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Certain breast lesions diagnosed as benign on core needle biopsy have cancer at surgical excision and thus should be removed, according to a study appearing in the March issue of Radiology.
"Our study shows that all papillary lesions of the breast should be surgically excised to avoid missing a cancer," said the study's lead author, Cecilia L. Mercado, M.D., assistant professor of radiology at New York University Medical Center in New York City.
Papillary lesions are benign growths in the duct of the breast. They comprise approximately 1 to 3 percent of all lesions sampled by core needle biopsies. Currently, the treatment of these lesions alternates between radiographic follow-up and surgical excision, and is often dependent upon physician recommendation.
"To date, the management of benign papillary lesions on core needle biopsy has been controversial and may be based on anecdotal evidence or small published studies," Dr. Mercado said. "No definite guidelines are published for management of these lesions."
While papillary lesions may be diagnosed as benign, they can harbor adjacent atypical ductal hyperplasia (ADH) - a condition characterized by cells of unusual size, shape, and number in the lining of the milk ducts - and ductal carcinoma in situ (DCIS), which are cancerous cells confined to the lining of the milk ducts. Left unchecked, both these conditions pose increased risk of future malignancy.
For the study, Dr. Mercado and colleagues reviewed the imaging and histologic follow-up findings in 42 patients diagnosed with benign papillary lesions after breast core needle biopsy. Forty-three biopsies were performed on the 42 patients. Of the 43 biopsies, 36 (84 percent) of the lesions were surgically removed, and seven (16 percent) received long-term imaging follow-up.
Upon surgical excision and follow-up, the diagnoses of nine of 42 patients (21.4 percent) were upgraded to ADH or DCIS. This is a much higher percentage than reported by previous studies.
"This is one of the largest series and shows statistically significant findings," Dr. Mercado said. "The results of our study revealed a considerable upgrade rate to either ADH or DCIS at core-needle biopsy. Therefore, all benign papillary lesions of the breast should be surgically excised, since a considerable number of atypical lesions and malignant lesions could be missed."
Feb 27, 2006
HRT Use And Risk Of Breast Cancer
If you're taking postmenopausal hormone therapy this is the time to stop it. A new research has found that postmenopausal hormone therapy with estrogen or estrogen-progestin combination is associated with an increase in breast cancer risk across all ethnic groups.
The link between postmenopausal hormone therapy and breast cancer has been established in previous studies, but it is unclear whether this association varies by specific prognostic factors and ethnicity.
The current research is consistent with previous studies showing an association between hormone therapy use and breast cancer. This risk is higher with estrogen-progestin combination therapy.
Dr. Malcolm Pike from the University of Southern California, Los Angeles, and colleagues write in the International Journal of Cancer about these new research findings. Moreover, "our study provides some of the first results comparing breast cancer risk among different ethnic groups in relation to hormone therapy use. The results suggest that risk among women of other races is similar to the risk previously reported among Whites," they note.
These new conclusions are based on data from the Multiethnic Cohort Study of more than 55,000 women. Current use of estrogen-progestin increases the risk of breast cancer by about 29 percent per 5 years of use. Current use of estrogen was associated with a 10 percent increased risk of breast cancer per 5 years of use.
Feb 27, 2006
Sheryl Crow Undergoes Breast Cancer Surgery
As per her own reports, Rocker Sheryl Crow underwent "successful minimally invasive surgery for breast cancer". This fact is reported on her own web site. The post says, "Her doctors confirm her prognosis as excellent and she will receive radiation treatment as a precaution."
Sheryl Crow, would now will l have radiation therapy as the reports. Just days before undergoing this top-secret surgery for breast cancer, "Extra" spotted a smiling and carefree Sheryl Crow in Santa Monica.
Sheryl Crow is certainly not new to this disease. Her ex-fiance, Lance Armstrong, and her good friend Melissa Etheridge both survived the disease, and she has previously performed at benefits to fight cancer.
Crow had been scheduled to be the first act to perform in the downtown, with a March 31 concert, but had to undergo this surgery.
The singer-songwriter had the surgery in Los Angeles and is now recovering without any complications, said Dave Tomberlin, her publicist. "Her doctors think her prognosis is excellent," said Tomberlin.
Her web site states that she will have to postpone a North American concert tour that was scheduled to begin in March. She said she hoped to reschedule the dates as soon as possible.
Feb 27, 2006
Obesity And Estrogen Related To Breast Cancer
Obesity and estrogen breakdown products may play a significant role in the development of breast cancer, among those women who never used hormone therapy, as per findings published in the International Journal of Cancer.
Dr. Francesmary Modugno, of the University of Pittsburgh, and colleagues, studied the effects of obesity and say "Hormone therapy and body mass index (BMI) have been associated with postmenopausal breast cancer...... Because estrogen metabolism may affect breast cancer risk and can be altered by weight and hormone therapy, it might play a role in the hormone therapy-BMI-breast cancer associations."
These researchers reached this conclusion after analyzing data from women enrolled in the Observational Study of the Women's Health Initiative. They compared levels of two estrogen metabolic products, in 200 women who developed breast cancer and in 200 women who did not.
The researchers found that in women who used hormone therapy, there was a modest but significant increase in breakdown products of estrogen. In this group of women, there was no association among BMI, estrogen metabolism and breast cancer risk.
On the other hand in the group of women who did not use hormone therapy greater BMI and higher levels of estrogen breakdown products were individually and jointly associated with increased cancer risk. The study showed that women with high BMI and high estrogen breakdown products had 3.5-times more likely to develop breast cancer compared to their counterparts.
Feb 23, 2006
Taxotere Beats Navelbine
Taxotere is more effective than Navelbine in the adjuvant treatment of women with history of breast cancer. A new study, which compared these two drugs, showed docetaxel (Taxotere) would beat vinorelbine (Navelbine), in a head-to-head comparison.
This new study comes from Finland and is published in the latest issue of the New England Journal of Medicine. The study also found that patients who received nine weeks infusions of trastuzumab (Herceptin) were less likely to have disease recurrences with no increase in cardiac toxicity compared to those who did not receive Herceptin.
Treatment with Taxotere translated into a 42 percent reduction in the risk of breast cancer recurrences compared to treatment with Navelbine in the adjuvant setting. However, this comes with a price: women treated with docetaxel had more side effects compared to those who received vinorelbine such as allergic reactions, swelling and fever.
For this large study, Joensuu and his colleagues randomly assigned more than a thousand women with breast cancer three cycles of either docetaxel or vinorelbine, followed by three cycles of other cancer drugs.
Those patients, who had overexpression of HER2/neu gene (numbering 232), were also assigned either to receive nine weeks infusions of Herceptin or a placebo. Those who received the Herceptin had 58 percent reduction in cancer recurrences during the three-year follow-up compared to those who didn't get the drug.
Previous studies have shown that administration of adjuvant trastuzumab (Herceptin) for one year reduces the risk of breast cancer recurrence by about 50 percent in those women who have HER2 over expression. Those studies also found Herceptin to be related to increased risk heart problems. The current study with the shorter duration of Herceptin showed 58 percent reduction in cancer recurrence with no significant cardiac toxicity.
Feb 21, 2006
HRT And Risk Of Tubular Breast Cancers
Postmenopausal hormone replacement therapy (HRT) using estrogen-progestin combinations may be associated with a more than two-fold higher relative risk of developing lobular cancer or tubular cancer than of developing ductal cancer. These results come from a large study from Europe, which was recently published in the journal Breast Cancer Research. Findings from this research show for the first time that estrogen-progestin therapy combination is associated with a higher relative risk of developing tubular cancer than ductal cancer, when taken for more than five years. This study also confirms previous findings that postmenopausal hormone therapy using estrogen-progestin is associated with a higher relative risk of lobular cancer than ductal cancer.
This study was conducted by Lena Rosenberg and colleagues from the Karolinska Institutet in Stockholm, Sweden together with researchers from Genome Institute of Singapore. They combed through the records of 1,888 women with ductal breast cancer, 308 women with lobular cancer and 93 women with tubular breast cancer. All women were matched for age with 3,065 women randomly selected from the population, acted as controls. Both patients and controls were asked to fill in a questionnaire about their medical history, health status and use of menopausal hormone therapy.
Results of the published study show that women who used medium potency estrogen-progestin combination therapy had a higher risk of developing lobular or tubular breast cancer than of developing ductal cancer, compared with women who did not use hormone therapy. Woman who used combination therapy for more than five years were at higher risk for any of these subtypes of breast cancers.
Feb 17, 2006
MRI And Mammography
Researchers have found that mammography coupled with magnetic resonance imaging (MRI) is extremely sensitive in the detection of ductal carcinoma in situ (DCIS). DCIS, or early stage breast carcinoma, is a pre-invasive malignancy and MRI may help identify this type of disease, which may not be visible on a mammogram. This study is published in The Breast Journal.
The study examined the medical records of women diagnosed with DCIS, aged 34 to 79 years, who underwent MRI and mammographic examinations during a period of approximately two years. The results revealed 39 sites of pure DCIS in 33 breasts of 32 women. In each of these women, both MRI and mammograms were performed prior to surgery. Of the 33 breasts involved, DCIS was detected by MRI alone in 64 percent, and detected by mammography alone in only 3 percent. MRI and mammography together detected DCIS in 24 percent of breasts; in 9%, DCIS was found at mastectomy but the mammogram and MRI were negative.
"The results from our small, select group of patients suggest that in women with known or suspected DCIS, determination of the presence and extent of disease may be best established with mammography complemented by MRI," say researchers.
The nuclear grade of DCIS detected by MRI and mammography was similar, though the size of lesions identified by MRI was larger. Breast density did not affect the results.
The American Cancer Society recommends that women age 40 and older should have a mammogram every year and that those at increased risk should talk with their doctors about the benefits and limitations of starting mammograms when they are younger, having additional tests (such as MRI) or having more frequent exams. Source: http://www.blackwellpublishing.com/
Feb 16, 2006
COX-2 Inhibitors May Cut Breast Cancer Risk
Those who use the popular painkillers belonging to the group of COX-2 inhibitors and other nonsteroidal anti-inflammatory agents (NSAIDs) regularly may derive substantial benefit in terms of breast cancer protection from the therapy, as per the research report published in the journal BMC Cancer. Popular COX-2 inhibitors include Celebrex and Vioxx. Vioxx have been recently removed from the market due to the concerns of increased risk of heart attack associated with this drug.
The Lead researcher, Dr. Randall Harris and colleagues from the Ohio State College of Medicine and Public Health in Columbus studied 323 breast cancer patients and 649 cancer-free controls to come to this conclusion. They observed a 71 percent reduction in the risk of breast cancer with the use of selective COX-2 inhibitors, such as Celebrex and Vioxx, for 2 years or more. Benefits were also observed for those who use ibuprofen and regular full dose (325 mg) of aspirin, but the amount of benefit was less compared to use of COX-2 inhibitors. There were no significant benefits observed with the use of acetaminophen, which has negligible COX-2 activity, or with low-dose (81 mg) aspirin.
Dr. Harris, says that this leads stronger evidence for the theory that COX-2 overexpression may lead to breast cancer and opens up potential avenues for chemoprevention and possibly therapy with selective COX-2 blocking agents.
COX-2 inhibitors have been recently implicated in causing increased risk of heart attacks. COX-2 inhibitors have also been shown to be beneficial in other cancers. Additional clinical studies are required to establish the safety and efficacy of COX-2 inhibitors in the treatment of breast cancer.
Feb 15, 2006
Breast Scanner May Replace Mammography
Photo: Martin Tornai, Ph.D., associate professor of radiology and biomedical engineering at Duke University Medical Center with the 3-D breast scanner (photo credit Duke University Medical Center).Researchers at Duke University have created a new type of breast scanner that will dramatically improve their ability to visualize small tumors while also reducing radiation exposure to one-tenth that of normal mammograms. This may also provide relief from the often-painful experience of breast compression that is involved in the traditional mammograms.
These new scanner uses computed tomography (CT), which is the same technique used in obtaining a CT scan of the chest, but with a unique variation: it provides a three-dimensional image of the breast. The new scanner is capable of rotating around the breast to obtain a complete image of the breast, from the nipple to the chest wall. On the other hand, traditional mammograms provide only a two-dimensional image and they compress the breast, thereby distorting the image and causing discomfort for many women.
The Duke researchers have successfully demonstrated their new CT scanner can detect lesions as small as 5 mm in artificial breast models and in cadavers. Current threshold of detection of soft tissue tumors in mammograms are estimated to be around 1 cm, which is about the size of a marble. However mammogram can detect far smaller micro-calcifications, which could be indicators of disease.
The Duke scientists expect that this scanner would be ready for use within two years and is in the process of developing a start-up company to commercialize the device.
Traditional mammography fails to detect some tumors because it is two-dimensional and thus projects a flattened image of the breast. The compression and two-dimensional image cause overlapped tissues to obscure some tumors. With 3-D imaging, the breast is fully depicted and the contrast between normal and cancerous tissues would be more apparent.
Feb 13, 2006
More Likely To Be Diagnosed With Breast Cancer In Summer
[imgl]/images/blog/summer-woman-654580.jpg[/imgl]Scientists have observed that woman generally tend to have diagnosis of breast cancer in spring and summer months compared rest of the year. They believe that this is due to the fact that women are more aware of their body in these months due to skimpier clothes in the warmer weather. This would make them more aware of their body and in turn they examined themselves more often.
Researchers in Manchester combed through the records of 9,500 women who had been diagnosed with breast cancer in the North-West since 2001. They evaluated the date of diagnosis of these women.
These researchers were surprised to find that rates of breast cancer detection soared by about 25 per cent between April and July. It is to be noted that these women's cancers were not detected through the National Screening Programme which involves screening mammogram for those women who are aged more than 50 but were younger women who had gone to their general practitioner because of their own concerns about breast cancer.
This interesting study was lead by Professor Gareth Evans who is an oncologist and consultant in medical genetics at both Christie Hospital-and St Mary's Hospital in Manchester.
Source: Daily Mail; London (UK)
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Every year, more than 200,000 women are diagnosed with breast cancer in the United States. Breast cancer ranks second as the leading cause of cancer deaths in American women. Until recently breast cancer topped the list of leading causes of cancer deaths in women, but lately lung cancer has claimed the top position. If skin cancer is excluded, breast cancer is the commonest cancer among American women.
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