Wednesday 29 April 2009
April 2009
Record fall in deaths from breast cancer
Data from Cancer Research UK has revealed that for the first time since records began, in 1971, the number of women dying from breast cancer has fallen below 12,000. This is despite the increase in breast cancer diagnosis, up by more than 50% in the last 25 years.
Cancer Research UK data showed that in 2007, 11,990 women died from breast cancer in the UK. In 1971, the figure was 12,472. That figure rose to a peak in 1989 with 15,625 women dying from the disease, but since then figures have been falling, apart from a small rise in 2005.
The fall in deaths is thought to be due to a range of factors including the introduction of the NHS Breast Screening Programme in 1988, breast awareness among women and improved treatments given in addition to surgery, such as chemotherapy, radiotherapy and hormone treatments, used to try and prevent the disease from coming back.
Professor Peter Johnson, Cancer Research UK's chief clinician, said: "It's incredibly encouraging to see fewer women dying from breast cancer now than at any time in the last 40 years, despite breast cancer being diagnosed more often. Research has played a crucial role in this progress leading to improved treatments and better management for women with the disease. The introduction of the NHS breast screening programme has also contributed as women are more likely to survive the earlier cancer is diagnosed. We hope these new figures will encourage women over the age of 47 to attend screening and to know that even if a tumour is found, their chances of beating it are better than ever."
However, rates of breast cancer have risen significantly over the last 25 years and continue to rise year on year. It is the most common cancer in the UK and is the second most common cause of death from cancer after lung cancer. This is thought to be due to a number of factors such as age, obesity, drinking alcohol, reproductive factors and to a decreasing extent, HRT.
Also, many believe that improved detection rates may be leading to a higher incidence of breast cancers being detected. According to figures produced by the NHS Breast Screening Programme, more than 19 million women have been screened and over 117,000 cancers have been detected. In 2007-08 over 2 million women were invited for screening and 1.7 million were actually screened. This figure was an increase of 500,000 from the previous decade. It seems that inevitably, this rise in the number of women being screened has had a significant impact on the numbers being diagnosed.
The NHS Breast Screening Programme is currently available to women aged 50-70, but is intended to include women aged 47-73 by 2012 as part of the Government’s Cancer Reform Strategy.
Sources and references:
Cancer Research UK
BBC website
The Times newspaper
Eating walnuts could help reduce the risk of developing breast cancer
This is the claim made by a US study presented to the 100th Annual Meeting of the American Association for Cancer Research.
Researcher Dr Elaine Hardman, of Marshall University School of Medicine, said that although the study was carried out in mice, the beneficial effect of walnuts was likely to apply to humans too.
Dr Hardman and her colleagues studied mice that were fed a diet that they estimated was the human equivalent of two ounces of walnuts per day. A separate group of mice were fed a control diet. Standard testing showed that walnut consumption significantly decreased breast tumour incidence, the number of glands with a tumour and tumour size and that those that did arise took longer to develop and were smaller.
Dr Hardman said: "We know that a healthy diet overall prevents all manner of chronic diseases. It is clear that walnuts contribute to a healthy diet that can reduce breast cancer."
The BBC reports Anna Denny, a nutrition scientist at the British Nutrition Foundation, saying that evidence for nuts reducing the risk of heart disease was currently stronger than it was for their anti-cancer properties. She said: "Although nuts are high in fat (and thus calories), the fatty acids in nuts are predominantly 'good' unsaturated fatty acids.
"Other additional components of nuts that may contribute to a reduction in heart disease and cancer risk include fibre and 'bioactive' compounds.
"More research is needed before it will be possible to attribute specific health benefits of nuts to specific bioactive compounds because nuts contain a complex mixture of different bioactive compounds."
They also report Josephine Querido of Cancer Research UK saying that there was insufficient evidence to show that eating walnuts could prevent breast cancer in humans. She said: "We know that a healthy balanced diet - rich in fruit and vegetables - plays an important part in reducing the risk of many types of cancer.”
Dr Alexis Willett, Policy Manager at Breakthrough Breast Cancer, said: “It is very difficult to know which individual foods influence the chance of getting breast cancer. That’s why this study in mice is interesting, but more research is needed in humans so we can understand more about how walnuts may affect breast cancer risk. “
Sources and References:
BBC
American Association for Cancer Research
Breakthrough Breast Cancer
March 2009
Alcohol Risks - red and white wine.
It has been known for some time that one of the risk factors associated with breast cancer is alcohol consumption. However, while previously, some research had suggested that red wine might have a small beneficial effect, a recent study says that this is not the case and that red and white wine have a similar impact on risk.
A study looking at alcohol, tobacco and breast cancer was published in the British Journal of Cancer in 2002. The results showed that not only was the risk of developing breast cancer slightly increased by drinking but the evidence also suggested that the more a woman drank, the greater her risk of developing breast cancer. Although the increase in risk per drink is small, it does add up (i.e. about 7% per drink)
The figures suggested that by the age of 80, the number of women who would develop breast cancer would be:
• 8.8 out of 100 if they don't drink at all
• 10.1 out of 100 if they have 2 drinks a day
• 13.3 out of 100 if they have 6 drinks a day
In March 2009, the results of a study carried out at the Fred Hutchison Cancer Research Centre in the US (and published in the Cancer Epidemiology, Biomarkers and Prevention journal) showed that red and white wine have a similar effect on the risk of developing breast cancer.
The team interviewed over 6,000 women with breast cancer and over 7,000 who had no history of breast cancer. All were aged between 20 and 69. Both groups drank a similar amount of alcohol, including equal amounts of red and white wine. The results showed that women who drank 14 or more alcoholic beverages were 24% more likely to develop breast cancer than those who drank no alcohol, regardless of the type of alcoholic drink.
Dr Polly Newcomb, head of the Centre’s Cancer Prevention Programme said:
‘The general evidence is that alcohol consumption overall increased breast cancer risk, but other studies made us wonder whether red wine might in fact have some positive value’.
However: ‘We found no difference between red or white wine in relation to breast cancer risk. Neither appears to have any benefits… And if a woman chooses red wine, she should do so because she likes the taste, not because she thinks it may reduce her risk of breast cancer.’
Sources and references:
Cancer Research UK
‘No Difference Between Red Wine or White Wine Consumption and Breast Cancer Risk’ : Cancer Epidemiology, Biomarkers and Prevention, 18 (3) 1007-1010 DOI
Night Shifts and Breast Cancer
A number of news sources reported that Denmark had begun compensating “dozens” of women who developed breast cancer after working night shifts. The BBC said the Danish government’s decision was based on a report from WHO’s International Agency for Research on Cancer (IARC), which concluded that working nightshifts could increase women’s risk of breast cancer. Although this report has not yet been published, a summary “found a modestly increased risk of breast cancer in long-term employees compared with those who are not engaged in shift work at night".
The NHS website commenting on this story said: ‘It is not clear exactly how working at night might increase risk of cancer. There is a theory that disruption of the circadian system and the hormone melatonin are involved. Working at night is known to disrupt our circadian system, which regulates how we respond to night and day. This system affects how active we are, which hormones are produced, and which genes are switched on and off. Some of the genes affected by the circadian system can affect tumour growth, while the hormone melatonin, which is normally produced at night, affects immune system function.’
The UK’s Health and Safety Executive (HSE) has commissioned its own report (due to be published in 2011) on the health impact of night-shift work, including its effects on breast cancer risk and will then consider what if any changes need to be made to recommended working practices in this country.
Cancer Research UK, commenting on this story have said that in their opinion: ‘the studies to date are unclear as to whether shift work actually causes breast cancer, in and of itself, or whether shift workers are more likely do other things that increase their risk, like being inactive or overweight’.
Sources and References:
• Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, Altieri A, Benbrahim-Tallaa L, Cogliano V, WHO International Agency for Research on Cancer Monograph Working Group. Carcinogenicity of shift-work, painting and fire-fighting. Lancet Oncol 2007; 12:1065-1066.
• NHS website
• Cancer Research UK
NICE reject NHS funding for cancer drug Tyverb (lapatinib) – GSK to appeal
GSK , the manufacturers of the drug Tyverb (also known as lapatinib) are appealing a decision by NICE (and also the SMC ) to reject funding for it by the NHS.
Tyverb is commonly used to treat a particular type of advanced breast cancer which has returned, despite use of standard treatments. It is not a cure, but can delay the progression of the cancer. It hit the headlines when it was used by Jane Tomlinson, who was given the drug as part of a trial. Her husband claimed the drug: ‘… gave Jane three months of reasonable quality life’. However, NICE said that it did not extend life by long enough to justify the cost to the NHS and as such would not recommend it for routine treatment.
GSK had offered to fund 12 weeks of treatment, on the basis that the NHS would only have to pay for ongoing treatment if the patient was still benefitting at the end of the trial period. GSK claimed that the cost for patients would be about £16,000 per annum and added that it could control the disease after standard chemotherapy and treatment with Herceptin had not stopped the disease from returning. They also said that a number of other European countries had granted funding for the drug (including France and Germany).
However, NICE considered that the cost would be nearer to £70,000 per annum and concluded that it was not a cost-effective use of NHS resources.
GSK have appealed the decision and the appeal panel will convene on 8th June 2009 to hear representations from the appellants.
GlaxoSmithKline
The National Institute for Health & Clinical Excellence – drugs watchdog for England & Wales
Scottish Medicines Consortium – Scotland ‘s drugs watchdog
Sources and References:
The Scotsman
NICE
It has been known for some time that one of the risk factors associated with breast cancer is alcohol consumption. However, while previously, some research had suggested that red wine might have a small beneficial effect, a recent study says that this is not the case and that red and white wine have a similar impact on risk.
A study looking at alcohol, tobacco and breast cancer was published in the British Journal of Cancer in 2002. The results showed that not only was the risk of developing breast cancer slightly increased by drinking but the evidence also suggested that the more a woman drank, the greater her risk of developing breast cancer. Although the increase in risk per drink is small, it does add up (i.e. about 7% per drink)
The figures suggested that by the age of 80, the number of women who would develop breast cancer would be:
• 8.8 out of 100 if they don't drink at all
• 10.1 out of 100 if they have 2 drinks a day
• 13.3 out of 100 if they have 6 drinks a day
In March 2009, the results of a study carried out at the Fred Hutchison Cancer Research Centre in the US (and published in the Cancer Epidemiology, Biomarkers and Prevention journal) showed that red and white wine have a similar effect on the risk of developing breast cancer.
The team interviewed over 6,000 women with breast cancer and over 7,000 who had no history of breast cancer. All were aged between 20 and 69. Both groups drank a similar amount of alcohol, including equal amounts of red and white wine. The results showed that women who drank 14 or more alcoholic beverages were 24% more likely to develop breast cancer than those who drank no alcohol, regardless of the type of alcoholic drink.
Dr Polly Newcomb, head of the Centre’s Cancer Prevention Programme said:
‘The general evidence is that alcohol consumption overall increased breast cancer risk, but other studies made us wonder whether red wine might in fact have some positive value’.
However: ‘We found no difference between red or white wine in relation to breast cancer risk. Neither appears to have any benefits… And if a woman chooses red wine, she should do so because she likes the taste, not because she thinks it may reduce her risk of breast cancer.’
Sources and references:
Cancer Research UK
‘No Difference Between Red Wine or White Wine Consumption and Breast Cancer Risk’ : Cancer Epidemiology, Biomarkers and Prevention, 18 (3) 1007-1010 DOI
Night Shifts and Breast Cancer
A number of news sources reported that Denmark had begun compensating “dozens” of women who developed breast cancer after working night shifts. The BBC said the Danish government’s decision was based on a report from WHO’s International Agency for Research on Cancer (IARC), which concluded that working nightshifts could increase women’s risk of breast cancer. Although this report has not yet been published, a summary “found a modestly increased risk of breast cancer in long-term employees compared with those who are not engaged in shift work at night".
The NHS website commenting on this story said: ‘It is not clear exactly how working at night might increase risk of cancer. There is a theory that disruption of the circadian system and the hormone melatonin are involved. Working at night is known to disrupt our circadian system, which regulates how we respond to night and day. This system affects how active we are, which hormones are produced, and which genes are switched on and off. Some of the genes affected by the circadian system can affect tumour growth, while the hormone melatonin, which is normally produced at night, affects immune system function.’
The UK’s Health and Safety Executive (HSE) has commissioned its own report (due to be published in 2011) on the health impact of night-shift work, including its effects on breast cancer risk and will then consider what if any changes need to be made to recommended working practices in this country.
Cancer Research UK, commenting on this story have said that in their opinion: ‘the studies to date are unclear as to whether shift work actually causes breast cancer, in and of itself, or whether shift workers are more likely do other things that increase their risk, like being inactive or overweight’.
Sources and References:
• Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, Altieri A, Benbrahim-Tallaa L, Cogliano V, WHO International Agency for Research on Cancer Monograph Working Group. Carcinogenicity of shift-work, painting and fire-fighting. Lancet Oncol 2007; 12:1065-1066.
• NHS website
• Cancer Research UK
NICE reject NHS funding for cancer drug Tyverb (lapatinib) – GSK to appeal
GSK , the manufacturers of the drug Tyverb (also known as lapatinib) are appealing a decision by NICE (and also the SMC ) to reject funding for it by the NHS.
Tyverb is commonly used to treat a particular type of advanced breast cancer which has returned, despite use of standard treatments. It is not a cure, but can delay the progression of the cancer. It hit the headlines when it was used by Jane Tomlinson, who was given the drug as part of a trial. Her husband claimed the drug: ‘… gave Jane three months of reasonable quality life’. However, NICE said that it did not extend life by long enough to justify the cost to the NHS and as such would not recommend it for routine treatment.
GSK had offered to fund 12 weeks of treatment, on the basis that the NHS would only have to pay for ongoing treatment if the patient was still benefitting at the end of the trial period. GSK claimed that the cost for patients would be about £16,000 per annum and added that it could control the disease after standard chemotherapy and treatment with Herceptin had not stopped the disease from returning. They also said that a number of other European countries had granted funding for the drug (including France and Germany).
However, NICE considered that the cost would be nearer to £70,000 per annum and concluded that it was not a cost-effective use of NHS resources.
GSK have appealed the decision and the appeal panel will convene on 8th June 2009 to hear representations from the appellants.
GlaxoSmithKline
The National Institute for Health & Clinical Excellence – drugs watchdog for England & Wales
Scottish Medicines Consortium – Scotland ‘s drugs watchdog
Sources and References:
The Scotsman
NICE
February 2009
Breast cancer screening peril
In a letter to The Times 23 signatories accuse the NHS Screening Programme of failing to provide women with all the facts when inviting them to routine breast cancer checks . They say that ‘none of their invitations for screening comes close to telling the truth. As a result, women are being manipulated…into attending’. The letter says that ‘there are harms associated with early detection of breast cancer by screening that are not widely acknowledged’. It notes that many breast cancers will not do any harm if left alone; but once detected, a woman may go on to a conveyor belt of unnecessary and often aggressive treatment, including surgery, radiotherapy and possibly chemotherapy.
This letter was published the day before an analysis by the Nordic Cochrane Centre of breast cancer and screening was published in the British Medical Journal. The analysis concluded that the information distributed by the NHS was one sided and misleading for those invited to take part. While it talks of the benefits of attending the programme, it does not tell them of the disadvantages i.e. the possibility of over-diagnosis, misdiagnosis, the potential harm of the treatments for cancer and the psychological trauma of being given a cancer diagnosis. They say ‘The leaflet has the authoritative title Breast Screening: The Facts suggesting that the information can be trusted…[but] it is inadequate as a basis for informed consent’. Their research showed that if 2000 women were screened regularly for 10 years, one would avoid dying from breast cancer, but 10 healthy women would be treated unnecessarily and a further 200 healthy women will have a false alarm.
The Nordic Centre study, led by Peter Gotzsche, notes that despite the fact that20% of cancers detected by screening were DCIS cases, the NHS leaflet makes no mention of this. Fewer than half of DCIS cases become invasive cases and it is often referred to as a pre cancerous condition. DCIS has been found to exist harmlessly in the breasts of about 9% of women at post mortem, but the increased use of mammography has led to vastly increased rates of DCIS being reported. One of the signatories to The Times letter, Professor Michael Baum, said that more cases should be treated like many prostate cancer cases, with a number of men allowed to live with the cancer and often dying of unrelated causes. He said ‘the number of invasive breast cancers being detected is not falling, despite the number of cases picked up by screening rising dramatically… You would expect serious cancers to drop because the early detection means the DCIS cases are not progressing. It just doesn’t add up.’ He has said that instead of screening the whole female population over the age of 50, every 3 years, women should be tested according to their level of risk.
However, the study is disputed by the NHS who report that the national screening programme detects more than 14,000 cancers annually and saves 1,400 lives. They add that 79% of cancers detected through screening are invasive. Professor Peter Johnson, Cancer Research UK's chief clinician, said that any debate about the details "should not be allowed to distract anyone from the benefits of breast screening".
"Screening offers the best possible opportunity for early diagnosis of breast cancer and experts agree that this means a better chance of successful treatment," he explained.
"The information women receive at time of screening is based on careful research into the views of the women being screened. Improvements can always be made and we are contributing to a review by the Department of Health.”
19th February 2009
including surgeons, GP’s, oncologists, public health specialists and patient representatives
Done by mammography
Currently available to all women aged 50-70 every three years. It is to be extended to include women from 47-73 by 2012.
Ductal carcinoma in situ
Sources and Information:
The Times
The Sunday Times
Cancer Research UK
NHS
‘Breast Screening: the facts - or maybe not’ by Peter Gotzsche et al in the BMJ 2009;338:b86
Decline in breast cancer risk when HRT use stopped
The results of a US study, published in the New England Medical Journal, has provided further evidence that post menopausal women who take HRT (combined oestrogen plus progestin hormone therapy being the most commonly prescribed HRT in the UK) face a greater risk of breast cancer, but that when they stop taking HRT, the risk falls sharply again.
The study was part of a larger trial, started in the early 90’s, investigating post menopausal women. The HRT part of the study was stopped in 2002, when researchers found that women taking HRT had higher rates of breast cancer than those taking a placebo. This was followed by a significant drop in the number of women taking HRT, which was in turn followed by a corresponding fall in breast cancer rates. There has been much debate on whether these two facts are linked, but in this latest study, the researchers were satisfied that there was a clear link.
The study continued monitoring 15,000 women from the original study, who had all been urged to stop taking HRT in 2002 and compared this with data from women not originally involved, who had been given no specific advice on giving up. In the first group, the incidence of breast cancer was much higher in the 5 years up to 2002, but then fell rapidly, with diagnosed cases falling by 28% in a year. These women had approximately the same number of mammograms before and after 2002. This is relevant as some had argued previously that a reduction in the frequency of mammograms among women who stopped taking HRT might have contributed to the apparent fall.
Many women in the other group of women chose to stop taking the therapy and this coincided with a 43% fall in breast cancer rates between 2002 and 2003. Women in this group who continued taking HRT were at a higher risk of cancer, with the risk doubling for every 5 years of taking the HRT.
Dr Marcia Stafanik (co author and professor of medicine at Stanford University) said:
‘You start women on hormones and within five years, their risk of breast cancer is clearly elevated. You stop the hormones and within one year, their risk is essentially back to normal. It’s reasonably convincing cause-and-effect data’.
Dr Rowan Chlebowski, (chief investigator at the Los Angeles Biomedical Research Institute and lead author of the study) advised:
‘Postmenopausal women and their physicians should consider these findings in weighing the risks and benefits of combined oestrogen plus progestin use, especially if the women plan to take the medication for more than five years’.
Professor Valerie Beral (director of Cancer Research UK Epidemiology Unit at Oxford University) said:
‘There has been a big drop in HRT use since 2002. Because of this about 1000 fewer UK women are developing breast cancer every year’.
However, Dr David Sturdee (president of the International Menopause Society, which represents HRT specialists) is not convinced. He said:-
‘There’s no doubt there has been a drop in breast cancer rates, which is good news, but this started before the reduction in HRT use. Breast cancer takes years to develop, so if this drop was due to stopping HRT, we wouldn’t be seeing it just yet. There’s something happening, which is worth investigating, but it’s unlikely to be HRT.
Sources and References:-
BBC News
Cancer Research News
Chlebowski RT et al. Breast Cancerafter use of estrogen plus progestrin in postmenopausal women.
N Engl J Med Feb 5; 360:573
Hormone injections improve survival in premenopausal breast cancer patients
A study in the Journal of the National Cancer Institute is thought to be the first to look at the long term impact of goserelin (more commonly known as Zoladex and given by injection) and its effectiveness compared to tamoxifen, an oestrogen blocking drug. Cancer Research UK scientists and their colleagues have shown that treatment with goserelin improves long term survival in premenopausal breast cancer patients.
Hormonal therapies interfere with the production or action of particular hormones in the body. Most breast cancers need supplies of the hormone oestrogen to grow. Production of oestrogen by the ovaries is stimulated by a hormone called leuteinising hormone, which is produced by the pituitary gland in the brain. Zoladex stops the production of leuteinising hormone from the pituitary gland, which leads to a reduction in oestrogen levels. The cancer cells then grow more slowly or stop growing altogether. The cancer may shrink in size.
Researchers recruited over 2700premenopausal women with breast cancer and placed them randomly in one of four treatment groups, receiving either Zoladex, tamoxifen, both drugs or neither one, for 2 years.
It was found that women who were given Zoladex experienced similar outcomes to those taking tamoxifen. 15 years after the start of treatment there were 8.5 fewer deaths per 100 and 13.9 fewer recurrences per 100 among those who were given Zoladex alone than among those taking neither drug. There was no significant benefit from taking both drugs.
It seems that based on long term follow up of this trial, Zoladex is as effective as tamoxifen when each are given for 2 years. Researchers said:
‘IT may be that women who are unlikely to complete 5 years of tamoxifen tablets may prefer two years of goserelin injections.’
Sources:
Cancer Research UK
Cancerbackup
In a letter to The Times 23 signatories accuse the NHS Screening Programme of failing to provide women with all the facts when inviting them to routine breast cancer checks . They say that ‘none of their invitations for screening comes close to telling the truth. As a result, women are being manipulated…into attending’. The letter says that ‘there are harms associated with early detection of breast cancer by screening that are not widely acknowledged’. It notes that many breast cancers will not do any harm if left alone; but once detected, a woman may go on to a conveyor belt of unnecessary and often aggressive treatment, including surgery, radiotherapy and possibly chemotherapy.
This letter was published the day before an analysis by the Nordic Cochrane Centre of breast cancer and screening was published in the British Medical Journal. The analysis concluded that the information distributed by the NHS was one sided and misleading for those invited to take part. While it talks of the benefits of attending the programme, it does not tell them of the disadvantages i.e. the possibility of over-diagnosis, misdiagnosis, the potential harm of the treatments for cancer and the psychological trauma of being given a cancer diagnosis. They say ‘The leaflet has the authoritative title Breast Screening: The Facts suggesting that the information can be trusted…[but] it is inadequate as a basis for informed consent’. Their research showed that if 2000 women were screened regularly for 10 years, one would avoid dying from breast cancer, but 10 healthy women would be treated unnecessarily and a further 200 healthy women will have a false alarm.
The Nordic Centre study, led by Peter Gotzsche, notes that despite the fact that20% of cancers detected by screening were DCIS cases, the NHS leaflet makes no mention of this. Fewer than half of DCIS cases become invasive cases and it is often referred to as a pre cancerous condition. DCIS has been found to exist harmlessly in the breasts of about 9% of women at post mortem, but the increased use of mammography has led to vastly increased rates of DCIS being reported. One of the signatories to The Times letter, Professor Michael Baum, said that more cases should be treated like many prostate cancer cases, with a number of men allowed to live with the cancer and often dying of unrelated causes. He said ‘the number of invasive breast cancers being detected is not falling, despite the number of cases picked up by screening rising dramatically… You would expect serious cancers to drop because the early detection means the DCIS cases are not progressing. It just doesn’t add up.’ He has said that instead of screening the whole female population over the age of 50, every 3 years, women should be tested according to their level of risk.
However, the study is disputed by the NHS who report that the national screening programme detects more than 14,000 cancers annually and saves 1,400 lives. They add that 79% of cancers detected through screening are invasive. Professor Peter Johnson, Cancer Research UK's chief clinician, said that any debate about the details "should not be allowed to distract anyone from the benefits of breast screening".
"Screening offers the best possible opportunity for early diagnosis of breast cancer and experts agree that this means a better chance of successful treatment," he explained.
"The information women receive at time of screening is based on careful research into the views of the women being screened. Improvements can always be made and we are contributing to a review by the Department of Health.”
19th February 2009
including surgeons, GP’s, oncologists, public health specialists and patient representatives
Done by mammography
Currently available to all women aged 50-70 every three years. It is to be extended to include women from 47-73 by 2012.
Ductal carcinoma in situ
Sources and Information:
The Times
The Sunday Times
Cancer Research UK
NHS
‘Breast Screening: the facts - or maybe not’ by Peter Gotzsche et al in the BMJ 2009;338:b86
Decline in breast cancer risk when HRT use stopped
The results of a US study, published in the New England Medical Journal, has provided further evidence that post menopausal women who take HRT (combined oestrogen plus progestin hormone therapy being the most commonly prescribed HRT in the UK) face a greater risk of breast cancer, but that when they stop taking HRT, the risk falls sharply again.
The study was part of a larger trial, started in the early 90’s, investigating post menopausal women. The HRT part of the study was stopped in 2002, when researchers found that women taking HRT had higher rates of breast cancer than those taking a placebo. This was followed by a significant drop in the number of women taking HRT, which was in turn followed by a corresponding fall in breast cancer rates. There has been much debate on whether these two facts are linked, but in this latest study, the researchers were satisfied that there was a clear link.
The study continued monitoring 15,000 women from the original study, who had all been urged to stop taking HRT in 2002 and compared this with data from women not originally involved, who had been given no specific advice on giving up. In the first group, the incidence of breast cancer was much higher in the 5 years up to 2002, but then fell rapidly, with diagnosed cases falling by 28% in a year. These women had approximately the same number of mammograms before and after 2002. This is relevant as some had argued previously that a reduction in the frequency of mammograms among women who stopped taking HRT might have contributed to the apparent fall.
Many women in the other group of women chose to stop taking the therapy and this coincided with a 43% fall in breast cancer rates between 2002 and 2003. Women in this group who continued taking HRT were at a higher risk of cancer, with the risk doubling for every 5 years of taking the HRT.
Dr Marcia Stafanik (co author and professor of medicine at Stanford University) said:
‘You start women on hormones and within five years, their risk of breast cancer is clearly elevated. You stop the hormones and within one year, their risk is essentially back to normal. It’s reasonably convincing cause-and-effect data’.
Dr Rowan Chlebowski, (chief investigator at the Los Angeles Biomedical Research Institute and lead author of the study) advised:
‘Postmenopausal women and their physicians should consider these findings in weighing the risks and benefits of combined oestrogen plus progestin use, especially if the women plan to take the medication for more than five years’.
Professor Valerie Beral (director of Cancer Research UK Epidemiology Unit at Oxford University) said:
‘There has been a big drop in HRT use since 2002. Because of this about 1000 fewer UK women are developing breast cancer every year’.
However, Dr David Sturdee (president of the International Menopause Society, which represents HRT specialists) is not convinced. He said:-
‘There’s no doubt there has been a drop in breast cancer rates, which is good news, but this started before the reduction in HRT use. Breast cancer takes years to develop, so if this drop was due to stopping HRT, we wouldn’t be seeing it just yet. There’s something happening, which is worth investigating, but it’s unlikely to be HRT.
Sources and References:-
BBC News
Cancer Research News
Chlebowski RT et al. Breast Cancerafter use of estrogen plus progestrin in postmenopausal women.
N Engl J Med Feb 5; 360:573
Hormone injections improve survival in premenopausal breast cancer patients
A study in the Journal of the National Cancer Institute is thought to be the first to look at the long term impact of goserelin (more commonly known as Zoladex and given by injection) and its effectiveness compared to tamoxifen, an oestrogen blocking drug. Cancer Research UK scientists and their colleagues have shown that treatment with goserelin improves long term survival in premenopausal breast cancer patients.
Hormonal therapies interfere with the production or action of particular hormones in the body. Most breast cancers need supplies of the hormone oestrogen to grow. Production of oestrogen by the ovaries is stimulated by a hormone called leuteinising hormone, which is produced by the pituitary gland in the brain. Zoladex stops the production of leuteinising hormone from the pituitary gland, which leads to a reduction in oestrogen levels. The cancer cells then grow more slowly or stop growing altogether. The cancer may shrink in size.
Researchers recruited over 2700premenopausal women with breast cancer and placed them randomly in one of four treatment groups, receiving either Zoladex, tamoxifen, both drugs or neither one, for 2 years.
It was found that women who were given Zoladex experienced similar outcomes to those taking tamoxifen. 15 years after the start of treatment there were 8.5 fewer deaths per 100 and 13.9 fewer recurrences per 100 among those who were given Zoladex alone than among those taking neither drug. There was no significant benefit from taking both drugs.
It seems that based on long term follow up of this trial, Zoladex is as effective as tamoxifen when each are given for 2 years. Researchers said:
‘IT may be that women who are unlikely to complete 5 years of tamoxifen tablets may prefer two years of goserelin injections.’
Sources:
Cancer Research UK
Cancerbackup
January 2009
Cancer patients eligible to apply for free prescriptions
From 1 April 2009, all cancer patients will be eligible for free NHS prescriptions covering all treatments, not just those related to their cancer.
The scheme is available to those undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment.
Patients need to get an application form from their GP’s surgery or oncology clinic. The form must be signed by the patient and their GP, hospital doctor or service doctor.
The certificate lasts for 5 years and can be renewed as many times as necessary, as long as the patient still satisfies the qualifying conditions.
If you haven’t got a certificate yet, ask for a refund form whenever you pay for a prescription after April 1. When you receive your certificate, you can reclaim that money, but note that after April 1, any certificates issued will only be backdated to begin one month prior to receipt of application.
It is estimated that up to 150,000 people will benefit from this scheme, with individuals saving up to £100 each year in prescription charges.
Source: www.nhs.uk
Drinking tea can cut risk of breast cancer
In January 2009, various newspapers reported that drinking 3 cups of tea a day could cut the risk of younger women developing breast cancer on the basis that the anti cancer properties of tea could have a more potent effect on the types of tumours commonly seen in younger women.
The claim was based on a case-control study of 5,000 women aged 20-74, who had been treated for breast cancer. These women were interviewed on their consumption of tea over the 5 years prior to their cancer being diagnosed and their responses were compared with those of 4,500 healthy women, with similar medical histories and lifestyles.
While the authors say that tea consumption is not related to breast cancer risk overall, they report that in their sub group analyses, women under 50, who drank 3 or more cups of tea a day, had a 37% reduced breast cancer risk compared to women reporting no tea consumption. The researchers said that while further research was needed on this issue, their results provide support for the theory that ‘regular tea consumption, particularly at moderately high levels, might reduce breast cancer risk in younger women’.
The research was conducted by Dr Nagi Kumar of the Cancer Center & Research Institute in Tampa, Florida and colleagues from various other institutions and published in a peer-reviewed medical journal.
The view of the NHS Knowledge Service is that while this study is interesting, they should not provide the basis by which people decide what to drink and that the research should be seen as low-level evidence .
Sources and References:
www.nhs.uk/news
‘Tea Consumption and Risk of Breast Cancer ‘– Cancer Epidemiology Biomarkers & Prevention 18, 341-345, January 1, 2009 by Kumar N, Titus-Ernstoff L, Newcomb PA et al.
Embryo Screening and the BRCA1 gene
January 2009, saw the birth of the first British baby, genetically screened before conception, to be free of the faulty BRCA1 gene. Paul Serhal (medical director of the assisted conception unit at University College Hospital, London) said:
‘This little girl will not face the spectre of developing this genetic form of breast cancer or ovarian cancer in her adult life. The parents will have been spared the risk of inflicting this disease on their daughter. The lasting legacy is the eradication of the transmission of this form of cancer that has blighted these families for generations.’’
A woman carrying a faulty BRCA1 gene has a 50%-85% chance of developing breast cancer and in this case, the girl was considered to have an 80% chance of developing the disease based on the fact that the faulty gene ran through her father’s family.
PGD (pre-implantation genetic diagnosis) has already been used in this country to free babies of life shortening inherited diseases such as cystic fibrosis and Huntington’s, but special permission had to be sought from the Human Fertilisation and Embryology Authority by the London Clinic which performed the procedure. For the first time, embryo selection was made for the purpose of reducing rather than eliminating the baby’s chances of getting breast cancer as an adult. PGD involves testing a group of embryos to ensure that the one returned to the womb does not carry faulty genes. In this case, 6 out of the 11 embryos tested carried the defective BRCA1 gene. Two embryos which were free of the gene were implanted, resulting in a single pregnancy.
However, it is recognised that the decision to screen embryos for this gene is a complex area and raises a number of ethical issues. The discarded embryos might have become women who would never have had cancer and although women with faulty BRCA1 and 2 genes have a risk of up to 7 times higher than other women of developing breast or ovarian cancer, some of them will be cured and some might never have developed these diseases at all. Finally, it cannot be said that this baby will be cancer free during her lifetime; all that can be said with certainty is that she does not carry the BRCA1 gene.
Source:
The Guardian Newspaper
From 1 April 2009, all cancer patients will be eligible for free NHS prescriptions covering all treatments, not just those related to their cancer.
The scheme is available to those undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment.
Patients need to get an application form from their GP’s surgery or oncology clinic. The form must be signed by the patient and their GP, hospital doctor or service doctor.
The certificate lasts for 5 years and can be renewed as many times as necessary, as long as the patient still satisfies the qualifying conditions.
If you haven’t got a certificate yet, ask for a refund form whenever you pay for a prescription after April 1. When you receive your certificate, you can reclaim that money, but note that after April 1, any certificates issued will only be backdated to begin one month prior to receipt of application.
It is estimated that up to 150,000 people will benefit from this scheme, with individuals saving up to £100 each year in prescription charges.
Source: www.nhs.uk
Drinking tea can cut risk of breast cancer
In January 2009, various newspapers reported that drinking 3 cups of tea a day could cut the risk of younger women developing breast cancer on the basis that the anti cancer properties of tea could have a more potent effect on the types of tumours commonly seen in younger women.
The claim was based on a case-control study of 5,000 women aged 20-74, who had been treated for breast cancer. These women were interviewed on their consumption of tea over the 5 years prior to their cancer being diagnosed and their responses were compared with those of 4,500 healthy women, with similar medical histories and lifestyles.
While the authors say that tea consumption is not related to breast cancer risk overall, they report that in their sub group analyses, women under 50, who drank 3 or more cups of tea a day, had a 37% reduced breast cancer risk compared to women reporting no tea consumption. The researchers said that while further research was needed on this issue, their results provide support for the theory that ‘regular tea consumption, particularly at moderately high levels, might reduce breast cancer risk in younger women’.
The research was conducted by Dr Nagi Kumar of the Cancer Center & Research Institute in Tampa, Florida and colleagues from various other institutions and published in a peer-reviewed medical journal.
The view of the NHS Knowledge Service is that while this study is interesting, they should not provide the basis by which people decide what to drink and that the research should be seen as low-level evidence .
Sources and References:
www.nhs.uk/news
‘Tea Consumption and Risk of Breast Cancer ‘– Cancer Epidemiology Biomarkers & Prevention 18, 341-345, January 1, 2009 by Kumar N, Titus-Ernstoff L, Newcomb PA et al.
Embryo Screening and the BRCA1 gene
January 2009, saw the birth of the first British baby, genetically screened before conception, to be free of the faulty BRCA1 gene. Paul Serhal (medical director of the assisted conception unit at University College Hospital, London) said:
‘This little girl will not face the spectre of developing this genetic form of breast cancer or ovarian cancer in her adult life. The parents will have been spared the risk of inflicting this disease on their daughter. The lasting legacy is the eradication of the transmission of this form of cancer that has blighted these families for generations.’’
A woman carrying a faulty BRCA1 gene has a 50%-85% chance of developing breast cancer and in this case, the girl was considered to have an 80% chance of developing the disease based on the fact that the faulty gene ran through her father’s family.
PGD (pre-implantation genetic diagnosis) has already been used in this country to free babies of life shortening inherited diseases such as cystic fibrosis and Huntington’s, but special permission had to be sought from the Human Fertilisation and Embryology Authority by the London Clinic which performed the procedure. For the first time, embryo selection was made for the purpose of reducing rather than eliminating the baby’s chances of getting breast cancer as an adult. PGD involves testing a group of embryos to ensure that the one returned to the womb does not carry faulty genes. In this case, 6 out of the 11 embryos tested carried the defective BRCA1 gene. Two embryos which were free of the gene were implanted, resulting in a single pregnancy.
However, it is recognised that the decision to screen embryos for this gene is a complex area and raises a number of ethical issues. The discarded embryos might have become women who would never have had cancer and although women with faulty BRCA1 and 2 genes have a risk of up to 7 times higher than other women of developing breast or ovarian cancer, some of them will be cured and some might never have developed these diseases at all. Finally, it cannot be said that this baby will be cancer free during her lifetime; all that can be said with certainty is that she does not carry the BRCA1 gene.
Source:
The Guardian Newspaper
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