women

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ALIGN="bottom" WIDTH="195" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="id107_m.htm#top" TARGET="TRLX_Middle" TITLE="women"><U><B>GO TO TOP OF PAGE</B></U></A></div> </td> <td valign="top" BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="115f0f03.jpg"> <div> <I>women</I></div> <div> <IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="top"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>BREAST</div> <div> <A HREF="#breast_self_exam" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">BREAST SELF EXAM</U></A></div> <div> <A HREF="#screening__prevention_" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Breast Cancer Screening / Prevention </U></A></div> <div> <A HREF="#normal_breast_anatomy_and_non_cancerous" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Normal Breast Anatomy</U></A></div> <div> <A HREF="#the_best_time_to_perform_breast" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The Best Time to Perform Breast Self-Exam</U></A></div> <div> <A HREF="#breast_changes_and_warning_signs_to" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Breast Changes and Warning Signs To Watch for During Breast Self-Exam:</U></A></div> <div> <A HREF="#breast_examination_during_and_after" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Breast Examination During and After Pregnancy Is Critical</U></A></div> <div> <A HREF="#breast_self_exam_pads" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Breast Self-Exam Pads</U></A></div> <div> <A HREF="#olive_oil_fights_breast_cancer" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Olive oil fights breast cancer</U></A></div> <div> <A HREF="#new_test_may_better_predict_breast" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">New test may better predict breast cancer return</U></A></div> <div> <A HREF="http://www.us.femara.com/info/page/why" TARGET="_top" TITLE="http://www.us.femara.com/info/page/why"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">femara</U></A></div> <div> <A HREF="#switch_to_exemestane_better_than" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Switch to Exemestane Better than Long-term Tamoxifen in Breast Cancer Study</U></A><A HREF="#switch_to_exemestane_better_than" TITLE="women"><U> </U></A></div> <div> <A HREF="#more_evidence_aspirin_protects_against" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Aspirin Protects Against Breast Cancer</U></A></div> <div> <A HREF="#cox_2_inhibition_in_breast_cancer" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">COX-2 Inhibition in Breast Cancer</U></A></div> <div> <A HREF="#broccoli_compound_arrests_breast_cancer" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Broccoli Compound Arrests Breast Cancer Cell Growth</U></A></div> <div> <A HREF="id104_genes_boost_fish_oils__effect_against.htm" TARGET="_top" TITLE="FISH OIL"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Genes Boost Fish Oils' Effect Against Breast Cancer</U></A></div> <div> <A HREF="http://www.cancer.gov/cancertopics/types/breast" TARGET="_top" TITLE="http://www.cancer.gov/cancertopics/types"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">National Cancer institute on Breast Cancer </U></A></div> <div> <A HREF="#atac__arimidex" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial Published online December 8, 2004. IN LANCET</U></A></div> <div> <A HREF="http://www.ama-assn.org/special/womh/library/library.htm" TARGET="_top" TITLE="http://www.ama-assn.org/special/womh/lib"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">WOMENS HEALTH ARTICLES</U></A></div> <div> <A HREF="#risks_of_a_combination_hrt_regimen" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Risks of a Combination HRT Regimen Outweigh Benefits</U></A></div> <div> <A HREF="http://health.excite.com/preg_track" TARGET="_top" TITLE="http://health.excite.com/preg_track"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Pregnancy Tracker</U></A></div> <div> <A HREF="id84.htm" TARGET="_top" TITLE="osteoporosis"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">osteoporosis page</U></A></div> <div> <A HREF="#accounting_for_racial_breast_cancer" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Accounting for Racial Breast Cancer Differences</U></A></div> <div> <A HREF="#switch_to_aromatase_inhibitor_better" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Switch to Aromatase Inhibitor Better than Continuing Tamoxifen</U></A></div> <div> <A HREF="#herceptin_is_great_for_her2_positive" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Herceptin is great for Her2 positive breast cancer</U></A></div> <div> <A HREF="id103_grapefruit_may_cause_breast_cancer.htm" TARGET="_top" TITLE="CANCER"><U><IMG BORDER="0" SRC="Symb075c00b700dc99006600.png" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Grapefruit may cause breast cancer</U></A></div> <div> <A HREF="#fda_approves_bristol_myers_breast" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">new drug for women with breast cancer that does not respond to other therapies </U></A></div> <div> <A HREF="#high_fiber_intake_linked_to_reduced" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">High Fiber Intake Linked to Reduced Risk of Breast Cancer</U></A></div> <div> <A HREF="#cleveland_clinic_researchers_develop" TITLE="women"><U><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cleveland Clinic Researchers Develop Prototype Vaccine To Prevent Breast Cancer</U></A></div> <bR> <bR> <div> <IMG SRC="1dd0a0a0.png" border=0 width="10" height="10" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><A HREF="id165_red_and_processed_meat_consumption_and.htm" TARGET="_top" TITLE="NUTRITION IN THE NEWS"><U>processed meats  but not red meat linked to heart disease and</U></A></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="cleveland_clinic_researchers_develop"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Cleveland Clinic Researchers Develop Prototype Vaccine To Prevent Breast Cancer</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">5/31/2010</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A first-of-its-kind vaccine to prevent breast cancer has shown overwhelmingly favorable results in animal models, according to a study by researchers at Cleveland Clinic’s Lerner Research Institute.</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The researchers found that a single vaccination with the antigen ?-lactalbumin prevents breast cancer tumors from forming in mice, while also inhibiting the growth of already existing tumors. Enrollment in human trials could begin next year. If successful, it would be the first vaccine to prevent breast cancer.</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The research is published online at http://www.nature.com/naturemedicine and will be published in the June 10 issue of Nature Medicine.</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">“We believe that this vaccine will someday be used to prevent breast cancer in adult women in the same way that vaccines have prevented many childhood diseases,” said Vincent Tuohy, Ph.D., the study’s principal investigator and an immunologist in Cleveland Clinic’s Lerner Research Institute.“If it works in humans the way it works in mice, this will be monumental. We could eliminate breast cancer.”</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In the study, genetically cancer-prone mice were vaccinated – half with a vaccine containing ?-lactalbumin and half with a vaccine that did not contain the antigen. None of the mice vaccinated with ?-lactalbumin developed breast cancer, while all of the other mice did.</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The U.S. Food and Drug Administration has approved two cancer-prevention vaccines, one against cervical cancer and one against liver cancer. However, these vaccines target viruses – the human papillomavirus (HPV) and the Hepatitis B virus (HBV) – not cancer formation.</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In terms of developing a preventive vaccine, cancer presents a quandary not posed by viruses. While viruses are recognized as foreign invaders by the immune system, cancer is not. Rather, cancer is an over-development of the body’s own cells. Trying to vaccinate against this cell over-growth would effectively be vaccinating against the recipient’s own body, destroying healthy tissue.</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The key, Dr. Tuohy said, is to find a target within the tumor that is not typically found in a healthy person. In the case of breast cancer, Dr. Tuohy and his research team targeted ?-lactalbumin – a protein that is found in the majority of breast cancers, but is not found in healthy women, except during lactation. Therefore, the vaccine can rev up a woman’s immune system to target ?-lactalbumin – thus stopping tumor formation – without damaging healthy breast tissue. The strategy would be to vaccinate women over 40 – when breast cancer risk begins to increase and pregnancy becomes less likely. (If a woman would become pregnant after being vaccinated, she would experience breast soreness and would likely have to choose not to breast feed.) For younger women with a heightened risk of breast cancer, the vaccine may be an option to consider instead of prophylactic mastectomy.</B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">“Most attempts at cancer vaccines have targeted viruses, or cancers that have already developed,” said Joseph Crowe, M.D., Director of the Breast Center at Cleveland Clinic. “Dr. Tuohy is not a breast cancer researcher, he’s an immunologist, so his approach is completely different – attacking the tumor before it can develop. It’s a simple concept, yet one that has not been explored until now.”</B></div> <bR> <div> <B>Dr. Tuohy believes that the findings of this study go beyond breast cancer, providing insight into the development of vaccines to prevent other types of cancer. The results show that the antigen used in a cancer vaccine must meet several criteria: it must be over-expressed in the majority of targeted tumors; and it must not be found in normal tissue, except under specific, avoidable conditions (such as lactation).</B></div> <bR> <bR> <bR> <div> <B> <A NAME="high_fiber_intake_linked_to_reduced"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>High Fiber Intake Linked to Reduced Risk of Breast Cancer</B></div> <div> <U>Am J Clin Nutr.</U><FONT SIZE="3" COLOR="#660099" FACE="Arial" > 2009 Sep;90(3):664-71. Epub 2009 Jul 22. </FONT></div> <div> <B>Dietary fiber intake and risk of breast cancer in postmenopausal women: the National Institutes of Health-AARP Diet and Health Study.</B></div> <div> <B><U>Park Y</U></B><FONT SIZE="3" COLOR="#660099" FACE="Arial" >, </FONT><B><U>Brinton LA</U></B><FONT SIZE="3" COLOR="#660099" FACE="Arial" >, </FONT><B><U>Subar AF</U></B><FONT SIZE="3" COLOR="#660099" FACE="Arial" >, </FONT><B><U>Hollenbeck A</U></B><FONT SIZE="3" COLOR="#660099" FACE="Arial" >, </FONT><B><U>Schatzkin A</U></B><FONT SIZE="3" COLOR="#660099" FACE="Arial" >.</FONT></div> <bR> <div> Divisions of Cancer Epidemiology and Genetics and Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. parkyik@mail.nih.gov</div> <bR> <div> BACKGROUND: Although dietary fiber has been hypothesized to lower risk of breast cancer by modulating estrogen metabolism, the association between dietary fiber intake and risk of breast cancer by hormone receptor status is unclear. OBJECTIVE: The objective was to examine the relation of dietary fiber intake to breast cancer by hormone receptor status and histologic type among postmenopausal women in the National Institutes of Health-AARP Diet and Health Study (n = 185,598; mean age: 62 y). DESIGN: Dietary intakes were assessed with a food-frequency questionnaire. Incident breast cancer cases were identified through linkage with state cancer registries. Cox proportional hazard models were used to estimate relative risks (RRs) and 2-sided 95% CIs. RESULTS: During an average of 7 y of follow-up, 5461 breast cancer cases were identified, of which 3341 cases had estrogen receptor (ER) and progesterone receptor (PR) status. Dietary fiber intake was inversely associated with breast cancer risk [RR for the highest quintile (Q5) compared with the lowest quintile (Q1): 0.87; 95% CI: 0.77, 0.98; P for trend: 0.02]. The inverse association appeared to be stronger for ER(-)/PR(-) tumors (RR(Q5vsQ1): 0.56; 95% CI: 0.35, 0.90; P for trend: 0.008; 366 cases) than for ER(+)/PR(+) tumors (RR(Q5vsQ1): 0.95; 95% CI: 0.76, 1.20; P for trend: 0.47; 1641 cases). The RR(Q5vsQ1) of lobular tumors was 0.66 (95% CI: 0.44, 0.97; P for trend: 0.04), and the RR(Q5vsQ1) of ductal tumors was 0.90 (95% CI: 0.77, 1.04; P for trend: 0.10). Fiber from grains, fruit, vegetables, and beans was not related to breast cancer. CONCLUSION: Our findings suggest that dietary fiber can play a role in preventing breast cancer through nonestrogen pathways among postmenopausal women.</div> <bR> <div> Publication Types: </div> <div> <U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Research Support, N.I.H., Intramural</U></div> <bR> <div> PMID: 19625685 [PubMed - indexed for MEDLINE] </div> <div> PMCID: PMC2728649 [Available on 2010/09/01]</div> <bR> <bR> <bR> <div> <B> <A NAME="fda_approves_bristol_myers_breast"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>FDA approves Bristol-Myers breast cancer drug </B></div> <div> October 16, 2007 04:34:02 PM PST </div> <div> A new chemotherapy drug called Ixempra made by Bristol-Myers Squibb Co for women with advanced breast cancer that does not respond to other therapies has won U.S. approval to be sold and is expected to be available in days. </div> <div> Known generically as ixabepilone, the drug could generate annual sales of $500 million by 2012, according to industry analysts. </div> <div> The U.S. Food and Drug Administration said on Tuesday it approved Ixempra as a stand-alone treatment for patients with advanced tumors that do not respond to Roche Holding AG's Xeloda or drugs known as anthracyclines or taxanes. </div> <div> It also was cleared for use with Xeloda certain advanced breast cancer patients, the FDA said and Bristol-Myers said. </div> <div> &quot;We now have an important new option for patients with metastatic breast cancer who have rapidly progressed through currently approved chemotherapies,&quot; Dr. Linda Vahdat, a cancer expert at New York-Presbyterian Hospital/Weill Cornell Medical Center, said in a Bristol-Myers statement. </div> <div> For most patients the total cost of a full course of Ixempra is expected to run from $18,440 to $23,050, Bristol-Myers spokesman Tony Plohoros said. </div> <div> An estimated 160,000 women, and a relatively small number of men, in the United States are diagnosed with breast cancer each year. About 40,000 die of the disease despite treatment with leading current drugs such as Bristol's older Taxol, Sanofi-Aventis' Taxotere and Xeloda. </div> <div> Ixempra, a chemotherapy drug designed to kill cancer cells, is part of a new class called epothilones. </div> <div> Among patients who took Ixempra with Xeloda in clinical trials, tumors either shrank or did not grow for an average of 5.8 months. That was compared to 4.2 months seen for patients taking only Xeloda. </div> <div> Two ongoing trials are expected to determine by late 2008 whether Ixempra actually extends survival. </div> <div> Potential side effects from Ixempra include tingling or numbness in the hands and feet, bone-marrow suppression, constipation, nausea, vomiting, muscle pain, joint pain, fatigue and weakness, FDA spokesman Christopher DiFrancesco said. </div> <div> The combination of Ixempra and Xeloda should not be given to patients with moderate to severe liver failure because of an increased risk of toxicity and death, DiFrancesco said. </div> <div> (Additional reporting by Bill Berkrot in New York)</div> <bR> <bR> <div> <B><U> <A NAME="herceptin_is_great_for_her2_positive"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Herceptin is great for Her2 positive breast cancer</U></B></div> <bR> <bR> <bR> <div> In May 2005, oncologists attending the annual meeting of the American Society of Clinical Oncology heard presentations about the breast cancer drug Herceptin (trastuzumab) that many considered a treatment breakthrough. Researchers had found that using Herceptin early in the course of breast cancer could cut recurrences in half and improve survival for women with a particularly aggressive form of the disease.</div> <bR> <div> Now those studies have been published, giving doctors and patients more details about the advantages and side effects of this new treatment strategy. They appear in this week's issue of the New England Journal of Medicine and are again being hailed by experts.</div> <bR> <div> "Clearly, the results reported in this issue of the journal are revolutionary," writes Gabriel Hortobagyi, MD, in an editorial discussing the findings. Hortobagyi is professor and chair of Breast Medical Oncology at the University of Texas M.D. Anderson Cancer Center in Houston and a noted expert in the field of breast cancer care. He was not involved in the studies.</div> <bR> <div> The published reports justify the excitement generated by the presentations earlier this year, according to Len Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society.</div> <bR> <div> "There's always that nagging caution that maybe the results were premature, or that perhaps the data wasn't accurately analyzed, or that the study was not as well done as it seemed at the time," he said. "Experience has taught us that it is usually best to wait until the study is published in a peer-reviewed journal before accepting it as truly legitimate."</div> <bR> <div> The newly published studies do not disappoint. "The editorial says the results are 'stunning' and I certainly agree," he said.</div> <div> Thousands of Women Could Benefit</div> <bR> <div> Herceptin is a monoclonal antibody, a targeted drug that only works in breast cancers that have too much of a protein called HER2/neu. About 15%-25% of breast cancers are HER2-positive. These cancers tend to grow quickly and do not respond as well to certain types of chemotherapy or to tamoxifen.</div> <div>             MORE RESOURCES:</div> <bR> <div> Breast Cancer Awareness Month</div> <div> Breast Cancer Screening and Early Detection</div> <div> What Research Is Currently Being Done on Breast Cancer?</div> <div> ACS Support Programs</div> <bR> <div> Until now, Herceptin has been used only in women whose breast cancer has returned after initial treatment or spread beyond the breast. These new reports, however, promise to change the standard of care for women with early-stage breast cancer that is HER2-positive.</div> <bR> <div> "Our care of patients with HER2-positive breast cancer must change today," Hortobagyi writes.</div> <div> Herceptin Given After Adjuvant Chemotherapy</div> <bR> <div> The first report in the journal presents the results of the HERA trial, an international study that compared women who took Herceptin after adjuvant chemotherapy to women who had no further treatment after chemotherapy. All of the women had cancers that overexpressed the HER2/neu protein. The women had all received standard treatment with surgery and tamoxifen (if they had hormone-responsive tumors). Researchers excluded women whose cancers had already spread to the skin, chest wall, distant lymph nodes, or other parts of the body, as well as women with heart problems (including congestive heart failure, angina, unstable heart rhythms, and poorly controlled high blood pressure).</div> <bR> <div> The researchers randomly assigned 1,694 women to take Herceptin for 1 year after finishing their chemotherapy. They were taken off the drug if they developed serious heart problems or other severe side effects. Another 1,693 women were assigned to get no further treatment after chemotherapy. (A third group of 1,694 women was assigned to 2 years of Herceptin after chemotherapy, but results are not yet complete for these subjects.)</div> <bR> <div> After 1 year of treatment, Herceptin cut the risk of breast cancer returning almost in half. Just 127 women (7.5%) in the Herceptin group had a relapse, developed a second cancer, or died, compared to 220 women (13%) in the chemotherapy-only group. The researchers calculated that Herceptin improved disease-free survival by 8.4% after 2 years -- a very large amount for a chemotherapy trial, especially after such a short period of time. The type of chemotherapy drug given (various ones were allowed) did not appear to make a difference in outcome.</div> <bR> <div> "This is probably the biggest evidence of a treatment effect I've ever seen in oncology. It's quite remarkable," said Richard Gelber, PhD, of the Dana-Farber Cancer Institute in Boston. Gelber led the statistical analysis on the study.</div> <bR> <div> The researchers did not find a difference in overall survival between the groups of women, but they say one could become evident as the trial continues. The women will be followed through 2008.</div> <bR> <div> There were more side effects in the women who got Herceptin than the women who received no further treatment: 132 women (7.9%) in the Herceptin group had a serious side effect compared to just 75 (4.4%) in the other group. Women taking Herceptin were more likely to develop congestive heart failure and other heart problems -- known side effects of the drug. Still, just 0.5% of women on Herceptin developed severe heart problems. The researchers acknowledge, though, that longer follow-up may show that more heart problems develop down the line.</div> <div> Herceptin Given Along With Adjuvant Chemotherapy</div> <bR> <div> The second report in the journal describes the combined results of 2 studies (National Surgical Adjuvant Breast and Bowel Project trial B-31 and North Central Cancer Treatment Group trial N9831), which compared women who got Herceptin at the same time as chemotherapy to women who took only chemotherapy. As in the HERA trial, the women in these studies had HER2/neu-positive cancers. They had already received standard treatment with surgery and radiation (if necessary) and with tamoxifen or an aromatase inhibitor (if their tumors were hormone-receptor positive). Women with metastatic cancer or heart problems were excluded. The NEJM report includes results from 2,043 women enrolled in the B-31 trial and 1,633 women enrolled in the N9831 trial.</div> <bR> <div> All the women were given chemotherapy with doxorubicin and cyclophosphamide, followed by paclitaxel. Some of the women in each study were randomly assigned to take Herceptin along with the paclitaxel; they continued taking Herceptin for 1 year.</div> <div>             MORE HERCEPTIN STORIES:</div> <bR> <div> Early Herceptin Use a Breast Cancer Breakthrough</div> <div> Herceptin Shows Benefits in Early Stage Breast Cancer</div> <bR> <div> As in the HERA trial, Herceptin cut the risk of recurrences almost in half. After about 2 years of follow-up, 133 women on Herceptin had had a relapse, second cancer, or had died, compared to 261 women in the group that got only chemotherapy. After about 3 years, 87% of Herceptin patients were still alive and cancer-free, compared to 75% of women who got only chemotherapy. At 4 years, more than 85% of the women on Herceptin were still alive and cancer-free, compared to 67% of women in the chemotherapy-only group. The difference was so significant that the trials were stopped early.</div> <bR> <div> Unlike the HERA trial, researchers conducting these 2 studies did see a significant difference in overall survival between women who took Herceptin and those who did not. More than 91% of patients on Herceptin survived 4 years, compared to about 87% of patients on chemotherapy alone. Overall, 92 women in the chemotherapy-only group died, and 62 women who took Herceptin died.</div> <bR> <div> Heart problems, especially congestive heart failure, were also a problem for women who took Herceptin in these studies. In the B-31 trial, just 4 women (0.8%) who got chemotherapy alone developed congestive heart failure after 3 years, while 31 women (4.1%) in the Herceptin group developed this side effect. In N9831, none of the women on chemotherapy alone developed heart failure, but 20 Herceptin patients (2.9%) did.</div> <div> Questions Remain Over Side Effects, Scheduling</div> <bR> <div> More research must be done to best determine how to deal with the heart problems that Herceptin can cause, Hortobagyi said. Doctors need to learn how serious these problems are, if they can be reversed, and how long they must be treated.</div> <bR> <div> Researchers also need to find out if it's better to give Herceptin at the same time as chemotherapy, or if it should be taken afterward. From the new reports, it appears that giving Herceptin after chemotherapy may be less damaging to the heart, Hortobagyi writes, but it's not clear whether one of these schedules is more effective at controlling cancer than the other.</div> <bR> <div> Another issue, raised in a second editorial, is how to deal with resistance to Herceptin. Doctors have seen drug resistance develop in some patients, but they don't yet understand how it happens -- or how to stop it.</div> <bR> <div> Citations: "Trastuzumab after Adjuvant Chemotherapy in HER2-Positive Breast Cancer." Published in the Oct. 20, 2005, New England Journal of Medicine (Vol. 353, No. 16: 1659-1672). First author: Martine J. Piccart-Gebhart, MD, PhD, Jules Bordet Institute, Belgium.</div> <bR> <div> "Trastuzumab plus Adjuvant Chemotherapy for Operable HER2-Positive Breast Cancer." Published in the Oct. 20, 2005, New England Journal of Medicine (Vol. 353, No. 16: 1673-1684). First author: Edward H. Romond, MD, University of Kentucky, Lexington.</div> <bR> <div> "Trastuzumab in the Treatment of Breast Cancer." Published in the Oct. 20, 2005, New England Journal of Medicine (Vol. 353, No. 16: 1734-1736). Author: Gabriel N. Hortobagyi, MD, University of Texas M.D. Anderson Cancer Center.</div> <bR> <div> "The Distinctive Nature of HER2-Positive Breast Cancers." Published in the Oct. 20, 2005, New England Journal of Medicine (Vol. 353, No. 16: 1652-1654). Author: Harold J. Burstein, MD, PhD, Dana-Farber Cancer Institute. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="627" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="259"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="259" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="361"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="361" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div>  <A NAME="switch_to_aromatase_inhibitor_better"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Switch to Aromatase Inhibitor Better than Continuing Tamoxifen</div> <bR> <div> August 9, 2005 04:19:51 PM PST</div> <bR> <div> Breast cancer patients who switch to the aromatase inhibitor anastrozole (sold as Arimidex) after 2 years on tamoxifen do better than women who continue taking the full 5-year course of tamoxifen, results of a new analysis indicate. Writing in the Lancet, researchers from Austria and Germany report the combined findings of 2 recently completed studies.</div> <bR> <div> The studies involved more than 3,000 postmenopausal women who received standard treatment for early-stage breast cancer (lumpectomy plus radiation or mastectomy) followed by tamoxifen. After 2 years on the drug, 1,608 women were randomly assigned to continue tamoxifen and 1,618 were assigned to switch to anastrozole.</div> <bR> <div> Aromatase inhibitors and tamoxifen are types of hormone therapy that affect estrogen, which can cause breast cancer to grow. They only work in women whose tumors have hormone receptors; about 2/3 of breast cancer patients have these types of tumors. There are currently 3 aromatase inhibitors on the market: anastrozole, letrozole, and exemestane.</div> <div> Different Side Effects</div> <bR> <div> After about 28 months, women who took anastrozole had a lower risk of their cancer spreading or of a new cancer developing in the opposite breast compared to women who continued with tamoxifen. Nearly 96% of women on anastrozole were still cancer-free at that time, compared to almost 93% of women on tamoxifen.</div> <bR> <div> There was no significant difference in overall survival between the groups after 3 years. As expected, however, the drugs did have different side effects. Women on anastrozole experienced significantly more bone fractures and significantly fewer blood clots than women on tamoxifen. Women on anastrozole also reported more bone pain and nausea.</div> <bR> <div> Lead author Raimund Jakesz, MD, of the Vienna Medical University, says the findings support those of earlier trials -- particularly one called ATAC -- that showed aromatase inhibitors are better than tamoxifen at preventing breast cancer recurrences. That means women who have taken 2-3 years of tamoxifen should consider switching to an aromatase inhibitor for the remaining years of their treatment, he added.</div> <bR> <div> That group of patients is likely getting smaller, said Christy Russell, MD, of the University of Southern California's Norris Comprehensive Cancer Center. Russell was not involved in the new research. She serves as chair of the American Cancer Society's Breast Cancer Advisory Group.</div> <bR> <div> "I'd say since the ATAC data came out -- the head-to-head comparison of tamoxifen and anastrozole -- that any newly diagnosed postmenopausal woman with breast cancer has for the most part been started on anastrozole as her initial therapy," she said.</div> <div> Premenopausal Women May Still Start with Tamoxifen</div> <bR> <div> But are there some women who should get tamoxifen first, despite the fact that aromatase inhibitors seem to work better?</div> <bR> <div> "There's no reported trial that has answered that question," said Russell.</div> <bR> <div> But women who get breast cancer before they reach menopause may be candidates for taking tamoxifen first, Russell said. That's because aromatase inhibitors don't work in premenopausal women. Many doctors would start such a woman on tamoxifen, and only switch her to an aromatase inhibitor if she goes into permanent menopause -- either naturally or because of her breast cancer treatment.</div> <bR> <div> The question of side effects also causes some doctors to start women on tamoxifen rather than an aromatase inhibitor, Russell said.</div> <bR> <div> "The concerns being raised by physicians are for women with severe osteoporosis or who have already had fractures because we know there are more fractures on aromatase inhibitors," she explained.</div> <bR> <div> Russell, however, thinks the benefits of aromatase inhibitors are greater than the risks to bone health, even in women at high risk for bone problems, such as the elderly. These women can be given other drugs like bisphosphonates to build bone strength while they're on an aromatase inhibitor, she said.</div> <bR> <div> Moreover, Russell noted, elderly women are also at higher risk for blood clots and strokes -- and tamoxifen can increase this risk even more.</div> <bR> <div> The ongoing Breast International Group 1-98 (BIG1-98) trial may provide some clarification about whether some women should stick with tamoxifen, Russell said. That study includes both a head-to-head comparison of the aromatase inhibitor letrozole and tamoxifen, as well as a comparison of women who take one of the drugs then switch to the other. Results are expected in a couple of years.</div> <bR> <div> Citation: "Switching of postmenopausal women with endocrine-responsive early breast cancer to anastrozole after 2 years' adjuvant tamoxifen: combined results of the ABCSG trial 8 and ARNO 95 trial." Published in the Lancet (Vol. 366, No. 9484: 455-462). First author: Raimund Jakesz, MD, of Vienna Medical University, Austria.</div> <div>     </div> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="627" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="617"><div>  <A NAME="accounting_for_racial_breast_cancer"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Accounting for Racial Breast Cancer Differences</div> <bR> <div> Risk Factors and Biology Play a Role </div> </tD> <tD VALIGN=CENTER ROWSPAN=2 WIDTH="3"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="56" ALIGN="bottom" WIDTH="3" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="617"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="617" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <div> April 18, 2005 12:00:00 AM PST</div> <div> Researchers have long known that <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>breast cancer</U></FONT> affects African-American women differently than white women. Black women are less likely to get the disease, but more likely to die from it if they do. Black women also get the disease at younger ages than white women do.</div> <div> But what accounts for these discrepancies? Social factors like poverty and access to care are certainly a large part of the problem. But a growing body of research suggests biological factors may also be at work.</div> <div> A recent study led by Rowan Chlebowski, MD, PhD, of Harbor-UCLA Medical Center, found that breast cancer differences between white and black women persisted even after accounting for numerous risk factors that could influence the development of the disease, like age, body weight, family history of breast cancer, and whether the women got mammograms. The findings were published in the <I>Journal of the National Cancer Institute</I> (Vol. 97, No. 6:439-448).</div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="302" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 76 WIDTH="298"><div> The researchers looked at the records of more than 156,000 postmenopausal women in the Women's Health Initiative, a large study of lifestyle factors and disease. </div> </tD> </tR> </TABLE></div> <div> They compared breast cancer occurrence rates and deaths among American women of various ethnic groups, including white, African American, Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander. They also looked at the differences in risk factors among the ethnic groups.</div> <div> Women in all the minority groups were less likely to develop breast cancer than white women, the researchers found. For all groups except African Americans, those differences could be explained by differences in <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>breast cancer risk factors</U></FONT>. For instance, minority women were less likely to drink alcohol than white women, and less likely to use hormone therapy; both alcohol use and hormone therapy are known to raise a woman's risk of breast cancer.</div> <div> More Aggressive Tumors in African Americans </div> <div> African-American women were much more likely to be obese than white women (obesity raises the risk of breast cancer after menopause), and they got fewer mammograms than white women. But even these differences couldn't fully explain why African-American women had higher death rates from breast cancer, despite having a lower incidence of the disease.</div> <div> The researchers looked at tumor characteristics and found that black women were more likely than women of all other races to have high-grade (aggressive) tumors, and tumors without estrogen receptors (ER-negative). Those characteristics make a tumor more difficult to treat. The differences between black and white women in this regard were especially great. </div> <div> The different obesity rates might account for some of this gap, Chlebowski and his colleagues wrote, but not all of it.</div> <div> "It remains to be determined whether differences in unidentified environmental exposures, genetic makeup, or other factors lead to the higher frequency of high-grade, ER-negative cancers in African Americans," they wrote.</div> <div> Some Evidence for Genetic Differences </div> <div> There is some evidence to suggest genetic differences may play a role. Chlebowski and colleagues noted that breast tumors from African-American women are more likely than tumors from white women to have a particular gene, BP1, that is associated with aggressive breast cancer and ER-negative status.</div> <div> Another study, published in the journal <I>Cancer</I> (Vol. 103, No. 8: 1540-1550), found similarities between breast cancer in African-American women and in black women from sub-Saharan Africa. Like black women in the US, black women in Africa have a relatively low incidence of breast cancer, but high death rates from the disease. They are also more likely to develop breast cancer at younger ages, and to have advanced tumors.</div> <div> To a large degree, the advanced stage and poor outlook for African breast cancer patients can be explained by poverty; African women have limited access to screening and are often unable to get timely, high-quality care.</div> <div> But researchers Alero Fregene, MD, and Lisa Newman, MD, PhD, of the University of Michigan Comprehensive Cancer Center, noted that there may also be genetic similarities between African and African-American women, since many African Americans are descended from African slaves brought to the US centuries ago.</div> <div> Some of these genetic factors may increase the risk of breast cancer, or make black women more likely to develop high-grade, hormone-receptor negative tumors. The researchers noted that further study will be needed to clarify the role of genetics in the development and progression of breast cancer in these women.</div> <div> Differences in BRCA1 and BRCA2 </div> <div> African-American families also tend to have different mutations in the <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>BRCA1 and BRCA2 genes</U></FONT> than families of other races. These gene mutations make women more susceptible to breast and ovarian cancer. </div> <div> Genetic testing, which is available to women with a family history of either disease, can reveal whether a women carries a BRCA mutation. If she does, she can take steps to lower her risk of developing one of these cancers, such as taking tamoxifen, getting more frequent mammograms, or having her breasts or ovaries removed before disease can strike them.</div> <div> Yet African-American women are much less likely to get tested for BRCA mutations than white women, researchers from the University of Pennsylvania reported in the <I>Journal of the American Medical Association</I> (Vol. 293, No. 14: 1729-1736). </div> <div> In their study of 408 women with a family history of the disease, only a handful of African-American women chose to get tested. The researchers couldn't fully explain why. None of the factors they looked at -- likelihood of having the mutation, socioeconomic status, worry about developing breast cancer, attitudes about the benefits and risks of testing, or talking to a doctor about testing -- seemed to play a major role.</div> <div> The researchers speculated that distrust of the health care system, fear of discrimination based on the test results, and differences in doctors' attitudes toward testing may be at least partly to blame (though they didn't measure these factors in this study).</div> <div> Knowledge Is Power </div> <div> In an editorial published with the study, University of Chicago genetics experts Michael Hall, MD, and Olufunmilayo Olopade, MBBS, added other possible reasons for the discrepancy.</div> <div> "The average African-American woman underestimates her risk of breast cancer and African Americans are on the whole less aware of genetic testing technology as a means of assessing personal risk," they wrote.</div> <div> All Americans, and especially ethnic and racial minorities, need to learn more about inherited cancer risks and the pros and cons of genetic testing, they said.</div> <bR> <bR> <div>  <A NAME="olive_oil_fights_breast_cancer"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><FONT SIZE="4" COLOR="#660099" FACE="Arial" ><B><U>Olive oil fights breast cancer</U></B></FONT></div> <bR> <div> <B>Oleic Acid Key to Olive Oil's Anti-Cancer Effect</B></div> <div> LONDON (Reuters) - <FONT SIZE="3" COLOR="#660099" FACE="arial" >Scientists have discovered why eating a Mediterranean diet rich in fruits, vegetables and particularly olive oil can help to protect women from developing breast cancer. </FONT></div> <div> The key is oleic acid, the main component of olive oil. </div> <div> Dr Javier Menendez, of Northwestern University Feinberg School of Medicine in Chicago, said oleic acid blocks the action of a cancer-causing oncogene called HER-2/neu which is found in about 30 percent of breast cancer patients. </div> <div> "We have something now that is able to explain why the Mediterranean diet is so healthy," Menendez told Reuters. </div> <div> Doctors and researchers had been aware that eating a Mediterranean diet reduced the risk of breast cancer and other illnesses such as heart disease. But until now they did not know how. </div> <div> Menendez and his colleagues in the United States and Spain studied the impact of oleic acid in laboratory studies of breast cancer cells. </div> <div> "We are able to demonstrate that the main component of olive oil, oleic acid, is able to down-regulate the most important oncogene in breast cancer," Menendez explained. </div> <div> "The most important source of oleic acid is olive oil." </div> <div> They found that oleic acid not only suppressed the action of the oncogene, it also improved the effectiveness of the breast cancer drug Herceptin, a targeted therapy made by Swiss drug maker Roche Holding AG that works against the HER-2/neu gene. </div> <div> Breast cancer patients with HER-2/neu positive tumors suffer from an aggressive form of the disease and have a poor prognosis. </div> <div> "There is no evidence at all that olive oil is toxic," said Menendez, who reported his findings in the journal Annals of Oncology, explained. </div> <div> "It is totally safe to consume olive oil," he added. </div> <div> More than one million cases of breast cancer are diagnosed worldwide each year. In 1998, the disease caused 1.6 percent of all female deaths, according to the International Agency for Research on Cancer in Lyon, France. </div> <div> Although oleic acid works against the oncogene in a different manner than Herceptin and enhanced the drug's effectiveness. </div> <div> But Menendez stressed that although the laboratory results are promising, more research is needed. They are hoping to uncover the mechanism by which the acid targets the oncogene and are planning studies of animals with breast cancer to see if a diet high in olive oil can alter the activity of the oncogene and the impact of Herceptin. </div> <div> "We have a molecular link than can explain why the Mediterranean diet is demonstrating all these benefits," Menendez added. </div> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="626" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 38 WIDTH="622"><div>  <A NAME="atac__arimidex"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer </div> </tD> </tR> </TABLE></div> <div> <I>ATAC Trialists' Group* </I></div> <div> <B>Summary</B> </div> <div> The standard adjuvant endocrine treatment for postmenopausal women with hormone-receptor-positive localised breast cancer is 5 years of tamoxifen, but recurrences and side-effects restrict its usefulness. The aromatase inhibitor anastrozole was compared with tamoxifen for 5 years in 9366 postmenopausal women with localised breast cancer. After a median follow-up of 68 months, anastrozole significantly prolonged disease-free survival (575 events with anastrozole vs 651 with tamoxifen, hazard ratio 0·87, 95% CI 0·78-0·97, p=0·01) and time-to-recurrence (402 vs 498, 0·79, 0·70-0·90, p=0·0005), and significantly reduced distant metastases (324 vs 375, 0·86, 0·74-0·99, p=0·04) and contralateral breast cancers (35 vs 59, 42% reduction, 12-62, p=0·01). Almost all patients have completed their scheduled treatment, and fewer withdrawals occurred with anastrozole than with tamoxifen. Anastrozole was also associated with fewer side-effects than tamoxifen, especially gynaecological problems and vascular events, but arthralgia and fractures were increased. Anastrozole should be the preferred initial treatment for postmenopausal women with localised hormone-receptor-positive breast cancer. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="626" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="622"><div> Published online December 8, 2004. </div> </tD> </tR> </TABLE></div> <bR> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="421" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 1023 WIDTH="417"><div>  <A NAME="broccoli_compound_arrests_breast_cancer"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B><U>Broccoli Compound Arrests Breast Cancer Cell Growth</U></B></div> <div> Thu Sep 9 By Amy Norton</div> <bR> <div> NEW YORK (Reuters Health) - In findings that could make broccoli and Brussels sprouts easier to swallow, early research suggests a chemical found in the vegetables may impede the spread of breast cancer cells.</div> <bR> <div> Scientists found that the compound, called sulforaphane, hindered the growth of human breast cancer cells in the lab. It did so by apparently disrupting the action of protein 'microtubules' within the cells, which are vital for the success of cell division.</div> <bR> <div> The findings are published in the Journal of Nutrition.</div> <bR> <div> Past research has suggested a role for sulforaphane in preventing cancer, possibly due to its effects on detoxification enzymes that can defend against cancer-promoting substances. A study in rats showed that oral sulforaphane blocked the formation of breast tumors, and scientists have found that the chemical can push colon cancer cells to commit suicide.</div> <bR> <div> This latest research suggests a new mechanism -- microtubule disruption -- by which sulforaphane may bestow anti-cancer benefits, according to study co-author Dr. Keith Singletary, a professor of nutrition at the University of Illinois at Urbana-Champaign.</div> <bR> <div> What's "intriguing" about this finding, he told Reuters Health, is that certain cancer drugs work in a similar manner. It's possible that sulforaphane, perhaps in combination with other compounds or drugs, could eventually aid in the prevention or treatment of cancer, according to Singletary.</div> <bR> <div> Whether a diet rich in broccoli and other sulforaphane-containing foods packs enough of the compound to lower cancer risk is unknown. Numerous studies in the general population have linked high vegetable and fruit intake to a lower risk of cancer, including breast cancer -- but zeroing in on which components of these foods may deserve the credit is a tough task.</div> <bR> <div> Much remains to be learned about the chemicals in plant foods, Singletary noted, and scientists generally believe that it's important to get the full complement of nutrients and chemicals in these foods.</div> <bR> <div> "Most people would recommend eating a variety of whole vegetables and fruits," he said.</div> <bR> <div> SOURCE: Journal of Nutrition, September 2004. </div> </tD> </tR> </TABLE></div> <div>  <A NAME="cox_2_inhibition_in_breast_cancer"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>COX-2 Inhibition in Breast Cancer</div> <div> It is well known that cyclooxygenase-2 (COX-2) is overexpressed in colorectal and other types of cancer. Furthermore, from animal and epidemiologic studies, it appears that certain non-steroidal anti-inflammatory drugs (NSAIDs) may inhibit tumorigenesis and reduce the incidence of some cancers, including gastrointestinal cancers. According to Timothy Hla, PhD, Professor of Physiology, Genetics, and Developmental Biology, University of Connecticut School of Medicine at Farmington, researchers have begun to investigate the potential role of COX-2 in breast cancer and the mechanism by which certain NSAIDs may disrupt breast cancer cell pathways. </div> <div> <B>The Potential Role of COX-2 in Breast Cancer</B></div> <div> In one Finnish study, Ristimaki and colleagues investigated COX-2 expression in about 1500 patients with breast cancer. Using rigorous immunohistochemical techniques, these re-searchers found that 37% of breast cancer tissue expressed high levels of COX-2, and 90% expressed moderate levels of COX-2. “These findings are significant in that normal breast tissue does not express COX-2, and high COX-2 expression is correlated with poor distant disease-free survival,” Dr. Hla explained.</div> <bR> <div> Hla and colleagues then investigated whether COX-2 overexpression in breast tissue is sufficient to induce tumorigenesis. After introduction of human COX-2 gene via a mammary tumor virus promotor into mice, the researchers found COX-2 expression in the mammary gland to be zero in normal control mice, minimal in virgin transgenic mice, and high in pregnant and lactating transgenic mice. In mice expressing COX-2, high levels of prostaglandin, particularly prostaglandin E2, were also found. In female virgin transgenic mice, minor precocious lobuloalveolar differentiation and increased expression of prostaglandin-dependent B-casein gene were observed, and this was reversed by treatment with the COX-2 inhibitor indomethacin. In addition, a delay in mammary gland involution was correlated with decreased apoptosis of mammary epithelial cells in transgenic mice. “Overall, if the transgenic animals did not become pregnant, they did not develop high levels of COX-2 expression and did not develop cancers. However, after cycles of pregnancy and lactation, almost all transgenic mice developed mammary tumors,” Dr. Hla explained. Data further suggested that “COX-2 expression in the mammary gland can lead to invasive carcinoma development, and this appears to require prostaglandin synthesis. Further, when the transgenic mice were placed on COX-2 inhibitors, tumor development was suppressed in 80% of cases.”</div> <div> <B>Conclusion</B></div> <div> According to Dr. Hla, the mechanism of COX-2 in inducing tumor growth requires further study, but may include angiogenesis or dysregulation of apoptosis. Indeed, COX-2 tumor cells showed reduced levels of Bax and Bcl-x proteins and increased levels of Bcl-2, suggesting that decreased apoptosis of mammary epithelial cells may be sufficient to promote tumorigenesis. “These and other data suggest a scientific basis for further study of NSAIDs, particularly COX-2 inhibitors, for their potential effects on tumor biology. Clearly, whether this effect will have a role in breast cancer prevention or treatment needs to be determined,” Dr. Hla concluded.</div> <bR> <div> <FONT SIZE="4" COLOR="#660099" FACE="Arial" ><B> <A NAME="more_evidence_aspirin_protects_against"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>More Evidence Aspirin Protects Against Breast Cancer</B></FONT> <B>Only Hormone-Receptor Positive Tumors Affected</B> <B>May 26, 2004 07:22:37 AM PDT , ACS News Center</B> Regular aspirin use appears to reduce the risk of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>breast cancer</U></FONT>, according to a new study, but the drug only seems to protect against tumors that are hormonally sensitive. </div> <div> The report, published in the <I>Journal of the American Medical Association</I> (Vol. 291, No. 20: 2433-2489) is <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>not the first</U></FONT> to suggest aspirin can help prevent breast cancer. But it <I>is</I> the first to find a difference in protection according to tumor type. </div> <div> "That [aspirin] reduced the risk of breast cancer was not surprising," said study co-author Alfred I. Neugut, MD, of Columbia University. "I think the more novel finding is that it seems to be focused on hormone-receptor positive breast cancer." </div> <div> He and his colleagues suspect that aspirin spurs a process that decreases the production of aromatase, which in turn suppresses the production of estrogen, the female hormone that can fuel the growth of breast cancer. </div> <div> Daily Aspirin Lowered Risk </div> <div> Neugut and his colleagues studied nearly 3,000 women on Long Island, New York, of whom about half had breast cancer. They asked the women about their use of aspirin, ibuprofen, and acetaminophen, and about breast cancer risk factors like hormone use, menopausal status, reproductive history, and family history of the disease. </div> <div> Women who used aspirin daily reduced their risk of breast cancer by nearly 30%. But when the researchers looked at what types of tumors were affected, aspirin only seemed to protect against tumors that expressed the hormones estrogen or progestin (or both). These types of tumors tend to have a better prognosis than hormone-receptor negative tumors because they respond to hormonal treatments like tamoxifen. </div> <div> Ibuprofen, which belongs to a class of drugs similar to aspirin called non-steroidal anti-inflammatory drugs (NSAIDs), had only a very weak effect on breast cancer risk. That may be because fewer women in the study used ibuprofen compared to aspirin, so any effect was not noticeable. </div> <div> Acetaminophen, which is not an NSAID, did not have any appreciable effect on breast cancer risk. That was expected, Neugut said, because acetaminophen relieves pain differently than either aspirin or ibuprofen, in a way that does not ultimately affect estrogen. That fact adds weight to the theory that aspirin acts against breast cancer by suppressing estrogen. </div> <div> Too Soon to Recommend Aspirin as Prevention </div> <div> But the researchers didn't take any measurements that might back up their theory; they didn't collect samples of breast tissue, for instance, to measure levels of hormones and enzymes. More research is needed to determine whether they're right about how aspirin works. </div> <div> If they are right, though, it raises the possibility that aspirin could one day be combined with aromatase inhibitors to provide an even higher degree of protection from breast cancer, Neugut said. Aromatase inhibitors have been shown to dramatically reduce the risk of recurrence in women who have already had breast cancer. </div> <div> Because there are so many unanswered questions, Neugut and other experts said it's still too soon to give women the all-clear to take aspirin or NSAIDs as a means of preventing breast cancer. </div> <div> "This relationship is only now being tested in randomized clinical trials, and there is conflicting information about the optimal dose, duration, and drug," said Michael Thun, MD, vice president of epidemiology and surveillance research at the American Cancer Society. "The evidence remains incomplete and these drugs have side effects [like stomach bleeding] that are uncommon but can be serious." </div> <div> Still, millions of American women already take aspirin daily because it has been proven to reduce the risk of heart disease. For these women, the study could provide some hopeful news, Neugut said. </div> <div> "While I'm not suggesting that anyone take aspirin for breast cancer, women who already take it for cardiac prophylaxis might be getting a little icing on the cake," he said. </div> <bR> <div> <FONT SIZE="4" COLOR="#660099" FACE="Arial" ><B> <A NAME="switch_to_exemestane_better_than"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Switch to Exemestane Better than Long-term Tamoxifen in Breast Cancer Study</B></FONT> <B>Delays Recurrence, Reduces Cancers in Opposite Breast</B> <B>March 10, 2004 11:24:17 AM PST , ACS News Center</B> A new study is challenging the practice of giving <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>breast cancer</U></FONT> survivors 5 years of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>tamoxifen therapy</U></FONT> to prevent a recurrence of the disease. In a report appearing in the <I>New England Journal of Medicine</I> (Vol. 350, No. 11: 1081-1092), women who switched to the drug exemestane after 2 or 3 years of tamoxifen were less likely to see their cancer return than women who stayed on tamoxifen the full 5 years. </div> <div> The lead researcher of the trial, R. Charles Coombes, MD, PhD, of Imperial College and Charing Cross Hospital, London, said doctors should consider switching their patients to exemestane after a few years of tamoxifen because of these results. </div> <div> But other experts said it's still too early to know for sure whether exemestane and drugs like it are a better choice for some breast cancer survivors. </div> <div> "We cannot make a firm recommendation as to what women should do as a result of this study," said Len Lichtenfeld, MD, Deputy Chief Medical Officer of the American Cancer Society. "There must be more follow-up of the women on this study to answer the many questions that remain about this treatment option." </div> <div> An Aromatase Advantage? </div> <div> Most breast cancers grow in response to estrogen. Tamoxifen blocks estrogen receptors on breast cancer cells (although it does not affect overall estrogen levels). Studies have shown that giving tamoxifen after initial breast cancer treatment such as surgery reduces the chance the cancer will return. For many years, doctors have advised most women to take tamoxifen for 5 years after initial treatment. </div> <div> Exemestane (Aromasin), on the other hand, belongs to a class of drugs called aromatase inhibitors, which work in a slightly different way ? they prevent the body from producing estrogen. Because of the way these drugs work, they're only effective in postmenopausal women. </div> <div> Previous studies of other aromatase inhibitors for breast cancer survivors have suggested they may be at least as good, if not better, at preventing cancer recurrences. Last October, a <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>trial of the aromatase inhibitor letrozole</U></FONT> (Femara) found it cut recurrences so dramatically that the trial was stopped early so that all the women involved could be given the drug. Women in that study, though, had already completed 5 years of tamoxifen therapy. Another trial is comparing the aromatase inhibitor anastrozole (Arimidex) directly against tamoxifen therapy. Early results of this study showed a slight advantage in terms of recurrence and survival in the women taking anastrozole. </div> <div> The latest study involved more than 4,700 postmenopausal breast cancer survivors who had been taking tamoxifen for 2 or 3 years. Half the women continued to take tamoxifen for the full 5 years, while the rest switched to exemestane and took that drug for the remainder of the therapy period. </div> <div> Three years after the switch, 91.5% of the women on exemestane were still cancer-free, compared to 86.8% of the women still on tamoxifen. Moreover, fewer women on exemestane developed cancer in the opposite breast or other parts of the body. Overall survival was the same between the two groups, but the researchers said it may simply be too soon to see a survival advantage of one drug over the other. </div> <div> Coombes and his colleagues speculate that switching to exemestane may help women because many become resistant to tamoxifen after a few years. </div> <div> Questions About Long-Term Effects </div> <div> In the study, women on exemestane had more joint pain and diarrhea than women on tamoxifen, but fewer gynecological symptoms like vaginal bleeding and cramps. Exemestane caused more cases of osteoporosis (bone loss), while tamoxifen caused more blood clots. </div> <div> But this and previous studies had follow-up periods of only a few years; Lichtenfeld and other experts cautioned that little is known about the long-term effects of aromatase inhibitors. An editorial accompanying the study noted that long-term estrogen deprivation may have negative effects on bone and heart health, as well as sexual and mental function. </div> <div> "Many more years will be required to fine-tune the risk-benefit assessment of adjuvant aromatase inhibitors," wrote editorialist Martine J. Piccart-Gebhart, MD, PhD, of the Jules Bordet Institute in Belgium. </div> <div> Doctors who discuss aromatase inhibitors with their patients should be sure to tell them what is <I>not</I> known about the drugs, along with what is, she added. </div> <div> Piccart-Gebhart said women at high risk of recurrence may well be good candidates for treatment with an aromatase inhibitor after primary therapy. Women at low risk of recurrence, on the other hand, might be better off with the standard 5 years of tamoxifen since more is known about its long-term effects. </div> <div> Lichtenfeld agreed with that assessment, and stressed that women must consult their doctors before deciding to switch drugs. "We must emphasize that women should be informed of the potential benefits and risks of making such a change in treatment," he said. </div> <bR> <div> <B><U> <A NAME="new_test_may_better_predict_breast"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>New test may better predict breast cancer return</U></B></div> <div> Friday, December 5, 2003 Posted: 11:42 AM EST (1642 GMT)</div> <bR> <div> SAN ANTONIO, Texas (AP) -- A first-of-its-kind genetic test will soon be available to help women with breast cancer make one of their most crucial decisions: whether to undergo the rigors of chemotherapy. </div> <div> Genomic Health Inc., a Silicon Valley biotech company, said it has identified nearly two dozen genes that, taken together, can predict with a high degree of accuracy the likelihood that tumors will return in women whose breast cancer was caught at an early stage. </div> <div> Currently, doctors predict the chances of a relapse in pretty much the same way they have been doing it for almost a century: by looking at the patient's age, the size of the tumor, and the tumor's aggressiveness. </div> <div> If the chances of recurrence are seen as very low based on the gene test, a woman may opt to not endure the vomiting, hair loss and high cost of chemo. But if the odds of the cancer coming back are high, she may view chemo as the difference between life and death. </div> <div> "For the women in that highest group, it makes their decision so much easier," said Dr. Melody Cobleigh, a breast cancer researcher at Rush-Presbyterian-St. Lukes Medical Center in Chicago. "For women in the lowest group, they'll still agonize." </div> <div> The biotechnology company's research -- done with the National Surgical Adjuvant Breast and Bowel Project -- was outlined Thursday at a breast cancer conference in San Antonio. </div> <div> Chief executive Randy Scott said his company plans to make the test available to newly diagnosed cancer patients in early 2004. </div> <div> Other genetic tests for predicting the chances of a relapse have been developed, but this would be the first to move beyond the experimental stage and reach the market. </div> <div> The genetic test was developed by analyzing tumor samples from nearly 700 women involved in a 1980s cancer study. Genomic Health used its findings to create a point system to express escalating chances of recurrence within 10 years. </div> <div> The sample group included women from their 30s to their 70s. All had early-stage breast cancer that had not spread to other parts of the body, and all had been treated for at least five years with tamoxifen, a drug that slows or stops the growth of new breast cancer cells. </div> <div> Genomic Health found that just over half of the women in its sample group fell into the low-risk category. Their average recurrence rate was about 7 percent after surgery to remove the tumor, followed by tamoxifen. </div> <div>  <A NAME="1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Version 1.0</div> <div> At the other end of the scale, 27 percent of the sample were determined to be at high risk of recurrence. About three in every 10 of these patients developed new breast cancer within 10 years of treatment. </div> <div> In the intermediate-risk group, the 10-year recurrence rate averaged about 14 percent. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="339" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 134 WIDTH="200"><div> What we're seeing here is version 1.0. (It's) a great step forward, but we should not overestimate what we have right now. </div> </tD> <tD VALIGN=CENTER ROWSPAN=2 WIDTH="132"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="134" ALIGN="bottom" WIDTH="132" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 ><NOBR><div> <I>-- Dr. Matthew Ellis</I> </div> </NOBR></tD> </tR> </TABLE></div> <div> The error rate in each of the three categories was plus or minus 2 to 3 percentage points, said Dr. Steven Shak, Genomic Health's chief medical officer. </div> <div> Scott said that by using a scoring system, his company's test can give women a more individualized prognosis. </div> <div> "What we'll be able to provide is not just that you are low-risk, medium-risk or high-risk," he said. "It's that you have a score of X and that in our 668-patient clinical trial, that corresponded to a recurrence rate of Y." </div> <div> Dr. Daniel Hayes, who heads the breast oncology clinic at the University of Michigan, said too many breast cancer patients are needlessly undergoing chemo because the established ways of predicting recurrence do not provide enough information for them to say no. </div> <div> Chemo "is a heart-wrenching, gut-wrenching, hand-wringing decision" that nearly half of his patients have to make, Hayes said. If the new genetic test proves accurate, he could tell a patient she might safely be able to avoid chemo, he said. </div> <div> Dr. Matthew Ellis, a breast cancer specialist at Washington University in St. Louis, said he sees much promise in the scoring method, even though it does not precisely measure each woman's individual risk of relapse. </div> <div> "What we're seeing here is version 1.0," said Ellis, who is part of a National Cancer Institute group focused on finding the best way to predict recurrence. "Version 1.0 is a great step forward, but we should not overestimate what we have right now." </div> <div> Scott said his Redwood City, California, company will keep tinkering with the product. </div> <div> "Our long-term vision is to take this technology and broaden it out," he said. "We will continue to investigate not only in other areas of breast cancer, but in other cancers in general." </div> <bR> <div> <B><U> <A NAME="screening__prevention_"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Breast Cancer Screening / Prevention </U></B></div> <div>    Breast self-examination (BSE) is a very important part of every adult woman’s personal health regimen. BSE should be performed once each month beginning at age 20 and should continue each month throughout a woman’s lifetime. In addition to BSE, adult women should receive regular physician-performed clinical breast exams. The American Cancer Society recommends women 40 years of age receive a screening mammogram every one to two years. Begininning at age 50, mammography should be performed every year. This article discusses general information on BSE. Click on one of the links below for more specific information on how to perform BSE, to watch a video on BSE, or for additional resources.</div> <bR> <div>  </div> <bR> <div> <B><U>The Importance of Breast Self-Exam</U></B></div> <div> Regularly examining her own breasts allows a woman to become familiar with how her breasts normally look and feel and can help her more readily detect any changes that may occur. Many women naturally have some lumpiness and asymmetry (differences between the right and left breast). The key to the breast self-exam is to learn how to find changes in the breasts that persist over time.</div> <bR> <div> While most women are aware of monthly breast self-examination, many still do not know how to perform it properly. Performing BSE incorrectly can be almost as bad as not doing the exam at all since it can give women a false sense of security. After reading these sections on BSE, women should discuss any questions they might have about BSE techniques with their physicians and ask him or her to demonstrate how to perform BSE during the clinical breast exam portion of the physical exam.</div> <bR> <div> <B><U> <A NAME="the_best_time_to_perform_breast"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>The Best Time to Perform Breast Self-Exam</U></B></div> <div> Menstruating women: Hormonal changes due to the menstrual cycle may make the breasts more lumpy or swollen. Women who are menstruating should perform breast self-exam from a few days to about a week after menstruation (period) has ended, when breasts are usually less tender or swollen.</div> <bR> <div> Breast self-exams should be performed once each month beginning at age 20 and continue each month throughout a woman’s lifetime. </div> <bR> <div> Women who are no longer menstruating: should do their BSE on the same day every month. Try to pick a day that is easy to remember, such as the first or fifteenth of every month, and make that the day each month for breast self-exam.</div> <bR> <div> Women using oral contraceptives: are encouraged to do their BSE each month on the day they begin a new package of pills.</div> <bR> <div> <B><U> <A NAME="breast_changes_and_warning_signs_to"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Breast Changes and Warning Signs To Watch for During Breast Self-Exam:</U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Any new lump or hard knot found in the breast or armpit </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Any lump or thickening that does not shrink or lessen after your next period </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Any change in the size, shape or symmetry of your breast </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A thickening or swelling of the breast </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Any dimpling, puckering or indention in the breast </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Dimpling, skin irritation or other change in the breast skin or nipple </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Redness or scaliness of the nipple or breast skin </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Nipple discharge (fluid coming from your nipples other than breast milk), particularly if the discharge is bloody, clear and sticky, dark or occurs without squeezing your nipple </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Nipple tenderness or pain </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Nipple retraction: turning or drawing inward or pointing in a new direction </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f099006600.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Any breast change that may be cause for concern </div> <bR> <div> If any of these changes are noted, women should see their physicians as soon as possible for clinical evaluation. However, in the majority of cases (80%), breast lumps and changes are not cancer. Women should not allow their fear of breast cancer keep them from telling their physician or healthcare provider about a lump or change they have found.</div> <bR> <div> <B><U> <A NAME="women_with_normally_lumpy_breasts"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Women with Normally Lumpy Breasts Should Also Perform BSE</U></B></div> <div> Even if a woman has normally lumpy breasts (typically called fibrocystic breasts), she can still learn the usual pattern of lumps and then point out new or unusual lumps to her physician. While lumpy breasts or breasts with benign (non-cancerous) masses or cysts can be more difficult to examine, monthly breast self-exams (BSE) are still critical. In fact, without knowledgeable direction from the patient, it may be more difficult for a physician to differentiate between a new mass and a stable lump. If a woman’s breasts are normally lumpy, she should note how many separate lumps she feels and their corresponding locations when performing self-exams. Then, during subsequent exams, she should check for any changes, particularly an increase in the size of lumps that persist after her period. Any changes should be reported to a physician or healthcare provider.</div> <bR> <div> <B><U> <A NAME="breast_examination_during_and_after"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Breast Examination During and After Pregnancy Is Critical</U></B></div> <div> Women should continue monthly breast self-examination (BSE) during pregnancy. Clinical breast examination by a healthcare professional should also be made on a monthly basis during pregnancy. It is especially important that clinical breast exam be performed during the first doctor visit of the pregnancy, before the breasts go through significant physiologic changes. Some changes or lumps are more difficult to evaluate once the breasts have enlarged and become more nodular. The main problem with breast cancer during pregnancy is a delay in diagnosis that results in women being diagnosed with breast cancer at a later, more advanced stage. Vigilant, monthly breast self-examination during pregnancy and afterwards during breast-feeding can help prevent delayed diagnosis of breast cancer and enables optimal treatment.</div> <bR> <div>  </div> <bR> <div> <B><U> <A NAME="normal_breast_anatomy_and_non_cancerous"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Normal Breast Anatomy and Non-Cancerous Lumps</U></B></div> <div> <B><U><IMG SRC="2105c990.png" border=0 width="348" height="409" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></div> <bR> <div> The breast is made up of various anatomic structures including skin, fat, milk glands or lobules, milk ducts, and connective tissue. Breast milk is produced by the glands during lactation (breast-feeding) and carried through the ducts to the nipple. Underneath the breast are the pectoral muscles in the chest and the ribs. A web of lymph canals also feeds the breast. Together with lymph nodes, the lymph system helps filter infection and disease from the body.</div> <bR> <div> In addition to this normal breast anatomy, there may be masses present such as cysts (packets of fluid) that are found in many women with fibrocystic breasts  and are not cause for concern:</div> <bR> <bR> <div> Normal, non-cancerous lumps such as cysts are usually soft, smooth and moveable </div> <div> Suspicious lumps are usually firm, irregular in shape and fixed in place </div> <bR> <div> If something that seems unusual is felt in one breast, women should feel for it in the other breast. If the area is found in both breasts, it is probably normal breast anatomy.</div> <bR> <div> <B><U> <A NAME="breast_self_exam_pads"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Breast Self-Exam Pads</U></B></div> <div> The U.S. Food and Drug Administration (FDA) recently approved several products to help women practice monthly breast self-exams. Two such products are the Aware Breast Self-Examination Pad (made by Women’s Health Products) and the Sensability Breast Pad (made by Becton Dickinson). These products can help make performing breast self-exams easier for some women. The goal of both products is to heighten touch sensation when examining the breasts. </div> <bR> <div>  </div> <div> Aware breast pad</div> <div> The Aware breast pad can help increase a woman’s confidence when she performs monthly breast self-exams. The pad consists of two ten-inch plastic sheets with a silicone lubricant sealed inside. During clinical trials, the Aware pad increased a woman’s sense of touch by reducing friction between her fingers and her breast.</div> <bR> <div>  </div> <bR> <div> Sensability breast pad</div> <div> The Sensability breast pad can also help women perform self-exams. A clinical trial conducted with 72 breast cancer patients revealed that patients who used the Sensability pad (then known as Sensor Pad) were able to use the product as effectively as nurses familiar with the proper breast examination technique.</div> <bR> <div>  </div> <bR> <bR> <bR> <bR> <bR> <bR> <bR> <div> <B><U> <A NAME="breast_self_exam"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>BREAST SELF EXAM</U></B></div> <div> <IMG SRC="2037f780.jpg" border=0 width="127" height="120" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>Introduction</B></div> <div> Monthly <FONT SIZE="3" COLOR="#000099" FACE="Arial" ><A HREF="http://imaginis.com/breasthealth/bse.asp" TARGET="_top" TITLE="http://imaginis.com/breasthealth/bse.asp"><U><U>breast self-examination</U></U></A></FONT> (BSE) includes both<I> looking </I>and <I>feeling</I> over the entire breast and chest area. The steps can be performed in any order, but each step is important. Women should use the pads, not the tips, of the three middle fingers when performing BSE. The time required to perform the exam varies with the size and features of a woman's breasts but usually only takes about 15 to 20 minutes each month. Women should be sure to examine the breasts in the same manner each month, check the entire breast and armpit area, and remember how the breasts feel from month to month. Some women prefer to keep a small diary of their monthly breast self-exam<FONT SIZE="2" COLOR="#660099" FACE="Arial" >s.</FONT></div> <bR> <div> <B>Patterns to Use When Performing BSE</B></div> <div> Women should use three different patterns when examining the breasts each month:</div> <DIV ALIGN="LEFT"></DIV> <div>  </div> <div> <IMG SRC="206355d0.png" border=0 width="309" height="93" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <DIV ALIGN="LEFT"></DIV> <div> <I>Courtesy of the </I><FONT SIZE="2" COLOR="#000099" FACE="Arial" ><A HREF="http://www.cancer.org" TARGET="_top" TITLE="http://www.cancer.org"><U><I><U>American Cancer Society</U></I></U></A></FONT></div> <div> Vertical or "up and down" pattern (or "squares") covering the entire breast. </div> <div> Spiral or ring pattern, making concentric rings that tighten in a spiral, starting on the outer edges of the breast and ending around the nipple. </div> <div> Wedge patterns in and out (or "quadrants"). </div> <div> Women should use three levels of pressure (light, medium, and firm) and small "massaging" circles when palpating the breast using the patterns described above. Women should not lift the fingers while feeling the breasts to ensure that no area is missed. An example of good palpation technique can be seen in the <FONT SIZE="2" COLOR="#000099" FACE="Arial" ><A HREF="http://imaginis.com/breasthealth/bse_video.asp" TARGET="_top" TITLE="http://imaginis.com/breasthealth/bse_vid"><U><U>video program</U></U></A></FONT>.</div> <div> Women should perform BSE when they can be in a private place that is free from disturbances, so they may concentrate fully on the examination. BSE should be performed in a warm room or during a warm shower so that the breast tissue is relaxed and easier to examine. Cold air or cold water causes the breasts and nipples to contract and may make examining the breasts more difficult.</div> <div> Some women prefer to use a small amount of baby powder or talcum powder on the skin of their breasts to help reduce friction and allow the fingers to move more easily over the skin. In addition to performing BSE in front of a mirror, some women also like to do the standing portion of breast self-exam while taking a warm shower. Soapy fingers reduce friction and allow some breast changes to be more easily recognized.</div> <bR> <div> <I><B>Any persistent breast lump or abnormality</B></I></div> <div> <I><B> of the breast or nipple should be reported</B></I></div> <div> <I><B> to a physician as soon as possible</B></I><B>.</B></div> <bR> <div> <B>Areas to Examine with Particular Care</B></div> <div> It is important to thoroughly examine the entire area of the breast every month:</div> <div> Outside: armpit to collar bone, and below the breast </div> <div> Middle: the breast itself </div> <div> Inside: the nipple area </div> <div> However, cancerous tumors are more likely to be found in some parts of the breast than in others. Approximately half of all breast cancers occur in the upper, outer region of the breast toward the armpit. Some physicians refer to this upper outer region as the "tail" of the breast and encourage women to examine it with great care.</div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="453" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 147 ><NOBR><div> <IMG SRC="208988d0.png" border=0 width="152" height="141" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="298"><div> Approximate percentage of breast cancers found in each area: </div> <div> 41% in the upper, outer quadrant </div> <div> 14% in the upper, inner quadrant </div> <div> 5% in the lower, inner quadrant </div> <div> 34% in the area behind the nipple </div> <div> 6% in the lower, outer quadrant </div> </tD> </tR> </TABLE></div> <div> <I>Image courtesy of the </I><FONT SIZE="2" COLOR="#000099" FACE="Arial" ><A HREF="http://www.ama-assn.org/" TARGET="_top" TITLE="http://www.ama-assn.org/"><U><I><U>AMA</U></I></U></A></FONT></div> <div> <B>BSE Method While Standing in Front of a Mirror</B></div> <div> Because the upright position can make it easier to check the upper and outer portions of the breasts and armpit, breast self-examination (BSE) should be performed standing up in addition to lying down. Looking (inspection) should take place in front of a mirror in a well-lit area. A tall dressing mirror is often best. While standing in front of a mirror, undress down to the waist.</div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="532" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 126 ><NOBR><div> <IMG SRC="2097f780.jpg" border=0 width="127" height="120" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="398"><div> Place the arms at the sides. Check the breasts for any changes in size, shape or position, dimpling or puckering of the skin, pushed-in or misshapen nipples, other changes in the nipple, redness, swelling or other irregularities. Then, repeat this process with the hands on the hips, pressing firmly to flex the chest (pectoral muscles). Bend forward with the hands on the hips and note any irregularities. </div> </tD> </tR> </TABLE></div> <div>  </div> <div>  </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="432" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 126 ><NOBR><div> <IMG SRC="20a7f780.jpg" border=0 width="127" height="120" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="298"><div> Raise the arms overhead or put the hands behind the head. Turn to each side to check the breasts in profile. Note any <I>changes</I> in symmetry between the right and left breast. Remember, it is often normal for women to have one breast that is larger or a different shape than the other.</div> </tD> </tR> </TABLE></div> <div>  </div> <div>  </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="432" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 181 ><NOBR><div> <IMG SRC="20b7f780.jpg" border=0 width="127" height="120" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="298"><div> Examine each breast separately and feel for any new lumps, changes, or irregularities. Use the pads of the fingers, not the tips, and practice the patterns of examination described in the above section (up and down line, spiral, wedge pattern). The nipple should also be examined during this time. First, squeeze the nipple and check for any discharge (see section below for more information on <FONT SIZE="2" COLOR="#000099" FACE="Arial" ><A HREF="http://imaginis.com/breasthealth/nipple.asp" TARGET="_top" TITLE="http://imaginis.com/breasthealth/nipple."><U><U>nipple discharge</U></U></A></FONT>). Then push the nipple deep into the hollow beneath it. Note any unusual resistance, hardness or lump beneath the nipple. </div> </tD> </tR> </TABLE></div> <div> During the standing portion of the exam, the <FONT SIZE="2" COLOR="#000099" FACE="Arial" ><A HREF="http://imaginis.com/breasthealth/lymph_nodes.asp" TARGET="_top" TITLE="http://imaginis.com/breasthealth/lymph_n"><U><U>lymph nodes</U></U></A></FONT> in each armpit and surrounding areas under the arm should be carefully examined. Lymph nodes are normally about the size of kidney beans. Sometimes the lymph nodes may be enlarged by a non-cancerous infection. Occasionally, lymph node enlargement may be caused by a cancerous process. As with any breast or nipple changes, women should report any lymph node changes or enlargement to their physicians. </div> <div> <B>BSE Method While Lying Down</B></div> <div> In addition to standing, breast self-examination (BSE) should also be performed while lying down. Women should use the pattern of examination described in the above section and should ask their physicians if they have questions about performing BSE. The <FONT SIZE="2" COLOR="#000099" FACE="Arial" ><A HREF="http://imaginis.com/breasthealth/bse_video.asp" TARGET="_top" TITLE="http://imaginis.com/breasthealth/bse_vid"><U><U>video program</U></U></A></FONT> also shows the proper BSE technique.<FONT SIZE="3" COLOR="#660099" FACE="Arial" > </FONT></div> <div>  </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="532" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 148 ><NOBR><div> <IMG SRC="2037f780.jpg" border=0 width="127" height="120" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="398"><div> Lie down with a pillow or folded towel under the right shoulder and place the right arm behind the head. Check the entire breast and armpit area using the pads of the first three middle fingers on the left hand to feel for lumps, changes, or irregularities in the right breast. Press firmly enough to know how the breast feels. A firm ridge in the lower curve of each breast is normal. The exam should then be repeated on the left breast, using the finger pads of the right hand (the pillow or folded towel should also be moved under the left shoulder at this time).</div> </tD> </tR> </TABLE></div> <div>  </div> <div>  </div> <div> <IMG SRC="20d7f780.jpg" border=0 width="127" height="120" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">While performing BSE lying down, the nipple should also be checked for any changes. After making an initial examination, gently squeeze the nipple to check for any discharge of fluid. Note any changes in appearance, discharge (including the color and whether the discharge occurs spontaneously or by squeezing), or cracking. </div> <div>  </div> <div>  </div> <div> Nipple fluid that is green or yellow is usually normal. Nipple fluid that is bloody, dark or clear and sticky is considered abnormal (although most suspicious nipple discharges are found to be caused by non-cancerous conditions such as <FONT SIZE="2" COLOR="#000099" FACE="Arial" ><A HREF="http://imaginis.com/breasthealth/benign.asp#papilloma" TARGET="_top" TITLE="http://imaginis.com/breasthealth/benign."><U><U>papillomas</U></U></A></FONT>). In approximately 10% of all cases, nipple discharge is due to a cancerous lesion. In women less than 30 years of age, less than 10% of nipple discharge is due to cancer. Nevertheless, any persistent nipple discharge should be reported to a physician for clinical evaluation.</div> <div> <B>BSE Method While in the Shower</B></div> <div> Many women find that performing breast self-examination (BSE) in the shower in addition to standing in front of a mirror and lying down is helpful because the skin can be lubricated by soap. Some breast changes can be felt more easily when the skin is wet and soapy. </div> <div>  </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="439" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 197 ><NOBR><div> <IMG SRC="20e867f0.jpg" border=0 width="134" height="127" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="298"><div> Raise the right arm above the head and place the right hand behind the head. Using the left hand, examine the right breast using the methods described in the above sections. Feel the breast with the pads of the index and middle fingers, moving in increasingly smaller circles from the outside inward. Compress gently, feeling for lumps. When circling the nipple, look for changes or discharge. Repeat the exam with the left breast using the right hand. Make sure to examine the area adjacent to the breast and below the armpit (this area contains breast tissue and lymph nodes).</div> </tD> </tR> </TABLE></div> <bR> <bR> <div> <B><U> <A NAME="risks_of_a_combination_hrt_regimen"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></U></B><B><U>Risks of a Combination HRT Regimen Outweigh Benefits</U></B></div> <div> <B>Laurie Barclay, MD</B> </div> <div> Medscape Medical News 2002. © 2002 Medscape</div> <div> July 9, 2002 — Results of the Women's Health Initiative (WHI), reported in the July 17 issue of <I>The Journal of the American Medical Association</I>, indicate that the combination of conjugated equine estrogen (0.625 mg/day) and medroxyprogesterone acetate (2.5 mg/day) (Prempro) is associated with an increased overall health risk. Although the absolute risk was low, investigators stopped this arm of the study and suggested discontinuing this therapy. </div> <div> "During one year, for every 10,000 women taking estrogen plus progestin, we would expect seven more women would have heart attacks (than in the placebo group), eight more women with strokes, eight more women with breast cancer, and 18 more women with blood clots," investigator Denise E. Bonds, MD, MPH, from Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina, says in a news release. </div> <div> Despite the low absolute risk (2.5%) and the positive effect of six fewer cases of colorectal cancer and five fewer hip fractures per 10,000 women treated with Prempro, Bonds says that "the balance of risks significantly outweighed the benefits." </div> <div> This randomized, controlled, primary prevention trial taking place at 40 U.S. clinical centers from 1993-1998 enrolled 16,608 postmenopausal women aged 50 to 79 years with an intact uterus at baseline. Although the study has a planned duration of 8.5 years, the study's Data and Safety Monitoring Board discontinued the Prempro treatment arm after a mean follow-up period of 5.2 years. </div> <div> For women on this combination hormone therapy, the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect (hazard ratio, 1.26; 95% confidence interval, 1.00-1.59), and the global index statistic suggested that risks exceeded benefits. Mortality was not increased in the Prempro treatment arm, but the absolute excess risk of adverse events was 19 per 10,000 person years. Most adverse outcomes occurred within one to two years, except for breast cancer risk, which was not increased until four years. </div> <div> Women in other groups in the study, including women taking estrogen alone, women on a low-fat diet, women taking calcium and vitamin D supplementation, and those on observation alone are advised to continue with their assigned treatment. </div> <div> "The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that [Prempro] should not be initiated or continued for primary prevention of coronary heart disease," the authors write. </div> <div> In an accompanying editorial, Suzanne W. Fletcher, MD, MSc, and Graham A. Colditz, MD, DrPH, from Harvard Medical School in Boston, Massachusetts, call the methods "strong" and the findings "surprising" but "consistent with the growing body of literature." Because results were similar across subgroups, they suggest that there is no subgroup appearing to benefit from Prempro. </div> <div> "To date, estrogen alone may be safer than the combination estrogen/progestin," they write. "We recommend that clinicians stop prescribing this combination for long-term use. Primum non nocere applies especially to preventive health care....The WHI provides an important health answer for generations of healthy postmenopausal women to come — do not use estrogen/progestin to prevent chronic disease." </div> <div> <I>JAMA.</I> 2002;288(3):321-333, 366-368 </div> <div> <I>Reviewed by Gary D. Vogin, MD</I> </div> <bR> <bR> <div> Laurie Barclay, MD, is a staff writer with WebMD.</div> <div> Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to <U>news@webmd.net</U>. </div> <bR> </td> </tr></table></body>