow-up is needed to determine whether less radiation is effective over the long term, she added. 

Moreover, in the case of this ongoing study, additional results will be reported in another five years. For now, “physicians and patients should have detailed discussions about the expected risks and benefits of radiotherapy in each particular case,” Jagsi said. “Many approaches to radiation treatment are now available, and informed deliberation and discussion of this and many other relevant studies is necessary to ensure that each patient can select the approach that is right for her.”

Breast Cancer Survivors Could Have Increased Risk of Thyroid Cancer

Breast Cancer Survivors Could Have Increased Risk of Thyroid Cancer

Women who survive breast or thyroid cancer are linked to an increased risk for the other, according to a new analysis. University of Chicago researchers who reviewed 37 published studies found breast cancer survivors were 1.55 times more likely to develop thyroid cancer than women who hadn’t had breast cancer. And, female thyroid cancer survivors were 1.18 times more likely to get breast cancer than women who hadn’t had thyroid cancer, researchers said.
The study lead author Dr. Raymon Grogan, director of the university’s endocrine surgery research program said that this is a real risk. People who have had one of these cancers need to be aware that they are at higher risk for developing the other cancer.
Thyroid cancer cases have nearly tripled in the United States over the past 30 years, and breast cancer is the most common cancer among women, according to background notes with the study. Thanks to medical advances, more women are surviving each cancer, Grogan said. Moreover, Doctors need to be more aware of the link between the two cancers, he said.
“It should just become one of the common discussions between a patient and her doctor,” he said. “It doesn’t change the recommendations for screening, but people need to be aware and be screened at the appropriate time.”
The report was published Feb. 5 in the journal Cancer Epidemiology, Biomarkers and Prevention. Carol DeSantis, director of breast and gynecological cancer surveillance at the American Cancer Society, said the connection between thyroid and breast cancer is known.
She said her concern with this new report is that by lumping together so many studies that differ in their methods and findings, it’s impossible to come up with a single number that accurately reflects the risk of having one cancer after having had the other.
“The review of different studies is helpful to see that there is that link, but combining them all together, I am not sure who that would be applicable to,” DeSantis said.
Grogan said the research team tried to control for those differences as best they could. Nineteen of the studies analyzed breast cancer patients and their risk of thyroid cancer. Another 18 looked at thyroid cancer cases and their incidence of breast cancer. The researchers then combined these data and calculated the odds of a women having thyroid cancer after breast cancer and vice versa.
In addition, the researchers combed through the studies to find reasons why these cancers seemed related. One explanation was that women who survive either cancer were more likely to be screened and examined so that other cancers were found early.
Another possible connection was that breast and thyroid cancers share hormonal risk factors. There is some evidence that exposure to estrogens and to thyroid-stimulating hormones may contribute to both cancers, Grogan said.
A third theory points to radiation therapy, which has been shown to increase the risk for lung, esophageal, and blood cancers, and sarcomas. Also, earlier research found that radioactive iodine, used to treat thyroid cancer, may play a small role in the development of other cancers, including breast cancer, but that is not clear, Grogan said.
Finally, it is possible that a genetic mutation might be responsible for the connection, Grogan said. DeSantis said that cancer survivors should be aware of the increased risk of developing other cancers.
She said that generally, cancer survivors are at risk for developing a second cancer and breast cancer survivors are at risk for blood cancers, uterine cancer, ovarian cancer and other cancers. Likewise, thyroid cancer survivors are at risk for a number of other cancers, including breast cancer.

Preventive Mastectomy May Not Boost Sense of Well-Being

Preventive Mastectomy May Not Boost Sense of Well-Being

Women with breast cancer who choose to have their unaffected breast removed to potentially prevent a new cancer may not be giving themselves as much peace of mind as they expected, a new study finds. An increasing number of women are having what’s known as prophylactic mastectomy — a procedure chosen by actress Angelina Jolie when she found out she had a substantially increased risk of developing cancer due to her genes.

The percentage of breast cancer patients in the general U.S. population opting to have a double mastectomy at the time of their initial cancer treatment rose from about 2 percent in 1998 to more than 11 percent in 2011, the researchers said. Women often choose the procedure to reduce their anxiety about a new cancer developing.
However, the decision doesn’t seem to affect overall quality of life, the new research suggests Dr. Shelley Hwang, a breast surgeon and chief of breast surgery at Duke Cancer Institute at Duke University in Durham, N.C said that they found that the quality of life for women who chose to remove their healthy breast in addition to the other breast that had cancer was not that different from those who didn’t.

While those who had a prophylactic mastectomy and reconstruction surgery reported slightly higher satisfaction in how their breasts looked and felt, and somewhat higher measures of psychosocial well-being (such as feeling confident), the differences between the groups were small, Hwang said.
Hwang’s team surveyed nearly 4,000 women who had a mastectomy, including about 1,600 who had a prophylactic mastectomy. Those who had a prophylactic mastectomy tended to be slightly younger than those who didn’t, the study showed. 

Researchers asked the women about sexual well-being, physical well-being, expectations about the surgery and satisfaction with care. Sixty percent of the prophylactic mastectomy group said they were satisfied with their breasts. And 58 percent of those who didn’t have a prophylactic mastectomy were satisfied, the study found.

Physical well-being was slightly lower in the prophylactic mastectomy group. When the researchers took into account factors such as age and disease stages, they found the prophylactic mastectomy group still reported higher satisfaction with their breasts. And they had slightly higher psychosocial well-being, but no difference in other measures of quality of life.

However, having breast reconstruction had a greater impact on quality-of-life scores than prophylactic mastectomy alone, Hwang found. About 80 percent of those who had prophylactic mastectomy had breast reconstruction surgery — either immediate or delayed, the researchers said.

Women who had breast reconstruction reported greater sexual well-being. They also had higher psychosocial well-being and higher satisfaction with their breasts’ appearance than prophylactic mastectomy alone provided, the study found. 

Over time, the differences between the two groups diminished even more, Hwang found. Both groups had increases in the psychosocial well-being measures, even 10 years or more after treatment, the research showed.

For years, experts have known that having prophylactic mastectomy has little impact on reducing deaths among women diagnosed with cancer in only one breast, Hwang said. However, little research has focused on how the prophylactic mastectomy decision improves quality of life, or if it does.

In addition, the findings don’t surprise Dr. Veronica Jones. She’s a clinical assistant professor of surgery and a breast surgical oncologist at the City of Hope Cancer Center in Duarte, Calif. She wasn’t involved in the study but reviewed the findings. Jones said in her experience, women who decide on prophylactic mastectomy are generally more worried about a new cancer occurring. Both groups of patients, she said, are making the decision based on what they perceive as their risk of a future cancer.

On the other hand, the risk is low. For the general population, Hwang said, the risk of getting cancer in the opposite breast is less than 5 percent. The general population excludes those with genetic mutations that significantly increase their breast cancer risk, such as the BRCA 1 or 2 mutations, Hwang explained.

What You Need to Know About Breast Self-Exams

What You Need to Know About Breast Self-Exams

You know the drill: The breast self-exam (BSE) illustrations on those pamphlets usually show a woman with one arm up over her head, pushing the fingers of her other hand across her breast—in search of a lump or some other sort of change. Your ob-gyn may have talked to you about doing this every month at home, ideally at a time when your breasts don't feel tender or swollen. 

The truth is, even doing regular BSEs (without regular mammograms) may not protect you. A large study conducted in China by researchers from the Fred Hutchinson Cancer Research Center in Seattle made headlines in 2002 by suggesting that women who were taught to do regular BSEs didn't fare any better—or live any longer—than women who were not taught to do them. On average, they didn't find cancer any earlier. Still, many medical experts believe women should familiarize themselves with how their breasts feel.

However, BSEs can be tricky for women with dense breast tissue—which is common for younger women. "Mostly they don't know what they're feeling or are not confident," says Janet Wolter, MD, a medical oncologist and the Brian Piccolo Chair of Breast Cancer Research at Rush University Medical Center in Chicago. "The breast is constructed like an orange or a grapefruit; you'll feel segments, and that's scary, but it's normal."

For premenopausal women, "the easiest day to remember to do a BSE is the first day of your cycle, when you get your period," suggests Julia A. Smith, MD, director of the NYU Cancer Institute's breast cancer screening and prevention program and director of the Lynne Cohen breast cancer preventive care program at NYU in New York City. If you feel something, wait two weeks and then do another BSE. The odds are it'll be gone—breast tissue often changes throughout the menstrual cycle, says Dr. Smith. But if the abnormality persists, you should see your doctor. Furthermore, older women generally have easier BSEs, because after menopause the tissue gets much softer: "If you put a Ping-Pong ball in there, you'd feel it right away," as Dr. Wolter puts it.

Diabetes Treatment May Affect Breast Density

Diabetes Treatment May Affect Breast Density

Women with diabetes who take insulin appear to have a higher risk of dense breasts, a known risk factor for breast cancer, new research suggests. Women with diabetes who take insulin “have considerably increased breast density (compared to) women without diabetes,” said study lead researcher Zorana Andersen. She’s an associate professor of epidemiology at the University of Southern Denmark in Esjberg.

Conversely, women taking the oral medication metformin instead of insulin to treat their diabetes seem less likely to have dense breasts, Andersen said. Women with breasts that were more than 75 percent dense had a four to six times higher risk of breast cancer than women whose breasts were fattier, with a density of less than 25 percent, the researchers said.

Andersen and her team emphasized that, while insulin treatment was linked with greater chances of higher breast density, that doesn’t prove insulin increases breast cancer risk. The study wasn’t designed to prove a cause-and-effect relationship. Andersen was to present the findings Wednesday at the European Breast Cancer Conference in Amsterdam, the Netherlands. Research from meetings is generally viewed as preliminary until published in a peer-reviewed journal.

For the study, Andersen evaluated more than 5,600 women. They all had mammograms between 1993 and 2001. The average age was 56. Most of the women were past menopause. More than half had breasts classified as mixed or dense. Slightly more than 2 percent of the women had diabetes.

Overall, women with diabetes were less likely to have mixed or dense breasts, the study found. However, women taking insulin injections were more than twice as likely to have dense or mixed (dense and fatty) breasts, the study found. This was true regardless of their body mass index, or whether they had gone through menopause — when breasts may become less dense, the researchers said.

Meanwhile, women with diabetes who managed their condition with diet or with non-insulin medications were less likely to have dense breasts, the study found. Diabetes has previously been linked with a higher risk of breast cancer, Andersen said. But, exactly why there has been an association hasn’t been clear. It’s also not clear how insulin may be increasing the odds of denser breasts.

Moreover, cancer cells grow rapidly and uncontrollably, and growth factors are crucial for cancer to progress, Andersen said. “Insulin is a growth promoting factor of all body tissues,” she said, “and thus it is plausible that it can increase the amount of epithelial or stromal tissue in the breast, thus increasing overall breast density.”

For now, Andersen said, women should be aware that different types of diabetes treatments seem to affect breast density differently. Women on insulin should consider asking their doctor about whether they need extra screening with mammograms and other tests, she added. Andersen wants to look further at the effect of different diabetes treatments on breast cancer risk, including the finding that the non-insulin medications were linked with less breast density.

A Breast Cancer Diagnosis Checklist

A Breast Cancer Diagnosis Checklist

It is true that it is helpful to carry around a checklist of all the information you want to gather about your breast cancer diagnosis, because you’ll be seeing results from the various tests at different times. Although you may have already had a biopsy, for instance, your doctor might still need to remove lymph nodes to determine whether the cancer has spread. 

Mary McHugh, MD, a pathologist at Mount Carmel St. Ann's hospital in Westerville, Ohio, and a member of the College of American Pathologists, recommends finding out the following. What type of cancer is it? The most common form is IDC. Other common types include DCIS, ILC, and LCIS. Click here for a detailed explanation of each type. Is it invasive? Says Dr. McHugh: "If the cancer breaks through the wall of the breast duct, it's considered invasive. If it hasn't broken through, though, it's called in situ or noninvasive cancer." Invasive cancer is more serious.

What size is the tumor? This is measured in centimeters. What stage is it? Ductal carcinoma in situ (DCIS) is stage 0, the most curable; cancer that has spread to other parts of the body is stage IV. What is the histopathologic grade? This is a total score combining three different characteristics of the tumor as it appears under the microscope. Scores range from 3 to 9; a higher score indicates more aggressive cancer. Your report will include a histopathologic grade of 1 if your combined score is 3 to 5; 2 if your score is 6 to 7; and 3 if the score is 8 to 9.

After surgery: Are the margins clear (aka negative) or positive? The surgeon removing the tumor tries to take a rim of cancer-free tissue around the tumor. "We're trying to confirm that the surgeon got it all out," explains Dr. McHugh. If the margins are positive, that may mean scheduling more surgery to get the rest out.

Do the lymph nodes or blood vessels show cancer? Is the cancer hormone receptive? "Some cancer cells have a higher number of hormone receptors in the nucleus and that can promote the growth of the cells," Dr. McHugh says. Your report will say you're ER-positive, or estrogen receptor-positive, and/or PR-positive, progesterone receptor-positive, or negative for one or both. This helps doctors determine if you're a candidate for hormone therapy, such as tamoxifen, which blocks these receptors and can slow down or stop the growth of tumors.

And finally, what is the cancer's HER2/neu status? "If tumor cells are HER2-positive, it means they're associated with a more aggressive tumor," says Dr. McHugh. Your HER2/neu status tells your oncologist whether the drug Herceptin (trastuzumab), which targets the HER2 protein, should be part of your treatment plan.

Is Fat From Another Area of Body Safe for Breast Reconstruction?

Is Fat From Another Area of Body Safe for Breast Reconstruction?

Using women’s own fat cells to enhance breast reconstruction following cancer surgery doesn’t increase the risk they will experience a recurrence of their disease or develop a new cancer, research suggests.

The procedure is known as lipofilling. Fat is taken from the belly or another part of the body and injected into the breast to enhance appearance, the researchers explained. According to the report in the February issue of Plastic and Reconstructive Surgery, this technique can be safely used during breast reconstruction following a partial or total mastectomy.

The study’s lead author, Dr. Steven Kronowitz, of Kronowitz Plastic Surgery in Houston, said in a journal news release that their controlled study shows that, used as part of breast reconstruction, lipofilling is a safe procedure that does not increase the risk of recurrent or new breast cancers.
The study included more than 1,000 women who had lipofilling after cancer-related breast surgery. About one-third of these women had a high genetic risk for breast cancer and underwent a risk-reducing mastectomy.

Rates of new or recurrent breast cancers in these women were compared against a similar group of women who had cancer-related breast reconstructions without lipofilling. Women who’d had lipofilling after a mastectomy due to cancer were followed for about five years, the study said.

Overall, cancer recurrence rates were similar among the women who had lipofilling and those who didn’t. This was true for cancers that recurred in the breast or surrounding tissue as well as recurring systemic cancers that affect other parts of the body, the study authors said.

None of the women who had a preventive mastectomy developed breast cancer, the findings showed.  There was a slightly higher risk of cancer recurrence for women on hormone therapy who had lipofilling during breast reconstruction, the investigators found.

In addition, plastic surgeons are increasingly using lipofilling as part of breast reconstruction surgery. But the researchers said many doctors remain concerned that the procedure may affect women’s risk for new or recurring breast cancer.