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Research we're watching: Analysis raises new questions about treating noninvasive breast cancer

Updated October 21, 2015

The purpose of treating ductal carcinoma in situ (DCIS)—the earliest, noninvasive form of breast cancer (often called "precancer")—is to prevent those lesions from becoming invasive and thereby greatly reduce the risk of dying from breast cancer. As mammography has become more precise, it has detected more DCIS, and more women get treatment with surgery and often radiation as well. An analysis published online by JAMA Oncology on Aug. 20, 2015, adds to increasing questions about the best way to manage DCIS in most women diagnosed with it.

Canadian researchers analyzed 20 years of data from 108,000 women with DCIS in a database maintained by the National Cancer Institute. Most women were treated with lumpectomy, often followed by radiation, or mastectomy. The researchers found that treatment with radiation or mastectomy did not lower the overall breast cancer death rate in women with DCIS. It remained at 3.3%—the average death rate from all breast cancers. However there were some groups—including African American women and women under 40—in whom the death rate was higher (7% to 8%).

Untangling the non-invasive breast cancer controversy

Published September 18, 2015

Last month, JAMA Oncology published a study that suggests standard treatment for non-invasive breast cancer (DCIS) may be too aggressive and that perhaps some women with DCIS would do just as well without lumpectomy or mastectomy. As expected, this has generated a lot of controversy and confusion. For some women, DCIS is a “precursor” to invasive breast cancer, but in many others, it may not progress. But right now, doctors don’t understand these cancers well, and it is difficult to predict how these abnormal cells will behave in any given woman. More research is needed to determine optimal treatment for each individual woman diagnosed with DCIS. In the meantime, a woman with DCIS and her doctor should take into account certain risk factors (age and race among them), as well as that woman’s personal preferences when creating a treatment plan.

Mediterranean diet may prevent breast cancer, but there are other reasons to pour on the olive oil

Published September 17, 2015

The PREDIMED study showed that the Mediterranean diet can statistically lower a person’s risk for cardiovascular disease, including heart attacks, strokes, and death from heart-related causes. The data also suggest that a Mediterranean diet is associated with a reduced chance of getting breast cancer. This small analysis has some limitations, but provides another reason to consider this already healthful way of eating.

Increased mammography may find more breast cancers without lowering deaths

Updated September 10, 2015

Ideally, screening mammography detects small breast cancers so that they can be removed before they grow, metastasize, and kill. To tell whether screening is succeeding, researchers from Harvard and Dartmouth looked at the rates of mammography, the diagnosis of small breast cancers, large breast cancers, and breast cancer deaths in 16 million women 40 or older in the United States from 2000 through 2010. They found that when mammography rates increased 10%, the number of small cancers detected went up 25%, and the number of large cancers increased by 7%. There was no decline in breast cancer deaths. They concluded that mammography is finding—and women are being treated for—small cancers that may not progress to invasive disease or metastasize to other parts of the body.

The results, which were published online July 6, 2015, by JAMA Internal Medicine, echo those of earlier findings. They underscore a dilemma facing women and their doctors: To get annual mammograms and risk being treated for a tumor that may never become harmful, or have mammograms less frequently and risk missing a cancer until it is larger. The U.S. Preventive Services Task force recommends having a mammogram every one to two years for women ages 50 to 79. The American Cancer Society suggests annual mammograms beginning at age 40. You may want to discuss your personal risk profile, and your preferences, with your doctor.

Should postmenopausal women boost their aerobic exercise time?

Updated October 1, 2015

Among 400 postmenopausal women who were previously inactive, those who did 300 minutes per week of moderate or high intensity exercise had more success at reducing total fat after one year than those who exercised for 150 minutes per week.

Study gives new insights into obesity and breast cancer

Updated August 6, 2015

An analysis from the Women's Health Initiative (WHI) suggests not only that postmenopausal women who are overweight or obese have a higher risk of invasive breast cancer than women of normal weight but also that the excess risk increases as a woman's weight rises beyond obesity. The results were published online June 11, 2015, by JAMA Oncology.

A team of investigators from several medical centers studied data on 67,000 postmenopausal women who enrolled in the WHI between 1993 and 1998. They were followed for a median of 13 years. During that time, 3,388 invasive breast cancers were detected. The researchers analyzed the distribution of breast cancer among weight classes and calculated the risks for women who were overweight (body mass index, or BMI, of 25 to 30), obese (BMI 30 to 35), or very obese (BMI over 35) compared with women of normal weight (BMI 25 or less). They found that the increased risk of developing breast cancer ranged from 17% in women who were overweight to 59% in those with a BMI over 35. Among women who began the study at a normal weight, those who gained at least 5% of their original weight had a 12% higher risk of developing breast cancer than those who maintained their original weight. Neither losing weight nor using hormone therapy had a significant effect on risk for women of any weight.

Draft recommendations on screening mammography continue to stir debate

Published May 18, 2015

The release of new guidelines on mammography never fails to renew the heated controversy over the potential benefits and harms of this procedure. The latest draft guidelines from the U.S. Preventive Services Task Force (USPSTF) are no exception. The USPSTF recommends that women begin having mammograms at age 50 and stop at age 75. (The American Cancer Society and other medical organizations recommend that women begin getting regular mammograms at age 40.) The draft recommendations say there isn’t enough evidence to recommend or discourage the use of a new technique called 3-D mammography for screening, and also say there isn’t enough evidence to recommend that women with dense breasts, who are at higher risk of breast cancer, should have an ultrasound or MRI in addition to screening mammography. Comments can be made on the USPSTF draft until 8:00 pm Easter Time today. A final version of the recommendations is expected to be released in the fall of 2015.

Good news about early-stage breast cancer for older women

Updated February 14, 2015

Image: Thinkstock

Although the chance of developing breast cancer increases after age 60, the likelihood of dying from it is low.

If you're like most women, you consider the possibility of learning you have breast cancer every time you have a mammogram. But breast cancer probably doesn't seem as scary as it did when you were younger, because there has been so much good news about breast cancer in the last 20 years—improvements in mammography, advances in surgery and reconstruction, and drugs that are more effective and less toxic.

Women over 70 may be getting unneeded radiation for breast cancer treatment

Updated January 9, 2015

Although research suggests that women over 70 with early-stage breast cancer can skip radiation treatment, nearly two-thirds of women in that age group continue to receive it, according to findings published online Dec. 2, 2014, by the journal Cancer.

Researchers from Duke University sought to determine whether evidence from a large, randomized clinical trial published in 2004 had influenced treatment for early breast cancer. That study showed that adding radiation therapy to surgery plus tamoxifen does not reduce five-year recurrence rates or prolong survival in older women with early-stage tumors.

Only a few alternative therapies improve breast cancer side effects, analysis finds

Updated December 6, 2014

Image: Thinkstock

Although more than 80% of women with breast cancer use alternative therapies to relieve the side effects of treatment, there has been no scientific consensus on which ones are safe and effective. Researchers from several major cancer centers have analyzed data on over 80 such therapies and created a set of guidelines to help women with breast cancer and their oncologists. The results were published online in Journal of the National Cancer Institute Monographs on Oct. 27, 2014.

Only a few therapies were deemed to have enough evidence to justify recommendation—meditation, yoga, and relaxation with imagery for anxiety, stress, depression, and fatigue, and acupuncture for controlling nausea and vomiting from chemotherapy. Acetyl-L-carnitine, a supplement used to ease nerve pain, was found to increase nerve damage instead.

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