From lymph nodes to nicotine:

April 1, 2011

Surgical vs. needle breast-cancer biopsies examined

A study headed by Stephen R. Grobmyer, MD,
director of the breast-cancer program at the University of Florida-Gainesville, found that 30% of the breast biopsies there from 2003 to 2008 were surgical or “open” biopsies.
According to medical guidelines, that rate should be 10% or less, reported The New York Times on Feb. 19, 2011.

Grobmyer's study was published by The American Journal of Surgery and was based on 172,342 biopsies entered into a Florida state database;
it is the largest study of open-biopsy rates in the U.S., as well as the first to include patients with and without cancer. Of the estimated 1.6 million annual breast biopsies,
in 2010 only 261,000 open biopsies found cancer, 207,000 of which were invasive breast cancer, and 54,000 of which were ductal carcinoma in situ (DCIS).

The Florida researchers say that about 300,000 women annually are having unnecessary surgery costing hundreds of millions of dollars.
In addition, for women who do have cancer, a surgical biopsy means two operations instead of one.
The reason for the overuse of open biopsies is not known, although the researchers surmised that the problem may occur because not all physicians keep up with medical advances and guidelines.
Also noted was surgeons may keep doing open biopsies so as not to lose the doctors' open-biopsy fee ($1,500-$2.500) to radiologists who perform the needle biopsies ($750-$1,500).
Hospital charges for open biopsies range from $10,000 to $12,000, twice that of needle biopsies. Needle biopsies, rather than surgical, are safer, less invasive, and cheaper, the study showed.


Manly linebacker is “pretty in pink”

Dallas Cowboy Linebacker Bradie James was still playing football at Louisiana State University (LSU) when he lost both his parents within months of one another.
While his mother, Etta James, battled breast cancer, his father was suffering from liver disease. She gave up her health insurance and ended her medical treatment
so they could afford to have his liver disease treated.

After James finished his college education and joined the NFL's Dallas Cowboys, he launched Foundation 56 (his uniform number) in 2007 to honor his mother who died in 2002
(go to Bradie James Foundation). Foundation 56 helps women in need get free breast-cancer screenings.

Foundation 56 is a donor advisory fund to the Baton Rouge Area Foundation. James has invested his energy in identifying breast-cancer programs and services designed to provide early detection,
mammogram screening, and treatment for the disease. He teamed up with his alma mater to create the Etta James Memorial Meet, an annual gymnastics event at LSU's Pete Maravich Assembly Center,
raising thousands of dollars since its inception.

He currently partners with agencies in Louisiana and North Texas to improve manpower resources, as well as financial outreach services, aimed at reducing the impact of breast cancer
on women with limited access to medical resources. James (6'2″, 245 lbs.) wore pink gloves and pink cleats during Breast Cancer Awareness Month.
Says James, “I want to send a message that breast cancer does not just affect women, it affects the entire family.”

Mammography's effectiveness

Time's Healthland's article “Why mammograms are less effective among breast-cancer survivors” (Feb. 24, 2011) says scientists pooling data from several U.S. cancer registries measured the number of cancers detected among women within a year of a first screening. Compared to matched controls, women with a breast-cancer history had nearly three times as many cancers detected. The sensitivity of the mammograms in picking up these growths was about 65% among these women versus 76% in women without breast cancer.

Mammograms may not as effective in picking up cancers in breast-cancer patients because women who survive breast cancer are likely to be more vigilant in looking for future growths and may perform more self-exams to detect any tumors. If these women were finding such cancers, they would count as being missed by mammography, lowering the sensitivity of the screen. Also, among women with a history of breast cancer, mammograms tended to be better at picking up localized growths in breast tissue DCIS as opposed to invasive cancer. X-ray-based mammograms are better at detecting calcifications associated with DCIS, as opposed to invasive cancers, which are embedded in soft tissues.

And survivors of cancer are more likely to develop metastases, which are more invasive, than women without a history of the disease, which could also explain mammography's weaker sensitivity among cancer survivors.


New oncogene ZNF703 discovered

Researchers based at Cancer Research U.K.'s Cambridge Research Institute at the University of Cambridge and at the British Columbia Cancer Agency in Vancouver, Canada, have pinpointed a key cancer-causing gene — called ZNF703 — that, when overactive, triggers a particularly aggressive type of breast cancer to develop. This is the first time in more than five years that scientists have discovered a new breast-cancer oncogene — those cancer-causing genes that, when overactive, upset the normal checks and balances that control when and how often a cell divides.

The researchers believe testing patients' tumors to see if the ZNF703 gene is overactive could help identify patients with more aggressive tumors, so their treatment could be tailored accordingly. It is thought that up to a third of more aggressive estrogen-positive breast cancers could have multiple copies of the ZNF703 gene. The research is published in the journal EMBO Molecular Medicine alongside a study from an independent research group identifying the same gene, providing definitive evidence that ZNF703 is a genuine breast-cancer oncogene.

Read the complete article at

Nicotine related to breast cancer?

Smoking is considered the foremost avoidable cause of disability, disease, and death in the United States. In addition to causing 90% of lung-cancer cases, cigarette smoke increases the risk of birth defects, miscarriage, lung disorders, and cardiovascular disease. Secondhand smoke alone kills 38,000 people per year.

And now, according to a study conducted by researchers from Taipei Medical University and published in the Journal of the National Cancer Institute, nicotine may promote the development of breast cancer.

While tobacco products are known to contain at least 60 chemicals that cause cancer, up until now nicotine — the chemical that makes tobacco products addictive — had not been classified as one of them.

Researchers exposed both healthy and cancerous breast tissue to nicotine and found that cancerous cells had more receptors for the chemical than healthy cells did, and that nicotine exposure increased the risk that normal cells would turn cancerous.

The study raises concerns over the safety of nicotine-based smoking cessation aids such as nicotine gum, patches, and inhalers. Nicotine is produced by plants as a natural insecticide.


Removal of lymph nodes not necessary?

An article published in the Feb. 9, 2011, issue of The Journal of the American Medical Association suggests that many women being treated for early breast cancer can keep the lymph nodes under their arms without fear that it will hurt their chances of survival or the increase the odds that their cancer will return.

A new study shows that about 92% of women with early-stage breast cancers that have spread to a nearby lymph node who have lumpectomies and radiation to treat their tumors will be alive five years later, whether or not they have multiple lymph nodes removed from under their arms via a procedure called an axillary lymph-node dissection.

“The traditional treatment of breast cancer had been to remove the lymph nodes underneath the arm,” says Grant W. Carlson, MD, a breast-cancer surgeon at the Winship Cancer Institute at Emory University in Atlanta.

“That thought probably lasted more than 50 years, then we realized that a lot of cancers spread through the bloodstream first or at the same time as they are spreading through the lymph nodes, and that removing the lymph nodes is not curative in and of itself.” Carlson co-authored an editorial that accompanied the study.

Removal of the lymph nodes from the underarm area can lead to infection, pain, stiffness, numbness, and swelling. It also increases the length of time spent on the operating table.

For the study, doctors randomly split 891 women — all with breast tumors two inches or less in diameter that had spread to their lymph nodes — into two groups. In one group, surgeons removed only the first one or two lymph nodes to which cancer had spread, the “sentinel” nodes. In the other group, doctors removed at least 10 more lymph nodes under the arm.

Women in both groups had lumpectomies to remove their tumors and radiation of their entire breasts. Five years later, about 92% of women were still alive in both groups. “Survival was exactly the same,” Carlson says.

And the vast majority of study participants were still cancer free at five years — about 84% who had only their sentinel lymph nodes taken and about 82% in the group that had their axillary lymph nodes removed.

This study suggests that many breast-cancer patients may not need to have their axillary lymph nodes removed, but Carlson cautions that there are still certain circumstances where women and their doctors may decide to take that step — for example, in later-stage cancers or in cases where only part of the breast is treated with radiation.

Whole-breast irradiation appears to also treat lymph nodes under the arms, so only treating part of the breast may miss some spread of the cancer.