Yes!? Maybe. Initial results are suggestive.
In a study published in J Natl Cancer Inst, Cuzick, et al, report an intriguing finding http://jnci.oxfordjournals.org/content/103/9/744.full. In a subset of patients from the International Breast Cancer Intervention Study (we call it IBIS-1) they compared breast density of those that got cancer who took tamoxifen and those that did not. If breast density decreased by more than 10% on mammograms at 12-18 months, then the women in that group had 63% fewer cancers! Less density reduction was associated with no risk reduction. 46% of women showed >10% reduction in density.
Admittedly, this was a small study and not controlled for all variables and defining breast density is operator dependent. But, it is exciting to think that we might be able to save half of the women who might take tamoxifen long-term from the side effects. If we knew it wasn't working for that woman, we could stop it or maybe try another medicine.
Another step closer to personalized medicine for breast cancer prevention! In the mean time it probably is time for some exercise!
Together we can prevent 86,000 breast cancer cases this year!
This is general content and not personal medical advice.
Friday, May 31, 2013
Wednesday, May 15, 2013
Breast Density as a Biomarker for Breast Cancer Risk
We have previously posted about the risk of breast density: women with more dense breast tissue on mammogram have more breast cancers http://drwinsett.blogspot.com/2012/03/link-between-progesterone-and-breast.html.
Breast density poses two problems: increased risk for breast cancer and decreased ability of the mammogram to "find" the cancer in the dense tissue http://drwinsett.blogspot.com/2013/02/know-your-breast-density.html. The latter finding has led to the recommendation of supplemental screening (in addition to and not replacing the mammogram) for those women with dense breast tissue.
Can we change the dense breast tissue into less dense tissue and does that lower the breast cancer risk? We will see tomorrow that decreasing the breast density is associated with fewer breast cancers. If we had a medicine or surgical technique or life style change that would change the density it could be a biomarker of the effectiveness of the intervention. The intervention would be working to decrease the breast cancer risk in those whose breast density was decreasing. Just as cardiologists follow statin drug effectiveness with cholesterol measurements we could follow the effectiveness of our intervention with breast density measurements. Sounds exciting, doesn't it?
Check back tomorrow for one of the answers!
Together we can prevent 86,000 breast cancers this year!
This content is general and not personal medical advice, but you should know your breast density!
Breast density poses two problems: increased risk for breast cancer and decreased ability of the mammogram to "find" the cancer in the dense tissue http://drwinsett.blogspot.com/2013/02/know-your-breast-density.html. The latter finding has led to the recommendation of supplemental screening (in addition to and not replacing the mammogram) for those women with dense breast tissue.
Can we change the dense breast tissue into less dense tissue and does that lower the breast cancer risk? We will see tomorrow that decreasing the breast density is associated with fewer breast cancers. If we had a medicine or surgical technique or life style change that would change the density it could be a biomarker of the effectiveness of the intervention. The intervention would be working to decrease the breast cancer risk in those whose breast density was decreasing. Just as cardiologists follow statin drug effectiveness with cholesterol measurements we could follow the effectiveness of our intervention with breast density measurements. Sounds exciting, doesn't it?
Check back tomorrow for one of the answers!
Together we can prevent 86,000 breast cancers this year!
This content is general and not personal medical advice, but you should know your breast density!
Tuesday, May 14, 2013
A reminder about the BRCA 1 & 2 genetic deleterious mutations
A brief hiatus in our breast cancer prevention series for the sporadic or breast cancers which apply to 80% of women (most women who get breast cancer don't have a family history of breast cancer).
Some 20% of women have a familial history of breast cancer and in 5-7% a deleterious mutation in the breast cancer genes, BRCA 1 & 2 can be found. Since the deleterious mutations in these genes may carry almost a 90% life-time risk of breast cancer and 45% risk of ovarian cancer, it is worth reviewing to whom the test might apply. Because a high profile figure described her experiences today in the NYTimes http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?hpw&_r=0, I decided to review the Hereditary Breast and/or Ovarian Cancer Syndrome Testing Criteria established by the National Comprehensive Cancer Network. You may find more information at the NCCN website http://www.nccn.org/patients/default.asp, but I will summarize some of the guidelines so that if any of these apply to you, you may ask your doctor about the test.
Testing for the BRCA1/BRCA2 mutation may apply to you if:
Some 20% of women have a familial history of breast cancer and in 5-7% a deleterious mutation in the breast cancer genes, BRCA 1 & 2 can be found. Since the deleterious mutations in these genes may carry almost a 90% life-time risk of breast cancer and 45% risk of ovarian cancer, it is worth reviewing to whom the test might apply. Because a high profile figure described her experiences today in the NYTimes http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?hpw&_r=0, I decided to review the Hereditary Breast and/or Ovarian Cancer Syndrome Testing Criteria established by the National Comprehensive Cancer Network. You may find more information at the NCCN website http://www.nccn.org/patients/default.asp, but I will summarize some of the guidelines so that if any of these apply to you, you may ask your doctor about the test.
Testing for the BRCA1/BRCA2 mutation may apply to you if:
- Anyone in your family has been tested and has a BRCA1/2 mutation
- You have been diagnosed with breast cancer and have one of the following:
- diagnosed < 45 years old
- diagnosed any age with one close blood relative with breast cancer < 50 years old
- diagnosed any age with one close blood relative with ovarian cancer any age
- you have 2 separate breast cancer before age 50
- diagnosed with triple negative breast cancer < 60 years old
- diagnosed < 50 years with limited family history
- diagnosed at any age with 2 or more blood relatives with breast cancer
- diagnosed at any age with 2 relatives with high grade prostate cancer
- close male relative with breast cancer
- any woman of ethnicity associated with high mutation frequency (eg Ashkenazi)
- You have been diagnosed with ovarian cancer
- Personal history of male breast cancer
- Personal history of pancreatic or aggressive prostate cancer with 2 blood relatives with breast and/or ovarian cancer and/or pancreatic or prostate cancer
- Three blood relatives on the same side of the family with breast and/or ovarian cancer
See how complicated it can get? These are the most frequent reasons for testing, but tell your doctor all your family history of cancer, not just breast and ovarian, but prostate and pancreatic.
Thanks to Angelina Jolie for her op-ed.
Together we can prevent 86,000 breast cancer cases this year!
This is content is general and not personal medical advice, but remember to ask your doctor if you have a family history of the above, or call me for help: 512-451-5788.
Friday, May 10, 2013
A new way of thinking...prescription drugs to prevent breast cancer!
Well, new in the last 30 years. Selective Estrogen Receptor Modulators (SERM) do prevent breast cancer! This finding has been reconfirmed in a recent Lancet publication http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60140-3/abstract.
These investigators, led by Dr Jack Cuzick at the Center for Cancer Prevention at Queen Mary University London, performed a meta-analysis of data from 9 breast cancer prevention trials using 4 SERMS (some call these estrogen [receptor] blockers), looking at breast cancer incidence at a median follow-up of 65 months. Two of the SERM's may be familiar to you: tamoxifen and raloxifene(Evista); but studies with arzoxifene and lasoxifene were also included.
They analyzed data from 83,399 women in 306,617 women-years of follow-up! Overall they report a 38% reduction in breast cancer incidence. 38% did not get breast cancer! We know the drugs work, so now the key is to find out who would benefit and what is the risk.
Today, there are general guidelines, which differ by country, which basically state that those of higher risk should be offered the medicine. Interestingly, in the US the "break-point" for recommendation falls around 20% life-time risk (population life-time risk for breast cancer risk is 12%) and in the UK, at 30% risk.
Several drugs may be used in postmenopausal women but only tamoxifen is approved for use in the premenopausal woman. Each has unique side effects and risks and at least one is approved for another beneficial use (maintaining bone health).
Now the exciting part; just as cardiologists can tell whether a statin drug may be "working" by following cholesterol levels, we now may have a biomarker for efficacy of a SERM. Imagine, giving the medicine only to those who benefit most! Personalized medicine! Basing your decision to continue the medicine on information about its efficacy in you and not just the population at large, statistical, benefit!
The first biomarker discovered is breast density. We will discuss the effect of breast density on breast cancer risk and the change in breast density on the effectiveness of the SERM's next week! Then how the SERM's work and finally how to individualize the prescription, weighing benefits vs risks. Check back!
Together we can prevent 86,000 breast cancer cases this year.
This is general content and not personal medical advice.
These investigators, led by Dr Jack Cuzick at the Center for Cancer Prevention at Queen Mary University London, performed a meta-analysis of data from 9 breast cancer prevention trials using 4 SERMS (some call these estrogen [receptor] blockers), looking at breast cancer incidence at a median follow-up of 65 months. Two of the SERM's may be familiar to you: tamoxifen and raloxifene(Evista); but studies with arzoxifene and lasoxifene were also included.
They analyzed data from 83,399 women in 306,617 women-years of follow-up! Overall they report a 38% reduction in breast cancer incidence. 38% did not get breast cancer! We know the drugs work, so now the key is to find out who would benefit and what is the risk.
Today, there are general guidelines, which differ by country, which basically state that those of higher risk should be offered the medicine. Interestingly, in the US the "break-point" for recommendation falls around 20% life-time risk (population life-time risk for breast cancer risk is 12%) and in the UK, at 30% risk.
Several drugs may be used in postmenopausal women but only tamoxifen is approved for use in the premenopausal woman. Each has unique side effects and risks and at least one is approved for another beneficial use (maintaining bone health).
Now the exciting part; just as cardiologists can tell whether a statin drug may be "working" by following cholesterol levels, we now may have a biomarker for efficacy of a SERM. Imagine, giving the medicine only to those who benefit most! Personalized medicine! Basing your decision to continue the medicine on information about its efficacy in you and not just the population at large, statistical, benefit!
The first biomarker discovered is breast density. We will discuss the effect of breast density on breast cancer risk and the change in breast density on the effectiveness of the SERM's next week! Then how the SERM's work and finally how to individualize the prescription, weighing benefits vs risks. Check back!
Together we can prevent 86,000 breast cancer cases this year.
This is general content and not personal medical advice.
Wednesday, May 8, 2013
A New Way of Thinking...Exercise to prevent recurrence!
I know everyone wants to know another benefit of regular exercise! How about, exercise to prevent breast cancer recurrence? YES, it does!
Today, we will look at studies of women who, unfortunately, have been diagnosed with breast cancer. But there is good news. Many studies have demonstrated significantly better outcomes for women who regularly exercise.
For example, we look to another cohort from the Nurses' Health Study. This time JAMA reports http://jama.jamanetwork.com/article.aspx?articleid=200955 on almost 3000 women who were diagnosed with breast cancer (stages I, II or III) and followed at least 4 years.
When compared to non-exercisers (<1hour/week), those women who walked at an average pace (2-2.9mph), or did the equivalent, at least 3 hours per week, did significantly better: 50% fewer recurrences, 50% fewer deaths from breast cancer and 50% fewer deaths from any cause!
Another group that should get an exercise prescription!
Together we can prevent 86,000 breast cancer cases this year and help those who have been diagnosed. If you want to help a friend who has been diagnosed, tell her about this information and have her check with her doctor for an exercise prescription!
This content is general and not personal medical advice, but if you know someone who might benefit, call me 512-451-5788.
Today, we will look at studies of women who, unfortunately, have been diagnosed with breast cancer. But there is good news. Many studies have demonstrated significantly better outcomes for women who regularly exercise.
For example, we look to another cohort from the Nurses' Health Study. This time JAMA reports http://jama.jamanetwork.com/article.aspx?articleid=200955 on almost 3000 women who were diagnosed with breast cancer (stages I, II or III) and followed at least 4 years.
When compared to non-exercisers (<1hour/week), those women who walked at an average pace (2-2.9mph), or did the equivalent, at least 3 hours per week, did significantly better: 50% fewer recurrences, 50% fewer deaths from breast cancer and 50% fewer deaths from any cause!
Another group that should get an exercise prescription!
Together we can prevent 86,000 breast cancer cases this year and help those who have been diagnosed. If you want to help a friend who has been diagnosed, tell her about this information and have her check with her doctor for an exercise prescription!
This content is general and not personal medical advice, but if you know someone who might benefit, call me 512-451-5788.
Monday, May 6, 2013
A new way of thinking? Exercise prescription!
Didn't we talk about this? Yes, we did http://drwinsett.blogspot.com/2012/08/should-we-doctors-treat-inactivity.html.
The Canadians are doing it http://www.cbc.ca/news/health/story/2013/05/03/exercise-prescription.html and its working!
Since the US Center for Disease Control (CDC) says 79% of americans are not meeting guidelines for exercise, maybe we doctors should write more exercise prescriptions. See http://www.usatoday.com/story/news/nation/2013/05/02/physical-activity-guidelines/2128971/?cid=xrs_rss-nd%3C.
For those of you who need a jump-start to your exercise and be active program, would that work?
If it would work for you, call your doctor or call me 512-451-5788 to get your personalized exercise prescription. Remember, over 75 studies have shown that those who regularly exercise have fewer breast cancers http://drwinsett.blogspot.com/2012/06/maybe-youve-heard-exercise-reduces.html.
Together we can prevent 86,000 breast cancers this year!
This is general content and not personal medical advice, but if you know someone who needs an exercise prescription, have them call me at 512-451-5788.
The Canadians are doing it http://www.cbc.ca/news/health/story/2013/05/03/exercise-prescription.html and its working!
Since the US Center for Disease Control (CDC) says 79% of americans are not meeting guidelines for exercise, maybe we doctors should write more exercise prescriptions. See http://www.usatoday.com/story/news/nation/2013/05/02/physical-activity-guidelines/2128971/?cid=xrs_rss-nd%3C.
For those of you who need a jump-start to your exercise and be active program, would that work?
If it would work for you, call your doctor or call me 512-451-5788 to get your personalized exercise prescription. Remember, over 75 studies have shown that those who regularly exercise have fewer breast cancers http://drwinsett.blogspot.com/2012/06/maybe-youve-heard-exercise-reduces.html.
Together we can prevent 86,000 breast cancers this year!
This is general content and not personal medical advice, but if you know someone who needs an exercise prescription, have them call me at 512-451-5788.
Friday, May 3, 2013
A new way of thinking...about breast cancer screening
Screening is a test offered to a group of people to find a disease. In the our business, usually an imaging test to find a potentially deadly disease: breast cancer.
The problems with screening are many: financial cost, emotional cost (worry about result and false negative findings), ethics (to whom to recommend the test) and what to do with the positive result (as so many like to write about now: over treatment).
To look at mammography, specifically, lives are saved (see earlier blog posts) so the test works. But, apparently, according to some experts, we are learning more about to whom to recommend the test. Let's look at just one issue today. One group recommends routine mammography beginning at age 40 and others at age 50 years.
I offer one solution: the BREVAGen Risk Assessment Test. This test, combining your genetics (cheek swab) with features of your clinical history, gives the clearest picture we have today of your risk, so that you may decide about screening. See http://drwinsett.blogspot.com/2012/04/more-personalized-breast-cancer.html.
Ask your doctor, if the test is right for you or ask us 512-451-5788. If you have had the test, then tell a friend.
In the meantime, keep walking, jogging, swimming or biking, etc, to lower your risk for breast cancer! And think about how long to do one of these to offset the calories in that latte you just had!
Together we can prevent 86,000 breast cancers this year!
This is general content and not personal medical advice.
The problems with screening are many: financial cost, emotional cost (worry about result and false negative findings), ethics (to whom to recommend the test) and what to do with the positive result (as so many like to write about now: over treatment).
To look at mammography, specifically, lives are saved (see earlier blog posts) so the test works. But, apparently, according to some experts, we are learning more about to whom to recommend the test. Let's look at just one issue today. One group recommends routine mammography beginning at age 40 and others at age 50 years.
I offer one solution: the BREVAGen Risk Assessment Test. This test, combining your genetics (cheek swab) with features of your clinical history, gives the clearest picture we have today of your risk, so that you may decide about screening. See http://drwinsett.blogspot.com/2012/04/more-personalized-breast-cancer.html.
Ask your doctor, if the test is right for you or ask us 512-451-5788. If you have had the test, then tell a friend.
In the meantime, keep walking, jogging, swimming or biking, etc, to lower your risk for breast cancer! And think about how long to do one of these to offset the calories in that latte you just had!
Together we can prevent 86,000 breast cancers this year!
This is general content and not personal medical advice.
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