African American women have higher rates of a type of breast cancer that isn’t dependent for growth on the hormones estrogen or progesterone. They also have a higher rate of childbearing than do white American women.
A new study finds there is likely a link between those two facts – that bearing a baby to term raises the risk for this type of cancer, called estrogen or progesterone receptor-negative breast cancer.
The study also finds that black women who breastfeed their babies can lower their odds of developing this cancer back down again.
The study, published Tuesday in the journal Cancer Epidemiology, Biomarkers & Prevention, followed a group of 47,000 African American women from 1996 through 2009. Researchers had participants fill out, every two years, a detailed questionnaire assessing a wide range of factors that affect a woman’s risk for breast cancer — including weight, age at which they began menstruating, pregnancies and age of first childbearing, birth control or hormone-replacement use, physical activity and alcohol consumption.
What they found was that African American women who had given birth to more children were more likely to develop estrogen or progesterone-negative cancer than their peers who had not given birth or who had given birth to only one child. But when a woman with two or more childbirths breastfed her babies, that risk declined considerably.
The authors — epidemiologists from Boston University, Georgetown University and Roswell Park Cancer Institute in Rochester, N.Y. — surmised that given the prevalence of infectious diseases in Africa, women of African origins may respond to pregnancy with a particularly strong immune response, which in turn can allow cancers to gain a foothold in the body. Lactation, they noted, appears to blunt that effect.
Estrogen or progesterone receptor-negative breast cancers are less common than those that are fueled by those hormones, representing just one in four breast cancers. But they tend to be more aggressive and harder to treat.
Despite aggressive public health campaigns touting the benefits — to mother and child — of breastfeeding, the practice is less common among African American women than among white women. Future efforts to promote breastfeeding, wrote the authors, should let African American women know that moms who nurse their babies may also reduce their odds of developing a breast cancer that affects them disproportionately and is difficult to treat.
As health care costs play an ever-increasing role in Washington’s budget drama, Medicare officials announced last week they will continue to pay for two extremely expensive cancer treatments despite lingering questions about their effectiveness.
At a cost of about $88,000 per year, the cancer-fighting Avastin will still be available to eligible senior citizens for breast cancer treatment. The same goes for Provenge, a new “therapeutic vaccine” that boosts the immune system to fight prostate cancer for about $93,000 per course.
Even the staunchest number-crunchers are hesitant to argue against effective cancer medications. But in this economic climate, the high costs and limited benefits of the two drugs make them a target for health care analysts on both sides of the health care debate. Given the circumstances, they wonder, can Medicare afford it?
An advisory committee to the FDA unanimously voted last week to rescind Avastin’s approval for breast cancer patients, citing recent studies that show it is ineffective at combating the disease. But because Avastin maintains its FDA blessing to fight other cancers — and because so many women swear it saved their lives — doctors can continue to prescribe it “off label” for breast cancer and Medicare will continue to fit the bill.
Also last week, the Center for Medicare & Medicaid Services announced its conclusion that Provenge “improves health outcomes for Medicare beneficiaries” and is “reasonable and necessary.” Only men with advanced prostate cancer that has spread throughout the body and does not respond to hormone therapy or radiation are eligible for the treatment.
Medicare’s coverage decision will greatly expand access to the drug, extending the lives of thousands of elderly men by an extra four or five months.
When CMS began studying whether to pay for the new Provenge treatment several months ago, critics of health care reform swiftly joined outcry from prostate cancer sufferers who accused the agency of “rationing care” based upon costs.
That argument echoes the criticism that care will be rationed even further in the years ahead after the establishment of the Independent Payment Advisory Board — a panel created by the health reform law to cut costs in the Medicare system.
Rep. Phil Gingrey, R-Ga., recently reignited the debate by saying that under the presidentially appointed IPAB, “a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy.”
“I guarantee you when you withdraw that, the patient is going to die,” he said. “It’s rationing.”
Neera Tanden, chief operating officer for the Center for American Progress, a liberal advocacy group, said Republicans have been too quick to vilify the administration’s attempts to find savings in the current Medicare model — including comparative effectiveness research for expensive drugs.
“When the White House offers up ideas for comparative effectiveness, it’s really just about funding research that would show if they work or if other drug are more effective. Republicans attack that as rationing,” said Tanden, a former member of the president’s health reform team. “I’m concerned that discourse makes CMS intimidated when it comes to these decisions — and that drives up premiums and costs for everyone in the private and public sector.”
It’s still unclear whether treatments like Avastin and Provenge might be targeted for cost-saving in the years ahead. But Joseph Antos, a scholar of health care and retirement policy at the American Enterprise Institute, a conservative think tank, said there is already overwhelming pressure on Medicare to pay for these drugs, and that won’t change.
“From the patient side, there is an awful lot of expectation that these drugs should be provided and that translates into political pressure,” he said. “It’s really hard to tell a doctor who firmly believes this could help someone that they can’t use the fancy stuff.”
They likely won’t have to do that, said Gail Wilensky, a senior fellow at the international health group Project HOPE. If political buzz words like “rationing” and “death panels” keep flying around the nation’s capital, Medicare is unlikely to discontinue coverage for cancer drugs — no matter how limited their effectiveness.
“Whether or not this is sensible outside of a trial environment is a question we should be discussing as a society,” Wilensky said. “If we’re going to pay for these medications that other countries don’t, it would be nice to have a more rational discussion about all of this.”
Drugs used to treat prostate cancer in men may also be useful for difficult-to-treat breast cancers in some women, a Cancer Research UK study suggests. Hormone treatments like tamoxifen and aromatase inhibitors are ineffective against up to 30% of breast cancers. But laboratory research in Cambridge, reported in The EMBO Journal, suggests some of these tumours may respond to drugs for male cancers. Cancer Research UK said the findings were a “great surprise”. Hormones can switch on genes which lead to cells dividing uncontrollably and developing into tumours.
In women, breast cancers can be driven by the female sex hormone oestrogen. In men, prostate cancer can be driven by male sex hormones – androgens. Breakthroughs have been made in treatments for breast cancer by developing drugs which interfere with the oestrogen’s action, halting the tumour’s progress. However, tumours which are not driven by the hormone have been harder to treat.
Researchers at the Cancer Research UK Cambridge Research Institute found that some of these oestrogen negative tumours were instead influenced by male hormones. The same genes which were switched on by female sex hormones in oestrogen responsive tumours were activated by the male sex hormones. It raises the prospect that drugs already developed for prostate cancer could help some women. While androgens, such as testosterone, are typically associated with male development, they are also present in women.
The lead researcher Dr Ian Mills said: “This important discovery suggests that patients with a type of oestrogen-receptor-negative breast cancer may potentially benefit from therapies given to prostate cancer patients, which could transform treatment for this patient group in the future. ”But at the moment this laboratory research is still at an early stage.” Researchers said this could apply to up to 5% of all breast cancers. Dr Lesley Walker, from Cancer Research UK, said: “Prostate cancer depends on the androgen receptor for growth so it’s a great surprise that a type of breast cancer might also be fuelled by this protein.” Dr Caitlin Palframan, policy manager at Breakthrough Breast Cancer, said: “This fascinating research opens the door to personalised treatment for a small group of breast cancer patients.
“Women with oestrogen receptor negative disease have fewer treatment options and new ways to tackle it are urgently needed.”
With the identification of more than 25 types of prostate cancer by PCF-funded scientists in the past 24 months, and the fact that it remains one of the least talked about cancers, it’s no wonder there remains a great deal of confusion surrounding this disease.
Ask any group of men about prostate cancer. If they don’t abruptly change the subject or take the opportunity to crack a few wise remarks, chances are you will get a wide variety of answers when it comes to what it is, how it should be treated and whether or not (and when) one should be screened for this disease. Against this reality, it is always a good idea to review some of the more popular myths and misconceptions about this disease that claims the lives of more than 32,000 men in the U.S. each year.
While it may be true that the older you are, the more likely you are to be diagnosed with prostate cancer (65% of cases are diagnosed in men who are 65 or older), the fact remains that 35% of those diagnosed, or more than 76,000 each year, are diagnosed at an earlier age. I was diagnosed at age 51 and I have met many men who were diagnosed in their early 40s. Although only 1 in 10,000 men under age 40 will be diagnosed, the rate skyrockets up to 1 in 38 for ages 40 to 59, and 1 in 15 for ages 60 to 69.
There are many risk factors to consider. Your race, family history, physical health and lifestyle—even geographic location—are all factors that can increase your likelihood of developing prostate cancer.
Wrong. Prostate cancer is one of the most asymptomatic cancers in oncology, meaning not all men experience symptoms. Many times symptoms can be mistaken or attributed to something else. Signs of prostate cancer are often first detected by a doctor during a routine check-up. Common symptoms include a need to urinate frequently, difficulty starting or stopping urination, weak or interrupted flow of urination, painful or burning urination, difficulty having an erection, painful ejaculation, blood in the urine or semen, or frequent pain and stiffness in the lower back, hips or upper thighs. If you experience any of these symptoms, be sure to tell your doctor.
The answer to this one is sometimes, yes. Sometimes, no. With the 25 types of prostate cancer discovered by PCF-supported researchers, we can confirm that there are those prostate cancers a man may die with and not of, while others are very aggressive. Once a biopsy confirms the presence of cancer in the prostate, a physician uses the data contained in the pathologist’s report to characterize the potential aggressiveness of the cancer and make recommendations for treatment based on many factors, including a patient’s age and health status. There are many treatments available for patients and one approach does not fit all cases. Patients need to understand the complexity of this disease and make treatment decisions that are right for them in consultation with a trusted medical professional.
The good news is that we believe, with the accelerated pace of scientific discovery, we will soon be able to identify the specific cancer a patient has at time of their diagnosis and match the most effective treatments for their prostate cancer and their biological makeup. This will enable us to cure more and overtreat less.
Wrong. While a family history of prostate cancer doubles a man’s odds of being diagnosed to 1 in 3, the fact remains that 1 out of 6 American men will be diagnosed with prostate cancer in their lifetime. This compares to 1 in 8 women who will be diagnosed with breast cancer. African-American men are 60% more likely to be diagnosed with prostate cancer and 2.4 times more likely to die as a result.
Family history and genetics do, however, play a role in a man’s chances for developing prostate cancer. A man whose father or bother had prostate cancer is twice as likely to develop the disease. The risk is further increased if the cancer was diagnosed in a family member at a younger age (less than 55 years old), or if it affected three or more family members.
In 2010, approximately 218,000 new cases were diagnosed in the U.S. and more than 32,000 men died as a result of this cancer. The number of new U.S. cases could exceed 300,000 per year by 2015.
Incorrect. The PSA tests measures levels of prostate-specific antigen in the prostate, not cancer. PSA is produced by the prostate in response to a number of problems that could be present in the prostate including an inflammation or infection (prostatitis), enlargement of the prostate gland (benign prostatic hyperplasia) or, possibly, cancer. Think of it as a first alert smoke alarm, instead of a fire alarm. The PSA test is the first step in the diagnostic process for cancer. It has made detection of cancer in its early stages, when it is best treated, possible. Experts believe the PSA test saves the life of approximately 1 in 39 men who are tested. Personally, I believe the PSA test saved my life and will continue to save it as we track my response to treatment.
Although prostate cancer is a common cause of elevated PSA levels, some men with prostate cancer may even have low levels of PSA. PSA can also be diluted in men who are overweight or obese, due to a larger blood volume, and a biopsy should be considered at a relatively lower number (i.e. 3.5 instead of 4). Again, elevated levels can be an indication of other medical conditions.
Having a vasectomy was once thought to increase a man’s risk. This issue has since been carefully researched by epidemiologists. Vasectomy has not been linked to increasing a man’s chance of getting prostate cancer but has led to the prostate being checked by the urologist more often and prostate cancer consequently being detected in the clinic.
While erectile dysfunction (ED) and urinary incontinence are possibilities following surgery or radiation therapy for prostate cancer, it is not true that all men experience complications. These side effects can also be highly dependent on age and physical condition. Numerous therapies and aids can improve erectile function and limit incontinence following treatment and nerve sparing surgical procedures have improved outcomes for patients as well. When selecting a surgeon, patients should inquire about the surgeon’s outcomes for ED and incontinence as well as the number of surgical procedures (open or robotic) performed.
High levels of sexual activity or frequent ejaculation were once rumored to increase prostate cancer risk. In fact, some studies show that men who reported more frequent ejaculations had a lower risk of developing prostate cancer. Ejaculation itself has not been linked to prostate cancer.
Prostate cancer is not infectious or communicable. This means that there is no way for you to “pass it on” to someone else.
The first step in dealing effectively with prostate cancer is knowing the facts and eliminating confusion. Recent studies have shown that lifestyle decisions such as maintaining a healthy diet and regular exercise, such as walking 30 minutes a day, may also play a pivotal role in reducing the risk of getting prostate cancer and surviving it if you get the disease. Talk to your family and friends about prostate cancer and, if you are over 40, talk to your physician to develop a prostate health and screening plan that is right for you.
By Dan Zenka
Abiraterone, 4th New Drug for Prostate Cancer is Approved in 12 Months
In the past few months I have often said there is no better time to be a prostate cancer patient than now. In my position here at the Prostate Cancer Foundation, I have uttered this statement with enthusiasm and a bit of pride. As a patient, I have said it with a healthy portion of relief and a prayer of thanksgiving for progress. Not that I want to ever need any of these new drugs, but, as I grapple with my disease and the ever present possibility of recurrence, I am reassured that these new treatments will be ready and waiting for me and my medical team if and when I need them.
To recap, the four new drugs are: Provenge (the first ever immunotherapy for the disease); Cabazitaxel, an advanced chemotherapy agent also known as Jevtana; Denusomab, marketed as Xgeva for bone health during androgen dperivatrion tehrapy; and now, Abiraterone (Zytiga). Approved just yesterday by the FDA, Abiraterone has been in development since the 1990s and will be utilized for the treatment of castration-resistant, metastatic prostate cancer following docetaxel chemotherapy. It’s a clinical break-through for patients who previously had few good clinical therapies available to them.
During Phase III clinical studies, patient response was so encouraging that those patients who were taking the placebo were given the option of switching to the drug. Good news indeed for so many.
You can read more about Abiraterone here.
Here’s to progress. Here’s to better outcomes.
It’s surprising how landmark deep science can be supported by deeply rooted fun like Movember.
Researchers have sequenced the genomes of prostate tumors from seven men–a landmark event that promises to one day help clinicians learn how to differentiate between those tumors that will be highly aggressive and require immediate treatment and those that are essentially benign and that can be simply observed through proactive surveillance. This project represents a transforming moment in understanding the underlying biology of prostate cancer.
Geneticists have been sequencing a variety of tumors of different types, but the effort on prostate tumors introduces a new level of complexity. If the data for each genome were presented in the form of a printed telephone book, it would form a book 35 feet high.
All of this is deeply complicated science, indeed. And it’s promising news for millions of prostate cancer patients. But it is important to note that is was made possible by an entirely fun–even frivolous–annual campaign known as Movember. Each year, thousands of men around the world grow moustaches to raise funds that support crucial research that can ”change the face of men’s health.” In the case, whole genome sequencing of prostate cancer was made possible by unrestricted funds raised by Movember in the U.S. and donated to PCF.
What really surprised the researchers, said geneticist Levi Garraway from the Dana-Farber Cancer Institute, was the wholesale shuffling of large segments of the genomes, with relatively big chunks of DNA broken out from one site and reinserted elsewhere. The team found more than 100 such rearrangements, far more than had been observed in any other form of cancer studied so far. “Not only were they much more common than one might have imagined, but there were certain patterns,” Garraway said. “It’s important for prostate cancer, but it might be telling us something fundamental about how cancer genomes become messed up in the first place.”
Complete information on this historic sequencing of whole prostate cancer genomes can be found at PCF’s website.
Men of America: Grow on!
For those looking for a meaningful commitment on Valentine’s Day, RC Cancer Centers along with the Georgia Prostate Cancer Coalition, Atlanta Hawks, KISS 104.1, Atlanta Thrashers, WSB Radio, UPS, C.R. Bard, WXIA Television and Morehouse School of Medicine have issued a challenge to have 10,000 men in Georgia pledge to engage in a conversation with their doctors and/or get screened for prostate cancer between now and April 30, 2011.
Prostate cancer is one of the most common non-skin cancers in America. It affects 1 in 6 men and accounts for 28 percent of all new cancer cases among Georgia males each year. Getting a loved one tested may be the greatest gift of all this Valentine’s Day.
“Early detection is the greatest preventative measure a person can take,” says Dr. Mark Merlin radiation oncologist at RC Cancer Centers. More than 2 million men in the U.S. have been diagnosed with prostate cancer at some point and are still alive today, according to the American Cancer Society.
“It is crucial for men to maintain an ongoing relationship with their healthcare provider as the risk for prostate cancer will vary from person to person,” says Dr. Philip Shrake, radiation oncologist at RC Cancer Centers.
Show romance and affection a little differently this year and encourage the one you love to get a prostate cancer screening and start the dialogue with their doctor this Valentine’s Day.
RC Cancer Centers has partnered with the Atlanta Hawks and Atlanta Thrashers, UPS, CR Bard, WXIA Television, Morehouse School of Medicine, KISS 104.1 Radio and WSB Radio to support the Georgia Prostate Cancer Coalition in an effort to better educate men about their health choices and raise awareness about prostate cancer in the state of Georgia.
The prostate specific antigen (PSA) screening is a simple blood test that RC Cancer Centers is encouraging you to do for your love. Do it for each other.
To take the pledge or learn more about the Georgia Pledge Campaign, visit www.GeorgiaProstateCancerPledge.com.
Susan G. Komen for the Cure is a wonderful organization, working arduously to protect woman and families everywhere. But, its current litigation efforts against other non-profits isn’t winning over a lot of hearts.
As a patient and advocate for eradicating all cancers (which represents an estimated $58 trillion burden on our nation’s economy in addition to the obvious human toll) I have to wonder why so much of an organization’s funds and human resources are going into laying exclusive claim to an activity–finding cures–that thousands of medical foundations are pursuing. Why dampen the efforts of so many inspired organizations that are merely wanting to support much needed research?
Finding a cure… or doing something for the cure… It seems kind of generic to me. Say “Komen,” and I know exactly what you are talking about. Walk up and say “for the cure” to me and I respond with “What?” Say “Race for the Cure,” and I know we’re talking Komen. Say “Mush for a Cure” or “Cupcakes for the Cure,” and I know these aren’t Komen gigs.
It’s never productive when one’s mission begins to wander.
Unfortunately, Komen still has to live down its misguided “Buckets for the Cure…” campaign. Whoever approved deep fried chicken as a good thing for cancer had to be asleep at the wheel. What about all that data on the role of nutrition and exercise and its role in cancer? Or the epidemic obesifying of America? Not exactly a good way to super-size one’s donations. But that’s another issue.
On NBC Nightly News last evening, Komen was certainly in the hot seat. Listening to their spokesperson, I heard that they are working to develop a plan for moving beyond this debate. I applaud that direction. In support of a worthy cause, I would like nothing more than to see Komen refocus on what it does best: finding a cure or doing stuff for the cure. It’s what so many admirable organizations and their supporters are trying to do.
Godspeed for the Cure, Komen. With a little reset, you have my support.
Ty Lewis’ 3 year battle with cancer is an inspiration his son & soccer team at one of the biggest tournaments in the US.
MyNewYorkMinute.org – If you haven’t guessed it already, I love my job. But there are times when I REALLY get excited about where I work… This week’s announcement of a Veridex (a Johnson & Johnson company) five-year, $30 million (that’s a 10x factor) partnership with researchers at Massachusetts General Hospital provides another concrete example of PCF’s ability to lead investment in game-changing research and technology development and parlay its investments into expanded funding for promising new technologies and treatments for patients. When I first joined PCF almost three years ago, the foundation had just made a three year Challenge Award to Dr. Daniel Haber and his research team at Massachusetts General Hospital. It was my first introduction to circulating tumor cells (CTCs). Having just jumped from the nanotech sector, I immediately tracked with the idea and understood its potential. I just had no idea how quickly it would progress.
Circulating tumor cells, found in patients’ bloodstreams, are shed from tumors and may be responsible for metastases. The ability to capture and analyze CTCs from a routine blood draw promises less invasive and better diagnostic tools for prostate and other cancers. CTC “liquid biopsies,” (a term coined in 2007 by PCF for CTC research) can confirm the presence of cancer and provide a tool for researchers to distinguish between the numerous genotypes of prostate cancer, leading to personalized treatments. The ability to actually count cancer cells may also inform physicians if patients are responding to a specific treatment sooner than is currently possible. Studies show that when CTC numbers drop during a course of treatment, it indicates a favorable response to therapy. This ability could alert patients and their physicians when a medicine isn’t working so that new options can be assessed earlier.
As reported this week by ABC, CBS and numerous other leading national media outlets, researchers at Massachusetts General Hospital first published a paper in 2007 in the journal Nature.The paper announced that they had developed new technology—a microfluidic device—to isolate and catch whole CTCs on a microchip covered with 78,000 micro posts. The tiny posts were coated with antibodies that bind to cancer cells. When blood was forced across the chip, the posts combed a few cancer cells out of billions of blood cells and held them for analysis. In the trial, the microchip successfully captured CTCs in nearly all patients with lung, breast, prostate, pancreatic, and colon cancer. Prostate and lung cancer demonstrated the best results. As a result, in 2008, the Prostate Cancer Foundation made a $3 million, multi-year Challenge Award commitment to fast forward research and development of CTC technology specifically for prostate cancer.
Now, less than three years after PCF’s initial investment, the progress made by Dr. Haber’s team in CTC research has resulted in the five-year, $30 million development partnership with Johnson & Johnson’s Veridex. The goal of the partnership is to commercialize a “Version 3.0” of this innovative technology that is capable of rapid and efficient isolation and analysis of CTCs. We anticipate seeing the introduction of this latest version of the technology in clinical trials in approximately 24 months.
As a member of PCF, I am proud and excited. But, as a patient, I am over the moon. Even though it will likely be several years before it can be utilized widely in clinical practice, I am comforted that it may be there for me should I cross the line into that 60 percent chance of recurrence. This device would give me and my doctors a better prognostic tool for my disease and enable them to more rapidly assess my response to new treatments. Further development of this technology may enable the evaluation of even more information such as the genotype of my CTCs, which could help my doctors select the next best treatment for me or, better yet, assure me that I need not worry at all. Wouldn’t that be nice?
As I said, you gotta’ love it.
I will continue to update you on progress in CTC applications for prostate cancer, including updates that come out of PCF’s Annual Scientific Retreat in September.
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Also known as RC Cancer Centers.