Mammography screening debate rages on

Stamatia Destounis, M.D.

CHICAGO -- Women ages 40 to 49 with no family history of breast cancer have similar rates of invasive disease as those with familial risk, radiologists reported here, firing yet another salvo at government mammography guidelines.

Among a group of more than 1,000 breast cancer patients, 64% of those with no family history of breast cancer had invasive disease, as did 63.2% of those with family history, a non-significant difference, according to Stamatia Destounis, MD, of Elizabeth Wende Breast Care in Rochester, N.Y., and colleagues.

• MedPage Today
• MedScape

FDA revokes Avastin approval for breast cancer

FDA Commissioner Margaret A.
Hamburg, M.D. speaking at a press
briefing last May in Geneva.

FDA Commissioner Margaret A. Hamburg, M.D., said today she is revoking the agency’s approval of the breast cancer indication for Avastin (bevacizumab) after concluding that the drug has not been shown to be safe and effective for that use.

Avastin will still remain on the market as an approved treatment for certain types of colon, lung, kidney and brain cancer (glioblastoma multiforme).

“This was a difficult decision. FDA recognizes how hard it is for patients and their families to cope with metastatic breast cancer and how great a need there is for more effective treatments. But patients must have confidence that the drugs they take are both safe and effective for their intended use,” Dr. Hamburg said. “After reviewing the available studies it is clear that women who take Avastin for metastatic breast cancer risk potentially life-threatening side effects without proof that the use of Avastin will provide a benefit, in terms of delay in tumor growth, that would justify those risks. Nor is there evidence that use of Avastin will either help them live longer or improve their quality of life.”

• FDA Press Release
• MedPage Today
• NY Times

Light-Induced, Specific Killing of Cancer Cells

By Anna Azvolinsky
Researchers have developed a novel way to molecularly target and kill cancer cells, called photoimmunotherapy. The method uses a monoclonal antibody against the epidermal growth factor coupled to a near-infrared dye. The result is a target-specific photosensitizer that causes specific cell death of cells bound by the antibody when NIR light is applied.

• Cancer Network

Small Study Shows Promise of a Vaccine for Metastatic Breast and Ovarian Cancer

By Anna Azvolinsky

Breast and ovarian cancer patients with limited tumor burden and minimal prior chemotherapy appear to have benefited from a novel vaccine, according to trial results just published in Clinical Cancer Research. This trial, and especially the over 3-year sustained response of a patient with advanced breast cancer shows the potential of a therapeutic vaccine for improved outcomes in a selective subset of patients.

• Cancer Network

Prolonged sitting linked to breast cancer, colon cancer

More than 90,000 new cancer cases a year in the United States may be due to physical inactivity and prolonged periods of sitting, a new analysis shows.

The analysis, being presented today at the annual conference of the American Institute for Cancer Research (AICR) in Washington, D.C., cites about 49,000 cases of breast cancer and 43,000 of colon cancer.

• USA Today, Nov. 4, 2011

Data links high doses of bone drug to cancer

A Medtronic product, when used in high doses during spinal fusion procedures, might increase patient cancer risks, according to data released Thursday at a national conference of spine surgeons.

The data had been given to the Food and Drug Administration by Medtronic when it sought approval to market a high-strength version of an existing bone growth product called Infuse. Based on those study findings, the F.D.A. rejected that higher-dose formulation, known as Amplify, citing concern about cancer risks.

• NY Times, Nov. 3, 2011

More evidence obesity tied to colon cancer: study

Nov. 4, 2011 (Reuters) - Older adults who are heavy, especially around the middle, seem to have a higher risk of developing colon cancer than their thinner peers -- and exercise may lower the incidence of the disease, especially for women, a European study said.

• Reuters

Dendreon stock tumbles on Provenge sales forecast

Dendreon stock fell 21.9 percent in after-hours trading Wednesday after the Seattle company said it expected "modest growth" in fourth-quarter sales of its prostate-cancer drug Provenge.Dendreon reported Provenge sales rose 5.6 percent in October to $26.4 million from $25 million in September. But November sales will be "slightly below" October's, CEO Mitch Gold said in a conference call with analysts after the company reported third-quarter results.

Originally published Nov. 2, 2011

• Seattle Times
• Reuters

COPD detection adds more bang to CT screening for lung cancer

Adding a short, low-dose sequence to a CT scan for lung cancer proved useful in identifying current and former heavy smokers with asymptomatic chronic obstructive pulmonary disease (COPD), a new Dutch study shows. Whether adding the ability to diagnose COPD while screening for lung cancer will make the use of CT scans for this purpose cost effective remains unclear.

• Health Imaging Hub
• Medscape

Study shows saw palmetto extract has no effect on prostate

A new study in the Journal of the American Medical Association (JAMA) shows that a popular over-the-counter supplement sold as a treatment for enlarged prostate and as a way to reduce cancer risk, has not effect whatsoever on the prostate. Even at triple the normal dose, there was no effect. At the same time there were few side effects, other than the waste of time and money for a medicine with no benefit.

• JAMA press release

False-Positives Par for Course With Yearly Mammograms

Most women who start getting annual mammograms at age 40 can expect to need re-imaging because of a false-positive result at least once by age 50, a national, cohort study determined.

Over 10 years of annual screening starting at age 40, the cumulative probability was 61.3% for a false-positive recall and 7% for a false-positive biopsy, Rebecca A. Hubbard, PhD, of the Group Health Research Institute in Seattle, and colleagues found. 

• MedPage Today
• Patient Summary of the study in the Annals of Internal Medicine

Study indicates ginger may be root of lower colon cancer rates in Asian diets

People who took ginger supplements showed reduced signs of inflammation in the colon compared to people who didn't take the supplements, researchers say.

The small study of 30 healthy adults was designed to see if studies in mice and rats that have shown ginger may prevent tumor development might also have similar cancer prevention properties in humans. The study was published in the journal Cancer Prevention Research, and was reported on by WebMD.

Federal panel discourages PSA test for prostate cancer

A federal advisory panel wanted to figure out whether widespread PSA testing saves enough lives to justify the considerable medical fallout of the test. The panel said no, for several reasons. Here are some facts about the U.S. Preventive Services Task Force's draft report, released Friday, that recommended against routine use of the PSA test. 

• LA Times
• USA Today

Who are these people?

October 07, 2011 – By Melissa Healy/Los Angeles Times/For the Booster Shots blog

If the world of primary-care physicians had a supreme wizarding council that only weighed in on screening tests and pills promising to head off disease, it would be called the U.S. Preventive Services Task Force.

• LA Times

Breast cancer unawareness month

October 7, 2011 – Perhaps no other disease gets the attention that breast cancer does during October, National Breast Cancer Awareness month. There are countless walks, runs, and relays for breast cancer, NFL players wear pink shoes, politicians appear in public without a pink ribbon at their own peril. Amid all the hoopla about beating this dreaded disease, there are all those breast cancer survivors who are not so lucky. Instead of marching triumphantly having beaten the disease, they survive with hour glass with the sand running out on their survival. These are women and yes men who live with metastatic breast cancer, and there is no cure for this advance stage disease. This report on MedPage Today brings that perspective to Breast Cancer Awareness month.

• MedPage Today blog

Takeda withdraws FDA application for expanding use of Velcade

Takeda Oncology Company has withdrawn its application for expanding the use of the drug Velcade to treat relapsed follicular lymphoma in combination with rituximab. The decision was made after disappointing results of the LYM-3001 trial published last July in Lancet Oncology. The study showed that combining Velcade with rituximab  slowed the progression of relapsed follicular lymphoma by an median of 1.8 months or about 54 days. Velcade remains on the market for the treatment of mantle cell lymphoma.

• Genetic Engineering & Biotechnology News

Annual mammograms after breast cancer needed for survivors

Oct. 2, 2011 – Women who have had breast cancer should have annual mammograms for at least 10 years to cut their chances of dying of the disease, a review of past studies suggests.

The findings support current guidelines in both the United States and the United Kingdom, but a separate survey conducted by the researchers led by Clare Robertson of the University of Aberdeen, Scotland, found that 74 percent of surgeons and radiologists stopped following women with annual mammograms before 10 years post treatment. The study and the survey were published online in Health Technology Assessment ahead of the Oct. issue. 

Hospitalization risk following prostate biopsy higher than thought

Transrectal ultrasound-guided needle biopsy of the prostate.
(Illustration courtesy of National Institute of Diabetes and
Kidney Diseases)

Sept. 23, 2011 – Cancer Digest – Men who undergo prostate biopsy for suspected cancer are more than twice as likely to be hospitalized within a month of the biopsy compared to men who don’t have the procedure, a new study shows.

For first time lung cancer rates for women drop

Sept. 19, 2011  (Cancer Digest) – The Centers for Disease Control (CDC) reported this week that the number of men and women being diagnosed with lung cancer dropped over the recent decade of 1999 to 2008, that’s the first time the rate for women has dropped.

While men have been quitting steadily over the past decade the rates for women had been going up until 2006, when the trend reversed, and lung cancer rates for women began to decline.

The CDC's report, which was issued Sept. 18, showed that the decrease in lung cancer cases corresponds with decreases in smoking. States that have made the greatest investments in effective tobacco control strategies are seeing larger reductions in smoking and greater savings in smoking-related health care costs. 

Such states with the lowest lung cancer rates among men were in the West, and lung cancer rates among women declined in California, Florida, Nevada, Oregon, Texas and Washington. 

The CDC published the study results in the CDC’s Morbidity and Mortality Weekly Report. To read the full report, visit the CDC's Vital Signs report: Adult Smoking in the US.

Daughters' breast cancer showing up earlier than their moms

(Photo courtesy National Institutes
of Health)

Sept. 12, 2011 (Cancer Digest) – What you don’t know can hurt you, and now researchers know that what you do know may hurt you sooner, at least as far genetic mutations for breast cancer are concerned.

A new study shows that women carriers of two genetic mutations that dramatically boost the risk of breast cancer are being diagnosed with breast cancer at an average age of 42 compared to age 48 for their mothers and aunts. The study was published online ahead of print in the journal Cancer.

Co-Author Dr. Jennifer Litton, assistant professor in MD Anderson Cancer Center’s department of Breast Medical Oncology, and colleagues say the study raises the possibility that having the genetic mutations in BRCA-1 or BRCA-2 may be causing cancer at an earlier age with each successive generation, a phenomenon called anticipation.

Bone Cancer Drug Reconsidered by UK's National Health Service

SEPT. 7, 2011 – Japanese drugmaker Takeda won acceptance of its bone cancer drug, Mepact, to be included in the approved formulary of the state-funded National Health Service after reducing the price of the drug. The drug had failed to meet the National Health Service's cost-benefit profile last October. Takeda revised its proposal by adding a price-reduction scheme that would make the drug free for the first seven doses.

• Reuters
• Bloomberg

Chemotherapy before surgery gives big boost to women with BRCA1 gene

Women with the BRCA1 gene mutation
are more likely to achieve a complete
response with chemotherapy before
surgery. (Photo courtesy NCI.)

SEPT. 6, 2011 (CancerDigest) – If there is a silver lining to being a woman with the BRCA1 gene mutation that increases the risk of breast cancer, it is that they also have a good chance of responding to therapy. Almost half the women with the BRCA1 gene mutation who underwent chemotherapy before surgery achieved a complete response, meaning disappearance of all cancer based on microscopic examination of tissue samples in a recent study.

The study, led by Dr. Banu Arun, professor in the Department of Breast Medical Oncology at MD Anderson Cancer Center, is the largest to date to find that complete response rate is significantly higher in women with the BRCA1 mutation than for women with BRCA2 mutations. The study showed that 46 percent of the BRCA1 women achieved the complete response compared to 13 percent of those with BRCA2, and 22 percent of women without either gene mutation. The study was published online Sept. 6, 2011 in The Journal of Clinical Oncology.

Skin-Cancer Diagnostic Device Gains EU Approval

SEPT. 6, 2011 – A device to detect the deadly form of skin cancer that has been ruled as not approvable by the U.S. FDA, has been approved by The European Union. The handheld imager and a computer program that analyzes images of the skin in an attempt to distinguish melanoma from harmless blemishes. The company says its study showed MelaFind was 98.3% effective in identifying melanoma. The study, which examined 1,632 skin lesions on 1,383 patients, was published in the Archives of Dermatology. 

• Wall Street Journal
• Business Week

DNA bits can ID most likely fatal prostate cancers

Dr. Janet Stanford, led an
international team that
identified gene variants
linked to lethal prostate
cancer. (Photo by Suzie
Fitzhugh, courtesy
FHCRC)

Researchers have identified inherited gene variations that provide doctors with a way to predict which prostate cancers need to be treated aggressively and which may be safely watched.

Led by Dr. Janet Stanford, co-director of the Program in Prostate Cancer Research at Fred Hutchinson Cancer Research Center, in Seattle, the researchers analyzed DNA in blood samples from 1,309 prostate cancer patients in the Seattle area. They found 22 bits of DNA, called single-nucleotide polymorphisms or SNPs that are significantly associated with prostate cancer-specific mortality. When they then compared them with a similar Swedish study, they identified five of these SNPs in common, suggesting that these five SNPs are valid markers of prostate-cancer mortality. The study was published Aug. 16 in the journal Cancer Epidemiology Biomarkers and Prevention.

Virtual colonography less cost-effective than stool tests

Virtual colonoscopy is more effective than not screen-
ing, but more costly and less effective than stool test
with sigmoidoscopy, and colonoscopy.
(photo used by permission of RSNA)

MADISON, WI – (Cancer Digest) –There’s no perfect colorectal cancer screening method, but if cost-effectiveness is one of your considerations, the least invasive is also the least cost-effective, according to a new study.

Led by Dr. David Vanness, assistant professor at the University of Wisconsin School of Medicine and Public Health, the researchers compared the cost-effectiveness of CT colonography for colorectal cancer screening in average-risk asymptomatic subjects in the United States aged 50 years. The study was published this week online in the journal Radiology.

First long-term success for gene therapy cures leukemia

In the study the researchers used a disabled lentivirus to

introduce a gene into T-cells that would produce a protein 

on the cell surface that would lock on to the leukemic cells.

(Image provided by the National Institutes of Health)

For the first time a patient’s own cells have been successfully re-engineered to kill leukemia cells over a long period of time, researchers in Pennsylvania report.

In this first successful use of gene therapy to treat cancer, two people with advanced stage chronic lymphocytic leukemia have seen their cancers eliminated for more than a year, and a third has been living with the cancer held in check for that long.  Chronic lymphocytic leukemia, or CLL, is a common form of leukemia that causes over-production of non-functioning B-cells, the blood cells that normally protect the body with antibodies.

Updated old test accurately IDs colon cancer

Newer versions of the fecal occult
blood test is 90 percent accurate in
identifying colon cancer. (photo
courtesy Andrew Scott, Wikipedia)

A newer version of the inexpensive stool test proved to be 90 percent accurate in identifying colon cancer, according to a new study, Reuters Health reports.
The new test called the immunochemical fecal occult blood test, or iFOBT, has replaced the older version of the test but there have been few studies comparing it to the "gold standard" colonoscopy.  The new study led by Dr. Yi-Chia Lee of National Taiwan University Hospital was published in the Canadian Medical Association Journal online Aug. 2, 2011 ahead of the print edition.

Eating lots of fiber lowers breast cancer risk

Consuming high amounts of high-fiber
foods, such as legumes, may reduce
breast cancer risk. (Photo courtesy
U.S. Department of Agriculture) 

Women who participated in previous studies of diet and breast cancer and ate the most fiber had a 11 percent lower chance of developing breast cancer. That's the conclusion of a re-analysis of the data pooled from the studies, according to a Reuters report.

Chinese researchers led by Jia-Yi Dong of Soochow University in Suzhou, conducted the meta-analysis, which is a study that combines the data from previously conducted studies. In this case they combined data from 10 nutrition studies that individually had produced mixed results in terms of finding a link between fiber consumption and breast cancer.

Computer-aided mammograms no better for detecting cancer

CAD software serves as a "second read" for
screening mammography, marking image pat-
terns for the radiologist to review. (Image
courtesy, of Hologic, Inc.)

Adding computerized detection to screening mammography adds to the cost, but not the effectiveness in terms of catching potentially dangerous lesions, a new study finds.

In what may be the largest study yet to look at the real-world value of the widely used add-on for mammography, Dr. Joshua Fenton, an assistant professor in the UC Davis Department of Family and Community Medicine, and colleagues with the Breast Cancer Surveillance Consortium analyzed screening results of 1.6 million mammograms from 684,956 women in seven states.

Zytiga gets European nod for advanced prostate cancer

A European panel recommended approval of Zytiga an oral drug that has been shown to extend survival in men with advanced prostate cancer. The European Committee for Medicinal Products is expected to approve the drug for sale in the next three months.

The drug approved by the U.S. FDA last April works by blocking the production of an enzyme required for the production of androgen hormones in the adrenal glands, the testes and by prostate tumors themselves. 

Taller people have a higher cancer risk

An Oxford study of nearly 1.3 million women
found a 16 percent increase in cancer risk for
every four inches above five feet.

Apparently being tall isn’t all good, a new study has found that taller women have an increased chance of 10 common cancers.

Led by Dr. Jane Green, the Oxford University study followed nearly 1.3 million middle-aged women for five years between 1996 and 2001. They gathered information about about height and other factors relevant to cancer. They published their findings today in The Lancet Oncology.

"Many previous studies have looked at height and cancer risk- most of  them were not large enough to compare risk across different types of cancer," the 5'7" Green told Cancer Digest in an e-mail interview,  "or to look in detail at other factors such as smoking. We were able to do this in our study of 1.3 million women."

Breast cancer drug to seek FDA and European approval

ZURICH – JULY 15, 2011 – Swiss pharmaceutical giant, Hoffman-La Roche announced that it will seek FDA and European approval for its breast cancer drug pertuzumab, according to the Wall Street Journal, Reuters and others.

The drug works by slowing the growth of the cancer-causing protein HER2, and has been shown in early trials to prolong progression-free survival, or lengthen the time that the cancer does not get worse, when used in combination with Roche’s Herceptin®.

Seeking approval for a cancer drug based only on progression-free survival is controversial. The company previously won approval for Avastin as a breast cancer drug based only on progression-free survival. The FDA approved it with a requirement that additional studies be done to establish its effectiveness in terms of prolonging overall survival. The FDA removed that approval last December after additional studies showed the drug prolonged progression free survival by only a short time, and did not prolong overall survival.

Whether the FDA and European regulators will approve another breast cancer drug based only on progression-free survival remains to be seen.

• Wall Street Journal
• Reuters 

Cancer deaths higher in men than women

Malignant mesothelioma, indicated by yellow
 arrows, is one of the cancers in which men are more
likely to die than women. (courtesy Wikipedia, by
Stevenfruitsmaak)

It may not surprise many that men diagnosed with cancer are more likely to die of the disease than women. A new study, however, quantifies the differences in mortality between men and women for a variety of cancers.

The study’s lead author Michael Cook, a researcher in the division of epidemiology and genetics at the National Cancer Institute and colleagues published their findings today in the journal Cancer, Epidemiology, Biomarkers & Prevention.

The study reported widely by Reuters, Medical News Today and the Seattle Times analyzed 36 types of cancer by gender over the 30-year period between 1977 and 2006. They found that five men die of lip cancer, for example, for every woman with the disease. Similarly 2.3 males with lung cancer die of the disease compared to women with lung cancer.

Overall, women were more likely than men to die of only a few cancers including breast, thyroid and gall-bladder cancer.

The researchers attributed the difference in mortality between men and women with cancer to a variety of factors. Women tend to be more health conscious and seek medical attention more often than men. Consequently cancer in women tends to be caught earlier at a more treatable stage. Other factors include work environments and genetic differences.

•    The Seattle Times

•    Reuters

•    Medical News Today

First synthetic windpipe made from stem cells transplanted into man

The trachea or windpipe is the primary airway serving
the lungs. (Diagram from Wikipedia)

The day when you go in for a periodic checkup and have a few body parts replaced with new ones grown from your own cells is much closer than you might think.

A 36-year-old African man with advanced cancer of the windpipe (trachea) received an artificial trachea implant that was grown in the laboratory using the patient’s own stem cells. NPR and others reported the first-of-its-kind transplant Monday, a month after the transplant took place. The researchers say the man  had recovered fully and would return home later this week.

Researchers at the Karolinska University Hospital in Stockholm led by Dr. Paolo Macchiarini said that while previous windpipe transplants have been performed using donor tracheas treated with the patient’s own stem cells, this is the first to use an entirely man-made organ.