Monday, September 28, 2015

Breast cancer news

“Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live.” — Angelina Jolie

BELOW find an ABC News story about a new genetic test that identifies which breast cancer patients can skip chemotherapy — and a New York Times piece by a woman with the BRCA breast cancer mutation. 

(To read previous, related Hey Look Something blog posts, click on these links: Get a Mammogram and Breast Cancer in Younger Women.)

Gene Test Finds Which Breast Cancer Patients Can Skip Chemo

By Marilynn Marchione
September 28, 2015

Many women with early-stage breast cancer can skip chemotherapy without hurting their odds of beating the disease — good news from a major study that shows the value of a gene-activity test to gauge each patient's risk.

The test accurately identified a group of women whose cancers are so likely to respond to hormone-blocking drugs that adding chemo would do little if any good while exposing them to side effects and other health risks. In the study, women who skipped chemo based on the test had less than a 1 percent chance of cancer recurring far away, such as the liver or lungs, within the next five years.

"You can't do better than that," said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York.

An independent expert, Dr. Clifford Hudis of New York's Memorial Sloan Kettering Cancer Center, agreed.

"There is really no chance that chemotherapy could make that number better," he said. Using the gene test "lets us focus our chemotherapy more on the higher risk patients who do benefit" and spare others the ordeal.

The study was sponsored by the National Cancer Institute. Results were published online Monday by the New England Journal of Medicine and discussed at the European Cancer Congress in Vienna.

The study involved the most common type of breast cancer — early stage, without spread to lymph nodes; hormone-positive, meaning the tumor's growth is fueled by estrogen or progesterone; and not the type that the drug Herceptin targets. Each year, more than 100,000 women in the United States alone are diagnosed with this.

The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo, to help kill any stray cancer cells that may have spread beyond the breast and could seed a new cancer later. Doctors know that most of these women don't need chemo but there are no great ways to tell who can safely skip it.

A California company, Genomic Health Inc., has sold a test called Oncotype DX since 2004 to help gauge this risk. The test measures the activity of genes that control cell growth, and others that indicate a likely response to hormone therapy treatment.

Past studies have looked at how women classified as low, intermediate or high risk by the test have fared. The new study is the first to assign women treatments based on their scores and track recurrence rates.

Of the 10,253 women in the study, 16 percent were classified as low risk, 67 percent as intermediate and 17 percent as high risk for recurrence by the test. The high-risk group was given chemotherapy and hormone-blocking drugs. Women in the middle group were randomly assigned to get hormone therapy alone or to add chemo. Results on these groups are not yet ready — the study is continuing.

But independent monitors recommended the results on the low-risk group be released, because it was clear that adding chemo would not improve their fate.

After five years, about 99 percent had not relapsed, and 98 percent were alive. About 94 percent were free of any invasive cancer, including new cancers at other sites or in the opposite breast.

"These patients who had low risk scores by Oncotype did extraordinarily well at five years," said Dr. Hope Rugo, a breast cancer specialist at the University of California, San Francisco, with no role in the study. "There is no chance that for these patients, that chemotherapy would have any benefit."

Dr. Karen Beckerman, a New York City obstetrician diagnosed with breast cancer in 2011, said she was advised to have chemo but feared complications. A doctor suggested the gene test and she scored very low for recurrence risk.

"I was convinced that there was no indication for chemotherapy. I was thrilled not to have to have it," and has been fine since then, she said.

Mary Lou Smith, a breast cancer survivor and advocate who helped design the trial for ECOG, the Eastern Cooperative Oncology Group, which ran it, said she thought women "would be thrilled" to skip chemo.

"Patients love the idea of a test" to help reduce uncertainty about treatment, she said. "I've had chemotherapy. It's not pretty."

The test costs $4,175, which Medicare and many insurers cover. Others besides Oncotype DX also are on the market, and Hudis said he hopes the new study will encourage more, to compete on price and accuracy.

"The future is bright" for gene tests to more precisely guide treatment, he said.

The Breast Cancer Gene and Me
By Elizabeth Wurtzel
September 25, 2015

I DID not know I have the BRCA mutation. I did not know I would likely get breast cancer when I was still young, when the disease is a wild animal. I caught it fast and I acted fast, but I must have looked away: By the time of my double mastectomy, the cancer had spread to five lymph nodes.

I had eight rounds of the strongest chemotherapy there is for breast cancer. Two months later, my body still tingles from the blast. My insides are shimmering. I am reconfigured.

I have six weeks of daily radiation coming up. I have scans all the time. I have waiting rooms in my future, full of Golf Digest and Time from four months ago and that same issue of W that’s always there. I have waiting ahead. If you don’t like waiting, cancer is not for you.

I could have avoided all this if I had been tested for the BRCA mutation. All Ashkenazi Jewish women should be tested, because we have it at least 10 times the rate of the rest of the population: Up to one in 400 women is BRCA-positive, as opposed to one in 40 Ashkenazi Jews.

It seems I am the designated driver at my Seder table.

I could have had a mastectomy with reconstruction and skipped the part where I got cancer. I feel like the biggest idiot for not doing so.

The statistics vary wildly, but they are scary at the low end: According to a 2012 article in the Journal of Clinical Oncology, the lifetime breast cancer risk for BRCA carriers is between 56 and 84 percent. From where I am, if you are BRCA-positive, you get breast cancer — because, voilà.

All I know is I have the BRCA mutation most unexpectedly, and, still in my 40s, I had the kind of cancer that meant three surgeries in six months.

I did not know I was a carrier because I do not fall within testing parameters. Most insurance companies cover testing specifically for Ashkenazi Jewish women only once we present with breast cancer. Before that doomed moment, testing is only for women who have a family history of BRCA or who have had breast cancer at a young age, or who have close relatives with the disease.

Mary-Claire King, a geneticist whose work led to the discovery of a gene that carries an added risk for breast cancer, has called for testing to be offered to all American women 30 and older.New Genetic Tests for Breast Cancer Hold PromiseAPRIL 21, 2015
But that is not how mutations operate. They are sneaky.

I could not have guessed I am BRCA-positive. My mother has not had breast cancer, nor has her sister, nor did her mother. My first cousin — my mother’s sister’s daughter — did have breast cancer at the same age as I did, but not as a result of BRCA.

I did not think of my father in this situation, or perhaps I did not think of my father at all, as I last saw him in 2001. At the time he told me to beware of gum disease, and maybe something else. But I know his mother lived to be an old woman, and she did not die of breast or any other cancer, and my father made no mention of anything going wrong with his sister.

A 2009 Genetics in Medicine study of Ashkenazi women with breast cancer in New York found that about 10 percent carried the BRCA gene — but of these, only 50 percent “had any family history of breast cancer among the first or the second degree relatives.”

Click here to read the entire New York Times piece.

1 comment:

  1. WOW! Good info. Prevention would be so much better than treatment. My other in law died of metastasized breast cancer and my dear friend is dying of it right now. :( How much help would it be had they been able to test for it to skip the cancer or obtain earlier treatment. Thank you for this.