Here are a list of risk factors from the American Cancer Society. They are broken down into those that can (such as excessive alcohol use) and cannot be modified (such as age or family history)
Risk Factors for Breast Cancer
This is the breast cancer site of Prof John Boyages, author of Breast Cancer: Taking Control
Wednesday, 31 December 2008
AI vs Tam - now or later? Update from the 2008 San Antonio Breast Conference
More evidence suggesting that aromatase inhibitors (AIs) have slightly better efficacy than tamoxifen (Tam) as adjuvant therapy for postmenopausal women with estrogen-receptor-positive (ER+) breast cancer was at the 31st Annual San Antonio Breast Cancer Symposium (SABCS) on December 17.
Both drug approaches reduce estrogen, but in different ways. Tamoxifen is a selective estrogen-receptor modulator (also called a SERM) that prevents estrogen from interacting with its receptor, whereas AIs act by inhibiting an enzyme involved in the synthesis of estrogen from androgen after the menopause, and hence reduce the level of the hormone interacting with its receptor.
Three AIs are currently marketed in Australia— letrozole (Femara, Novartis), anastrozole (Arimidex, AstraZeneca) and exemestane (Aromasin, Pfizer).
So far, various combinations of trials (giving an AI versus Tam for 5 years), giving Tam for 2-3 years and then “switching” to an AI or giving 5-years of an AI after 5 years of Tam have all shown that AI’s are slightly better in reducing relapse but survival gains have been relatively small.
Relapse free survival time is the measure of time between diagnosis and an “event”. These events include a new cancer in the opposite breast, disease coming back in the same breast (if breast conservation was undertaken) or the chest-wall (if a mastectomy was undertaken) or disease coming back elsewhere in the body. Many trials also include the appearance of a totally different cancer or dying from something unrelated to breast cancer as an “event”. A more robust end-point for assessing the benefit of anticancer drugs is overall survival (the time from diagnosis to death from any cause) or breast cancer mortality (the time from diagnosis until death from breast cancer).
Apart from relapse or survival, quality of life is also very important. Although the survival data are very similar between Tam and AI’s, the toxicity profiles are quite distinct, with great sexual morbidity for some women with the AIs and more joint pain and osteoporosis. This has to be balanced with a slightly higher risk of a blood clot (or “DVT”) or cancer of the womb (endometrial cancer) with Tam.
The meta-analysis that Dr. Ingle presented at the meeting was split into two cohorts:
Cohort 1 consisted of data from “monotherapy” clinical trials that directly compared an AI to tamoxifen (9586 patients with a median follow-up of 5.9 years).
Cohort 2 consisted of data from "switching" trials in which the patients on tamoxifen were switched to an AI after 2 or 3 years (9015 patients with a median follow-up of 3.9 years). Here’s the fine print from the abstracts:
Cohort 1: 9,856 pts with 50,000 woman-years of follow-up. At 5 yrs, AI therapy was associated with an absolute 2.7% (standard error [SE] 0.7) decrease in BC recurrence (10.7% vs 13.4%, relative decrease 20% [SE 5], p=0.00004). There appeared to be greater proportional decreases in isolated local recurrence (30% [SE 10], p=0.003) and in contralateral disease (38% [SE 12], p=0.003) than in distant recurrence (12% [SE 6], p= 0.04). AIs yielded an absolute 1.0% (SE 0.5) decrease in BC mortality (5.5% vs 6.5%, relative decrease 7% [SE 7], p=0.28. The difference was even less and about 0.5% at 8 years.
Cohort 2: 9,015 pts with 33,000 woman-years of follow-up. At 6 yrs from treatment divergence (i.e., 8-9 yrs from diagnosis), AI therapy was associated with an absolute 3.5% (SE 1.1) decrease in BC recurrence (12.6% vs 16.1%, relative decrease 29% [SE 6], p<0.00001). There appeared to be greater proportional reductions in isolated local recurrence (40% [SE 13], p=0.002) and in contralateral disease (35% [SE 16], p=0.03) than in distant recurrence (24% [SE 7], p= 0.001). AIs yielded an absolute 1.6% (SE 0.8) decrease in BC mortality (6.3% vs 8.0%, relative decrease 22% [SE 9], p=0.02). Subset analyses with respect to PgR status, age, tumor grade and nodal status revealed no apparent heterogeneity between the proportional reductions in recurrence and no indication of an increase or decrease in non-breast deaths with AIs in either cohort 1 or 2.
Very importantly non breast cancer mortality and overall mortality were not higher with the AIs in either cohort was reassuring regarding their overall safety.
My view is that any efficacy gain had to be balanced not only against tolerability for each patient but also the risk of recurrence and presence of other risk factors such as osteoporosis or a family history of thrombosis. If the risks of recurrence are low (e.g a strongly ER positive grade 2 tumour measuring under 15mm) then the benefit of an AI over Tam is miniscule at most. If the risk of recurrence is higher then I would tend to favour an AI. On the other hand if a woman is perimenopausal and I am not really sure if she has stopped ovulating it is safer to start off with Tamoxifen as AI’s can stimulate ovulation and cause an unwanted pregnancy. If a woman has a strong family history of blood clots or more rarely endometrial cancer then Ais are a better approach.
Tamoxifen is now available as a generic, so is much cheaper than the branded AIs. In Australia the the difference may be between $20 and $300, for Tam versus an AI. Of course there needs to be a return on the multiple millions of dollars invested by pharmaceutical companies testing and discovering new drugs but in many situations, such as poorer Pacific islands or countries without pharmaceutical reimbursement, Tam may be a much better option.
Although AIs carry the risk for osteoporosis, this can be monitored and countered with bisphosphonates. I usually recommend baseline blood levels of calcium, vitamin D and parathyroid hormone and organise a baseline bone density measure before we start AI’s. Many women are Vit D deficient and this can make matters worse for bone strength.
A good middle ground approach supported by this new metaanalysis is to start patients with Tam for 2-3 years which can maintain or indeed increase bone strength particularly in the younger perimenopausal woman where we may not be certain that ovulation has ceased. The switching data also show that there may be a small survival advantage.
A major question than remains, however, is how long such treatment should be continued. Studies are currently in progress, comparing 5 years of therapy with 10, and 10 years of therapy with 15. Certainly, for women at higher risk of relapse (say with positive nodes) it makes sense to continue treatment for at least 10-years for the moment based at least on the MA-17 trial which shows a survival advantage of 5-years of Femara after 5-years of Tam (2). Ultimately, each patient needs to be assessed almost on an individual basis based on her prognosis, psychology and side-effect questions.
References:
1. http://sabcs.org/
2. http://www.ncbi.nlm.nih.gov/pubmed/16730271
Both drug approaches reduce estrogen, but in different ways. Tamoxifen is a selective estrogen-receptor modulator (also called a SERM) that prevents estrogen from interacting with its receptor, whereas AIs act by inhibiting an enzyme involved in the synthesis of estrogen from androgen after the menopause, and hence reduce the level of the hormone interacting with its receptor.
Three AIs are currently marketed in Australia— letrozole (Femara, Novartis), anastrozole (Arimidex, AstraZeneca) and exemestane (Aromasin, Pfizer).
So far, various combinations of trials (giving an AI versus Tam for 5 years), giving Tam for 2-3 years and then “switching” to an AI or giving 5-years of an AI after 5 years of Tam have all shown that AI’s are slightly better in reducing relapse but survival gains have been relatively small.
Relapse free survival time is the measure of time between diagnosis and an “event”. These events include a new cancer in the opposite breast, disease coming back in the same breast (if breast conservation was undertaken) or the chest-wall (if a mastectomy was undertaken) or disease coming back elsewhere in the body. Many trials also include the appearance of a totally different cancer or dying from something unrelated to breast cancer as an “event”. A more robust end-point for assessing the benefit of anticancer drugs is overall survival (the time from diagnosis to death from any cause) or breast cancer mortality (the time from diagnosis until death from breast cancer).
Apart from relapse or survival, quality of life is also very important. Although the survival data are very similar between Tam and AI’s, the toxicity profiles are quite distinct, with great sexual morbidity for some women with the AIs and more joint pain and osteoporosis. This has to be balanced with a slightly higher risk of a blood clot (or “DVT”) or cancer of the womb (endometrial cancer) with Tam.
The meta-analysis that Dr. Ingle presented at the meeting was split into two cohorts:
Cohort 1 consisted of data from “monotherapy” clinical trials that directly compared an AI to tamoxifen (9586 patients with a median follow-up of 5.9 years).
Cohort 2 consisted of data from "switching" trials in which the patients on tamoxifen were switched to an AI after 2 or 3 years (9015 patients with a median follow-up of 3.9 years). Here’s the fine print from the abstracts:
Cohort 1: 9,856 pts with 50,000 woman-years of follow-up. At 5 yrs, AI therapy was associated with an absolute 2.7% (standard error [SE] 0.7) decrease in BC recurrence (10.7% vs 13.4%, relative decrease 20% [SE 5], p=0.00004). There appeared to be greater proportional decreases in isolated local recurrence (30% [SE 10], p=0.003) and in contralateral disease (38% [SE 12], p=0.003) than in distant recurrence (12% [SE 6], p= 0.04). AIs yielded an absolute 1.0% (SE 0.5) decrease in BC mortality (5.5% vs 6.5%, relative decrease 7% [SE 7], p=0.28. The difference was even less and about 0.5% at 8 years.
Cohort 2: 9,015 pts with 33,000 woman-years of follow-up. At 6 yrs from treatment divergence (i.e., 8-9 yrs from diagnosis), AI therapy was associated with an absolute 3.5% (SE 1.1) decrease in BC recurrence (12.6% vs 16.1%, relative decrease 29% [SE 6], p<0.00001). There appeared to be greater proportional reductions in isolated local recurrence (40% [SE 13], p=0.002) and in contralateral disease (35% [SE 16], p=0.03) than in distant recurrence (24% [SE 7], p= 0.001). AIs yielded an absolute 1.6% (SE 0.8) decrease in BC mortality (6.3% vs 8.0%, relative decrease 22% [SE 9], p=0.02). Subset analyses with respect to PgR status, age, tumor grade and nodal status revealed no apparent heterogeneity between the proportional reductions in recurrence and no indication of an increase or decrease in non-breast deaths with AIs in either cohort 1 or 2.
Very importantly non breast cancer mortality and overall mortality were not higher with the AIs in either cohort was reassuring regarding their overall safety.
My view is that any efficacy gain had to be balanced not only against tolerability for each patient but also the risk of recurrence and presence of other risk factors such as osteoporosis or a family history of thrombosis. If the risks of recurrence are low (e.g a strongly ER positive grade 2 tumour measuring under 15mm) then the benefit of an AI over Tam is miniscule at most. If the risk of recurrence is higher then I would tend to favour an AI. On the other hand if a woman is perimenopausal and I am not really sure if she has stopped ovulating it is safer to start off with Tamoxifen as AI’s can stimulate ovulation and cause an unwanted pregnancy. If a woman has a strong family history of blood clots or more rarely endometrial cancer then Ais are a better approach.
Tamoxifen is now available as a generic, so is much cheaper than the branded AIs. In Australia the the difference may be between $20 and $300, for Tam versus an AI. Of course there needs to be a return on the multiple millions of dollars invested by pharmaceutical companies testing and discovering new drugs but in many situations, such as poorer Pacific islands or countries without pharmaceutical reimbursement, Tam may be a much better option.
Although AIs carry the risk for osteoporosis, this can be monitored and countered with bisphosphonates. I usually recommend baseline blood levels of calcium, vitamin D and parathyroid hormone and organise a baseline bone density measure before we start AI’s. Many women are Vit D deficient and this can make matters worse for bone strength.
A good middle ground approach supported by this new metaanalysis is to start patients with Tam for 2-3 years which can maintain or indeed increase bone strength particularly in the younger perimenopausal woman where we may not be certain that ovulation has ceased. The switching data also show that there may be a small survival advantage.
A major question than remains, however, is how long such treatment should be continued. Studies are currently in progress, comparing 5 years of therapy with 10, and 10 years of therapy with 15. Certainly, for women at higher risk of relapse (say with positive nodes) it makes sense to continue treatment for at least 10-years for the moment based at least on the MA-17 trial which shows a survival advantage of 5-years of Femara after 5-years of Tam (2). Ultimately, each patient needs to be assessed almost on an individual basis based on her prognosis, psychology and side-effect questions.
References:
1. http://sabcs.org/
2. http://www.ncbi.nlm.nih.gov/pubmed/16730271
Tuesday, 30 December 2008
Zoledronic Acid Significantly Reduced Relapse in Early Breast Cancer
A recent Austrian trial presented at the American Society of Clinical Oncology meeting in May 2008 showed that 4mg of Zoledronic Acid given twice a year significantly reduced relapse in early breast cancer.
Zoledronic acid is already marketed in Australia as Zometa by Novartis for use in the treatment of bone metastases.
Following surgery, women who had not reached the menopause were treated with the lutenizing hormone-releasing hormone (LHRH) agonist goserelin for ovarian suppression, combined with either the antiestrogen drug tamoxifen or the aromatase inhibitor anastrozole (Arimidex, AstraZeneca).
In addition, 1 group of women also received zoledronic acid (4 mg intravenously every 6 months). Treatment was continued for 3 years.
After a median follow-up of 5 years, there were 54 events in the zoledronic acid group and 83 events in the 2 goserelin groups (hazard ratio, 0.64; P = .015). This translates into a 36% reduction in the risk for disease progression, Dr. Gnant added. There was a significant reduction in locoregional disease progression (10 events in the zoledronic acid group vs 20 events in the 2 goserelin groups) and distant metastases, both bone and nonbone (29 events in the zoledronic acid group vs 41 events in the 2 goserelin groups).
None of the 1800 women in this study received adjuvant chemotherapy after their surgery and only 5% received it before their surgery. They all had hormone therapy.
At five years, 137 women (7.6%) had had a recurrence, while 42 (2.3%) deaths occurred. This means this study found a 98% chance of survival in young women who are given ovarian suppression and hormone therapy drugs but do receive any chemotherapy.
This is an importnat aspect of the study and certainly supports the view that many young women with small ER-positive may be being overtreated with chemotherapy.
Also, the study found that there was no difference between in recurrence risk in the women who took tamoxifen and those who took an aromatase inhibitor. This again is critically important as in my view, Tamoxifen is better tolerated in this age group with less sexual side-effects.
In the group that received Zometa, 39 had a recurrence and six developed contralateral breast cancer. In the group that did not received Zometa, 61 had a recurrence and 10 developed contralateral breast cancer. This was a statistically significant, 36% reduction in recurrence.
However, with zoledronic acid the most serious side effect is an increased risk of developing osteonecrosis of the jaw. The researchers monitored the women closely and no cases were seen as yet.
It's very important to note that this study was done in premenopausal women who were on hormone therapy to suppress ovarian function. The findings may not hold true for women who have had cehemotherapy or perhaps for women with hormone receptor negative cancers. We also don't know if the findings will be true for postmenopausal women.
For the moment we should keep an eye on this and other studies before we recommend it in routine practice but this is a good study worthy of a change in practice for selected patients.
The NCI in the US summarised this study
NCI report of Zoledronic acid study
Zoledronic acid is already marketed in Australia as Zometa by Novartis for use in the treatment of bone metastases.
Following surgery, women who had not reached the menopause were treated with the lutenizing hormone-releasing hormone (LHRH) agonist goserelin for ovarian suppression, combined with either the antiestrogen drug tamoxifen or the aromatase inhibitor anastrozole (Arimidex, AstraZeneca).
In addition, 1 group of women also received zoledronic acid (4 mg intravenously every 6 months). Treatment was continued for 3 years.
After a median follow-up of 5 years, there were 54 events in the zoledronic acid group and 83 events in the 2 goserelin groups (hazard ratio, 0.64; P = .015). This translates into a 36% reduction in the risk for disease progression, Dr. Gnant added. There was a significant reduction in locoregional disease progression (10 events in the zoledronic acid group vs 20 events in the 2 goserelin groups) and distant metastases, both bone and nonbone (29 events in the zoledronic acid group vs 41 events in the 2 goserelin groups).
None of the 1800 women in this study received adjuvant chemotherapy after their surgery and only 5% received it before their surgery. They all had hormone therapy.
At five years, 137 women (7.6%) had had a recurrence, while 42 (2.3%) deaths occurred. This means this study found a 98% chance of survival in young women who are given ovarian suppression and hormone therapy drugs but do receive any chemotherapy.
This is an importnat aspect of the study and certainly supports the view that many young women with small ER-positive may be being overtreated with chemotherapy.
Also, the study found that there was no difference between in recurrence risk in the women who took tamoxifen and those who took an aromatase inhibitor. This again is critically important as in my view, Tamoxifen is better tolerated in this age group with less sexual side-effects.
In the group that received Zometa, 39 had a recurrence and six developed contralateral breast cancer. In the group that did not received Zometa, 61 had a recurrence and 10 developed contralateral breast cancer. This was a statistically significant, 36% reduction in recurrence.
However, with zoledronic acid the most serious side effect is an increased risk of developing osteonecrosis of the jaw. The researchers monitored the women closely and no cases were seen as yet.
It's very important to note that this study was done in premenopausal women who were on hormone therapy to suppress ovarian function. The findings may not hold true for women who have had cehemotherapy or perhaps for women with hormone receptor negative cancers. We also don't know if the findings will be true for postmenopausal women.
For the moment we should keep an eye on this and other studies before we recommend it in routine practice but this is a good study worthy of a change in practice for selected patients.
The NCI in the US summarised this study
NCI report of Zoledronic acid study
Saturday, 25 October 2008
Myths about breast cancer
Here's a news story from the Sydney Morning Herald on the 23rd October 2008 about the common myths regarding breast cancer.
Sunday, 13 July 2008
HER2 Study update
What's been called our "HER2" study, this week Upali Jayasinghe, the BCI's consultant statistician, Kellie Bilinski, the study's project manager and Greg Heard, Research Manager at the BCI have been updating a submission to the National Cancer Institute (USA) which will examine a cohort of women with node-negative breast cancer treated between 1979 and 1994 at Westmead Hospital without chemotherapy or hormone therapy. This is a very important study, which will look at modern assays such as HER2, Ki-67 and also Vit-D receptors in over 260 archival parafin blocks. The study has been funded by the "Care for Her" Fund of which Steve and Karen Vamos are the patrons.
Trisha Goddard update
Former Play School host and current queen of British daytime chat shows Trisha Goddard announced she's been diagnosed with breast cancer in April this year.
The 50-year-old mother of two was diagnosed with the disease after a routine screening mammogram.
In an article from "The Press Association" picked up by Google News on this blog, Trisha talks about how she is coping with chemotherapy.
Read the article here
The 50-year-old mother of two was diagnosed with the disease after a routine screening mammogram.
In an article from "The Press Association" picked up by Google News on this blog, Trisha talks about how she is coping with chemotherapy.
Read the article here
Saturday, 28 June 2008
Farewell to Jane McGrath
Jane McGrath's death from breast cancer highlighted the fact that people from all walks of life can be struck down from this dreaded disease. Jane was one of the seven women in Australia who die from breast cancer every single day. Jane has left a lasting legacy to support women with breast cancer through her rural breast care nurses' scholarships and supporters have rallied to contribute even further to help her cause.
Find out more about the foundation's work at http://www.mcgrathfoundation.com.au/
Women across the country have flooded the national breast screening line - phone 13 20 50 - no doubt, boosting this week's booking stats.
Last week Elisabeth (Liz) Black, our clinical services manager, finalised our own breast care nurse mentoring report to the Commonwealth. It was great to see that we have brought in more than 50 nurses (mainly from rural areas) to give them a one-week intensive at the BCI. Thanks to the many clinicians and staff who generously gave their time to support this program. The program is coming to an end but the BCI wants to continue this program, which showcases the fabulous cancer program at Sydney West Area Health Service.
John
PS: The mouth swab test reported in the New England Journal of Medicine this week is not a substitute for screening and is at the very least 10 years away from any practical implementation. One interview I did this week is highlighted at this link:
Mouth Swab press
Find out more about the foundation's work at http://www.mcgrathfoundation.com.au/
Women across the country have flooded the national breast screening line - phone 13 20 50 - no doubt, boosting this week's booking stats.
Last week Elisabeth (Liz) Black, our clinical services manager, finalised our own breast care nurse mentoring report to the Commonwealth. It was great to see that we have brought in more than 50 nurses (mainly from rural areas) to give them a one-week intensive at the BCI. Thanks to the many clinicians and staff who generously gave their time to support this program. The program is coming to an end but the BCI wants to continue this program, which showcases the fabulous cancer program at Sydney West Area Health Service.
John
PS: The mouth swab test reported in the New England Journal of Medicine this week is not a substitute for screening and is at the very least 10 years away from any practical implementation. One interview I did this week is highlighted at this link:
Mouth Swab press
Thursday, 19 June 2008
Danes seek BCI expertise (fellowship possibility)
On Monday, 9 June, I was invted by the Danish Cancer Society to present the "BCI model of care" to a group, which included health department and medical representatives.
They were particularly concerned as their breast cancer mortality was higher in Denmark than Australia and other western countries. A particular problem in Denmark is the lack of acceptance of a national screening program and patchy uptake of multidisciplinary breast cancer care.
They were particularly concerned as their breast cancer mortality was higher in Denmark than Australia and other western countries. A particular problem in Denmark is the lack of acceptance of a national screening program and patchy uptake of multidisciplinary breast cancer care.
This followed a successful visit to Westmead Hospital whilst I was away in April this year.
Their visit to Westmead was in fact written up in the Australian newspaper and was a great credit to the delivery of cancer services in NSW and Westmead. Following discussions with Paul Harnett, one aspect I proposed was a regular cancer fellowship between Westmead and Denmark.
Their visit to Westmead was in fact written up in the Australian newspaper and was a great credit to the delivery of cancer services in NSW and Westmead. Following discussions with Paul Harnett, one aspect I proposed was a regular cancer fellowship between Westmead and Denmark.
Visit to the International Cancer Screening Network
On the 4-7th June I was invited as the Australian delegate to the Biennial Meeting of the International Screening network at the Lo-Skolen Conference Center in Helsingor, Denmark.
The first day involved a planning workshop on issues related to best-practice treatment after the detection of screen detected breast cancer.
I gave a presentation on the framework for cancer screening in Australia and associated results. I presented some of the results from the National monitoring report. The latest report can be found here:
National monitoring report
To say the least, many delegates were VERY interested in our digital roll-out strategy and thought our Myer strategy and our proposed strengthened links with treatment was very innovative. A few delegates from Italy wanted more information about our strategies.
I met with a Professor of Education, Berta Geller from the University of Vermont and we spoke about working on an analysis of the best way to provide feedback to radiologists. Berta has collected information from all over the world on this issue and presented a poster on various "visual", easy to digest options.
I also had some discussions with various delegates on the issue of annual screening - lots of research ideas but no real solutions to the "problem" of too many annual screens.
the International Screening Web site can be found at:
http://appliedresearch.cancer.gov/icsn/
The first day involved a planning workshop on issues related to best-practice treatment after the detection of screen detected breast cancer.
I gave a presentation on the framework for cancer screening in Australia and associated results. I presented some of the results from the National monitoring report. The latest report can be found here:
National monitoring report
To say the least, many delegates were VERY interested in our digital roll-out strategy and thought our Myer strategy and our proposed strengthened links with treatment was very innovative. A few delegates from Italy wanted more information about our strategies.
I met with a Professor of Education, Berta Geller from the University of Vermont and we spoke about working on an analysis of the best way to provide feedback to radiologists. Berta has collected information from all over the world on this issue and presented a poster on various "visual", easy to digest options.
I also had some discussions with various delegates on the issue of annual screening - lots of research ideas but no real solutions to the "problem" of too many annual screens.
the International Screening Web site can be found at:
http://appliedresearch.cancer.gov/icsn/
Sunday, 18 May 2008
Mastectomies for early-stage breast cancer rise after MRI
This study quoted in CBC News Canada gets to the crux of the problem with Breast MRI.
MRI and Breast Cancer
1. They have a high rate of false positives
2. We don't know if we are just picking up smaller disease that was always there and treated with radiation therapy.
3. It is feasible that having an MRI and recommending a mastectomy if a tumour is thought to be multifocal may not increase survival compared to treatment by cosnervative surgery and radiation therapy.
At the BCI, our pilot MRI study for women 50 years and under continues. Our target is 50 patients and we have NINE patients to recruit to complete the study.
Dr Nehmat Houssami, a research consultant at the BCI will be publishing a meta-analysis about MRI as part of an international collaboration
MRI and Breast Cancer
1. They have a high rate of false positives
2. We don't know if we are just picking up smaller disease that was always there and treated with radiation therapy.
3. It is feasible that having an MRI and recommending a mastectomy if a tumour is thought to be multifocal may not increase survival compared to treatment by cosnervative surgery and radiation therapy.
At the BCI, our pilot MRI study for women 50 years and under continues. Our target is 50 patients and we have NINE patients to recruit to complete the study.
Dr Nehmat Houssami, a research consultant at the BCI will be publishing a meta-analysis about MRI as part of an international collaboration
Vit D and Breast Cancer
There is more and more evidence that having normal Vit D levels is good for women with breast cancer. This new report is worth looking at (Click on the Title for more Details)
The researchers studied more than 500 women with breast cancer and found that women deficient in vitamin D were 94 percent more likely to have their cancer spread and 73 percent more likely to die from their cancer.
The findings of the study—which are expected to be presented at the American Society of Clinical Oncology's annual meeting, to be held May 31 to June 3, in Chicago —suggest that vitamin D deficiency is very common in women with breast cancer. The study found that only 24 percent of the patients had adequate levels of vitamin D when they were diagnosed. The researchers discovered that human breast cancer cells shriveled up and died when vitamin D was added to them.
Many women are now Vitamin D deficient as they protect themselves from the sun.
We also measure Vit D levels when a patient is on an Aromatase Inhibitor as the reduced oestrogen levels can increase the incidence of Osteoporosis.
The researchers studied more than 500 women with breast cancer and found that women deficient in vitamin D were 94 percent more likely to have their cancer spread and 73 percent more likely to die from their cancer.
The findings of the study—which are expected to be presented at the American Society of Clinical Oncology's annual meeting, to be held May 31 to June 3, in Chicago —suggest that vitamin D deficiency is very common in women with breast cancer. The study found that only 24 percent of the patients had adequate levels of vitamin D when they were diagnosed. The researchers discovered that human breast cancer cells shriveled up and died when vitamin D was added to them.
Many women are now Vitamin D deficient as they protect themselves from the sun.
We also measure Vit D levels when a patient is on an Aromatase Inhibitor as the reduced oestrogen levels can increase the incidence of Osteoporosis.
Thursday, 27 March 2008
NCI Washington Visit goes well!
Hi everybody, just resurfacing after my three weeks away.
Just to let you know it was a very successful trip with lots of new contacts and information that will help the BCI in the future.
My lecture in Washington at the National Cancer Institute on “Breast Conservation, Have We Gone Too Far?” was very well received. I met with multiple researchers and given a lot of opportuinities for collaboration.
It was great to meet with Kathy Cronin and Andrew Friedman. I have been doing research with them for two years but we have never met in person. The BCI was invited by the NCI to do some research on US data on the impact of changing use of HRT on the incidence of breast cancer in the USA.
Shown here is a picture of a three-hour brainstorming session on our second paper on the variation of breast cancer incidence by Race and HRT. The team really "clicked" over the phone over the past two years and well and truly “clicked” in person and I am sure lots of projects will follow and hopefully funding. Kathy, Andrew and their assistant Nadia are some of the world's best statisticians and have published widely on breast cancer risk and prognostic factors.
By the way, Andrew is responsible for all the Cancer Risk calculators on the NCI Web and he said "The BCI's breast cancer calculator is the best I've seen". If you haven't seen it go to www.seemyrisk.com
As you can imagine I was on top of the world after this two-day "intensive". More updates soon with a formal lecture at a tumour board shortly.
Just to let you know it was a very successful trip with lots of new contacts and information that will help the BCI in the future.
My lecture in Washington at the National Cancer Institute on “Breast Conservation, Have We Gone Too Far?” was very well received. I met with multiple researchers and given a lot of opportuinities for collaboration.
It was great to meet with Kathy Cronin and Andrew Friedman. I have been doing research with them for two years but we have never met in person. The BCI was invited by the NCI to do some research on US data on the impact of changing use of HRT on the incidence of breast cancer in the USA.
Shown here is a picture of a three-hour brainstorming session on our second paper on the variation of breast cancer incidence by Race and HRT. The team really "clicked" over the phone over the past two years and well and truly “clicked” in person and I am sure lots of projects will follow and hopefully funding. Kathy, Andrew and their assistant Nadia are some of the world's best statisticians and have published widely on breast cancer risk and prognostic factors.
By the way, Andrew is responsible for all the Cancer Risk calculators on the NCI Web and he said "The BCI's breast cancer calculator is the best I've seen". If you haven't seen it go to www.seemyrisk.com
As you can imagine I was on top of the world after this two-day "intensive". More updates soon with a formal lecture at a tumour board shortly.
Wednesday, 6 February 2008
Dragons abreast (DA) Hospital Challenge
The big boat race is coming up fast. Thanks to Liz and all her merry crew for taking part in this year's challenge. I'll be commentating again this year with Michelle Hanton, the DA national co-ordinator. Here's a photo from last year!
For more information see:
Monday, 21 January 2008
Subscribe to:
Posts (Atom)