In this video series, Dr. Rebecca Zuurbier discusses who is at risk for breast cancer and how it is diagnosed. She also covers the different stages of Breast cancer and discusses the latest advancements in treatments.

Not a day goes by without a new story about the environment. Although we often consider the environment on a global scale, cells in our body also have to contend with environmental factors. New studies from a team of researchers from the Research Institute of the MUHC and McGill University show that the environment surrounding breast cancer cells plays a crucial role in determining whether tumor cells grow and migrate or whether they fade away. Their study is the first to identify the genes behind this environmental control and correlate them with patient outcome. Their findings are published in this week’s issue of Nature Medicine.

“A tumour can not exist on its own. It has to be supported and nourished by the cell types around it, the microenvironment,” says senior author Dr Morag Park, Director of the molecular oncology group at the Research institute if the MUHC. “When we began this study there was little known about the importance of this microenvironment on cancer initiation and progression. We now know that this environment is pivotal; different patients have distinct tumour microenvironments at a gene level. Our findings show that the gene profile of these distinct microenvironments can be used to determine clinical outcome — who will fare well and who will not.”

Dr Park, a professor of oncology, biochemistry, and medicine at McGill University, and her team analyzed tissue from 53 breast cancer patients. They used a unique technique, laser capture microdissection (LCM), to separate tumour cells from microenvironment tissue. They compared the gene expression between the microenvironment tissue and controls using micro-array analysis. From thousands of genes they identified 163, which correlated with patient outcome. A good outcome was defined as having no tumour metastasis and tumour migration and non-responsiveness to therapy was considered poor outcome.

From the original 163 genes, the team further identified a panel of 26 specific genes that could be used to accurately predict clinical outcome. This 26 gene-profile, called the stromal derived prognostic predictor (SDPP), was used to predict outcome from a second set of beast cancer patients.

“We were able to show that the SDPP effectively predicts outcome in a second group of patients,” says Dr Park, “This panel accurately forecasted patient status, suggesting that this may be a promising diagnostic tool.

“Our next steps are to develop this 26-gene predictor into a functional test. We are currently working on this and we anticipate a product for clinical trials within a year,” adds Park.

“This work takes tremendous dedication and collaboration from a number of people including pathologists, surgeons, oncologists as well as researchers. I would like to thank the outstanding work done by G. Finak from the laboratory of Dr M. Hallett of McGill’s Computer Science Department, the breast surgeons of the MUHC, including Dr S. Meterissian, and by the Department of Pathology at McGill, where Dr A. Omeroglu works.”

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A connection between vitamin D level and the risk of developing breast cancer has been implicated for a long time, but its clinical relevance had not yet been proven.

The result of the study involving 1,394 breast cancer patients and an equal number of healthy women after menopause was surprisingly clear: Women with a very low blood level of 25(OH)D have a considerably increased breast cancer risk. The effect was found to be strongest in women who were not taking hormones for relief of menopausal symptoms.

However, the authors note that, in this retrospective study, diagnosis-related factors such as chemotherapy or lack of sunlight after prolonged hospital stays might have contributed to low vitamin levels of breast cancer patients.

In addition, the investigators focused on the vitamin D receptor. The gene of this receptor is found in several variants known as polymorphisms. The research team of the DKFZ and Eppendorf Hospitals investigated the effect of four of these polymorphisms on the risk of developing breast cancer.

They found out that carriers of the Taql polymorphism have a slightly increased risk of breast tumors that carry receptors for the female sex hormone estrogen on their surface. No effects on the overall breast cancer risk were found. A possible explanation offered by the authors is that vitamin D can exert its cancer-preventing effect by counteracting the growth-promoting effect of estrogens.

Besides its cancer-preventing influence with effects on cell growth, cell differentiation and programmed cell death (apoptosis), vitamin D regulates, above all, the calcium metabolism in our body.

Foods that are particularly rich in vitamin D include fish (cod liver oil), eggs and dairy products. However, the largest portion of vitamin D is produced by our own body with the aid of sunlight.

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Before breast cancer surgery, a preoperative magnetic resonance imagining (MRI) scan should be standard to determine tumor staging, researchers told the 6th European Breast Cancer Conference (EBCC) in Berlin, Germany today.

Preoperative MRI changed the surgical approach in at least 1 of every 9 patients in a series of 249 patients studied by David Martinez-Cecilia, MD, from the Hospital Universitario Reina Sofia, in Cordoba, Spain. Patients who had a malignancy on biopsy underwent an MRI, and the findings altered the surgical management of 32 patients (13%).

MRI found 20 additional malignant lesions in 18 patients (8%), he said. “That meant that for 15 patients, we were able to change the surgical treatment to one that took care of all of the tumors, as opposed to the single lesion that had originally been diagnosed.” In 11 of these patients, a planned lumpectomy was changed to a mastectomy, 3 other patients required surgery in both breasts, and 1 patient needed 2 lumpectomies in the same breast.

In other cases, the MRI showed a larger size tumor than was originally identified. This led to the management of 16 patients being changed from a lumpectomy to a mastectomy, and that of 1 patient to be changed from a lumpectomy to a quadrectomy.

After analyzing the tissue that had been removed during surgery, the researchers concluded that the change in surgical management was beneficial in 22 patients (9%), was not beneficial in 6 patients (2.4%), and was uncertain in 4 patients (1.6%). The correlation between tumor size on MRI and that from pathology was strongly positive, and was greater than that seen for mammography and for ultrasound, the researchers report.

MRI is expensive, but with results such as these it should be used as widely as possible presurgery, the researchers concluded. “It will not only improve the surgical treatment, which was our main aim, but in the long run it will probably reduce costs to healthcare systems by allowing us to identify exactly what needs to be treated, and in what way, to avoid possible recurrences of the cancer and the costs associated with its treatment,” Dr. Martinez-Cecilia said in a statement.

Asked to comment on this study, Emiel Rutgers, MD, PhD, from the Netherlands Cancer Institute and Antoni van Leeuwenhoek Hospital in Amsterdam, who chaired the EBCC meeting, said he fully agreed that breast MRI should be used preoperatively in the staging protocol. “I do feel that this investment is really worthwhile,” he told Medscape Oncology. He commented that MRI is not yet accepted as a standard procedure, but agreed with Dr. Martinez-Cecilia and colleagues that it should be.

Opponents of preoperative MRI question whether it can improve the local control rate after breast conservation, which is already good, Dr. Rutgers explained. However, work reported by his team at the same meeting suggests that it does, and “that in the long run, it really does help the patient, I am convinced of that,” he said. In a poster presented by Kenneth Pengel, MD, this research shows that preoperative MRI can lead to a lower rate of incompletely excised infiltrating ductal carcinoma (IDC) in breast-conserving surgery than that seen after conventional mammography, ultrasonography, and palpation only. The team reported on a series of 527 women, and found the rate of incompletely excised IDC to be 16/245 (6.5%) women in the non-MRI group and 3/153 (2%) women in the MRI group, a difference that was statistically significant (P = .03). However, there was no difference in the rate of incompletely excised infiltrating lobular carcinoma; it was 9/31 women (29%) in the non-MRI group and 6/21 women (29%) in the MRI group.

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Triple-negative breast cancers are a heterogeneous group and may not always be associated with lymph node spread, a new study shows.

The study of 145 triple negative breast cancers (i.e, cancer which is estrogen receptor-negative, progesterone receptor-negative and HER2-negative) in 128 women found that about 23% were moderate or low-grade lesions, said Cecilia Mercado, MD, of New York University School of Medicine, and an author of the study.

Triple negative breast cancer is found in about 15% of breast cancer patients and the patients are usually younger.

The study found that 11 of the 145 cancers had a low histologic grade. Only one of these patients had evidence that their cancer had spread into their lymph nodes. Twenty-three cancers were moderate grade lesions; only five of these 23 had spread into the lymph nodes. That compares to 37 of 111 cancers with a high histologic grade which had lymph node metastases, Dr. Mercado said.

“Our preliminary results show that triple negative breast cancers are a heterogeneous group. Although many are high grade lesions, some are moderate or low grade demonstrating a lower rate of lymph node metastasis,” Dr. Mercado said.

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Choline, an essential nutrient found in foods such as eggs, is associated with a 24 percent reduced risk of breast cancer, according to a study supported by a grant from the U.S. National Institutes of Health (NIH), to be published in The FASEB Journal’s print issue in June.(1) This study adds to the growing body of evidence that links egg consumption to a decreased risk of breast cancer.

“Choline is needed for the normal functioning of cells, no matter your age or gender,” says Steven H. Zeisel, MD, PhD, University of North Carolina, who is an author of the study and a leading choline researcher. “Increasing evidence shows that it may be particularly important for women, particularly those of child-bearing age.”

Only ten percent of Americans currently meet the recommended intake for choline, identifying a need to increase choline intake across the population.(2) According to the Institute of Medicine, adequate choline intake is 550 milligrams per day for men and breastfeeding women, 425 milligrams per day for women, and 450 milligrams per day for pregnant women.(3) One egg contains 125.5 milligrams of choline, or roughly a quarter the recommended daily supply, making eggs an excellent source of this essential nutrient.(4) Choline is found exclusively in the egg’s yolk. Other top food sources of choline include liver, wheat germ and cauliflower.

“While choline is an essential nutrient to the human diet, most people haven’t even heard of it,” says Gerald Weissmann, MD, Editor in Chief of The FASEB Journal and research professor of medicine and director of the Biotechnology Study Center at the New York University School of Medicine. “Given that in the U.S. there is a real need to understand how much choline we require in our diet, we hope that research, education and awareness about choline will increase as a result of this study published in The FASEB Journal.”

Eggs and Decreased Risk of Breast Cancer:

Two previously published studies, supported by NIH grants, have shown that women who eat eggs have a lower risk of developing breast cancer:

* A study published in 2003 by researchers at Harvard University found that women who reported higher consumption of eggs, vegetable fat and fiber during adolescence had a smaller risk of developing breast cancer as adults. Specifically, eating one egg per day was associated with an 18 percent reduced risk of breast cancer.(5)

* A study of Chinese women published in Cancer Epidemiology, Biomarkers & Prevention in 2005 showed that those who consumed the most fruit, vegetables and eggs were significantly less likely to have breast cancer. For those that reported eating at least six eggs per week, the risk of developing breast cancer was 44 percent lower than for those who ate two or less eggs per week.(6)

Other Benefits of Choline:

In addition to playing a role in the normal functioning of all cells, including brain and nerve function, liver metabolism and the transportation of nutrients throughout the body, choline has been shown to:

* Prevent Birth Defects: According to population-based research, infants from mothers whose diets were deficient in choline were four times more likely to have neural tube defects such as spina bifida. This increased risk was observed even when other nutrients that help prevent birth defects, such as folic acid, were in adequate supply.(7)

* Improve Memory: Research suggests that choline is essential for proper fetal and infant brain development. It appears that choline affects the areas of the brain responsible for memory function and life-long learning ability.(8)

* Reduce Heart Disease Risk: Choline, like folate, is involved in breaking down homocysteine, an amino acid in the blood that may be associated with an increased risk of heart disease. In fact, research shows that choline deficiency results in increased homocysteine levels.(9) This may help to explain why 30 years of research have shown that healthy adults can consume eggs without increasing their risk of heart disease

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