Best of Breast: news for week ending 15 November 2013

A summary of the latest medical developments in breast cancer from Google Alerts, for the week ending 15 November 2013.

1.  Breast cancer breakthrough: Queensland scientists identify molecule linked to disease’s spread


MiR-139-5P sounds like a Space Station.  If they renamed it “Rogue Breast Cancer Molecule” I think it could sell more T-shirts.

  •  Scientists in Queensland have identified a pivotal molecule, the miR-139-5P, that shows whether a woman’s breast cancer will spread and how quickly.
  • miR-139-5P acts a cellular brake to inhibit breast cancer cells from proliferating
  • The discovery will help provide a clearer prognosis for breast cancer patients and could lead to treatments that are more personalised, i.e. treatments for aggressive cancers vs less aggressive cancers.

For more information:

RNA Journal, “miR-139-5p is a regulator of metastatic pathways in breast cancer”


2.  Why some people are resistant to tamoxifen

  • Breast cancers that initially respond to hormone therapies, like tamoxifen, eventually become resistant to treatment.
  • A new study finds this may be because of a mutation in the receptor present in the cancer cell to which tamoxifen binds.
  • The mutation makes the receptor more active and resistant to endocrine treatments
  • The only treatment option available currently for patients whose breast cancers develop resistance to endocrine therapies is chemotherapy, which is highly toxic and less effective compared with endocrine therapies.

For more information:

American Association for Cancer Research “Study Finds New Explanation for Resistance to Breast Cancer Treatment

3.  Sentinel Lymph Node Biopsy (SLNB) after neoadjuvant breast cancer therapy not yet viable management strategy

SLNB is a procedure that is carried out during breast cancer surgery which allows a surgeon to evaluate the level of spread and staging of the cancer through the lymph nodes.  This then determines how aggressive any lymph node removal must be, and any post-operative treatment.

Neoadjuvant therapy is chemotherapy administered before surgery.  This may result in a downgrading of the cancer staging and tumour which may mean less aggressive treatment – good news, no?  According to this study, this may also blur the information that is necessary for post-operative treatment of the cancer if SLNB is used as a diagnosis tool.  What the study is saying is that if neoadjuvant therapy is used, then SLNB may not be an accurate predictor of post-operative treatment.

“Sentinel lymph node biopsy (SLNB) provides reliable nodal staging information with less morbidity than axillary lymph node dissection in patients with node-negative breast cancer.

However, the staging of the axilla following chemotherapy in patients with initial node-positive and clinically node-negative breast cancer is not known, according to background information provided by researchers.

Decisions about using systemic therapy after neoadjuvant therapy are not dependent upon identifying residual cancer in lymph nodes when all the planned chemotherapy is given preoperatively to maximize the cancer response.

However, accurate detection of residual lymph node cancer may be important in prospective trials of novel agents in which post-neoadjuvant treatment decisions, including possible research protocol participation, may hinge on the detection of residual disease.”

It also is important to remember patients with residual cancer after neoadjuvant therapy have at some level of resistance to systemic therapy.”

For more information:

  • Boughey JC. JAMA. 2013;doi:10.l001/jama.2013.7844.
  • Morrow M. JAMA. 2013;doi:10.l001/jama.2013.7844.

4.  Postmastectomy pain rated as most troubling symptom by breast cancer survivors

Oh dear, this sounds like another of those chicken-and-egg studies.  Yes, perhaps high levels of anxiety may contribute to lingering post-mastectomy pain, but what about the reverse causality scenario – that the persistent pain has led to the high levels of anxiety?  Which came first?

Look, even Angelina Jolie is rumoured to be experiencing pain from her mastectomy – stand up the first person who dares ask her if it’s all in the mind?

The new research showed that the type of surgery performed did not impact persistent post-mastectomy pain (PPMP). Psychological factors, on the other hand, did affect pain.

The study found that women who reported high levels of anxiety, depression, troubled sleep, unexplained physical symptoms and/or excessive negative thinking were likely to experience persistent post-mastectomy pain.

5.  Breast cancer risk from immune cells

Researchers at the University of Adelaide, Australia, discovered that immune cells play a significant role in the development of breast cancer.

The study is published in the journal Biology of Reproduction and proves that immune cells have their role in the breasts but during menstrual cycles, these tend to develop the risks to breast cancer.

“These cells should be protecting our body from cancer, but at certain times of the month it appears macrophages might be allowing cancerous cells to escape immune system detection.”

“We think there is a window risk that opens up around the time when women have their period. This is when levels of the hormone progesterone drop, and this affects how the breast functions.

At this time, immune defences in the breast tissue are down and women could be more susceptible to the initiating factors that lead to breast cancer”

For more information:

Biology of Reproduction, “Macrophage Phenotype in the Mammary Gland Fluctuates over the Course of the Estrous Cycle and Is Regulated by Ovarian Steroid Hormones”

6.  Study determines which breast cancer genes spread to the brain

  • Study was carried out by Wayne State University and Detroit Medical Center.
  • Researchers extracted micro RNA from the tumors of 90 women with breast cancer, including 45 whose cancer had spread to the brain (metastasized) and 45 whose cancer had not. After analysing the data, researchers found that several micro RNAs were significantly altered in patients whose breast cancer had spread to the brain. They also identified several target genes involved in the process.
  • Researchers think that micro RNAs are helpful in determining which of the breast cancer genes spread up to the brain and to establish how aggressive the treatment for this should be.

7.  One-stop breast cancer treatment: Radiation breakthrough will help thousands

  • ‘Gentle’ X-rays is used to destroy any remaining tumour cell
  • 30-min procedure removes need for weeks of the conventional treatment.
  • Findings from the Targit trial, published in The Lancet medical journal, show intra-operative radiotherapy has a comparable recurrence rate, of around 1 per cent, and a reduction in side effects.
  • Deaths from other causes including heart disease were significantly fewer in the group having one-stop treatment.
  • Results of a trial could see wholesale change in NHS practice

8.  Early stages of breast cancer could soon be diagnosed from blood samples

  • What could someday be the first blood test for the early detection of breast cancer was shown in preliminary studies to successfully identify the presence of breast cancer cells from serum biomarkers
  • Technology developed by scientists at the Houston Methodist Research Institute scientists
  • With a New York University Cancer Institute colleague, the researchers report in an upcoming Clinical Chemistry (now online) that the mixture of free-floating blood proteins created by the enzyme carboxypeptidase N (CPN) accurately predicted the presence of early-stage breast cancer tissue in mice and in a small population of human patients.
  • CPN is an enzyme that modifies proteins after the proteins are first created.
  • Past studies have only shown the enzyme is more active in lung cancer patients.
  • The present report in Clinical Chemistry is the first to show CPN isn’t merely more active in breast cancer patients, but there’s more of it.
  • The technology is not yet available to the public, and may not be for years. More extensive clinical tests are needed, and those tests are expected to begin in early 2014.

For More information: “Circulating Proteolytic Products of Carboxypeptidase N for Early Detection of Breast Cancer” Clinical ChemistryDOI: 10.1373/clinchem.2013.211953

9.  Trastuzumab And Anthracyclines Do Not Need To Be Given Concurrently For Breast Cancer Remission

  • Trastuzumab and anthracyclines given concurrently are effective at treating HER-2-positive breast cancer but there is worry that this could lead to increased risk of cardiac toxicity.
  • New research shows these agents do not need to be given concurrently to achieve a high rate of complete pathological remission. The findings investigated the timing of trastuzumab administration with anthracycline and taxane chemotherapy.

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