Friday, June 22, 2018

Oncologists told about chances of recurrence

Pregnancy after breast cancer is now believed safe, lead author of European study says

Breast cancer survivors who want to have children may be sighing with relief.

According to a recent story by Marilynn Marchione of the Associated Press, a study of 1,207 women in Europe shows those who became pregnant after their diagnoses "were no more likely to have their cancer come back than those who did not have a baby."

This was true, the story added, "even if their cancers were the type fueled by hormones, which surge during pregnancy and theoretically might spur a recurrence."

Results of the study were discussed at an American Society of Clinical Oncology conference in Chicago.

Dr. Matteo Lambertini
The study's lead author, Dr. Matteo Lambertini of the Jules Bordet Institute in Brussels, Belgium, was quoted as saying the test results show that "pregnancy after breast cancer can be considered safe."

Dr. Richard Schilsky, chief medical officer for ASCO, agreed.

Marchione quoted him as saying the results indicate, "fairly convincingly," that women needn't worry. 

More and more women are being diagnosed with breast cancer in their childbearing years, perhaps an outgrowth of "the average age of moms…rising in the United States," the AP story says.

In fact, it notes, "about 11 percent of new breast cancer cases in the U.S. are in women under 45."

The story also reported that a big study now underway "in the U.S. and other countries is taking this research one step further, testing whether it's safe for breast cancer survivors who want to get pregnant to temporarily suspend taking the hormone-blocking drugs like tamoxifen usually recommended for five years after initial treatment."

More details about studies relating to the disease can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Tuesday, June 12, 2018

Are toxic treatments a thing of the past?

Many early-stage breast cancer patients may now skip chemo, new study's docs indicate

Lots of women with early-stage forms of breast cancer don't need chemotherapy.

At least that's the bottom line of a major international study, according to a recent report by Denise Grady in The New York Times.

Dr. Ingrid A. Mayer
Grady quotes Dr. Ingrid A. Mayer of Vanderbilt University Medical Center, an author of the study, as saying, "We can spare thousands and thousands of women from getting toxic treatment that really wouldn't benefit them. This is very powerful. It really changes the standard of care."

Instead of chemo, the study found, some women could "take only a drug that blocks the hormone estrogen or stops the body from making it."

That drug, tamoxifen, and related medicines "have become an essential part of treatment for most women," Grady's article says, "because they lower the risks of recurrence, new breast tumors and death from the disease."

The findings, which refer to that alternative endocrine therapy, apparently apply to about 60,000 women a year in the United States, according to Dr. Joseph A. Sparano of Montefiore Medical Center in New York, the study's leader.

The Times quotes Sparano as saying that "now we can spare chemotherapy in about 70 percent of patients who would be potential candidates for it based on clinical features."

But, the story adds, both Mayer and Sparano say women 50 and younger "might benefit from chemo even if gene-test results suggest otherwise. It is not clear why. But these women require especially careful consultation, they said."

The study, called TAILORx, was published in The New England Journal of Medicine and presented at a Chicago meeting of the American Society of Clinical Oncology. It was started in 2006 and was paid for by the U.S. and Canadian governments and philanthropic groups.

After 2016, Genomic Health, the company that makes the gene test Oncotype DX Breast Cancer Assy, the one most used in the United States, helped pay for it.

The test, available since 2004, costs about $3,000, and insurance usually covers it.

Some 260,000 new cases of breast cancer are expected in women in the United States this year, and 41,000 deaths. Globally, according to the Times, "the most recent figures are from 2012, when there were 1.7 million new cases and more than half-a-million deaths."

Chemo, long feared because of nausea and hair loss, puts patients at risk for infection and leukemia later in life. But endocrine therapy also has side effects. According to Grady, they include "hot flashes and other symptoms of menopause, weight gain and pain in joints and muscles."

Tamoxifen can increase the risk of cancer of the uterus, the story notes.

Despite the discomforts and risks, women with breast cancer have been getting chemo since 2000, when the National Cancer Institute recommended it even for those whose disease had not spread to lymph nodes "based on studies showing it could prevent the cancer from recurring elsewhere in the body and becoming incurable."

Sparano contends, however, that although "recurrences were being prevented, and lives prolonged…we were probably overtreating a lot of these women."

Mayer admitted that "we couldn't figure out who we really needed to treat."

More details on studies about the disease, treatments and risks can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Wednesday, June 6, 2018

Java industry fighting California jurist's decision

Professor-doctor rebukes judge's final ruling that coffee labels warn about cancer risks

After countless delays (that have taken eight years), it's a done deal at last. Almost.

At least a Los Angeles Superior Court judge's final ruling about the need for warning labels on coffee has become a fait accompli, though not everyone's sanguine about his decision. 

The decision, as might be expected, is being appealed by coffee producers.
Dr. Aaron E. Carroll

And in a recent article in The New York Times under the rubric The New Health Care, Dr. Aaron E. Carroll claims the ruling — which harkens back to statewide ballot Proposition 65 enacted in 1986 and concerns a suit filed against about 90 coffee companies by a nonprofit, Council for Education and Research on Toxics — isn't backed by evidence and could do more harm than good.

The judge's decision is based on the fact that coffee contains acrylamide, which the International Agency for Research on Cancer has warned is a "probable human carcinogen." 

But Carroll, a pediatrics prof at the Indiana University School of Medicine who blogs on health research and policy, maintains the agency "has backpedaled in recent years, [essentially reversing itself when] in 2016 it declared that 'drinking coffee was not classifiable as to its carcinogenicity to humans.'"

Superior Court Judge Elihu Berle finalized his ruling in early May after having tentatively made the same decision in March.

The coffee industry has argued all along that the acrylamide is present in coffee but at harmless levels.

What's next? 

The nonprofit, according to an Associated Press story, now must "seek a permanent injunction that would either lead to ominous warning labels" or a commitment by the industry to reduce the chemical from their product, as the potato chip industry did years ago when it, too, was sued by the same group.

Carroll, who's also been outspoken that there's little evidence to support the notion that artificial sweeteners pose a health risk, asserts that acrylamide "is found in about 40 percent of the calories consumed by people in the United States," and notes that the Food and Drug Administration "reports that there is no viable commercial process for making coffee without producing at least some acrylamide."

The writer, who's opposed to most warning labels, points out that "meta analyses have shown that coffee is associated with lower risks of liver cancer, and no increased risk of prostate cancer or breast cancer," and that "when we look at cancer over all, it appears that coffee — if anything — is associated with a lower risk of cancer."

Carroll has authored a new book, "The Bad Food Bible: How and Why to Eat Sinfully," which contends that butter, salt, diet soda and alcohol have undeserved bad reputations.

Prop 65 had mandated "that businesses with more than 10 employees warn consumers if their products contain one of many chemicals that the state has ruled as carcinogenic" — a category acrylamide falls into. 

More details on which carcinogens appear in which products can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.