Breast Cancer is a major health concern for all women, including women with disabilities. About 30% of women aged 40 years or older have a disability. In the US in 2008, 76.2% of women aged 40 or older reported having a mammogram in the past two years, while women with a disability have a lower reported mammography rate than women without a disability. The Center for Disease Control and Prevention (CDC) has prepared a fact sheet that includes tips for women with disabilities to help them eliminate difficulties they may encounter while undergoing screening. To view the CDC article, click HERE.
October is Breast Cancer Awareness Month----it's a good time for ALL women to be sure they have appropriate screenings. For the men who read this blog, make sure the women in your lives take care of themselves and find time to be screened. Remember, too, that about 1% of breast cancer cases (nearly 2,000 per year) are found in men so if you have an unusual growth or swelling in the chest area, have it checked out! They sometimes do mammograms on men, too!
Dr. Teresa Woodruff, Director of the Institute for Women's Health Research at Northwestern, and her colleagues have just released their second book on oncofertility. Oncofertility is a new field of study named by Dr. Woodruff who is a leader in the study of fertility preservation in women who have lost their fertility due to cancer therapies and other conditions that threaten their ability to conceive and bear children. The issue of fertility preservation is of particular concern to young breast cancer survivors and their health care team. To learn more about this book and where to find it read below.
The Oncofertility Consortium® is pleased to announce that the second volume of its Oncofertility series is now available on Amazon.com!
Fertility preservation is an emerging field not only in the basic and clinical sciences, but also in the social sciences and humanities. Oncofertility: Ethical, Legal, Social, and Medical Perspectives offers insights by experts and scholars in bioethics, philosophy, religion, communication, and history, who tackled questions such as,
“What are the Jewish, Muslim, and Catholic perspectives on oncofertility?”
“What barriers to adoption do couples with a history of cancer face?”
“What decisionmaking processes do families undergo when considering fertility preservation?”
Purchase your copy of this one-of-a-kind book to discover the answers to these questions and to learn more!
Complete your Oncofertility collection with the first volume, Oncofertility: Fertility Preservation for Cancer Survivors, also available on Amazon.com!
Women who undergo treatment for breast cancer may be offered the possibility of reconstruction if they opt for mastectomy. This may lead to a discussion on whether or not to do reconstruction immediately during the initial surgery or delay it until any other treatments like chemotherapy are complete. Two new studies published in the September edition of the Archives of Surgery provide additional information that could influence this decision.
One study finds that about half of the women who need radiation therapy after having had a mastectomy with immediate reconstruction develop complications that require additional surgery. Another study finds that chemotherapy does not affect complication rates after mastectomy and immediate reconstruction.
Dr. Rodney Pommier, professor of surgery at Knight Cancer Institute in Portland and his colleagues found that among the women who had mastectomies and who needed radiation, complications occurred in 44 percent of those who had immediate reconstruction, but only in 7 percent of those who did not have immediate reconstruction. Both scenarios, having radiation after mastectomy and having reconstruction done immediately---strongly predicted the risk of complications according to the researchers. Radiation tripled the risk, and immediate reconstruction increase the risk eightfold.
Implants had to be removed in 31 percent of patients who had radiation after mastectomy, compared to just 6 percent of those who did not have to have radiation, the researchers reported. Pommier said that these results were higher than expected and have changed his way of thinking. He now suggests that having a biopsy of the sentinel lymph node (if positive for tumor, generally indicates that radiation may be needed) would be important. Typically this sentinel node biopsy is performed during the mastectomy but it can be done as an outpatient procedure before the mastectomy and before the decision to have reconstruction is made. The determination to do radiation also depends on other factors, such as tumor size, and some surgeons may have a different opinion about the additional sentinel node surgery. There are also different reconstructive techniques that may influence outcome.
In the second study, researchers from the University of California, San Francisco, found that chemotherapy, either before or after the mastectomy and immediate reconstruction, had no bearing on complications and the need for more procedures.
A new report by the Institute of Medicine issued on Sept. 23, concludes that there has been some progress in women's health over the past two decades especially in lessening the burden of disease and reduced deaths among women in the areas of cardiovascular disease, breast cancer and cervical cancer, specifically. The effort has yielded less but still significant progress in reducing the effects of depresssion, HIV/AIDS, and osteoporosis in women. However, the report also identifies several areas that are important to women that have seen little progress, namely, unintended pregnancy, autoimmune disease, alcohol and drug addiction, lung cancer, and dementia.
Overall, few gains have been made on chronic and debilitating conditions that cause significant suffering but have lower death rates, pointing to the need for researchers to give quality of life similar consideration as mortality for research attention. The report also points out that barriers such as socio-economic and cultural influences still limit the potential reach and impact of research developments, especially among disadvantaged women.
Several observations made by the experts who wrote the report are in areas the Institute for Women's Health Research at Northwestern has raised as ongoing problems. One of those issues is the the fact that many research projects, even if they include both men and women, rarely report the results by sex. Furthermore, as pointed out in a recent paper in Nature, written by IWHR director, Teresa Woodruff, PhD, and her graduate students, scientific journals should require authors to include sex data in their publications.
Another challenge discussed in the report is how best to communicate complex research findings to the public and the media. The IWHR through it blog, website and monthly e-newsletters is striving to meet that challenge.
Over the next month or so, this blog will discuss issues in the IOM report in greater detail but in the meantime click HERE to read the press release, the entire report on line or to order a copy.
A new study underscores the importance for women with a family history of breast or ovarian cancer to get genetic counseling and testing for the BRCA1 and BRCA2 genes that make them more likely to develop lethal breast or ovarian cancer, says a Northwestern Medicine oncologist. The study, which was published in the Sept. 1 issue of the Journal of the American Medical Association (JAMA), shows women with the gene live longer and nearly eliminate their risk of cancer by having prophylactic surgeries to remove their ovaries and fallopian tubes (salpingo-oophorectomy) or their breasts in a mastectomy.
“This is the first study to prove women survive longer with these preventive surgeries and shows the importance of genetic testing when there is a family history of early breast or ovarian cancer,” said Virginia Kaklamani, M.D., co-author of an accompanying editorial in JAMA. Kaklamani is director of translational breast cancer research at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. She also is an associate professor of medicine at Northwestern University Feinberg School of Medicine and an oncologist at Northwestern Memorial Hospital.
In the editorial, Kaklamani and coauthor, Laura Esserman, M.D., a physician at the University of California, San Francisco, describe what the findings mean to women and their physicians.
“Primary care physicians, gynecologists and women need to be more aware that these tests exist,” Kaklamani said. “So if a woman has a family history of ovarian cancer or breast cancer, the woman can be genetically tested. Testing should not start with the oncologists. That’s when patients already have breast cancer. The primary care doctors and gynecologists are the ones who should evaluate patients and offer them genetic counseling.”
About 10 to 20 percent of breast and ovarian cancers are due to BRCA1 or BRCA2 genes. “Most of these women will die of ovarian cancer, so you can save 20 percent of them with the prophylactic surgery,” Kaklamani said. “And you can save the majority of women who would have died of their breast cancer.”
Even women diagnosed with breast or ovarian cancer can still benefit from genetic testing “because the presence of a mutation significantly increases the risk of a second primary (breast or ovarian) diagnosis and often influences the choice of treatments,” the authors write.
While some women diagnosed with the gene mutation may opt for surveillance with an alternating mammogram and breast magnetic resonance imaging every six months, the authors emphasize surveillance is not prevention. And, ovarian cancer screening has limited value.
Women should be aware that options for these preventive surgeries have improved, the authors note. A laparoscopic salpingo-oophorectomy is a relatively low-risk procedure and can be done in an out-patient setting. And cosmetic options for women getting mastectomies have greatly improved.
All living organisms have a circadian clock, sometimes called a biological clock, that is an important part of maintaining optimal health. The circadian rhythm is a roughly 24-hour cycle in the biochemical, physiological, or behavioral processes of living things. Although circadian rhythms originate from within our bodies, they are synchronized to the environment by external cues, including the day-night cycle caused by the Earth's rotation. Researchers are looking more closely at the role circadian rhythms play in the development of diseases such as breast cancer and also how factors such as hormones affect this biological clock.
Carla Finkielstein, a molecular biologist at Virgina Tech, has launched a research project to study how changes in circadian rhythms may contribute to the development of breast cancer in women. According to Finkielstein, "There are a number of epidemiological studies that show women working night shifts have a higher incidence of breast cancer." The question she asks is: Can working odd hours actually alter a women's body chemistry--turning healthy cells into cancer cells?
With support from the National Science Foundation, she is using frog embryos to help figure out on a molecular basis the physiological changes in women who work night shifts. She says studies show that night workers have abnormal levels of specific protein in their cells, which act by turning on and off genes that regulate how cells grow and divide. Proper timing of cell division is a major factor contributing to the regulation of normal cell growth and is a fundamental process in the development of most cancers. She explains," Our research explores ways in which the loss of circadian function impairs the death of cells in the cell cycle and leads to the accumulation of damaged, or cancerous, cells."
Where is this leading us, what is the clinical application? "If we were to generate a panel of markers that we can follow regularly for women who works night shifts, it would enable us to record changes in circadian-controlled genes and thus predict whether a person is at risk of developing breast cancer, " Finkielstein said. "If we see abnormal changes, all we may need to do is to alter this person's work schedule."
This study reinforces the important role circadian rhythm plays in sex and gender-based research. In another example, researchers at Northwestern University who are working in the lab of Dr. Fred Turek have determined that sex differences in hormone status in female mice are critical to better understanding stress or sleep deprivation. There is growing evidence that circadian rhythm may play a part in other health issues like cardiovascular disease and diabetes.
I have noticed that recently there have been a lot of commercials on television about getting your BRACAnalysis®. You might be wondering what a BRAC analysis is? Or maybe you are wondering if you should get one? The BRAC test is a genetic test that will test your genome for the presence of two genes that have been correlated with certain types of breast and ovarian cancer.
Mutations in these genes, known as BRCA1 and BRCA2, are strongly associated with 7% of breast cancers and 11-15% of ovarian cancers (1). In most people, the BRCA genes are tumor suppressors, meaning they encode proteins that help regulate cell growth. When these genes are mutated, they can lose their ability to control cell growth, and cancer can thus develop. However, it is important to realize that not every woman who has a mutated BRCA1 or BRCA2 gene will develop cancer. About 12% of the general population of women will develop breast cancer; while approximately 60% of women with a BRCA mutation will develop breast cancer. Similarly, about 1.4% of women will develop ovarian cancer, compared to 15-40% of women with a BRCA mutation. However, since these two genes are only associated with certain types of breast and ovarian cancer, a negative test (no mutation) does not guarantee that you will not develop cancer at some point in your lifetime (2).
Because the genes are located on the autosomal chromosomes (as opposed to the sex chromosomes), the mutation can be inherited from either your mother or your father. Most women who decide to undergo genetic BRCA testing have a family history of breast or ovarian cancer. However, there are no current medical guidelines for recommending BRCA tests. Also, having a family member with the mutation does not necessarily mean you will have it to. Once a woman tests positive for either BRCA1 or BRCA2, she has several options to help reduce her risk. The most conservative options would be to monitor the breast and ovarian tissue with frequent screenings such as mammography or ultrasound. More drastic options include removing the breast tissue and/or ovaries before cancer has a chance to develop, or taking chemotherapeutic drugs to help prevent cancer (clinical trials have demonstrated some success of these drugs in prevention of breast cancer).
A BRAC analysis test usually involves collection of a blood sample, and could cost you anywhere from several hundred to several thousand dollars, and it may not be covered by your insurance company. The good news however, is that the Genetic Information Nondiscrimination Act of 2008 prevents discrimination from insurance companies or employers against people who have undergone genetic testing. With personalized medicine on the rise, many individuals are concerned that their genetic information might be sold to employers and insurance providers and used to exclude them from employment or health coverage. This law is meant to protect an individual’s right to privacy with his or her genetic information.
Ultimately it is your decision if you would like to undergo genetic testing. It is important, however, to think about the emotional stress of undergoing such a test and receiving your results. You might want to think beforehand about what you would do with the information. If your test is positive, would you elect for preventative surgery? Will your insurance cover early screening if you think you need it? Knowing your risk can be both empowering and daunting. I recently watched a wonderful documentary by filmmaker Joanna Rudnick, titled In the Family, that explores her own emotional struggle with genetic testing for breast and ovarian cancer. View the trailer below:
It’s been all over the news this week--the US Preventative Services Task Force came out with a new set of recommendations for breast cancer screening, including recommending against yearly mammograms for women ages 40-49. Their recommendations say that there is only a small benefit from starting testing at 40, and that this benefit isn't enough to outweigh potential harms of testing, including psychological harms, unnecessary biopsies, and false positives.
The task force also recommends against teaching breast self-examination, another issue that raises controversy. Alison wrote a post a couple months ago about whether breast self exams are beneficial, take a look to get a couple more viewpoints on the issue.
The main point is that starting routine mamography at age 40 doesn't save or add years to enough women's lives to recommend screening for everyone. But mammography does sometimes detect cancer in women in their 40s, and these recommendations have many people worried that insurance may stop covering mammograms for women under 50. Since the task force states, "the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms," it seems unlikely that insurance companies will be able to refuse coverage for women whose physicians believe they should get earlier testing. Women with a strong family history of breast cancer or with genetic mutations that predispose them to the disease will still be encouraged to start testing earlier.
Keep in mind that these recommendations aren't from some random group of government officials with no knowlegde of healthcare out to save money at the cost of peoples health; on the contrary, members of the task force include mostly physicians and professionals with degrees in public health and nursing from across the country.
You may have noticed the NFL players wearing their pink gloves and shoes for Breast Cancer Awareness Month. But did you know that breast cancer is the leading cause of cancer-related deaths in American women? It is caused by abnormal cell growth in the breast tissue, usually beginning in the milk-producing ducts. The abnormal growth may spread (metastasize) through your breast to your lymph nodes, or other parts of your body. The most common symptom of breast cancer in both men and women is a lump in the breast, which is usually painless. Most breast lumps are non-cancerous, but it is still important to have any lumps evaluated by a physician. Other symptoms of breast cancer include clear or bloody discharge from the nipple, change in breast size or shape, retraction or indentation of the nipple and skin around the breast. Treatment for breast cancer often involves surgery, radiation therapy, and/or chemotherapy. A variety of surgical techniques are available depending on the size of the lump or tumor.
The good news is there are many resources for breast cancer treatment and research at Northwestern!
The Lynn Sage Cancer Research Foundation in partnership with Northwestern Memorial Hospital and the Robert H Lurie Comprehensive Cancer Center has established the Lynn Sage Breast Cancer Program to provide women with access to the latest advances and technology in breast cancer treatment. The center offers clinical, diagnostic, rehabilitation and counseling services at a single location.
Northwestern Memorial Hospital also offers breast reconstruction surgery for patients who have undergone lumpectomy or mastectomy or who have other cancer-related deformities. Dr. Neil Fine, a plastic surgeon at NMH has developed an innovative technique as an alternative to total mastectomy. The technique involves repositioning portions of the latissimus dorsi into the breast where a tumor has been removed. Only a handful of other hospitals across the country are offering this procedure.
IWHR Highlighted Researcher
Dr. Seema A. Khan M.D., is the Bluhm Family Professor of Cancer Research at Northwestern University’s Feinberg School of Medicine. She is also the Director of the Bluhm Family Breast Cancer Early Detection and Prevention Program at Feinberg. She received her medical degree from Dow Medical College in Pakistan and a Master’s in Epidemiology from the Harvard School of Public Health. Dr. Khan is a board-certified surgeon whose research interests involve prevention, early detection and treatment of breast cancer. Currently she has multiple active clinical trials including a study designed to identify biomarkers for breast cancer risk in benign breast tissue. Similarly, she is investigating the level of estrogen in nipple fluid as a marker for breast cancer risk. Other recent studies include the development of a topical treatment for non-invasive breast cancer and the multi-center evaluation of a preventive breast cancer therapy for post-menopausal women taking Hormone Replacement Therapy.
“The Promises and Myths of Breast Cancer Research”
Sunday, October 4, 2009 from 1:00 p.m. until 4:00 p.m.
Fairmont Chicago, 200 N. Columbus Dr.
Do you have questions about breast cancer treatment options, family history, integrative medicine, diagnosis and support? The Lynn Sage Breast Cancer Town Hall Meeting, hosted by the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, provides an opportunity to have your questions answered by experts, visit exhibits of breast cancer advocacy organizations and products, and to learn about local and national support services.
William Gradishar, M.D., Director of Breast Medical Oncology at the Lurie Cancer Center will moderate. Topics and panelists include: Nora Hansen, MD--surgery, John Hayes, MD--radiation oncology, Virginia Kaklamani, MD--cancer genetics, Melinda Ring, MD--integrative medicine. This event is free and open to the public.
Please call 312-695-1304 or visit www.cancer.northwestern.edu to register. Walk-ins welcome. Discounted parking and free shuttle available from Erie/Fairbanks/Ontario Garage, 321 E. Ontario (Ontario St. exit).