It's been documented that many terminal cancer patients don't benefit from chemotherapy and other types of treatments toward the end of their lives. Nonetheless, many, with their doctors, opt to continue treatment -- faced with impossible choices, they hold on to hope that treatment might buy some time, or improve the quality of the days they have left.
Background: The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) collaborate annually to produce updated, national cancer statistics. This Annual Report includes a focus on breast cancer incidence by subtype using new, national-level data.
Methods: Population-based cancer trends and breast cancer incidence by molecular subtype were calculated. Breast cancer subtypes were classified using tumor biomarkers for hormone receptor (HR) and human growth factor-neu receptor (HER2) expression.
Results: Overall cancer incidence decreased for men by 1.8% annually from 2007 to 2011. Rates for women were stable from 1998 to 2011. Within these trends there was racial/ethnic variation, and some sites have increasing rates. Among children, incidence rates continued to increase by 0.8% per year over the past decade while, like adults, mortality declined. Overall mortality has been declining for both men and women since the early 1990's and for children since the 1970's. HR+/HER2- breast cancers, the subtype with the best prognosis, were the most common for all races/ethnicities with highest rates among non-Hispanic white women, local stage cases, and low poverty areas (92.7, 63.51, and 98.69 per 100000 non-Hispanic white women, respectively). HR+/HER2- breast cancer incidence rates were strongly, positively correlated with mammography use, particularly for non-Hispanic white women (Pearson 0.57, two-sided P < .001). Triple-negative breast cancers, the subtype with the worst prognosis, were highest among non-Hispanic black women (27.2 per 100000 non-Hispanic black women), which is reflected in high rates in southeastern states.
Conclusions: Progress continues in reducing the burden of cancer in the United States. There are unique racial/ethnic-specific incidence patterns for breast cancer subtypes; likely because of both biologic and social risk factors, including variation in mammography use. Breast cancer subtype analysis confirms the capacity of cancer registries to adjust national collection standards to produce clinically relevant data based on evolving medical knowledge.
For over 15 years, the American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) have collaborated to provide the Annual Report to the Nation on the Status of Cancer, which contains updated cancer incidence and mortality data for the United States. These reports have documented a sustained decline in cancer mortality, starting with our first report in 1998. In addition to providing contemporary cancer rates and trends, each report has featured an in-depth analysis of a special topic.[2–16] This Annual Report to the Nation on Status of Cancer presents newly available data on national breast cancer incidence rates by demographic and tumor characteristics for the four intrinsic molecular subtypes.
Female breast cancer mortality has a bimodal age distribution that was first identified in the early 1900s, with early and late age distributions at diagnosis. This pattern led researchers to postulate that there were two main types of breast cancer according to age at onset and hormone dependence. The first breast cancer type is hormone-dependent with peak incidence (or mode) near age 50 years, whereas the second breast cancer is hormone-independent with peak incidence near age 60 years. Later research further suggested that these two age-based groups of breast cancers were etiologically different.[19–22] Analyses of gene-expression profiling have confirmed two main groups of breast cancers which can be further separated into four molecular subtypes according to hormone receptor expression (HR±) and/or epithelial cell of origin (luminal or basal). There are two HR+ breast cancers (Luminal A and Luminal B) and two HR- cancers (human growth factor-neu receptor (HER2)-enriched and basal-like).[19–23] Understanding the epidemiology of breast cancer by subtype is critical for guiding treatment, predicting survival, and informing prevention activities.[22,24] Gene-expression profiling is not currently standard clinical practice, but, for nearly a decade, testing for joint HR/HER2 status has been a routine part of treatment planning. The molecular subtypes can be approximated by HR/HER2 status; ie, Luminal A (HR+/HER2-), Luminal B (HR+/HER2+), HER2-enriched (HR-/HER2+), and triple-negative (HR-/HER2-).[19,21,22,25,26]
More women with breast cancer in one breast are choosing double mastectomies, even when a single mastectomy, a lumpectomy or radiation might be medically preferable, raising concerns among oncologists and surgeons.
Purpose: The US Preventive Services Task Force recommends identifying candidates for breast cancer (BC) chemoprevention and referring them for genetic counseling as part of routine care. Little is known about the feasibility of implementing these recommendations or how low-income women of color might respond to individualized risk assessment (IRA) performed by primary care providers (PCPs).
Methods: Women recruited from a federally qualified health center were given the option to discuss BC risk status with their PCP. Comprehensive IRA was performed using a software tool designed for the primary care environment combining three assessment instruments and providing risk-adapted recommendations for screening, prevention, and genetic referral. Logistic regression models assessed factors associated with wanting to learn and discuss BC risk with PCP.
Results: Of 237 participants, only 12.7% (n = 30) did not want to discuss IRA results with their PCP. Factors associated with lower odds of wanting to learn results included having private insurance and reporting ever having had a mammogram. Factors associated with higher odds of wanting to learn results included older age (50 to 69 years) and increased BC worry. For all women wishing to learn results, IRA was successfully completed and delivered to the PCP immediately before the encounter for incorporation into the well-visit evaluation.
Susan Zager's insight:
Conclusion: Incorporation of US Preventive Services Task Force recommendations as part of routine primary care is feasible. Interest in IRA seems high among underserved women. This approach warrants further investigation as a strategy for addressing disparities in BC mortality.
Researchers who developed a high-speed form of atomic force microscopy have shown how to image the physical properties of live breast cancer cells, for the first time revealing details about how deactivation of a key protein may lead to metastasis.
ASCO has released a conceptual framework for assessing the value of new cancer therapies based on treatment benefits, toxicities, and costs. The initial version of the ASCO Value Framework was published on June 22, 2015 in the Journal of Clinical Oncology.
This group has been invaluable in helping me come to terms with my post-surgery body. Being part of this community I know I am not "militant" as one of the hospital nurses described me, but just a woman who was absolute in her resolve to avoid any additional surgery. For me, getting back to normal life after cancer is not about getting a new breast but getting as healthy as possible, as quickly as possible. The truth is I have lost my breast to cancer and no surgery will replace it.
"Research suggests that genetic factors play a key role in determining who is at increased risk of developing breast cancer, as well as the type of breast cancer they develop. Genome-wide association studies (GWAS), which compare the genome of healthy individuals to those affected with breast cancer, have helped to identify more than 90 common genetic variations that are associated with breast cancer risk. Although GWAS have greatly enhanced our understanding of the genetic component of breast cancer susceptibility, the results to date explain only a small portion of the estimated genetic contribution to breast cancer risk.
NCI, a part of the National Institutes of Health (NIH), wants to increase the number and diversity of minds tackling this problem. They teamed up with SAGE Bionetworks, to inspire novel cross-disciplinary approaches to more fully decipher the genomic basis of breast cancer.
NCI will award up to $50k in prizes based on identification of novel findings, replication of findings, innovation of approach, evidence of novel biological hypotheses, and collaboration. Challenge organizers aim to shift the focus of analysis from individual genetic variants to genetic pathways, and explore the heritable contribution of breast cancer disparities.
The U4C will make breast cancer genetic epidemiologic data more widely available."
Within the oncology community, a debate is raging about two controversial topics. The first is overdiagnosis. According to a recent report in The Wall Street Journal, some leading cancer experts say that zealous screening is finding ever-smaller abnormalities that are being labeled cancer or precancer with little or no justification.
Boston, Mass.-based MetaStat Inc., whose Scientific and Clinical Advisory Board is chaired by Oscar L. Bronsther, MD, is aiming to provide more clarity for patients and oncologists when deciding what’s next after a tumor is removed. The company has developed new tests to analyze whether a specific individual’s cancer has metastatic potential, MetaSite Breast and MenaCalc. These tests are intended to potentially allow clinicians to customize cancer treatment decisions by identifying and differentiating high-risk patients who need aggressive therapy, and by possible sparing low-risk patients from the harmful side effects and expense of additional treatment….
MetaStat’s researchers have identified the important predictive role of the Mena protein. Mena is found in the developing embryo where it is an important actor in the developing nervous system among other functions. It facilitates and organizes formation, extension and navigation of growing nerve fibers through tissue to link with other neurons, forming the proper circuits needed for a functional nervous system. Its expression decreases from embryonic to adult life. However in metastatic cancer cells, high levels of the Mena protein accumulate and influence a number of intracellular signaling programs. "
Susan Zager's insight:
The work they are doing to see if they can identify an individuals cancer and predict whether it will become metastatic, appears to be worthwhile research. While they have not competed the MedaSite Breast test (immunohistochemistry-based test performed on FFPE tissue from a biopsy), this research is something to watch out for in the future. By furthering this research we hope it leads to how mets can be reversed so it can also help those who already have mets.
"Breast cancer patients can achieve pregnancy rates comparable to those for women in the general population undergoing in vitro fertilization (IVF), thanks to embryo cryopreservation after ovarian stimulation with letrozole and follicle-stimulating hormone, according to a study published online in the Journal of Clinical Oncology.
Investigators led by Kutluk Oktay, MD, a professor of obstetrics and gynecology at the Innovation Institute for Fertility Preservation and In Vitro Fertilization in New York City, reported on fertility preservation in 131 women no older than 45 years with stage <3 breast cancer who underwent ovarian stimulation with cryopreservation of IVF-generated embryos before receiving adjuvant chemotherapy. Estrogen-receptor-positive tumors were present in 69% of patients, 18% carried a mutated BRCA gene, and 57% had received tamoxifen."
"SEATTLE. (Ivanhoe Newswire/WTVM) - Triple negative breast cancer accounts for about 15 percent of all new breast cancer cases in the U.S., but it leads to 25 percent of all breast cancer deaths. A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growth are not present in the cancer tumor. It’s an aggressive cancer that, until now, has only been treated with standard chemo. Now, a new therapy is offering patients hope for the first time.
Eight years ago, Brenda Beguin was diagnosed with an aggressive breast cancer. Three years ago, it came back."
The American Journal of Hematology/Oncology is a monthly peer-reviewed publication that provides original research, reviews, and editorial/commentaries that address cutting-edge developments in genomics, targeted therapies, molecular diagnostics, and pathways related to oncological science and clinical practice. As the official publication of Physicians' Education Resource (PER), the Journal's mission is to advance cancer care through professional education. The Journal aims to provide practical interpretations of the latest advances in medical and hematologic oncology and to help practicing oncologists gain a better understanding of how these advances have changed the treatment landscape for both solid and hematologic malignancies. Articles published in the Journal will illustrate successes and failures in clinical practice and will provide practical insights into the myriad decisions that oncologists face in everyday clinical practice.
"If you missed the webinar with Dr. Dizon, watch it here!
Dr. Don S. Dizon presents news from the annual meeting of the American Society of Clinical Oncology (ASCO) as it relates to those living with metastatic breast cancer. Dr. Dizon is board certified in medical oncology and is the Clinical Co-Director of Gynecologic Oncology at the Massachusetts General Hospital Cancer Center."
"The often tenuous relationship between the clinical effectiveness of new cancer drugs and their exorbitant cost is a worldwide problem. Over the past decade, more and more such drugs have come onto the market and into national health systems.
“It happens in waves,” said Prof. Raphael Katan, a senior oncologist at both Sheba Medical Center and Shaare Zedek Medical Center and the former head of oncology at Sheba. “Every time there’s another drug that’s considered good and desirable, it creates hope. Then it turns out that it’s not so good, or that it’s only good in very specific situations.”
Impressive presentations about the latest clinical trials aren’t confined to the annual meeting of the American Association of Clinical Oncology, attended by some 40,000 oncologists from all over the world (the most recent was in Chicago a few weeks ago). They quickly find their way to the international media, and from there to patients and national health systems.
The drug companies are commercial enterprises and they’re trying to get the best price,” Katan said. “Over the last few years, the public has evidently been willing to pay higher amounts for drugs, even if the benefit is small.
“Even wealthy countries like the United States and some European countries have begun to be aware of this and are trying to limit it,” he added. “But it’s not simple. When there’s a new drug, even if it’s not so effective, but just a little better than another drug, we feel obligated to recommend it.”
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