MedicalResearch.com Interview with:
Edith A. Perez, MD
Mayo Clinic
Jacksonville, FL 32224
Medical Research: What are the main findings of the study?
Dr. Perez: Our joint analysis of two large prospective trials showed that adding one year of Trastuzumab to otherwise standard adjuvant chemotherapy significantly improved long term survival in women with resected HER2+ breast cancer.
MedicalResearch.com Interview with:
Professor Xiaodong Zhang
Professor of Macromolecular Structure and Function
Department of Medicine
Imperial College, London, UK
Medical Research: What are the main findings of the study?
Prof. Zhang: Since its discovery 20 years ago, the BRCA2 gene and its protein product, BRCA2, have been under intensive investigations. The importance of the BRCA2 protein lies in the central roles it plays in the most faithful DNA damage repair pathway. Mutations in BRCA2 thus can cause defects in this repair pathway, making the repair inefficient or forcing cells to use alternative repair methods that are prone to mistakes, all of which contribute to mutations in the genomic DNA, thus increase the risk of cancer development. Our study aims to understand how BRCA2 works through studying its 3-dimensional structures and its interactions with other key partners in the repair pathway.
Our study provides first 3-dimensional views of BRCA2 and BRCA2-RAD51 and reveals that BRCA2 molecules exist as pairs and a BRCA2 pair recruit two sets of RAD51 molecules arranged in opposite orientations. Our study also shows a single stranded DNA binds across the BRCA2 dimer and that BRCA2 increases the frequency of RAD51 filament formation events, presumably to increase the efficiency of establishing a longer filament required for searching for matching strands of DNA in intact sister chromatin. Our results thus not only define the precise roles of BRCA2 in helping RAD51 filament formation, but how it helps RAD51 loading onto single stranded DNA.
MedicalResearch.com Interview with:
Gary Ulaner, MD, PhD
Assistant Attending Radiologist
Memorial Sloan Kettering Cancer Center
Assistant Professor of Radiology, Weill Cornell Medical School
Chair, Radiology Research Committee
Medical Research: What are the main findings of the study?
Dr. Ulaner: FDG PET/CT revealed distant metastases in 17% of asymptomatic stage IIB breast cancer patients below 40 years of age. Although NCCN guidelines recommend against systemic staging in patients with stage II disease, our data suggests that PET/CT might be valuable in younger patients at earlier stages of disease than previously expected.
MedicalResearch.com Interview with:
Blake Cady MD
Professor of Surgery (emeritus) at Harvard Medical School
Partners HealthCare, Harvard Medical
School institutions, Boston
Medical Research: What are the main findings of this study?
Dr. Cady: Our findings support mammography screening, and our data is consistent
with the randomized trials. Breast cancer screening with mammography is the most extensively researched screening method ever studied. Only one “randomized" trial failed to show reduced mortality, (Canadian NCSS studies), and there were major flaws in its design and execution that negate their results, as noted in multiple critical publications (volunteers, not geographic assignment, palpable masses detected at examination assigned to “screening” arm, large contamination bias (control group got screened anyway), and very poor quality of mammography). Yet it is this NCSS study that is cited by critics and the press. “Failure Analyses” look backward from death, rather than forward from assignment in randomized trials. The concept of failure studies is well established as noted in recent reports of air-bag failures in cars, and many industrial studies. Seat belt prevention of deaths was discovered by police recording injuries and deaths in crashes after the fact - a failure analysis - not by randomized clinical trials. In breast cancer, failure analyses have advantages of little cost, early results, simplicity, and convenience, compared to randomized trials. Since our results support findings from randomized clinical trials (RCT), they can be accepted as reliable and accurate.
Our findings show that about 71% of deaths from breast cancer occur in the approximately 20% of our patients not in regular screening programs, while only 29% of deaths occur in the 80% of women who were regularly screened by mammography. By extrapolation, women regularly screened have only about a 5% breast cancer mortality, but women not screened have close to a 50% mortality.
(This is my extrapolation from our data, not direct data from our “Failure Analysis”)
MedicalResearch.com Interview with:
Nienke de Glas, MD PhD-student
Leiden University Medical Center
Department of Surgery
Leiden The Netherlands
Medical Research: What are the main findings of the study?
Dr. de Glas: It remains unclear whether mass breast cancer screening has a beneficial effect in older women. In the Netherlands, the upper age limit of the breast cancer screening program was extended from 69 to 75 years in 1998. If a screening program is effective, it can be expected that the incidence of early stage tumours increases, while the incidence of advanced stage tumours decreases. The aim of this study was to assess the incidence of early stage and advanced stage breast cancer before and after the implementation of mass screening in women aged 70-75 years in the Netherlands. We showed that the extension of the upper age limit to 75 years has only led to a small decrease of advanced stage breast cancer, while the incidence of early stage tumours has strongly increased. For every advanced stage tumour that was prevented, 20 “extra” and early stage tumours were diagnosed.
MedicalResearch.com: Interview with:
Isabelle Bedrosian, M.D., F.A.C.S.
Associate Professor, Department of Surgical Oncology, Division of Surgery
Medical Director, Nellie B. Connelly Breast Center
The University of Texas MD Anderson Cancer Center, Houston, TX
Medical Research: What are the main findings of the study?
Dr. Bedrosian:
• National BCT (breast conserving therapy) rates have increased during the last two decades.
• Disparities based on age, geographic facility location and type of cancer treatment facility have lessened over time.
• Insurance type and travel distance remain persistently associated with underutilization of breast conserving therapy.
• Annual income of less than $35K may be emerging as a new association with underutilization of breast conserving therapy.
MedicalResearch.com Interview with: Dr. Gudrun Jonasdottir Bergman PhD National Board of Health and Welfare Sweden, Stockholm, Sweden Medical Research: What are the main findings of this study? Dr. Gudrun Jonasdottir Bergman: A recent study by Li et al [1] showed that long term use of Calcium Channel Blockers (CCB) increases the risk of developing breast cancer....
MedicalResearch.com Interview with:
Ying Wang PhD
Epidemiology Post-Doc Fellow
American Cancer Society Inc
Atlanta, GA 30303
Medical Research: What are the main findings of the study?
Dr. Wang: Previous studies suggest that higher intake of fruits and vegetables are associated with lower risk of breast cancer risk, especially estrogen receptor (ER) negative (ER-) tumors that are more aggressive and difficult to treat. We found that postmenopausal women who had higher intake of flavones, a subgroup of flavonoids that are widely distributed in fruits and vegetables, had lower risk of breast cancer. Furthermore, higher intake of flavan-3-ols which is high in non-herbal tea was associated with lower risk of ER- but not ER positive breast cancer.
MedicalResearch.com Interview with
Lynn Rosenberg, ScD
Slone Epidemiology Center at Boston University
1010 Commonwealth Avenue
Boston, MA 02215
Medical Research: What are the main findings of the study?
Response: With prospective data from the Black Women’s Health Study, we assessed vigorous exercise and walking in relation to incidence of invasive breast cancer . We found that the overall incidence of breast cancer was lower among women who exercised vigorously or walked briskly than among women who were sedentary. The reduction was most apparent among women who exercised at least 5 hours per week. The association of exercise with breast cancer risk did not differ by estrogen receptor status of the breast tumor, but further study is needed to firmly establish this. Sitting for long periods at work or watching television was not significantly associated with breast cancer incidence.
MedicalResearch.com Interview with:
Dr. Judith Malmgren PhD
Affiliate Assistant Professor, Epidemiology
University of Washington
School of Public Health
Seattle, WA 98177
Medical Research: What are the main findings of the study?
Dr. Malmgren: We found a significant shift to lower stage breast cancer at diagnosis with an observed increase in mammography detected breast cancer over time and a significant decrease in later stage cancers found by the patient or her doctor.
Mammography detected breast cancers were more often treated with lumpectomy and radiation and less likely to require mastectomy or adjuvant chemotherapy.
We also observed better 5 year invasive breast cancer specific survival among the mammography detected patients as opposed to the patient or physician detected breast cancer cases.
MedicalResearch.com Interview with:
Dr Marc Tischkowitz MD PhD
University Lecturer (Associate Professor) and
Honorary Consultant Physician in Medical Genetics
Department of Medical Genetics, University of Cambridge
Medical Research: What are the main findings of the study?
Dr. Tischkowitz: The PALB2 gene was first identified in 2006 and linked to breast cancer in 2007 but until now we have not had good breast cancer risk estimates for women who have inherited PALB2 mutations. This study was started in 2009 by an group of research institutions (The PALB2 Interest Group) in Canada, US, Europe (UK, Belgium, Greece, Italy, Finland) and Australia. We studied 362 individuals with PALB2 mutations from 154 families. We found that awomen with a PALB2 mutation will on average have a 35% risk of developing breast cancer by the age of 70, rising to 58% if there is a strong family history. Our study will help clinicians to better advise and manage such women.
There are several new aspects.
edicalResearch.com Interview with
Steven M. Hill, Ph.D.
Professor, Structural & Cellular Biology
Edmond & Lily Safra Chair for Breast Cancer Research
Co-Director, Molecular Signaling Program, Louisiana Cancer Research Consortium
Director, Tulane Circadian Biology Center
Medical Research: What are the main findings of the study?
Dr. Hill: The main findings of our study are that exposure to even dim light at night can drive human breast tumors to a hyper metabolic state, activating key tumor cell signaling pathways involved in tumor cell survival and proliferation, leading to increased tumor growth, all resulting in a tumor which is completely resistant to therapy. Our work shows that this effect is due to the repression of nighttime melatonin by dim light at night. When nighttime melatonin is replace the tumors become sensitive to tamoxifen resulting in cell death and tumor regression.
MedicalResearch.com Interview with:
Rajkumar Lakshmanaswamy, PhD
Basic Science Research Director of the Center of Excellence in Cancer Research.
The Paul L. Foster School of Medicine
Texas Tech University Health Sciences Center
Medical Research: What are the main findings of the study?
Dr. Lakshmanaswamy: Our study supports a growing body of research suggesting a safe and effective role for natural steroid hormones in treating postmenopausal breast cancer, with fewer detrimental side effects and an improved health profile than with standard anti-hormone therapies. Using a mouse model mimicking human breast cancer after menopause, we found that treatment with estrogen, progesterone, and testosterone was associated with greater physical activity, improved cognition, and better cardiovascular and bone health, which demonstrates the potential significance of hormone treatment in postmenopausal women.
Dr. Qiuyin Cai, M.D., Ph.D. Courtesy: Vanderbilt University[/caption]
MedicalResearch.com Interview with:
Qiuyin Cai, M.D., Ph.D.
Associate Professor of Medicine
Vanderbilt University
Medical Research: What are the main findings of the study?
Dr. Cai: We conducted a genome-wide association study in East Asians to search for additional genetic changes that are linked to breast cancer development. The study was conducted as part of the Asia Breast Cancer Consortium, which includes 22,780 women with breast cancer and 24,181 control subjects. We found DNA sequence changes in two genes, PRC1 and ZC3H11A, and a change near the ARRDC3 gene were associated with breast cancer risk. These results were also replicated in a large consortium, including 16,003 breast cancer cases and 41,335 control subjects of European ancestry.
MedicalResearch.com Interview with:
Florien Boel MSc
VU University Medical Center
Department of Medical Psychology
Amsterdam, The Netherlands
Medical Research: What are the main findings of the study?
Answer: In postmenopausal breast cancer patients, endocrine therapy is widely used, and often for many years on end. Endocrine therapy is thought to have an effect on cognitive functioning, but previous studies have not yet accounted for the possible influence of the diagnosis of cancer and subsequent anxiety, depression or fatigue on cognitive performance. In addition, the cognitive effects of endocrine therapy after long-term use are still mostly unknown.
Therefore, we compared cognitive functioning of postmenopausal breast cancer patients who underwent surgery and/or radiotherapy (N=43) with the cognitive performance of women who also received adjuvant endocrine therapy (tamoxifen) (N=20) and a group of healthy matched individuals (N=44). In accordance with the literature, we found that especially cognitive domains that rely heavily on verbal abilities (verbal memory and fluency) seem to be at risk for deterioration during long-term treatment (~2.5 years) with tamoxifen.
MedicalResearch.com Interview with:
Dr. Olivia Pagani
Clinical Director of the Breast Unit of Southern Switzerland
Ospedale San Giovanni, Switzerland
Medical Research: What are the main findings of the study?
Dr. Pagani: The study showed that the aromatase inhibitor Exemestane is superior to Tamoxifen (both given together with ovarian function suppression) in preventing breast cancer recurrence in premenopausal women with oestrogen receptor positive early breast cancer.
MedicalResearch.com Interview with:
Dr. Rahul Potluri
Honorary Clinical Lecturer in Cardiology
School of Medical Sciences, Aston University
Birmingham UK;
Medical Research: What are the main findings of the study?
Dr. Potluri: Study was conducted by a retrospective analysis of more than 1 million anonymous patient records across the UK between 2000 and 2013 using the Algorithm for Comorbidities, Associations, Length of stay and Mortality (ACALM) protocol.
There were 664,159 women and of these, 22 938 had hyperlipidaemia and 9 312 had breast cancer. Some 530 women with hyperlipidaemia developed breast cancer. A statistical model to study the association between hyperlipidaemia and breast cancer. They found that having hyperlipidaemia increased the risk of breast cancer by 1.64 times (95% confidence interval 1.50-1.79).
MedicalResearch.com Interview with:
Dr. Katja Pinker MD
Department of Radiology
Medical University of Vienna ·
MedicalResearch.com: What are the main findings of the study?
Dr. Pinker: We hypothesized that by imaging multiple key processes involved in cancer development and growth with multiparametric PET/MRI an improved non-invasive diagnosis of breast tumors is possible. To test this hypothesis, we conducted this first clinical feasibility study.
Mutliparametric PET/MRI allows an improved non-invasive differentiation of benign and mailgnant breast tumors than currently used contrast-enhanced MRI alone. By its use unnecessary breast biopsies in benign tumors can be avoided without missing cancer.
MedicalResearch.com Interview with
Sai-Ching Jim Yeung, MD, PhD, FACP
Professor of Medicine
The University of Texas MD Anderson Cancer Center
Department of Emergency Medicine
Department of Endocrine Neoplasia & Hormonal Disorders
Houston, Texas 77230-1402
MedicalResearch: What are the main findings of the study?
Dr. Yeung: We believe that this study has bridged a significant gap in knowledge between epidemiological data (the association of obesity and poor breast cancer prognosis) and biological mechanisms mediating the impact of obesity on cancer. This study provides an important mechanistic insight into the causal relationship between obesity and breast cancer growth.
MedicalResearch.com Interview With
Dorothy N. Pierce, DNP, MSN, RN, NP-C, CRN, OCN, CBCN
Advanced Practice Nurse
Rutgers Cancer Institute of New Jersey
Rutgers, The State University of New Jersey
New Brunswick, NJ 08901
MedicalResearch: What are the main findings of the study?
Answer: The main findings from the study were:
MedicalResearch.com Interview with:
Dalliah Black, MD F.A.C.S.
Department of Surgical Oncology
The University of Texas
MD Anderson Cancer Center, Houston
MedicalResearch: What are the main findings of the study?
Dr. Black: This is a retrospective study from 2002 - 2007 using the SEER/Medicare database of over 31,000 women with node negative breast cancer evaluating the utilization of sentinel node biopsy (SNB) as it transitioned from an optional method for axillary staging to the standard of care instead of complete axillary lymph node dissection (ALND). We found that SNB use increased each year in both white and black breast cancer patients throughout the study period. However, SNB was less often performed in black patients (62.4%)compared to white patients (73.7%) and this disparity persisted through 2007 with a 12% difference. Appropriate black patients more often had an ALND instead of the minimally invasive sentinel node biopsy which resulted in worse patient outcomes with higher lymphedema rates in black patients. However, when black patients received the minimally invasive SNB, their rates of lymphedema were low and comparable to white patients who received SNB.
MedicalResearch.com Interview with:
Jack Cuzick PhD
Centre for Cancer Prevention
Wolfson Institute of Preventive Medicine
Queen Mary University of London,
London UK
Dr. Cuzick offers the manuscript below to put the results of the Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial in focus for MedicalResearch.com.
The Prevention of Breast Cancer
The first human evidence that drug treatment might reduce the incidence of breast cancer was reported in 19851, where it was found that use of tamoxifen in a trial of women with breast cancer to reduce recurrence of existing tumours also had a major impact on new tumours in the opposite breast, reducing them from 10 to 3. That observation has subsequently been confirmed in several other adjuvant trials and an overview of all such trials indicates that after an average of about 8 years of follow up, 5 years of tamoxifen reduced new contralateral tumours by 39%, with similar effects in years 0-5 and 5-10 in women with oestrogen receptor positive or unknown primary tumours2. These observations and positive results from animal studies3, led to the evaluation of 5 years of tamoxifen in women without breast cancer, but at high risk in 4 large trials. A recent overview4 indicates a 33% reduction in all breast cancer after a 10 years follow up, with a larger reduction in years 0-5 (48%), when treatment was given, and a continuing (22%) effect in years 5-10. Reductions were seen for oestrogen receptor positive invasive cancer (44%) and DCIS (28%), but no effect was seen for both oestrogen receptor negative invasive cancer, where in fact a non-significant 13% (P=0.4) increase was observed. Somewhat larger effects were seen for these other selective estrogen receptor modulators (SERMs) – raloxifene, lasofoxifene and arzoxifene – in trials of osteoporotic women, where the primary endpoint was fracture reduction4. A subsequent head-to-head trial of raloxifene vs tamoxifen, showed tamoxifen to be about 20% more effective, but raloxifene had fewer side effects5. Lasofoxifene not only showed benefits for breast cancer reduction but also reduced fracture rates and heart disease6, and this multi-dimensional set of benefits makes it an attractive candidate for prevention.
MedicalResearch.com Interview with:
Dr. Benjamin D. Smith MD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, TX 77030
MedicalResearch: What are the main findings of the study?
Dr. Smith: Although use of needle biopsy to diagnose breast cancer increased during the time period we studied, it remained lower than targeted benchmarks. The patient’s surgeon seemed to exert a major influence on use of needle biopsy.
MedicalResearch.com Interview with
Dr. Maryam Farvid MSc, Ph.D.
Takemi fellow, and Associate Arofessor
Senior author: Prof Walter Willett
Department of Nutrition, Harvard School of Public Health,
Boston, MA,
MedicalResearch: What are the main findings of the study?
Dr. Farvid: Compared to women who had one serving per week red meat, those who consumed 1.5 serving per day red meat had a 22 percent higher risk of breast cancer. Red meat intake is associated with breast cancer risk in a dose-response manner. Each additional serving/day increase in total red meat was associated with a 13% increase in risk of breast cancer. Furthermore, each additional serving/day of poultry was associated with a 25% lower risk of postmenopausal breast cancer. Substituting one serving/day of legumes for one serving/day of red meat was associated with a 15% lower risk of breast cancer, substituting one serving/day of poultry for one serving/day of red meat was associated with a 17% lower risk of breast cancer overall, and substituting one serving/day of combined legumes, nuts, poultry, and fish for one serving/day of red meat was associated with a 14% lower risk of breast cancer.
MedicalResearch.com Interview Invitation
Dr. Barbara Pockaj, MD
Professor of Surgery
Mayo Clinic, Arizona
MedicalResearch: What are the main findings of the study?
Dr. Pockaj: The study analyzed 515 triple negative breast cancer samples using a multi-platform approach including whole genome mRNA expression, protein expression, gene copy number changes and gene sequencing for immune markers. The study found that a cohort of the triple negative breast cancer patients had high expression of PD-L1 (program death ligand) and other immune regulators such as CTLA-4 (Cytotoxic T-lymphocyte Antigen) and IDO-1 (indoleamine 2,3-dioxygenase). High PD-L1 expression was found in patients whose tumors were triple negative and androgen receptor negative. High PD-L1 expression was related to DNA repair gene abnormalities including BRCA1.