Best of Breast: news for week ending 9 May 2014

News from Google Alerts, for Breast Cancer and Cancer, for the week ending 9 May 2014.

Lots 0f goodies this week, from the importance of sleep in survival rates to screening techniques, to more discoveries of genetic triggers for breast cancer.  But what stands out is news from Australia.  Graham Kelly, chief of Novogen, who is using a breakthrough cancer treatment for his own prostate cancer promises to deliver the drug at an affordable price.

One of the main criticisms of Big Pharma is how it overcharges for cancer drugs, leading to the accusation (and conspiracy theories) that all they want to do is exploit cancer patients who are desperate for a cure.  True, the path from discovery to trials to commercial release is expensive, but Graham Kelly of Novogen accuses Big Pharma of overpricing, and vows to do better with a fair price.  Whether this remains to be seen is debated, but it’s refreshing to see someone who’s in the business put his money where his mouth is, and to fess up to what critics of Big Pharma have been saying all along.  Good luck to him, is all I can say, long may he live and prosper.


Superhero outfit optional. “We believe innovative medicine can be developed without the obscene price tags that make families mortgage their homes or strain federal health budgets” … Novogen boss Graham Kelly. Picture: Jim Trifyllis Source: News Corp Australia

1A.  Breakthrough cancer cell treatment from the University of NSW offers new hope

1B.  Novogen CEO Graham Kelly says he will make an anti-cancer drug at an affordable price

  • BREAKTHROUGH treatment that prompts cancer cells to kill themselves is set to revolutionise treatment and could be available within five years.
  • The medical breakthrough by scientists at the University of NSW came from research into the devastating and deadly childhood cancer neuroblastoma.
  • However it has also been proven to destroy melanoma cancer cells and is expected to be effective in treating most cancers.
  • The journal Cancer Research reports today that the compound TR100 targets the protein tropomyosin, which is one of the building blocks of cancer cells. “It is much like what happens when you see a building collapse on the TV news,” researcher Professor Peter Gunning, from UNSW Medicine said.
  • An Australian drug company chief, Graham Kelly, has made the astounding vow he’ll deliver a breakthrough new cancer drug at a price families can afford without mortgaging their home.
  • Big pharmaceutical companies claim you can’t develop a breakthrough cancer treatment for less than $1.5 billion but Novogen chief Graham Kelly, who is using his own experimental cancer medicine on himself to beat his aggressive prostate cancer, accuses them of “obscene” price gouging.


2.  Better sleep predicts longer survival time for women with advanced breast cancer

  •  A new study reports that sleep efficiency, a ratio of time asleep to time spent in bed, is predictive of survival time for women with advanced breast cancer.
  • Results show that higher sleep efficiency was significantly associated with lower mortality over the ensuing six years, an effect that remained after adjusting for baseline prognostic factors such as age, estrogen receptor status and treatments received.
  • There was no association between sleep duration and survival.
  • According to the authors, this is the first study to demonstrate the long-term detrimental effects of objectively quantified sleep on survival in women with advanced cancer.
  • Although the mechanism of the relationship between sleep quality and advanced breast cancer survival is unclear, they suggested that sleep disruption may lead to diminished immune function or impaired hormonal stress responses that are more directly responsible for the decrease in survival.

For more information:  Actigraphy-Measured Sleep Disruption as a Predictor of Survival among Women with Advanced Breast CancerSLEEP, 2014; DOI: 10.5665/sleep.3642

See also:  American Academy of Sleep Medicine, September 1, 2009,  Chemotherapy for Breast Cancer is Associated with Disruption of Sleep-Wake Rhythm in Women

3.  Radiotherapy Trumps Lymph Node Dissection in Breast Cancer

  • Sentinel node biopsy is standard for evaluating axillary lymph node status in cN0 breast cancer patients. If treatment is advised after a positive biopsy, ALND is currently the standard of care. Although patients can achieve excellent results with this treatment, it is associated with adverse events.
  • For breast cancer patients with a positive sentinel node, axillary radiotherapy (ART) might be a better option than surgery to remove the nodes because it is associated with less morbidity and fewer complications, according to new data.
  • The results come from a large international trial — dubbed AMAROS (After Mapping of the Axilla: Radiotherapy or Surgery?) — conducted in 4806 breast cancer patients randomized to either ART or axillary lymph node dissection (ALND).
  • One year and 5 years after treatment, lymphedema was less common in patients treated with ART than in those treated with either ALND or with both therapies.

For more information:  American Society of Breast Surgeons (ASBS) 15th Annual Meeting. Presented April 30, 2014.

4.  Breast implant used by 99% of women in Britain is ‘triggering new cancer’, warn scientist

  • 150 cases of anaplastic large cell lymphoma  (ALCL) of the breast reported worlwide, with a handful in Britain
  • Nine in 10 cases of the disease have been in women who have received breast implants with a textured outer shell
  • Textured shell implants uncommon in the US, but in Britain – where 30,000 women have implants every year – they account for 99 per cent of market
  • Scientists say this rougher surface is ‘the ideal breeding ground’ for bacteria which could sow the seed of cancer. Women should be warned of the cancer risk before undergoing implant operations, they argue.
  • Scientists suggest ALCL is linked to a relatively common complication of having textured breast implants inserted, called capsular contracture.

5.  First international molecular screening program at IMPAKT for metastatic breast cancer

  • While research has made great strides in recent decades to improve and significantly extend the lives of patients with early breast cancer, the needs of patients with advanced or metastatic disease have largely been ignored.
  • Moreover, despite the fact that the overall breast cancer death rate has dropped steadily over the last decade and significant improvements in survival have been made, metastatic breast cancer represents the leading cause of death among patients with the disease.
  • In this context the Breast International Group (BIG) recently launched AURORA, which will use molecular screening to improve understanding of metastatic breast cancer and its response or lack of response to available drug therapies.
  • In total 1300 women and men from about 60 hospitals in 15 European countries are expected to take part in the programme. Over time, BIG hopes to expand the programme well beyond Europe to involve several 1000 more patients.
  • AURORA will be the first broadly international programme of its kind to focus on metastatic breast cancer in order to improve patient survival and quality of life today and to develop individualised cures for the future.
  • AURORA is being made possible by The Breast Cancer Research Foundation (BCRF), the Fondation Cancer (Luxembourg), the National Lottery (Belgium), NIF Trust, and individual donors.

For more information:


A transcription factor on its way to the beerfest.

6.  A transcription factor called SLUG helps determines type of breast cancer

  • Stem cells are immature cells that can differentiate, or develop, into different cell types. Stem cells are important for replenishing cells in many tissues throughout the body.
  • Defects that affect stem-cell activity can lead to cancer because mutations in these cells can cause uncontrollable growth.
  • Some transcription factors regulate the differentiation or “programming” of breast stem cells into the more mature cells of the breast tissue.
  • Abnormal expression of these transcription factors can change the normal programming of cells, which can lead to imbalances in cell types and the over-production of cells with enhanced properties of stem cells.
  • Breast tissue has two main types of cells: luminal cells and basal cells.
  • Transcription factors, like SLUG, help control whether cells are programmed to become luminal cells or basal cells during normal breast development.
  • In cancer, transcription factors can become deregulated, influencing what type of breast tumor will form.
  • In aggressive basal-type breast tumors, SLUG is often over-expressed.

For more information: Stem Cell Reports, Volume 2, Issue 5, p633–647, 6 May 2014, Cell-State Transitions Regulated by SLUG Are Critical for Tissue Regeneration and Tumor Initiation

7.  Lymph node ultrasounds more accurate in obese breast cancer patients

  • Research into whether ultrasounds to detect breast cancer in underarm lymph nodes are less effective in obese women has produced a surprising finding.
  • Fat didn’t obscure the images — and ultrasounds showing no suspicious lymph nodes actually proved more accurate in overweight and obese patients than in women with a normal body mass index,.

For more information:  Mayo Clinic. “Lymph node ultrasounds more accurate in obese breast cancer patients.”

Mepitel Film

8.  Special film dressing prevents skin reaction during radiotherapy

  • Radiation-induced skin reactions occur in 80-90% of breast cancer patients and can range from mild redness to ulceration, with symptoms of pain, burning and itchiness. This can have a very negative impact on day to day life for patients, who already have to cope with being diagnosed with and treated for cancer.
  • Until now, creams, gels and dressings have been used to reduce these severe side effects, but none have been able to completely prevent them.
  • Mepitel Film dressings prevent the development of moist desquamation: painful skin ulcerations associated with breast cancer radiation therapy.
  • The study also found that the same dressing reduced the overall severity of skin reactions such as itching and irritation.
  • 78 patients undergoing radiation therapy for breast cancer took part in the trial.
  • Each patient’s irradiated skin area was divided into two halves, with Mepitel Film used on one side and aqueous cream on the other.
  • The study found that there were no cases of ulceration or severe skin reactions on the skin under Mepitel Film, whilst cream-treated skin developed these wounds in 26% of patients.
  • In addition, the skin reactions that did develop under Mepitel Film were 92% less severe than in the cream-treated control group.

For more information:  Radiotherapy and Oncology Journal, 2014,,  Prophylactic use of Mepitel Film prevents radiation-induced moist desquamation in an intra-patient randomised controlled clinical trial of 78 breast cancer patients. 

9.  Australian study into using MRI to determine if cancer has spread

  • Breast cancer patients usually have a sentinel node removed to determine if it has metastasised, but these operations require a general anaesthetic and can have permanent side effects.
  • Using one of the most powerful magnetic resonance imaging (MRI) machines in the world, the Hunter Medical Research Institute (HMRI) study in New South Wales, Australia, is detecting the most minor of changes to cells taken from a breast cancer.
  • Surgeon David Clark says the findings show cells from the breast cancer itself are the best indicator of spread.
  • “We can tell them that they don’t have any cancer in their lymph glands, and they can avoid any lymph gland surgery.”
  • Dr Clark says the MRI study showed a 95 per cent accuracy in determining if a cancer has spread.
  • “I think in the next couple of years we should be able to put this into clinical practice,” he said.
  • “It is going to change the whole way we manage people with breast cancer, and will decrease the side effects of that cancer.
  • “This is spectroscopy where we look at the cells in the breast cancer itself.”

Untangling a 30-year puzzle … the CTCF gene protein

10.  30-year Puzzle in Breast Cancer Solved

  • More than 30 years ago, frequent loss of one copy of chromosome 16 was first reported in breast cancer but the gene or genes responsible remained to be identified.
  • In a new study published in Cell Reports, scientists at the Fred Hutchinson Cancer Research Center demonstrate that mice lacking one copy of a gene called CTCF have abnormal DNA methylation and are markedly predisposed to cancer.
  • CTCF is a very well-studied DNA binding protein that exerts a major influence on the architecture of the human genome, but had not been previously linked to cancer.
  • “In this current study we explored whether loss of just one copy of the CTCF gene could trigger epigenetic changes and predispose to tumor development,” said Dr. Filippova of Fred Hutch.
  • The study demonstrates that indeed, loss of one copy of CTCF caused large scale epigenetic changes and greatly enhanced tumor formation in multiple tissues. In addition, recent large scale analysis of the human cancer genome revealed that deletions or mutations in CTCF are one of the most common events in breast, endometrial, and other human cancers.
  • Collectively, these findings indicate that CTCF is major tumor suppressor gene in human cancer and highlights the power of the mouse models to prove that a candidate gene has a function in cancer.
  • These results have implications for understanding the origin of DNA methylation alterations in cancer and suggest that epigenetic instability may both precede and accelerate the emergence of cancer.
  • “This answers a 30 year riddle in cancer research,” said Dr. Kemp. “And it shows once again, as we first showed in 1998, that one hit is enough.

For more information:  Cell Reports, DOI:,  CTCF Haploinsufficiency Destabilizes DNA Methylation and Predisposes to Cancer

11.  PTEN-mutated Cowden disease increased risk for second malignant neoplasms

  • Researchers evaluated data from 2,912 patients with Cowden disease, a disease in which multiple hamartomas and carcinomas develop in the thyroid, breast, endometrium and kidney.
  • Patients with Cowden disease who harbored PTEN germline mutations were at increased risk for all second malignant neoplasms, according to study results.
  • PTEN mutations in these patients — known as PTEN hamartoma tumor syndromes — are associated with increased risk of breast, thyroid, endometrial and renal cancers, according to background information provided by the researchers.
  • Prophylactic mastectomy should be considered on an individual basis given the significant risk of subsequent breast cancer.

For more information:  Journal of Clinical Oncology, JCO April 28, 2014  JCO.2013.53.6656  Second Malignant Neoplasms in Patients With Cowden Syndrome With Underlying Germline PTEN Mutations



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