Oral Contraceptive Use Tied To Prostate Cancer

There is a significant link between use of oral contraceptives or birth control pills and the incidence of prostate cancer, said researchers who set out to investigate the suggestion that byproducts of these drugs get into the environment, for instance the water supply, and lead to an increase in low level estrogen exposure in affected populations.
David Margel, and Neil E Fleshner from the Princess Margaret Hospital at the University of Toronto in Canada, write about their findings in the 14 November online issue of BMJ Open. They conclude that their study shows a significant association between oral contraceptives and prostate cancer and that:

"It is hypothesised that the [oral contraceptive] effect may be mediated through environmental oestrogen levels; this novel concept is worth further investigation."
Several studies have already suggested that exposure to estrogen may increase the risk of prostate cancer, so Margel and Fleshner took this a stage further: what if use of oral contraceptives could be placing enough estrogen into the environment that it increases prostate cancer risk in the exposed population?
For their ecological study they analyzed global data from the International Agency for Research on Cancer (IARC) for 2007 and the United Nations World Contraceptive Use 2007 report to correlate statistics on prostate cancer incidence and related deaths to use of contraceptives.
They analyzed the data by country and by continents, and they compared results from oral contraceptive use with all other forms of contraception, such as intra-uterine devices, condoms or vaginal barriers.
The results showed that:

• Oral contraceptive use was significantly tied to prostate cancer incidence and related deaths in individual nations.
• Oral contraceptive use was also linked to prostate cancer incidence in Europe.
• There was no link between use of other forms of contraceptive and prostate cancer incidence or deaths.
• Further analysis showed the links with oral contraceptive use did not depend on a country's wealth.

Although the authors point out the study does not prove a cause and effect link, the findings suggest there is a need for further investigation, both to confirm them and to try and find out the chemical and biological pathways between possibles causes and effects.
In their discussion, they suggest one plausible explanation for the link between oral contraceptive use and prostate cancer is that the oral contraceptives in use today frequently contain high doses of ethinyloestradiol (an orally bio-active estrogen), that is "excreted in urine without degradation. This can then end up either in the drinking water supply or passed up the food chain".

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Ovarian Cancer Spread Fuelled By Abdominal Fat Cells

Fat cells in the omentum, a large fatty pad of tissue that drapes over the intestines in the abdomen, fuel the spread of ovarian cancer by providing nutrients and energy for rapid tumor growth, according to a new study published online in Nature Medicine at the weekend.
Study author Ernst Lengyel, professor of obstetrics & gynecology, the University of Chicago, told the press:
"The cells that make up the omentum contain the biological equivalent of jet fuel. They feed the cancer cells, enabling them to multiply rapidly."
He explained that the fatty tissue of the omentum is extraordinarily rich in energy-dense lipids, which provide a "lauching pad" and energy source for ovarian cancer cells, enabling the spread of this lethal disease.
Ovarian cancer is the fifth leading cause of cancer deaths in women, and it tends to spread to the omentum as opposed to distant organs. For the vast majority of women, by the time their ovarian cancer is diagnosed, it has already spread to the omentum, and tumors here often become bigger than the original cancer:
"Currently, it is unclear why tumor cells preferentially home to and proliferate in the omentum, yet omental metastases typically represent the largest tumor in the abdominal cavities of women with ovarian cancer," write the authors.
To try and find out more about the role of these fat cells in fuelling ovarian cancer spread, Lengyel and colleagues carried out a series of experiments using ovarian cancer cell cultures and live mice.
When they injected ovarian cancer cells into the abdomens of healthy mice, the cells took only 20 minutes to reach the omentum, showing they find their way there very quickly.
The researchers discovered that adipokines, a type of cell-to-cell signalling protein, inside the omentum were attracting the ovarian cancer cells. When they blocked these signals, the attraction reduced by at least 50%. In their paper they describe what they found:
"... primary human omental adipocytes promote homing, migration and invasion of ovarian cancer cells, and ... adipokines including interleukin-8 (IL-8) mediate these activities."
Once the cancer cells reach the omentum, they immediately set about making the tools that will enable them to make use of the nutrients and energy in the fatty tissue: they even reprogram the fat cells' metabolism to enable the "direct transfer of lipids from adipocytes to ovarian cancer cells".
In culture, the researchers found that the cancer cells also appear to be able to use the fat cells as a source of energy:
"... coculture induced lipolysis in adipocytes and [beta]-oxidation in cancer cells, suggesting adipocytes act as an energy source for the cancer cells."
It does not take very long for the cancer to transform the entire omentum into a solid mass of cancer cells.

Lengyel and colleagues discovered that a fatty acid binding protein, FABP4, which transports fat, may be very important to this process and could be a potential target for therapy.

They discovered this when they compared cells from primary ovarian cancer tissue to cells from tumors at the migration sites in the omentum.

They found the cancer cells next to the fat cells in the omentum produced high levels of FABP4, whereas cancer cells that were far away from the omentum fat cells did not produce any.

They showed that inhibiting FABP4 drastically reduced the transport of nutrients from the fat cells to the cancer cells in the omentum. It also slowed down the growth of tumors and their ability to generate new blood vessels.

"FABP4 deficiency substantially impaired metastatic tumor growth in mice, indicating that FABP4 has a key role in ovarian cancer metastasis," they conclude.

Lengyel and colleagues suggest fat metabolism may also be a factor in other cancers where there is a rich source of fat cells, such as breast cancer. And in the case of FABP4 specifically, it may be implicated in cancers that develop in the abdomen, and therefore:

"... FABP4 emerges as an excellent target in the treatment of intra-abdominally disseminating tumors, which preferentially metastasize to adipose tissue such as ovarian, gastric, and colon cancers."

Funds from the National Institutes of Health, the Burroughs Wellcome Fund, the Committee on Cancer Biology at the University of Chicago and Bears Care, the charitable beneficiary of the Chicago Bears Football Club, helped pay for the study.

Written by Catharine Paddock PhD

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Colon Cancer Prevention: More Fruits and Vegetables, Please

Researchers in Australia are reporting that different foods affect the risks of cancer in different parts of the colon. The investigators found that consumption of broccoli and other cruciferous vegetables (cauliflower, kale, cabbage, Brussels sprouts and turnips) seems to reduce the risk of cancer in the upper colon. Total fruit and vegetable consumption was associated with a decreased risk of cancer in the lower part of the colon - and eating a lot of apples and yellow vegetables also appeared to significantly reduce the cancer risk in that area.

The study, which included more than 1,000 men and women with no history of colorectal cancer, also found that drinking a lot of fruit juice was associated with an increased risk of rectal cancer. They tracked food intake among the study participants via extensive nutritional questionnaires. The study appears to be the first to look at the effects of diet on the risk of cancer in different areas of the colon. The study was published in the October issue of the Journal of the American Dietetic Association.

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IVF May Be Tied To Ovarian Tumors Later In Life

A Dutch study suggests that stimulating the ovaries to produce eggs for in vitro fertilization or IVF, may increase the risk of developing ovarian tumors, some of which may become cancerous, later in life. Overall, the researchers found rates of non-fatal "borderline ovarian tumors" were increased four-fold and rates of malignant tumors were increased two-fold compared to other women seeking fertility treatment who did not undergo IVF.

However, while these relative risks sound alarming and large, concerned women should bear in mind that in absolute terms they are very small indeed and this is only a preliminary study. The researchers concluded that further studies with much larger numbers of participants are now needed to investigate this further.
Flora van Leeuwen, a professor at the Netherlands Cancer Institute in Amsterdam, and colleagues, write about their investigation in the 26 October online issue of Human Reproduction.

In vitro fertilization (IVF) is used to help couples having difficulty conceiving. The woman is given hormones to stimulate her ovaries to make eggs which are harvested and fertilized with the man's sperm in a test tube. The fertilized egg is then inserted into the woman's uterus where it hopefully results in a successful pregnancy.
The world's first "test tube" baby was Louise Brown, born in 1978 in Oldham, Greater Manchester, UK. The physiologist who helped her parents conceive through IVF was Robert G. Edwards who won the Nobel Prize in Physiology or Medicine in 2010 for developing the treatment.

However, although the treatment has been around for three decades, we know don't know if and to what extent the hormone stimulation may affect the risk of developing ovarian cancer.
So, for their preliminary study, Van Leeuwen and colleagues followed up a nationwide cohort of 19,146 women who received IVF treatment in the Netherlands between 1983 and 1995. For comparison, they also had data on 6,006 counterparts with similar fertility problems who did not undergo IVF. By cross-referring with disease registers and other sources, they managed to find enough complete data to do a risk analysis on 65% of the women.
They compared risks of developing ovarian malignancies in the IVF group with risks in the general population and the non-IVF comparison group.
The results showed that:

• After a median follow-up of 14.7 years, the risk of borderline ovarian tumors was higher in the IVF group than in the general population (Standardized Incidence Ratio, SIR, was 1.76, with Confidence Interval CI ranging from 1.16 to 2.56).
• The risk for invasive ovarian cancer was not significantly higher, but this did go up with time, such that the longer the follow up period since first IVF, the higher the risk (after 15 years the SIR was 3.54, with 95% CI of 1.62-6.72).
• After taking into account age, parity and cause of subfertility, the risk of borderline ovarian tumors was signficiantly over 4 times higher in the IVF group than the comparison group of similarly subfertile women who did not undergo IVF (hazard ratio HR 4.23, with 95% CI 1.25-14.33).
• After similar adjustments, the risk of cancerous ovarian tumors was also significantly over 2 times higher in the IVF group than the comparison group of similarly subfertile women who did not undergo IVF (HR 2.14, 95% CI 1.07-4.25).

The authors conclude that:
"Ovarian stimulation for IVF may increase the risk of ovarian malignancies, especially borderline ovarian tumours."
They call for "more large cohort studies ... to confirm these findings and to examine the effect of IVF treatment characteristics".
Van Leeuwen told the BBC that "the absolute risk of these tumours is very low. But there is an increased risk of a borderline malignant tumour that needs surgery."
She said doctors should tell women about this risk but not overstate it.
Written by Catharine Paddock PhD

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Breast Cancer Risk Higher If Estrogen Or Testosterone Levels Higher

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The risk of breast cancer is greater if levels of hormones estrogen or testosterone are higher in post-menopausal women, researchers from Brigham and Women's Hospital reported in Breast Cancer Research, an open-access BioMed Central journal. The researchers examined six different growth and sex hormones and discovered that higher levels raised breast cancer risk by 16% for each one.
Dr Shelley Tworoger and team examined blood samples of nurses up to nine years before their breast cancer status was recorded. They matched post-menopausal females who had been diagnosed with breast cancer with two controls of the same age.
The following hormones were individually linked to a 50% to 200% rise in breast cancer risk:

• Estrone - one of several natural estrogens.
• Estradiol - one of several natural estrogens.
• Testosterone - steroid hormone from the androgen group. Secreted in the testes of males and ovaries of females.
• Androstenedione - a 19-carbon steroid hormone. An intermediate step in the biochemical pathway that produces testosterone, estrone and estradiol.
• DHEA (Dehydroepiandrosterone) - a 19-carbon endogenous (originates from within the organism) steroid hormone. The most abundant circulating steroid in humans.
• DHEA-sulfate - a metabolite of of DHEA.

Breast cancer risk increases with the number of high level hormones

The higher the number of hormones at elevated levels, the higher the breast cancer risk, the scientists found. For example, a woman with one elevated hormone may have a 10% higher risk when compared to those with normal levels, while women with five or six hormones with elevated levels would have double (100% higher) the risk. For those with seven or eight hormones at high levels, there can be triple the risk.
The risk was a little higher for females with estrogen receptor (ER) positive disease.
Dr Shelley Tworoger said:

"Elevated estrogens had the biggest effect on risk, especially for ER positive cancer. However, androgens, and prolactin also contribute to increasing risk of breast cancer.
These hormones are known to stimulate the growth of breast cancer cells in the lab and, while androgens can be converted to estrogen in the body, these hormones have also been found to stimulate cancer cell growth in the absence of ER.

Our results suggest that models used to assess breast cancer risk could be improved by taking into account multiple sex hormone and growth hormone levels."

Written by Christian Nrodqvist

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Does Fertility Treatment Raise Breast Cancer Risk?

Does Fertility Treatment Raise Breast Cancer Risk?

Breast Cancer Diagnosis for Giuliana Rancic Raises Questions About In Vitro Fertilization
By Sonya Collins

When E! News anchor Giuliana Rancic made her breast cancer diagnosis public, there was speculation about whether fertility treatment might have been a factor.
On NBC's Today show, Rancic, 37, said she got a mammogram when her doctor strongly recommended it before starting another round of IVF (in vitro fertilization). On their reality TV show, Rancic and her husband, Bill, have chronicled their previous fertility treatments.
Rancic's diagnosis has raised questions about whether fertility treatment can increase the risk for breast cancer. WebMD got answers from fertility and breast cancer specialists.

Is there a link between IVF and breast cancer risk?

Fertility and cancer experts interviewed for this story agree that there is no strong evidence to connect fertility drugs with increased risk for breast cancer. Oncologists add that there is a need for studies that follow women who have undergone IVF for longer periods of time.

Couldn't the increased levels of estrogen in fertility treatments increase risk for breast cancer?

Exposure to estrogen and progestin after menopause has been linked to increased risk for breast cancer for women in their 50s and 60s, but fertility drugs do not expose women to estrogen at that age, says Samantha Pfeifer, MD. She is chair of the practice committee at the American Society for Reproductive Medicine.
Pfeifer says fertility drugs raise estrogen levels for up to seven days at a time. "Estrogen levels are not significantly raised for a prolonged period of time."

Is it possible that women undergoing fertility treatment have other risk factors unrelated to fertility drugs?

Yes. There are many factors that affect breast cancer risk.
Most women undergoing fertility treatment are over 32 and have never had a child, which is a risk factor for breast cancer, says Jennifer Litton, MD. Litton is a breast medical oncologist at the University of Texas M.D. Anderson Cancer Center.

Are there special recommendations for women who want to undergo IVF but who have increased risk factors for breast cancer, such as the BRCA gene mutation or a family history?

Recommendations about undergoing fertility treatment are no different for women who have breast cancer risk factors. "As long as you don't have a cancer diagnosis," Litton tells WebMD, "at this point, there is no evidence that IVF will increase risk for patients with greater risk factors, even those with the BRCA gene mutation or family history."

Is it common for fertility doctors to recommend a mammogram before a woman undergoes IVF?

Any woman who is trying to get pregnant should be following the regular guidelines for health maintenance. "You want to make sure the Pap smears are up to date and that any routine screening has been done," Pfeifer says. "We follow the established guidelines of mammograms starting at age 40 for women who don't have significant risk factors."
The guidelines about when to start screening mammograms are also controversial.

Is fertility treatment an option for breast cancer survivors?

"It can be an option, but it depends on several factors," says Eric Widra, MD, who chairs the practice committee for the Society for Assisted Reproductive Technologies.
These factors include a woman's age at the time of treatment because fertility naturally decreases over time, and most oncologists recommend a woman be cancer-free for around five years before trying to get pregnant. Future pregnancy also depends on the damage chemotherapy may have done to a women's reproductive system. It is ideal to see a fertility specialist before beginning cancer treatment rather than after.
"What we often do for our patients, especially if they are over 30, is consider fertility preservation before they go through chemo," Litton tells WebMD, "by retrieving eggs and freezing the eggs or embryos. Freezing embryos is the standard. Freezing eggs is still considered experimental."

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Obese Women Have Higher Risk Of Suffering Breast Cancer

University of Granada researchers have proven that overweight women -especially those with morbid obesity- develop this disease at an earlier age.
A total of 524 women with breast cancer participated in the study. The researchers found that women who started menstruating at a very early age between 9 and 10 years- developed breast cancer at a younger age.
Obese women develop breast cancer at a younger age than other women. Furthermore, the likelihood of developing breast cancer is much higher in patients with morbid obesity.
This is one of the main conclusions drawn in an article recently published in the Spanish journal Nutrición Hospitalaria by the University of Granada research group CTS 367, coordinated by the Nursery Department professor María José Aguilar Cordero.
The researchers examined a sample of 524 women diagnosed with breast cancer who were treated at the university hospital San Cecilio from January 2009 to September 2010 in Granada, Spain. They assessed the nutritional status of these patients (normal weight, obesity and morbid obesity) and their age at diagnosis. Women with a family history of breast cancer were separated from those lacking it.
The researchers found that obesity in women is associated with diagnosis of breast cancer at a younger age. This finding contrasts with the results obtained in previous studies that demonstrated that individuals with higher body mass index had lower risk of suffering breast cancer.
Age At First Menstruation
The University of Granada researchers found that women diagnosed with breast cancer at an earlier age were those who started menstruating when younger than 10 years. Thus, age at menarche is determinant in the development and diagnosis of breast cancer, especially in women with morbid obesity.
Therefore, although genetics and family history of cancer are very relevant factors (up to 18% of breast cancer in obese women had a genetic factor), this study proved that obesity -especially the most severe cases- is the most relevant factor in early development of breast cancer.

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Folate and Colon Cancer Risk

Here's more good news about diet and cancer: a, recent large study shows that people whose diets included the most folate were 30 percent less likely to develop colon cancer than were those whose intake of this nutrient was low. Researchers from the National Cancer Institute looked at data from diet surveys that reflect the effects of fortification of food with folic acid (a synthetic form of folate) instituted in the late 1990s.

They found the lowest risk of colon cancer among individuals whose folate intake was highest (at least 900 micrograms per day) compared to those who got less than 200 mcg daily. The investigators were also looking for links between high levels of folate and higher risks of colon cancer, but found no evidence of a connection. However, this study couldn't rule out the possibility that those who get too much folate through the combination of supplements and fortified foods might be at increased risk for colon cancer, as some other studies have suggested. The findings were published online on August 3 by the American Journal of Nutrition.

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Foods That Lower Breast Cancer Risk

The latest on links between breast cancer and diet suggests that consuming an abundance of vegetables, fruits and legumes may help women cut their risks of one type of breast cancer. After 26 years of following more than 86,000 nurses in the U.S., researchers have reported that those whose diets were rich in plant foods, while low on meat, sodium and processed carbohydrates had a 20 percent lower risk of developing estrogen-receptor-negative breast cancer, malignancies that account for about 25 percent of all cases. Here, breast cancer cells lack receptors for estrogen. When estrogen receptors are present, as they are in most cases of breast cancer, treatment can include tamoxifen and other drugs to "block" estrogen's access to cells, thus reducing the risk of recurrence. No drugs are currently available to reduce the risk of recurrence of estrogen receptor negative breast cancer. The dietary findings were published online August 10 by the American Journal of Epidemiology. In other news, a study performed with mice published in the August/September issue of Nutrition and Cancer showed that breast cancer risk dropped significantly when the animals' regular diet included walnuts in an amount that would translate to about 2 ounces a day for humans. Neither of these findings proves that eating vegetables - or walnuts - are directly responsible for the reported risk reductions, but suggest that follow up studies are worth pursuing.
My take? While there's no surefire dietary strategy to prevent breast cancer, we do know that women who gain weight as adults are at higher risk, as are women whose diets include the most meat (compared to women who eat little or no meat). In addition to watching your weight and eating less meat, I also recommend avoiding alcohol (drinking can raise your risk), eating lots of cruciferous vegetables, which give you protective phytonutrients, exercising regularly, which can help lower your risk of many diseases, and avoiding the long term use of estrogen replacement therapy at menopause.

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Melanoma May Be More Aggressive in Kids

Melanoma May Be More Aggressive in Kids

Some children with melanoma are more likely to have invasive disease than adults with this potentially deadly type of skin cancer, a new study indicates.
The findings suggest that there may be biological differences between childhood and adult melanoma, said the researchers at the Johns Hopkins Children's Center in Baltimore.
They analyzed the medical records of 717 children and 1,368 young adults (aged 20 to 24) diagnosed with melanoma and compared sentinel lymph node biopsy results based on tumor size, tumor appearance and patient age. Sentinel lymph nodes are those that surround the tumor, and sentinel lymph node biopsy is the standard way to assess spread (metastasis) of the cancer and determine treatment.
Cancer cells were found in the sentinel lymph nodes of 25% of children and 14% of adults who had biopsies. Tumor thickness was the strongest predictor of lymph node metastases in both children and adults.
But children with tumors with a thickness of 1.01 and 2 millimeters were nearly six times more likely than young adults with same-thickness tumors to have cancer cells in sentinel lymph nodes.
The researchers also found that children younger than 10 were more likely to have distant metastases (spread of cancer beyond the immediate tumor site) and greater tumor thickness, compared with older children and young adults.
Regardless of age, patients with bleeding tumors or those with open sores were more likely to have metastases.
The study was published online Oct. 5 in the journal Cancer.
"Our finding is a powerful reminder that there's much about pediatric melanoma that we don't understand and that, just as is the case with other diseases, children are not small adults, but differ markedly in their response to disease," senior investigator Dr. John Strouse, a pediatric hematologist and oncologist, said in a Johns Hopkins Medicine news release.
Although still uncommon, melanoma diagnoses in children are increasing, and unprotected sun exposure, sunburns and indoor tanning are some of the known causes.
-- Robert Preidt

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Poorer Women More Likely to Die From Breast Cancer

 Less-affluent women now face a greater risk of dying from breast cancer than wealthier patients, a new American Cancer Society report finds.

The trend represents a reversal of a previous trend, in which women with greater means had been at a greater risk for dying from the disease.
"In general, progress in reducing breast cancer death rates is being seen across races/ethnicities, socioeconomic status and across the U.S.," said Dr. Otis Brawley, chief medical officer for the American Cancer Society, in a society news release. "However, not all women have benefited equally."
"Poor women," he noted, "are now at greater risk for breast cancer death because of less access to screening and better treatments. This continued disparity is impeding real progress against breast cancer, and will require renewed efforts to ensure that all women have access to high-quality prevention, detection and treatment services."
The report, "Breast Cancer Statistics, 2011" is in the current issue of CA: A Cancer Journal for Clinicians.
More than 230,000 women will face a breast cancer diagnosis this year, and nearly 40,000 will die. The disease is the most common cancer among American women, after skin cancer, according to the report.
However, the overall U.S. breast cancer death rate has been on a steady decline for more than two decades. For women under 50, fatalities fell roughly 3% per year since 1990. For patients over 50, the drop was about 2% per year.
Death rates have gone down in 36 states and the District of Columbia between 1998 and 2007.
Yet the new report finds that death rates have not fallen at the same pace across all racial and socioeconomic lines, with the remaining 14 states experiencing little to no drop-off.
Until the early 1990s, women living in more-affluent areas had a higher death rate than those in poorer neighborhoods. But in the ensuing years, a relatively slow drop in death rates among poorer women has reversed the situation, so that today it is the less- affluent who are burdened with the highest death risk.
Dr. Rachel A. Freedman, a Boston-based medical oncologist with the Dana Farber Cancer Institute, said that less-affluent breast cancer patients face a "perfect storm" when it comes to mortality risk.
"Women from lower economic status have less access to resources, have suboptimal insurance coverage, may receive substandard care and often present with more advanced cancer at diagnosis," she noted. "So it's not surprising that they often face a substandard outcome."
"So it's a really complicated situation ... and that will mean that complicated interventions will be required to tackle this problem," she added. "But unfortunately, I don't see anything happening right now that's going to turn this around in the near term."
-- Alan Mozes

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What Is A Breast Self Exam? Are Breast Self Exams Useful?

While breast self-exams are not recommended as a substitute for breast screening, most experts encourage women to become familiar with the way their breasts look and feel. This familiarity makes it much more likely that any changes might be detected early on. The American Cancer Society says that BSE (breast self-exams) play a small role in detecting breast cancer, when compared to finding a lump by chance or simply being aware of what is normal.

Some women are quite happy to do a BSE after each period. It is a step-by-step approach to examining (observing) and feeling the breasts. Others, however, prefer random checks and general awareness, such as checking while in the shower, getting up in the morning or going to bed at night - a less systematic approach.

It is important that the woman does what feels best for her and does not become over-anxious about whether she has got the technique right.

The aim of a monthly breast self-exam is to report any detected changes to a health care professional immediately.

In some countries, such as Russia and China, studies concluded that BSEs cause such an increase in unnecessary biopsies that they do not recommend BSE, and advise women to attend regular breast screening.

How to do a breast self-exam

• Stand in front of the mirror with your upper body exposed
• Look carefully in the mirror for signs of swelling, redness or dimpling either on the breast, or near it
• Repeat the instruction above in different positions, with hands on hips and arms overhead
• Palpate (touch exploringly) your breasts with the pads of your fingers and seek out any lumps which may be on the surface or deeper inside. Look out for any soreness as you do this.
  
  Move the fingers up and down over the breast.Then start at the nipples and move outwards.
  
  Move the fingers around the nipples in concentric circles moving outwards.
• Some doctors or nurses advise the woman to imagine the breast is divided into four quadrants, and to check each one separately.
• Palpate the area including the part of the breast that extends to the armpit - the axillary tail. You should do this once while standing and once while lying down.
• Squeeze the nipple and check for any discharge. Do not do this if you are breastfeeding.

Pic 1 to 3 involves inspecting the breast with the arms hanging, behind head, and on hips. Pic 4 is the palpitation (touching) of the breast. Pic 5 is palpitation of the nipple. Pic 6 is a BSE while lying down.

Health care professionals say that women who menstruate (pre-menopausal) should perform their BSA at the same point in their cycle each month - hormonal variations during the cycle can cause changes in breast characteristics. Most doctors and nurses advise doing the BSE just after a period, when the breasts are most swollen and tender. Tell your doctor or nurse if you notice any of the following:

• A lump inside the breast or underarm area
• A thickening inside the breast or underarm area
• A hard knot inside the breast or underarm area
• Darkening of the breast
• Swelling anywhere on the breast
• Redness on the breast
• Any alteration in the size of the breast
• Any change in the shape of the breast
• Puckering or dimpling of the skin
• A rash on the nipple
• Scaly skin on the nipple
• Itchiness on the nipple
• Nipple discharge, especially one that starts suddenly. If the discharge is clear (not milky), occurs just on one nipple, has blood in it, or comes out without squeezing, tell your doctor or nurse.
• A pain anywhere that does not go away

In most cases, lumpiness is nothing to worry about - breast tissue has a bumpy texture anyway. If you feel any lumpiness, compare it to the lumpiness in the other breast - most likely it is nothing. If you are concerned, tell your doctor.
Written by Christian Nordqvist

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Colon Cancer Initial Screening For Men Should Be Earlier Than For Women, Study

New research from Austria finds men have a higher rate of advanced colon cancer tumors than women of the same age and suggests male sex is a risk factor for the disease. The researchers propose this means men should be screened earlier than women, but do not say whether this ought to be by delaying the age when women are initially offered screening or bringing forward the age men are offered it.
You can read how Dr Monika Ferlitsch, of the Austrian Society for Gastroenterology and Hepatology in Vienna, and colleagues, analyzed the results of more than 40,000 screening colonoscopies to reach these conclusions in a paper published in the September 28 issue of JAMA.
Their results show that men have a higher rate of advanced tumors compared to women in all the age groups they examined.
Colorectal or bowel cancer is the fourth leading cancer killer worldwide and claims 610,000 lives a year.
Even though some studies show that men are at a greater risk for advanced tumors than women, current practice is that both men and women aged 50 and over are urged to have an initial screening colonoscopy. This looks for adenomas, which are polyps or benign tumors and also detects advanced adenomas and colorectal cancer.
Ferlitsch and colleagues investigated the most appropriate age for initial screening colonoscopy in groups of male and female patients to attain a higher detection rate of advanced tumors and cancer which could result in lower death rates.
For their study, they examined data from 44,350 participants (51% women) in Austria who took part in a national colonoscopy screening between 2007 and 2010. The median age of the females was 60.7 years and of the males was 60.6 years.
They found a significantly higher rate of colorectal cancer and advanced tumors among men compared with women in all age groups, suggesting that "male sex constitutes an independent risk factor for colorectal carcinoma and indicating new sex-specific age recommendations for screening colonoscopy".
For example, they found the prevalence of colorectal cancer overall among men was double that of women (1.5% compared to 0.7%).
And among 50- to 54-year-olds, 5% of men had advanced adenomas compared to only 2.9% of women.
And they also found that men in their mid-50s had a similar rate of colorectal cancer as women ten years older (CRC rate was 1.3% in men aged 55-59 and 1.2% in women aged 65-69).
Another measure they examined was the average number needed to screen (NNS) to detect adenomas. They found this to be 5.1 for all individuals, 4.0 for men, and 6.7 for women.
However, in 50- to 54-year-old women, NNS was nearly twice as high as in men at the same age (9.3 for men compared with 5.4 for women). And among 45- to 49-year-old men, NNS was 5.9, similar to the 6.0 found for women aged 60 to 64 years.
The authors recommend that:
"... deciding whether to adjust the age at which screening begins also requires considering whether the recommended age for women should be older or the recommended age for men younger."
They also urge further prospective studies be done to establish the relative clinical effectiveness of colonoscopy screening at different ages.
Written by Catharine Paddock PhD
Copyright: Medical News Today

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These Foods May Promote Colon Health

A new study from a California research team suggests that eating more legumes (dried beans, dried peas and lentils) at least three times a week can cut the risk of developing colon polyps (which can lead to cancer) by 33 percent. Brown rice reduces the risk, too, by 40 percent. Researchers at Loma Linda University also found that eating cooked green vegetables at least once a day, and dried fruit at least three times a week offers additional protection. The researchers analyzed data from more than 2,800 adults in the Adventist Health Study-1 performed in 1976-77, including information on participants who responded to a follow up study 26 years later. The first study asked participants how often they consumed specific foods. The investigators also considered other factors that could influence colon cancer risk, including family history of the disease, education, physical activity level, and constipation. They also checked alcohol intake, how often the participants ate sweets, used pain medication and took multivitamins. The study was published in the May 2011 issue of Nutrition and Cancer.

My take? These new findings provide welcome support for dietary strategies that aim to help prevent both colon polyps and colon cancer. In addition to eating the high fiber foods associated with lower risks of colon polyps seen in this study, we already know that avoiding red meat can reduce the risks of polyps and colon cancer. I also recommend limiting alcohol intake - research has suggested that the more alcohol you drink, the higher your risk of developing colon cancer. Another dietary tip: Make green tea your beverage of choice. Regular consumption of green tea is linked with lower incidence of many kinds of cancer.

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Folate May Cut Colon Cancer Risk

A higher dietary intake of folate from produce and folic acid from fortified foods and supplements may lower the risk of colon cancer. This news comes from a study involving more than 99,000 participants in a cancer prevention study who were followed for eight years. Folate, also known as vitamin B9, is found naturally in spinach, green vegetables, beans, asparagus, bananas, melons, lemons, legumes, yeast, and mushrooms. Foods fortified with folic acid (a synthetic form of folate) include orange juice, baked goods, and cereals. This isn't the first study to show that high folate intake reduces the incidence of colorectal cancer, but it is the first to show that the risk is lower regardless of whether the vitamin comes from natural folates in unprocessed foods or as folic acid in supplements or fortified foods. In addition, the study found no evidence that fortification of foods with folic acid increases the risk of cancer as has been suggested. The researchers reported that no increased risk of colorectal cancer was found even at high levels of folate intake. The study was published in the July, 2011 issue of Gastroenterology.

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Cancer Centers Recognizing Yoga as Therapeutic Care for Cancer Patients

Yoga is gaining popularity as a method of dealing with side effects of cancer and chemotherapy. According to the American Institute for Cancer Research, however, yoga may actually be able to help in the prevention of cancer. In fact, yoga done at a brisk pace actually counts toward the recommended daily dose of cardiovascular exercise.
Now yoga instructors at the M. D. Anderson Cancer Center say that all kinds of yoga are beneficial because they encourage healthy breathing techniques and keep the body moving. They list the following as being improved by a consistent yoga practice: balance, sleep, mood, flexibility, and circulation. Not only does exercise support the immune system, but it also leads to healthier life styles and eating habits – showing great potential in slowing down and managing cancer.
Although there are many styles of yoga, all have the same goals: balancing the mind, body, and spirit. Different kinds of practices appeal to different people, and the choice may also be influenced by health issues and physical ability. Many medical centers are now beginning to provide yoga classes for their patients, and yoga classes may serve as support groups as well as opportunities for exercise.
As its benefits become more well-known, yoga classes will become even more available and suitably geared to those with special needs. Already, special groups are being formed specifically for breast cancer patients and people with rare cancers like mesothelioma that is triggered from asbestos exposure, and results are thought to improve mesothelioma prognosis. Yogi B. K. S. Iyengar, developer of the Iyengar method of yoga, said these words about the importance of the ancient art in the healing process: "Yoga teaches us to cure what need not be endured and endure what cannot be cured."
In the past, misconceptions about the practice of yoga limited its use for both healthy people and those suffering from chronic conditions. Today that is changing, and the following facts are now accepted by most of the population:
• Yoga is not only for young and flexible bodies. Exercises can easily be adapted by trained instructors to suit people with various forms of disabilities. Even chair yoga is an option.
• Yoga is not affiliated with any religious belief system. Although it does include eight limbs that embrace breathing techniques, meditation, spirituality, morals, and life style, the emphasis in many classes is on exercise. Healthy living is also encouraged.
• There are many styles of yoga, ranging from gentle and restorative to strenuous and fast-paced. The key is finding a style that suits individual needs.
Cancers centers are paving the way for a new holistic treatment that has the potential to improve quality of living, manage and prevent illnesses, and create a more peaceful society.

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Potential New Hope And Treatment For Endometrial Cancer Released

Advanced endometrial cancer refers to several types of malignancies that arise from the endometrium, or lining, of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year. However, in a new research, there may be progress to a single treatment solution called AEZS-108.

Overall, "tolerability" of AEZS-108 was good and commonly allowed retreatment as scheduled. Only one patient had a dose reduction, and less than 10% of treatment courses were postponed, including more than half of the cases in which the delay was not related to toxicity.

Good tolerability of AEZS-108 was also reflected by a low rate of severe non-hematological possibly drug-related adverse events which included single cases each of nausea, diarrhea, fatigue, general health deterioration, creatinine elevation, and blood potassium decrease. No cardiac toxicity was reported.

Juergen Engel, Ph.D., President and CEO of Aeterna Zentaris comments:

"We would first like to thank Dr. Wimberger and all those involved in this trial for their dedicated work which is now being presented to the international gynecological community. We are very excited about these final results achieved with AEZS-108 alone, which compare favorably with those usually seen with more aggressive and less well tolerated combination regimens for endometrial cancer. On this basis, we have requested Parallel Scientific Advice from both the FDA and the EMA for the further pivotal development of AEZS-108 in this indication in the upcoming months."

The referred to Dr. Wimberger added:

"The safety and efficacy of AEZS-108 in our study on advanced endometrial cancer was very encouraging. Although used as a single agent treatment only, AEZS-108 achieved good response rates and disease stabilization. Personally, I was impressed to see three responses in the five patients treated at my institution, including one long-lasting complete response."

This year, the American Cancer Society estimates that more than 43,000 cases of endometrial cancer will be diagnosed in the United States. Symptoms can include unexplained vaginal bleeding, painful urination, painful intercourse and soreness in the pelvic area. There is no routine test to identify endometrial cancer.

Endometrial cancer may sometimes be referred to as uterine cancer. However, different cancers may develop not only from the endometrium itself but also from other tissues of the uterus, including cervical cancer, sarcoma of the myometrium, and trophoblastic disease.

Treatment options include surgery, radiation therapy, hormone therapy and chemotherapy; however, there are new treatments in development that work by targeting and destroying cancerous cells.

Basically, AEZS-108 represents a new targeting concept in oncology using a hybrid molecule composed of a synthetic peptide carrier and a well-known chemotherapy agent, doxorubicin. AEZS-108 is the first intravenous drug in a clinical study that directs the chemotherapy agent specifically to LHRH-receptor expressing tumors, resulting in more targeted treatment with less damage to healthy tissue.

Currently, the primary treatment is surgical. Surgical treatment should consist of, at least, cytologic sampling of the peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious lymph nodes, abdominal hysterectomy, and removal of both ovaries (bilateral salpingo-oophorectomy).

Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is sometimes performed for tumors that have high risk features, such as pathologic grade 3 serous or clear-cell tumors, invasion of more than 1/2 the myometrium, or extension to the cervix or adnexa. Sometimes, removal of the omentum is also performed.

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Study Shows Annual Cervical Cancer Screening Still Recommended By Most Prima...

Researchers from the Centers of Disease Control and Prevention (CDC) have determined that most primary care providers still recommend annual cervical cancer screening, and less than 15% would extend the screening interval when using the Papanicolaou test and human papillomavirus (HPV) test together, as some guidelines suggest. The results of the investigation are published online today in the American Journal of Obstetrics & Gynecology (AJOG).

Issued by the American Cancer Society in 2002 and the American College of Obstetricians and Gynecologists in 2003, the current cervical cancer screening guidelines recommend a combination of a Papanicolaou test and an HPV test, (known as an HPV co-test) for women aged 30 years and over. If the results of these tests are normal, upon screening, women can wait three years for their next test. However, annual cervical cancer screening continues to be a frequent recommendation, irrespective of whether a woman has a history of normal pap tests or normal HPV co-test. Roughly one-half of providers investigated ordered the HPV co-test for their patients.
Lead researcher Katherine B. Roland, MPH, a behavioral scientist in CDCs Division of Cancer Prevention and Control explained,

"Use of the HPV co-test and adherence to the extended screening interval with normal test results reduce patient harms that can be caused by over-testing, including pain, inconvenience, morbidity, and unnecessary follow-up procedures and treatments

Appropriate use of cervical cancer screening technologies is essential, now more than ever, if HPV co-testing is to be considered a preventive service for women covered by insurance providers."

Evaluating nationally representative information gathered in 2006 through the CDCs National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, investigators examined HPV testing and co-testing practices and recorded the recommendations for screening intervals given by private office-based providers at hospital outpatient departments (OPDs). Responses from 376 private office-based physicians and 216 physicians from hospital and outpatient facilities were included in the investigation.

Health providers who ordered the HPV co-test were asked their recommendation for the next Papanicolaou test according to 3 clinical vignettes. The vignettes describe a woman between 30 and 60 years of age with a current normal Papanicolaou test with:

1. no current HPV test results and history of 2 consecutive normal Papanicolaou test results
2. a current negative HPV test result and a history of 2 consecutive normal Papanicolaou test results, and..
3. a current negative HPV test result and no history of Papanicolaou tests.

The guidelines support extending the screening interval up to 3 years in each of the vignettes described.
76.4% of office-based providers and 85.2% of hospital OPDs would recommend a next screening in one year, for vignette 1. For vignette 2, 66.6% of office-based providers and 72.7% of hospital OPDs would recommend a next Papanicolaou test in 12 months. However, only 14% of office-based providers would recommend, as guidelines suggest, a next test in 3 years or more. 73.4% of office-based providers and 73.5% of hospital OPDs would recommend a next Papanicolaou test in 12 months, for vignette 3.

Establishing a record of normal Papanicolaou test results with the patient appears to be a key factor to providers making guideline-supported screening interval recommendations. Roland continued,

"Our findings suggest a need for continued surveillance on cervical cancer screening guideline adherence. Evaluating provider screening behaviors, whether they reflect national guidelines and policies, and how those behaviors and policies translate to a woman's clinical preventive care are vital, especially in an area where science and policy are rapidly evolving."

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New Study Explores Immune System Stimulation In Battle Against HER-2/neu Pos...

The Mayo Clinic is excited to announce a Phase I study of a new therapeutic vaccine in HER-2/neu positive breast cancer patients in the fourth quarter of 2011. To understand the importance of this development, the HER-2/neu and the significance of HER-2/neu positive breast cancer must be examined.
Due to a genetic change, cancerous cells produce an excess of HER2 in approximately 1 in 5 breast cancer cases as well as in other forms of cancer. For unknown reasons, HER2-positive breast cancers are less responsive to hormone treatment and tend to be more aggressive than other types of breast cancer.
HER-2/neu is a protein homologous to epidermal growth factor receptor providing growing, dividing and repair signals to cells. Whilst healthy breast cells contain 2 copies of the HER2 gene, some forms of breast cancer develop when a breast cell contains 2 or more copies of the gene which results in over-production of HER2 protein (over-expression) leading to increased growth and division of the affected cells.
HER-2/neu is over-expressed on the cell surface of several cancers, including breast, colorectal, ovarian, and pancreatic carcinomas, supporting the malignancy of several tumors with poor prognosis in cancer patients. With HER-2/neu expressing ~20% to 30% of breast and ovarian cancers it has been identified by the National Cancer Institute as one of the top priorities for the development of cancer drugs.
The common treatment for HER-2/neu positive patients is Herceptin (trastuzumab), a monoclonal antibody that targets HER-2/neu receptors on cells, however, the treatment results in a significant amount of patients (estimated to be ~70%) failing to respond or losing their responsiveness. The authors recommend more widely applicable therapies for this patient population.
So far, previous attempts to develop a vaccine against the Her-2/neu protein proved unsuccessful in overcoming the difficulty of developing a robust and a long-acting immune response by positively stimulating cytotoxic T-cells and T-helper cells in the immune system, which is necessary for a successful vaccine, however, some previous trials managed to progress to clinical trials.
Once stimulated, cytotoxic T-cells identify cancer cells, infiltrate tumors and kill abnormal cells, with T-helper or T-memory cells being responsible for long-term memory, enabling the immune system to continuously recognize abnormal cells.
It has been determined that the function of TAP (Transporters Associated with Antigen Processing - reference 1 provides further background) is significantly reduced in many cancers due to inadequate stimulation of cytotoxic T-cells, resulting in poor recognition of cancer cells. The process can be re-instated by replacing TAP through TapImmune's AdhTAP1 technology, which is similar to turning on a light bulb allowing these cells to 'see' tumor cells.
Dr Keith Knutson and colleagues at the Mayo Clinic, together with collaborators discovered a unique set of peptides (HER-2/neu antigens - reference 2 provides further background) that stimulated these cells in ~ 80% of HER-2/neu positive patients during research on stimulating T-helper cells.
In their clinical evaluation, The Mayo Clinic will be assessing the proficiency of two technologies, the unique peptide antigen and the combination of TapImmune's, TAP vector technology, to stimulate an immune response in HER-2/neu breast cancer patients and to improve patient prognosis and survival rates.
In a concluding statement the authors said,

"We believe that this approach which stimulates two key components of the cellular immune system in HER-2/neu breast cancer patients could have a significant advantage with respect to strength and duration of the immune response. We envisage that the approach will result in an injectable product that will be simple to manufacture,"

..continuing that,

"The initial clinical pathway of cancer vaccines is generally to seek approval for products that can be used as therapeutic vaccines to improve patient survival. However, our ultimate vision on the future use of such vaccines, for the treatment of breast cancer, is to have prophylactic vaccines that can be used at the earliest stage of disease diagnosis, e.g. in situ ductal carcinoma. For those of us who have lost loved ones to breast cancer, who initially presented with this indication, the importance of this goal cannot be overstated."

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