LEDs may help reduce skin wrinkles, researchers report

Researchers in Germany are describing a potential alternative to Botox and cosmetic surgery for easing facial wrinkles. Their study, scheduled for the November 5 issue of ACS’ Crystal Growth & Design, a bi-monthly journal, reports that high intensity visible light from light emitting diodes (LEDs) applied daily for several weeks resulted in “rejuvenated skin, reduced wrinkle levels, juvenile complexion and lasting resilience.” LEDs are the miniature lights used in an array of products, from TV remote controls to traffic lights.

In the study, Andrei P. Sommer and Dan Zhu point out that high-intensity visible light has been used in medicine for more than 40 years to speed healing of wounds. That light actually penetrates into the skin, causing changes in the sub-surface tissue. Until now, however, scientists have not known the physicochemical nature of those changes.

They report identifying how the visible light works – by changing the molecular structure of a glue-like layer of water on elastin, the protein that provides elasticity in skin, blood vessels, heart and other body structures. Figuratively speaking, the light strips away those water molecules that are involved in the immobilization of elastin, gradually restoring its elastic function and thus reducing facial wrinkles. “We are justified in believing that our approach can be easily converted to deep body rejuvenation programs,” the researchers state. – AD

“From Microtornadoes to Facial Rejuvenation: Implication of Interfacial Water Layers”

CONTACT:
Andrei P. Sommer, Ph.D.
University of Ulm
Ulm, Germany

Spinning natural proteins into fabrics for new wound-repair products

Scientists in Israel are reporting the first successful spinning of a key natural protein into strong nano-sized fibers about 1/50,000th the width of a human hair. The advance could lead to a new generation of stronger, longer-lasting biocompatible sutures and bandages to treat wounds. The study is scheduled for the November 10 issue of ACS’ Biomacromolecules, a monthly journal.

Eyal Zussman and colleagues point out that researchers have tried for years to develop wound repair materials from natural proteins, hoping that such fibers would be more compatible with body tissue than existing materials. Scientists recently focused on producing these fibers through “electrospinning,” a high-tech weaving process that uses electrical charges to draw out nano-sized fibers from a liquid. But the approach has achieved poor results until now.

In the new study, the scientists describe a new method for producing electrospun polymers using bovine serum albumin (BSA), a so-called “globular” protein found in cow’s blood. BSA is similar to serum albumin, one of the most abundant proteins in the human body. The method involves adding certain chemicals to a solution of BSA to loosen the bonds that hold these highly-folded proteins together. That results in a thinner, more spinnable protein solution. Using electrospinning, the process resulted in strong fibers that are easily spun into suture-like threads or thick mats resembling conventional wound dressings. This approach is being followed by the groups of Zvi Nevo and Abraham Katzir at Tel-Aviv University, the researchers said, noting that the new method also can be applied to other types of natural proteins. – MTS

“Nanofibers Made of Globular Proteins”

CONTACT:
Eyal Zussman, Ph.D.
Technion-Israel Institute of Technology
Haifa, Israel

The American Chemical Society – the world’s largest scientific society – is a nonprofit organization chartered by the U.S. Congress and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.

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Forget expensive moisturisers and cosmetic surgery, a compound found in the humble elderberry could give a natural boost to skin.

In the first study of its kind, a team of researchers led by Prof Aedin Cassidy at the University of East Anglia and Dr Paul Kroon at the Institute of Food Research, will explore whether the skin’s condition is improved by a compound which gives berries their vibrant colour (called ‘anthocyanin’).

In a 12-week trial starting in September, post-menopausal women will consume either extracts from elderberries or placebo capsules, and will have their skin’s structure and appearance measured with state-of-the-art equipment used by experts in skin science. At the same time, researchers will also test whether the elderberry extract can reduce risk factors for heart disease.

‘We already know that a healthy diet can help protect against heart disease and skin damage, and that a mixture of similar food components have been shown to improve the skin’s structure. There is also evidence that the active components have anti-inflammatory properties, which may be important in helping people stay healthy,” said UEA’s Dr Peter Curtis who is leading the project.

“If the results of our study are positive, it may lead to innovations in skin health products and may also give us vital information about diets which promote healthier hearts.”

Dr Curtis at the University of East Anglia, UK is asking for generally healthy post-menopausal women to take part in the trial. They must be aged between 45 and 70, non-smokers and not on HRT. The volunteers will take four capsules each day for 12-weeks, while maintaining their normal skin health regimes. Volunteers will also be asked to avoid eating anthocyanin rich foods such as berries, and limit the intake of some other foods which may affect the results of the study. During the trial volunteers will be required to give blood, urine and skin samples and measurements will be taken of their skin condition and appearance.

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New research suggests that the identification and examination of key cell signaling events required for initiation and progression of cancer might be best accomplished at the single cell level. The research, published by Cell Press in the October issue of the journal Cancer Cell, provides new insight that may lead to better diagnosis and treatment of some complex cancers.

Recent advances in flow cytometry, a technique that allows detailed examination of individual cells, have enabled simultaneous measurement of cell type and signaling pathways. Lead study authors Dr. Garry P. Nolan from the Stanford University School of Medicine and Dr. Mignon L. Loh from the UCSF Children’s Hospital and the Helen Diller Family Comprehensive Cancer Center were interested in determining whether examination of cellular signaling abnormalities caused by genetic mutations associated with cancer could provide a precise correlation between aberrant signaling events and disease physiology.

“We had a strong hunch that we could use ‘deranged’ cellular signaling to track how cancer cell populations behave at diagnosis through therapy, as well as during remission or return of the cancer,” explains Dr. Nolan. “By measuring how signaling proteins respond to certain stimuli at diagnosis and which are modified by resistant cancers, we are essentially monitoring key highways that cancers use to drive their own growth. The advantage of diagnosing a patient’s cancer at the single cell level provides us an approach for early detection of cancer and yield insights into how cancer cells are responding or adapting to therapy. A byproduct of the single cell technique, when appropriately extended, is that we should eventually be able to predict those pathways cancer cells might be using to circumvent current therapies and more intelligently direct the patient towards alternative treatments.”

The researchers focused on juvenile myelomonocytic leukemia (JMML), an aggressive myeloproliferative disorder of young children. JMML is difficult to diagnose and has a complex molecular profile. Although genetic lesions impacting Ras signaling and alterations downstream of the activated GM-CSF receptor (both linked with inappropriate cell growth and survival) have been linked with JMML, there are very few methods for identifying therapeutic agents and assessing efficacy in JMML patients.

The researchers used flow cytometry to profile signaling at the single cell level, including molecules associated with GM-CSF and Ras signaling, for the presence of primary JMML cells with altered signaling behavior that correlated with disease physiology. Cells samples came from JMML patients, healthy individuals and patients with other myeloproliferative disorders, some who had initially been diagnosed with JMML. An unexpected STAT5 signaling signature was seen in most of the JMML patients, suggesting a critical role for JAK-STAT signaling in the biological mechanism of this cancer and suggesting potential targets for future therapies.

“This work successfully used single-cell profiling to follow patients over time and show that disease status in JMML – at diagnosis, remission, relapse and transformation – was indicated by a subset of cells with an abnormal signaling profile,” says Dr. Loh. “Revealing cell subpopulations, even rare cells, that are associated with disease opens additional avenues for measuring minimal residual disease, assessing biochemical effects of targeted therapies at the single cell level and understanding drug actions and mechanisms of diseases of heterogeneous origins and manifestations in diverse patient populations.”

The researchers include Nikesh Kotecha, Stanford University School of Medicine, Stanford, CA; Nikki J. Flores, University of California, San Francisco, San Francisco, CA; Jonathan M. Irish, Stanford University School of Medicine, Stanford, CA; Erin F. Simonds, Stanford University School of Medicine, Stanford, CA; Debbie S. Sakai, University of California, San Francisco, San Francisco, CA; Sophie Archambeault, University of California, San Francisco, San Francisco, CA; Ernesto Diaz-Flores, University of California, San Francisco, San Francisco, CAMarc Coram, Stanford University School of Medicine, Stanford, CA; Kevin M. Shannon, University of California, San Francisco, San Francisco, CA; Garry P. Nolan, Stanford University School of Medicine, Stanford, CA; and Mignon L. Loh, University of California, San Francisco, San Francisco, CA.

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According to legend, it was The Fountain of Youth that the famed Spanish explorer Ponce de Leon was seeking when he landed on the Floridian coast in 1513. It has long been said that he who drinks from the Fountain will have his youth restored. Without a doubt, the quest for eternal youth is as ancient as any pursuit. However, although we are now living longer than ever, there is now growing concern that quantity of years is not nearly as important as quality of those years. Indeed, as we experience the many joys of living longer, we also must deal with myriad consequences accompanying this aging trend. For instance, osteoporosis, arthritis, and other serious and often painful bone and joint diseases are much more common as we get older. And, not surprisingly, seniors often struggle daily with what was once the simple task of getting around. Hence, the obvious question in today’s society concerning our longevity is “What choices can we make to help ease these inconveniences of aging?”

One area of particular interest is the role that diet plays in keeping bones and muscles strong from infancy to old age. For instance, a limited number of studies point to the possibility that optimal intake of vitamin D (the “sunshine” vitamin) might help keep our muscles strong and preserve physical function. Although there are only few longitudinal studies investigating this relationship, their findings have been mixed. To help understand this diet-health association, Dr. Denise Houston from the Sticht Center on Aging at Wake Forest University and her collaborators studied the relationship between vitamin D status and physical function in a group of relatively healthy seniors living in Memphis, TN and Pittsburgh, PA. Their results will be presented on Sunday, April 25 as part of the scientific program of the American Society for Nutrition, composed of the world’s leading nutrition researchers, at the Experimental Biology 2010 meeting in Anaheim.

This study was part of the Health, Aging, and Body Composition (Health ABC) study initially designed to assess the associations among body composition, long-term health conditions, and mobility in older adults. For Houston’s segment of the investigation, she studied 2788 seniors (mean age: ~75 years) for 4 years. At the beginning of the study, they assessed vitamin D status by analyzing each person’s blood for 25-hydroxyvitamin D, a precursor for activated vitamin D. At baseline and then 2 and 4 years later, the research team then determined whether circulating 25-hydroxyvitamin D was related to the participants’ physical function. Specifically, they looked at how quickly each participant could walk a short distance (6 meters) and rise from a chair five times as well as maintain his or her balance in progressively more challenging positions. Each participant was also put through a battery of tests assessing endurance and strength.

When the results were tabulated, participants with the highest levels of 25-hydroxyvitamin D had better physical function. And, although physical function declined over the course of the study, it remained significantly higher among those with the highest vitamin D levels at the beginning of the study compared to those with the lowest vitamin D levels. The scientists were not surprised to learn that, in general, vitamin D consumption was very low in this group of otherwise healthy seniors. In fact, more than 90% of them consumed less vitamin D than currently recommended, and many were relying on dietary supplements.

The good news: higher circulating 25-hydroxyvitamin D is related to better physical function in seniors. But it’s impossible to tell from this type of research whether increasing vitamin D intake will actually lead to stronger muscles and preserve physical function. This is partly due to the fact that our bodies can make vitamin D if they get enough sunlight. So, it is possible that the participants with better physical function had higher vitamin D status simply because they were able to go outside more often. Indeed, the ominous “chicken-or-the-egg” question can only be answered by carefully controlled clinical intervention trials. Nonetheless, it is possible that getting more vitamin D from foods (like fortified milk and oily fish) or supplements will help maintain youth and vitality as we enjoy longer lifespans. As Houston points out: “Current dietary recommendations are based primarily on vitamin D’s effects on bone health. It is possible that higher amounts of vitamin D are needed for the preservation of muscle strength and physical function as well as other health conditions. However, clinical trials are needed to definitively determine whether increasing 25-hydroxyvitamin D concentrations through diet or supplements has an effect on these non-traditional outcomes.”

Will vitamin D research lead us to The Fountain of Youth? Probably not. But paying attention to how much vitamin D we get is likely important at every age and will help enhance the “quality” component of life as we enter our senior years.

Dr. Denise Houston (Wake Forest University, Winston Salem, NC); Dr. Janet Tooze (Wake Forest University); Rebecca Neiberg (Wake Forest University), Dr. Kyla Shea (Wake Forest University), Dr. Dorothy Hausman (University of Georgia, Athens, GA), Dr. Mary Ann Johnson (University of Georgia), Dr. Jane Cauley (University of Pittsburgh, Pittsburgh, PA), Dr. Doug Bauer (University of California, San Francisco, CA), Dr. Frances Tylavsky (University of Tennessee, Memphis, TN), Dr. Marjolein Visser (VU University, Amsterdam, Netherlands), Dr. Eleanor Simonsick (National Institute on Aging, Baltimore, MD), Dr. Tamara Harris (National Institute on Aging), and Dr. Stephen Kritchevsky (Wake Forest University) were coauthors on this paper.

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Federation of American Societies for Experimental Continue reading →

If a patient’s breast cancer is detected early enough, the five-year survival rate is well over 95%, say experts. In 2005 breast cancer caused 502,000 deaths worldwide. It is estimated that about 12% of all women either already have or will develop breast cancer during their lifetime. Globally, breast cancer is the firth most common cause of cancer death, after lung cancer, stomach cancer, liver cancer and colon cancer. For women globally, breast cancer is the most common cancer and the most common cause of cancer death. The number of breast cancer cases increased substantially since the mid 1970s.

Breast cancer does not only affect women. Men can also develop the disease – in the USA more than 1,500 males will probably be diagnosed with breast cancer with year.

According to the Canadian Cancer Society, the Canadian breast cancer death rate is going down as a result of better screening and more effective treatments. This is also the case in most industrialized countries.

Heather Chappell, Senior Manager, Cancer Control Policy, Canadian Cancer Society, says “As we enter Breast Cancer Awareness Month, we celebrate the progress that has been made against this devastating disease that affects so many women and their families across Canada. However, inroads must continue to be made against this devastating disease that continues to take a significant toll. It is the most common cancer among Canadian women.”

Since 1986 the age-standardized death rate for breast cancer has dropped by 25% in Canada. Evidence indicates that organized screening with mammography and clinical breast examination have been major contributory factors towards the falling death rates.

Chappell said “We know screening works. Barriers to screening must continue to be identified and overcome. If more women are screened, more will survive.”

The following guidelines are recommended by the Canadian Cancer Society:

– Every woman aged 50-69 should have a mammogram every two years
– Women aged 40-49 should consult with their doctors about their risk of breast cancer and the benefits and risks of mammography
– Women over 70 should discuss a screening program with their doctors
– Women over 40 should have a clinical breast examination by a trained health professional at least once every two years
– Women are encouraged to get to know their breasts and to discuss any detected changes with their doctors

Chappell said “We encourage women to be familiar with their breasts so they know what is normal for them. We no longer recommend routine breast self-examination as a way to find cancer. While it’s important for women to look and feel for any changes in their breasts, they don’t need to follow a particular technique or schedule. Many women have found their own cancers, and being aware of what is normal for them is an important part of this.”

The ultimate goal with breast cancer is to find out how to prevent it in the first place, as is the goal with all cancers, explained Chappell.

What is Breast Cancer?

Breast cancer is a tumor that has become malignant – it has developed from the breast cells. A ‘malignant’ tumor can spread to other parts of the body – it may also invade surrounding tissue. When it spreads around the body, we call it ‘metastasis’.

A woman’s breast consists of lobules. Lobules are milk-producing glands. The breast is also full of ducts – milk passages that connect the lobules to the nipple. There is also fatty and connective tissue surrounding the ducts and lobules – this is called stroma.

The most common breast cancers start in the cells around the ducts. Others can start in the cells that line the lobules. A smaller number of breast cancers can start in other parts of the breast.

The human body has two ways of moving fluid about. One is through the blood stream, which carries plasma, red and white blood cells and platelets. Lymphatic vessels carry tissue fluid, waste products and infection fighting cells (immune system cells). Immune system cells are located in the lymph nodes – the nodes are shaped like a bean.

It is common for cancer cells to grow in the lymph nodes. They get there via the lymphatic vessels.

The lymphatic system of the breasts connects to the lymph nodes in three areas: Under the arm (axillary lymph node), in the chest (internal mammary node) and by the collarbone (supra or infraclavicular node).

Doctors guess that if cancer cells are in the lymphatic system, they are most likely to be in the bloodstream and will spread to other organs in the body. It is very hard to test for breast cancer cells in the bloodstream.

If breast cancer cells have got to the nodes under the arm (axillary), it will most likely swell. Whether or not it has swollen there, will decide what type of treatment a patient should have. If cancer cells are found in more lymph nodes, then the likelihood of it turning up in different parts of the body is greater. However, there is no hard and fast rule here. Women have had swellings in many nodes and did not develop metastases, while some women with no swellings in their nodes did.

Most breast lumps are benign (harmless)

Although most breast lumps do not develop into anything dangerous some will need to be biopsied (doctor takes a piece out and tests it). Most lumps are harmless cysts – sacs filled with fluid.

A benign tumor cannot spread to other parts of the body – it stays inside the breast. They pose no threat to the patient’s life. They are not cancer. Some of them, however, can increase the woman’s chance of developing breast cancer later on. Tumors such as papillomas and atypical hyperplasia are examples of this.

How common is breast cancer?

Breast cancer is the most common cancer for women. About one in every nine women will develop breast cancer in her lifetime. 99% of all breast cancers are diagnosed in women, 1% affect men.

In the USA there were 100,000 new cases in 1985. In 1994 the number rose to 180,000. The main reason for the increase is better awareness leading to more diagnostic tests.

Why do some women get breast cancer?

We don’t know the answer to that yet. We know that heredity plays a part. The more close relatives a woman has who had breast cancer, the higher is her risk of developing it.

– Canadian Cancer Society – What is Cancer?
– Susan G. Komen for the Cure

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A case report published Online First and in a future edition of The Lancet documents the case of a 22-year-old woman who survived a serious case of swine-flu. She was treated with the unlicensed intravenous form of relenza, in combination with high-dose corticosteroids. Her immune system was impaired due to recent chemotherapy. The article is the work of Dr Michael Kidd and Dr Mervyn Singer, University College London Hospitals NHS Foundation Trust, London, UK, and colleagues.

The woman had received chemotherapy as part of treatment for Hodgkin’s disease. She was referred on the 8 of July 2009 to the Intensive Care Unit (ICU) at the University College Hospital. She had laboratory-confirmed H1N1 infection, increasing shortness of breath, build-up of fluid in both lungs. Her condition was not responding either to tamiflu (75mg twice daily) or broad-spectrum antimicrobials. Her progressive deterioration indicated she needed artificial ventilation from the third day of her ICU admission. Since she did not appear to be absorbing the tamiflu, this was switched to nebulised relenza for ICU days 6 to13. However this had no noticeable clinical benefit. High levels of H1N1 RNA were detected on the tenth day in ICU. Increasing the relenza dose for ICU days 13 to16 did not improve her clinical state.

She remained critically ill with severe respiratory failure. For that reason, doctors decided on day 16 to begin treatment using unlicensed intravenous relenza provided by GlaxoSmithKline. Permission for the treatment was granted by the hospital and a close relative. Treatment with the corticosteroid methylprednisolone was also started to treat the lung inflammation. The patient’s condition improved within 48 hours. H1N1 viral load had decreased over 100-fold by ICU day 21. She was extubated the same day. She then was discharged back to the ward after 24 days in ICU. Inhaled relenza was sustained as a precaution due to her immunocompromised state.

The authors explain: “Since her inflamed, atelectatic lungs were probably impeding adequate drug absorption, and clinical improvement was not forthcoming, we decided to use intravenous (unlicensed) zanamivir. High dosing achieves effective respiratory epithelial concentrations and is well-tolerated. Our patient progressively recovered with no drug related side-effects.”

Atelectatic lungs have numerous small areas of collapse filled with fluid and possibly dead material.

Generally, deaths due to pandemic H1N1 influenza are associated to severe respiratory failure, or acute respiratory distress syndrome (ARDS). The authors point out that persistent high level H1N1 replication may drive ongoing lung inflammation. In this case, the intravenous relenza and high-dose corticosteroids may possibly have worked together. However, this may be considered controversial. In addition, high-dose corticosteroids are not recommended in swine influenza treatment guidelines. The authors mention: “However, controlled trials are lacking and a rationale does exist for the use of corticosteroids in ARDS.”

They write in conclusion: “Although this is a single case report and direct cause and effect cannot be confirmed, the improvement in clinical status following intravenous relenza encourages prompt further investigation, both alone and in combination with high-dose methylprednisolone.”

“H1N1 pneumonitis treated with intravenous zanamivir”

I Michael Kidd, Jim Down, Eleni Nastouli, Rob Shulman, Paul R Grant, David CJ Howell, Mervyn Singer
DOI: 10.1016/S0140-6736(09)61528-2
The Lancet

Written by Stephanie Brunner (B.A.)

View drug information on Relenza; Tamiflu capsule.

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The American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) today issued a joint guideline aimed at improving the accuracy of immunohistochemistry (IHC) testing for the expression status of estrogen (ER) and progesterone receptors (PgR) in breast cancer. The two groups conducted a systematic review of medical research literature in partnership with Cancer Care Ontario to develop the recommendations. The guideline is being published in the April 19 issues of ASCO’s Journal of Clinical Oncology (JCO) and the CAP’s Archives of Pathology & Laboratory Medicine.

As many as two-thirds of breast cancers are ER and/or PgR-positive with their growth influenced by activation of the estrogen receptor pathway. The purpose of ER/PgR testing is to identify breast cancer patients whose tumors express ER and/or PgR (hormone receptor-positive), and who should therefore be considered candidates for treatment with endocrine therapies, which may include options like tamoxifen, an aromatase inhibitor, and/or suppression of ovarian function, as appropriate. These treatments can substantially improve survival in patients with hormone receptor-positive invasive breast cancer. Immunohistochemistry is an established assay to determine the ER/PgR status of a tumor by measuring protein amounts of ER and PgR in breast cancer cells. However, up to 10-20 percent of IHC test results throughout the world may be inaccurate (false-positive or false-negative).

“There is clearly a need to accurately identify breast cancer subtypes as ER and/or PgR-positive to help us identify those patients most likely to benefit from endocrine therapy and minimize the risk of potentially denying effective and life-saving therapy to patients incorrectly labeled as having ER/PgR-negative invasive disease, while allowing patients with true ER/PgR-negative disease to be considered for other therapies.” said Antonio C. Wolff, MD, FACP, co-chair of the ASCO/CAP Hormone Receptor Testing in Breast Cancer Panel and associate professor of oncology at the Johns Hopkins Kimmel Comprehensive Cancer Center.

The guideline recommends the following:

- Testing ER and PgR status on all newly diagnosed invasive breast cancers (primary site and/or metastatic site), and whenever appropriate, repeat testing in patients with a known breast cancer diagnosis who now present with a local or distant recurrence.
- Establishing uniform testing measures that focus on proven, reliable and reproducible assays and procedures.

- Having testing laboratories validate their assays against existing and clinically validated tests. Results should agree at least 90 percent of the time with those of the clinically validated assays for positive receptor status and at least 95 percent for negative receptor status.

- Transporting breast tissue specimens from the operating room to the pathology laboratory as soon as they are available for gross assessment. The time from tumor removal to initiation of fixation should be kept to one hour or less. Fixation of the sample in neutral buffered formalin must extend for at least 6 hours and no longer than 72 hours.

- Performing ER and PgR testing in a CAP-accredited laboratory or in a laboratory that meets the accreditation requirements spelled out in the guideline. The CAP will require that every accredited lab performing testing participate in a mandatory proficiency testing program.

- Considering an ER and PgR test performed by an IHC assay as positive if at least one percent of the tumor in the sample tests positive, which helps predict whether a patient is likely to benefit with endocrine treatment. The panel recognized that it is reasonable for oncologists to discuss the pros and cons of endocrine therapy with patients whose tumors contain low levels of ER by IHC (one percent to ten percent weakly positive cells) and to make an informed decision based on available information.

“The main goal of the ASCO/CAP ER/PgR guideline is to improve the accuracy of test results and ensure that patients receive appropriate care like endocrine therapy, as it has the potential to improve survival and save lives. Widespread access to accurate ER/PgR testing is also critical because breast cancer is the most common cause of cancer death in women in low and middle-income countries, and most of them have ER and/or PgR-positive disease,” said Dr. Wolff.

According to Elizabeth Hammond, MD, FCAP, co-chair of the ASCO/CAP Hormone Receptor Testing in Breast Cancer Panel, pathologist at Intermountain Healthcare, and professor of pathology at the University of Utah School of Medicine, “Increased attention to simple measures such as the handling of tissue specimens from the moment they are taken from the patient to when they reach the pathologist, the uniform fixation of specimens, the standardization and validation of lab assays, rigorous reporting procedures, and greater access to treatment interventions have the potential to significantly improve breast cancer outcomes around the world.”

Classifying subtypes of breast cancer by a tumor’s biological characteristics (tumor phenotype) can include whether or not it is hormone (estrogen or progesterone) receptor positive, human epidermal growth factor receptor 2 (HER2) positive, or “triple negative,” lacking receptors for estrogen, progesterone, and HER2. The latter, HER2, plays a role in cancer cell growth and spread and identifies patients that may be considered candidates for treatment with anti-HER2 drugs in the adjuvant or metastatic settings. In 2007, ASCO and the CAP issued clinical practice guideline recommendations to improve HER2 testing accuracy.

About 20 percent of all women with invasive breast cancer are HER2-positive, meaning they overexpress HER2, and about 15 percent of breast cancers do not express HER2, ER, or PgR receptors (triple-negative). Accurate determination of tumor phenotype is critical to properly select therapy options and individualize treatments.

The ASCO/CAP Panel also expects that the new ER/PgR guideline will foster improved communications among cancer specialists and also between patients and their doctors. Because of the availability of effective therapies for patients with hormone-receptor positive disease, the panel chairs encourage women who are told to have an ER/PgR-negative breast cancer to discuss the test result with their cancer specialists, including their oncologist and pathologist. This conversation would touch on questions like whether the hormone receptor test result is consistent with the overall pathology assessment of the tumor and whether the ER/PgR testing was done in a manner that is consistent with the new ASCO/CAP guideline.

The ASCO/CAP Panel chose to specifically focus on IHC assays for ER/PgR testing based on its widespread use, worldwide impact, and large body of evidence available. In the future, the ASCO/CAP Panel may review new methods and predictive assays to identify patients most likely to benefit from endocrine therapies as new high-level data on validated assays and outcomes become available.

“All medical professionals involved in cancer care want to do the right thing and offer the most correct and appropriate care to their patients. It is our hope that the ASCO/CAP ER/PgR guideline will facilitate processes at each health system and institution, so that appropriate measures to ensure accurate predictive biomarker testing (including ER/PgR) are in place and that breast cancer patients receive the highest quality care possible,” said Dr. Hammond.

In conjunction with the publishing of the guideline, ASCO and CAP have developed clinical tools and resources for oncologists and pathologists that summarize the findings and recommendations. These resources include a slide presentation on ASCO’s website and a guideline summary in the Journal of Oncology Practice. In addition, CAP has developed a Breast Predictive Factors Testing Certificate Program and associated Continuing Medical Education (CME), which will also allow pathologists to gain special expertise in the development and implementation of these tests.

The clinical practice guideline and other resources are available at asco/guidelines/erprand cap/center. ASCO also has developed a corresponding patient guide available on ASCO’s patient website, cancer. In addition, a patient resource explaining the new guideline can be found on CAP’s patient website, MyBiopsy.

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ASCO Continue reading →

The Society for Cardiovascular Angiography and Interventions (SCAI) will provide physicians a unique opportunity to practice the latest procedures for treating cardiovascular disease in a risk-free environment. During its 29th Annual Scientific Sessions, May 2006, SCAI will host the Boston Scientific Mobile SimSuite® Simulation Training Unit, a state-of-the-art replication of a cardiac catheterization lab equipped with realistic simulation technology. This hands-on training facility allows physicians to practice new procedures or use new technologies in a realistic, yet safe and risk-free, environment before treating actual patients.

The Boston Scientific Mobile SimSuite® Training Unit is a 35-foot bus, complete with a pre-procedure patient briefing area, an area for performing interventions on a simulated patient named Simantha®, and a post-procedure computer station for providing the operator feedback on his or her decisions in the case.

Physicians can perform simulated interventions with lesions in the coronary arteries that are considered “high risk” and are difficult to treat because of their type, location, or size. Historically, these cases required bypass surgery; however, break-through technologies now increase the likelihood of successfully treating these difficult cases with less invasive procedures.

“Simulation training not only gives physicians a unique opportunity to learn new approaches to challenging cases, but it also allows us to hone our skills and techniques,” said Mark Turco, MD, FSCAI, an active SCAI member and faculty for Boston Scientific’s high-risk coronary simulation training program. “SCAI is pleased to welcome Boston Scientific to the meeting and to enable our attendees to have hands-on training in the latest treatment methods alongside the more traditional continuing medical education provided at the meeting.”

Approximately 1,000 interventional cardiologists are expected to attend this year’s Annual Scientific Sessions, a four-day educational event highlighting the latest advances in the treatment of cardiovascular disease. Interventional cardiologists specialize in percutaneous coronary interventions (PCI) — procedures for diagnosing and treating potentially clogged arteries. By threading a slender tube, or catheter, into the blood vessels, interventional cardiologists can identify and often treat lesions, or blockages, that are reducing blood flow and can lead to heart attack or stroke.

Headquartered in Bethesda, Md., the Society for Cardiovascular Angiography and Interventions is a 3,400-member professional organization representing invasive and interventional cardiologists. SCAI’s mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI was organized in 1976 under the guidance of Drs. F. Mason Sones and Melvin P. Judkins. The first SCAI Annual Scientific Sessions were held in Chicago in 1978.

Contact: Kathy Boyd David
Society for Cardiovascular Angiography and Interventions Continue reading →

Tamoxifen is more effective than radiotherapy at preventing breast enlargement and breast
pain in men with prostate cancer, concludes a randomised trial published online today by
The Lancet Oncology.

A drug called bicalutamide has been licensed in some European countries as an additional
therapy to the main treatment (removal of the prostate or radiotherapy) for early prostate
cancer. Breast enlargement and breast pain are common side effects of bicalutamide therapy,
and can cause some patients to withdraw from treatment. Because early withdrawal from
treatment may compromise outcome, effective management strategies for breast
enlargement and breast pain are needed. Currently, the most commonly used treatment to
prevent breast enlargement in prostate patients is low-dose radiotherapy. Trials have
suggested that preventative treatment with anti-oestrogen drugs, such as tamoxifen, could
also be effective.

Giuseppe Di Lorenzo (University Federico II, School of Medicine, Naples, Italy) and colleagues
undertook a randomised trial to compare the effectiveness of tamoxifen with that of
electron-beam radiotherapy for the prevention and treatment of breast enlargement and
breast pain caused by bicalutamide therapy for prostate cancer. They recruited 151 men who
had received primary treatment for prostate cancer from five Italian centres between January
2002 and February 2004. 51 patients were randomly assigned to 150 mg bicalutamide only
per day, 50 patients to 150 mg bicalutamide per day and 10 mg tamoxifen per day for 24
weeks, and 50 patients to 150 mg bicalutamide per day and one dose of radiotherapy at the
start of treatment.

Patients were followed-up for an average of 25 months. The investigators found that 35 of
the 51 patients assigned to bicalutamide alone developed enlarged breasts, compared with
four of the 50 assigned the bicalutamide and tamoxifen and with 17 of the 50 assigned
bicaluatmide and radiotherapy.

29 of the 51 patients on the drug alone developed breast
pain, compared with three of the 50 receiving additional tamoxifen, and 15 of the 50
receiving an additional dose of radiotherapy. 35 patients assigned to bicalutamide only
subsequently developed breast enlargement or had moderate to severe breast pain and were
randomly allocated to receive additional treatment of 10mg tamoxifen or one dose of
radiotherapy. In this sub-group tamoxifen substantially reduced the frequency of breast
enlargement and breast pain when compared with radiotherapy. The treatments were well
tolerated and the groups did not differ in quality of life or relapse-free survival.

Dr Di Lorenzo concludes: “We have shown that tamoxifen and radiotherapy can prevent
breast enlargement and breast pain in some patients receiving bicalutamide therapy for
prostate cancer, and that tamoxifen is more effective than radiotherapy.”

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The University of Pittsburgh Cancer Institute (UPCI) has announced the establishment of the Frieda G. and Saul F. Shapira BRCA Cancer Research Program. BRCA 1 and 2 are two genes that, when mutated, dramatically increase the risk of breast, prostate, ovarian and pancreatic cancers.

“I am excited about the addition of this research program to UPCI,” said Ronald Herberman, M.D., director of UPCI and the University of Pittsburgh Medical Center (UPMC) Cancer Centers. “The more we learn about these mutations, the better chance we have to target high-risk patients and to find innovative ways to reduce their cancer risk.”

Women who possess either mutation have a 50 to 80 percent lifetime risk of developing breast cancer, and the disease progresses more quickly than in individuals without the mutations. Experts estimate that as many as one out of every 345 people in the U.S. carries a BRCA mutation, but for individuals of Ashkenazi (Eastern European) Jewish descent, the number is approximately one in 40.

These mutations have been linked primarily with an increased risk of breast cancer in women, but they also increase the risk for other cancers. Both men and women can carry the genetic mutations, which means they can be passed to children from either parent.

The David S. and Karen A. Shapira Foundation committed an initial $1 million for the program, structuring the gift as a matching grant to raise an additional $1.5 million from individuals and foundations. UPMC is matching these gifts on a dollar-for-dollar basis, for an overall goal of $5 million.

“Currently, the burden of cancer costs each American approximately $936 a year,” said Dr. Herberman. “The National Cancer Institute’s budget supporting research amounts to only $21 per American annually. To fund promising cancer research, researchers need other means of support. A gift like the one we have received from the Shapira Foundation, complemented by funds from the community and UPMC, will go a long way to supporting this important program.”

Already, community leaders and local foundations have contributed $850,000 toward the fundraising goal. To learn more about the groundbreaking research that this money will support, please click here.

Founded in 1984, the University of Pittsburgh Cancer Institute became a National Cancer Institute (NCI) -designated Comprehensive Cancer Center in record time (by 1990). UPCI, the only cancer center in western Pennsylvania with this elite designation, serves the region’s population of more than 6 million. Presently, UPCI receives a total of $154 million in research grants and is ranked 10th in funding from the NCI.

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