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12 December 2013 Last updated at 13:30 GMT
Breast cancer: Drug 'halves' risk of tumours
By James Gallagher
Health and science reporter, BBC News
A "landmark study" shows a drug can more than halve the development of breast cancer in high-risk women.
A trial on 4,000 women, published in the Lancet, showed anastrozole was more effective, cheaper and had fewer side effects than current medications.
It stops the production of the hormone oestrogen, which fuels the growth of the majority of breast cancers.
Doctors and campaigners are asking health services to consider offering the drug to healthy women.
Some countries already offer the drugs tamoxifen and raloxifene to prevent breast cancer.
The use of drugs to prevent cancer has the potential to transform care - a mastectomy is no longer the only preventative treatment.
But who should get the drugs?
There are side-effects to chemicals which affect the hormone oestrogen so these drugs will not be given to all women.
Meanwhile, those with very high risks, such as BRCA gene mutations, may think the risks are still too high even with medication so may still opt for a mastectomy.
A challenge for cancer research will be to identify those women who would gain the most from treatment.
Advances in genetics and new ways of analysing breast tissue are getting a clearer picture of a woman's risk.
However, it is important to remember that many lifestyle choices have a huge impact too.
Breast feeding, reducing alcohol intake and losing weight will all cut the risk of breast cancer.
They both block oestrogen activity, however, they also increase the risk of cancers of the womb, deep vein thrombosis and hot flushes.
Aromatase inhibitors, such as anastrozole, stop oestrogen being produced in the first place and are already used as a treatment for breast cancer.
'More effective'
The study at Queen Mary University of London has followed women with a high risk of breast cancer, based on their family history, for an average of five years.
It showed that out of 2,000 high-risk women given no treatment there were 85 cases of breast cancer in the study.
But in the same number of women given anastrozole there were 40 cases, with virtually no side-effects.
Lead researcher Prof Jack Cuzick, who also pushed for the introduction of tamoxifen, told the BBC: "I think this is an exciting moment, breast cancer is by far the most common cancer in women and we have a chance to reduce cases."
He added: "This class of drugs is more effective than previous drugs such as tamoxifen and crucially, it has fewer side effects."
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New findings could tackle over-diagnosis and over-treatment of breast cancerNew research from Queen Mary University of London has revealed, for the first time, the molecule αvβ6 (alpha v beta 6) could tell doctors which cases of Ductal Carcinoma in Situ (DCIS), a condition where non-invasive cancerous cells are contained within the milk ducts of the breast, are most likely to develop into early ‘invasive’ breast cancer.
Tuesday 3 December 2013
Around 4,800 cases of DCIS are diagnosed each year in the UK, with two thirds diagnosed through breast screening. If left untreated, up to half of DCIS cases could progress into invasive breast cancer but it is not possible to say which ones. This means all women are offered treatment and faced with the difficult decision of whether to have it or not.
The study, funded by Breast Cancer Campaign, indicates with further research αvβ6 could be used to stratify patient treatment, meaning a significant proportion of the 4,800 women diagnosed with DCIS each year in the UK could avoid unnecessary procedures. This would mean a reduction in the number of women requiring surgery and other treatments such as radiotherapy, addressing the issue of over-diagnosis and over-treatment of the condition.
Researchers looked at 583 breast tissue samples from normal breasts and those with DCIS, and showed there to be a link between levels of αvβ6 in myoepithelial cells (cells which form part of the milk duct walls) and whether breast tissue was normal, had DCIS or had progressed to invasive breast cancer. There was almost no αvβ6 in cells from normal tissues, whereas over half of the DCIS cases had αvβ6 in the surrounding cells (52% of non-high grade DCIS and 69% of high grade DCIS) and nearly all DCIS cases that had already started to become invasive breast cancer had αvβ6[1].
The researchers then looked at a further 104 cases of DCIS matched to long term follow up information on each woman and found that the levels of αvβ6 in patients’ myoepithelial cells were strongly associated with their DCIS recurring or progressing, and this effect was seen independently of the grade and size of the DCIS.
Women whose myoepithelial cells contained αvβ6 saw their disease recur around nine years earlier than those without αvβ6; cases with αvβ6 recurred in an average of 2.3 years compared to 11.4 years for those without αvβ6.
Professor Louise Jones, Professor of Breast Pathology at Queen Mary University of London’s Barts Cancer Institute, comments:
“We are confident these results will be validated in further studies and from there we don’t envisage any barriers to this research resulting in the development of a routine test which could take place in the clinic. This will be a huge step forward in how we treat women with DCIS. Our ultimate goal is that women diagnosed with DCIS without αvβ6 could be offered active monitoring, saving them from potentially unnecessary surgery and radiotherapy.”
Further experiments using cell and mouse models showed that αvβ6 encouraged breast cancer cells to spread out and grow much faster. They also revealed that αvβ6 is dependent on two other proteins to promote cancer growth, TGFβ and MMP9, and with further research these could potentially be targeted with drugs to prevent DCIS from progressing.
Dr Michael Allen, Postdoctoral Research Assistant at Queen Mary University of London’s Barts Cancer Institute, comments:
“These findings show that we are really starting to find some clarity in the grey areas surrounding the subject of DCIS, and interestingly this insight has come from specialised cells which surround the DCIS, rather than the cancer cells themselves. There is still much more we need to do, but we have found some important correlations between the presence of the marker, αvβ6, and the progression of DCIS into invasive breast cancer, and that is very exciting.”
For media information, contact:
Charli Scouller
Public Relations Manager
Queen Mary, University of London
email: c.scouller@qmul.ac.uk
Related links:
Notes to Editors
1. Grade is assessed on how different the cells look compared to normal breast cells.
Reference and link to paper: Allen, M.D., et al. (2013) Altered Microenvironment Promotes Progression of Pre-Invasive Breast Cancer: myoepithelial expression of αvβ6 integrin in DCIS identifies high-risk patients and predicts recurrence. Clinical Cancer Research. doi: 10.1158/1078-0432.CCR-13-1504
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