Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

BREAST CANCER CELLS IN THE BLOOD PREDICT HIGH RISK OF RECURRENCE

During my time in the lab, as a research fellow at the John Wayne Cancer Institute, I completed several research studies that revealed a powerful link between the presence of tiny numbers of cancer cells floating in the blood and overall survival in patients without any evidence of recurrent cancer by standard laboratory and radiographic tests.  In these research studies, we used a powerful test, reverse transcriptase-polymerase chain reaction (RT-PCR) to detect fragments of genetic material from otherwise undetectable cancer cells in the blood of patients with a prior history of cancer.  (RT-PCR, which can detect the presence of a single tumor cell floating amongst more than a million normal blood cells, is a powerful tool for detecting trace numbers of cancer cells present in the blood, bone marrow, lymph nodes, and other tissues of the body.)

A newly published RT-PCR research study appears in the current issue of the British Journal of Cancer. In this study, the blood of 82 early-stage breast cancer patients was tested for occult breast cancer cells using RT-PCR. Additionally, 16 patients with advanced breast cancer and 45 patient volunteers without breast cancer were used as “control groups.” All of these patient volunteers were then followed for an average of 51 months.

Among the women with very early breast cancer, 20 percent were found to have occult breast cancer cells lurking in their blood. By comparison, 81 percent of the women with late-stage breast cancer were found to have breast cancer cells circulating in their blood. (None of the healthy volunteers were found to have genetic evidence of circulating breast cancer cells in their blood.)

In this study, as with the findings of my own research in this area, the presence of rare circulating cancer cells in the blood of even patients with early-stage breast cancer was a powerful predictor of future breast cancer recurrence. Among these early-stage breast cancer patients, a positive RT-PCR test of the blood was associated with more than 5 times the risk of breast cancer recurrence (a more than 500 percent increase in recurrence risk) when compared to the early-stage breast cancer patients who did not have any detectable tumor cells circulating in their blood.

As with my own research, and the research of other cancer scientists, this newly published breast cancer research study confirms that the presence of trace numbers of cancer cells in the blood, even in patients with very early breast cancer, is highly predictive of future breast cancer recurrence. This is an important finding, and for several reasons. First of all, the detection of even tiny numbers of circulating tumor cells in the blood of early-stage breast cancer patients indicates a much worse prognosis for such patients, even when all of our standard laboratory and x-ray tests do not reveal any evidence of persistent or recurrent cancer in these same patients. Secondly, “ultra-staging” cancer patients with RT-PCR may be able to help us to identify early-stage cancer patients who might benefit from more aggressive treatment than patients who have no detectable tumor cells circulating in their blood.

Based upon the findings of this study, and those of other similar research studies (including my own), RT-PCR has the potential to become a very powerful clinical tool to help us to more accurately stage patients with early-stage cancers, and to individualize and personalize cancer treatment based upon this so-called “molecular” approach to cancer diagnosis and treatment.

For a comprehensive guide to living an evidence-based cancer prevention lifestyle, order your copy of my new book, A Cancer Prevention Guide for the Human Race.  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million,Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com “Top 100 New Book Releases in Cancer” list!

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author

For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

NEW DRUG DRAMATICALLY REDUCES BREAST CANCER RISK

Known risk factors for breast cancer include: (1) age greater than 60, (2) a previous personal history of breast cancer or precancerous conditions of the breast (such as atypical lobular hyperplasia, lobular carcinoma in situ, atypical ductal hyperplasia, or ductal carcinoma in situ), (3) one or more first degree relatives with breast cancer, (4) A personal history or family history of BRCA-1 or BRCA-2 hereditary breast and ovarian cancer gene mutations, (5) not having children, or having children after age 35, (6) multiple prior breast biopsies for non-cancer lumps, and (7) early-onset of menstruation, or late onset of menopause, as well as other less powerful breast cancer risk factors.

There are very few prescription medications available that significantly reduce the risk of developing cancer. However, for women who are at increased risk of developing breast cancer, the so-called SERMs (Selective Estrogen Receptor Modulators) can significantly reduce breast cancer risk. The most widely prescribed SERM is tamoxifen, which has been shown to decrease the risk of developing breast cancer, in high-risk women, by nearly 50 percent. However, while tamoxifen is commonly prescribed for women who have hormone-sensitive breast cancer (because this drug also reduces the risk of breast cancer recurrence in such cases), it is not widely prescribed for cancer prevention purposes.

There are several reasons why tamoxifen is not frequently prescribed as a breast cancer prevention medication. First of all, tamoxifen is most commonly prescribed by Oncologists, and so most primary care physicians are not comfortable enough with this medication to prescribe it. Secondly, tamoxifen has been associated with potentially serious side effects, including an increased risk of uterine cancer, blood clots in the veins and lungs, and cataracts. (Another SERM, raloxifene, does not appear to significantly increase the risk of uterine cancer, but this medication otherwise has the same potential side effects as tamoxifen.)

A new class of estrogen-blocking medications, aromatase inhibitors, is now commonly used in place of tamoxifen as hormone-blocking therapy in postmenopausal patients with breast cancer. Although aromatase inhibitors, like virtually all medications, have side effects of their own, they are not known to be associated with an increased risk of cancer or potentially life-threatening blood clots, like tamoxifen, and they appear to be even more effective in reducing the risk of breast cancer recurrence than tamoxifen and other SERMs.

Now, a newly published clinical research study, which appears in the current issue of the New England Journal of Medicine, has revealed that exemestane, an aromatase inhibitor, appears to be even more effective in preventing breast cancer than tamoxifen (as well as being safer, in terms of side effects, than tamoxifen).

This clinical research trial was a prospective, randomized, placebo-controlled, double-blinded study (which is the “gold standard” method of performing clinical research). A total of 4,560 women, ages 35 and older (the average age was 63 years), were enrolled in this clinical research study, and were secretly and randomly assigned to receive either exemestane or an identical-appearing placebo (“sugar pill”). These patient volunteers, all of whom were at increased risk of developing breast cancer, were then followed for an average of about 3 years.

By the end of the study, 11 women in the exemestane (treatment) group had developed breast cancer, while 32 women in the placebo (control) group were diagnosed with breast cancer. These findings translated into a 65 percent reduction in the risk of developing breast cancer associated with the use of exemestane in these high-risk women.

Although the prolonged use of aromatase inhibitors can lead to osteoporosis (“thinning” of the bones), there was no increase in the incidence of bone fractures or other skeletal complications noted among the women who took exemestane during the course of this research study. (Aromatase inhibitors can also cause significant bone and joint pain.) Indeed, during the course of this clinical study, there were no significant differences between the exemestane group and the placebo group in terms of side effects or complications.

Therefore, this breakthrough clinical research study showed that an aromatase inhibitor, exemestane, was more effective in preventing breast cancer in high risk women than tamoxifen and other SERMs; and unlike tamoxifen, exemestane did not appear to be associated with any significant side effects or complications following three years of treatment. Because of this clinically important combination of greater effectiveness and fewer side effects, this study’s findings are highly likely to change recommendations for the “chemoprevention” of breast cancer in women who are at an elevated risk of developing this most common of cancers in women. (One important caveat to note is that aromatase inhibitors, unlike tamoxifen and other SERMS, can only be used in postmenopausal women.)

For a comprehensive guide to living an evidence-based cancer prevention lifestyle, order your copy of my new book, A Cancer Prevention Guide for the Human Race.  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com “Top 100 New Book Releases in Cancer” list!

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author

For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

TOBACCO, SMOKING AND BREAST CANCER

Tobacco smoke is unquestionably the single greatest cause of preventable cancer cases.  However, the link between smoking (including passive exposure to secondhand tobacco smoke) and breast cancer has been rather unclear, so far.  Now, a newly published study, which appears in the current issue of the British Medical Journal, has strongly linked exposure to tobacco smoke with breast cancer risk.

More than 79,000 women (ages 50 to 79 years) enrolled in the enormous landmark, prospective Women’s Health Initiative (WHI) study between 1993 and 1998.  (This is the very same study that confirmed the long suspected link between hormone replacement therapy and breast cancer risk.)  All participants in this huge clinical study provided detailed information regarding their history of both active and passive exposure to tobacco smoke.  Known risk factors for breast cancer were also assessed, and accounted for, when analyzing this study’s data.  During more than 10 years of follow-up, 3,520 cases of breast cancer were diagnosed within this very large group of women.

Compared with women who had never smoked, former smokers were 9 percent more likely to be diagnosed with breast cancer, while current active smokers were 16 percent more likely than never-smokers to develop breast cancer.  Women who had smoked for 50 years or more were at especially high risk of developing breast cancer (they were 35 percent more likely to be diagnosed with breast cancer when compared to never-smokers).

Among women who had never smoked, women with 10 or more years of childhood exposure to secondhand tobacco smoke, or 20 or more years exposure as an adult, had a 32 percent greater risk of developing breast cancer than never-smokers who had not been exposed to secondhand tobacco smoke.

Taken together, these new findings from the powerful WHI study significantly link both active exposure to tobacco smoke and exposure to secondhand tobacco smoke with large increases in the risk of developing breast cancer.  As if there were not already enough reasons to avoid tobacco, this very powerful prospective clinical research study’s findings confirm yet another life-threatening risk associated with tobacco (including exposure to secondhand smoke).

For a complete discussion of evidence-based approaches to cancer risk and cancer prevention, order your copy of my new book, A Cancer Prevention Guide for the Human Race.  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com “Top 100 New Book Releases in Cancer” list!

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author

For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

AXILLARY LYMPH NODE DISSECTION FOR BREAST CANCER MAY NOT BE NECESSARY

The management of breast cancer has undergone many advances since the radical mastectomy that first came into popularity in the United States in the late 19^th century.  At that time, even early cancers of the breast were managed by surgically removing the entire breast, the underlying chest wall muscles, and all of the lymph nodes under the armpit (axilla).  It wasn’t until the 1970s that surgeons began to abandon radical mastectomy, in favor of the less disfiguring modified radical mastectomy, based upon emerging research data at the time.  By the 1980s, additional research data had confirmed that women who underwent lumpectomy plus radiation therapy experienced equivalent survival when compared to women who underwent mastectomy.  In the late 1990s, another major paradigm shift in the surgical management of breast cancer occurred with the rapid adoption of sentinel lymph node (SLN) biopsy, which had previously also revolutionized the surgical management of melanoma.  Following the successful application of SLN biopsy to breast cancer, the 60 to 70 percent of women with breast cancer who have normal axillary SLNs (i.e., no evidence of spread of breast cancer cells to the lymph nodes in the axilla) could now avoid undergoing complete axillary lymph node dissection (ALND), wherein about two-thirds of the armpit lymph nodes are surgically removed.  As the risk of arm swelling (lymphedema), numbness, and other long-term side effects associated with ALND are only one-tenth as common following SLN biopsy, the majority of women undergoing breast cancer surgery over the past decade have been able to avoid many of the chronic complications and side effects associated with the more radical surgical approaches used in the past.  However, between one-fourth and one-third of women diagnosed with breast cancer will still be found to have tumor cell in their SLNs, and most of these women have routinely been advised to undergo ALND to remove additional armpit lymph nodes.

Now, a newly published clinical research study from the American College of Surgeons Oncology Group has, once again, dramatically shifted the paradigm of breast cancer management.  This clinical research study, which I was privileged to participate in when I was a Surgical Oncology Fellow at the John Wayne Cancer Institute, enrolled 891 women newly diagnosed with breast cancer, and with early metastatic cancer involving one or more of their axillary SLNs.  These women were evenly randomized into two groups.  One group underwent the standard therapy of ALND, while the other half of these patient volunteers were observed, without further surgery, following SLN biopsy.  The results of this pioneering breast cancer research study appear in the current issue of the Journal of the American Medical Association.

After an average duration of patient follow-up of more than 6 years, this pivotal clinical study has confirmed what many of us oncologists have long suspected.  In women with evidence of microscopic spread of breast cancer to one or more axillary SLNs, there was no difference in overall survival whether or not they went on to undergo ALND, as long as they underwent otherwise standard therapy for lymph-node-positive breast cancer (including lumpectomy, radiation therapy to the breast, and chemotherapy).

I cannot overstate the potential impact of the findings of this important clinical study.  However, while some have heralded the findings of this study as breaking important new ground, in fact that ground was broken by the very same pioneering prospective clinical research study (the National Surgical Adjuvant Breast and Bowel Project’s NSABP B-04 study, which began in 1971) that originally led surgeons to abandon radical mastectomy.  Within this older large prospective clinical study was an important subgroup of 586 women with palpably enlarged axillary lymph nodes (and which actually indicated a more advanced stage of lymph node involvement than the women who participated in the more modern American College of Surgeons Oncology Group study).  Like all of the women who participated in the NSABP B-04 study, these 586 breast cancer patients with enlarged armpit lymph nodes were randomized to undergo radical mastectomy with radical ALND versus mastectomy alone (and no lymph node surgery at all ) combined with radiation therapy.  After an average follow-up of 25 years, there wasabsolutely no difference in survival between the women who underwent radical lymph node surgery combined with radical mastectomy versus those women who underwent simple mastectomy alone (and no lymph node surgery) followed by radiation therapy.

Thus, the newly reported findings of this pivotal American College of Surgeons Oncology Group clinical study only further validates the findings of the nearly 40 year-old NSABP B-04 study, and should put to rest, once and for all, the decades-old debate about the role of surgery in the management of the axillary lymph nodes in patients with newly diagnosed breast cancer.  At a minimum, surgeons should now advise their breast cancer patients that there is now 40 years worth of high-level clinical research data showing that the surgical removal of most or all of the armpit lymph nodes (ALND) does not improve survival in women who otherwise undergo standard breast cancer treatment that includes lumpectomy (or mastectomy), chemotherapy, and radiation therapy.

I predict that the findings of these two landmark breast cancer surgical studies will, together, once again revolutionize the surgical management of breast cancer, and will further reduce the adverse impact of surgery on hundreds of thousands of women around the world each year.  Indeed, this latest revolution in the management of breast cancer has already started at major cancer centers in the United States, where women are already being advised that the finding of early spread of breast cancer cells to their axillary SLNs no longer mandates “completion ALND,” as long as these patients undergo standard chemotherapy and radiation therapy following lumpectomy and SLN biopsy.

For a complete discussion of evidence-based approaches to cancer risk and cancer prevention, order your copy of my new book, A Cancer Prevention Guide for the Human Race.  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com “Top 100 New Book Releases in Cancer” list!

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

For a different perspective on Dr. Wascher, please click on the following YouTube link: Texas Blues Jam

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.