Best of Breast: news for week ending 29 August 2014

The latest news from the world of Breast Cancer and Cancer, aggregated from Google Alerts, for the week ending 29 August 2014.

Last week’s Best of Breast (week ending 22 August 2014) highlighted the issue of screening, or over-screening of breast cancer, and the dangers of high levels of cumulative radiotherapy as a result of Pet-CTs.  According to an article this week, European hospitals are using a variety of scanning methods, including breast MRIs.  That’s news to me.  About a month back, when I asked my surgeon for an MRI instead of a Pet-CT [as I’d had 4 in the past year] he expressed ignorance of this method of screening for breast cancer.  Back to the drawing board … [Update 24 Sept 2014 – miracle of miracles – in a recent consultation, I asked if a Pet-CT should be done at this stage, and was told … let’s see about an MRI!!???  So if you’re reading this, print off the chart about radiation levels and unless you need a Pet CT for staging, please ask for an MRI instead]


Funny how no-one ever asks for the Cure for Cancer …

This week’s can of worms is the debate on whether or not cancer is curable or not.  A scientist who has done research into a primitive life form claims that cancer has been around since the dawn of time, and because of that, it is designed by evolution to survive, rather like the cellular version of a cockroach.

Another scientist echoes this view, and believes that we should stop trying to cure cancer, instead treating it as a chronic disease, or better still, trying to prevent it, or even try to slow down its onset using drugs like aspirin.

[Update 24 September.  Please check out these links on aspirin which were kindly sent to me by a reader:

Aspirin pharmacokinetics –
Useful “reverse guide” of food high in Salicylate –]

I think it is a fact that even when cancer is in remission, there are no guarantees that it won’t return – that is the fear that all cancer survivors have.  Cancer is a numbers game.  We hope, by following the gold standard, that we’re going to beat the odds.  Some do, some don’t, that’s the brutal fact.  The gold standard is based on trials.  And the medical profession is letting patients down when they tout surgery, chemotherapy and radiotherapy as cures.  Or am I being too pessimistic?  After all, diseases like tuberculosis and typhoid, HIV and even diabetes were once killers, but are now managed as long-term chronic diseases.

Finally, research shows that patients with cancer experience relationship problems.  If it’s the wife who has cancer, there is a higher risk of the relationship failing, than if it’s the husband who develops cancer.  I once chatted to the husband of Anita Moorjani (who had Stage 4 Hodgkin’s, and a near death experience and spontaneous remission) and told him how impressed I was by his love and support for his wife.  He said that a lot of people came up to him and told him how their husbands/wives had left them on diagnosis of cancer.

It’s easy to judge the person who abandons the cancer patient, but who knows what you would do if the roles were reversed?  The idea that illness brings people together is a fairy tale.  Getting cancer is like turning up the volume in your life.  If your relationship was bad before cancer, it’s going to get worse.  We are not saints, and cancer is a terrible stress on any relationship.

1.  ‘The war on cancer may NEVER be won’: Cure ‘could be impossible’ because the disease is so highly evolved


Tumour-bearing Hydra-Polyp (right) next to a healthy animal (left). Credit: Photo/copyright: Klimovich/ CAU

  • Evolutionary biologists in Germany and Croatia found that cancer is more evolved than previously thought
  • They reached the sobering conclusion: the disease is here to stay
  • Found the first evidence of tumours in hydra polyps – simple freshwater animals
  • Suggests cancer is as old as multi-cellular life on earth but researchers said it does not mean medical technology can’t fight the disease
  • Professor Thomas Bosch, said: ‘Knowing your enemy from its origins is the best way to fight it and win many battles’
  • Bosch said: ‘Now we have discovered tumour-bearing polyps in two different species of hydra, an organism very similar to corals.
  • ‘This provides proof that tumours indeed exist in primitive and evolutionary old animals.’
  • A further discovery was that the invasive nature of the disease also dates back millions of years.
  • If tumour cells are introduced into a healthy organism, they can trigger tumour growth in the hydras, the team found.
  • Professor Bosch concluded: ‘Our study makes it unlikely that the War On Cancer proclaimed in the 1970s can ever be won.
  • ‘Cancer cells have deep evolutionary roots. Any crucial cell in your body can make a mistake. You carry a time bomb in your body when you’re born.
  • ‘It can explode early in life, or middle age or later. That doesn’t mean that, with a patient who develops cancer, there’s nothing you can do.
  • ‘Medical technology will allow us at early time points… at least in some cases, to successfully treat and clean a patient completely and forever of troublemaking cells
  • ‘Knowing your enemy from its origins is the best way to fight it, and win many battles,’ he added.

For more information:  Nature Communications 5, Article number: 4222doi: 10.1038/ ncomms5222, Naturally occurring tumours in the basal metazoan Hydra

2.  Let’s stop trying to cure cancer, says cancer professor

  • Most cancers cannot be cured and scientists should give up trying and, instead, look for ways to manage the disease, the director of the Centre for Evolution and Cancer at The Institute of Cancer Research, has claimed.
  • Professor Mel Greaves, an expert in childhood leukaemia, said developing more advanced cures would only lead to cancer cells becoming more resistant to treatment.
  • He believes that scientists should focus on prevention, such as giving aspirin to all over 50s to stop the onset of stomach cancer, and stalling the disease once it has emerged.
  • “Talking about a cure in terms of elimination is just not very realistic. There are some examples of it. Childhood leukaemia had a cure rate now of 90 per cent but that is an exception.
  • “There are a few cancers that are curable but most are probably not including the common carcinomas in adults.
  • “We should be a bit more subtle. We should not try to eliminate the cancer, we should try to hold it in check.”
  • Prof Greaves believes no therapy will work in the long term because tumours continue to evolve like all life-forms.
  • He is a leading figure in the study of cancer evolution – the Darwinian process by which cancer cells mutate and diversify by natural selection within our tissue ecosystems
  • “You must have noticed that when you read reports about new target therapies, isn’t it odd that they work dramatically, but three months later (cancer) is back with a bang. It’s almost always the story.
  • “I would argue that if you look at the age distribution of cancers, most people are in the 60s, 70s and 80s. If you could slow everything down for 10 to 15 years, maybe 20, then that would be a huge advance.”
  • However, leading cancer expert Professor Karol Sikora, Dean of Medicine at the University of Buckingham, said he was confident cures could still be found.“I think this is a pessimistic view, and strange given that Professor Greaves has done so much to help find a cure for leukaemia.
  • “I absolutely think we will find new cures in the future and the closer we get to understanding the mechanism of the disease, the quicker this will happen.”


3.  Cancer patients often face relationship problems, say health care professionals

  • A series of interviews with professionals working in cancer care conducted by the Dutch newspaper de Volkskrant have revealed that relationship problems are worryingly common amongst cancer patients.
  • Psychiatrist Leo van Weezel of the Antoni van Leeuwenhoek hospital in Amsterdam said: “Cancer can turn patients into extremely unpleasant, difficult partners. The idea that cancer brings a couple closer together is a romanticised idea. This assumption makes people feel even lonelier; they feel they’re not fulfilling expectations.”
  • Van Weezel also emphasised that contrary to popular belief, it isn’t just the couples who had a strained relationship prior to diagnosis that end up in trouble. In his experience, cancer can have devastating effects on any partnership.
  • Social support has frequently been shown to have a significant impact on the outcome of cancer treatment. Those whose partner leaves them after a cancer diagnosis are less likely to complete their therapy or try new treatment options.
  • Women who are diagnosed with cancer appear to be especially at risk of losing the support of their significant other.
  • Research led by Dr. Marc Chamberlain, chief of the neuro-oncology division at the Fred Hutchinson Cancer Research Center in Seattle, showed that women who fall ill are far more likely to be abandoned by their partners than men in the same position.
  • Chamberlain and his team found that although overall divorce rates of couples with one seriously ill spouse were comparable to the general divorce rate in the US, there was a marked difference depending on which partner had received the diagnosis.
  • In cases where the husband became seriously ill, divorce rates were actually far lower than average at three per cent.
  • However, a staggering 21 per cent of wives who had been diagnosed with serious illness ended up separated or divorced within the same time frame.
  • In fact, Chamberlain’s study revealed that in ninety per cent of post-diagnosis divorce cases, the wife was the sick party. The researchers suggested that a possible explanation for this striking difference could be that men find it harder to take on a care-giving
  • Here in the UK, funded couples counselling is usually only on offer if one of the partners is suffering from a mental health problem which affects the relationship.
  • The Cancer Counselling Trust offered free counselling to cancer patients, but was forced to discontinue their service in 2010 due to financial hardship.

4.  European Medical Centers Using Multi-Modality Breast Imaging for Accurate Cancer Detection

  • In addition to mammography, European medical centers are employing a wide variety of breast imaging techniques including breast ultrasound, breast magnetic resonance imaging (MRI), molecular breast imaging (MBI) and even breast computer-aided detection (CAD).
  • Not only is this leading to increased detection rates and decreased false positives, but it is also leading to increased market revenues for the multi-modality breast imaging system market in general.

5.  Mammography False Alarms Linked With Later Tumor Risk

  • Women whose screening mammograms produce false alarms have a heightened risk of being diagnosed with breast cancer years later, but the reason remains mysterious, researchers say.
  • An increased risk of breast cancer among women with a “false positive” mammogram has been reported before.
  • A mammogram is considered false positive when it suggests possible breast cancer but additional screenings or a biopsy fails to find it.
  • What’s new about this study is that the authors tried to figure out how much, if any, of the extra risk is simply due to doctors missing the cancer the first time they investigated the worrisome mammogram findings.
  • Of more than 58,000 Danish women who had mammography between 1991 and 2005, her study identified 4,743 women with suspicious findings that were eventually declared negative.
  • By 2008, 295 of those 4,743 women had been diagnosed with breast cancer, von Euler-Chelpin and colleagues reported in Cancer Epidemiology.
  • Radiologists reread the original mammograms and found that doctors had actually missed the cancer in 72 of the 295 women, for a false-negative rate of 1.5 percent.
  • Even after taking those missed cancers into account, however, the researchers found that women with false-positive mammograms were still 27 percent more likely to be diagnosed with breast cancer years later, compared to women with only negative test results.
  • The risk was slightly higher in women who had surgical biopsies that turned out to be negative.
  • The excess rate of breast cancer among women who have had false-positive mammograms points to the need to personalize screening programs for women.

For more information: Cancer Epidemiology, online July 14, 2014.

6.  Latest trials do not support link between bisphosphonate use and reduced breast cancer risk

  • Several observational studies have reported that use of bisphosphonates is associated with a decreased risk of breast cancer in postmenopausal women.
  • Now, long-awaited results from two randomised clinical trials published in JAMA Internal Medicine (online, 11 August 2014) have found no evidence to support such an association.
  • The studies, known as FIT and HORIZON-PFT, were placebo-controlled and evaluated alendronate and zoledronic acid, respectively, in nearly 15,000 postmenopausal women with osteoporosis.
  • Neither of the bisphosphonate drugs decreased women’s risk of developing invasive breast cancer during three to four years of treatment.
  • Low oestrogen levels are the most likely explanation for the previously observed associations, say the researchers, since having low oestrogen both weakens bones and protects against most breast cancers.

For more information:  JAMA Internal Medicine. Published online, August 11 2014. Available from: doi:10.1001/jamainternmed.2014.3634, Effect of Bisphosphonate Use on Risk of Postmenopausal Breast Cancer. Results From the Randomized Clinical Trials of Alendronate and Zoledronic Acid.

7.  Could Breast Cancer Drugs Treat Brain Tumors?

  • Letrazole is taken orally for the treatment of breast cancer in post-menopausal women and works by decreasing the amounts of estrogen, a hormone which has been found to increase the growth of some breast cancers.
  • A study, conducted on rats with implanted gliomas, determined that, “Letrazole’s permeability across the blood brain barrier is high, and the exposure to the brain is dose dependent.
  • Furthermore, the brain tumoral letrozole levels are markedly higher than those in the tumor-free regions, which underscore potential selectivity of its activity against tumor studies.
  • If effective, this research could drastically change the prognosis for patients who develop primary brain tumors, such as gliomas.

For more information:  Cancer Chemotherapy and PharmacologyAugust 2013, Volume 72, Issue 2, pp 349-357, The pharmacokinetics of letrozole in brain and brain tumor in rats with orthotopically implanted C6 glioma, assessed using intracerebral microdialysis

8.  Discovered:  An estrogen that does not increase the risk of breast cancer

  • Scientists at Indiana University have since developed a compound called GLP-1-oestrogen.
  • They say the compound helped body weight control and would not increase the risk of breast cancer because it did not deliver oestrogen to the breast tissue.
  • Dr Xu and his colleagues then used the compound to show that when an injection of the compound was given in mice, there was  increased activity of oestrogen in the serotonin region of the brain.
  • This means the compound can deliver oestrogen into the serotonin region where binge behaviour is thought to be regulated.
  • They further showed that the compound actually substantially inhibits binge eating in mice.

For more information:  J Clin Invest. doi:10.1172/JCI7472, Estrogens stimulate serotonin neurons to inhibit binge-like eating in mice

9.  New biomarker highly promising for predicting breast cancer outcomes

  • A protein named p66ShcA shows promise as a biomarker to identify breast cancers with poor prognoses, according to research published ahead of print in the journal Molecular and Cellular Biology.
  • Cancer is deadly in large part due to its ability to metastasize, to travel from one organ or tissue type to another and malignantly sprout anew.
  • The vast majority of cancer deaths are associated with metastasis.
  • In breast cancer, a process called “epithelial to mesenchymal transition” aids metastasis.
  • Epithelial cells line surfaces which come into contact with the environment, such as skin and the gastrointestinal tract.
  • Mesenchymal cells are a type of cell in embryonic tissue and in connective tissue, where they form very loose contacts with one-another.
  • Tumor cells lose mature epithelial characteristics, such as the ability to adhere to their neighbors, and gain those of the mesenchymal cells which enable them to move easily through the cellular matrix and into the blood stream.
  • That enables their metastatic migration to distant organs and tissues.
  • In this study the researchers, led by Josie Ursini-Siegel of McGill University, show that the protein p66ShcA is highly enriched in breast cancers that have undergone epithelial to mesenchymal transition.
  • “We showed that elevated p66ShcA expression levels are strongly associated with expression of numerous epithelial to mesenchymal transition genes in all breast cancer subtypes.  Thus, p66ShcA may serve as one of the first prognostic biomarkers to identify poor outcome breasts cancers regardless of their molecular subtype.”

For more information:  Molecular and Cellular Biology, 28 July 2014, doi:10.1128/MCB. 00341-14, p66ShcA Promotes Breast Cancer Plasticity by Inducing an Epithelial to Mesenchymal Transition

10.  Accelerated Partial Breast Irradiation (APBI) Trial For Breast Cancer Shows Promise

  • A new form of radiation therapy, accelerated partial breast irradiation (APBI), may offer women with breast cancer faster and more accurate treatment, delivering a more direct and targeted dose of radiation to the affected area of a patient’s breast.
  • Furthermore, it allows for a higher dose of radiation to be delivered in each treatment session.
  • The researchers used the AccuBoost Brachytherapy System, a non-invasive breast brachytherapy approach that delivers APBI through non-invasive image-guided breast brachytherapy (NIBB), thus allowing clinicians to deliver targeted radiation to the affected area while minimizing radiation to the heart, lungs, opposing breast, and skin.
  • Until now, radiologists had one of two methods to deliver APBI, either through time-consuming scheduled appointments requiring extreme planning and an imprecise method of imaging, targeting a much larger are of the breast, or through insertion of catheters that would remain in place for a week, causing extreme discomfort and creating a risk of infection.

For more information:

11.  Endogenous Hormones Improve Breast Cancer Risk Models

  • Inclusion of endogenous hormones in prediction models improves prediction of invasive breast cancer risk in postmenopausal women, according to a study published online Aug. 18 in the Journal of Clinical Oncology.
  • Improvement was assessed with inclusion of each of plasma estradiol, estrone, estrone sulfate, testosterone, dehydroepiandrosterone sulfate, prolactin, and sex hormone binding-globulin (SHBG) to the Gail and Rosner-Colditz risk scores in 437 patient cases and 775 controls not using postmenopausal hormones.

For more information:  Journal of Clinical Oncolog, doi:10.1200/ JCO.2014.56.1068,  Inclusion of Endogenous Hormone Levels in Risk Prediction Models of Postmenopausal Breast Cancer

12.  Focused ultrasound treatment for benign breast tumours

  • The University of Virginia Medical Center will be the first hospital in the U.S. to experiment with a treatment that could remove benign breast tumors without surgery, officials said.
  • Researchers said their ultimate goal is to use the technology to treat cancerous tumors.
  • UVa Medical Center is the leading focused ultrasound center in the nation, officials said. The technology uses ultrasound waves to generate heat that can destroy damaged tissue or tumors without damaging surrounding tissues.
  • A two-year trial on 15 patients with essential tremors — led Dr. Jeffrey Elias in 2011 — showed patients responded almost immediately to the treatment, in which doctors use an MRI machine to guide the system.
  • In a new trial, researchers are looking to test the focused ultrasound on fibroadenomas, or noncancerous breast tumors.

13.  New research to probe protein kinases in cancer cells

  • Researchers from the Cancer Research UK Manchester Institute based at The University of Manchester – part of the Manchester Cancer Research Centre – and the Institute of Cancer Research, London, looked at protein kinases, molecules that control various aspects of cellular function.
  • The team investigated the make-up of over 200 protein kinases.
  • They used a technique known as mass spectrometry to develop a method that can both identify and measure the amount of various kinases in a biological sample – for example from a part of a tumour removed in surgery.

For more information:  Nature Methods(2014) doi:10.1038/nmeth.3072, Systematic evaluation of quantotypic peptides for targeted analysis of the human kinome


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