Some women with abnormal breast lesions may avoid surgery

Main Category: Breast Cancer
Article Date: 01 Aug 2013 - 1:00 PDT
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Some women with abnormal breast lesions may avoid surgery

Surgery is not always necessary for women with a type of breast tissue abnormality associated with a higher risk of cancer, according to a new study published online in the journal Radiology. Researchers said that periodic imaging and clinical exam are effective in these patients when radiology and pathology findings are benign and concordant, or in agreement.

Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are abnormal breast lesions that occasionally appear as incidental findings in breast biopsies. Women with ALH or LCIS have a four to 10 times higher risk of developing breast cancer, according to Michael A. Cohen, M.D., FACR, professor of radiology at the Emory University School of Medicine in Atlanta. As a result, it is often recommended that ALH and LCIS diagnosed on image-guided core biopsy be removed surgically.

"Because of the possibility of upgrade to cancer, the bulk of the published literature says that the prudent thing to do is excise ALH and LCIS," Dr. Cohen said.

But new research from Dr. Cohen, Kristen Atkins, M.D., and colleagues may alter that thinking.

Dr. Atkins is a pathologist and associate professor at the University of Virginia in Charlottesville, Va. At one time, Drs. Cohen and Atkins were colleagues there and had many discussions about balancing the risk of cancer in ALH and LCIS patients with the costs and potential complications of surgery.

"From a pathology perspective, ALH and LCIS are often very tiny lesions, so we wondered why they were getting excised," Dr. Atkins said. "These surgeries may involve general anesthesia and possible disfigurement."

The researchers studied 10 years of pathology and radiology data to look for a correlation between the number of ALH and LCIS cases that were upgraded to cancer after surgery or follow up and the concordance between the radiologist and pathologist.

The research yielded 50 cases from 49 women aged 40 to 73 years. Radiologist and pathologist findings were concordant in 43 of the 50 cases. None of the benign concordant cases were subsequently upgraded to cancer, strongly suggesting that observation in these patients would have been a viable alternative to surgery. Of the seven discordant cases, two were upgraded to ductal carcinoma in situ, or DCIS, an early-stage, noninvasive form of breast cancer.

Dr. Cohen repeated the study after moving to Emory and found the same results.

"When there's no discordance between the radiologist and pathologist after thorough radiology-pathology correlation, there's no upgrade from ALH or LCIS to cancer in our study," Dr. Cohen said. "These findings show that some women can avoid surgery, and that yearly mammograms along with MRI or ultrasound as second-line screening tools may suffice."

The researchers suggested that their findings will help physicians and patients make informed decisions about ALH and LCIS.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject.

"Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast Biopsy: Use of Careful Radiologic-Pathologic Correlation to Recommend Excision or Observation." Collaborating with Drs. Cohen and Atkins were Brandi Nicholson, M.D., and Sandra Rao, M.D.

For patient-friendly information on mammography, MRI and ultrasound, visit RadiologyInfo.org.

Radiological Society of North America

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Osteoporosis Prevention Tips for Women

Osteoporosis is a highly prevalent disease among women; half of women over 50 will break a bone due to osteoporosis, according to the National Osteoporosis Foundation. Characterized by thinning of the bone that leads to fractures, the condition is caused by the fact that the body stops rebuilding bone fast enough to replace degeneration as we age. This generally begins in the mid 30's, but it usually doesn't pose any risks until women reach menopause. Men also suffer from osteoporosis, but usually at a much older age.

When a woman hits menopause, her shares of the hormone estrogen decline dramatically. This hormone is responsible for preventing the breakdown of women's bones. Any situation indicating low estrogen levels, including lack of a menstrual period before a woman reaches a natural age for menopause, is a risk factor for osteoporosis. Combined with the sudden drop in estrogen, women also have smaller, thinner bones than men generally. It's important for women to focus on preventative methods.

Below are several measures you can take to help prevent osteoporosis.

1) Take calcium and vitamin D supplements, the latter of which helps the body absorb calcium.

2) Do exercise that subjects the bones to weight-bearing, which encourages rebuilding.

3) Increase your intake of foods that contain calcium. Dairy products aren't the only foods that contain calcium. Kale, collard greens, tempeh, fortified orange juice, turnip greens and blackstrap molasses are all potent sources.

4) Avoid excess salt consumption. Aside from increasing your risk of heart disease, a Japanese study, available at http://www.sciencedaily.com/releases/2013/06/130617110931.htm, found that very high sodium intake correlates with bone fracture risk.

5) Research is currently inconclusive, but the results of some studies suggest that fructooligosaccharides, aside from being fun to say, are good for your bones. These non-digestible carbs may increase your body's ability to absorb calcium. They're found in chicory root, onions, tomatoes, asparagus and wheat.

6) Take steps to avoid insulin resistance, the hallmark of type 2 diabetes. Insulin resistance is common among people who are overweight. A study, found at http://www.sciencedaily.com/releases/2013/06/130617110715.htm, determined diabetics to have weaker bones than non-diabetics. The best ways to prevent type 2 diabetes are to exercise and eat well, maintaining a healthy weight.

7) If you're too young to be experiencing menopause but have stopped getting your period (or never started), see a doctor. If no dysfunction is found, you may wish to begin using birth control to regulate your hormones. The extra estrogen will help keep your bones strong.

As with most health conditions, preventing osteoporosis involves eating right and exercising. Taking simple steps now to prevent this and other conditions will help you live longer and better as you age.

Solutions specific to pregnancy back pain, weight loss and other women specific issues. Please ask questions, give comments or stories related to this article submission for women's issues.

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Women and heart disease: more deaths, less care

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Academic Journal
Main Category: Cardiovascular / Cardiology
Also Included In: Preventive Medicine
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Women and heart disease: more deaths, less care

Coronary artery disease (CAD) kills more women than men each year, yet women are still not receiving as many preventive recommendations as men, according to a paper published in Global Heart.

Researchers from Ohio State University wanted to analyze the risk for CAD in women, as well as its impact and female-specific strategies for treatment.

They found that the disease should be managed differently for women, based on varying risk factors related to pregnancy and autoimmune diseases.

According to the authors, 8.6 million women die each year around the world from heart-related diseases, making up a third of all deaths in women. Additionally, cardiovascular diseases are the number one cause of death for both males and females worldwide.

Although the researchers note that awareness about the impact of CAD on women is slowly increasing, it still has a long way to go. In 2004, a survey revealed that only one in five doctors acknowledged that more women die each year from CAD. In addition, women are 55% less likely to participate in cardiac rehabilitation activities than men.

The authors say:

"More women than men die of CAD and more women have died from CAD than of cancer (including breast cancer), chronic lower respiratory disease, Alzheimer's disease, and accidents combined."

Deaths from CAD in the US fell by 30% between 1998 and 2008, but rates are going up in younger women under 55 years of age.

A number of risk factors differ between men and women, the authors note:

Obesity raises risk of coronary artery disease by 64% in women, but by only 46% in men.Women who suffer a heart attack related to CAD at a younger age are twice as likely to die as their male counterparts.42% of women are likely to die within a year of suffering a heart attack versus 24% of men.Women are 20% more likely to suffer angina than men.

The researchers say that women have narrower coronary arteries than men, and so are more likely to suffer CAD as a result of microvascular disease - disease of the heart affecting its small arteries.

The danger, the researchers say, is that while women may not appear to have major blockages of the coronary artery, they do suffer blockages of the smaller vessels. They add that over half of symptomatic women who do not have obstructive CAD still have signs and symptoms of ischemia.

Conditions that affect women rather than men also raise their risk of CAD, including polycystic ovary syndrome, pre-eclampsia and gestational diabetes, the researchers say.

"Women are affected by CAD in large numbers and to a large degree," the researchers say. "CAD is the leading cause of mortality in women. The manifestation of CAD has unique characteristics in women. Increasing data demonstrate that some treatment strategies have sex-specific effectiveness."

The researchers add:

"Further research regarding the pathophysiology of CAD in women, diagnosis and treatment strategies specific to women is required.

CAD is not a 'man's only' disease, and we eagerly await future studies that examine its unique presence in women."

Written by Marie Ellis

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our cardiovascular / cardiology section for the latest news on this subject.

“Coronary artery disease in women: A 2013 update,” Kavita Sharma, Martha Gulati, Global Heart, Volume 8, Issue 2, June 2013, Pages 105–112.

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Hope for women with hormone resistant breast cancer

Main Category: Breast Cancer
Article Date: 24 Jul 2013 - 1:00 PDT
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Hope for women with hormone resistant breast cancer

A new finding provides fresh hope for the millions worldwide with oestrogen receptor positive breast cancer. Australian scientists have shown that a specific change, which occurs when tumours become resistant to anti-oestrogen therapy, might make the cancers susceptible to treatment with chemotherapy drugs.

Seventy percent of breast cancer patients have oestrogen receptor positive cancer, and most patients respond well to anti-oestrogen therapies, for a few years at least. Within 15 years, however, 50% will relapse and eventually die from the disease.

Dr Andrew Stone, Professor Susan Clark and Professor Liz Musgrove, from Sydney's Garvan Institute of Medical Research, in collaboration with scientists from Cardiff University, have demonstrated that the BCL-2 gene becomes epigenetically 'silenced' in resistant tumours. This process is potentially detectable in the blood, providing a diagnostic marker. Their findings are now online in the international journal Molecular Cancer Therapetics.

Epigenetics involves biochemical changes in our cells that directly impact our DNA, making some genes active, while silencing others. Epigenetic events include DNA methylation, when a methyl group - one carbon atom and three hydrogen atoms - attaches to a gene, determining the extent to which it is 'switched on' or 'switched off'.

Dr Stone and colleagues have shown in human disease, as well as in several different cell models, that BCL-2 is silenced in oestrogen-resistant tumours by DNA methylation.

"The main purpose of the BCL-2 gene is to keep cells alive, so when the gene is silenced, cells become more vulnerable to chemotherapy," said Dr Stone.

"The next step will be to test our findings in clinical studies. We propose that if the BCL-2 gene is silenced, patients with oestrogen receptor positive breast cancer would benefit from combination therapy. In other words, tamoxifen could be used in combination with a chemotherapy drug, to kill off vulnerable tumour cells."

"Excitingly, this is something that could be implemented into clinical practice very quickly, since the technology now exists to profile methylation of BCL-2 in all patients - both oestrogen responsive and oestrogen resistant patients. In addition, the proposed chemotherapy drugs are already in use."

"If such a test were to be implemented, we believe it could help patients much earlier - hopefully shutting down tumours at an early stage."

Further information

Oestrogen is a hormone that drives reproduction, menstruation and menopause in women. Oestrogens are also present in men, but to a lesser degree.

Many breast cells have oestrogen receptors on their surface. When one of those cells becomes malignant and starts to multiply, an oestrogen receptor positive tumour develops. Typically these tumours are fed by high concentrations of oestrogen in the bloodstream, triggered by circumstances such as late first pregnancy, not breastfeeding, or too much body fat.

At present, there are three different therapeutic strategies for oestrogen receptor positive breast cancer: blocking the body's production of oestrogen with aromatase inhibitors; preventing oestrogen from 'binding' to the oestrogen receptor by 'binding' the drug tamoxifen instead; and destroying the oestrogen receptor completely.

Tamoxifen, now the gold standard treatment, became available in the 1970s.

Endocrine therapies, including tamoxifen, are inexpensive and well-tolerated, and are usually given for 5 years. Over time, however, many tumours become resistant to therapy. When one form of treatment starts to fail, a second is put in place, and then a third. Response times shrink, and tumours start to spread to other parts of the body, usually the brain, lungs, liver and bone.

At this late stage, there is little that can be done to help someone, as the brain, lungs, liver and bone are parts of the body that cannot be biopsied or operated upon.

While breast cancer predominantly targets women, with 1 in 9 women being affected, it also affects 1 in 100,000 men, some of whom have oestrogen responsive cancers.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Study: Women Who Survived Childhood Cancer Still Have Good Chance Of Conceiving

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Academic Journal
Main Category: Fertility
Also Included In: Cancer / Oncology
Article Date: 14 Jul 2013 - 0:00 PDT Current ratings for:
Study: Women Who Survived Childhood Cancer Still Have Good Chance Of Conceiving

Researchers have found that although females who survived cancer in their childhood have an increased risk of infertility, they still have a good chance of conceiving.

The study, published in The Lancet Oncology, revealed that around two-thirds of women who suffered from childhood cancer become pregnant. The researchers say this is a pregnancy rate similar to that seen in non-cancer survivors who have received infertility treatment.

Researchers from Dana-Farber/Boston Children's Cancer and Blood Disorders Center, as well as Brigham and Women's Hospital in Boston, carried out a survey of participants in the Childhood Cancer Survivor Study (CCCS). The study tracks people who were diagnosed with cancer under the age of 21 at over 26 US and Canadian institutions.

The study focused on women who were trying to get pregnant. The researchers analyzed 3,531 women from the CCCS aged between 18 and 39 years who reported being sexually active at some point in their lives, as well as 1,366 of the women's female siblings for comparison.

The results showed that of 455 study participants who reported clinical infertility, 64% of them eventually became pregnant.

The results also revealed that in the youngest group of survivors and their siblings, who were under the age of 24, infertility was almost three times more common in the survivors than in their siblings.

But the results showed that this difference was less pronounced in women in their late 30s. The study authors say this may be because infertility is more common in all women in that age group and is not limited to cancer survivors.

Surprisingly, the study also revealed that although survivors were just as likely as their siblings to seek medical treatment for infertility, the siblings were twice as likely to be prescribed drugs for it.

Dr Sara Barton, the leader of this study, says:

"We do not have data about why providers did not prescribe infertility drugs, but are concerned about a provider bias against treating cancer survivors for infertility.

Perhaps providers assessed the chance of success as poor and therefore decided not to attempt therapy, or perhaps survivors were less motivated to take drugs after previous extensive treatment. Alternatively, reproductive medicine providers might have been uncomfortable with perceived medical comorbidities."

Barton adds that clinicians caring for childhood cancer survivors who request information about the likelihood of pregnancy or the success of infertility treatment have a scarce amount of data on which to provide recommendations.

She adds: "To our knowledge, ours is the first large study of female childhood cancer survivors to quantify the risk of infertility that is based on a clinical definition, and characterizes the use and success of infertility treatments in this setting."

In a comment alongside the study, Richard Anderson of the MRC Centre for Reproductive Health at the UK's University of Edinburgh says: "Barton and colleagues' data highlight the risk of infertility in childhood cancer survivors beyond the risk of ovarian failure and the need for this risk to be addressed by oncologists at the time of diagnosis and during follow-up as a key part of long-term care."

Written by Honor Whiteman

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our fertility section for the latest news on this subject. "Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort", Sara E Barton et al, The Lancet Oncology, July 13, 2013. Link to article. Please use one of the following formats to cite this article in your essay, paper or report:

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Breast Cancer An Increased Risk For Women Who Give Birth To Multiple Babies After IVF

Main Category: Fertility
Also Included In: Breast Cancer
Article Date: 11 Jul 2013 - 0:00 PDT Current ratings for:
Breast Cancer An Increased Risk For Women Who Give Birth To Multiple Babies After IVF

Women who give birth to multiple babies following IVF treatment are at a higher risk of breast cancer than those giving birth to singletons or who remain childless. Dutch investigators from the Omega study group said the explanation may not be the multiple pregnancy per se but a maternal trait related to a higher implantation potential and to breast cancer itself.

Although the results were derived from a large nationwide cohort study, the investigators emphasise that the findings should next be replicated in further studies and that presently there is no reason for earlier breast cancer screening than is recommended for the general population.(1)

The study, presented at the annual meeting of ESHRE by Dr Els Groeneveld from the VU University Medical Centre of Amsterdam, the Netherlands, analysed data from the Omega study, a large Dutch nationwide cohort of 19,861 women who received IVF or ICSI treatment between 1983 and 1995. Between 1997 and 1999 all patients were questioned (by questionnaire) about their treatment and its outcome. Those who completed the questionnaire (12,589 women) were cross-referred to the Netherlands Cancer Registry.

Cohort analysis showed that over a median 16.7 years of follow-up 1688 women in the study gave birth to multiples (13%), 6027 delivered singletons (48%), and 4874 remained childless (39%). Among these women there were 317 confirmed diagnoses of breast cancer, of whom 57 gave birth to multiples, 155 to singletons, and 105 remained childless. When these findings were analysed statistically, results showed that mothers of multiples had a (44%) higher breast cancer risk than the mothers of singletons (hazard ratio 1.44, statistically significant) when adjusted for year of IVF treatment, number of IVF cycles, height and age at first birth. Nulliparous women were at no increased risk of breast cancer.

Remarkably, only multiple pregnancies conceived after the complete implantation of all transferred embryos were associated with an increased breast cancer risk (HR 1.86), whereas multiple pregnancies conceived after incomplete implantation were not (HR 1.31, not statistically significant). This finding, says Dr Groeneveld, supports the hypothesis of a link between high embryo implantation potential and breast cancer risk.

She explained: "It has been generally assumed that increased levels of estrogen and progesterone in multiple pregnancies stimulate cellular proliferation in the breast, which increases accumulation of somatic mutations during cell division and leads to the development of breast cancer. Thus, breast cancer could be seen as a consequence of the multiple pregnancy itself. However, we also hypothesise that an additional maternal trait might be associated with an increased breast cancer risk in these women."

Such a trait could be maternal serum concentrations of vascular endothelial growth factor (VEGF), a known protein involved in breast cancer progression and which Dr Groeneveld's group in Amsterdam has recently found associated with improved embryo implantation potential.

"In our study women who developed a multiple pregnancy from all transferred embryos represent women with high embryo implantation potential, possibly through increased levels of VEGF," said Dr Groeneveld. "Future studies will reveal whether the significant association between improved embryo implantation potential and breast cancer risk shown in our study is actually based on increased levels of VEGF. "So the main message of our study is that the increased breast cancer risk is not only a consequence of the multiple pregnancy itself because of high hormone levels, but that the risk of breast cancer may already be elevated prior to conception in women who have the potential - the 'maternal trait' - to develop a multiple pregnancy from all transferred embryos."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our fertility section for the latest news on this subject.

Abstract 110

Increased breast cancer risk after multiple implantation in IVF: a cohort study

European Society of Human Reproduction and Embryology

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Wait, What?! Super Freaky Photos of Women Who Dress Like Dolls

The latest Internet trend has girls radically altering their bodies to look like living dolls, and then posting photos online

By Alesandra Dubin - June 12, 2013

The Internet is home to many creepy things you can never un-see. Right now, it's the breeding ground for a bizarre craze in which women (and a man or two) show off the results of their attempts — through dramatic plastic surgery, makeup and other methods — to look just like human Barbies or porcelain dolls.

And wouldn't you know? Some are gathering huge followings on social media or YouTube pages with their video beauty tutorials. Many followers are fans legitimately interested in emulating the living dolls' looks — and others gawk for the same reason you probably can't look away right now.

Here we bring you some of the most unbelievable living doll photos we've seen. It's downright baffling. You've been warned.

Facebook.com/valerialukyanovaamatue21

We are trying to figure out how Ukraine's Valeria Lukyanova walks without falling over, but we figure her left hand is propping her up out of frame.

Twitter.com/dakotakoti

Dakota Rose has more than 77,000 Twitter followers — plus a YouTube channel with tutorials on how anyone interested can emulate her style.

venusangelic.com

Here's what Venus Angelic wants you to know about her, per her website: "My sparkling personality, my voice and my me exists only once in this entire universe." We think that's probably true.

Facebook.com/pages/Olga-Olyenik/495864760447997

We're glad Olga Oleynik is sitting down in these shots, because it seems like falling over every time she stands up would be a real risk and that makes us nervous.

Facebook.com/AnastasiyaFukkacumiShpagina

Ukraine's Anastasiya Shpagina has close to 100,000 Facebook followers, including many who gush over her porcelain good looks in the photo comments.

justinjedlica.com

Oh yes, there's at least one Ken doll to go with all these Barbies: New York's Justin Jedlica credits a fascination with the lives of celebs like Michael Jackson and Donald Trump for his desire to transform his looks this way (presented without further comment).

Alesandra Dubin is a contributing writer on iVillage and founder of home and travel blog Homebody in Motion. Follow her on Google+ and Twitter. Connect with Us Follow Our Pins

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