Fish Habit May Reduce Breast Cancer Risk, Study Suggests

Researchers found that higher fatty acid intake cut chances of disease by 14 percent

By Kathleen Doheny

HealthDay Reporter

THURSDAY, June 27 (HealthDay News) -- Regularly eating oily fish such as salmon, tuna or sardines may help reduce the risk of breast cancer, a new report suggests.

These fish contain a type of fatty acid known as n-3 polyunsaturated fatty acids (PUFAs).

"Increased n-3 PUFA intake has a protective effect for breast cancer," said researcher Duo Li, a professor of nutrition at Zhejiang University in Hangzhou, China.

Li and his team reviewed 21 different studies that looked at the intake of fish and PUFAs. The previously published research included more than 800,000 women in the United States, Europe and Asia, and 20,000 cases of breast cancer. The follow-up time varied, from four years to 20.

The new report is published online June 27 in the journal BMJ..

Fish include several types of PUFAs that are involved in chemical messaging in the brain, helping to regulate both blood vessel activity and the immune system. The fatty acids also have been linked with other health benefits, such as lower risk of heart problems.

Earlier studies have shown conflicting results about the protective effects of PUFAs that are found in fish and breast cancer risk. So Li decided to pool the results of the 21 studies and reanalyze them.

In his analysis, consumption of most types of PUFAs -- but not fish itself -- was linked with a lower risk. Women with a high intake of PUFAs had a 14 percent reduction in breast cancer risk. For every 0.1-gram-per-day increase in the intake of the fatty acids, there was a 5 percent lower risk of breast cancer, the study found.

So how much fish should you eat? "One to two servings of oily fish per person per week is suggested," Li said.

Li said he can't explain with certainty the association between PUFAs and lowered breast cancer risk. Among other possibilities, he speculated that the fatty acids may help regulate the activities of molecules involved in cell growth and in the spread of cancer cells.

Two U.S. experts who reviewed the new findings saw pros and cons to the report.

Although the number of women studied was large, the link found between fatty acid intake and breast cancer risk reduction "is not necessarily cause-and-effect," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City.

Dr. Joanne Mortimer, director of women's cancer programs at the City of Hope Comprehensive Cancer Center in Duarte, Calif., agreed. "My take on this is it may be more than just what they eat" that helps reduce breast cancer risk, she said. "To make an assumption that the lower risk is due entirely to diet may be a false one."

The women with a high intake of PUFAs also may be more apt to exercise and follow other healthy habits, Mortimer said.

Both Mortimer and Bernik cautioned against focusing too much on fish for risk reduction or on eating too much of it. "It's no cure-all," Bernik said. And, if eaten in excess, the mercury content of some fish can be unhealthy, she added.

Besides eating oily fish, Bernik tells patients to exercise regularly, eat plenty of fruits and vegetables, and not smoke to reduce the risk of breast and other cancers.

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Socializing May Ease Pain of Breast Cancer

THURSDAY, May 9 (HealthDay News) -- Having fun with family and friends can help relieve breast cancer patients' pain and improve their quality of life, a new study indicates.

The study included more than 3,100 women in California who were diagnosed with breast cancer between 2006 and 2011. Within about two months of their diagnosis, they completed questionnaires on their social networks, the kinds of support they received, their emotional and physical quality of life, and their physical symptoms from breast cancer.

Women with the largest social networks were most likely to report the best overall quality of life during breast cancer treatment. Higher levels of social support were also linked with better emotional quality of life, according to the Kaiser Permanente researchers.

Having family and friends to do fun things with (positive social interaction) was the most important predictor of good physical quality of life. Patients with little or no positive social interaction were three times more likely to report a low quality of life and more physical symptoms, the investigators found.

The study also found that the benefits of tangible support from others -- such as doing household chores, bringing food or providing transportation to the doctor -- were strongest among women with late-stage breast cancer. Those with low levels of tangible support were nearly three times more likely to have a lower-than-average quality of life.

The study was published May 9 in the journal Breast Cancer Research and Treatment.

"This study provides research-based evidence that social support helps with physical symptoms," study author Candyce Kroenke, a staff scientist with the Kaiser Permanente division of research, said in a Kaiser news release. "Social support mechanisms matter in terms of physical outcomes."

Each year in the United States, about 230,000 women are diagnosed with invasive breast cancer and, in 2012, there were about 2.9 million breast cancer survivors. The fact that more women are being cured of breast cancer increases the importance of quality of life after diagnosis, Kroenke said.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Kaiser Permanente, news release, May 8, 2013

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Longer Wait for Mammogram After Benign Breast Biopsy May Be Warranted

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Longer Wait for Mammogram After Benign Breast Biopsy May Be Warranted

By Kathleen Doheny
HealthDay Reporter

THURSDAY, May 2 (HealthDay News) -- Women who have a breast biopsy that turns out to be benign are typically told to undergo another imaging test, such as a mammogram, in six to 12 months. Now, a new study suggests that the longer interval might be better.

Researchers who followed women who had benign breast biopsies say having that test less than a year later finds few cancers and is a drain on health care dollars.

''Doing a follow-up imaging study six months after a benign needle breast biopsy has a low likelihood of finding breast cancer at the biopsy site," said study author Dr. Andrea Barrio, an attending breast surgeon at Bryn Mawr Hospital, in Pennsylvania.

Most of these women, she said, can wait longer than six months before repeating the mammogram, ultrasound or MRI.

Dr. Demitra Manjoros, a breast fellow at Bryn Mawr, is due to present the research Thursday at the American Society of Breast Surgeons' annual meeting, in Chicago.

A biopsy is done after an abnormality is found on an imaging test such as a mammogram. The standard of care is to perform an image-guided needle biopsy, Barrio said.

"However, when you do a needle biopsy, you only sample the lesion or abnormality, instead of removing it," she said.

So, the follow-up imaging was suggested. Under current National Comprehensive Cancer Network guidelines, the repeat imaging is recommended six to 12 months after a benign breast biopsy.

"In my practice, I perceived that this short-term imaging did not seem to add anything to the care of the patient," Barrio said.

So, she launched the study, focusing on 337 women who had benign biopsies and met one other criterion: Their pathologic findings explained the finding on the image. Researchers then looked to see if the interval for repeat imaging made a difference in finding cancer.

Of the 337 women, 169 had imaging repeated less than 12 months after their benign biopsy result. Another 101 had no documented imaging test repeated. And another 67 had repeat imaging 12 months or later after the biopsy.

Of the 169, just one breast cancer was identified. Of the 67 who had repeat imaging at 12 months, no malignancies were found.

The cost of detecting a missing cancer with the shorter interval follow-up was nearly $193,000 in this group.

The study findings support a policy of discontinuing repeat testing less than 12 months after such a benign finding, Barrio said.

The findings don't mean no one should have shorter-term imaging follow up, Barrio said. While in general, routine short-term repeat imaging after such a benign biopsy is not needed, she said, "I'm not saying nobody should do it."

"Certain women would require six months follow-up," she said. For instance, a woman whose initial imaging findings were vague or not specific might be advised to get repeat imaging in less than a year, she said.

A breast cancer expert commented on the new research.

The study is sound, said Dr. Laura Kruper, director of the Cooper Finkel Women's Health Center and co-director of the breast cancer program at the City of Hope Comprehensive Cancer Center in Duarte, Calif.

"I think most women would be fine having repeat imaging in 12 months," she said, "but it should be done on a selective basis." A doctor must take the whole patient into account, she said, weighing such factors as family history and a woman's views of the testing intervals.

"There are some patients who are going to be so nervous waiting a year," Kruper said.

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Andrea Barrio, M.D., attending breast surgeon, Bryn Mawr Hospital, Bryn Mawr, Pa.; Laura Kruper, M.D., director, Cooper Finkel Women's Health Center, and co-director, breast cancer program, City of Hope Comprehensive Cancer Center, Duarte, Calif.; May 2, 2013, presentation, American Society of Breast Surgeons annual meeting, Chicago

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Scientists Create Breast Cancer Survival Predictor

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Menopause-Like Woes Hinder Breast Cancer Treatment: Study

FRIDAY, April 12 (HealthDay News) -- Hot flashes and other unpleasant side effects are a major reason one-quarter of breast cancer patients do not start or do not complete their recommended hormone-blocking therapy, a new study finds.

Five years of daily pills -- either tamoxifen or aromatase inhibitors -- is recommended for many women whose breast cancer expresses the hormones estrogen or progesterone. The drugs have been shown to reduce the risk of cancer returning and to extend survival.

Despite such benefits, this study of more than 700 breast cancer patients in Detroit and Los Angeles who were eligible for hormone therapy found that about 11 percent never started treatment and 15 percent stopped it early.

Unpleasant, menopause-type side effects, such as vaginal dryness, hot flashes or joint pain, were the most common reasons women either stopped or never started the therapy.

"We need to develop better ways of supporting women through this therapy," lead study author Christopher Friese, an assistant professor at the University of Michigan School of Nursing, said in a university news release.

Those most likely to complete their hormone therapy were patients who were most worried about their cancer returning and those who already took medication regularly, according to the study, which was published online March 31 in the journal Breast Cancer Research and Treatment.

Patients least likely to begin hormone therapy included those who received less information about hormone therapy, which suggests that doctors need to properly educate patients before treatment begins, the researchers said.

Women who saw a breast cancer surgeon instead of a medical oncologist as their primary follow-up also were less likely to begin hormone therapy.

"It was particularly interesting that greater fear of recurrence was associated in our patient sample with greater adherence to endocrine therapy," study senior study author Dr. Jennifer Griggs, a professor of internal medicine at the University of Michigan Medical School.

"We don't want our patients living under a cloud of fear, so we need to develop creative ways to both reassure and motivate them," said Griggs, a medical oncologist. "This means providing better education about the importance of staying on these medications and partnering with primary care and cancer doctors to help patients manage symptoms."

More than 234,000 Americans will be diagnosed with breast cancer this year and more than 40,000 will die from the disease, the American Cancer Society estimates.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of Michigan Comprehensive Cancer Center, news release, April 9, 2013

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New Clues to How Exercise May Reduce Breast Cancer Risk

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When Breast Cancer Spreads to Lungs, Surgery May Increase Survival

Title: When Breast Cancer Spreads to Lungs, Surgery May Increase Survival
Category: Health News
Created: 4/1/2013 10:35:00 AM
Last Editorial Review: 4/1/2013 12:00:00 AM

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More Evidence Shows Hormone Therapy May Increase Breast Cancer Risk

In new analysis, researchers found risk highest when used just before menopause

By Kathleen Doheny

HealthDay Reporter

FRIDAY, March 29 (HealthDay News) -- Women who take hormone therapy that includes estrogen and progestin are at increased risk of developing breast cancer and dying from it, especially if they start taking the therapy just as menopause begins, a new analysis confirms.

Researchers followed nearly 42,000 women, all of whom were past menopause, for an average of more than 11 years. Of those, more than 25,000 did not use hormone therapy and more than 16,000 took estrogen and progestin, also called combined hormone therapy. For this analysis, the researchers did not include estrogen-only therapy, used by women who have had a hysterectomy.

At the end of the follow-up period, more than 2,200 of the women were found to have breast cancer. Compared to non-users, those who took combined therapy were more likely to have breast cancer, said Dr. Rowan Chlebowski, a medical oncologist at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. Chlebowski led the study, which was published in the March 29 issue of the Journal of the National Cancer Institute.

The link has been found in other studies, but Chlebowski also found the risk was greatest among those who took the hormones closest to menopause. "Women starting within months of menopause had about a threefold greater risk than women starting 10 years after menopause," Chlebowski said.

For the new analysis, Chlebowksi looked at results from the Women's Health Initiative observational study. He compared the findings with those from the Women's Health Initiative randomized clinical trial, in which women were assigned to different treatments.

The Women's Health Initiative included four clinical trials and an observational study. Women were all past menopause and were aged 50 to 79.

Chlebowski said he did the new analysis to resolve what he saw as unanswered questions. In the trial, only about one-third, or 5,000, of the women were in their 50s when they started the study. As that is the typical age for menopause to start, about two-thirds of the women in the trial were in their 60s or beyond, so began to take hormones several years after menopause.

Chlebowski set out to see if the link between breast cancer risk and combined hormone therapy use was influenced by earlier use of hormones.

"We had a substantial number closer to menopause than the clinical trial of [the Women's Health Initiative]," he said.

He found, however, that not only was the risk of breast cancer still increased, but it also increased even more if the women were closer to menopause when they began to take the hormones.

He speculated that women who start the hormone therapy close to menopause still have circulating levels of estrogen high enough to make them exceed some threshold, beyond which it may become hazardous.

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DNA Test Shows Promise in Guiding Advanced Breast Cancer Care

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Breast Cancer Radiation Has Long-Term Heart Effects: Study

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Q&A: Breast Cancer in Young Women

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1 in 4 Breast Cancer Diagnoses May Spur PTSD

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More Younger Women Diagnosed With Advanced Breast Cancer: Study

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Breast Cancer Research Needs More Focus on Environment: Report

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New Drug Regimens May Slow Advanced Breast Cancer

Title: New Drug Regimens May Slow Advanced Breast Cancer
Category: Health News
Created: 12/5/2012 10:35:00 AM
Last Editorial Review: 12/5/2012 12:00:00 AM

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Racial Disparities Still Seen in Use of Breast Cancer Treatments

Title: Racial Disparities Still Seen in Use of Breast Cancer Treatments
Category: Health News
Created: 12/5/2012 10:35:00 AM
Last Editorial Review: 12/5/2012 12:00:00 AM

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Longer Tamoxifen Use Helps Breast Cancer Survival

ByBrenda Goodman, MA
WebMD Health News Reviewed byLouise Chang, MD

Dec. 5, 2012 -- Doubling the time that breast cancer patients take tamoxifen cuts the risk that the cancer will come back and further lowers the risk of dying of the disease, a new study shows.

The study is expected to change the way doctors prescribe tamoxifen, a drug that blocks the effects of estrogen on breast cells. About 80% of all breast cancers are sensitive to the hormone estrogen for growth.

The research also hints that longer courses of other kinds of hormone-reducing medications may also work better than shorter courses after breast cancer surgery, though trials testing that theory are ongoing.

“I think the result of this trial will have a major immediate impact on premenopausal women,” says Peter Ravdin, MD, PhD. Ravdin is the director of the Breast Health Clinic at the Cancer Therapy and Research Center at the University of Texas Health Science Center, in San Antonio.

Newer kinds of estrogen-reducing drugs, called aromatase inhibitors, have largely replaced tamoxifen as the preferred therapy for postmenopausal women with estrogen-sensitive cancers. This study won’t change that.

But those kinds of drugs don’t work for women before menopause. For them, doctors still recommend taking tamoxifen.

Current guidelines recommend that women stop tamoxifen after five years because the drug increases the risk of uterine cancers and dangerous blood clots.

The new study found small increases in cases of uterine cancer in women who took the drug for an additional five years. Those women also had slightly higher risks of developing a blood clot in their lungs. But those additional risks did not appear to outweigh the survival benefits of staying on the drug.

“I think that for women who are now approaching five years of therapy, where we’d usually be telling them -- up to this point -- that we’re going to be stopping the tamoxifen, now we’re going to be telling them that there is clinical evidence that 10 years is superior to five years, and I’m going to be comfortable doing that,” says Ravdin, who led a news briefing on the study but was not involved in the research.

The study was published in the Lancet and presented to doctors at the 2012 San Antonio Breast Cancer Symposium.

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Fruits, Veggies Tied to Lower Breast Cancer Risk

BySalynn Boyles
WebMD Health News Reviewed byLouise Chang, MD

Dec. 6, 2012 -- Women now have one more reason to eat their fruits and veggies.

A new study suggests that women with higher levels of carotenoids (nutrients found in fruits and vegetables) have a lower risk of breast cancer -- especially cancers that are harder to treat and have a poorer prognosis.

When researchers from Harvard Medical School pooled the results of studies that measured carotenoid levels in women’s blood, they found that those with the highest levels had a lower risk of breast cancer compared to those with the lowest levels.

The association appeared to be stronger for smokers than for non-smokers and for women who were lean compared to those who were overweight.

Eat Your Carrots, Avoid Breast Cancer?

Carotenoids are the micronutrients in fruits and vegetables that give them their vibrant orange, yellow, and red colors. Foods that are good sources of carotenoids include carrots, sweet potatoes, spinach, kale, red peppers, and winter squash.

Having higher circulating blood-carotenoid levels may be particularly protective against breast cancers that do not need estrogen to grow.

The finding suggests that eating a healthy, plant-based diet may be one of the first modifiable risk factors for these less common, poorer-prognosis cancers.

“Breast cancer risk factors we have known about all involve more common estrogen-dependent cancers,” says researcher A. Heather Eliassen, ScD.

The study combined data from eight trials that included more than 3,000 women with breast cancer and close to 4,000 women without the disease.

It is not clear if carotenoids directly lowered cancer risk.

But Stephanie Bernik, MD, who is chief of surgical oncology at Lenox Hill Hospital in New York City, says the message to women does not change.

“We have said if we want to reduce the risk of cancer -- not just breast cancer -- eating a plant-based diet low in fat and animal protein may help,” she says. “This study, like others, suggests this is the case.”

The study was published Dec. 6 in the Journal of the National Cancer Institute.

Fruits, Veggies May Help High-Risk Women Most

Bernik says the suggestion that eating plenty of fruits and vegetables may be particularly beneficial for women at risk for non-estrogen-dependent tumors is especially intriguing.

Many breast cancers in women with a family history of the disease and specific genetic mutations that dramatically increase their breast cancer risk fall into this category.

Sue Friedman, DVM, says making healthy lifestyle choices is important for women with a genetically increased risk for cancer. She is executive director of the genetic cancer research and support group Facing Our Risk of Cancer Empowered (FORCE).

But she adds that maintaining a healthy lifestyle is no guarantee that a high-risk woman will not get cancer, and it's no substitute for aggressive screening.

Friedman should know.

She exercised regularly, didn’t drink or smoke, and had been a vegetarian for 15 years when she was diagnosed with breast cancer at age 33.

At the time she was unaware that she carried the BRCA2 mutation, which dramatically increased her breast cancer risk.

Now more than 14 years later, Friedman believes her healthy lifestyle is one of many things that has contributed to her survival.

“It’s exciting that fruits and vegetables may help prevent breast cancer, but we don’t want to give high-risk women a false sense that if they eat right they don’t have to be vigilant about screening,” she says.

View Article Sources

SOURCES:

Eliassen, A.H., JNCI, Dec. 6, 2012.

Heather Eliassen, ScD, Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital and Harvard Medical School.

Stephanie Bernik, MD, chief of surgical oncology, Lenox Hill Hospital, New York, N.Y.

Sue Friedman, DVM, executive director, Facing Our Risk of Cancer Empowered.

News release, JNCI.

WebMD: "Types of Breast Cancer."

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Existing Breast Cancer Drugs May Help More Women

ByCharlene Laino
WebMD Health News Reviewed byLaura J. Martin, MD

Dec. 7, 2012 (San Antonio) -- Current screening tests may miss as many as 1 in 50 women with breast cancer who would benefit from treatment with highly effective breast cancer drugs.

At issue is HER2-positive breast cancer, an aggressive form of the disease that was difficult to treat until the FDA approved the drug Herceptin in 1998. Herceptin revolutionized the treatment of HER2-positive breast cancer, reducing the risk of recurrence and prolonging lives.

Since then, two other drugs, Tykerb and Perjeta, have been approved for the treatment of HER2-positive breast cancer. Others are in the pipeline.

The new study involved 1,500 women found to be HER2-negative on routine HER2 testing. Genetic analysis showed 25 had HER2 mutations.

"These mutations would be missed by current HER2 testing," says researcher Ron Bose, MD, PhD, of the Washington University School of Medicine in St. Louis.

"As a result, the women would not receive potentially lifesaving treatment with HER2 targeted drugs," he says.

The findings were presented at the San Antonio Breast Cancer Symposium (SABCS) here and published online in the journal Cancer Discovery.

A Visual Guide to Breast Cancer

HER2 Mutations

A patient must have more than the normal two copies of the HER2 gene to be classified as HER2-positive. About 20% to 25% of women with breast cancer fall into this category. The excess HER2 drives tumor growth.

The HER2 mutations stimulate tumor growth in a different way. "Many turn on HER2 activity in an inappropriate manner, which probably results in abnormal, unregulated HER2 signaling. This is likely driving the cancer cell," Bose says.

The genetic analyses revealed that 1.5% to 2% of all breast cancer patients have these genetic mutations. With about 230,000 new cases of breast cancer in the United States each year, even this modest percentage translates into more than 4,000 patients per year.

Will HER2 Targeted Drugs Help?

In laboratory tests, Herceptin and Tykerb killed many of the mutant cells. Two mutations that were resistant to Tykerb responded well to neratinib, an experimental anti-HER2 drug.

Some mutations were found to be "silent," meaning they did not drive tumor growth and therefore would likely not respond to anti-HER2 drugs, Bose says.

Now the researchers have launched a study in which women will be screened for HER2 mutations. Those who have the mutations will be given neratinib. Doctors will follow the women to see if the drug is effective and safe.

Asked if the high cost of genetic analysis would prohibit its routine use, Bose says that it is increasingly being used in other forms of disease, such as lung cancer.

If trial results show that attacking the newfound mutations can prevent recurrences and save lives, then gene tests -- and their cost -- will quickly be accepted as part of the standard of care.

"In the future, we will probably be talking about panels of relevant genes that will need to be sequenced in breast cancer," he says.

SABCS co-director Kent Osborne, MD, a breast cancer specialist at Baylor College of Medicine in Houston, says he believes even more mutations that drive breast cancer growth will be discovered in coming years.

And it's likely the newly discovered mutations may promote growth of other types of tumors as well, he says.

Osborne says he would also like to see studies testing whether the anti-HER2 drugs already on the market benefit women with the mutations.

View Article Sources

SOURCES:

San Antonio Breast Cancer Symposium, San Antonio, Texas, Dec. 4-8, 2012.

Bose, R. Cancer Discovery, published online Dec. 7, 2012.

Ron Bose, MD, PhD, Washington University School of Medicine, St. Louis.

Kent Osborne, MD, Baylor College of Medicine, Houston.

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