Breast cancer awareness

Five additional studies on the early detection, treatment and evaluation of breast cancer were highlighted today by the co-sponsoring organizations of the 2009 Breast Cancer Symposium. The symposium, occurring this year during Breast Cancer Awareness Month, is being held October 8-10, 2009, at the San Francisco Marriott.

The additional studies being highlighted feature a short summary and perspective from Lori Pierce, MD, professor of radiation oncology at the University of Michigan School of Medicine, and chair of the symposium news planning team.

Click here to view the additional studies and the complete release.

To view the complete 2009 Breast Cancer Symposium press kit, visit http://www.asco.org/BCSpresskit09.

Source
ASCO

The House Energy and Commerce Committee Health Subcommittee on Wednesday heard testimony on four bills related to breast cancer detection, prevention and treatment, CQ HealthBeat reports.

A bill (HR 995) sponsored by Rep. Jerrold Nadler (D-N.Y.) would require health insurance plans to cover annual mammograms for women ages 40 and older. Plans would also have to cover annual screenings and MRIs for women at high risk of breast cancer. Nadler said that although the health reform legislation being debated in Congress aims to improve preventive care services, it could be years before the regulations take effect, and the overhaul “won’t necessarily prevent these women from falling through the cracks.”

Rep. Rosa DeLauro (D-Conn.) spoke in favor of her bill (HR 1691) to prohibit group health plans from restricting medically necessary hospital stays to less than 48 hours after mastectomies or breast-conserving surgeries and to less than 24 hours for lymph node dissections. A similar measure passed the House with 421 votes last year, but the Senate did not take up the legislation. DeLauro said that women are sometimes forced to leave the hospital too soon after surgeries because insurers will not pay for longer stays.

Rep. Debbie Wasserman Schultz (D-Fla.), a breast cancer survivor, said her bill (HR 1740) would direct HHS to conduct a national awareness campaign about the risk of breast cancer in young women, with a focus on risks associated with particular ethnic and cultural groups. She called claims that the bill would detract from other efforts or take money from a national detection program “wrong,” adding that she will “continue to fight for a multi-faceted approach to combating breast cancer.”

The committee also heard testimony on Rep. Kathy Castor’s (D-Fla.) bill (HR 2279) to require HHS to create a breast cancer treatment quality performance system to track and publicly disclose information on the quality of care offered by specific providers. Under the bill, providers’ Medicare payments would be linked to performance by 2012.

Subcommittee Chair Frank Pallone (D-N.J.) said that many of the provisions in the four bills before the subcommittee “hopefully will be addressed in the larger health care reform bill,” adding, “But I don’t mean to suggest that takes away from the need to have this hearing today or to move forward on these bills” (Norman, CQ HealthBeat, 10/7).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women 2009 The Advisory Board Company. All rights reserved.

Women with breast cancer should be given high doses of vitamin D because a majority of them are likely to have low levels of vitamin D, which could contribute to decreased bone mass and greater risk of fractures, according to scientists at the University of Rochester Medical Center.

In a study of 166 women undergoing treatment for breast cancer, nearly 70 percent had low levels of vitamin D in their blood, according to a study being presented Thursday, Oct. 8, at the American Society of Clinical Oncology’s Breast Cancer Symposium in San Francisco. The analysis showed women with late-stage disease and non-Caucasian women had even lower levels.

“Vitamin D is essential to maintaining bone health, and women with breast cancer have accelerated bone loss due to the nature of hormone therapy and chemotherapy. It’s important for women and their doctors to work together to boost their vitamin D intake,” said Luke Peppone, Ph.D., research assistant professor of Radiation Oncology, at Rochester’s James P. Wilmot Cancer Center. He is a member of the National Cancer Institute’s Community Clinical Oncology Program research base in Rochester.

Scientists funded by the NCI analyzed vitamin D levels in each woman, and the average level was 27 nanograms per milliliter; more than two-thirds of the women had vitamin deficiency. Weekly supplementation with high doses of vitamin D — 50,000 international units or more — improved the levels, according to Peppone’s study.

The U.S. Institute of Medicine suggests that blood levels nearing 32 nanograms per milliliter are adequate.

This problem is not unexpected, Peppone said, because previous studies have shown that nearly half of all men and women are deficient in the nutrient, with vitamin D levels below 32 nanograms per milliliter. Vitamin D, obtained from milk, fortified cereals and exposure to sunlight, is well known to play an essential role in cell growth, in boosting the body’s immune system and in strengthening bones.

Symptoms of Vitamin D deficiency include muscle pain, weak bones/fractures, low energy and fatigue, lowered immunity, symptoms of depression and mood swings, and sleep irregularities, many of which are common for women undergoing breast cancer treatment.

Source:
Leslie White

University of Rochester Medical Center

Locally advanced breast cancer patients who received the same class of neoadjuvant chemotherapy were found to have no evidence of disease at the time of their surgery, or achieved pathological complete response, at the same rate regardless of race, according to researchers at The University of Texas M. D. Anderson Cancer Center.

The study, presented in a poster discussion session at the 2009 Breast Cancer Symposium in San Francisco, is the largest in a homogenous group of breast cancer patients evaluating pathological complete response (pCR) according to race. Only one other study, also conducted at M. D. Anderson but limited to triple negative breast cancer patients (estrogen and progesterone receptor negative, HER2 negative), has analyzed the relationship between the two.

“Our findings confirm pathological complete response is a strong prognostic indicator and a surrogate for good survival, despite a patient’s race, and that it’s vital we continue to strive towards achieving this milestone for all women with breast cancer,” said Mariana Chavez Mac Gregor, M.D., a medical oncology fellow at M. D. Anderson. “The study also mandates that we continue to research the differences across races in breast cancer.”

Racial disparities in breast cancer are known: the American Cancer Society (ACS) estimates that 19,540 blacks and 14,200 Hispanics will be diagnosed with the disease in 2009. While the overall incidence rate is 10 percent lower in blacks than whites, in 2001-2005, they had a 37 percent higher death rate. ACS also reports that overall breast cancer mortality rates are lower in Hispanic women than white women.

Understanding the reasons for such disparities – be it access to care and screening, biological differences in tumors and/or breast cancer subtypes – is the focus of ongoing research efforts across the cancer community, explained Chavez Mac Gregor, the study’s first author.

“While these disparities are known, we also understand that breast cancer patients who achieve pathological complete response have better outcomes,” said Chavez-Mac Gregor. “What we didn’t understand until now was if pathological complete response rates had any relationship with race. If a specific ethnic group had a better or worse response rate, maybe we could then determine which groups may be in need of additional and /or improved therapies.”

Using the M. D. Anderson Breast Medical Oncology database, the retrospective study identified 2,074 patients diagnosed with Stages II and III breast cancer and treated at the institution between 1994 and 2008. Of the patients, 1,334 (64.3 percent) were white, 302 (14.6 percent) black, 316 (15.2 percent) Hispanic, and 122 (5.9 percent) were classified as “other” race groups. The median age of the women was 50. All received neoadjuvant anthracycline- and taxane-based chemotherapy; receiving similar class of therapy was an important component in the design of the study, said Chavez Mac Gregor.

At the time of surgery, the researchers found no difference of statistical significance in pCR rates among racial groups: 12.3 percent in whites; 12.5 percent in blacks; 14.24 percent in Hispanics; 11.5 percent in other.

Among all patients, at a median follow-up of 30 months, there were 438 recurrences and 327 deaths. The five year unadjusted recurrence-free (RFS) and overall survival (OS) rates were: 71 percent and 79 percent in whites; 60 percent and 57 percent in blacks; 76 percent and 79 percent in Hispanics; and 75 percent and 84 percent in “other,” respectively. Lack of achieving pCR, HER2-positive and triple-negative subtypes, lymph node involvement were all found to be independent predictors of worse RFS and OS.

In further analysis, the study reconfirmed what had been noted in literature – although not statistically significant, blacks tended to have poorer outcomes, while Hispanics had improved outcomes compared to whites, said Chavez Mac Gregor.

The study is not without limitations, she noted: in design, it was both retrospective and a single-institution study, and race was self-reported. In addition, the research focus was until the time of surgery, with less attention towards patients’ experience post-surgery, such as compliance to hormone therapies or other adjuvant treatments, other than RFS and OS.

In the same cohort of patients, Chavez Mac Gregor plans further analysis of patients who did not achieve pCR to better understand why they might not have reached this milestone.

The study was funded by grants from the National Cancer Institute and Susan G. Komen for the Cure.

In addition to Chavez Mac Gregor, M. D. Anderson authors on the study include: Gabriel N. Hortobagyi, M.D.; Ana Maria Gonzalez-Angulo, M.D., the study’s senior author; Jennifer Litton, M.D.; Vicente Valero, M.D.; and Huiqin Chen, all of the Department of Breast Medical Oncology; Funda Meric-Bernstam, M.D., Department of Surgery; and Melissa Bondy, Ph.D., Department of Epidemiology. Other authors include: Clifford A. Hudis, M.D., Memorial Sloan Kettering; and Antonio C. Wolff, M.D., The Sidney Kimmel Comprehensive Cancer Center.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For six of the past eight years, including 2009, M. D. Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News