Showing posts with label breast cancer. Show all posts
Showing posts with label breast cancer. Show all posts
Wednesday, March 07, 2012
Tuesday, March 06, 2012
Medpage: LaCroix A, et al "Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial" JAMA 2011; 305: 1305-1314.
Blogger's Note: also see website for video
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New WHI Estrogen Analysis Shows Lower Breast Ca Risk
In contrast to other studies of unopposed postmenopausal estrogen therapy, long-term follow-up of Women's Health Initiative (WHI) Estrogen-Alone Trial participants showed a persistent reduction in breast cancer risk, researchers said.
But other benefits and risks associated with use of conjugated equine estrogens (CEE) quickly dissipated after the therapy was stopped, according to Andrea Z. LaCroix, PhD, of Fred Hutchinson Cancer Research Center in Seattle, and colleagues.
"Considering the entire follow-up period, rates of total mortality and the global index of chronic diseases were essentially the same in the conjugated equine estrogen and placebo groups," LaCroix and co-authors wrote in the April 6 issue of the Journal of the American Medical Association.
"Statistically significant age interactions for conjugated equine estrogen use, suggesting greater safety and possible benefit among women in their 50s and potential harm among older women, were observed for coronary heart disease, total MI, colorectal cancer, total mortality, and the global index of chronic diseases," they added.
An editorial in the same issue suggested more caution in interpreting the breast cancer results.
Commentary: Oestrogen and breast cancer: results from the WHI trial : The Lancet Oncology
Blogger's Note: this Lancet Oncology article is subscriber based ($$$)
Commentary
The Lancet Oncology, Early Online Publication, 7 March 2012
Commentary
The Lancet Oncology, Early Online Publication, 7 March 2012
Oestrogen and breast cancer: results from the WHI trial
"In The Lancet Oncology , the Women's Health Initiative (WHI) investigators report 1 that receipt of conjugated equine oestrogen for a median of 5·9 years reduced the risk of invasive breast cancer by 23% compared with placebo (151 cases in 5310 women who received oestrogen vs 199 cases in 5429 controls; p=0·02). Women who did develop breast cancer after receipt of oestrogen had significantly reduced breast cancer-specific mortality (six deaths in the oestrogen group vs 16 deaths in controls; p=0·03) and ..."
The Lancet Oncology: Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial
The Lancet Oncology, Early Online Publication,
7 March 2012
doi:10.1016/S1470-2045(12)70075-X
Cite or Link Using DOI
Cite or Link Using DOIFeature
The Women's Health Initiative
Women who use the oestrogen-only form of hormone replacement therapy
(HRT) appear less likely to develop breast cancer in the longer term,
according to new research published in The Lancet Oncology. A follow-up study
of over 7500 women from the Women's Health Initiative trial who took
oestrogen for about 6 years and then stopped has found that they are
over 20% less likely to develop breast cancer and remain significantly
less likely to die from the disease than those who never used HRT, a
period of nearly 5 years after stopping treatment. The findings are
discussed further in a Comment.
Summary
Background
By contrast with many observational studies, women in the Women's Health Initiative (WHI) trial who were randomly allocated to receive oestrogen alone had a lower incidence of invasive breast cancer than did those who received placebo. We aimed to assess the influence of oestrogen use on longer term breast cancer incidence and mortality in extended follow-up of this cohort.
Methods
Between 1993 and 1998, the WHI enrolled 10 739 postmenopausal women from 40 US clinical centres into a randomised, double-masked, placebo-controlled trial. Women aged 50—79 years who had undergone hysterectomy and had expected 3-year survival and mammography clearance were randomly allocated by a computerised, permuted block algorithm, stratified by age group and centre, to receive oral conjugated equine oestrogen (0·625 mg per day; n=5310) or matched placebo (n=5429). The trial intervention was terminated early on Feb 29, 2004, because of an adverse effect on stroke. Follow-up continued until planned termination (March 31, 2005). Consent was sought for extended surveillance from the 9786 living participants in active follow-up, of whom 7645 agreed. Using data from this extended follow-up (to Aug 14, 2009), we assessed long-term effects of oestrogen use on invasive breast cancer incidence, tumour characteristics, and mortality. We used Cox regression models to estimate hazard ratios (HRs) in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00000611.
Findings
After a median follow-up of 11·8 years (IQR 9·1—12·9), the use of oestrogen for a median of 5·9 years (2·5—7·3) was associated with lower incidence of invasive breast cancer (151 cases, 0·27% per year) compared with placebo (199 cases, 0·35% per year; HR 0·77, 95% CI 0·62—0·95; p=0·02) with no difference (p=0·76) between intervention phase (0·79, 0·61—1·02) and post-intervention phase effects (0·75, 0·51—1·09).
In subgroup analyses, we noted breast cancer risk reduction with oestrogen use was concentrated in women without benign breast disease (p=0·01) or a family history of breast cancer (p=0·02). In the oestrogen group, fewer women died from breast cancer (six deaths, 0·009% per year) compared with controls (16 deaths, 0·024% per year; HR 0·37, 95% CI 0·13—0·91; p=0·03). Fewer women in the oestrogen group died from any cause after a breast cancer diagnosis (30 deaths, 0·046% per year) than did controls (50 deaths, 0·076%; HR 0·62, 95% CI 0·39—0·97; p=0·04).
In subgroup analyses, we noted breast cancer risk reduction with oestrogen use was concentrated in women without benign breast disease (p=0·01) or a family history of breast cancer (p=0·02). In the oestrogen group, fewer women died from breast cancer (six deaths, 0·009% per year) compared with controls (16 deaths, 0·024% per year; HR 0·37, 95% CI 0·13—0·91; p=0·03). Fewer women in the oestrogen group died from any cause after a breast cancer diagnosis (30 deaths, 0·046% per year) than did controls (50 deaths, 0·076%; HR 0·62, 95% CI 0·39—0·97; p=0·04).
Interpretation
Our findings provide reassurance for women with hysterectomy seeking relief of climacteric symptoms in terms of the effects of oestrogen use for about 5 years on breast cancer incidence and mortality. However, our data do not support use of oestrogen for breast cancer risk reduction because any noted benefit probably does not apply to populations at increased risk of such cancer.
Wednesday, February 29, 2012
Stopping menopausal hormone therapy: If breast cancer really decreased, why did colorectal cancer not increase? Maturitas "Alternative explanations must be found."
Abstract
Objective
The Women's Health Initiative (WHI) study of postmenopausal hormone therapy (HT) found that estrogen plus progestogen therapy (EPT) decreased colorectal cancer risk.
Thus, the decline in EPT use from 2002 to 2003 should have precipitated an increase in the incidence of colorectal cancer. We tested this prediction using the SEER 9 epidemiologic database.
Methods
We analyzed WHI data concerning the effects of EPT and estrogen therapy (ET) on colorectal cancer risks. We also examined HT prescription sales data, as well as SEER 9 colorectal cancer incidences from 2001 to 2004.
Results
In the WHI study, the incidence of colorectal cancer was comparable in EPT placebo-users, ET users, and ET placebo-users, but significantly lower in EPT users. Assuming that 30% of eligible women used HT in 2001, the decline in EPT sales from 2002 to 2003 of 63% should have increased the incidence of colorectal cancer by 2.8% in the overall population at risk. However, the SEER 9 colorectal cancer incidence fell by 5.9% in this population, which is comparable to the 6.7% decrease observed for invasive breast cancer from 2002 to 2003.
Conclusions
Declining EPT use from 2002 to 2003 should have precipitated an increase in the incidence of colorectal cancer, but the opposite trend was seen in the SEER 9 database during this time. The incidences of invasive breast cancer and colorectal cancer both declined by a similar amount from 2002 to 2003, despite the results of the WHI study predicting opposing trends for the two different types of cancer. Thus, the SEER 9 findings are fundamentally incompatible with expectations from the WHI findings. This implies that reductions in HT use from 2002 to 2003 cannot account for the contemporaneous changes in invasive breast cancer and colorectal cancer incidences.
Alternative explanations must be found.
Sunday, February 26, 2012
abstract: Controlling angiogenesis in breast cancer: A systematic review of anti-angiogenic trials
Controlling angiogenesis in breast cancer: A systematic review of anti-angiogenic trials
Source: Cancer Treatment Reviews
Purpose
Angiogenesis is critical for tumor growth and a promising therapeutic target. This review will summarize and analyze data from clinical trials of anti-angiogenic agents in the treatment of breast cancer (BC).
Design
A systematic search of PubMed and conference databases was performed to identify reports of randomized clinical trials investigating specific anti-angiogenic agents in the treatment of BC.
Results and discussion
Phase III trials in advanced BC have demonstrated a reduction in the risk of disease progression (22–52%), improved response rates and net improvements in progression-free survival of 1.2 to 5.5 months, but no significant improvements in overall survival with the addition of bevacizumab to chemotherapy. Results of phase III trials in early breast cancer have been inconsistent. Bevacizumab-containing regimens have also been associated with higher overall adverse event rates compared to chemotherapy alone. Phase III trials of the tyrosine kinase inhibitor sunitinib were negative, while randomized phase II trials of sorafenib and pazopanib have improved some outcomes when combined with chemotherapy or targeted therapy compared to controls. In addition to expected vascular class safety signals, tyrosine kinase inhibitors show “off-target” side effects. Ongoing clinical trials evaluating combinatorial strategies based on biological synergies and translational studies identifying biological predictors of response will be crucial to establish meaningful clinical benefits in selected BC populations.
Conclusion
Most trials of anti-angiogenic agents in BC have reported improved response rate and progression-free survival but no increase in overall survival compared to chemotherapy alone. Optimizing the therapeutic indices of these agents is a focus of ongoing research and will be critical to their future development.
Thursday, February 09, 2012
JCO: Editorial - Ovarian Suppression for Prevention of Premature Menopause and Infertility: Empty Promise or Effective Therapy? (in Breast Cancer) see note/your comments?
Blogger's Note: compared with other young cancer survivors??
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"Fertility and premature menopause are major concerns for young patients who are undergoing treatment for cancer. Young women with breast cancer face particular challenges when considering future fertility compared with other young cancer survivors.1 The greatest concern is whether preservation of ovarian function and a subsequent pregnancy in a breast cancer survivor could increase the risk of recurrence, particularly in patients with hormone receptor–positive disease....."
See accompanying article on page 533
Sunday, February 05, 2012
She the People - Komen, go back to your roots By Donna Trussell (author/ovarian cancer survivor) (including public comments)
"...... There is a school of thought that when charity founders retire or die, the organizations should die with them. The original mission gets lost amid the everyday tasks of promoting a brand, delivering services, and managing employees.......What did surprise me about Susan Komen’s story was how similar cancer experiences are. When you have a less publicized form of cancer, you tend to notice the boundaries between cancers, and the unequal allocation of resources......."
Friday, February 03, 2012
Wednesday, February 01, 2012
Monday, January 30, 2012
Friday, January 27, 2012
Wednesday, January 25, 2012
(NEJM)The New England Journal of Medicine: 3 artiicles - breast cancer/Avastin (Bevacizumab) Jan 2012
original article (abstract)
Bevacizumab and HER2-Negative Breast Cancer
original article (abstract)
Studies Reignite Debate over Avastin (Bevacizumab) in Breast Cancer - in Oncology/Hematology, Breast Cancer from MedPage Today
Action Points
- These two studies found a benefit in the surrogate endpoint of complete pathologic response with the addition of bevacizumab in neoadjuvant treatment for HER2-negative breast cancer.
- Note that pathologic complete response was defined differently in the two studies -- in the breast and nodes in one and only in the breast in the other; applying the more stringent breast-plus-nodes criterion in the second study eliminated the statistical significance.
Tuesday, January 24, 2012
BMC Cancer | Full text | Breast cancer patients with lobular cancer more commonly have a father than a mother diagnosed with cancer
Conclusion
We propose that lobular breast cancer is associated with having a father diagnosed with cancer, most commonly prostate carcinoma. Since the association remained after excluding family history of breast cancer, the association seems independent of classical breast cancer heredity. The association with a father diagnosed with cancer also remained after removing prostate cancer, indicating an independence from prostate cancer as well. The reason for this association is genetically unclear, but could involve sex-specific imprinting.
Sunday, January 22, 2012
New Genetic Clues to Breast Cancer? - Drugs.com MedNews
SUNDAY Jan. 22, 2012 --
"Researchers have identified three new genomic regions they believe are linked with breast cancer that may help explain why some women develop the disease..........Scientists conducting genome-wide association studies -- research that looks at the association between genetic factors and disease to pinpoint possible causes -- had already identified 22 breast cancer susceptibility loci. Locus is the physical location of a gene or DNA sequence on a chromosome. "The three [newly identified] loci take the number of common susceptibility loci from 22 to 25," said Easton. However, the three new susceptibility loci might explain only about 0.7 percent of the familial risks of breast cancer, bringing the total contribution to about 9 percent, the researchers said.'".......
Thursday, January 19, 2012
abstract: Exposure to and Intention to Discuss Cancer-Related Internet Information Among Patients With Breast Cancer (Sloan Kettering)
Patients and Methods:
We asked 558 patients with breast cancer who were waiting to see their physicians about their experiences reading cancer-related information from the Internet and their intent to discuss the information in their current visit.
Conclusion:
The proportion of patients with breast cancer planning to discuss Internet information during their current physician visit was relatively small. Few characteristics were associated with recent Internet use or intent to discuss.
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