New Genomic Test REDUCES Need for Chemotherapy in Breast Cancer Patients

For some women, surviving breast cancer may no longer need to involve chemotherapy. Doctors have long known that many early-stage breast cancer patients who undergo chemotherapy don’t actually need it to prevent recurrence of the disease after surgery. But they haven’t known exactly which patients might safely skip the toxic treatment.

A new study published in the New England Journal of Medicine says based on the gene activity of tumor.  The so-called genomic test measures the activity of genes that control the growth and spread of cancer, and can identify women with a low risk of recurrence and therefore little to gain from chemotherapy.

The MINDACT trial analyzed whether a different genomic test – the 70-gene MammaPrint test — could also determine which women needed chemotherapy with early stage breast cancer. The researchers estimated that their findings would apply to 35,000 to 40,000 women a year in the United States, and 60,000 to 70,000 in Europe. They are patients with early disease who because of tumor size, cancerous lymph nodes and other factors would normally be prescribed chemotherapy. The biggest benefit to patients, using this genomic test, is the ability to avoid the toxicities of chemotherapy (potentially including permanent nerve damage, heart failure and leukemia).

The results of the study will be of most use for cases that have fallen into a gray zone, when the disease is in an early stage but has some anatomical features that suggest it may be aggressive. But the genomic test says it is low risk.

Dr. Fatima Cardoso, an author of the study and a breast oncologist at Champalimaud Clinical Center in Lisbon, said that traditionally, women with early cancer, but a high clinical risk were usually given chemotherapy. She said that doctors knew that not all would benefit from it, but gave it to all anyway to err on the side of caution, because they could not identify which women did not really need it.

The main goal of the study was to find out whether women with a high clinical risk but a low genomic risk could safely forgo chemotherapy. The researchers said that it was safe for women with early disease and high clinical risk, but low genomic risk, to skip chemotherapy. The findings mean that 46 percent of women with early-stage disease who are thought to be at high clinical risk may be able to skip chemotherapy.

The genomic test is expensive, but the price pales in comparison to the cost of chemotherapy. By allowing patients to avoid toxic and costly unnecessary chemotherapy treatments, this particular test demonstrates the value of advanced diagnostic testing which leads to better decision-making for women with breast cancer.

Bottom line: Genomic testing and other advanced diagnostic tools are re-shaping the way we treat breast cancer and improving decision making. The end result is better for patient care and improves clinical outcomes.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Molecular Breast Imaging for Detecting Breast Cancer? The What and How.

Molecular breast imaging (MBI) is a method for detecting breast cancer. The technique is also known as a Miraluma test, sestamibi, scintimammography, or breast specific gamma imaging.

MBI uses a radioactive tracer that “lights up” any areas of cancer inside the breast. This tracer is injected into the body through a vein in the arm. Breast cancer cells tend to take up the radioactive substance much more than normal cells do. A special camera called a nuclear medicine scanner then scans the breast, looking for any areas where the radioactive substance is concentrated. The process takes about half an hour, and unlike mammography, it yields images of cancerous tissue regardless of the tissue’s density.

MBI continues to be tested, but it appears to hold promise for detecting breast cancer in women who are at higher-than-average risk for the disease and have dense breasts. When women have a lot of dense breast tissue, tumors become hard to spot on mammograms. On mammograms, fatty breast tissue looks dark, but dense tissue is light, like tumors, so it can hide any cancerous areas that may be present.

In a recent study published in the August 2016 issue of the American Journal of Roentgenology, Molecular breast imaging was shown to be effective as a supplementary screening tool to mammography for women with dense breasts. Researchers from Ohio, California, and New Hampshire performed a retrospective study to assess the utility of MBI as a supplementary screening tool for 1,696 women with dense breast tissue. The results showed that 13 mammographically occult malignancies were detected among the study group. Eleven were invasive, one was node positive, and one had unknown node positivity. Other findings showed:

  • Lesion size ranged from 0.6 to 2.4 cm, mean 1.1 cm
  • Incremental cancer detection rate was 7.7%
  • Recall rate was 8.4%
  • Biopsy rate was 3.7%

When incorporated into a community-based clinical practice environment, molecular breast imaging yielded a high incremental cancer detection rate of 7.7 cases of breast cancer for every 1,000 women at an acceptable radiation dose. However, one drawback of MBI is that it involves a much greater dose of radiation than mammograms.

MRI (magnetic resonance imaging), is often the preferred tool for evaluating women who are considered high-risk and have dense breasts. However, MRI has no radiation, but is more expensive than MBI and can return false positive results, leading to unnecessary biopsies. If a mammogram shows that you have dense breast tissue, MBI may be an alternative to ask about.

Bottom line: If you are at average risk for breast cancer and do not have dense breasts, mammography remains the screening tool of choice for you. Many doctors believe that, for most women, mammography is better than MBI at detecting breast tumors when they are small and generally easier to treat.

 

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area


Heart Disease in Women: Breast Cancer Takes a Back Seat

When it comes to women’s health, breast cancer tends to get more attention than heart disease. Many women believe that cancer is more of a threat, but they’re wrong. Nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer.  New research shows at least five times as many women die from heart disease as breast cancer and misconceptions about cardiovascular risks among women — and doctors who treat them — is partly to blame.

In a new study published in Global Heart, the journal of the World Heart Federation, researchers from Ohio State University found that awareness of women’s risks of developing coronary artery disease (CAD) has increased over the past decade, but men are still more aggressively treated at the first signs of the heart-related condition.

The research indicates CAD kills at least as many women as men each year, but doctors are less likely to recommend preventive measures for women, compared to men at risk for the condition — such as lowering cholesterol, taking aspirin, or making lifestyle changes in their dietary and exercise habits.

Heart disease is still largely considered a “man’s disease” by many women and doctors who should know better, according to lead researchers Martha Gulati, M.D., and Kavita Sharma, M.D. “One in three women get heart disease; one in two get heart disease or stroke, and one in eight get breast cancer,” states Dr. Gulati. “One in four women die from heart disease and one in 30 women die from breast cancer. Heart disease is the No. 1 killer of women. Lack of awareness is a [factor].”

According to the study, cardiovascular diseases are the leading cause of death for men and women worldwide, killing 8.6 million women alone each year. That’s one-third of all deaths in women.

According to the American Heart Association, cardiovascular disease — including heart disease, high blood pressure, and stroke — kills nearly a half-million women in the U.S. each year. That figure exceeds the next seven causes of death combined. More women die from CAD than of all cancers (including breast cancer, which kills about 40,000 women annually), respiratory conditions, Alzheimer’s disease, and accidents combined. Women are also 15 percent more likely than men to die of a heart attack and twice as likely to have a second heart attack in the six years following the first.

The researchers added that while most American women can identify breast cancer as a risk to their health, few can do the same for heart disease.

The new research highlights other differences between men’s and women’s heart risks:

  • Obesity (tied to lack of exercise and unhealthy diets) increases the risk of CAD by 64 percent in women but only 46 percent in men.
  • CT scans and other imaging techniques show that women have narrower coronary arteries than do men, which may account for the greater risks women face.
  • Women with an immediate family member who has had CAD face greater risks than men.
  • Diabetes raises a woman’s CAD risk by three to seven times, while for men it is two to three times.

The researchers said awareness of the impact of CAD on women is growing. In 1997, only 30 percent of American women surveyed were aware that the leading cause of death in women is heart disease. By 2009, that level of awareness had grown to 54 percent. But that figure still indicates many women mistakenly believe breast cancer is a bigger threat to their lives than heart disease. In addition, fewer than one in five physicians recognize that more women than men die each year from CAD.

Health experts recommend the following heart-healthy tips:

  • Diet: Consume at least five daily servings of fruit and vegetables; limit consumption of fried and fatty foods; buy lean, low-fat protein; and choose lower-fat and whole grain foods.

 

  • Exercise: Get at least 20-30 minutes of moderate-intensity exercise five days a week (150 minutes weekly). That activity should be strenuous enough to increase your heart rate and make you break a sweat, but light enough that you can carry on a conversation.

 

  • Stress: Look for ways to lower your stress level through exercise, relaxation techniques, Yoga, swimming, or other activities.

Bottom line: Cardiovascular disease is the number one killer of men and women and far more dangerous to women than breast cancer. Greater awareness is needed among patients and physicians about the prevalence of CVD in women. Following a “heart healthy” lifestyle can significantly reduce your risk of cardiovascular death.

 

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.