What’s In Your Genes?

A new genetic tool (that determines which genes in a tumor cell are very active or extremely inactive) can help doctors predict early on whether a tumor is likely to metastasize and spread quickly. In a recent study, published in the New England Journal of Medicine, tumor samples of 295 women with breast cancer were compared to their medical outcomes. Those who had a good prognosis, according to the genetic signature technique, had an 85% chance of being disease-free for the next ten years, while those with a poor prognosis had only a 51% chance of no tumor recurrence. This controversial study implies that a tumor has an inherent ability to metastasize at a very early stage, instead of late in the process, as most doctors believe. Before treatment models are developed, however, additional studies need to be conducted.

Aromatase Inhibitors vs. Tamoxifen:
Round One

According to results of a study presented at the San Antonio Breast Cancer Symposium last December, aromatase inhibitors, a new class of hormonal agents, may be more effective than Tamoxifen in preventing disease recurrence in postmenopausal women. In the study, which covered 47 months of treatment and 54 months of follow up in 9,000 postmenopausal women with breast cancer, only 11% of women with hormonally-sensitive tumors on a particular aromatase inhibitor developed a recurrence or died, but 13% of patients who took Tamoxifen had the same results. Although bone fractures may develop in women taking aromatase inhibitors, the agents are not associated with an increase in uterine cancer and blood clots (known side effects of Tamoxifen). Still, for now until additional studies are performed, experts continue to recommend Tamoxifen as the treatment of choice.

A Proper Dose

“ Dose-dense therapy” or administering chemotherapy more frequently, appears to improve survival in breast cancer patients with fewer side effects, according to a recent report. With “dose-dense therapy,” the tumor growth interval between treatments is shorter and there are fewer malignant cells to treat. In fact, 31% of patients are less likely to die using this method, when compared to women who undergo conventional treatment. “This new regimen could potentially save thousands of lives a year in this country alone,” says Larry Norton, MD, senior researcher of the study and head of the division of Solid Tumor Oncology at Memorial Sloan-Kettering Cancer Center. In the study, nearly 2,000 women who were diagnosed with breast cancer that spread to lymph nodes were enrolled in this treatment protocol after undergoing surgical resection to remove the malignancy. Some of the women received chemotherapy treatment every two weeks (dose-dense therapy) while another group received chemotherapy on the usual 3-week schedule. Results indicated that 82% of the group that received chemotherapy at more frequent intervals were cancer-free four years later compared to 75% of women who received the standard 3-week therapy. Three year survival was 92% in the dose-dense treatment group vs. 90% in the conventionally treated group. However, a side effect of more frequent chemotherapy can be a greater incidence of infection since more white blood cells are killed along with the tumor cells. Luckily, the problem of infection can be controlled with drugs that can increase a woman's white blood cell count between therapies. More studies will need to be conducted to see whether this therapy will become the new standard of care.

Study Hall

Are you interested in volunteering for a groundbreaking clinical trial? Then sign up for The Study of Tamoxifen and Raloxifene, or The STAR trial, which is recruiting volunteers at more than 500 centers across the United States, Puerto Rico and Canada. The trial will include 22,000 postmenopausal women at increased risk of breast cancer to determine whether the osteoporosis prevention drug Raloxifene (Evista™) is as effective in reducing the chance of developing breast cancer as Tamoxifen (Nolvadex™). For more information and a list of participating centers call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Under Reconstruction

A woman’s choice to have breast reconstruction is influenced by her race, age, geographic location and stage of disease, according to a new study of 10,406 patients who had mastectomies, published in Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons (ASPS). According to the study, African American, Hispanic and Asian women were significantly less likely to have breast reconstruction than Caucasian women. Atlanta reported the highest rate of breast reconstruction, with Hawaii reporting the lowest rate. Younger women (35 to 44 years old) were the most likely to have breast reconstruction, and women in advanced stages of the disease, or ones who received radiation therapy were the least likely to choose reconstruction.