Because breast cancer is just one of many cancers, because having had breast cancer doesn’t exempt us from other cancers, we need to take a look at what the experts are saying about prevention of all cancers.

Early this month, I had the opportunity to attend a presentation, “Cancer Prevention: What’s Working, What Isn’t and What’s Next,” given by a panel of experts from Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James). Designated as a Comprehensive Cancer Center by the National Cancer Institute (NCI),  OSUCCC-James is one of only seven  centers, across the US  funded by NCI to conduct both phase I and phase II clinical trials.

The presentation covered several topic areas including foods we need to be eating to prevent cancer, the role of genetic studies in predicting who is at risk and how knowing that information can help to prevent getting cancer, and issues and concerns of long-term survivors. I will post on these areas in future blogs, drawing on information from the OSUCCC-James presentation.

I am limiting my sharing from the presentation, in this post, to a statistical overview on cancer in the US and the need for adopting risk-reducing behaviors known to prevent developing cancers

• 1.5 million people in the US will be diagnosed with cancer this year
• 1 out 0f two men will be diagnosed with cancer in his life time
• 1 out of 3 women will be diagnosed with cancer in her life time
• Every minute a person in the U. S. dies of cancer
• There are twelve million people alive today who have survived cancer in the US
• Over 50% cancer deaths in the US are caused by human behaviors such as smoking, excessive alcohol consumption, obesity, poor diet, and lack of physical activity
• Environmental causes account for 1-2% of cancers
• 5-10% of cancers are hereditary

Numbers don’t lie; they tell a story of too much cancer, over half of which, that can be prevented by eliminating known causes of cancer.

The experts presenting from OSUCCC-James were quite clear  that living a balanced life style that includes; a diet rich in foods that are known to reduce the risk of cancer, maintaining a healthy weight, a daily routine that includes exercise, abstaining from using tobacco products and limited alcohol consumption is the best means available to us for preventing cancer.

It is good to know that we have it withing our power to live a balanced life style. Hopefully that will help many of us from getting cancer. However, we need to always remember that there are exceptions.

There are those of us who have always lived a healthy, balanced life style and yet we got cancer. We may have no family history of  the cancer we have or have had. We are at a loss to explain it to ourselves or to others.

So what do we tell ourselves? Until the day scientists can tell us otherwise…causes unknown.

For more information about OSUCCC-James, go to www.cancer.osu.edu

On May 7^th, I wrote about a study that stated that whole breast radiation following breast conserving surgery may be a better choice than brachytherapy. The study was published in the May 2 issue of the Journal of the American Medical Association. Since the study appeared, a few groups within the medical community, have challenged certain aspects of the study.

What follows is a report on the outcomes of a multi-site study, with a median follow-up of four years, on the uses of Strut-based breast brachytherapy, a 5-day radiation therapy, a form of accelerated partial breast irradiation (APBI), which follows lumpectomy surgery.

The study was presented at the European Society for Radiotherapy & Oncology (ESTRO) World Congress of Brachytherapy in Barcelona, May 10-12. The study documented that breast brachytherapy with a strut-based applicator is a well-tolerated and effective treatment for early-stage breast cancer.

The data from UC San Diego Moores Cancer Center and two other institutions encompasses the longest-term study to date on breast brachytherapy with a strut-based applicator.

“This longer term follow-up gives more weight to the evidence that strut-based brachytherapy is a valid option for women with early-stage breast cancer,” said Catheryn Yashar, lead author of the study and a radiation oncologist at UC San Diego Moores Cancer Center.

“It’s an approach women should consider,” Dr. Yashar said.  “Women lead busy lives and they want a radiation option that will control their cancer, spare their healthy tissue and fit into their schedule more easily than six weeks of whole-breast radiation therapy.”

Other sites participating in the study were Arizona Breast Cancer Specialists (Phoenix,Az.) and 21st Century Oncology (Fort Myers, Fla.)

The research is based on 50 patients treated at those three different institutions with APBI using the Strut-Adjusted Volume Implant (SAVI). Successful completion of treatment was achieved in all 50 cases with favorably low recurrence rates and minimal acute and late toxicities.

“It is significant that these findings encompass patients over a median follow-up of four years since treatment – meaning we now have longer term data with outstanding results that show the efficacy of this therapy,” said Constantine Mantz, M.D., a study co-author and a radiation oncologist and Chief Medical Officer of 21st Century Oncology, the largest radiation oncology provider in the U.S.  “One likely reason for these favorable findings is that this technology spares healthy tissues and directs the radiation more precisely to the immediate area that needs to be treated.”

There were no symptomatic cases of seroma, fat necrosis, or breast asymmetry from radiation treatment. Rates of other side effects including fibrosis, breast pain and hyperpigmentation were also reported to be acceptably low.

The cancer recurrence rate in the study was comparable to the recurrence rate reported in the literature for whole-breast irradiation, which takes six weeks and is the traditional form of radiotherapy for early-state breast cancer.

A second study presented at the Barcelona conference, on the dosimetry of a small strut-based APBI device (SAVI 6-1 Mini), showed that the device is an excellent solution for patients with smaller breasts. The finding helps confirm the applicator’s ability to make breast brachytherapy an option for more women.

The 38-month study of 72 patients, by Serban Morcovescu, MS, and physician colleagues at Texas Oncology and North Texas Hospital (Denton, Texas) showed that the breast brachytherapy device, which is the smallest of its kind, allowed for precise targeting of radiation.

Content Sources: Dowling & Dennis Public Relations Liz@DowlingDennis.net

Cianna Medical , Inc manufacturers of SAVI^® (strut adjusted volume implant)

I wish all the mothers and grandmothers, who are in treatment, a time out from all thoughts and activities related to your breast cancer. I wish you a day of fun and love with family and friends.

For all of of you mothers and grandmothers who have moved past treatment and are getting on with life, I hope your day is all the sweeter, knowing what a gift it is to be well enough to be here enjoying the love of your children.

To all the mothers and grandmothers who are now, or were caregivers to those of us with breast cancer…thank you for your love and  selfless sharing. None of us, who’ve had breast cancer, want to think about what we would have done, how we would have done without you.

To the sisters, cousins, nieces, and aunts who also mothered us during treatment…thanks for making us feel less alone with our fears.

To our dear friends who are mothers, and those who are not…thanks for mothering us during an incredibly difficult time of our lives. You made our time in treatment bearable with your calls, your visits, the hours of listening, the dinners, your company in treatment rooms, and at medical appointments, childcare and child comfort when we were to sick to do so, the errand running and most of all…your upbeat, positive attitudes.

To those women, on our treatment team, that treated us as individuals with feelings and fears that needed attention, not just women with breast cancers that required medical interventions…thank you!

As women, as caregivers, as survivors, as mothers, we all have so much to celebrate about ourselves today!

While the incidence of breast cancer is low in men, a recent national study shows their survival rates lags behind women.

Jon Greif, D.O. of Alta Bates Summit Medical Center in Oakland, Calif., reported on the new study at a press briefing in conjunction with the American Society of Breast Surgeons meeting in Phoenix. He and his colleagues found that while the five-year overall survival rates among women is 83%, it is 74% for men.

Briefing moderator, Deanna J. Attai, MD, of the Center for Breast Care in Burbank, Calif. said, “Even though we think of male breast cancer as a rare disease, we all see at least one or two cases a year in our practice.”

The study used the world’s largest breast cancer data bank, focusing on the 13,457 cases of male breast cancer diagnosed from 1998 through 2007. Findings showed that men with breast cancer were more likely to have disease characteristics associated with poorer outcomes, including:

• Older age at diagnosis (mean 63 versus 59 in women)

• Larger tumors

• Higher grade tumors

• Higher lymph node metastasis rates

•  Men were more likely than women to have hormone receptor-positive tumors (88% versus 78% estrogen receptor positive and 77% versus 67% progesterone receptor positive).

While men accounted for just 0.9% of breast cancer cases in the analysis of the National Cancer Data Base, Greif suggested more needs to be done for them.”If the example of female breast cancer is any indication, simply raising public awareness should boost early detection and thus drive down mortality from the disease in men,” he told reporters.

“Treating men according to standard guidelines for women and screening those with known breast cancer risk mutations or a history of breast cancer might also help,” he added.

For higher risk men, he recommended not only mammography and yearly clinical breast exam but also monthly breast self-exams after age 40. “He should periodically take a look at his breast, make sure he doesn’t see anything out of the ordinary — a lump, a distortion, a discharge, a crustiness, an ulceration, that sort of thing — and then he should just feel the area for lumps,” Greif said at the briefing. “There’s very little to the exam. It shouldn’t take more than a minute.”

Greif cautioned that large databases can unearth statistically significant findings that aren’t necessarily clinically significant and noted possible under reporting of treatment for male breast cancer.

Another limitation, according to Greif, was the older age of the men at diagnosis. Greif told reporters,”In the absence of disease-specific mortality data, we do not know whether the deaths were due to breast cancer or other conditions.”

Source reference: Greif J, et al “Gender differences in breast cancer: Analysis of 13,000 male breast cancers from the National Cancer Data Base” ASBrS 2012; Abstract 104.

Thirteen years ago, following a lumpectomy (surgical removal of that part of the breast containing a malignant tumor) brachytherapy was not an option for me. I received 36 treatments of external beam radiation.

Since then, brachytherapy has become an increasingly popular treatment choice  for women with early-stage breast cancer following  a lumpectomy. The treatment involves inserting a radioactive pellet near the lumpectomy site. The treatment can take as little as one or two weeks, a far cry from  my treatment with external beam radiation, which took six+ weeks.

In a current study published in the May 2 issue of the Journal of the American Medical Association, researchers looked at the rates of mastectomy (surgical removal of the  breast), survival and complications following brachytherapy and whole-breast radiation from national Medicare records of women aged 67 and older between 2003 and 2007.

The  study included nearly 93,000 women aged 67 and older. About 7,000 women received brachytherapy, while almost 86,000 had whole-breast radiation.

Researchers found that women receiving brachytherapy may go on to have higher rates of breast cancer recurrence and side effects such as breast pain and infection than women receiving whole-breast radiation.

Four percent of the women who received brachytherapy had a mastectomy within five years of their radiation treatment, compared with about 2 percent of the women in the whole-breast radiation group.

The rates of infection and other complications were about 28 percent among women who received brachytherapy, compared with 17 percent of women who received whole-breast radiation.

Researchers were quick to point out that although brachytherapy patients experienced more complications and had more mastectomies, indicating their breast cancer came back, there was no difference in survival rates between the two groups five years after treatment.

“There is nothing in our study saying that a woman should not choose brachytherapy if they want the convenience, but I think it is helpful for women to think about the trade-offs, such as higher rates of mastectomy, postoperative complications and infections,” said study author Dr. Benjamin Smith, a radiologist at University of Texas M.D. Anderson Cancer Center, in Houston.

Brachytherapy is appropriate for women aged 60 and older with small tumors that have not spread outside of the breast, along with other indicators of less-advanced breast cancer, according to a 2009 American Society for Radiation Oncology statement written by a group of doctors that included Smith.

“In younger women, breast cancer is generally thought to be more aggressive and data is lacking about the effectiveness of brachytherapy in this group,” Smith said. Dr Smith went on to say that his practice only offers brachytherapy to younger women as part of clinical trials.

While the current study looked at Medicare records of women who had already been treated, “The definitive trials, that follow women, comparing brachytherapy to whole-breast irradiation are still ongoing, but they are years away from giving definitive results,” Smith said.

SOURCE: Benjamin Smith, M.D., assistant professor, radiation oncology, University of Texas M.D. Anderson Cancer Center, Houston;  May 2, 2012, Journal of the American Medical Association