Cervical Cancer

More than 82,000 women are diagnosed each year with gynecologic malignancies, which include ovarian, uterine, and cervical cancers. Combined, they are the fourth most common cancers among American women, and many could be prevented with lifestyle changes and the use of available screening techniques.

Cervical cancer is diagnosed in close to 13,000 U.S. women each year and is the most preventable of gynecologic cancers.

Diagnostic Tests

Although aggressive new therapies are being evaluated by Gynecologic cancer specialists at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, early detection and diagnosis remain a woman's best opportunity to treat gynecologic cancers. Routine annual gynecologic examinations are the first line of defense.
Cervical cancer is the only gynecologic cancer that, in most instances, can be avoided by regular Pap test screening. The Pap test, a simple procedure that can be performed during routine gynecologic visits, detects pre-cancerous changes in the cervix.

Following the development of this test, mortality rates from cervical cancer have dropped by 74 percent. Still, some 4,600 U.S. women will die this year from cervical cancer.

Our physicians offer valuable advantages in the diagnosis of gynecologic cancers. Because it is difficult to distinguish between some types of cancerous and benign cells on biopsies, our gynecologists created a special division headed by a gynecologist who is board certified in both obstetrics/gynecology and pathology (the study of tissue and cells). The field of gynecologic pathology was pioneered at Hopkins, where specialized pathologists examine all gynecologic cancer tissue samples.

Cancer Symptoms

Early cervical cancer also does not cause many symptoms, but when the cancer spreads, women may experience abnormal bleeding and increased vaginal discharge. Other symptoms may include difficult or painful urination, pain during intercourse, or pain in the pelvic area.

Current Treatments

Surgery, radiation, hormone therapy or chemotherapy may be used to treat gynecologic cancers. The treatment plan depends on a number of factors, including the type and stage of disease, the woman's age and her general health.
Approximately one in every 20 women in the U.S. will be diagnosed with a gynecologic cancer in her lifetime. though many of these cancers are preventable, studies indicate that many women are not aware of the risks or preventative measures available. The Johns Hopkins Breast and Ovarian Surveillance Service (BOSS) uses research dicoveries about the inherited predispositions and the genetic causes of these cancers to provide individualized risk assessment for women. BOSS experts discuss cancer susceptibility and risk factors, genetic testing, and screening and prevention.

Gynecologic cancer patients have access to all the counseling and support services of the Kimmel Cancer Center, including therapists who specialize in the diseases and their psychological impact on patients and families, support groups for patients and support groups for their families.

New Treatment Approaches

A team of researchers at the Kimmel Cancer Center has developed a possible new weapon in the fight against cervical cancer. Clinical studies of vaccine that targets an antigen of the human papillomavirus (HPV) most commonly associated with cervical cancer are underway. The vaccine works by activating the immune system against all cells expressing the antigen. Investigators expect this new therapy will stop the progression of pre-cancerous lesions to actual cancers. A research study is now underway on the vaccine to prevent cervical cancer in women positive for certain types of HPV. For questions regarding the HPV vaccine clinical trial call Mihaela Paradis (study coordinator) or Barbara Wilgus-Wegweiser (research nurse) at 410-502-0512. For more information about new treatments for abnormal pap smears.

Mouth Cancer

Head, Neck, Mouth, Throat, Salivary and Laryngeal CancersHead and neck cancers are diagnosed in more than 70,000 Americans each year. Men are nearly three times more likely to develop the disease than are women. Head and neck cancers include cancers of the mouth, such as lip and tongue, the pharynx or throat and the larynx or voice box. Early symptoms occur as a lump or nodule, numbness, swelling, hoarseness, sore throat or any difficulty moving the jaw or swallowing.

Risk Factors

Risk factors include smoking, excessive alcohol consumption and chewing smokeless tobacco. Kimmel Cancer Center doctors have found that people who smoke one pack of cigarettes a day are six times more likely than nonsmokers to get cancer of the head or neck. Those who also have two alcoholic drinks a day increase their risk 20-fold.

Diagnostic Tests

Otolaryngologists at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins are among the most experienced in the diagnosis of head and neck cancers, most of which are diagnosed by clinical examination, imaging tests and other specialized pathologic tests. These subspecialists are experts at differentiating benign from malignant tumors and accurately assessing the stage of progression. Patients suspected of disease see a physician within a few days to be evaluated for appropriate tests. Upon receipt of the test results, the physician develops an appropriate and highly individualized treatment plan.

Current Treatments

Of particular benefit to our patients is a team of specialists from a variety of departments who meet weekly to review each patient's test results and records to determine the best treatment plan. Specialists include head and neck surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, pathologists, rehabilitation therapists, radiologists, neurologists, oral surgeons and dentists. Each patient's care is coordinated with the multidisciplinary team to achieve the most comprehensive treatment, reconstruction and palliative care available.

After evaluation and consultation with team members, treatment is recommended based on the location, size and type of head or neck cancer. Treatment may include surgery, radiation and/or chemotherapy. Reconstructive techniques are planned before any treatment to optimize the patient's facial restoration, speech and swallowing. For example, one program that was developed at Hopkins five years ago is aimed at preserving speech and swallowing function in situations when standard surgery would result in severe impairment or loss of these functions. Initially, these patients are treated with chemotherapy and radiation. This treatment, on occasion, has cured patients with advanced cancers of the mouth, such as tongue and palate, and cancers involving the larynx or voice box.

New Treatment Approaches

More than a dozen clinical trials are in place for selected head and neck cancer patients at the Kimmel Cancer Center.
Gene therapy is under investigation in many areas at our Cancer Center and is planned for head and neck cancers to improve early diagnosis and enhance treatment. Our physicians are developing a number of sensitive tests that may help detect head and neck cancers early, before the cancer spreads, leading to more effective treatments. One study already has shown that if a patient with cancer has a specific gene mutation, the tumor will be more resistant to radiation therapy.
In another study, our researchers are investigating the use of a vitamin A derivative for prevention of secondary cancers. Here, drugs being studied for the treatment of these disorders include topotecan, taxotere and Taxol, shown to be effective against other cancers; and tirapazamine for patients requiring radiation treatments. Preliminary information suggests that tirapazamine makes a patient more sensitive to radiation and thus enhances the treatment effect.

One of the most exciting studies in progress at Hopkins involves molecular tests to examine surrounding tissue after removal of a cancerous tumor. Researchers are finding this new test so sensitive that cancer cells that once were missed during surgery -- enabling the cancer to grow back -- now can be detected. The test has shown remarkable accuracy in identifying the most minute traces of the cancer. This means that surgeons potentially could remove all the cancerous tissue the first time while leaving as much healthy tissue in place as possible. The procedure is undergoing rigorous, confirmatory testing.

Stomach Cancer

Although the incidence of stomach cancer has declined during the last several decades, 24,000 new cases per year are diagnosed in the United States, and the disease causes about 13,000 deaths. Worldwide, more than half a million deaths result from stomach cancer, which is much more common in Asia and Latin America. Stomach cancer (also called gastric cancer) can develop in any part of the stomach. It begins in the inner lining and can spread throughout the stomach, penetrate the wall and progress to the adjacent lymph nodes. The cause is unknown but has been associated with dietary factors, Helicobacter pylori infection, smoking and alcohol consumption. Current research on the molecular genetics of stomach cancer points toward prevention and early detection of the disease.

Diagnostic Tests

Unlike in Japan, where the incidence of stomach cancer is high and aggressive screening for the disease is undertaken, diagnosis of early gastric cancer in the United States remains uncommon. Nonspecific symptoms such as vague abdominal pain, indigestion or black stools (from bleeding) often are attributed to peptic ulcer disease or other more common problems, and the diagnosis of stomach cancer often is delayed.

Diagnosis is made by biopsy using flexible fiberoptic endoscopy, in which a light tube is introduced through the mouth, esophagus, stomach and first part of the small intestines. Suspicious areas are sampled by biopsy and examined under the microscope by the pathologist. Anyone in whom stomach cancer is suspected should undergo this examination. Upper gastrointestinal series is another test occasionally used to diagnose stomach cancer. Further imaging can determine the extent and stage of the cancer before surgery. Helical CT scan is used to see whether advanced or metastatic disease is present. Kimmel Cancer Center physicians use endoscopic ultrasound, which determines the depth of penetration of the tumor and whether local lymph nodes are enlarged. Such valuable information can aid the surgeon in planning the best therapeutic approach.

Current Treatments

Surgery is the mainstay of curative therapy for stomach cancer. If preoperative studies demonstrate the disease is confined to one area, an operation is recommended. Typically, surgery involves removing most of, and occasionally all of, the stomach to achieve safe removal of all cancer. An extended lymphadenectomy (removal of a wide area of lymph nodes in the area of the cancer) may increase the potential for cure. Such radical operations are being performed in selected patients by the surgeons at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Chemotherapy and radiation therapy also are used to treat stomach cancer. Currently, the cancer center is participating in a national study using radiation and chemotherapy after surgery for stomach cancer.

New Treatment Approaches

Our physicians are participating in large national study groups to examine new drugs for the treatment of early-stage disease after successful surgical resection. For advanced stomach cancer, our doctors are investigating novel drug therapies as well as new biological therapies -- a form of treatment that helps the body's immune system attack and destroy cancer cells.

New Treatment Approaches

Physicians at the Kimmel Cancer Center have remained at the forefront of the diagnosis and treatment of liver, bile duct, and gall bladder cancers through extensive research. New studies track the role environmental factors play in the development of bile duct and gallbladder cancers. Other studies continue to examine the role that estrogen plays in the development of these tumors. Physicians research the cause and prevention of gallstones, a major risk factor for gallbladder cancer and the reason this tumor occurs more often in women. New robotic methods of delivering treatments and gene therapy are on the horizon.

Liver Cancer

Cancers of the liver, bile duct and gallbladder account for 20,000 new cancer cases per year. Liver cancer can originate in the liver (primary liver cancer) or from some other point in the body and spread to the liver.

Patients throughout the nation are referred to the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, where physicians have been providing highly advanced diagnoses and treatments for two decades. A team of experts, including hepatologists, liver and transplant surgeons, medical and radiation oncologists and diagnostic and interventional radiologists, has been assembled to provide comprehensive, state-of-the-art care. Risk Factors
There are several risk factors for liver cancer. People who have hepatitis B or C or cirrhosis of the liver are more likely than others to get adult primary liver cancer.

Diagnostic Tests

Our physicians use spiral CT scans (computerized tomography tests) and MRIs (magnetic resonance imaging studies) to determine accurately the type and stage of the tumor. Radiologic studies have evolved so rapidly that some tests that were performed routinely just a few years ago are no longer necessary. Our physicians can screen patients whose exposure to hepatitis may have put them at greater risk for developing liver cancer. Patients with rare bile duct disorders are at higher risk of developing bile duct cancer. These patients can have their bile tested for carcinoembryonic antigen (CEA), a marker that reveals tumor activity. The test for CEA originally was developed for colon cancer.

Cancer Symptoms

Please consult a physician if the following symptoms occur:
a hard lump just below the rib cage on the right side where the liver has swollen discomfort in the upper abdomen on the right side pain around the right shoulder blade yellowing of the skin (jaundice) Current Treatments

For tumors of the liver, bile duct and gallbladder, surgical removal of the tumor remains the treatment of choice. However, not all tumors are operable. For some patients, a combination of radiation and chemotherapy has been successful in shrinking the tumors so that surgery can be performed. For other patients with liver tumors, a team of interventional radiologists, radiation oncologists and medical oncologists works together to perform chemoembolization or chemoradiation. Chemoembolization delivers chemotherapy directly to the tumor at the same time that its blood supply is interrupted.

For some patients with liver tumors, cryotherapy is a treatment option. Using this technique, which presently requires surgery, our physicians freeze the tumor, rendering it harmless without damaging the surrounding liver.

For patients with bile duct cancer, Kimmel Cancer Center medical oncologists and radiation oncologists work together to insert tubes into the bile ducts, then deliver irridium 192, a radioactive isotope, through the tubes. This treatment usually is performed along with traditional radiation and chemotherapy. These physicians have been using this treatment for two decades.

AIDS-Related Cancers

Cancers that commonly arise in AIDS patients include lymphomas and Kaposi's sarcoma. Other cancers also occur, and many are characterized by the presence of a virus in the cancer cells. Scientists are studying the role of those viruses and a weakened immune system in the growth and development of such cancers. Our physicians have played a major role in defining AIDS-related cancers and in developing therapeutic approaches to treat them.

Current Treatments

A variety of options are available for patients with AIDS-related cancers, ranging from chemotherapy and radiotherapy to biological interventions (enhancing or altering natural body responses to fight cancer) to supportive care. The choices are discussed with the patient by physicians with special interest and experience in the treatment of AIDS-related cancers.
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins is a leader in national programs for the treatment of new and relapsed AIDS-related cancers. There are many opportunities for participation in research studies and for treatment outside the research setting.

Testicular Cancer

Testicular Cancer

Testicular cancer is one of the most common cancers in young men between the ages of 15 and 34 and quite rare after age 40. Caucasian men are affected more than men of other races. Only 7,400 new cases are diagnosed in the United States each year. The cure rate is very high when testicular cancer is diagnosed and treated early.
Diagnostic Tests


Most testicular cancers are found by men themselves. Whereas any testicular abnormality is cause for concern, an actual lump inside the testis is frequently a sign of cancer and should be evaluated immediately. The earlier testicular cancer is identified, the greater the likelihood of a cure. Physicians rely on the diagnostic test, transillumination, in which a bright light is shined through the scrotum; tumors will appear opaque, whereas other abnormalities such as hydrocele or spermatocele will appear translucent. Sonography is another test that confirms a testicular tumor. The only way to confirm the presence of cancer is to remove the testicle surgically and examine a tissue sample under the microscope. Ultrasound, CT scans and X-ray are used to determine whether the cancer has spread beyond the testicle. Blood tests for specific biochemical markers of testicular cancer can be used to track the response to treatment and detect the recurrence of cancer.

Current Treatments

In most cases, surgery is performed to remove the testicle. Subsequent treatment depends on the extent and cell type of the tumor. Often, radiation, chemotherapy, or more surgery also are recommended. Hopkins urologists are particularly sensitive to the emotional and physiologic impact of testicular cancer.
16.AIDS-Related Cancers
Cancers that commonly arise in AIDS patients include lymphomas and Kaposi's sarcoma. Other cancers also occur, and many are characterized by the presence of a virus in the cancer cells. Scientists are studying the role of those viruses and a weakened immune system in the growth and development of such cancers. Our physicians have played a major role in defining AIDS-related cancers and in developing therapeutic approaches to treat them. Current Treatments
A variety of options are available for patients with AIDS-related cancers, ranging from chemotherapy and radiotherapy to biological interventions (enhancing or altering natural body responses to fight cancer) to supportive care. The choices are discussed with the patient by physicians with special interest and experience in the treatment of AIDS-related cancers.

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins is a leader in national programs for the treatment of new and relapsed AIDS-related cancers. There are many opportunities for participation in research studies and for treatment outside the research setting.

Lung Cancer

About this Cancer Lung cancer is the most common type of cancer in both men and women. It is estimated that more than 175,000 new cases will be diagnosed in the United States this year alone. The majority of these cancers are directly linked to cigarette smoking.
Lung cancer has three main classifications:
Non-small cell lung cancer is the most common type of lung cancer, accounting for 75 percent of cases. Non-small cell lung cancer includes squamous cell carcinoma, adenocarcinoma, large cell carinoma, and undifferentiated carcinomas.
Small cell lung cancers grow more rapidly and are more likely to spread to other organs. They account for about 20 percent of lung cancers.

Mesothelioma is a rare tumor of the lining of lungs, often attributed to asbestos exposure, and represents 5 percent of lung cancer cases. Risk Factors
Cigarette smoking is the most important risk factor in the development of lung cancer. It is estimated that as many as 90 percent of lung cancer diagnoses could be prevented if cigarette smoking (see information on screening trial below) were eliminated. Exposure to certain industrial substances such as arsenic, some organic chemicals, radon, asbestos, radiation exposure, air pollution, tuberculosis, and environmental tobacco smoke in non-smokers also increases a person’s risk of developing lung cancer. Diagnostic Tests Lung cancer is usually diagnosed by X-rays and CT scans that provide images of the lung and show if a tumor is present.

Other tests used to diagnose lung cancer are:

examination of cells – cells obtained from sputum are examined under a microscope to see if they contain cancer cells.
fiberoptic examination – under anesthesia, a thin, fiberoptic camera is inserted into the bronchial passages of the lungs to examine the organ for tumors or lesions.
biopsy – a small sample of cells is removed from the tumor and examined for cancer cells under a microscope to see if it contains cancer cells. Cancer Symptoms The most common signs of lung

cancer are:

-- persistent cough-- sputum streaked with blood-- chest pain-- recurring pneumonia or bronchitis Current Treatments
Standard therapies for lung cancer typically include surgery , chemotherapy , and radiation therapy. In recent years, a number of innovative therapies have greatly improved the treatment of lung cancer. New anticancer drugs, better staging and imaging techniques, new surgical procedures, and combined approaches have shown promise in the treatment of these cancers.
At the Johns Hopkins Kimmel Cancer Center, a diverse team of specialists including surgeons, medical oncologists, radiation oncologists, pulmonary experts, radiologists, pathologists, and others come to together to plan and tailor a course of treatment for each patient based on their specific lung cancer diagnosis.

Non-Small Cell Lung Cancer

For non-small cell lung cancers that have not spread beyond the lung, surgery is used to remove the cancer. Surgery may also be used in combination with radiation therapy and chemotherapy in cancers that are more advanced. These treatments can also be given prior to surgery to shrink tumors and prevent the spread of cancer cells through the blood stream. This is called neoadjuvant therapy.

Small Cell Lung Cancer

Surgery is most commonly used in non-small cell lung cancers and less frequently in small cell lung cancer (SCLC), which tends to spread more quickly to other parts of the body. Chemotherapy is the most common treatment for small cell lung cancer, as these medicines circulate throughout the body killing lung cancer cells that may have spread outside of the lung. Radiation therapy is frequently used in combination with chemotherapy when the tumor is confined to the lung and other areas inside of the chest. Radiation therapy may also be used to prevent or treat the development of SCLC that has spread to the brain (metastasis). In radiation therapy, precisely targeted x-rays are used to destroy localized cancer cells. Radiation therapy can be used to prevent tumor recurrence after surgery, to treat tumors in patients who are not candidates for surgery, or to treat tumors causing symptoms in other parts of the body.
Mesothelioma

Chemotherapy, radiation, and surgery can all be part of the treatment for mesothelioma. Combined approaches that utilize these therapies together, particularly using chemotherapy prior to surgery, as well as new drugs that specifically target mesothelioma cells, are currently being tested.

New Treatment Approaches Johns Hopkins is a major center for the development and testing of new anticancer therapies. A number of these agents are now in clinical trials for patients with newly diagnosed and recurrent disease.

Laboratory Research:

Genetic DiscoveriesHopkins researchers have cloned a gene known as hASH1 and found it to be a critical factor in the development of SCLC and certain NSCLC. Our scientists continue to study the mechanisms by which this gene leads to lung cancer in hopes of identifying novel therapeutic strategies. Polyamine pathways are another genetic area of research in lung cancer. Our scientists are developing anticancer agents that target this pathway as an effective therapy for

lung cancer.

Molecular Analysis and ScreeningLung cancer often does not exhibit any symptoms until it has reach an advanced stage. A major objective of Hopkins clincians and scientists is to identify molecular screening markers for lung cancer to allow for earlier dectection. Our research scientists have created a panel of genetic alterations common to lung cancer that can be detected in cells washed from the lining of the lung. In screening selected high-risk populations for these alterations, our clinicians can diagnose cancers in their earliest stage and monitor existing lung cancer patients for recurrence.

Genetic Epidemiology of Lung Cancer ProjectJohns Hopkins Kimmel Cancer Center lung cancer experts are collaborating with colleagues at the University of Maryland and the National Institutes of Health to examine hereditary factors associated with lung cancer. They believe that certain individuals may be predisposed to certain genetic alterations that lead to an increased risk of lung cancer. This project studies DNA repair, p53 gene mutations, and cell death to identify potential culprits of lung cancer susceptibility.

SPORE

The Kimmel Cancer Center at Johns Hopkins is one of a select few cancer centers in the United States to receive the prestigious National Cancer Institute SPORE (specialized programs of research excellence) grant for translational lung cancer research. This grant provides funding for lung cancer research and its rapid transfer from the laboratory to the clinic.

Master Switches Found for Adult Blood Stem Cells

Johns Hopkins Kimmel Cancer Center scientists have found a set of "master switches" that keep adult blood-forming stem cells in their primitive state. Unlocking the switches' code may one day enable scientists to grow new blood cells for transplant into patients with cancer and other bone marrow disorders.

The scientists located the control switches not at the gene level, but farther down the protein production line in more recently discovered forms of ribonucleic acid, or RNA. MicroRNA molecules, once thought to be cellular junk, are now known to switch off activity of the larger RNA strands which allow assembly of the proteins that let cells grow and function.
"Stem cells are poised to make proteins essential for maturing into blood cells, but microRNAs keep them locked in their place," says cancer researcher Curt Civin, M.D., Ph.D., who led the study. The journal account will appear online the week of February 5 in the early edition of the Proceedings of the National Academy of Sciences.
To halt protein assembly, microRNAs pair up with matching full-length RNA, then fold and twist it, rendering the larger RNA useless. But the RNA pairings are not perfect, and one microRNA can latch on to several hundred RNA strands. "They act like a single circuit breaker to efficiently control hundreds of RNAs," says Civin, the Herman and Walter Samuelson Professor of Cancer Research.

"We're looking for ways to flip these microRNA switches, to control when stem cells grow into new blood cells," says Robert Georgantas, Ph.D., research associate at the Johns Hopkins Kimmel Cancer Center and first and corresponding author of the study.

To identify the key microRNAs, Georgantas sifted through thousands of RNA pieces with a custom-built, computer software program. Its algorithms let the software, fed data from samples of blood and bone marrow from healthy donors, match RNA pairs. The outcome was a core set of 33 microRNAs that match with more than 1,200 of the larger variety RNA already known to be important for stem-cell maturation.

Georgantas and Civin currently are testing whether these pair predictions are valid by using a non-reproducing virus to insert genetic instructions for each of the 33 microRNAs into adult stem cells. They'll then be cultured in Petri dishes. MicroRNA-155 -- the first microRNA tested -- was predicted to stop stem cells from developing into red and white blood cells. As expected, stem cells without microRNA-155 matured: they formed approximately 75 red and 150 white blood cell colonies per dish. Stem cells with microRNA-155 matured into far fewer red and white cell colonies -- about seven and 30 per dish, respectively.

"Using microRNAs to stall an adult blood stem cell in its early stage could help us grow new ones in test tubes, and perhaps give us more insight into stem-cell maturation for other tissue types," says Civin.

Civin and his team have filed for patents on the microRNA technology. The research was funded by the National Institutes of Health, National Cancer Institute, National Foundation for Cancer Research, and Kimmel Foundation for Cancer Research.

Additional authors include Richard Hildreth, Sebastien Morisot, and Jonathan Alder from Johns Hopkins; Chang-gong Liu, George A. Calin, and Carlo Croce from Ohio State University; and Shelly Heimfeld from the Fred Hutchinson Cancer Research Center.

The Johns Hopkins University holds patents on the CD34 monoclonal antibodies and inventions related to stem cells. Civin is entitled to a share of the sales royalty received by the University under licensing agreements between the University, Becton Dickinson Corporation and Baxter HealthCare Corporation. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict-of-interest policies.

What Happens When You Smoke a Cigarette?

Pop quiz: What is the single most preventable cause of death in the United States? Answer: Cigarette smoke. This is surprising, considering that smoking is a choice. It is even more shocking since 87 percent of lung cancer deaths are caused by cigarettes. Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.
As you inhale cigarette smoke, nicotine moves deep into your lungs, gets absorbed into the bloodstream and quickly affects key parts of your body – not just the lungs, but also your central nervous system, your heart, and your brain. The “buzz” new smokers and regular smokers get from that first cigarette is a reaction to the release of epinephrine, similar to adrenaline, which then raises the heart rate, increases blood pressure, and constricts blood vessels. This pattern greatly increases your risk of lung cancer and can lead to heart disease, emphysema and other breathing conditions, and even a heart attack.

So why do people keep smoking cigarettes? It’s the nicotine. Nicotine’s addictiveness has been compared to heroin and cocaine. It creates a mental and physical dependence, and can lead to serious drug withdrawals.

The Importance of a Second Opinion

Today, people are becoming more involved in their own healthcare, due to changes in health coverage plans, improvements in healthcare technology and treatments, and disease management and discoveries. These factors are playing a large role in patients who are seeking a second opinion. NFCR highlights some of the most common reasons to opt for another opinion, as well as ways to go about it.

Based on one’s current doctor-patient relationship, the patient should know whether their doctor is more conservative or aggressive about relaying health information. For example, a doctor may sugar-coat an illness to keep the patient at ease, instead of bluntly giving the facts. Considering the situation at hand, a second opinion may be a good idea to get the desired information. In cancer patient cases, second opinions regarding diagnosis, treatment plans and cancer specialists are very common and well-recommended. Medical experts note a second opinion is a good idea if you are:

Considering a major surgery or are told additional surgery is needed Diagnosed with a life-threatening disease such as heart disease or cancer Given a poor or unclear diagnosis on health problem Asked to participate in a clinical trial Considering a provider quality check A team approach to delivering quality healthcare is commonly utilized when dealing with severe bodily injuries, serious illnesses and diseases, including cancer. Most cancer patients will have a team of doctors and nurses during cancer treatment. Second opinions, even third opinions in certain cases, are not uncommon. Physicians work with one another on many acute patient cases and they will ask for a second opinion from a colleague or specialist.

Additionally, patients can seek a “blind” second opinion, meaning that medical records, test results and first physician’s opinion are not made available to the second physician. Though in most cases it is up to the patient whether to share second opinion options with his/her first doctor, there are advantages and disadvantages to both.

Should You Be Worried About Dioxins?

"Dioxin” is an umbrella term for a group of about 75 toxic chemicals that share certain chemical structures and biological properties. The dioxin family includes chlorinated dibenzo-p-dioxins (CDDs), chlorinated dibenzofurans (CDFs), and certain polychlorinated biphenyls (PCBs). The term dioxin is also sometimes used to refer to one specific dioxin, 2,3,7,8-tetrachlorodibenzene-p-dioxin (TCDD).

Why Are Dioxins Dangerous?

Research has shown that exposure to dioxins may pose a serious health threat: they are known cancer-causing substances (carcinogens). In fact, TCDD is the most potent animal carcinogen ever studied, and has been linked to cancer in humans. For example, studies have found that workers exposed over long periods of time to high levels of dioxins at the workplace have an increased risk of cancer. In addition, some studies have suggested that dioxin promotes soft-tissue sarcomas (cancers of the fat and muscle) and lung cancer.

Though the toxicity of dioxins is not as high as tobacco smoke, some researchers estimate that its potency may be comparable to that of radon or second-hand smoke. Dioxins have a strong affinity for receptors in the nuclei of animal and human cells, where they can do serious damage to the cells’ DNA. This damage can lead to cancer as well as adverse reproductive and developmental effects, birth defects, diabetes, immune system abnormalities, and endometriosis.

Where Do Dioxins Come From?

Dioxins are released into the air from combustion processes, such as waste incineration, and from burning fuels, such as wood, coal, or oil. They can also be produced during forest fires, chlorine bleaching of pulp and paper, the burning of household trash, and certain types of chemical manufacturing and processing.

After dioxin enters the air, people can breathe in the particles. Even worse, dioxin particles can fall into rivers and other bodies of water, where fish can ingest them. Likewise, dioxin can settle on grazing land, where it’s ingested by cattle. The dioxin particles then accumulate in the fat tissue of these animals. As a result, over 90 percent of human exposure to dioxin comes from the foods we eat, particularly meat, fish, poultry, cheese, milk, butter, and other foods with animal fat.

How to Minimize Your Exposure to Dioxin?

Most of the population has low-level exposure to dioxins. (Significantly greater exposures occur from food-contamination incidents, workplace exposures, and industrial accidents.) To keep everyday exposure to an absolute minimum, avoid foods high in animal fat, because dioxin resides in fat tissue. This means choosing leaner cuts of meat or poultry; trimming the fat and skin from meat, poultry, and fish; buying fat-free, low-fat, or skim versions of dairy products; and using egg whites or egg substitutes instead of whole eggs.

Over the past decade, the U.S. Environmental Protection Agency (EPA) has worked with industries that produce dioxins to dramatically reduce emissions. By 2002, dioxin emissions from municipal and medical waste incinerators and pulp and paper facilities will have been reduced 95 percent. That’s the good news. The bad news is that dioxins are extremely persistent compounds, breaking down so slowly that they remain in the soil—and in our bodies—for many years. As a result, the benefits of reducing dioxin levels can take several years to realize.

Coping with Cancer...After Cancer

As a continued testament to the investment in cancer research, there are over 9 million cancer survivors living in the United States. These survivors are living proof that our mission to improve cancer detection, diagnosis and treatment is saving lives. Still, cancer is a day-by-day disease that continues through the rest of one’s life.

Everyday, cancer survivors face on-going and new challenges, some of which include managing mixed and varying emotions that surface after surviving the disease. The emotions that survivors experience ranging from fear of recurrence to uncertainty and distress, all of which may have already been felt while fighting cancer and may resurface during survivorship.

Health professionals define these feelings as normal and stress that identifying and understanding is one of the first steps to cope and manage the emotions. On the other hand, it is also important to monitor the frequency, intensity and duration of these emotions to help determine if they are becoming abnormal and additional aid is needed from an outside source, such as a friend, family member or even a mental health professional.

If you or a loved one is a cancer survivor, take these steps to help cope with life after cancer:

Continue to keep a close relationship with your health care team to help minimize future health complications and emotional stress. Find a local counselor or support group to share feelings. Stay informed on the various emotional effects of cancer aftermath and ways to better well-being, through informational resources and organizations. Get involved in cancer advocacy, fundraising and research to have a sense of giving back to those who are fighting cancer.

A Toast to Your Health: Red Wine and Cancer

The relatively low incidence of heart disease among the French, whose diet contains high levels of saturated fat, is commonly known as the French Paradox. Many have attributed this phenomenon to their consumption of red wine. We know now that resveratrol, a compound found in the skins of red grapes, is very likely to be the major component that contributes to this phenomenon. But is it possible that the benefits of resveratrol can also help prevent cancer?
Resveratrol is an antibiotic compound produced as part of a plant’s defense system during times of environmental stress such as adverse weather, insect attack, or fungus invasion. It is also an antioxidant that can inhibit lipid peroxidation of Low-Density Lipoprotein (LDL), which plays an important role in preventing the occurrence of heart disease. Resveratrol also appears to intervene in cancer progression by inhibiting enzymes such as COX-1 and ribonucleotide reductase which play important roles in the development of tumor cells.

A recent study by Drs. Marty Mayo and Fan Yeung at the University of Virginia demonstrated that resveratrol can facilitate the initiation of cancer cells’ self-destruction by inhibiting the activity of nuclear factor-kappa B (NF-kB), which activates genes critical for cell survival. Additionally, its minimal toxicity to blood-forming cells makes it an appealing candidate as an anti-cancer agent.

Although present in foods such as mulberries and peanuts, resveratrol can be found most abundantly in the skins of red grapes. The resveratrol content can be further increased by allowing grape skins to be present during the fermentation process of wine making. As a result, resveratrol concentration in red wine is significantly higher than white wine because the skins are removed earlier during white wine production. Of the different types of red wine, resveratrol concentration is the highest in pinot noir, followed by cabernet Franc, merlot, and it varies greatly in cabernet sauvignon. Grape juice, which is not a fermented beverage, is not a significant source of resveratrol.

While there are many known benefits associated with resveratrol, doctors do not encourage heavy intake of resveratrol supplements, nor do they recommend a populationwide red wine consumption increase. Currently, we have limited knowledge about the absorption and clearance of resveratrol, the identities of its metabolic products, and its effects on the liver. Therefore, you should consult with your physician first to determine the amount of wine intake that can offer you the most health benefits.

Delays Progression of Metastatic Breast Cancer

Each year, more than 180,000 U.S. women are diagnosed with breast cancer. Many of these breast cancers will be hormone receptor-positive, meaning that they are stimulated to grow by the circulating female hormones estrogen and/or progesterone.

Treatment of hormone receptor-positive breast cancer often involves hormonal therapies that suppress or block the action of estrogen. These therapies include tamoxifen as well as agents known as aromatase inhibitors. Tamoxifen acts by blocking estrogen receptors, whereas aromatase inhibitors suppress the production of estrogen in postmenopausal women.
Tykerb is a drug that targets two related proteins that often function abnormally in breast cancer cells—HER2 and EGFR. Approximately 20-25% of breast cancers overexpress the HER2 protein; these cancers are referred to as HER2-positive.

Femara is an aromatase inhibitor that has been shown to improve outcomes among postmenopausal women with hormone receptor-positive or hormone receptor-unknown breast cancer.

To evaluate the combination of Tykerb and Femara in the initial treatment of hormone receptor-positive, metastatic breast cancer, researchers conducted a Phase III clinical trial among 1,286 postmenopausal women. A total of 219 of the study participants were HER2-positive.

In the subset of women who were HER2-positive, progression-free survival was 8.2 months among women treated with Femara plus Tykerb compared with 3.0 months among women treated with Femara alone.Among all patients (regardless of HER status), progression-free survival was 11.9 months among women treated with Femara plus Tykerb compared with 10.8 months among patients treated with Femara alone.This study suggests that compared with treatment with Femara alone, the combination of Tykerb and Femara delays cancer progression among women with HER2-positive, hormone receptor-positive, metastatic breast cancer.

Breast Cancer Is More Common but Less Deadly Among Women Who Use Postmenopausal Hormones

Additional information from the Women’s Health Initiative firmly establishes that postmenopausal hormone therapy with combined estrogen plus progestin increases a woman’s risk of developing breast cancer. According to another study, however, breast cancers that develop in women who have used estrogen plus progestin tend to be less deadly than breast cancers in other women. The results of both studies were presented at the 2008 San Antonio Breast Cancer Symposium.

Postmenopausal hormone therapy with the female hormones estrogen alone or estrogen plus progestin (combined hormone therapy) effectively manages several common menopausal symptoms. However, a large clinical trial conducted as part of the Women’s Health Initiative (WHI) raised concerns about the health risks of these therapies. In 2002, for example, it was reported that combined estrogen plus progestin increases the risk of breast cancer, heart disease, stroke, and blood clots. Women taking estrogen plus progestin had fewer fractures and were less likely to develop colorectal cancer, but for most women, these benefits were thought to be outweighed by the risks.

Researchers used updated information from the WHI clinical trial of estrogen plus progestin, as well as information from another component of the WHI (the WHI Observational Study), to further explore the relationship between estrogen plus progestin and risk of breast cancer.
In a second presentation, researchers assessed the impact on breast cancer survival of hormone use prior to breast cancer diagnosis. Using information from the California Teachers Study, researchers examined breast cancer survival among 2,783 postmenopausal women with breast cancer.

The results confirmed that users of estrogen plus progestin were more likely than nonusers to develop breast cancer. This increased risk declined markedly and fairly rapidly, however, once women stopped using hormones.These analyses of the WHI data support the claim that the recent decreases in breast cancer incidence in the United States. may be due to a reduction in the number of women using postmenopausal hormones. It also provides information to women and physicians about what happens to breast cancer risk after hormone cessation.

After accounting for other factors that may influence breast cancer survival (such as stage of disease and general health), women who used estrogen plus progestin before their breast cancer diagnosis were 47% less likely to die of breast cancer. There was a suggestion that estrogen alone may also decrease risk, but the effect was smaller and not statistically significant (suggesting that it could have occurred by chance alone).This study suggests that breast cancers that develop in users of estrogen plus progestin have a tendency to be less deadly than breast cancers that develop in women who have never used postmenopausal hormones. It must be remembered, however, that breast cancer is also more common in women who use estrogen plus progestin.

Women who are currently using postmenopausal hormones, or who are considering use, are advised to discuss the risks and benefits with their health care provider.

Reduced Breast Density May Indicate a Response to Tamoxifen

The International Breast Intervention Study I (IBIS-I) examined the effects of tamoxifen in the prevention of breast cancer and involved over 7,000 participants. During the study, women underwent a baseline mammogram, as well as mammograms at 18, 36, and 54 months to monitor for the development of breast cancer. When researchers observed a correlation between breast density reduction and reduced breast cancer risk, they conducted an analysis of a subpopulation of the IBIS-I participants.

Breast density refers to the extent of glandular and connective tissue in the breast. Breasts with more glandular and connective tissue—and less fat—are denser. Women with higher breast density are at increased risk of developing breast cancer.

The subpopulation included 120 women who developed breast cancer and 943 “controls” who did not develop breast cancer. The researchers examined the baseline mammograms, as well as the mammograms that took place 12-18 months after treatment with tamoxifen was initiated. The results indicated that 46% of the women in the tamoxifen group experienced a reduction in breast density of 10% or more. Furthermore, the women whose breast density was reduced by 10% or more experienced a 52% reduction in the risk of breast cancer relative to the control group. Conversely, women whose breast density was not reduced by 10% had a non-significant 8% reduction in breast cancer risk.

The researchers concluded that the changes in breast density induced after 12-18 months of treatment with tamoxifen can serve as an indicator, or biomarker, of the impact of tamoxifen on the reduction of breast cancer risk. They assert that changes in breast density may serve as an early indicator of treatment efficacy. Furthermore, these changes in density could even be used to determine which women are benefiting from treatment with tamoxifen and those who might need a different risk reduction approach.

Reduces Recurrence Risk in Early Breast Cancer

Xeloda is an oral chemotherapy drug that is used in the treatment patients with advanced breast or colorectal cancers.

To evaluate Xeloda in combination with other chemotherapy drugs for the treatment of high-risk early breast cancer, researchers conducted a Phase III clinical trial known as FinXX. Patients were considered to have high-risk cancer if their cancer was node positive or if their cancer was larger than 20 mm and progesterone receptor-negative.
The trial has enrolled 1,500 patients from 20 medical centers in Finland and Sweden. Approximately 43% of patients were premenopausal and three-quarters of patients had hormone-sensitive cancers.

Study participants were assigned to one of two treatment groups:
T-CEF: Taxotere® (docetaxel) followed by cyclophosphamide, Ellence® (epirubicin), and 5-FU.TX-CEX: Taxotere and Xeloda followed by cyclophosphamide, Ellence, and Xeloda.The results presented at SABCS were interim results; final analysis of study results is expected to take place in 2010.

Recurrence-free survival was 92.5% among patients treated with TX-CEX (the regimen that includes Xeloda) and 88.9% among patients treated with T-CEF (the regimen that does not include Xeloda).Overall survival was 95.6% with TX-CEX and 94.9% with T-CEF.More patients discontinued therapy in the Xeloda arm.Grades III/IV hand-foot syndrome, stomatitis, and diarrhea were more common in patients treated with TX-CEX. Neutropenia, on the other hand, was more common in patients treated with T-CEF.These results suggest that the addition of Xeloda to chemotherapy for high-risk early breast cancer reduces the risk of cancer recurrence. The final analysis of this study is expected to take place in 2010.

New Molecular Targets in Colorectal Cancer

Advances in metastatic colorectal cancer will require identification of other targets and pathways that contribute to colorectal cancer progression and metastasis. Inhibitors of several key molecules and pathways are currently being studied. Three candidate proteins and pathways are active areas of research in colorectal cancer: insulin-like growth factor-I receptor (IGF-IR), Src, and toll-like receptor 9 (TLR9).

IGF-IR is a cellular protein, and activation of the IGF-IR pathway results in increased cellular proliferation, malignant transformation, resistance to apoptosis (programmed cell death), tissue invasion and metastasis, and angiogenesis.16 IGF-IR is overexpressed in colon cancer, but activation rather than overexpression may play a more important role. There is substantial overlap in signaling between the IGF-IR and EGFR pathways, raising the possibility that activation of the IGF-IR pathway may be one way in which cells can escape EGFR inhibition. The first IGF-IR inhibitors to enter Phase I clinical testing have been monoclonal antibodies:

Src is a nonreceptor protein that is found on the intracellular portion of the cell membrane and was the first oncogene (a potentially cancer-inducing gene) discovered.17 Src promotes angiogenesis, the formation of new blood vessels to tumors, and is overexpressed in more than 80 percent of human colorectal cancers. Its activity increases with cancer progression, with higher levels found in metastases than in primary tumors. Src inhibitors are currently in clinical development; they are unlikely to cause shrinkage of solid tumors and are more likely to influence tumor progression, invasion, and metastasis.

TLR9 has a role in immune regulation in the gastrointestinal tract. It may also have a role in modulating cell signaling, including signaling through the EGFR pathway. Clinical evaluation of TLR9 agonists in cancer patients is under way.

Clinical TrialsPeople with colorectal cancer should always ask their physician if there is a clinical trial indicated for their type and stage of cancer. The recent advancements in the treatment of colorectal cancer emanate from results of large clinical trials investigating whether new drugs in combination with chemotherapy and radiation therapy improve survival. Members of the cancer healthcare team can help people with a colorectal cancer diagnosis decide whether to enroll in a clinical trial and to choose a trial that is right for them.

The Other Women’s Cancer

Although many women believe colorectal cancer to be a disease that affects men only, each year it takes the lives of just as many women as men. In fact, colorectal cancer takes the lives of more women each year than does ovarian, uterine, or cervical cancer.1 The good news is, with utilization of recommended screening options (see Table 1),2 colorectal cancer can be prevented altogether; and for those who are diagnosed with this disease, there are more treatment options available than ever before.

Who Is at Risk of Colorectal Cancer?Both men and women are at risk of developing colorectal cancer. In most cases colorectal cancer occurs in people age 50 or older, but younger individuals can also get this disease. In addition, there is some evidence to suggest that people of African-American or Ashkenazi Jewish descent are at increased risk of developing colorectal cancer.

Medical risk factors for colorectal cancer include:

Personal or family history of colorectal polyps or cancerPersonal history of inflammatory bowel diseasePersonal or family history of an inherited genetic cancer syndrome, such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC)Women who do not have any of these risk factors are considered at average risk for colorectal cancer and should begin screening at age 50. Women who do have one or more of these risk factors are considered at increased risk of the disease. Although these medical factors cannot be changed, women at increased risk can protect themselves by discussing their risk factors with their physician and undergoing earlier and more frequent screening as appropriate.

Lifestyle risk factors for colorectal cancer include obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and a diet inadequate in fruits and vegetables. Fortunately, these are risk factors that can be changed. Women who have any of these lifestyle risk factors can consult their physician or nutritionist about adjusting their lifestyle to reduce their colorectal cancer risk and optimize their overall health and well-being.3
The second step to reducing the risk of developing colorectal cancer and detecting any cancer early is to be vigilant about undergoing the recommended screening for this disease.

Who Should Be Screened and When?Colorectal cancer screening allows for both the prevention and the early detection of cancer. Early detection in turn allows for early treatment, when a cure is most likely. Indeed the five-year survival rate is 90 percent when this disease is detected in its early, localized stage.1 In addition, colorectal cancer is preventable when potentially precancerous colorectal polyps are detected and removed before they have the chance to develop into cancer.

It is hoped that with an increased awareness of the lifesaving benefit of colorectal cancer screening, more women will undergo this testing and colorectal cancer incidence and mortality rates will continue to decline.

For women and men at average risk for colorectal cancer, the American Cancer Society recommends one of the seven screening options, beginning at age 50 (see Table 1).2 In people who are at increased risk for colorectal cancer, screening may need to begin at a younger age and be performed at more-frequent intervals.

What Are the Symptoms?Early colorectal cancer causes no symptoms, which is why screening ideally begins when an individual feels well—before any symptoms of disease develop. As the cancer grows, however, symptoms may develop; these include rectal bleeding or blood in the stool, a change in bowel habits, abdominal pain, and unexplained fatigue.

In some cases people who experience the symptoms of colorectal cancer ignore them because they are scared or embarrassed. It’s important to understand that, first, these symptoms do not necessarily indicate colorectal cancer; they could be caused by another, less serious condition. Second, if the symptoms are due to colorectal cancer, this disease is treatable. And, third, no one should die of embarrassment. Anyone who experiences the symptoms of colorectal cancer should see a physician for prompt evaluation and diagnosis—the earlier the diagnosis, the greater the chance for cure.

What Are the Treatment Options?If a diagnosis of colorectal cancer is made, staging of the disease is the next step in the treatment plan. The term staging refers to the local and distant extent of the disease and provides a framework for outlining treatment options and discussions regarding prognosis. An important step in this process is a review of the biopsy specimen by a pathologist. This should be done prior to making any decisions regarding the need for further studies or surgery. This is especially important for cancerous polyps, which may sometimes be fully removed with surgery. Other parts of the staging process include a physical examination by the physician; imaging studies, such as a CT scan, PET scan, or endoscopic ultrasound; and laboratory blood tests, including tumor markers.

The staging of colorectal cancer is based on the depth of invasion of the cancerous tumor through the colon or rectal wall, and an integral component is the determination of whether cancer cells have spread to nearby lymph nodes or to distant organs. Stages I and II colorectal cancers are considered localized early-stage tumors that do not have lymph node involvement. Stage III colorectal cancer is locally advanced and has involvement of regional lymph nodes. Stage IV colorectal cancer indicates disease that has metastasized, or spread outside the colon to distant organs.4 Staging is critical in determining prognosis in colorectal cancer, as earlier-stage disease indicates longer survival and a better chance for cure.

Surgery

Surgery is the only curative treatment for localized colorectal cancer. Surgery is often required for diagnosis and staging of the disease or for bleeding or obstruction associated with the tumor. Surgery entails removal of the cancerous tumor, as well as an adequate amount of normal tissue surrounding the tumor, and removal of regional lymph nodes.

ChemotherapyWhen a disease recurrence develops after a potentially curative surgical

procedure, it is believed to come from microscopic tumor cells that are present and undetectable at the time of surgery. The goal of adjuvant (postoperative) chemotherapy is to eradicate these microscopic tumor cells to decrease the likelihood of recurrence and to increase the cure rate. Data from multiple clinical trials over the past 50 years support the routine use of adjuvant systemic chemotherapy after surgical resection of colon cancer with lymph node involvement. Adjuvant chemotherapy is associated with an approximately 30 percent reduction in the risk of disease recurrence and a 22 to 32 percent reduction in mortality.5 The average length of adjuvant chemotherapy treatment is six months. The routine use of adjuvant chemotherapy for Stage II colon cancer is controversial and is considered only for patients with tumors with features that may increase the rate of recurrence.

Radiation Therapy

Radiation therapy has emerged as a significant part of adjuvant treatment for rectal cancer, whereas adjuvant treatment of colon cancer that is removed by surgery includes chemotherapy alone. This is due to a higher rate of local recurrence in the pelvis in patients with rectal cancer. A series of clinical trials in the 1980s and 1990s determined that there is a survival advantage when postoperative radiation therapy is combined with chemotherapy following resection of Stage II and III rectal cancers.5,6,7,8,9,10
Chemotherapy and Targeted Therapies
Systemic chemotherapy and targeted antibody therapies represent newer treatment options for Stage IV colorectal cancer (disease that has spread to other sites in the body, also called metastatic disease). Approximately 30 to 40 percent of patients with colon or rectal cancer have metastatic disease at the time of diagnosis. Combining chemotherapy with targeted antibody therapy has been shown to improve survival in people with metastatic disease.11,12,13 The past decade in cancer therapy has led to the development of novel targeted therapies that enable people to live longer with metastatic disease. There is increased understanding of the biologic processes important for survival and growth of colorectal cancer cells, including the role of angiogenesis, which is the process by which a tumor makes blood vessels to support its own growth.13

Another important growth pathway in metastatic colorectal cancer is the epidermal growth factor receptor (EGFR) pathway. EGFR transmits signals through a set of proteins inside the cancer cell that instruct the cancer cell to reproduce and metastasize. Data suggest that blocking EGFR stops this growth signal. Antibodies have been developed that block the EGFR pathway (EGFR-blockers). These antibodies are used in combination with chemotherapy to slow the growth of tumors. In 2008 significant information about the use of EGFR-blockers was presented and published. This relates to another important gene inside the cancer cell called K-ras, which also controls cancer cell growth. Some tumors have mutations in the K-ras gene; this mutation leaves the K-ras protein always turned “on,” so signaling within the cancer cell continues regardless of whether the EGFR is blocked with an antibody. Mutations in the K-rasgene occur in approximately 40 percent of metastatic colorectal cancer patients. This finding is important because it affects what therapies can be used to fight the cancer.14,15

Improves Progression-free Survival in Triple-negative Metastatic Breast Cancer

Some breast cancers display different characteristics that require different types of treatment. The majority of breast cancers are hormone receptor-positive breast cancers, meaning that the cancer cells are stimulated to grow from exposure to the female hormones estrogen and/or progesterone. These cancers are typically treated with hormone therapy to prevent or reduce these hormones, thereby preventing the growth of cancer cells. Other cancers are referred to as HER2-positive, which means that they overexpress the human epidermal growth factor receptor 2, a biologic pathway that is involved in replication and growth of a cell. HER2-positive breast cancers account for approximately 25% of breast cancers and are treated with agents that target the receptor to slow growth and replication.

Breast cancers that are not stimulated to grow from exposure to estrogen or progesterone and are HER2-negative are called triple-negative breast cancers. Triple-negative breast cancers tend to be more aggressive than other breast cancers and have fewer treatment options.
Standard therapy for triple-negative metastatic breast cancers typically includes chemotherapy Adriamycin® (doxorubicin), Ellence® (epirubicin), and Doxil® (pegylated liposomal doxorubicin). Taxanes include agents such as Taxol® (paclitaxel) and Taxotere® (docetaxel).
Ixempra is a chemotherapy agent that prevents or reduces cancer cells from replicating. It is approved for the treatment of advanced breast cancer.

In a pooled analysis of patients from two large Phase III clinical trials, researchers evaluated the combination of Ixempra and Xeloda versus Xeloda alone for the treatment of metastatic breast cancer. The two studies included nearly 2,000 women with metastatic breast cancer who had previously been treated with anthracyclines and taxanes. The women were randomized to receive Ixempra plus Xeloda or Xeloda alone. A pooled subset of 443 women from both studies had triple-negative disease.

The analysis of the triple-negative subset indicated that patients who received Ixempra and Xeloda had an overall response rate of 31% compared with 15% for those who received Xeloda alone. Furthermore, the group that received the Ixempra/Xeloda combination had a progression-free survival rate of 4.2 months compared with 1.7 months for those who received Xeloda alone. These results were statistically significant.

The researchers noted that Ixempra plus Xeloda is the first combination to show a statistically significant improvement in progression-free survival in patients with advanced triple-negative breast cancer. Research will likely be ongoing to further evaluate this drug combination in this population of patients.

Offers Improved Estimation of Risk for Breast Cancer

Breast cancer is the second leading cause of cancer death in women in the United States, with approximately 180,000 cases diagnosed each year. The risk of developing cancer can be related to genetic, lifestyle, or environmental factors. Some women are at a higher risk of developing breast cancer either because of a family history of the disease or a specific genetic mutation.
Researchers have long sought to find a way to quantify a woman’s risk of developing breast cancer. Women who know the degree to which they are at risk can then make appropriate lifestyle changes to reduce their risk and they can also undergo more frequent and vigilant screening in order to detect the disease early when it is most treatable.

The Gail model is a tool that estimates a woman’s risk of developing breast cancer. The model has been used to identify high-risk women for inclusion in breast cancer prevention studies, and has also been used to counsel individual women about their risk of breast cancer. The model considers a woman’s age, family history of breast cancer, reproductive history (age at first menstrual period and age at first birth), and history of breast biopsies.
OncoVue is a new genetic-based breast cancer risk test that uses a combination of a questionnaire and a saliva test in order to assess risk. OncoVue measures genetic variations in single nucleotide polymorphisms (SNPs), which are small genetic changes within DNA that can indicate disease risk. OncoVue analyzes 22 SNPs in 19 genes and then uses this information in combination with the Gail Model risk factors.

The researchers then performed a blinded analysis that revealed that the OncoVue score was 2.4 times more accurate than the Gail model in estimating individual risk. OncoVue also exhibited a 51% improvement over the Gail Model in assigning elevated risk to cases. The improved performance was statistically significant.
The researchers concluded that OncoVue was significantly more accurate than the Gail Model alone in estimating the individual risk of breast cancer among the Marin county women.

In order to determine the accuracy of OncoVue, researchers collected DNA from 177 women without breast cancer and 169 women diagnosed with breast cancer between 1997 and 1999 in Marin County, California, an area which is known for its higher than average breast cancer incidence and mortality rates. All samples were then anonymously coded and sent to the lab for analysis.