Cleveland Kidnap Women Move from Victims to Survivors

The three women who were kidnapped, beaten and held in captivity for a decade in a Cleveland home appeared to be "genuinely happy" in an upbeat video they posted on YouTube today.

Amanda Berry, Gina DeJesus and Michelle Knight took one step closer to recovery, according to Jennifer Marsh, vice president of victim services for the Rape Abuse and Incest National Network (RAINN).

"When I was watching the video, it seemed as though they were making the transition from victim to survivor," said Marsh. "I am happy they have found support and it seems as if they are moving along the path of recovery."

"One of the things that struck me was how sincere they were and how genuinely happy they appeared to be," she said.

"Clearly, what they were reading was very scripted, but that doesn't take away from what they are saying. Speaking on camera is challenging for anyone and they have probably had limited interactions over the course of their captivity."

Catch up on all the details of the Cleveland kidnapping case.

Each of the women appeared separately in the 3-minute, 33-second video. Berry and Knight made a brief statement, while DeJesus answered questions from someone off camera, followed by her father, Felix DeJesus, and then her mother, Nancy Ruiz.

Berry, who with her 6-year-old daughter fought her way out from under their accused captor, 52-year-old Ariel Castro, was the first to speak. She appears calm and happy and smiles frequently in the video, which was filmed July 2.

"First and foremost, I want everyone to know how happy I am to be with my family and my friends, it has been unbelievable," said Berry, who was the most composed. "I want to thank everyone who has helped me and my family through this entire ordeal. Everyone who has been there to support us has been a blessing, to have such an outpouring of love and kindness. I am getting stronger each day and having my privacy has been helping immensely. I ask that everyone continues to respect our privacy and give us time to have a normal life."

Ariel Castro pleads not guilty to alleged crimes against the Cleveland women.

The three women looked healthy and strong in the video, all with stylish new haircuts. Knight, who had been held captive the longest and had allegedly been repeatedly beaten, wore a pair of designer-type glasses and spoke last.

"I may have been through hell and back, but I am strong enough to walk through hell with a smile on my face and with my head held high and my feet firmly on the ground," she says. "Walking hand-in-hand with my best friend, I will not let the situation define who I am. I will define the situation."

Marsh said that she noticed all three women were making eye contact with the camera and DeJesus was interacting with her parents.

"You could tell that [DeJesus] was happy, and her parents also seemed sincere," said Marsh. "I felt as though her mom appealed to other families who had children take and came from such a genuine place. Never give up hope."

DeJesus' mother Ruiz thanked The Cleveland Courage Fund, which was set up by the Cleveland Foundation to help the girls readjust to life. It has already raised $1 million.

Thanking her community and neighbors, Ruiz says, "Every single one, they know who they are. Awesome. So people, I'm talking not just about people but parents in general that does have a loved one missing, please do me one big favor. Count on your neighbors. Don't be afraid to ask for the help, because help is available."

The women's alleged abductor Castro has pleaded not guilty to 329 counts of rape, torture and murder for allegedly keeping the three women in his home. The former school bus driver is also accused of the aggravated murder of a fetus for allegedly forcibly causing an abortion in Knight, whom he is accused of impregnating, a charge that could potentially carry the death penalty.

Castro allegedly snatched Berry, DeJesus and Knight between 2002 and 2004 and imprisoned them, sometimes restrained by chains. Berry was 16, DeJesus was 14, and Knight was 20.

The women were freed on May 6 when Berry cried out for help from behind a closed screen door, getting the attention of neighbors.

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Signs that women may have cancer

Women need not worry if they go through this cancer sign - but they should still pay attention to them. Early detection doesn't help more than often, cure cancer, because they will be refunded quick help in medical facilities, including an alternative cancer treatment center.

Extreme fatigue

Fatigue prevents that you perform in the Office, as well as mixing with your kids before you go to bed. You think usually you have only to rest. But you did not know that there is already a week since you felt incredibly tired? It may be likely, that your work is exhausted you but you should looking for medical assistance. Some types of cancer, such as leukemia and stomach cancer, has fatigue as one of the symptoms.

Cough

Cough can be normal, if you it must to have examined you over a cold, flu or allergies but if your cough for three weeks to a month still, by a doctor. He is usually questions for your health background and make a request for full examination of lung and throat go through.

Digestive disorders

Indigestion is a type of concern among people, but when it comes to no reason on you, you are a doctor who will assess your case should. He makes the necessary verifications and on the potential for you having stomach, throat or esophagus cancer check. Not be compromised easily because this is only a possibility. In the event that the doctor confirms that you have cancer, you may undergo medical procedures, in a general hospital or in an alternative treatment Cancer Center.

Unexplained weight loss

Every obese person will want to not take in however in your case if you are shedding of pounds for reasons that you can't explain. Again, call and set a meeting with your doctor.

Abnormal bleeding

If you have observed blood in the urine or stool, let's not go through it without discussion with a medical professional. You can by colorectal, bladder and kidneys at risk. The same applies if you saw blood in your cough more than once.

Bloated stomach

This is one of the cancer symptoms, overlooked by most women. You think that this commonplace, especially for those that are a lot of food and life sedentary. They don't realize that in this case a little more time something can be drastically wrong, that this with their physicians as this maybe a sign to review of ovarian cancer. This is particularly so if the bloating with urinary problems and pelvic pain comes, and when they feel light filled.

Depression with abdominal pain

Some scientific studies found an association between going through pain in her abdomen and depression with pancreatic cancer. Need immediate medical assistance.

The above situations like typical for all of us, but you should not pay any attention to them as they are signs of cancer. Alternative cancer treatment center immediately go a medical center or one, so that you will receive the necessary medical assistance.

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700 Women with urinary Cancers missing out on prompt diagnosis each year

Main category: Urology / Nephrology
Also included in: Cancer / Oncology;??Women's health / Gynecology
Article Date: June 25, 2013-0:00 PDT current ratings for:
700 Women with urinary Cancers missing out on prompt diagnosis each year

Family physicians can be attributing symptoms of cancer of the bladder and kidneys, causes harmless

About 700 women in England with the symptoms of cancer of the kidney or bladder are missing out on a fast diagnosis and treatment of their condition, each year, research reveals in the journal online only BMJ Open.

It may be because of family physicians tend to give women, rather than men - first symptoms benign causes, such as bacterial infections and some women therefore need to visit their doctor several times before they are referred to a specialist, i.e. researchers.

Currently, the survival rates for cancer of the kidney and bladder in England show that fewer women than men living five years after diagnosis.

The researchers studied the numbers of patients diagnosed as cancer of the kidney and the bladder in England between 2009 and 2010. They used data from the National Audit of the diagnosis of Cancer in Primary Care, covering general practices representing 1170 - equivalent to about 14% of the total national. They studied two interrelated measures of the speed of diagnosis: the number of consultations, the patient is before he transferred. and the time interval between the first visit to the GP with symptoms and specialist referral.

In total, 920 patients have been diagnosed with cancer of the bladder during the study period, 252 (27%) were women; and 398 have been diagnosed with cancer of the kidney, 165 (42%) were women. These proportions are similar to national figures: 28% and 38%, respectively.

Women were nearly twice as likely than men to have consulted their doctor three or more times, before they were referred to a specialist, the analysis showed.

About one in ten (11%) men with bladder cancer had three or more visits before referral, compared to 27% of women. The corresponding figures for the kidney cancer were 18% and 30%.

The interval between the first GP consultation mean and specialist orientation is a not differ greatly between men and women - four against six days for bladder cancer and 10 to 16 days for kidney cancer. But among the 25% of women experiencing more delays, it took two more weeks to get referred that the 25% of men with longer deadlines. When this has been reduced to 10% of those who know longer delays, the figure rose to more than two months for women with bladder cancer and more than three weeks for those who have cancer of the kidney, compared with men.

Two-thirds of all patients with cancer of the bladder and a quarter of people with kidney cancer had blood in their urine (Hematuria), a symptom of the red flag for further investigation.

But the presence or absence of this symptom could not explain the difference between the sexes in the period of reference, the analysis said.

Even when they came to see their doctor with hematuria, women with bladder cancer were more than three times as likely to have three or more visits GP before the switch compared to men with the same symptom.

And women with kidney cancer were almost twice as likely as men to discover three or more consultations, when he had blood in their urine.

As nearly 3,000 women are diagnosed every cancer each year in England, the authors calculate that about 700 women will experience delays in diagnosis.

Reinforce the need to follow the guidelines and view the blood in the suspicious urine could encourage GPs to guide women faster, but it will not help in cases where this symptom is not present, warn the authors, requiring new approaches to address this problem.

"Great potential to improve the speed of diagnosis of cancer of the urinary tract in women, the conclusions of signals", the authors write. "Interventions to prevent the initial allocation of hematuria in women with cancer of the urinary tract to cause benign [GPs] must be quickly developed and evaluated," they urge.

Article adapted by Medical News Today press release original. Click on "references" tab above for the source.
Visit our Urology / Nephrology section for the latest news on this subject. "Gender inequalities in the promptness of the bladder and the kidney after symptomatic presentation: evidence from secondary analysis of a survey of primary care English checking ',
Georgios Lyratzopoulos et al.
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Domestic Violence Affects 1 in 3 Women

 

In the first major global review of violence against women, a series of reports released Thursday found that about a third of women have been physically or sexually assaulted by a former or current partner.

The head of the World Health Organization, Dr. Margaret Chan, called it "a global health problem of epidemic proportions," and other experts said screening for domestic violence should be added to all levels of health care.

Among the findings: 40 percent of women killed worldwide were slain by an intimate partner, and being assaulted by a partner was the most common kind of violence experienced by women.

Researchers used a broad definition of domestic violence, and in cases where country data was incomplete, estimates were used to fill in the gaps. WHO defined physical violence as being slapped, pushed, punched, choked or attacked with a weapon. Sexual violence was defined as being physically forced to have sex, having sex for fear of what the partner might do and being compelled to do something sexual that was humiliating or degrading.

The report also examined rates of sexual violence against women by someone other than a partner and found about 7 percent of women worldwide had previously been a victim.

In conjunction with the report, WHO issued guidelines for authorities to spot problems earlier and said all health workers should be trained to recognize when women may be at risk and how to respond appropriately.

Globally, the WHO review found 30 percent of women are affected by domestic or sexual violence by a partner. The report was based largely on studies from 1983 to 2010. According to the United Nations, more than 600 million women live in countries where domestic violence is not considered a crime.

The rate of domestic violence against women was highest in Africa, the Middle East and Southeast Asia, where 37 percent of women experienced physical or sexual violence from a partner at some point in their lifetimes. The rate was 30 percent in Latin America and 23 percent in North America. In Europe and Asia, it was 25 percent.

Some experts said screening for domestic violence should be added to all levels of health care, such as obstetric clinics.

"It's unlikely that someone would walk into an ER and disclose they've been assaulted," said Sheila Sprague of McMaster University in Canada, who has researched domestic violence in women at orthopedic clinics. She was not connected to the WHO report.

However, "over time, if women are coming into a fracture clinic or a pre-natal clinic, they may tell you they are suffering abuse if you ask," she said.

For domestic violence figures, scientists analyzed information from 86 countries focusing on women and teens over the age of 15. They also assessed studies from 56 countries on sexual violence by someone other than a partner, though they had no data from the Middle East. WHO experts then used modeling techniques to come up with global estimates for the percentage of women who are victims of violence.

Accurate numbers on women and violence are notoriously hard to pin down. A U.S. government survey reported almost two years ago that 1 in 4 American women said they were violently attacked by their husbands or boyfriends, and 1 in 5 said they were victims of rape or attempted rape, with about half those cases involving intimate partners.

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Screening Mammography Performs Poorly in Young Women

Screening mammography in women under age 40 results in high rates of callbacks, low rates of cancer detection, and high rates of false-positive results, according to the results of a study published early online in the Journal of the National Cancer Institute.[1]?

Screening mammography refers to mammograms that are conducted in the absence of breast symptoms. The goal of screening mammography is to detect breast cancer at an early stage when it is most easily treated.

The performance of screening mammography is known to vary by age. Younger women are less likely than older women to have breast cancer, and more likely to experience some of downsides of screening such as false-positive test results. This has made it challenging to identify the optimal age at which screening should begin. The U.S. Preventive Services Task Force recommends that routine screening of average-risk women begin at age 50. The American Cancer Society recommends that screening begin at age 40.

Although a great deal of attention has focused on the performance of screening mammography among women over the age of 40, there has been little information available about how mammography performs in very young women—those under the age of 40. To address this question, researchers from the University of North Carolina pooled data from six mammography registries in the United States. Their data included 117,738 women who underwent their first mammogram between the ages of 18 and 39. The researchers then followed the women for a year to determine the accuracy of the tests, evaluate the recall rate, and measure the cancer detection rates. The study included women who had screening mammograms as well as those who underwent diagnostic mammograms (due to a symptom such as a lump).

The researchers found that mammography performance improved in the presence of a breast lump – for diagnostic mammograms, the rate of detection was 14.3 cancers per 1,000 women tested, whereas for screening mammograms, the rate of detection was 1.6 cancers per 1,000 women. The researchers found that the screening mammograms had poor accuracy and high rates of recall for further testing.

The authors concluded that “in a theoretical population of 10,000 women aged 35-39 years, 1,266 women who are screened will receive further workup, with 16 cancers detected and 1,250 women receiving a false-positive result.” They found no cancers in women under the age of 25 and a poor performance of screening mammography in women ages 35-39.

It should be noted that the researchers did not have complete family history information or information about BRCA1 or BRCA2 mutation status, and were therefore not able to fully assess mammography performance in the subset of young women at high risk of breast cancer.

Women who have questions about when to begin breast cancer screening are advised to talk with their doctor.

Reference:

[1] Yankaskas BC, Haneuse S, Kapp JM, et al. Performance of first mammography examination in women younger than 40 years. Journal of the National Cancer Institute. Published early online: May 3, 2010.

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T-DM1 Benefits Women With Advanced HER2-Positive Breast Cancer

Among women with advanced, previously treated, HER2-positive breast cancer, trastuzumab emtansine (T-DM1)-an investigational drug that combines Herceptin(r)?

(trastuzumab) and a chemotherapy drug-resulted in better progression-free survival than standard treatment. The results of this Phase III clinical trial were presented at the 2012 Annual Meeting of the American Society of Clinical Oncology.?

Approximately 20-25% of breast cancers overexpress (make too much of) the HER2 protein. HER2-targeted therapies such as Herceptin have dramatically improved outcomes for women with HER2-positive breast cancer, but researchers continue to explore new approaches to treatment.?

T-DM1 links Herceptin with a chemotherapy drug (DM1). T-DM1 delivers Herceptin and DM1 directly to HER2-positive cells, and limits exposure of the rest of the body to the chemotherapy.?

To evaluate T-DM1 for the treatment of advanced, HER2-positive breast cancer, researchers conducted a Phase III clinical trial known as EMILIA. The study enrolled close to 1000 women with locally advanced or metastatic HER2-positive breast cancer that had progressed (worsened) in spite of previous chemotherapy and Herceptin. Study participants were treated with either T-DM1 or a standard treatment. The standard treatment consisted of Xeloda(r) (capecitabine) plus?

Tykerb(r) (lapatinib). ?

*???? Survival without cancer progression was 9.6 months among women in the?

T-DM1 group and 6.4 months among women in the Xeloda and Tykerb group. ?

*???? Two-year overall survival was 65.4% among women in the T-DM1 group and?

47.5% among women in the Xeloda and Tykerb group. The survival analysis is still considered preliminary and another analysis is planned for later in the study, and will provide more definitive information about the effect of T-DM1 on overall survival.?

*???? Compared with women treated with Xeloda and Tykerb, women treated with?

T-DM1 were less likely to experience side effects such as diarrhea, hand-foot syndrome, and vomiting. The most common serious side effects of T-DM1 were low platelet counts and changes in liver function tests. ?

These results suggest that T-DM1 may be safe and effective for the treatment of advanced, previously treated, HER2-positive breast cancer. ?

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Epidermal Growth Factor Receptor (EGFR) Levels Significantly Elevated in Women Who Developed Breast Cancer

Blood levels of epidermal growth factor receptor (EGFR) may be elevated in women up to 17 months prior to a diagnosis of breast cancer. These findings were recently presented at the American Association for Cancer Research 101st Annual Meeting.[1]?

In an attempt to improve survival by detecting breast cancer at an earlier stage, researchers are evaluating potential biomarkers of the disease. Levels of certain proteins in the blood, for example, may be higher in women with breast cancer than in women without breast cancer. If these markers reliably distinguish women with and without breast cancer, and if the markers can be identified early in cancer development (before the cancer would typically be diagnosed clinically), then they may contribute to the early detection of breast cancer.

In the current study, researchers first evaluated blood samples from 420 women with estrogen receptor-positive breast cancer and a set of matched controls (women without breast cancer). For the women with breast cancer, blood had been collected up to 17 months prior to cancer diagnosis. Biomarkers that appeared promising at this first stage (that appeared to distinguish women with and without breast cancer) were then further evaluated in a separate set of women with and without breast cancer.

EGFR levels were significantly elevated in women who developed breast cancer compared with controls. Women with the highest levels of EGFR had a 2.9-fold increased risk of developing breast cancer compared with women with the lowest EGFR levels. In women who used estrogen plus progestin hormone therapy, high EGFR levels were associated with a ninefold increased risk of developing breast cancer.

Although the results of this study did not indicate that EGFR levels were sufficient to be used as a sole predictor of breast cancer, the researchers were optimistic that “there may indeed be detectable changes of proteins in blood within two years of making a clinical breast cancer diagnosis.” This type of research continues to hold promise. ??

Reference:

[1] Pitteri SJ, Amon LM, Buson TB, et al. Elevated plasma levels of epidermal growth factor receptor prior to diagnosis of breast cancer in preclinical specimens from the Women’s Health Initiative Observational Study. Proceedings from the 101st Annual Meeting of the American Association for Cancer Research. April 17-21, 2010. Abstract 4815.

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Study Explores Risk of Invasive Breast Cancer in Women with DCIS

Among women with breast ductal carcinoma in situ (DCIS), evaluation of three molecular markers in a sample of DCIS tissue may provide information about the subsequent risk of invasive breast cancer. These results were published in the Journal of the National Cancer Institute.

DCIS refers to a condition in which abnormal cells are found within a breast duct, but have not spread outside of the duct to other tissues in the breast. It is most commonly detected by screening mammography. If not treated, some cases of DCIS may progress to invasive breast cancer.

The probability that DCIS will progress to invasive cancer is thought to vary widely among women, but thus far it hasn’t been possible to accurately predict risk. As a result, some DCIS patients are probably overtreated and some may be undertreated. Treatment for DCIS often involves lumpectomy plus radiation therapy or mastectomy. Women may also receive hormonal therapy.

An important goal of DCIS research has been to develop a better understanding of DCIS behavior and more individualized approaches to treatment. In the current study, researchers evaluated information from 1162 women diagnosed with DCIS between 1983 and 1994 and treated with lumpectomy alone.

Women with DCIS that was positive for three molecular markers—p16, COX-2, and Ki67—had a higher risk of subsequent invasive breast cancer. Risk was also higher when the DCIS had been detected by palpation of the breast (rather than by screening mammography). Among women with DCIS that was positive for all three markers or had been detected by palpation, the eight-year risk of invasive breast cancer was 20%. Approximately 28% of women fell into this high-risk group. In contrast, among women with DCIS that had been detected by screening mammography and was negative for all three markers, the eight-year risk of invasive breast cancer was 4%. Seventeen percent of women fell into this lowest-risk group.

Research in this area is still at an early stage, and the results of this study are not expected to change patient care in the near future. Nevertheless, this type of research offers hope for improved understanding of DCIS and more individualized DCIS treatment.

Reference: Kerlikowske K, Molinaro AM, Gauthier ML et al. Biomarker Expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. Journal of the National Cancer Institute. 2010;102:627-637.

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Outcomes in Older Women with Breast Cancer

Among postmenopausal women with hormone receptor-positive breast cancer, the likelihood of dying from breast cancer increases with age. These results were published in the Journal of the American Medical Association. ?

Of the more than 200,000 cases of breast cancer diagnosed each year in the United States, roughly 40 percent occur in women over the age of 65. Research that explores how breast cancer outcomes change as women age has the potential to improve care for this large group of women.?

To evaluate breast cancer outcomes by age, researchers analyzed information from a clinical trial known as TEAM (Tamoxifen, Exemestane, Adjuvant, Multinational). The study enrolled more than 9,700 postmenopausal women with non-metastatic, hormone receptor-positive breast cancer. All women were treated with surgery and hormonal therapy. Decisions about chemotherapy and/or radiation therapy were left to the treating physician.?

Women were followed for just over five years.?

Death from breast cancer occurred in 5.7 percent of women under the age of 65, 6.3 percent of women between the ages of 65 and 74, and 8.3 percent of women age 75 or older.?Older women continued to be more likely to die from breast cancer even after the researchers accounted for tumor characteristics and other factors known to affect outcomes.??

One of the possible explanations for the worse breast cancer outcomes among older women involves treatment. Studies have suggested that older women are less likely than younger women to received standard breast cancer treatments, possibly due to concern that about the ability of older women to tolerate these treatments. In the current study, for example, 48 percent of the oldest women had breast cancer that had spread to the lymph nodes, but only 5 percent received chemotherapy. Older women were also less likely than younger women to receive radiation therapy after a lumpectomy.?

Although older women in this study were more likely to die of breast cancer than younger women, it should be noted that most women—regardless of their age—did not die of breast cancer. It should also be noted that all of the women in this study were postmenopausal. This study did not address cancer outcomes in premenopausal women.?

Reference: van de Water W, Markopoulos C, van de Velde CJH et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA. 2012;307:590-597.?

Posted February 10, 2012

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Breast-Conserving Therapy Effective in Young Women with Breast Cancer

Two studies presented at the 2011 Breast Cancer Symposium provide evidence that breast-conserving therapy (lumpectomy plus radiation therapy) is as effective as mastectomy for young women with early-stage breast cancer. ?

Surgery for early-stage breast cancer may consist of mastectomy or lumpectomy. A?mastectomy involves removal of the entire breast, whereas a?lumpectomy?involves removal of the cancer and some surrounding tissue. A lumpectomy is usually followed by radiation therapy in order to reduce the risk of cancer recurrence in or near the breast. The combination of lumpectomy and radiation therapy is referred to as breast-conserving therapy. ?

Studies have indicated that mastectomy and breast-conserving therapy produce similar long-term survival among women with early-stage breast cancer. Some research has suggested, however, that young women may have a higher risk of breast cancer recurrence than older women after breast-conserving therapy. Concerns about recurrence risk may be contributing to the increasing use of mastectomy among young women.?

Two studies that will be presented at the 2011 Breast Cancer Symposium explore whether type of surgery affects outcomes among young women with breast cancer. The first study involved 628 women age 40 and younger who were treated for early-stage breast cancer at Massachusetts General Hospital.[1] ?

Risk of a local breast cancer recurrence (a recurrence in or near the breast) did not vary significantly by type of surgery. By five years, the risk of a local breast cancer recurrence was 4.6% among women treated with breast-conserving therapy and 8.5% among women treated with mastectomy. By ten years, the risk was 13.3% among women treated with breast-conserving therapy and 10.8% among women treated with mastectomy. ?

The second study collected information from a large national database about more than 14,000 breast cancer patients under the age of 40. [2] After accounting for patient and tumor characteristics, breast-conserving therapy and mastectomy produced similar overall survival. Ten-year overall survival was 83.5% among women treated with breast-conserving therapy and 83.6% among women treated with mastectomy.?

Together, these studies suggest that mastectomy and breast-conserving therapy produce similar outcomes among young women with early-stage breast cancer. Young women may wish to take this information into account when making decisions about breast cancer treatment.?

References: ??

[1] Buckley JM, Coopey S, Samphao S et al. Recurrence rates and long-term survival in women diagnosed with breast cancer at age 40 and younger. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 70.?

[2] Mahmood U, Morris CG, Neuner GA et al. Equivalent survival with breast-conservation therapy or mastectomy in the management of young women with early-stage breast cancer. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 85.?

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Oncotype DX DCIS Score Predicts Recurrence Risk for Women with DCIS

A DCIS Score generated by the Oncotype DX breast cancer test provides information about how likely it is that breast ductal carcinoma in situ (DCIS) will recur. This may help guide decisions about whether women with DCIS need radiation therapy after breast-conserving surgery. These results were presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.????

Ductal carcinoma in situ refers to a condition in which abnormal cells are found within a breast duct but have not spread outside of the duct to other tissues in the breast. It is most commonly detected by screening mammography. If not treated, some cases of DCIS may progress to invasive breast cancer.?

Treatment for DCIS may involve breast-conserving surgery (lumpectomy) or mastectomy. For DCIS patients who choose breast-conserving surgery, additional treatment with radiation therapy has been shown to reduce the risk of recurrence, but may not be necessary for all women. If the characteristics of the DCIS suggest that it is unlikely to recur, surgery alone (without radiation therapy) may be an option.??

The Oncotype DX breast cancer test was originally developed to provide information about recurrence risk and need for chemotherapy to certain groups of women with early-stage, invasive breast cancer. The test has been added to US medical guidelines for this purpose.????

To determine whether the test can also predict recurrence risk in women with DCIS, researchers developed a DCIS Score that can be generated by the test. The ability of the DCIS Score to predict recurrence risk was evaluated among 327 women with DCIS who had participated in an earlier clinical trial of DCIS treatment. The women had been treated with breast-conserving surgery but had not received radiation therapy.????

Three-quarters of the patients had a low risk of recurrence based on the DCIS Score. These patients may not need radiation therapy after breast-conserving surgery.?Among women with a low risk of recurrence based on the DCIS Score, the likelihood of any kind of local recurrence (a recurrence that was either DCIS or invasive breast cancer) was 12 percent. The likelihood of a recurrence that involved invasive breast cancer 5 percent.?Among women with a high risk of recurrence based on the DCIS Score, the likelihood of any kind of local recurrence was 27 percent. The likelihood of a recurrence that involved invasive breast cancer was 19 percent.?

These results suggest that the Oncotype DX DCIS Score provides information about the risk of recurrence among women with DCIS. This information may help guide decisions about whether radiation therapy is necessary.?

Reference: Solin LJ, Gray R, Baehner FL. A Quantitative Multigene RT-PCR Assay for Predicting Recurrence Risk after Surgical Excision Alone without Irradiation for Ductal Carcinoma In Situ (DCIS): A Prospective Validation Study of the DCIS Score from ECOG E5194. Presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium. December 6-10, 2011. Abstract S4-6.?

Posted December 13, 2011?

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Diagnosis of Early Breast Cancer Doesn’t Shorten Life Expectancy of Older Women

Among women age 67 or older, a diagnosis of ductal carcinoma in situ (DCIS) or Stage I breast cancer doesn’t appear to worsen survival; survival is similar to that of older women without breast cancer. Diagnosis of more advanced breast cancer, however, is linked with worse survival. These results were published in the Journal of Clinical Oncology.

Older women are a rapidly expanding segment of the U.S. population. The incidence of breast cancer increases with age, but it’s been uncertain how a diagnosis of breast cancer (particularly early-stage breast cancer) affects life expectancy among older women.

To explore the impact of a breast cancer diagnosis on the survival of older women, researchers conducted a study among more than 64,000 women who had been diagnosed with breast cancer at age 67 or older. Survival in these women was compared with survival in a group of similarly aged women without breast cancer. In the analysis, the researchers accounted for the other health problems, prior mammography use, and sociodemographic variables.??

Women who were diagnosed with DCIS or Stage I breast cancer and received standard treatment had similar survival to women without breast cancer. The most common cause of death among women with DCIS or Stage I breast cancer was cardiovascular disease. Women with Stage II or higher breast cancer had shorter survival than women without breast cancer. Risk of death was 50% higher among women with Stage II breast cancer, three-times higher among women with Stage III breast cancer, and close to 10-times higher among women with Stage IV breast cancer. The survival differences between women with advanced breast cancer and women without breast cancer decreased with age.

These results suggest that among older women, a diagnosis of DCIS or Stage I breast cancer does not shorten life expectancy.

Reference: Shonberg MA, Marcantonio ER, Ngo L, Li D, Silliman RA, McCarthy EP. Causes of death and relative survival of older women after a breast cancer diagnosis. Journal of Clinical Oncology. Early online publication March 14, 2011.

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Breast-Conserving Therapy May Outperform Mastectomy Alone for Women with Early-Stage Triple-Negative Breast Cancers

For women with early-stage triple-negative breast cancer, treatment with breast-conserving surgery plus radiation therapy may result in fewer cancer recurrences in or near the breast than mastectomy without radiation therapy. These results were published in the Journal of Clinical Oncology.???

Breast cancers that are estrogen receptor-negative, progesterone receptor-negative, and HER2-negative are called triple-negative breast cancers. Triple-negative breast cancers tend to be more aggressive than other breast cancers and have fewer treatment options.???

For women with small breast cancers that have not spread to the lymph nodes, treatment often includes breast-conserving surgery (lumpectomy) plus radiation therapy or mastectomy (removal of the entire breast) without radiation therapy. These two approaches are generally thought to produce similar outcomes, but it’s possible that for certain subtypes of breast cancer one approach may be more effective than the other.?????

To compare breast-conserving therapy (lumpectomy plus radiation therapy) to mastectomy among women with early-stage (T1-2N0) triple-negative breast cancers, researchers evaluated information from 468 patients. The group was fairly evenly split in terms of how many had been treated with breast-conserving therapy and how many had been treated with mastectomy without radiation therapy.???

Study participants were followed for a median of 7 years. One of the outcomes of interest was locoregional recurrence. This refers to a recurrence of the cancer in the breast, chest wall, or nearby lymph nodes.???

Five-year survival without a locoregional recurrence was 96% among women treated with breast-conserving surgery and 90% among women treated with mastectomy without radiation therapy. In other words, women treated with breast-conserving therapy had a lower risk of recurrence in the breast, chest wall, or lymph nodes than women treated with mastectomy without radiation therapy.?At the time of the analysis, overall survival was similar in the two groups.?

Although additional studies are needed, it’s possible that adding radiation therapy may improve outcomes among women who undergo mastectomy for early-stage, triple-negative breast cancer. In the current study, the risk of recurrence within or near the breast was lower among women treated with breast-conserving therapy (lumpectomy plus radiation therapy) than among women treated with mastectomy without radiation therapy.????

Reference: Abdulkarim BS, Cuartero J, Hanson J et al. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy. Journal of Clinical Oncology. Early online publication June 13, 2011.?

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Estrogen Alone May Reduce Breast Cancer Risk in Certain Women

Among women at low risk of breast cancer, postmenopausal hormone therapy with estrogen alone may reduce the risk of breast cancer. These results—which warrant additional research and should not be considered conclusive—came from further review of the Women’s Health Initiative clinical trial of estrogen alone and were presented at the 2010 San Antonio Breast Cancer Symposium (SABCS).

Hormone therapy with estrogen (with or without progestin) effectively manages many menopausal symptoms, but studies over the last several years have raised concerns about the health effects of postmenopausal hormone therapy. In the Women’s Health Initiative (WHI) clinical trial of estrogen plus progestin, hormone use decreased the risks of fracture and colorectal cancer, but increased the risks of heart disease, breast cancer, stroke, and blood clots.[1] More recent reports suggest that combined hormone therapy may also increase lung cancer mortality.[2]

Estrogen alone did not appear to increase the risk of breast or lung cancer but did increase risk of stroke.[3] Because estrogen alone increases the risk of endometrial (uterine) cancer, it is generally reserved for women who have had a hysterectomy.

In the results presented at SABCS, researchers evaluated subgroups of women enrolled in the WHI trial of estrogen alone.[4]

In the subgroups of women at low risk of breast cancer (women without a strong family history of breast cancer and women without a personal history of breast disease), use of estrogen alone was linked with a reduced risk of breast cancer. Among younger women (those under the age of 60), there was a suggestion that the benefits of estrogen alone may outweigh the risks for many women.

These results were discussed at a press conference moderated by Judy Garber, MD, MPH. Dr. Garber described the results as “provocative and preliminary.” Further research is required before firm conclusions can be drawn about the relationship between estrogen alone and risk of breast cancer.

?References:

[1] Rossouw JE, Anderson GL, Prentice RL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002; 288:321-33

[2] Chlebowski RT, Schwartz AG, Wakelee H et al. Oestrogen plus progestin and lung cancer in postmenopausal women (Women’s Health Initiative trial): a post-hoc analysis of a randomised controlled trial. Lancet. 2009;374:1243-1251.

[3] Anderson GL, Limacher M, Assaf AR et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA. 2004; 291:1701-1712.

[4] Ragaz J, Bajdik C, Wilson KS et al. Dual estrogen effects on breast cancer: endogenous estrogen stimulates while exogenous estrogen protects. Presented at the 33rd annual San Antonio Breast Cancer Symposium, December 8-12, 2010.

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Improved Breast Cancer Outcomes Among Women Using Beta-Blockers

Women who take beta-blockers for high blood pressure and are diagnosed with breast cancer may have better outcomes than women who do not take beta-blockers, according to findings from two recent studies. Results from both studies were recently published in the Journal of Clinical Oncology.?

Beta-blockers are a class of drugs used to treat heart conditions and high blood pressure. Studies have indicated that beta-blockers may help control growth and spread of breast cancer, possibly due to their ability to control stress hormones. Two current studies have further investigated this association.

One study, conducted by researchers from M.D. Anderson Cancer Center, reviewed 1,413 patients with breast cancer who had been treated with neoadjuvant chemotherapy (chemotherapy prior to surgery) between 1995 and 2007. Outcomes including complete response, relapse-free survival, and overall survival of those taking beta-blockers were compared with outcomes of those not taking beta-blockers.

Of the participants, 102 used beta-blockers. Rates of complete response among those using beta-blockers were not significantly different from complete response rates among non beta-blocker users. Beta-blockers use, however, was associated with significantly better relapse-free survival when the researchers accounted for age, race, disease stage and grade, receptor status, lymph node involvement, and other factors affecting disease outcome. Overall survival was not significantly improved among beta-blocker users. Patients diagnosed with triple-negative breast cancer who took beta-blockers had improved relapse-free survival but, like other patients, not significantly improved overall survival.

Another study of beta-blockers and breast cancer survival was conducted by researchers from Ireland.? Women diagnosed with Stage I to IV breast cancer between 2001 and 2006 were identified in a national cancer registry. Women who took beta-blockers in the year before they were diagnosed were matched and compared with women not taking beta-blockers. Two types of beta-blockers with different mechanisms were evaluated, propranolol and atenolol. The researchers assessed risk of tumor progression and spread and time to death from cancer.

Patients who used the beta-blocker propranolol had a significantly lower rate of death from breast cancer than their counterparts who didn’t used beta-blockers (9% versus 22%, respectively). Atenolol, however, was not associated with any improved outcomes.

These two studies suggest that beta-blockers could possibly improve outcomes among women with breast cancer, including those with difficult-to-treat triple-negative disease. However, it is far too early and beta blocker use should not be administered to women with breast cancer at this time until further research is done.

References:

Melhem-Bertrandt A, Chavez-MacGregor M, Lei X, et al. Beta-blocker use is associated with improved relapse-free survival in patients with triple-negative breast cancer. Journal of Clinical Oncology [early online publication]. May 31, 2011.
Barron TI, Connolly RM, Sharp L, et al. Beta blockers and breast cancer mortality: a population-based study. Journal of Clinical Oncology [early online publication]. May 31, 2011.

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Many Women Do Not Get Regular Mammograms

Despite professional recommendations and public support in favor of regular mammography, only about half of US women get an annual mammogram, even if they have insurance to cover the test. These results were presented at the 2010 San Antonio Breast Cancer Symposium.

The age at which mammographic screening should begin has recently been a subject of debate. The American Cancer Society continues to recommend that women at average risk of breast cancer begin mammographic screening at the age of 40. The US Preventive Services Task Force (USPSTF), however, recently recommended against routine mammographic screening of women in their 40s; instead, they recommend that screening begin at 50 and be performed every two years rather than annually.

Due to strong public reaction against the updated USPSTF recommendations, researchers became curious about how many women were actually getting regular mammograms. To determine mammography rates, researchers reviewed information on use of mammography from a database of more than 12 million people. Data used included mammography screening from January 2006 through December 2009. All participants had employer-provided insurance or were on Medicare.

In any given year, only 50% of women aged 40 to 85 years had a mammogram.Of women aged 40 to 85, only 60% had two or more mammograms over four years.Average annual mammography rates were as follows: 47% for women aged 40 to 49 years, 54% for women aged 50 to 64, and 45% for women aged 65 or older.

These findings indicate that many women do not receive regular mammograms, even if they are insured. Though this study did not investigate reasons why women may not get mammograms, it has been thought that discomfort from the test and lack of available screening centers may be among the reasons that some women do not undergo this screening.

Reference: Subar M, Lust SA, Lin W. Compliance with mammographic screening guidelines from an administrative claims database. Presented at the 33rd annual San Antonio Breast Cancer Symposium, December 8-12, 2010. Abstract S4-7.

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