Studies prove that mammography saves lives. The screening tool can detect breast cancer early when it’s still curable. But for the thousands of women with dense breast tissue, mammography is not enough. These women may need additional screening tests such as MRI’s. Now, researchers at Mayo Clinic have developed new technology that can spot breast tumors in dense tissue at a fraction of the cost of MRI’s.

Research proves that screening for breast cancer with mammograms saves lives. But mammograms are not perfect. They can miss tumors, especially in women with dense breast tissue. That’s why Doctors at Mayo Clinic also use MRI’s to screen for breast cancer in high risk women. The technology can detect some tumors that mammograms cannot.

Healthy choices and active screening for breast cancer are your best defenses in beating the disease. Also learn about today’s breast cancer treatments so you can discuss them with your doctor.

Jacqueline’s brothers call her “The Baby,” but she didn’t back down from her fight with breast cancer. Learn about her treatment plan and hear her advice for those battling cancer.

See how cancer forms inside the breast, and learn the possible signs and symptoms of breast cancer.

The lesson learned in eradicating dandelions from your yard could apply in treating breast cancer as well, said researchers from Baylor College of Medicine in Houston in a report that appears online in the Journal of the National Cancer Institute.

“It’s not enough to kill the dandelion blossom and stalk that appear above ground,” said Dr. Michael Lewis, assistant professor of molecular and cellular biology and a faculty member in the Lester and Sue Smith Breast Cancer Center at BCM. “You have to kill the root beneath the soil as well.”

In a study involving women with breast cancer, he and colleagues at BCM showed that while conventional anti-cancer drugs can kill the bulk of breast cancer tumors, they leave behind many of the breast cancer stem cells from which tumor cells arise, setting the stage for the tumor to come back.

“What we found is that one reason chemotherapy frequently does not work is that you kill the bulk of the tumor but leave many of the stem cells behind,” said Lewis. “It appears that these cells, by their nature, are resistant to the effects of anti-cancer drugs.”

However, treatment with the drug lapatinib and anti-cancer drugs appears to kill both the tumor and the stem cells, reducing the threat of relapse in patients whose tumors carry a protein marker called HER2, Lewis said.

In their study, he and colleagues took biopsies from the tumors of patients before and after treatment.

The study had two parts. In the first, 31 patients whose tumors did not have the HER2 marker received conventional chemotherapy. In the second part of the study, 21 patients whose tumors carried the HER2 marker, received treatment with lapatinib and two other common breast cancer drugs. (The HER2 marker meant that the tumors would be susceptible to lapatinib.)

The researchers stained the samples to highlight the subset of tumor cells that contained the stem cells, which can be identified by the presence of certain markers on the cell surface. This enabled them to estimate the percentage of stem cells in the biopsy. In addition, stem cells in the laboratory can grow into colonies of cells that scientists call mammospheres. Because of this, they could also measure those to estimate what proportions of stem cells are present in a sample.

In the group that received conventional chemotherapy, the number of tumor cells decreased markedly. However, after the treatment, the proportion of cancer stem cells (identified by special markers and mammosphere formation) to differentiated tumor cells was greater than before treatment. In other words, there was a higher percentage of stem cells because the chemotherapy killed the regular tumor cells but left stem cells behind.

In the group that received lapatinib, the number of tumor cells again decreased dramatically. However, the percentage of breast cancer stem cells did not change or even went down slightly (although the change did not reach statistical significance). Consistent with this, the percentage of patients who received lapatinib had significant tumor shrinkage at greater rates than that seen in patients who received conventional therapy.

“The tumor shrank dramatically,” said Dr. Jenny Chang, associate professor of medicine at BCM and medical director of the BCM Breast Care Cancer Center. “But in contrast to treatment with conventional chemotherapy, the relative proportion of stem cells did not go up. This means the stem cells were killed off with the same frequency as the bulk of the tumor. This is the first time this has been demonstrated.”

Finding drugs that work specifically against stem cells is a course for the future, said Lewis. He plans to start by characterizing the markers specific to breast cancer stems cells, and inhibiting them one-by-one.

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A high consumption of lignans is associated with better survival in postmenopausal women with breast cancer. Although the dietary intake of lignans did not have any effect on breast cancer survival in premenopausal women, postmenopausal women with a high intake of plant lignans were approximately 70% less likely to die from their breast cancer, according to study data presented here at the American Association for Cancer Research 2008 Annual Meeting.

“We can draw fewer conclusions about lignan intake in terms of overall mortality because, since this was a breast cancer study, most of the patients died from breast disease,” lead author Susan E. McCann, PhD, from the division of cancer prevention and population sciences at Roswell Park Cancer Institute, in Buffalo, New York, told Medscape Oncology. “But a high intake of lignans was associated with about a 50% reduction in mortality from all causes. This included cardiovascular disease and other cancers.”

Lignans are distributed in seeds, whole grains, berries, fruit, vegetables, and nuts, and have been studied for a possible effect on breast cancer risk. Several epidemiologic studies have found that the dietary intake of lignans is associated with a lower risk for breast cancer but, to date, there have not been any clinical trials evaluating the effect of lignan intake on breast cancer survival.

Dr. McCann and colleagues examined the association between dietary lignan intake and breast cancer survival in 1122 women with primary incident histologically confirmed breast cancer. All of the women were participants in the Western New York Exposures and Breast Cancer (WEB) study, a population-based case-control study of women living in Erie and Niagara counties in Western New York between 1996 and 2001. The women were followed through December 31, 2004.

Study participants completed an extensive food-frequency questionnaire, which assessed their diet in the 12 to 24 months before their cancer diagnosis. The researchers calculated dietary lignan intake using published food-composition data, and associations between dietary lignan intake and all-cause, total cancer, and breast cancer mortality were estimated using the Cox proportional hazards models after adjustment for confounders such as age, tumor stage, and body mass index.

By the end of the follow-up period, 130 patients had died —94 from cancer(of which 84 were breast cancer) and 36 from other causes. “The women who died from breast cancer tended to be older, tended to have a more advanced stage of cancer, and were more likely to be nonwhite,” said Dr. McCann. “They were also more likely to be estrogen-receptor negative, but it wasn’t statistically significant.”

There was no association between the consumption of dietary lignans and all-cause, total cancer, or breast cancer mortality among premenopausal women. However, postmenopausal women with the highest intake of lignans showed a statistically significant reduction in the risk for all-cause mortality (hazard ratio, 0.48) and a significantly lower risk for breast cancer mortality (hazard ratio, 0.35).

“In this study, lignan intake was derived primarily from dark bread, peaches, apricots, broccoli, winter squash, oranges, strawberries, onions, coffee, and tea,” said Dr. McCann.

The researchers did not find an association between mortality and the intake of fruits and vegetables, although a high intake of lignans might be a marker of a plant-based diet.

“This study is evidence that a healthy diet can contribute to improved survival in breast cancer and other chronic diseases,” she said. “It provides more evidence that a plant-based diet may help survival in cancer patients.”

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A novel peptide vaccine was able to reduce the mortality rate in women with HER2/neu overexpressing breast cancer by about half, researchers report here at the American Association for Cancer Research (AACR) 2008 Annual Meeting.

“The numbers in this study are small but the concept is good,” commented William N. Hait, MD, PhD, president of the AACR and senior vice president of Worldwide Hematology and Oncology Research and Development at Johnson & Johnson. “It’s a good first step and we are cautiously optimistic.”

HER2/neu is a source of immunologic peptides and approximately 30% of early-stage breast cancers have an amplified HER2/neu gene or overexpression of its protein product. There has been a great deal of interest in the HER2 gene, explained lead author Linda C. Benavides, MD, a general surgical resident at Brooke Army Medical Center in San Antonio, Texas. “Historically, we have focused on patients because they are candidates for Herceptin. Our vaccine showed a response in patients who expressed HER2/neu at all levels, including low expressers for whom no therapy is available.”

“Most vaccine trials have been performed in the metastatic setting,” she told journalists, “But our results show that the vaccine is safe in women with minimum symptoms. It decreased mortality and morbidity.”

What was most surprising in this study was that patients with low-HER2/neu-expressing tumors responded so well to the vaccine. In fact, Dr. Benavides pointed out, the patients with low-expressing (0 to 2+ on immunohistochemistry [IHC]) HER2/neu tumors had a better response to the vaccine than women with higher-expressing tumors. They experienced not only a better immune response, but a better clinical one as well, as demonstrated by a decreased rate of breast cancer recurrence and 0% mortality after E75 peptide vaccination.

The researchers had previously conducted clinical trials with the HER2/neu E75 peptide vaccine in both node-positive and node-negative breast cancer patients who demonstrated a variety of levels of HER2/neu expression. In this study, they performed a subset analysis review that was based on the level of HER2/neu expression in the 163 patients who were enrolled in their E75 vaccine trial.

All patients were typed for human leukocyte antigen (HLA). Women who were HLA-A2+/A3+ received the vaccine; women who were HLA-A2–/A3– served as the control group. Overexpression was defined as fluorescence in situ hybridization (FISH) greater than 2.0 and IHC 3+ HER2/neu tumors; low expression was defined as IHC ranging from 0 to 2+.

Of the 92 vaccinated patients, 29 (34%) were defined as HER2 overexpressors and 56 (66%) were defined as low-expressors. The control group (n = 71) included 22 (33%) overexpressors and 44 (67%) low-expressors. The HER2/neu overexpressors were similar in regard to prognostic and treatment factors, although a statistically larger number of vaccinated women who overexpressed HER2 were also hormone-receptor negative and node negative (P = 0.007).

At a median follow-up of 30 months, the rates of disease recurrence were similar between HER2/neu overexpressors in both the vaccine and control groups (18.2% vs 13.8%). However, the researchers noted that the mortality rate was 50% lower among the vaccinated patients who had a disease recurrence (25% vs 50%).

The researchers also noted that recurrence rates were substantially reduced in vaccinated patients with low HER2/neu expression. They experienced a 10.7% recurrence rate, compared with the 18.2% seen in the control group. This subgroup showed not only a better immunologic response, but also a better mortality rate (0%).

“This may represent a new form of HER2-directed therapy, because the low expressors do not qualify for trastuzumab,” Dr. Benavides said. “The vaccine has been registered for a phase 3 trial, which will focus on low-expressing women.”

The first phase 3 trial in low-expressing women is slated to begin in the fall. Based on the data presented at AACR, the phase 3 trial has been restructured and is the first to focus on low-expressing women, explained Dr. Benavides.

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A breast cancer patient’s age alone should not determine whether or not she receives standard breast-conservation treatments, including a lumpectomy and radiation therapy; however, if additional health problems (comorbidities) are present, treatments should be individualized based on age and the type of comorbidities, according to a study in the April 1 edition of the International Journal for Radiation Oncology Biology Physics, the official journal of the American Society for Therapeutic Radiology and Oncology.

The occurrence of breast cancer in women increases as women age. According to the National Cancer Institute’s SEER Cancer Statistics Review, women between the ages of 75 and 79 have the highest incidence of breast cancer diagnoses at 497 cases per 100,000 people. Along with cancer, most women in this age group are dealing with additional health problems. According to a 1999 women’s health and aging study in the Journal of Clinical Epidemiology, the majority of older patients diagnosed with cancer have at least one other medical condition and more than half of patients with cancer over the age of 65 have three or more associated medical conditions.

This study, conducted by the departments of Radiation Oncology, Biostatistics and Epidemiology, and Medicine, Division of Geriatrics, at the University of Pennsylvania School Of Medicine in Philadelphia, sought to determine the impact of these additional medical problems on breast cancer patients who receive the same standard treatments as patients with no additional medical problems and if old age is a reason to deny some standard treatments.

Most randomized trials that compare outcomes of breast-conserving surgery with and without radiation consistently show more positive outcomes when radiation is used; however, most of the trials exclude women older than 70 years old so there is not a lot of data on the impact of radiation on older women.

Between 1979 and 2002, 238 women, 70 years old and older, with Stage I or II invasive carcinoma of the breast received breast-conservation therapy and their outcomes were compared by age groups and comorbidities. Most of the patients studied had mild comorbidities.

The researchers found that the number of deaths from breast cancer among the patients studied was similar to the number seen among all age groups of patients without additional medical problems. The researchers also found that the majority of elderly women with early-stage breast cancers and mild comorbidities actually benefited from the use of radiation and had minimal side effects.

The overall survival rates for the patients in the five- and 10-year follow-up periods were 80 percent and 50 percent, respectively; however, more deaths during the 10-year period were caused by intercurrent diseases than breast cancer.

“Doctors need to understand that comorbidities should be the determining factor in deciding an older patient’s course of treatment, not age,” said Eleanor Harris, M.D., clinical director of radiation oncology at the Moffitt Cancer Center in Tampa, Fla. “There is a sense in the field that elderly women need less treatment than younger women, but we should not be under treating women simply because they have passed the age of 70.”

ASTRO is the largest radiation oncology society in the world, with 9,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy.

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