From medicalnewstoday.com:

UK scientists have discovered a new route to a potential cure for breast cancer, one that focuses on how the cancer manipulates genetic pathways to spread through the body, rather than on how tumors develop in the first place. They are already working on a new drug to switch off the cancer’s effect on the pathways and say it could be ready in a couple of years, but experts suggest this could be rather optimistic.

The landmark study was the work Dr Justin Stebbing of Imperial College London (ICL) and other colleagues from ICL and also from the Howard Hughes Medical Institute, Cold Spring Harbor Laboratory in New York, USA. They have written a paper on it in the 24 August online before print issue of the Proceedings of the National Academy of Sciences, PNAS.

Stebbing, who is senior lecturer and consultant medical oncologist at ICL was reported by the Daily Express as telling the media that the new discovery was a “step on the way” to a potential cure for breast cancer.

“It helps us understand the way breast cancer cells grow and divide and if we understand this then we understand how to stop it,” said Stebbing.

Breast cancer is the most common cancer of women in the western world, in Britain alone it kills 12,000 women a year.

In most cases the cancer depends on estrogen to fuel tumor growth, and current treatments focus on inhibiting the activity of the estrogen receptor. These treatments, for example tamoxifen, have been very successful at reducing deaths from breast cancer.

“The estrogen receptor is incredibly important in breast cancer,” said Stebbing.

“Most of the treatments around treating breast cancer are blocking it or inhibiting the oestrogen but despite that about half of all women relapse,” he added.

Many patients relapse because they eventually become resistant to hormone therapies.

Cancer is essentially a process where cell growth gets out of control. One of the ways that healthy cells stop growth getting out of control is via microRNA molecules that use genetic pathways to control various cellular processes in the body, such as making proteins.

As Stebbing explained:

“The way to cure breast cancer or any cancer is by fundamental biological understanding of what turns cells on and off, stopping the way tumours grow.”

Stebbing and colleagues’ breakthrough has been to discover how cancer cells switch off the microRNA molecules that control cell division to unleash the growth and proliferation of malignant cells.

“We can use these microRNAs as a new treatment and make them do what current drugs don’t do,” said Stebbing.

He said they had found a new microRNA pathway that the estrogen receptor activates. In normal cells estrogen encourages the production of microRNAs, but then as more of them are produced, they switch off estrogen activity, and this keeps cell division under control. Stebbing described this as a “perfect circle”.

“But in breast cancer cells, production of the molecules is turned off,” said Stebbing, and this is how the control over cell division is then lost and the malignant cells proliferate.

So their aim is to produce a drug that restores the “perfect circle” by stopping the deactivation of the microRNAs.

“If we know how to stop it then we can cure it. This only applies in oestrogen positive breast cancer but this could save millions of lives,” said Stebbing.

Experts welcomed the discovery but had reservations about a drug being available soon.

According to the Daily Express, Dr Laura Bell, of Cancer Research UK, said it was far too early to say whether the discovery will “translate into clinical benefits for people with cancer”. She said there was still a lot of work to be done.

Agreeing, Dr Alexis Willett, of Breakthrough Breast Cancer reportedly said, “this research is still at a very early stage”.

Being ‘at peace with God’ affects medical choices, study finds

From Sharp.com:

Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs, a new study suggests.
When asked what was important to them at the end of their lives, people dying of cancer ranked two factors highest: pain control and being at peace with God, the study found.
“Medicine tends to focus on the more scientific aspects of the person, and we’ve made wonderful strides in improving patient care, but there’s another important component of patient health: spirituality,” explained Dr. Tracy Anne Balboni, a radiation oncologist at the Dana-Farber Cancer Institute in Boston and the study’s lead author. “This is clearly an area where some important advancements can be made.”
The researchers discovered that people with advanced cancer were far more likely to choose hospice care when their spiritual needs had been addressed. And among those who were very religious, meeting spiritual needs increased the odds that a terminal patient would choose to forgo aggressive, yet often unsuccessful, medical treatments, the study found.
However, at least six of 10 people with advanced cancer reported that their spiritual needs were only minimally or not at all supported.
Results of the study were published online Dec. 14 in the Journal of Clinical Oncology.
Earlier research had found that the most religious patients are much more likely to choose aggressive treatments during their last week of life in an attempt to prolong their life — even if those treatments don’t improve their quality of life. Aggressive treatments include mechanical ventilation and cardiopulmonary resuscitation.
“A religious person might think they need to do aggressive care,” said Balboni, adding that they may feel it’s wrong to give up. “But, if the medical team engages them more, they can help them understand that it’s not necessarily against their religion to forgo futile medical procedures.”
The new study involved 670 people with advanced cancer from seven treatment centers in the Northeast and Texas. The final analysis included information from 343 people who later died and whose caregivers completed a post-death interview. The average time between the start of the study and the person’s death was 116 days.
For purposes of the study, spiritual care was defined as patient-perceived support of their spiritual needs by their medical team and the receipt of pastoral care services.
Most people (60 percent) said that their spiritual needs either hadn’t been met or were minimally supported at the start of the study, and 54 percent had not received pastoral care visits. In the final week of life, 73 percent of the participants received hospice care, and 17 percent received aggressive care.
Those who had greater spiritual support from their medical team, including doctors, nurses, chaplains and more, reported a higher quality of life as they neared death than did those who felt unsupported spiritually.
People who felt they were getting better spiritual support were 3½ times more likely to receive hospice care. And among highly religious people, those whose spiritual needs were supported were five times more likely to receive hospice care and five times less likely to receive aggressive medical care, the study reported.
“We found that patients whose spiritual needs were well-supported seemed to transition to hospice more frequently and had a marked reduction in the use of aggressive care,” Balboni said.
Yet despite the findings, said Dr. Harold G. Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center, “few people are getting their spiritual needs met by the medical system.”
“Many doctors are uncomfortable discussing spirituality and haven’t been trained to do so,” he said. “And churches have a role, too. Although it’s not a popular topic, churches need to talk about the end of life in the pulpit. People don’t know theologically what they’re supposed to do.”
Religious people, Koenig said, are often left to think they should always have hope and should always “give God a chance to provide a miracle.” Hospice care, though, can often provide spiritual guidance and help people prepare for death, he said.
Doctors don’t need to actually provide spiritual care, Koenig said, but it’s important for physicians to acknowledge their patients’ spiritual needs and make sure they’re addressed by pastoral care or hospice. “The doctor does have to be the one to orchestrate this,” he said.
But if someone’s spiritual needs are not being met, Koenig and Balboni agreed that the person — or a friend or family member — needs to speak up. And if the patient’s doctor doesn’t feel qualified to discuss end-of-life spiritual issues, the doctor should be able to refer you to someone who can.

From USAToday.com:

FromSoy foods may be safe, and possibly even beneficial, for breast cancer survivors, a new study says.
Many breast cancer doctors have been cautious about recommending soy products – such as soy milk, tofu, edamame or miso soup – because they contain plant estrogens. Most breast cancers are fueled by estrogen, which can make it risky to take additional hormones, such as for menopausal symptoms.

Studies of soy also have produced conflicting results, says Xiao Ou Shu of the Vanderbilt-Ingram Cancer Center in Nashville.

On the plus side, soy is a good source of protein with little fat and no cholesterol, which makes it popular with vegetarians, dieters and people who can’t handle milk. Women in regions with high soy consumption, such as Asia, tend to have lower rates of breast cancer, Shu says. But Asian women differ in many ways from Americans, especially in their weight, so scientists say soy can’t get all the credit.

Studying soy in America has been difficult, Shu says, because women here eat little of it. About 28% of Americans ate soy at least once a week in 2003, her study says.

That’s why Shu decided to study soy in more than 5,000 breast cancer survivors in China, where soy is a staple.

She divided women into four groups, based on how much soy they ate. Women with low soy levels consumed an average of about half a cup of soy milk a day, while the high-soy group had about three cups a day, Shu says.

After four years, 7.4% of those who ate the most soy had died, compared with 10.3% of those who ate the least soy, according to her study. It’s published today in The Journal of the American Medical Association.

Those results suggest that it’s probably safe for breast cancer survivors and other women to have one or two servings of soy foods a day, says Walter Willett, chairman of the nutrition department at the Harvard School of Public Health. But he cautions against women taking large doses of genistein pills or other soy supplements, which are unproven.

Previous studies have shown that genistein, an estrogen-like compound in soy, promotes the growth of breast tumor cells in lab dishes and animals, Shu says.

The latest study suggests that women benefited from eating whole soy, possibly because other nutrients from the plant act together in healthy ways, Shu says.

Willett says scientists are still trying to understand all of soy’s hormonal effects. It’s possible, he says, that soy acts like the breast cancer drug tamoxifen, which blocks the effects of estrogen.

But American patients may respond to soy very differently from those in China, says Claudine Isaacs of Georgetown’s Lombardi Comprehensive Cancer Center. Research suggests prenatal and childhood exposure to hormones and other chemicals can program how the body responds to them, Shu says. And other research suggests that soy is most effective at preventing cancer in women who are exposed to it during and after adolescence.

So it’s possible that a middle-aged American woman who adds soy to her diet for the first time may not reap the same benefits as Chinese women who grow up with it, Isaacs says.

“It makes sense not to go to extremes,” Willett says. “Having some soy in the diet is probably a good thing, especially if it replaces red meat,” which is linked to an increased risk of colon cancer, he says. “But there’s still good reason not to go overboard.”

From ScienceDaily.com:

In a finding with potentially major implications for identifying a viral cause of prostate cancer, researchers at the University of Utah and Columbia University medical schools have reported that a type of virus known to cause leukemia and sarcomas in animals has been found for the first time in malignant human prostate cancer cells.

If further investigation proves the virus, XMRV (Xenotropic murine leukemia virus-related virus), causes prostate cancer in people, it would open opportunities for developing diagnostic tests, vaccines, and therapies for treating the cancer, according to the study published Sept. 7 online in the Proceedings of the National Academy of Sciences. Prostate cancer is expected to strike nearly 200,000 U.S. males this year, making it the second most common form of cancer, outside of skin cancers, among men.
“We found that XMRV was present in 27 percent of prostate cancers we examined and that it was associated with more aggressive tumors,” said Ila R. Singh, M.D., Ph.D., associate professor of pathology at University of Utah and the study’s senior author. “We still don’t know that this virus causes cancer in people, but that is an important question we’re going to investigate.”
Singh, also a member of the U of U’s Huntsman Cancer Institute and associate medical director at ARUP Laboratories, moved to Utah from Columbia University Medical Center in 2008, where she began this research. She remains an adjunct faculty member at Columbia.
Along with providing the first proof that XMRV is present in malignant cells, the study also confirmed that XMRV is a gammaretrovirus, a simple retrovirus first isolated from prostate cancers in 2006 by researchers at the University of California, San Francisco (UCSF), and the Cleveland Clinic. Gammaretroviruses are known to cause cancer in animals, but have not been shown to do so in humans. The UCSF study did not examine benign (non-malignant) prostate tissues, so could not link XMRV to prostate cancer. They also did not find the virus in malignant cells.
Singh and her fellow researchers examined more than 200 human prostate cancers, and compared them to more than 100 non-cancerous prostate tissues. They found 27 percent of the cancers contained XMRV, compared to only 6 percent of the benign tissues. The viral proteins were found almost exclusively in malignant prostatic cells, suggesting that XMRV infection may be directly linked to the formation of tumors.
Retroviruses insert a DNA copy of their genome into the chromosomes of the cells they infect. Such an insertion sometimes occurs adjacent to a gene that regulates cell growth, disrupting normal cell growth, resulting in more rapid proliferation of such a cell, which eventually develops into a cancer. This mechanism of carcinogenesis is followed by gammaretroviruses in general. Singh is currently examining if a similar mechanism might be involved with XMRV and prostate cancer.
In another important finding of the study, Singh and her colleagues also showed that susceptibility to XMRV infection is not enhanced by a genetic mutation, as was previously reported. If XMRV were caused by the mutation, only the 10 percent of the population who carry the mutated gene would be at risk for infection with virus. But Singh found no connection between XMRV and the mutation, meaning the risk for infection may extend to the population at large.
While the study answers important questions about XMRV, it also raises a number of other questions, such as whether the virus infects women, is sexually transmitted, how prevalent it is in the general population, and whether it causes cancers in tissues other than the prostate.
“We have many questions right now,” Singh said, “and we believe this merits further investigation.”
Viruses have been shown to cause cancer of the cervix, connective tissues (sarcomas), immune system (lymphoma), and other organs. If the retrovirus is shown to cause prostate cancer, this could have important implications for preventing viral transmission and for developing vaccines to prevent XMRV infection in people.

From NYTimes.com:

For young women who have a high risk of breast cancer because of genetic mutations or family history, the radiation from yearly mammograms may make the risk even higher, researchers reported at a radiology conference on Monday.

The report is particularly troubling because it suggests that the very women who are told they need mammograms most may also be the most vulnerable to harm from them. Doctors routinely urge high-risk women to have mammograms earlier in life and more often than women judged to be at average risk.

Researchers caution that the new report is not conclusive, and that the issue needs more study.

High doses of radiation can increase the risk of breast cancer, especially in young women, but mammography uses a low dose. The American Cancer Society and many breast cancer experts say the benefits of screening far outweigh any theoretical risk from the radiation.

But the new findings will probably fuel the debate that was ignited by a recent article in The Journal of the American Medical Association questioning the value of breast cancer screening and a report by a government task force suggesting that most women could start having mammograms later in life and repeat them less often than had generally been recommended.

The latest findings come not from new research, but from an analysis that pooled the data from six earlier studies involving about 5,000 high-risk women in the United States and Europe, some who had breast cancer and some who did not. Their median age was 45.

Looking back at their medical histories, researchers found that those women who had had mammograms or chest X-rays (which use a lower radiation dose than mammography) were more likely to have breast cancer.

Specifically, women exposed to radiation before age 20 or women with five or more exposures were 2.5 times more likely to develop breast cancer than were women who had not been exposed. The difference was statistically significant after all the data was pooled, but only some of the individual studies had significant findings; in those that did not reach statistical significance, the results could have been due to chance.

The analysis applies only to women who, like those in the study, have a high risk of breast cancer — about 0.5 percent to 1 percent of the population.

Marijke C. Jansen-van der Weide, the first author of the study and an epidemiologist at University Medical Center Groningen in the Netherlands, presented the analysis in Chicago at a meeting of the Radiological Society of North America.

In a telephone interview, Dr. Jansen-van der Weide said it was of concern to find a doubling of risk in women whose baseline risk was already high, and she suggested that young women at high risk should avoid repeated exposure to even low-dose radiation. She said the same mutation that increased the risk of breast cancer might make the breast more susceptible to cancer caused by radiation.

“For high-risk women, it’s important to weigh the benefits and risks of mammography with their doctor and come together on a screening strategy, and to keep in mind that at a young age you can use an alternative screening technique like M.R.I.,” Dr. Jansen-van der Weide said.

Robert Smith, director of cancer screening for the American Cancer Society, questioned the analysis’ methodology and disagreed with the idea that M.R.I. could replace mammography in high-risk women. Dr. Smith said M.R.I. missed some tumors that mammography could find, and vice versa, so the best approach for high-risk women was to use the two tests together.

“It’s not as if clinicians are unaware and unconcerned about radiation risks in young women,” he said. “If mammography offered no advantage, they wouldn’t do it.”