Vitamin D supplements help fight treatment-related bone loss

Sometimes the medical fraternity tends to overlook simple solutions for apparently complex problems. It’s not unknown that women coping with breast cancer therapies run a relatively increased risk of fractures. Hundreds of breast cancer surgeons may have noticed that patients decreased bone mass and often suffered from fractures after even minor fall. But, until scientists at the University of Rochester Medical Center noticed this anomaly nobody probably had documented the obvious solution for the problem: vitamin D supplements.

"Vitamin D is essential to maintaining bone health, and women with breast cancer have accelerated bone loss due to the nature of hormone therapy and chemotherapy. It's important for women and their doctors to work together to boost their vitamin D intake," said LukePeppone, Ph.D., research assistant professor of Radiation Oncology, at Rochester's James P. Wilmot Cancer Center. He is a member of the National Cancer Institute's Community Clinical Oncology Program research base in Rochester.

Peppone was presenting the study which involved 166 women undergoing treatment for breast cancer. The study, recently presented at the American Society of Clinical Oncology's Breast Cancer Symposium in San Francisco, found that nearly 70 percent of the patients had low levels of vitamin D in their blood. The analysis showed women with late-stage breast cancer and non-Caucasian women had even lower levels. The average level among the women was 27nanograms of vitamin D per milliliter of blood. Levels of 32 nanograms per milliliter are considered adequate, according to the U.S. Institute of Medicine. Peppone and his colleagues found that weekly supplementation with high doses of vitamin D (50,000 IU or more) boosted the levels of the vitamin among all the women.

Previous studies by other researchers have already shown that 1 out of 2 women and men have vitamin D levels below 32 nanograms per milliliter. Vitamin D not only strengthens bones, but also plays an important role in cell growth and keeps the immune system strong.

You can get enough vitamin from foods such as milk and fortified cereals. But, do you know what’s the cheapest and easiest way to get the vitamin? Well, it’s sunlight. Just go for sunbathing and expose your bones to sunshine you’ll have plenty of this vitamin. Even you don’t have breast cancer or run the risk of getting the disease, the therapy will make you stronger.

This is why I told you that some solutions are really so simple and obvious that we doctors tend to overlook them.
-------

This article is brought to you by www.breastcancerstudies.blogspot.com

Breast Cancer & Hospital-Associated Infections: Stay Cautious

If you are a patient with breast cancer, you must have visited your hospital more than once. But have you ever cared for the infections that you caught, thanks to your hospital visit? These infections--that you develop at a hospital or any other patient care facility—are medically called Hospital-associated infections (HAI).

About 1.4 millions people around the globe, at any point of time, suffer from HAI, the World Health Organization suggests. In 2002, an estimated 98,987 people in the U.S. died of HAI, indicates a report in 2007 by the Centers for Disease Control (CDC). Although the human cost is much higher, if you just analyze the issue financially, you’ll find that the annual impact of HAIs—to healthcare facilities--is as high as $6.7 billion.

This is the statistics part. But, if you think deeply, as a patient with breast cancer, it’s important that you always stay away from HAIs. It’s simply because when breast cancer itself often leads to certain adversities to your life, HAIs can worsen your wellbeing by lengthening the period of hospitalization and increasing the chances of readmission, and also by substantially adding to the treatment cost.

So, next time you visit a hospital, stay cautious.

In order to educate people about HAIs, Kimblery-Clark Healthcare has launched a website "Not on My Watch" at www.haiwatch.com. The site is recommended, if you wish to know about various aspects of HAIs.

This article is brought to you by http://breastcancerstudies.blogspot.com

Tenderness a warning sign of breast cancer risk in women on hormone therapy

Now we have one more early warning sign for breast cancer, in the elderly women who are on a popular hormone replacement therapy (HRT). Post menopausal women, on combined estrogen-progestin treatment, a commonly prescribed version of HRT, should look out for unusual tenderness in their breasts to rule out a possible breast cancer, suggests a new study. Women who developed the so-called new-onset breast tenderness after taking the combo therapy are one and a half times more at risk of developing breast cancer, the study in the October issue of the Archives of Internal Medicine concludes.

The study headed by Carolyn J. Crandall, a clinical professor of general internal medicine and health services research at the David Geffen School of Medicine at University of California, Los Angeles (UCLA), was meant to look at the long-term effects of the estrogen-progestin therapy on 16,000 women. But the researchers had to halt the study prematurely when they found that healthy menopausal women on the HRT had been running a huge risk of getting invasive breast cancer. In other words, the risks so clearly outweighed the benefits.

In the trial, nearly half (precisely, 8,506) of the women were given a combination tablet of of the hormones daily and the other half (8,102) got a matching dummy (placebo) pill.

Women on the combo therapy who did not have breast tenderness at the beginning of the trial were found to have a threefold greater risk of developing tenderness during the annual check up, compared with participants who were on placebos (36.1 percent vs. 11.8 percent). Among the women who did report breast tenderness at the outset of the trial, the risk after a year was about 1.26 times than that of their counterparts on dummy pills. And, of the women who reported new-onset breast tenderness, more than 3 out of 4 of them had been on the HRT.

Prof. Crandall, of California University, pointed out (while announcing the findings): "To our knowledge no prior published studies have addressed whether there is an association between combined HRT-induced new-onset breast tenderness and breast cancer risk."

Does that mean that all post menopausal women on HRT have the chance of getting breast cancer? No, actually for most women, the risks of HRT are small, but there's no harm in discussing them with your doctor before starting the particular combo HRT. And also remember that, although the risk was getting breast cancer was higher in women on estrogen-progestin therapy, the majority of women who got breast tenderness in the trial didn't actually go on to get cancer.

So, my advise is: don't hesitate to tell your doctor if you start getting breast tenderness while taking HRT. I'm sure your doctor will weigh up the risks and benefits of therapy, so you can choose to carry on taking HRT or stopping it altogether.

This article is brought to you by http://breastcancerstudies.blogspot.com

Mastectomy Not Overused for Breast Cancer Treatment

I still remember the initial reaction of one of my young patients when she was diagnosed with breast cancer. She was upset thinking about mastectomy--the surgical operation that is, for the treatment of breast cancer, often undertaken by breast cancer surgeons to remove a breast. Although I'd reassured my patient that surgeons will certainly do what's medically appropriate and won't remove the entire breast if they felt it's possible to conserve the breast, I wondered if surgeons were too quick to perform a mastectomy.

Going by anecdotal evidence and some stray media reports it appeared that mastectomies were really being misused for breast cancer. Now finally a huge study at Memorial Sloan-Kettering Cancer Center, New York--reported in Journal of the American Medical Association (JAMA)--will dispel the doubts of all those who have been suspecting the breast cancer surgeons for overusing mastectomy. Well, the verdict the study is a clear 'no'--which means, mastectomy is not being overused for breast cancer treatment.

Simply put, when the lead author of the study Dr Monica Morrow, along with her colleagues, asked 1984 breast cancer survivors about their experience, they found that breast-conserving surgery (BCS) was attempted as the initial therapy in as many as 3 out of 4 women. They also found that nearly 1 out of 4 patients with breast cancer had initial mastectomy and roughly 1 out of 8 of the patients received initial mastectomy based on surgeon's recommendation. Furthermore, 8.8 percent received initial mastectomy when the first surgeon did not recommend one procedure over another or recommended BCS and 8.8 percent received mastectomy after unsuccessful attempts at BCS. More importantly, 38 percent of women who underwent BCS needed further surgery. Twelve percent of the women who underwent BCS had to have a mastectomy.

The findings will appear surprising to a lot of people because concern about an unnecessary use of mastectomy for patients with breast cancer have been raised for the past couple of decades. "The results of this study suggest that most surgeons in two large, diverse urban regions appropriately recommended local therapy options for patients with breast cancer. The majority of women who received a surgeon's recommendation for initial mastectomy reported a clinical contraindication to breast conservation," the authors pointed out. "Our results also suggest that patient preferences may play an important role in shaping the pattern of surgical treatment for breast cancer. One-third of patients appear to choose mastectomy as initial treatment when not given a specific recommendation for BCS or mastectomy by their surgeon, accounting for about one-quarter of total mastectomy use. Patients may prefer mastectomy for peace of mind or to avoid radiation," they added.

According to Morrow, a breast surgeon at Memorial Sloan-Kettering Cancer Center, the patients were often unaware that survival rates for the two surgeries are the same for early stage breast cancer. In other words, these patients didn't know that neither surgery guarantees that the breast cancer hasn't already spread. So, lack of breast cancer awareness seems to be the reason behind an apparent rise in the number of mastectomies. This is also the reason why many patients had to undergo mastectomy even after they had BCS. Morrow suggests doctors to communicate the information regarding the pros and cons of both mastectomy and BCS during the treatment of breast cancer.

This article is brouht to you by: http://breastcancerstudies.blogspot.com

Combo therapy promises to slow breast cancer progression

It's medicine's another small, but significant, assault against marauding breast cancer in the advanced stage. We've been hearing about targeted anticancer drugs--which are supposed to attack just the killer tumour cells, sparing the healthier ones--for quite some time. In one of the first of a series of trials to investigate the use of sorafenib--one such targeted anticancer drug --used to treat advanced breast cancer was found to stop the progression of tumors, if it is combined with another chemotherapy drug, capecitabine. The new combo therapy may not cure or eliminate cancer, but may make a significant difference to the time women live without their disease worsening.

Recently, the principal investigator of the study, Professor Jose Baselga told at the Europe's largest cancer congress (jointly organised by European Cancer Organisation and European Society for Medical Oncology), in Berlin, "This is the first, large, randomised study that demonstrates significant clinical activity of sorafenib in breast cancer when given in combination with chemotherapy. Our results showed that patients who received sorafenib plus capecitabine had a 74 per cent improvement in the time they lived without their disease worsening compared to those who received the chemotherapy alone. This is a very positive study and the magnitude of the benefit is such that it suggests that this agent will be an important addition to our therapeutic armoury in breast cancer."

Sorafenib is a type of anticancer drug called a multi-targeted kinase inhibitor which works by slowing the growth of new blood vessels within the tumour. Currently the drug is approved for the treatment of primary kidney cancer (advanced renal cell carcinoma) and advanced primary liver cancer (hepatocellular carcinoma).

Prof Baselga, who is head of the oncology department, Vall d'Hebron University Hospital (Barcelona, Spain), president of ESMO (European Society for Medical Oncology) and a member of the ECCO (European Cancer Organisation) executive committee, and his colleagues in Spain, France and Brazil enrolled 229 patients with locally advanced or metastatic breast cancer in an extensive phase II clinical trial between June 2007 and December 2008.

The patients were divided into two groups by the oncologists. They gave the first group of 114 women, capecitabine (1000 mg/m2 pill taken twice daily for 14 of every 21 days) along with a placebo or dummy pill. The rest of the group of patients with breast cancer (115 women) got capecitabine and sorafenib (400 mg pill taken twice daily continuously).

The results from the much awaited trial was presented for the first time in Berlin congress, and they show that the average progression free survival (the time that elapses without the cancer getting worse) was 6.4 months for women on capecitabine and sorafenib compared to 4.1 months for women taking the dummy pill. However, researchers told that it is too early for data on overall survival to be available. The only death that occurred during the trial was in group on placebo, believed to be the side-effect of capecitabine. The number of patients with breast cancer who stopped treatment due to adverse side-effects was nine (8 per cent) in the placebo group and 15 (13.4 per cent) in the sorafenib group.

According to Prof Baselga, the treatment regimen was tolerable and the side-effects were mostly manageable. Unexpected side effects were not observed with this combination. He also emphasised that the unique attribute of the treatment is that the anticancer drugs could be taken orally, a convenient treatment option for patients with breast cancer.

So, finally, the targeted cancer therapy seems to be working.

The article is brought to you by http://breastcancerstudies.blogspot.com

New strategies for dealing with painful breast cancer drug side effects

Healthcare professionals call these drugs aromatose inhibitors (or simply AIs)---hormone therapies used to tame breast tumors in post-menopausal women. But, for most breast cancer survivors who take these drugs consider them as harbingers of excruciating joint pain and a host of severe other side effects. I personally know a couple of patients with breast cancer who have discontinued these lifesaving medicines, even though the drugs have been reported to augment long-term survival rates. Well, if you are one of those patients who has been on these medications-—or know somebody with breast cancer undergoing AI medication-–there is some good news from the New University of Pennsylvania School of Medicine.

Researchers led by Jun J. Mao, an assistant Professor of Family Medicine and Community Health, at the university’s Abramson Cancer Center, has revealed useful clues to identify women who are likely to develop painful symptoms with aromatose inhibitors (AIs) and helped them stick to the same treatment regimen for breast cancer.

The hormone estrogen aids the growth of many breast tumors. And, AIs help block the growth of these tumors by lowering the amount of the hormone in the body. Estrogen is produced by the ovaries and other tissues of the body, using a substance called aromatase. Because AIs can not block estrogen production by the ovaries, but they can block other tissues from making this hormone, these drugs are used mostly in patients with breast cancer who have reached menopause, when the ovaries are no longer producing estrogen.

In a research paper published recently in the journal Cancer, Mao and his colleagues found that estrogen withdrawal could be playing a role in the onset of joint pain (known as arthralgia) during treatment. They also found that women who had their last menstruation within the five years prior to beginning AI medication were three times more likely to have these painful symptoms than women who had menopause 10 or more years earlier. According to the researchers the result indicates that women who had menopause more recently may have higher levels of residual estrogen in their bodies, which combined with exposure to AIs might have lead to an abrupt drop in the level of the hormone. Such steep drop in the estrogen levels could be responsible for severe symptoms.

In another study, published in the journal Integrative Cancer Therapies, the same group of researchers found that among women experiencing these painful side effects during treatment with AIs, those who received electro-acupuncture-–a technique that combines traditional acupuncture with electric stimulation-–had less severe joint pain and stiffness. Reportedly, these patients with breast cancer also suffered less fatigue and anxiety.

"Today we have many effective treatments for breast cancer, but many of these have debilitating side effects that can last for months or years after the treatment, and really harm the quality of life and productivity of women who receive them," Mao pointed out. "These findings are just a first step in our comprehensive research program aimed at understanding the nature of treatment-related symptoms, who is likely to get them, the mechanisms by which they occur, and how best to treat them."

Among the 300 breast cancer patients in the Penn study, 139 reported AI-related pain. In three out of four of these patients, symptoms appeared within the first three months of the therapy. Pain in the wrists, hands, and knees were common. More than half of the patients with breast cancer said they also had pain in their backs and ankles or feet.

Mao and his colleague Angela DeMichele, an associate professor of Medicine and Epidemiology and Biostatistics, have been running a comprehensive “Wellness after Breast Cancer” study to examine how clinical and genetic factors relate to treatment-related symptoms such as joint pain, hot flashes, insomnia, and fatigue both during and after cancer treatment. Ultimately, they hope to identify patients at greatest risk of these symptoms and late effects of treatments, and personalize therapy in a way that will prevent the side effects of cancer therapy while maximizing the effectiveness of treatment.

This Article is brought to you by http://breastcancerstudies.blogspot.com

Rigorous exercise can cut chance of developing breast cancer in older women

Finally I’ve got some good news for my mom and her friends-—who have been fretting over breast cancer risks ever since one of their close pal died of breast cancer a couple of years ago. To keep the dreaded disease at bay, these women on the wrong side of 50, need to stay fit and physically active. And my mom should not worry because she is quite active, even though she crossed 58 last month.

She’ll be too glad to know that moderate to vigorous exercise have been found to reduce the risk of breast cancer in post-menopausal women, especially if the women are not overweight. Simply put, it’s not just aerobics, running or fast jogging, but heavy housework like scrubbing floors or washing windows too can keep breast cancer at bay in older women. This is the finding of a group of researchers based at the U.S. National Cancer Institute, Bethesda, Maryland published in the journal BMC Cancer.

Led by Dr. Tricia M Peters at the institute, an international team of researchers investigated the link between breast cancer and vigorous exercise. Researchers asked more than 110,000 post-menopausal women to rate their physical activity levels--including everyday tasks like housework, work-related activity and leisure activity--at various stages of life. It was found that over the next six and half years of follow up, women in the group who had done more than 7 hours per week of moderate-to-vigorous exercise for the last 10 years were 16 per cent less likely to develop breast cancer than those who were inactive.

However, no link was observed between breast cancer risk and physical activity in women who were active at a younger age. Neither did light exercise (such as walking, playing golf, light jogging or less strenuous household works like vacuuming or gardening) help. The researchers categorically mention the benefits of heavy housework, garden digging, chopping wood, strenuous sports and exercise (such as, running, fast jogging and aerobics), cycling on hills (as opposed to on the flat surface), and even fast dancing.

Dr Peters writes, "Our findings could help inform the mechanisms of the physical activity-breast cancer relationship. With breast cancer still claiming so many lives, all the information of potential preventive measures we can get is vital".

So, my mom—who loves heavy household work—has nothing to worry about.


This Blog Post is brought to you by http://breastcancerstudies.blogspot.com.