Best of Breast: news for week ending 22 August 2014

Updated 16 September 2014

The weekly summary of medical news developments for Breast Cancer and Cancer for the week ending 21 August 2014.

This post focuses on screening.  Call it coincidence, but there were three articles on different ways to screen for breast cancer, this week.  The first is a trial into using dogs to sniff out breast cancer. I’ve covered dogs being used to sniff out cancer in previous posts, but this time, scientists are finally testing this on breast cancer.  Perhaps one day the gold standard in screening could be a golden labrador!

Dog

Dr Claire Guest and Daisy Photo: Janine Warwick

Item number 2 is a study that shows that MRIs are more accurate than ultrasound and mammogram in detecting recurrent tumours.  I wonder how MRIs compare to Pet-CTs in terms of radiation exposure.  There is no ionizing radiation in an MRI.  The dose for a typical PET-CT scan is 25 mSv for a 70-kg person.  The dose for a mammogram is 0.4 to 0.7 mSv.  The PET-CT gives 625 times more radiation.  CT scans alone produce 7 mSV, 10 to 15 times the dose of a mammogram.

RadiationDoseChart

From http://xkcd.com/radiation/. With thanks to Steve for this chart.

Did you know that four PET-CT scans in one year puts you at twice the total annual dose allowed to nuclear power plant workers?  In a healthy person, that might not be an issue, but people with cancer have a compromised immune system, and that level of radiation might cause further mutations.

The question is:  how sensitive is MRI compared to PET-CTs in detecting cancer?  And why aren’t doctors using MRIs?

Update 16 September 2014:  With thanks to reader Rebecca Coady for posting a comment on how to mitigate the damage caused by radiation:  one suggestion is to have an intranvenous vitamin C infusion of 25g.  Or check out the Life Extension website for more information on radiation, body scans, Pet-CTs, and ways to minimise the damage caused by radiation.

1.  Dogs to be used to detect breast cancer in new research trial

http://www.telegraph.co.uk/health/healthnews/11036491/Dogs-to-be-used-to-detect-breast-cancer-in-new-research-trial.html

  • Women at high risk of breast cancer could be screened for the disease by simply breathing into a tube which is then sniffed by a specially trained dog, in a new clinical trial after UK scientists found the animals are highly accurate at detecting other cancers.
  • The animals working for Medical Detection Dogs in Buckinghamshire have already been shown to be more reliable at detecting prostate cancer than current blood tests, with 93 per cent accuracy when sniffing urine samples.
  • The results of the prostate cancer trial were published in the British Medical Journal and other reputable scientific publications so now the team are moving on to breast cancer.
  • Dr Claire Guest, a behavioural psychologist and founder of the charity, said her dog Daisy alerted her to her own breast cancer when they were working on the prostate cancer trial.
  • Daisy has worked on 6,000 urine samples and has been found to be 93 per cent reliable in detecting prostate cancer.
  • Now six other dogs will be trained to sniff for breast cancer in breath samples for the new trial, which has already begun.
  • The best four will taken forward and tested in the trial using samples from 1,500 women.
  • It is thought the dogs, which can detect scent in one part per trillion, are sniffing out volatile substances given off by cancerous cells.
  • “If proven it would have a significant impact on what we consider possible in the diagnosis of cancer.
  • “High risk young women, who are too young for routine, regular mammograms could breathe into a tube every six months and find out quickly and painlessly if they have cancer.”
  • In the long-term it is hoped the substances that the dogs are detecting can be identified and electronic noses created to pick them up.

For more information:  http://medicaldetectiondogs.org.uk/breast.html:

— In an additional study in 2006, McCulloch et al. also tested the dog’s ability to distinguish exhaled breath samples of 31 breast cancer patients from those of the 83 healthy controls. Dog handlers and experimental observers were blinded to the identity of breath samples, obtained from subjects not previously encountered by the dogs during the training period. Among breast cancer patients and controls, sensitivity was 0.88 and specificity 0.98. However there were some limitations in the design of this study and number of subjects included and further work is needed with peer reviewed publication to support this finding.

See also British Medical Journal, BMJ 2004;329:712–5, Olfactory detection of human bladder cancer by dogs: proof of principle study

2.  Study: MRI Better Detects Recurrent Breast Cancer

http://www.empr.com/study-mri-better-detects-recurrent-breast-cancer/article/366485/

  • Single-screening breast magnetic resonance imaging (MRI) detects 18.1 additional cancers after negative findings with mammography and ultrasonography (US) per 1,000 women with a history of breast cancer, according to a study published in the August issue of Radiology.
  • The researchers found that MRI detected 11 additional cancers (18.1 cancers per 1,000 women).
  • “Our data suggest that women with a history of BCT for breast cancer may be appropriate candidates for breast MRI screening in view of the high detection yield for T1 invasive cancers, acceptable PPV,” the authors write.

For more information:  Radiology, August 2014, DOI: http://dx.doi.org/10.1148/ radiol.14131893Breast MR Imaging Screening in Women with a History of Breast Conservation Therapy

For more information  Cancer Res August 15, 201474; 4364, AEG-1 Regulates Retinoid X Receptor and Inhibits Retinoid Signaling

RTA trial

Topical application of RTA 408 improves skin appearance in a fractionated radiation-induced dermatitis model. Mice were irradiated (10 Gy/day) on days 2 – 57. Vehicle (sesame oil) and RTA 408 (0.01%, 0.1% or 1.0%) were both topically applied once daily staring on day 5 and ending on day 40. On the days that mice were irradiated, vehicle or RTA 408 was topically applied to the skin after radiation exposure. Starting on day 4 and every second day thereafter, each animal was photographed. The photo sequence above are representative digital photos of mouse skin from days 16 (anticipated peak injury), 30, and 40. Photos from the same animal from each dosing group are shown. (Image Credit: Radiation Research)

9.  New Study Tests Lotion To Treat Radiation Dermatitis in Breast Cancer Patients

http://radiationtherapynews.com/2014/08/19/radiation-dermatitis-breast-cancer-lotion/

  • Irving, Texas based Reata Pharmaceuticals has announced enrollment of its first patient in a Phase 2 dose-ranging study examining the safety, tolerability, and efficacy of the company’s RTA 408 Lotion versus vehicle for prevention and treatment of radiation dermatitis in breast cancer patients for whom radiation therapy (RT) is recommended.
  • Radiation dermatitis is a complication experienced by a majority of patients receiving radiation therapy for cancer.
  • RT can damage the cellular structures in the skin and cause pain, ulceration, necrosis, and fibrosis of exposed skin tissues.
  • Free radicals produced during cancer radiotherapy often lead to dermatitis, with the degree of insult to body tissues ranging from mild erythema to moist desquamation and ulceration.
  • Radiation dermatitis usually manifests within one to four weeks after initiation of RT and can result in delays in or failure to complete RT, limiting the dose effect of RT, which can negatively affect treatment outcomes.
  • Currently there are no approved agents for the prevention of radiation-induced dermatitis.
  • The researchers observe that this toxicity can be dose-limiting and promote chronic complications, such as fibrosis and wound recurrence.
  • The purpose of the study reported was to evaluate if RTA 408, a synthetic triterpenoid that potently activates the antioxidative transcription factor Nrf2 and inhibits the proinflammatory transcription factor nuclear factor-kappa b (NF-kB), could protect skin from radiation-induced dermatitis.
  • The coauthors note that dose-dependent improvements in the appearance of skin were also manifestly visible, with RTA 408 at 1.0% eliciting a normal macroscopic appearance by the end of the treatment period on day 40, including substantial hair regrowth.
  • Moreover, they report that 1.0% RTA 408 markedly reduced epidermal and collagen thickening, prevented dermal necrosis and completely alleviated skin ulcers.
  • These improvements were associated with significant increases in Nrf2 target genes and significant decreases in NF-kB target genes, concluding that together these data indicate that RTA 408 represents a potentially promising experimental therapy for the treatment of radiation-induced dermatitis.

10.  Following A Mastectomy, 58% Of Breast Cancer Survivors Do Not Choose Breast Reconstruction

http://www.medicaldaily.com/following-mastectomy-58-breast-cancer-survivors-do-not-choose-breast-reconstruction-298912

  • A study conducted by Memorial Sloan-Kettering revealed that less than 42 percent of women choose breast reconstruction following their mastectomy.
  • Of the 485 women, 24.8 percent underwent immediate breast reconstruction and 16.8 percent had delayed reconstruction: 41.6 percent total.
  • Common reasons for not choosing breast reconstruction were the desire to avoid additional surgery (48.5 percent), fear of breast implants (36.3 percent), and feeling reconstruction was not important (33.8 percent).
  • Nearly a quarter of these women felt concerned reconstruction might interfere with the detection of later cancer.
  • Among the factors linked to choosing against reconstruction were being black, a lower education level, being older, a major coexisting illness, and chemotherapy.

For more information:  JAMA Surgery, http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2014.548, Patient Perspectives on Breast Reconstruction Following Mastectomy

 

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One response

  1. When I was at An Oasis of Healing in Arizona Dr Lodi always had people come in right after a scan for an IV of 25 grams of vitamin C, because it went a long way to cancel the effects of radiation from PET and CT scans.

    There are also articles on http://www.LEF.org with other things you can do to mitigate the damage from scan radiation.

    I usually schedule an IV following my scans.

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