Breast Cancer Drug Raises Risk of Heart Problems in Older Women: Study

WEDNESDAY, Aug. 10 (HealthDay News) -- The breast cancer drug Herceptin increases the risk of heart problems in elderly patients, especially those with a history of heart disease and/or diabetes, a new study says.

Researchers analyzed the medical records of 45 women, ages 70 to 92, who were treated with Herceptin (trastuzumab) since 2005 and found that 12 (26.7 percent) of them developed heart problems caused by the drug.

That rate is slightly higher than what was noted in earlier clinical trials of younger, healthier women.

In this new study, 33 percent of the women with a history of heart disease developed either asymptomatic or symptomatic heart problems as a result of taking Herceptin, compared with 9.1 percent of women without a history of heart disease.

The researchers also found that about 33 percent of women with diabetes developed heart problems, compared with 6 percent of diabetes-free women.

When the women with heart problems stopped taking Herceptin, all but one recovered fully and five were able to re-start treatment with the drug.

The study appears in the journal Annals of Oncology.

"This is the first study specifically to assess trastuzumab-related cardiac toxicity and the cardiovascular factors that are associated with an increased risk in a selected population of elderly breast cancer patients," study author Dr. Cesar Serrano, who conducted the research while working as a clinical fellow at the Department of Medical Oncology Breast Cancer Centre at the Vall d'Hebron University Hospital in Barcelona, Spain, said in a journal news release.

"Trastuzumab is generally well-tolerated and, although there are some concerns about it causing heart problems, until now few risk factors have been identified among patients in clinical trials, most of whom are usually younger than 70 years and have good general health. Our study has demonstrated a significantly increased incidence of cardiac events among patients aged 70 and over with cardiovascular risk factors such as a history of cardiac disease and diabetes," said Serrano, who is now a postdoctoral research fellow at Brigham and Women's Hospital in Boston.

Serrano said the findings suggest that elderly women with one or more heart risk factors who are being treated with trastuzumab should be referred to a cardiologist. He also recommended closer monitoring of such patients for possible heart problems.

More information

The U.S. National Cancer Institute has more about breast cancer treatment.

SOURCE: Annals of Oncology, news release, Aug. 9, 2011

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Counseling May Help Women at Risk for Breast Cancer Gene

FRIDAY, Aug. 5 (HealthDay News) -- Although women whose mothers had breast cancer may worry about developing cancer themselves, many do not fully understand when and why they should be screened or their options to reduce their risk for the disease, a new study suggests.

"Young, high-risk women have little knowledge about the probabilities and options for managing the cancers for which their risks are remarkably increased. Further, many report intense anxiety related to their potential cancer development," principal investigator Andrea Farkas Patenaude, of the Dana-Farber Cancer Institute, said in an institute news release.

The daughters of women with BRCA1 or BRCA2 genes have a 50 percent chance of having this mutation themselves, which will increase their risk of breast cancer by 85 percent and raise their risk of ovarian cancer by up to 60 percent. The researchers pointed out that these women will be unable to make informed health decisions until they know about these risks as well as the genetic testing, other types of screening and risk-reducing surgery available to them.

In conducting the study, the investigators questioned the 18- to 24-year-old daughters of mothers who are BRCA1 or BRCA2 mutation carriers, about their attitudes, health behaviors, life plans and how much they knew about hereditary breast or ovarian cancer genetics.

The researchers found that the women surveyed worried a lot about hereditary breast or ovarian cancer. In fact, 40 percent of the daughters revealed they worried a great deal or to an extreme about hereditary cancer.

The study also revealed that the women were not well-informed about the genetics of breast or ovarian cancers, compared to those who had genetic counseling. The participants also did not fully understand their cancer screening and risk-reduction options, including when they should begin this screening process.

"These data support the need and can provide the foundation for the development of targeted educational materials to reduce that anxiety and ultimately improve participation in effective screening and risk-reducing interventions that can improve survival and quality of life for these young women," Farkas Patenaude said.

The findings were slated for presentation on Thursday in Orlando at the Era of Hope conference hosted by the Department of Defense Breast Cancer Research Program. Because this study was presented at a meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute provides more information on how to assess breast cancer risk.

SOURCE: Dana-Farber Cancer Institute, news release, Aug. 4, 2011

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Tamoxifen Wards Off Breast Cancer's Return for More Than a Decade

THURSDAY, July 28 (HealthDay News) -- Women who took the cancer-suppressing drug tamoxifen for five years after a breast cancer diagnosis were nearly 40 percent less likely to have the cancer return, and that protection lasted for more than a decade after they stopped taking the drug, a new study finds.

Researchers analyzed the results of about 20 randomized controlled trials on a five-year course of tamoxifen vs. not taking the drug. The trials involved 21,000 women from a dozen countries around the world, including the United States, Europe, China and Japan.

Some 15 years after their diagnosis -- and 10 years after they stopped taking the drug -- women who took tamoxifen still had one-third lower risk of dying than women who didn't take it.

"It's a remarkable drug," said study author Dr. Christina Davies, a lead investigator with the Early Breast Cancer Trialists Collaborative Group, which was established some 25 years ago to conduct periodic reviews of research on breast cancer from around the world. "It has probably saved more lives than any other oncological drug ever."

Of 10,645 women who took tamoxifen, about 26 percent had a relapse at the 10-year-mark, compared to 40 percent who didn't take the medication. By 15 years, 33 percent of women who took the drug had their cancer return, compared to 46 percent who didn't.

The statistics were similar when it came to death rates. After a decade, about 25 percent of women who didn't take the drug had died compared to 18 percent of those who did take it; at 15 years, 33 percent who didn't take the drug died compared to 24 percent of those who took tamoxifen.

"They not only gained the benefits while they were taking the drug, but for many years afterward," Davies said.

The study is published in the July 28 online issue of The Lancet.

Tamoxifen has been widely used for more than 30 years to treat the most common type of breast cancer, estrogen-receptor positive tumors.

The drug works by inhibiting the activity of estrogen, a female hormone that can drive the growth of breast cancer tumors. The drug is most often prescribed as a once-a-day pill for younger women with breast cancer.

Older, postmenopausal women are now often prescribed a newer class of drugs called aromatase inhibitors, which block estrogen released in body fat, experts said. Aromatase inhibitors are most easily used in women who no longer have ovaries that are producing estrogen, Davies said.

One reason for the switch to aromatase inhibitors: Prior research, as well as the current study, found that tamoxifen raises the risk of cancer of the lining of the uterus (endometrial cancer) and life-threatening blood clots in the lungs. The analysis found the added risk from tamoxifen to older women was small, and in younger women it was "almost non-existent," Davies said.

"The benefits greatly outweigh the risks," Davies said.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said studies such as this that look at death rates over the long-term are valuable.

"The study shows that tamoxifen as an adjuvant [additional] therapy for breast cancer has had a very successful track record that has been sustained over 30 years of use in the clinic, even though it's used less now," he said.

The analysis found tamoxifen worked equally well in women who underwent chemotherapy and radiation in addition to surgery, Davies noted. Another benefit: tamoxifen is inexpensive. Davies estimated a five-year course of the drug costs about $150, of particular importance in developing nations where breast cancer rates have risen dramatically, she said.

Many of the women in the analysis, she noted, failed to take the full five-year course of the drug, so it's possible the protective effect from fully taking the medication as prescribed might be even greater. The findings raise the question of whether, say, a 10-year course of tamoxifen might be even more beneficial than five years.

About half of the women worldwide diagnosed with breast cancer are pre-menopausal, she said. "For those women, tamoxifen is the main treatment option," she said.

About two-thirds of breast cancers in the United States are estrogen-positive. The drug worked even on those whose tumors are "weakly positive," she noted.

More information

The U.S. National Cancer Institute has more on tamoxifen.

SOURCES: Christina Davies, M.D., senior research scientist, Clinical Trial Service Unit, University of Oxford, Oxford, England; Len Lichtenfeld, deputy chief medical officer, American Cancer Society, Atlanta; July 28, 2011, The Lancet, online

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Drop in Breast Cancer Death Rates May Not Be Linked to Screening Rates

FRIDAY, July 29 (HealthDay News) -- Developed countries have seen a drop in breast cancer death rates in recent years, but a new international study suggests this trend is less about rising screening rates and more about the availability of increasingly effective treatments and improving health-care systems.

The finding stems from an analysis of World Health Organization (WHO) breast cancer data collected between 1980 and 2006, in which French, British and Norwegian researchers compared the screening and fatality rates of several Western European countries. The observations were presented online July 29 in the British Medical Journal.

"The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality," a team of researchers led by Philippe Autier, research director of the International Prevention Research Institute in Lyon, France, said in a journal news release.

To explore to what degree breast cancer screening rates appeared to be related to fatality rates, the authors chose six countries for points of comparison.

Northern Ireland was stacked up against the Republic of Ireland; the Netherlands was compared with Belgium/Flanders; and Sweden was examined alongside Norway.

The team noted that medical services and the prevalence of breast cancer death risk factors were comparable in each pairing. However, in the space of the study, the second country of each of the three groups was 10 to 15 years behind the first country in terms of their implementation of mammography screening protocols.

The results: Breast cancer death rates, which dropped across the board, were more or less similar in each country pairing, despite stark differences in screening histories.

For example, fatalities between 1989 and 2006 had plummeted by 29 percent in Northern Ireland, as compared with 26 percent in the Republic of Ireland.

The Netherlands registered a 25 percent drop, compared with a 20 percent to 25 percent drop in Belgium/Flanders, while the downward trend of 16 percent in Sweden compared with 24 percent in Norway.

In general terms, Autier's team also noted breast cancer death rates were not that different among women who had undergone almost no screening as compared with those who had been screened quite often.

And the biggest death rate drop seen overall was among women between the ages of 40 and 49, whether or not they had undergone screening.

Dr. Lauren Cassell, chief of breast surgery at Lenox Hill Hospital (affiliated with Northshore/LIJ) in New York City, cautioned that it's not clear that the current findings are easily generalizable to other nations.

"I'm not sure how well this finding would translate in comparison with the U.S.," she noted. "I suspect that we may be more aggressive in our screening protocols, and our health system is very different from the ones they looked at."

"And, in any case, I would certainly say that people should continue getting screened," Cassell stressed. "Because we still do know that catching any cancer at an earlier stage does translate into better outcomes and maybe less treatment. Because even if the end result is the same, and fatal, I certainly would like to have a cancer that could be treated with hormonal treatment and not chemotherapy, if possible."

More information

For more on breast cancer screening guidelines in the United States, visit the American Cancer Society.

SOURCE: BMJ, July 28, 2011, news release

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