News and perspectives from the breast cancer community.
Women with triple-negative breast cancer, a cancer that does not respond to hormonal therapy or HER2-targeted drugs, are treated with chemotherapy and tend to have a high recurrence rate. Lately, many high-profile clinical studies have focused on this patient group, including one announced in October at the American Society of Clinical Oncology Breast Cancer Symposium.
Researchers revealed that a large percentage of women with triple-negative breast cancer have one of the BRCA mutations, which carry a high risk of breast and ovarian cancers.
Unfortunately, many triple-negative breast cancer patients aren’t being tested for a mutation. The study calculated that about 43 percent of the women who tested positive in the study for a BRCA mutation would not have been tested for the mutation under current guidelines, which only suggest BRCA testing for women with a family history of breast cancer or a diagnosis of triple-negative breast cancer who are under age 45.
But there’s also good news. The same researchers at M.D. Anderson Cancer Center in Houston also noted that the 77-woman study shows that patients who have BRCA mutation-associated breast cancer may have a lower risk of recurrence than patients without the mutation even though they have a much higher risk of a diagnosis of breast cancer. Of the patients with a BRCA mutation, recurrence-free survival at five years was 86.2 percent compared with 51.7 percent in patients without the mutation. Five-year overall survival was 73.3 percent versus 52.8 percent.
As the first study to consider BRCA mutation status in triple-negative breast cancer patients, its results further suggest the need for genetic testing in this patient population.
For years, the National Comprehensive Cancer Network, a non-profit alliance of 21 leading cancer centers, has released guidelines to help steer doctors in directing the best treatments for various types of cancer. In September, the organization released its first NCCN Guidelines for Patients: Breast Cancer, written in understandable language for patients to learn more about breast cancer and its treatments.
The guidelines, which were funded by a $160,000 grant from Susan G. Komen for the Cure, are available at NCCN.com and Komen.org with plans to also distribute hard copies of the guidelines. In addition, the NCCN also released patient guidelines for lung cancer. Patient guidelines for melanoma, colon cancer, prostate cancer and non-Hodgkin lymphoma are in the planning stages.
The National Breast Cancer Coalition has set a goal to end breast cancer in less than a decade in its Deadline to End Breast Cancer campaign. It compares curing breast cancer to President John F. Kennedy’s pledge to walk on the moon and the development of a polio vaccine—both completed in under a decade.
“Hope will not end breast cancer. We need a plan … We need a deadline,” states NBCC president Fran Visco in a video statement from the NBCC, “not the goal of a new drug or a new way to find cancer. The goal needs to be the end of breast cancer.”
One of its first initiatives is to fund a strategic plan for a preventive breast cancer vaccine. You can view the video and a white paper on the organization’s campaign at www.stopbreastcancer.org.
You can also read a blog about the Breast Cancer Deadline, "Breast cancer research in 2010 and the Breast Cancer Deadline 2020" from Laura Nikolaides, director of research & quality care programs at the National Breast Cancer Coalition.
A study presented at the American Association for Cancer Research’s annual meeting in November displays a clearer relationship between smoking and breast cancer mortality than previous studies. Researchers set out to examine whether smoking raises the risk of death from breast cancer progression or non-breast cancer-related causes.
“Our study showed that breast cancer patients with a history of smoking have around a 40 percent greater risk of dying from breast cancer than non-smokers,” says Dejana Braithwaite, PhD, lead researcher and assistant professor of cancer epidemiology at the University of California, San Francisco.
The study included 2,265 women of different ethnicities who were diagnosed with breast cancer between 1997 and 2000. The women were followed for an average of nine years. When researchers looked at various characteristics of the patients, they found that the women who had the highest risk of dying had HER2-negative tumors, were postmenopausal and had a lower average body weight than other participants (a body mass index lower than 25 kg/m2). Smokers were also two times more likely to die from non-breast cancer-related causes than nonsmokers.
No direct cause and effect can be fully explained. Yet, Braithwaite says the assumption is that the longer a person has gone without smoking, the less risk there is of dying of breast cancer.
Previous studies that looked at increased risk and the association between smoking and survival rates in breast cancer patients have produced mixed results. However, this study is one of the largest trials examining smoking history and breast cancer, and one of the first to produce significant results, says Braithwaite.
The implication from the current study, says Braithwaite, is that quitting smoking might reduce the risk of dying from breast cancer. “Our study underscores the importance of promoting smoking cessation efforts among breast cancer patients.”
Accelerated partial-breast radiation (APBI) includes radiating the immediate area around the lumpectomy site in less time than tradition whole-breast radiation. APBI made headlines after preliminary results from a phase 3 trial showed that one to two weeks of twice daily APBI was just as effective as six weeks of whole breast radiation.
In a continuation of that study, looking specifically at a type of APBI called 3-D conformal external beam radiation (CEBR), researchers confirmed at this year’s ASCO Breast Cancer Symposium that there was also less early toxicity to the approach.
After studying 3,738 patients for a median of three years, researchers saw no significant acute toxicity-related issues. Less than 15 percent of patients had mild or moderate fibrosis—deep connective tissue toxicity. Several smaller trials in the past have suggested that early toxicity with this type of APBI may be worrisome, but this latest trial is the largest and has followed patients the longest. The trial is continuing to enroll and monitor women for 3-D CEBR’s efficacy, long-term effects and quality of life issues.
Although breast cancer during pregnancy is rare, researchers have aimed to learn more about the disease in this small patient population. Researchers at ASCO’s Breast Cancer Symposium in October described a study of 54 breast cancer patients who were treated in their second and third trimesters of pregnancy. The women received the standard therapy of 5-fluorouracil, doxorubicin and cyclophosphamide during pregnancy, and additional chemotherapy, Herceptin (trastuzumab), or hormonal therapy—if needed—after delivery.
Prior research confirmed that chemotherapy given in the last two trimesters does not affect the fetus, but what was not known was whether pregnancy predicts a worse outcome. It was believed that the hormonal changes during pregnancy could make breast cancer more aggressive. Surprisingly, the study showed that the women who were pregnant fared as well as the control patients in overall survival, progression-free survival, and disease-free survival. The study data encourage physicians and patients not to delay treatment since pregnancy appears to not affect treatment outcome.