TUESDAY, Dec. 11, 2018 (HealthDay News) — Younger breast cancer survivors are at increased risk for osteoporosis — weak, brittle bones — due to breast cancer treatments, new study finds.
The study included 211 women who had been diagnosed with breast cancer within the past nearly three years and 567 women with no history of cancer.
Over about six years of follow-up, women diagnosed with breast cancer at age 50 or younger had twice the risk of developing either osteoporosis or a severe bone-loss condition called osteopenia than those without cancer.
The risk was up to four times higher among breast cancer survivors who had undergone treatments that block estrogen production, according to the study.
“These findings show that even younger women have a relatively high risk of bone loss with standard breast cancer treatments, and in many cases we saw this bone loss occurring in just a few years,” said senior study author Dr. Kala Visvanathan. She’s a professor in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore.
“These results suggest that we should monitor even young breast cancer patients for bone loss during and after therapy,” Visvanathan said in a Hopkins news release.
Previous research has shown that older breast cancer survivors are at increased risk of bone loss.
Breast cancer treatments can trigger premature menopause by damaging the ovaries or otherwise interrupting estrogen production, making women more vulnerable to bone loss.
This study found that the risk of bone loss was particularly high after certain types of breast cancer treatment. Women receiving the standard combination of chemotherapy plus hormonal therapy had a 2.7 times increased risk of osteopenia and osteoporosis compared to those without cancer.
Chemotherapy plus tamoxifen was associated with a 2.5 times higher risk, but not tamoxifen alone. Aromatase inhibitors, which reduce estrogen production, were associated with a 2.7 times higher risk for bone loss alone, and a 3.8 times higher risk when combined with chemotherapy, the study found.
The increased risk of bone loss in breast cancer survivors was evident even when women with premature menopause were not included in the analysis.
“There seems to be an effect of cancer treatment on bone health that works independently of menopause — perhaps by directly inhibiting bone formation,” Visvanathan said.
The study was published recently in the journal Breast Cancer Research.
The U.S. Office on Women’s Health has more about osteoporosis.
FRIDAY, Dec. 7, 2018 (HealthDay News) — Younger breast cancer patients who have one or both breasts removed have lower levels of satisfaction and well-being than those who have breast-conserving surgery, a new study finds.
The study included 560 women diagnosed with breast cancer by age 40. Of those, 28 percent had breast-conserving surgery and 72 percent had breast removal surgery (mastectomy). Of those who had a mastectomy, 72 percent had both breasts removed (bilateral mastectomy).
Eighty-nine percent of the mastectomy patients had breast reconstruction surgery.
The researchers surveyed the patients and found that those who had a mastectomy had lower levels of breast satisfaction, psychosocial and sexual well-being than those who had breast-conserving surgery.
Physical function was similar for both groups, according to the study.
“These findings suggest that surgical choices may have long-term impact on quality of life,” said lead author Dr. Laura Dominici. She is a surgeon at Dana-Farber/Brigham and Women’s Cancer Center and division chief of breast surgery at Brigham and Women’s Faulkner Hospital, both in Boston.
The findings are scheduled for presentation Friday at the San Antonio Breast Cancer Symposium.
“Historically, about 75 percent of women are eligible for breast-conserving surgery. However, over time, more women, and particularly young women, are electing for bilateral mastectomy,” Dominici noted in a meeting news release.
“Women are becoming increasingly involved in the decision-making process, so we must make sure that they have as much information as possible about long-term outcomes, including quality of life,” Dominici said.
Further research could provide more information to help doctors advise patients of their options for breast cancer surgery, she suggested.
“In the future, I am hopeful that we will be able to predict quality of life outcome for an individual patient following the different types of surgery in order to help her decide what is best for her,” Dominici said.
Research presented at medical meetings is considered preliminary until published in a peer-reviewed journal.
Breastcancer.org offers more on breast cancer surgery.
FRIDAY, Dec. 7, 2018 (HealthDay News) — There’s more evidence that when a survivor of early stage breast cancer takes up healthy eating and regular exercise, the odds of the disease returning go down.
The key is sticking with such programs, said study lead author Dr. Wolfgang Janni.
Healthier lifestyles “might improve the prognosis of breast cancer patients if adherence is high,” said Janni, who directs obstetrics and gynecology at the University of Ulm in Germany. His team developed and implemented a new program to help keep those lifestyle changes on track.
The findings were scheduled for presentation on Thursday at the annual San Antonio Breast Cancer Symposium.
In the study, Janni’s team tracked outcomes for nearly 2,300 early stage breast cancer patients who’d been treated with chemotherapy. Half of these cancer survivors were randomly assigned to two years of ongoing telephone-based, personalized healthy living advice. The other half (the “control” group) received standard, general advice on a healthy lifestyle.
Those in the personalized lifestyle intervention group were coached in areas such as improving their diet, reducing fat intake, and increasing physical activity.
After two years, people in the intervention group saw an average weight loss of 2.2 pounds, while those in the control group experienced an average weight gain of 2.1 pounds, the findings showed.
But the real difference was in cancer outcomes, Janni’s team said. The rate of disease-free survival among the nearly 1,500 patients who completed the lifestyle intervention was 35 percent higher than that of those who didn’t complete the program. And it was 50 percent higher than women who didn’t get the intervention at all.
The findings shouldn’t come as a big surprise, Janni said.
Prior research “has shown that obesity and low physical activity are associated with higher risks of developing breast cancer, as well as an increased risk of recurrence and reduced survival,” he noted in a meeting news release.
One U.S. expert agreed.
Many women who’ve survived breast cancer may feel helpless, but “it is great to be able to tell patients that, yes, there is something they can do to help prevent a recurrence,” said Dr. Alice Police. She is regional director of breast surgery at the Northwell Health Cancer Institute, in Sleepy Hollow, N.Y.
She said sometimes women need a little nudge, though, to stay healthy.
“This is a very specific and focused look at the issues and includes information on exactly how a program of diet and lifestyle changes should look and function,” Police said, “and that makes it very important.”
Dr. Lauren Cassell is chief of breast surgery at Lenox Hill Hospital in New York City. Looking over the new study, she agreed that the new program appears to have merit.
“By providing the patient with a systematic telephone lifestyle intervention program — which was not difficult to develop and implement — they were able to increase patient compliance and as a result improve outcomes,” Cassell said.
“I believe patients want to help themselves,” Cassell said. “Sometimes they just need a little extra support.”
Because the findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.
The American Cancer Society has more on lowering the risk of breast cancer progression or return.
THURSDAY, Dec. 6, 2018 (HealthDay News) — Even with the same treatment, black women with the most common form of breast cancer experience higher recurrence and death rates than white women, a new trial reveals.
The finding pokes holes in the prevailing notion that black women with breast cancer fare worse due to less access to quality medical care, experts said. While that factor may contribute to poorer outcomes, other factors — such as the way drugs are metabolized based on race — may be at play.
“Going way back, there’s always been the concern about blacks in terms of cancer outcomes over time, but a lot of that was based on population [studies] where treatment wasn’t controlled,” said study author Dr. Kathy Albain. She’s chair of oncology research at Loyola University Chicago Stritch School of Medicine.
But “leveling the playing field by bringing women to the same doctors and getting the same treatment” didn’t equalize breast cancer outcomes between black and white women, Albain added.
More than 250,000 women in the United States were diagnosed with invasive breast cancer in 2017, according to the American Cancer Society. The disease claims the lives of about 40,000 people each year.
Albain and her colleagues evaluated the link between clinical outcomes and race in more than 10,000 women with early stage hormone receptor-positive, HER2-negative breast cancer, the most common type of the disease.
Findings from the same multinational research, known as the TAILORx trial, were released in June showing that most women with early breast cancer don’t benefit from chemotherapy. Treating them with chemotherapy and hormone therapy after surgery doesn’t improve outcomes more than hormone therapy alone.
In this latest analysis, patients’ tumors were analyzed using a molecular test that looks at the expression of 21 genes associated with breast cancer recurrence. About 84 percent of the patients were white, 7 percent were black, 4 percent Asian and 4 percent were of other or unknown race. Ethnically, 79 percent were non-Hispanic, 9 percent were Hispanic and 12 percent were of unknown ethnicity.
The types, use and length of treatments were similar between both black and white patients and between Hispanic and non-Hispanic patients.
But outcomes were significantly different: Black women experienced a 39 percent higher risk of breast cancer recurrence compared to white women and a 52 percent higher risk of dying.
These marked outcome disparities were not explained by reported adherence to therapy, or by factors such as age or tumor size or aggression level, Albain said. But she said it’s possible that differences in the way racial groups metabolize drugs could play a role.
“We inherit genes from our parents and the genes that metabolize drugs … differ,” Albain said. “It’s not any sort of racial bias, it’s just a fact.”
Also, because hormone therapy pill adherence was self-reported, she noted, the study authors don’t know if black and white patients actually took the pills according to directions, or in the same way.
“Patients will tell me all the time they’re taking their pills, and they’re not taking their pills,” Albain said. “Pill-counting wasn’t done in this trial” to confirm what patients reported.
Dr. Ann Partridge is a breast medical oncologist at Dana-Farber Cancer Institute in Boston and wasn’t involved in the new research. But she said she wasn’t surprised by the findings and agreed that black and white patients in the study may have adhered to hormonal pill therapy differently.
“We know that young people and African-Americans are less adherent with hormonal therapy — that’s been shown over and over again,” she said.
Partridge also noted that exercise behaviors have been shown to differ by race, and that white women tend to exercise more than black women, which could “have a profound impact” on cancer outcomes.
“This is also true for obesity and diet … which also tends to be different by race,” added Partridge, who’s also a professor of medicine at Harvard Medical School.
Albain and Partridge agreed that more research is needed to pinpoint all the reasons breast cancer outcomes differ according to race.
“We have to chip away at it all, increase our understanding of disease differences and not lump [factors together] as much as we do,” Partridge said.
The research is to be presented Thursday at the San Antonio Breast Cancer Symposium in Texas. Research presented at scientific conferences typically hasn’t been peer-reviewed or published, and results are considered preliminary.
The U.S. National Cancer Institute offers more information on breast cancer treatment.
THURSDAY, Dec. 6, 2018 (HealthDay News) — Tamoxifen is considered a vital weapon in the fight against breast cancer, but many women who have to take the drug struggle with its significant side effects.
Now, new research shows that a lower dose of the hormone therapy helped prevent breast cancer from returning and guarded against new cancers in women who had high-risk breast tissue.
On top of that, the lower dose — just 5 milligrams daily — came with fewer troubling side effects.
“Low-dose tamoxifen is as effective as the standard dose,” said study author Dr. Andrea De Censi. He is director of the medical oncology unit at the National Hospital E.O. Ospedali Galliera — S.C. Oncologia Medica in Genoa, Italy.
De Censi said the rate of side effects — such as hot flashes, vaginal dryness, pain during intercourse and muscle pain — was similar to the rate that occurred with a placebo pill. The side effect rate for the low-dose therapy was significantly less than what previous research has shown with the standard 20 milligram (mg) dose of tamoxifen, he noted.
In addition, the risk of serious side effects, such as blood clots and endometrial cancer, were similar to that of the placebo, and less than what typically occurs with the 20 mg dose, De Censi said.
Hormone therapy for breast cancer interferes with the growth of cancer cells in a few ways. One is by blocking the body from producing certain hormones. Another is by disrupting the effects of certain hormones on cancer cells, according to the American Cancer Society.
In the case of tamoxifen, it works by binding to estrogen-receptors. Some cancers — those called estrogen-receptor positive — are fueled by estrogen. Tamoxifen blocks the estrogen-receptors on cancer cells, keeping them from getting the fuel they need to grow.
De Censi said he was interested in doing the study because the minimum effective dose of tamoxifen hadn’t been researched.
The drug was developed in the late 1960s, he said, and at the time researchers weren’t looking for the minimum effective dose because prevention was the key issue. However, above a certain dose, tamoxifen won’t produce any extra benefit, but it will raise the risk of side effects, De Censi said.
The new study included 500 women. They all had either stage 0 breast cancer (called DCIS) or high-risk lesions in their breast tissue that could develop into breast cancer.
Half of the women took 5 milligrams of tamoxifen daily for three years. The other half took a placebo. The average follow-up time was five years.
By that time, 5.5 percent of the women taking tamoxifen and about 11 percent of the women taking a placebo had a breast cancer recurrence or a new cancer.
Taking low-dose tamoxifen lowered the risk of recurrent or new breast cancer by 52 percent, the researchers reported. And the rates of side effects were similar between the two groups.
About 35 percent of women in the tamoxifen group (and 39 percent in the placebo group) stopped treatment before the study was done. De Censi said if they had continued, it’s possible that the low dose of tamoxifen would have proven even more effective.
Dr. Douglas Marks is a clinical instructor in the oncology/hematology department at NYU Winthrop Hospital in Mineola, N.Y. He said the findings were impressive, and low-dose tamoxifen is a “very worthy idea to be explored.”
But, Marks added, the study doesn’t have data for a long enough time period. He said he’d like to see 15 years of follow-up. And the study really needs to compare the 5 mg dose to the standard 20 mg dose to see if it’s just as effective.
“Different strategies should be evaluated in hormonal therapy,” Marks said.
However, women need to know that the current prevention strategies are very effective, he said. If you’re taking one of these therapies, talk with your doctor if you’re having trouble with side effects, he added.
“Before you stop taking a medication, let your doctor know about your side effects. There are a lot of strategies to deal with side effects. Even if you’re between appointments, call your doctor to talk about it,” Marks advised.
The study is to be presented on Thursday at the San Antonio Breast Cancer Symposium. Findings presented at meetings are typically viewed as preliminary until published in a peer-reviewed journal.
Learn more about hormone therapy for breast cancer from the U.S. National Cancer Institute.
THURSDAY, Dec. 6, 2018 (HealthDay News) — For many breast cancer patients, removal of lymph nodes in the armpit area is a common procedure, due to worries that the tumor has spread to these tissues.
But the operation can also bring the difficult long-term side effect of lymphedema, a painful arm swelling.
Now, new Dutch research suggests that for early stage breast cancer patients, radiating the lymph nodes may bring about as good a chance of long-term survival as full removal — perhaps sparing women those tough side effects.
The new 10-year study finds that both lymph node removal or radiation treatments “provide excellent and comparable overall survival,” said study co-author Dr. Mila Donker, a radiation oncologist at the Netherlands Cancer Institute. Her team was scheduled to present the new findings Thursday at the annual San Antonio Breast Cancer Symposium.
All things being equal, many women may now opt for radiation only and spare themselves lymphedema, said one U.S. oncologist.
“If, in fact, the rate of recurrence in the breast or armpit is basically the same with radiation as compared to removal of lymph glands, this would make radiation very interesting as an alternative,” said Dr. Lauren Cassell, who wasn’t involved in the new study. She directs breast surgery at Lenox Hill Hospital in New York City.
The new research involved 1,425 women with early stage breast cancer that had spread to their armpit lymph nodes and was found by biopsy. Each patient was randomly assigned to have either surgery (744 women) or radiation therapy (681 women).
After 10 years, recurrence of cancer in the armpit lymph nodes had occurred in 1.82 percent (11 out 681 patients) of those who had received radiation therapy and 0.93 percent (7 out of 744 patients) of those who had undergone surgery.
Overall survival rates after 10 years were 81.4 percent for the radiation patients and 84.6 percent of those who’d had lymph nodes removed, Donker’s team found.
Dr. Emiel Rutgers, a surgical oncologist at the Netherlands Cancer Institute in Amsterdam, was the lead investigator of the new study. “Patients with early stage invasive breast cancer who have no clinical evidence of local spread of disease to axillary (armpit) lymph nodes, meaning that palpation or ultrasound shows no sign of disease spread, undergo a sentinel lymph node biopsy,” he explained in a meeting news release.
However, “data from another recent clinical trial suggested that there may be some patients who do not need axillary treatment even if they have a positive sentinel lymph node biopsy,” Rutgers added.
The new study seems to reinforce that view, at least for some patients, he said.
“Moving forward, we need to better tailor treatment for each individual patient. Some will still need axillary treatment, and our data indicate that axillary radiotherapy is a good option here,” Rutgers concluded.
One other U.S. expert was encouraged by the new findings.
“As breast surgeons, many of us have been excited about and eagerly anticipating the results,” said Dr. Alice Police, regional director of breast surgery at Northwell Health Cancer Institute in Sleepy Hollow, N.Y.
The notion that some patients can avoid lymph removal “is very appealing as a surgeon and as a human being,” she said. Police noted that in recent years, removal of just one or two so-called “sentinel” lymph nodes has become routine. Surgeons use these sample nodes to assess if (and by how much) breast cancer may have spread, before deciding on whether to remove more nodes.
Already, the number of full lymph-removal surgeries has been reduced by using this sentinel node approach, she said.
And with the results of the new Dutch trial, “we now know that even with one positive lymph node, more patients can have radiation therapy instead of more surgery,” Police said.
“Radiation therapy has fewer complications and is generally easier on patients,” she said. “This is wonderful news for breast cancer patients who can rest assured that radiation instead of more surgery will not increase their mortality rates or recurrence rates with only a small amount of [lymph node] disease. I am happy that for some patients we can make this an easier journey.”
Because the new findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.
The American Cancer Society has more on lymph nodes and cancer.
WEDNESDAY, Dec. 5, 2018 (HealthDay News) — For certain women with early stage breast cancer, a newer drug that combines an antibody with chemotherapy may cut the risk of disease recurrence in half, a new trial finds.
The study focused on nearly 1,500 women with early stage breast cancer that was HER2-positive — meaning it carries a protein that promotes cancer growth.
About one in every five breast cancers is HER2-positive.
All of the women in the new trial had undergone a standard treatment scenario. First, they received traditional chemotherapy and the drug Herceptin (trastuzumab) — an antibody that targets HER2-positive cancer cells. Then they had surgery to remove any remaining cancer.
Often, women find out that the chemo-Herceptin therapy has already wiped out the cancer, explained Dr. Charles Geyer, the lead researcher on the new study.
But for many other women, there is still “residual” cancer at the time of surgery. And they have a relatively higher risk of seeing their cancer come back, said Geyer, a professor of medicine at Virginia Commonwealth University in Richmond.
All of the women in his study fell into that category.
Right now, the standard of care is to keep those patients on Herceptin for another year after surgery. Geyer’s team wanted to know if women might fare better on a different drug, Kadcyla.
Kadcyla is a newer drug that combines Herceptin with a chemotherapy drug called emtansine. In the United States, it’s approved by the Food and Drug Administration for treating some women with advanced HER2-positive breast cancer.
Geyer explained the basics of how the drug works: “The chemotherapy is attached to the antibody. The idea is that the antibody will carry the chemo directly into the cells that you want to hit.”
Geyer and his colleagues reasoned that Kadcyla might be more effective than Herceptin at preventing recurrences in their early stage patients.
“It turned out that hypothesis was correct,” he said.
Of women who received the drug for a year after surgery, 88 percent were alive and cancer-free three years later. That compared with 77 percent of those given Herceptin.
“That difference is quite substantial,” said Dr. Eric Winer, a medical oncologist at Dana-Farber Cancer Institute in Boston.
Winer, who was not involved in the research, said the findings will probably “change practice in the short term.”
Kadcyla is not yet approved to treat patients like those in this trial. But doctors are free to use FDA-approved drugs for reasons other than their official indication — though insurers have to agree to pay.
Winer said that with this new evidence, “it’s likely” insurers will pay for Kadcyla in cases like these.
When it was approved in 2013, the drug’s cost was more than $90,000 for a typical course of treatment — about double the price of Herceptin.
Geyer was scheduled to present the findings Wednesday at the annual San Antonio Breast Cancer Symposium. The study was published simultaneously online in the New England Journal of Medicine.
The research was funded by Kadcyla maker F. Hoffmann La Roche/Genentech. Geyer is an unpaid member of the company’s breast cancer advisory boards.
The study involved 1,486 women with early stage cancer who still had tumor tissue left after standard chemotherapy and Herceptin. Following surgery, they were randomly assigned to receive either Kadcyla or Herceptin for about a year. Both drugs are given by infusion, every three weeks.
The women were followed for three years after their treatment. At that point, about 12 percent of Kadcyla patients had suffered a recurrence or died, versus 22 percent of Herceptin patients.
However, there were more side effects with Kadcyla, Geyer said. They included a drop in blood platelets — cells that help the blood clot — plus nerve symptoms such as numbness, and elevations in liver enzymes.
But the majority, according to Geyer, were at the milder “grade 1 or 2” level.
Winer framed the findings within a bigger picture: Over the past two decades, treatment advances — including Herceptin and similar drugs — have allowed more and more women with HER2-positive breast cancer to fare well.
“This study is another step in the direction of preventing more recurrences,” he said. “It’s exciting.”
Geyer agreed. “Women with HER2-positive cancer generally have a very favorable outlook,” he said. “The group having recurrences is getting smaller and smaller.”
The American Cancer Society has more on HER2-positive breast cancer.
WEDNESDAY, Nov. 28, 2018 (HealthDay News) — Women at increased risk for breast cancer should start receiving mammograms earlier than recommended, even as young as age 30, a new study contends.
Young women who have dense breasts or a family history of breast cancer appear to benefit from regular mammograms as much as women in their 40s do, researchers reported.
The findings support new breast cancer screening recommendations issued by the American College of Radiology this year, said lead researcher Dr. Cindy Lee, an assistant professor of radiology at NYU Langone Health in New York City.
“Every woman by age 30 should have a risk assessment with their primary care physician or ob-gyn to see if they are at increased breast cancer risk,” Lee said. “If there is family history, then maybe they should consider a baseline mammogram to determine their breast density.”
Breast cancer screening guidelines now call for women to start regular mammograms later in life.
The U.S. Preventive Services Task Force recommends mammograms every other year for women aged 50 to 74, while the American Cancer Society recommends annual mammograms from 45 to 54 and at least every other year from 55 onward.
But Lee said no one has really examined the benefits of starting breast cancer screening in a woman’s 30s.
“So far, everyone is talking about screening women above the age of 40, but we’re looking at a decade earlier because there’s just not enough evidence out there,” Lee said. “We’re looking to see if younger women with certain risk factors may benefit from earlier onset screening mammography.”
For this study, Lee and her colleagues analyzed data from more than 5.7 million screening mammograms performed on more than 2.6 million women between 2008 and 2015. The mammograms took place at 150 facilities in 31 states in the United States.
The researchers looked at women aged 30 to 39 with three specific risk factors — dense breasts, prior diagnosis of breast cancer, or breast cancer in a first-degree relative (mother, sister or daughter).
The investigators compared the results of mammography in these women against mammograms given to women aged 40 to 49 without those risk factors.
Breast cancer was detected about as often in younger women with these risk factors as in women in their 40s, the researchers found.
They also determined that women in their 30s with breast cancer risk factors have to come back to the doctor for further testing and biopsy about as often as older women undergoing regular screening.
“Women with at least one of these three risk factors likely benefit from screening mammogram beginning at age 30, instead of age 40,” Lee said.
The findings were to be presented Wednesday at the Radiological Society of North America annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.
A breast cancer risk assessment and possible initiation of mammograms at age 30 doesn’t necessarily run counter to current screening guidelines, said Robert Smith, vice president of cancer screening for the American Cancer Society.
“The ACS guidelines for women at higher risk already recommend breast cancer screening before age 40 if a woman is a carrier of a known or suspected mutation on a breast cancer susceptibility gene, or if she was exposed to radiation treatment for childhood cancer,” Smith said.
“Likewise, women and their doctors can make individual decisions. So if a woman has a family history in a first-degree relative diagnosed before the age of 50, it is not unreasonable for her to seek advice about whether she should begin screening before age 50,” he said.
The U.S. Preventive Services Task Force recommendation on breast cancer screening also includes some flexibility, saying that the decision to start regular mammography before age 50 “should be an individual one and take patient context into account.”
Smith added that mammograms for women who’ve already had breast cancer shouldn’t really be regarded as screening.
“If a woman has prior history of breast cancer, her regular exams are dictated by that experience,” Smith said. “Any woman diagnosed with breast cancer will undergo regular surveillance breast imaging from that point forward.”
The U.S. Preventive Services Task Force has more about breast cancer screening.
FRIDAY, Nov. 9, 2018 (HealthDay News) — Women confused by the conflicting advice surrounding the benefits and timing of mammograms will be interested in a new study out of Sweden.
The research, involving more than 50,000 breast cancer patients, found that those who took part in a breast cancer screening program had a 60 percent lower risk of dying from the disease in the 10 years after diagnosis, and a 47 percent lower risk 20 years after diagnosis.
“This is really what we’ve been waiting for because there has been so much hoopla about mammography not reducing the death rate from breast cancer,” said Dr. Lauren Cassell, chief of breast surgery at Lenox Hill Hospital in New York City. She was not involved with the study.
Many people have said it’s better treatment, and not screening, that has improved survival, Cassell explained.
“But when you do pick up cancers earlier, patients do better,” she said. “We’ve had a gut feeling that early detection makes a difference, and now we can prove it.”
Study co-author Robert Smith, vice president for cancer screening at the American Cancer Society, said, “The advantage of screening is that it offers a woman, if she develops breast cancer, the opportunity to treat that cancer early when the treatment can be less aggressive and when she has more treatment choices.”
Finding cancer in an early stage may also avoid aggressive treatments that can diminish quality of life, he added.
“Mammography today, in the setting of modern therapy, confers a substantial benefit to women who attend regular screening,” Smith said. “The mortality reductions we observe are principally due to mammography detecting the most aggressive cancers early.”
While the findings may seem obvious, the effect of mammograms on survival is something that’s been debated in recent years.
The American Cancer Society recommends annual breast cancer screening for women aged 45 to 54, while the U.S. Preventive Services Task Force recommends mammograms every other year for women aged 50 to 74.
The task force says the evidence for earlier screening isn’t convincing, but women should make that decision on an individual basis.
Part of the discrepancy is caused by how the evidence is gathered, Smith explained.
Much of the data that has gone into making recommendations came from older studies that weren’t able to clearly break out the benefit of early screening on survival, he said.
Early screening finds cancers that wouldn’t show symptoms for years, Smith said. Also, survival from breast cancer can get confused with improvements in treatment, making it hard to tease out the benefit of screening, he added.
For the new study, researchers were able to take advantage of highly detailed Swedish data that spanned 52 years. This enabled the researchers to look at data from the late 1950s to the early 1970s, when widespread screening didn’t exist, and 39 years later, when widespread screening was available.
What’s more, the data for the new study were “individualized” — so researchers could look at the outcome of every woman in the registry who had breast cancer and whether she was screened or not. This enabled Smith’s team to pinpoint the effect of screening on survival.
The researchers also were able to quantify the benefit of screening by looking at deaths after diagnosis.
“The latest study adds to the large body of literature that demonstrates early detection of breast cancer through screening programs saves the most lives,” said Dr. Nicole Saphier, director of breast imaging at Memorial Sloan Kettering Cancer Center, Monmouth Regional, in Middletown, N.J.
Breast cancers in women aged 40 to 49 tend to grow faster than breast cancers in older women, she said. “This means mammography and early detection are essential in these women, when the chances of survival are highest,” she added.
For the study, Smith and his colleagues collected data on more than 52,400 women aged 40 to 69 in Dalarna, Sweden. All were diagnosed with breast cancer between 1977 and 2015. All the patients received the latest treatment for their stage of cancer, regardless of how it was found.
Dr. Jay Baker is president of the Society of Breast Imaging. In a society news release, he said that, “The conclusion of this study could not be more clear — modern treatments are important but not solely sufficient. Women who get regular screening mammograms cut their risk of dying of breast cancer by about half.”
The findings were published online Nov. 8 in the journal Cancer.
To learn more about breast cancer screening, visit the American Cancer Society.
TUESDAY, Nov. 6, 2018 (HealthDay News) — Women who love the early hours of the day are less likely to develop breast cancer, a new study suggests.
British researchers analyzed two data banks that included more than 409,000 women to investigate the link between sleep traits and breast cancer risk.
Compared to night owls, women who are early risers had a 40 percent lower risk of breast cancer, the study found.
The data also showed that women who slept longer than the recommended seven to eight hours a night had a 20 percent increased risk of breast cancer for each additional hour slept.
“We would like to do further work to investigate the mechanisms underpinning these results, as the estimates obtained are based on questions related to morning or evening preference, rather than actually whether people get up earlier or later in the day,” said Rebecca Richmond. She is a research fellow in the Cancer Research U.K. Integrative Cancer Epidemiology Program at the University of Bristol.
“In other words, it may not be the case that changing your habits changes your risk of breast cancer; it may be more complex than that,” she said.
“However, the findings of a protective effect of morning preference on breast cancer risk in our study are consistent with previous research…,” Richmond noted.
“We also found some evidence for a causal effect of increased sleep duration and sleep fragmentation on breast cancer,” she added.
The study was presented Tuesday at the U.K.’s National Cancer Research Institute (NCRI) annual cancer conference, in Glasgow, Scotland.
The study did not prove a cause-and-effect relationship between sleeping patterns and breast cancer risk.
“These are interesting findings that provide further evidence of how our body clock and our natural sleep preference is implicated in the onset of breast cancer,” said Cliona Clare Kirwan, a member of the NCRI Breast Clinical Studies Group. She was not involved in this research.
“We know already that night shift work is associated with worse mental and physical health. This study provides further evidence to suggest disrupted sleep patterns may have a role in cancer development,” Kirwan said in a meeting news release.
Research presented at meetings is considered preliminary until published in a peer-reviewed journal.
The U.S. National Cancer Institute has more on breast cancer prevention.