Mother Daughter Relationship Important Key To HPV Vaccination

College women were more likely to be vaccinated against human papillomavirus (HPV) if their mothers communicated with them about sex and if they thought their mothers would approve of their getting vaccinated, according to new Dartmouth research.

Meg Gerrard, PhD, of Dartmouth Medical School and Norris Cotton Cancer Center, Megan Roberts, a PhD student at Dartmouth College, and their colleagues, surveyed 972 female undergraduates at a large Midwestern university between November 2007 and April 2009.

An anonymous questionnaire assessed the undergraduate’s sexual-risk behavior, knowledge of HPV, perceptions of HPV risk, communication from their mothers about sex-related topics (including HPV), and their current vaccination status.

Sixty-five percent of the women reported being sexually active, and 49 percent reported having received at least the first of the three-shot HPV vaccine series.

Those who were unvaccinated were more likely to be interested in future vaccination if they thought their mothers would approve. The young women’s perceptions of their risk of contracting HPV also contributed to their interest in getting vaccinated. Young women whose mothers had discussed values in relation to sex were, as a group, less interested in being vaccinated.

The authors concluded that “mother-daughter communication and approval of vaccination emerged as important predictors of young women’s HPV-vaccination behavior and intentions, even after the women were old enough to not require parental approval.” They also noted that college-age women “are still a very important population to target for vaccination.”

The study was published in the journal Pediatrics. For more information, visit: www.dartmouth.edu/

Study Finds Fish Oil May Reduce Risk Of Breast Cancer

A recent report in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, adds to the evidence that fish oil supplements may play a role in preventing chronic disease.

Researchers at the Fred Hutchinson Cancer Research Center in Seattle, Wash., led by Emily White, Ph.D., a member of the public health sciences division, asked 35,016 post-menopausal women who did not have a history of breast cancer to complete a 24-page questionnaire about their use of non-vitamin, non-mineral “specialty” supplements in the Vitamins and Lifestyle (VITAL) cohort study.

After six years of follow-up, 880 cases of breast cancer were identified using the Surveillance, Epidemiology and End Results registry.
Regular use of fish oil supplements, which contain high levels of the omega-3 fatty acids, EPA and DHA, was linked with a 32 percent reduced risk of breast cancer. The reduction in risk appeared to be restricted to invasive ductal breast cancer, the most common type of the disease.

The use of other specialty supplements, many of which are commonly taken by women to treat symptoms of menopause, was not associated with breast cancer risk.

This research is the first to demonstrate a link between the use of fish oil supplements and a reduction in breast cancer. Studies of dietary intake of fish or omega-3 fatty acids have not been consistent.

“It may be that the amount of omega-3 fatty acids in fish oil supplements are higher than most people would typically get from their diet,” White said.

However, White cautioned against gleaning any recommendations from the results of one study.

“Without confirming studies specifically addressing this,” she said, “we should not draw any conclusions about a causal relationship.”

Edward Giovannucci, M.D., Sc.D., professor of nutrition and epidemiology at the Harvard School of Public Health and an editorial board member of Cancer Epidemiology, Biomarkers & Prevention, agreed.

“It is very rare that a single study should be used to make a broad recommendation,” said Giovannucci. “Over a period of time, as the studies confirm each other, we can start to make recommendations.”
Still, fish oil continues to excite many, as evidence emerges about its protective effect on cardiovascular disease and now cancer.

Harvard researchers are currently enrolling patients for the randomized Vitamin D and Omega-3 Trial (also called VITAL), which will assess the impact of fish oil supplements and vitamin D on cancer, heart disease and stroke.

The researchers plan to enroll 20,000 U.S. men aged 60 years and older and women aged 65 years and older who do not have a history of these diseases and have never taken supplements.

Recruitment for this National Institutes of Health funded study began in January, and more information can be found at www.vitalstudy.org.

Late-Stage Ovarian Cancer Therapy Shows Promise In Phase I Trial

The combination of decitabine and carboplatin appears to improve the outcome of women who have late-stage ovarian cancer.

Indiana University researchers report 4 of 10 patients who participated in a phase I clinical trial had no disease progression after six months of treatment. One patient experienced complete resolution of tumor tissue for a period of time.

Advanced ovarian cancer is often diagnosed too late for treatment to be effective. Patients are often told they have virtually no chance of recovery and only months to live.

Women participating in the study were between 51 and 71, and had previously exhausted all approved treatments for ovarian cancer. They enrolled in an Indiana University Melvin and Bren Simon Cancer Center clinical trial designed to increase their sensitivity to the commonly prescribed ovarian cancer drug, platinum-based carboplatin.

Women with ovarian cancer usually survive less than one year after they become resistant to carboplatin and their cancer recurs, said co-principal investigator Daniela Matei, M.D., an associate professor of medicine at the Indiana University School of Medicine. Matei led the clinical portion of the trial.

“Carboplatin is the most efficient drug therapy for ovarian cancer,” Matei said. “Unfortunately, patients with recurrent disease become resistant to the drug after one or two rounds.”

Decitabine was first used to treat the study patients intravenously daily for five days followed on the eighth day with carboplatin. After a month, the regimen begins again.

Six months after the trial began, four of the patients had no disease progression. At eight-and-a-half months, seven patients were alive. Cancerous tissue in one of the patients shrank completely.
Adverse reactions to the treatment regiments were mild, including nausea, fatigue and neutropenia.

Encouraged by the results of the phase I trial, which determined the safety of two different dosing regimens, a phase II trial is now under way with 17 patients already enrolled. Phase II trials are primarily focused on assessing the effectiveness of a drug or treatment protocol.

The study’s other co-principal investigator, Kenneth Nephew, geneticist in the IU Medical Sciences Program-Bloomington, led the report’s biochemical and DNA analysis.

In a bid to resensitize patients to carboplatin, Nephew and Matei and co-investigator Jeanne M. Schilder, M.D., associate professor of obstetrics and gynecology in the Division of Gynecologic Oncology at the IU School of Medicine, turned to the DNA demethylating agent, decitabine.

Why trial patients were responsive to the combination of decitabine and carboplatin is not yet known, but based on the literature and an analysis of biopsy tissue and blood samples, Nephew and Matei suspect decitabine reactivates tumor suppression genes that are turned off in ovarian cancer cells.

One of the hallmarks of ovarian cancer is the aberrant methylation of cytosine, one of DNA’s four nitrogenous bases. Methylation prevents DNA readers from expressing genes. Some of the silenced genes won’t be terribly important, but some, like tumor suppression genes, are. Decitabine is a known methylation inhibitor that can help return tumor suppression genes to an active state, and also improve cells’ susceptibility to anti-cancer drugs like carboplatin.

“Our hypothesis is that decitabine isn’t just targeting active ovarian cancer cells, but also cancer stem cells that seem to survive the first treatments,” Nephew said. “By keeping tumor suppression genes from being methylated, carboplatin and other platinum-based treatments for ovarian cancer have a better chance of success in the late stages.”

The researchers also reported that decitabine appears to have caused six of the 10 patients to become hypersensitive to carboplatin (a mild allergic reaction, treatable with steroids). While Nephew and Matei say that the effect may not be observed in a larger patient population, the scientists say they are intrigued by the phenomenon.

The two-drug treatment protocol is not approved for general use. The IU Simon Cancer Center is the only site for this clinical study.

Also contributing to the report were Fang Fang (lead author), Curt Balch, Timothy Breen, Shu Zhang, Changyu Shen, Lang Li, Carol Kulesavage, and Anthony Snyder. It was funded by the National Cancer Institute, Phi Beta Psi, and Ovar’coming Together.

The study was published in the journal, Cancer. More information can be found by visiting: www.indiana.edu.

Screening Mammograms For Younger Women Have Low Accuracy

Screening mammograms in women under age 40 result in high rates of callbacks and additional imaging tests but low rates of cancer detection, according to a study published online May 3 in the Journal of the National Cancer Institute.

Many studies have assessed mammographies for women over age 40 years, but little is known about its usefulness in younger women. Although screening mammograms are not generally recommended under age 40, about 29 percent of women between 30 and 40 reported having had one.

To determine the accuracy and outcomes of mammograms in younger women, Bonnie C. Yankaskas, Ph..D., from the University of North Carolina at Chapel Hill, and colleagues, pooled data from six mammography registries around the country. Their study included 117,738 women who had their first mammogram between the ages of 18 and 39.

The researchers followed the women for a year to determine the accuracy of the tests and their cancer detection rates. They analyzed data for both screening mammograms and diagnostic mammograms, which were performed because a woman had a warning sign or symptom, such as a lump.

No cancers were detected in women 25. Among the 73,335 women aged 35-39, the researchers found that screening mammograms had poor accuracy (sensitivity, specificity, and positive predictive value) and high rates of recall for additional tests. The cancer detection rate in this group was 1.6 cancers per 1,000 women.

For diagnostic mammograms, accuracy was better and the detection rate was 14.3 cancers per 1,000 women aged 35-39.

The authors conclude that in a theoretical population of 10,000 women having a screening mammogram between ages 35 and 39, 1,266 would be called back for further testing, 16 cancers would be detected, and therefore 1,250 women would have false positives.

In this population, they write, “our findings support a need for serious discussion about the appropriateness of mammography in women without the presence of symptoms.”

In an editorial, Ned Calonge, M.D., of the Colorado Department of Public Health and Environment, notes that this “landmark descriptive study should inform women and physicians and guide research efforts” on early detection in younger women. He emphasizes that even women in the study with a family history of breast cancer had the same detection and false positive rates as women without a known family history. This calls into question he says, the recommendation of some health groups that women with a family history start screening early.

He concludes that “the study by Yankaskas et al. is a powerful reminder that we must continue to strive for better tests and better treatments…..Furthermore, we should not be satisfied with better detection rates alone. We need evidence that early detection of these cancers translates to improvements in important health outcomes.”

Fore more information, visit: http://jnci.oxfordjournals.org/.

FDA Approved Leukemia Drug Shows Promising Activity In Ovarian Cancer Cells

The drug Sprycel, approved for use by the U.S. Food and Drug Administration in patients with chronic myeloid leukemia, significantly inhibited the growth and invasiveness of ovarian cancer cells and also promoted their death, a study by researchers with UCLA’s Jonsson Comprehensive Cancer Center found.

The drug, when paired with a chemotherapy regimen, was even more effective in fighting ovarian cancer in cell lines in which signaling of the Src family kinases, associated with the deadly disease, is activated.

Ovarian cancer, which will strike 21,600 women this year and kill 15,500, causes more deaths than any other cancer of the female reproductive system. Few effective therapies for ovarian cancer exist, so it would be advantageous for patients if a new drug could be found that fights the cancer, said Gottfried Konecny, an assistant professor of hematology/oncology, a Jonsson Cancer Center researcher and first author of the study.

“I think Sprycel could be a potential additional drug for treating patients with Src dependent ovarian cancer,” Konecny said. “It is important to remember that this work is only on cancer cell lines, but it is significant enough that it should be used to justify clinical trials to confirm that women with this type of ovarian cancer could benefit.”

Recent gene expression studies have shown that about one-third of women have ovarian cancers with activated Src pathways, so the drug could potentially help 7,000 ovarian cancer patients every year.

In this study, the UCLA team tested the drug against 34 ovarian cancer cell lines and they conducted genetic analysis on all cell lines. Through these analyses, the researchers were able to identify genes that predict response to Sprycel. If the work is confirmed in human studies, it may be possible to test patients for Src activation and select those who would respond prior to treatment, personalizing their care.

“We were able to identify markers in the pre-clinical setting that would allow us to predict response to Sprycel,” Konecny said. “These may help us in future clinical trials in selecting patients for studies of the drug.”

Sprycel is what is known as a “dirty” kinase inhibitor, meaning it inhibits more than one pathway. Konecny said it also inhibits the focal adhesion kinase and ephrin receptor, also associated with ovarian cancer.

The next step, Konecny said, would be to test the drug on women with ovarian cancer in a clinical trial. The tissue of responders would then be analyzed to determine if the Src and other pathways were activated. If that is confirmed, it would further prove that Sprycel could be used to fight ovarian cancer. In studies, women would be screened before entering a trial and only those with Src dependent cancers could be enrolled to provide further evidence, Konecny said, much like the studies of the molecularly targeted breast cancer drug Herceptin enrolled only women who had HER-2 positive disease.

“Herceptin is different because we knew in advance that the only worked in women with HER-2 amplification,” he said. “In this case, we don’t clearly know that yet. The data reassure us that the drug works where the targets are over-expressed but we need more testing to confirm this.”

The tests combining the drug with chemotherapy are significant because chemotherapy currently is the first line treatment for ovarian cancer patients following surgery. Because Sprycel proved to have a synergistic effect when combined with chemotherapy – both made the other work better – it may be possible to add the targeted therapy as a first line treatment if its efficacy is confirmed in future studies, adding a new tool to an oncologist’s arsenal.

The study appeared in the British Medical Journal.

UCLA’s Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation’s largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2009, the Jonsson Cancer Center was named among the top 12 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 10 consecutive years.

For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.

Pregnancy Proteins May Prevent Breast Cancer

Researchers have found that hormones produced during pregnancy induce a protein that directly inhibits the growth of breast cancer. This protein, alpha-fetoprotein (AFP), may serve as a viable, well-tolerated agent for the treatment and prevention of breast cancer, according to findings published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

“Hormones in pregnancy, such as estrogen, all induce AFP, which directly inhibits the growth of breast cancer,” said lead researcher Herbert Jacobson, Ph.D., who is a basic breast cancer researcher in the Center for Immunology and Microbial Diseases and in the Department of Obstetrics, Gynecology and Reproductive Sciences at Albany Medical College, N.Y.

“The body has a natural defense system against breast cancer,” he added. “AFP needs to be safely harnessed and developed into a drug that can be used to protect women from breast cancer.”

Recent studies have shown that hormones released during pregnancy, such as estrogen, progesterone and human chorionic gonadotropin, reduce a woman’s risk for breast cancer. AFP is a protein normally produced by the liver and yolk sac of a fetus. Jacobson and colleagues sought to determine whether administering pregnancy hormones to carcinogen-exposed rats led them to produce AFP, which in turn produces the protective effect of pregnancy in the absence of pregnancy.

Results from this study showed that treatment with estrogen plus progesterone, estrogen alone or human chorionic gonadotropin reduced the incidence of mammary cancers in rats. Furthermore, the researchers noted that each of these treatments elevated the serum level of AFP and that AFP directly inhibited the growth of breast cancer cells growing in culture, suggesting that these hormones of pregnancy are preventing breast cancer through their induction of AFP.

Cancer Prevention Research Editorial Board Member Powel Brown, M.D., Ph.D., said while these preclinical findings are important and suggest a role of AFP in breast cancer prevention, they are not yet ready to be used in the clinic.

“The researchers have not directly demonstrated the cancer preventive activity of AFP, instead they found an association of these hormones preventing mammary tumors. None of these treatments prevented mammary tumors in 100 percent of the rats, it appears to delay mammary tumor formation and prevent breast cancer development in approximately 30 to 50 percent of the rats,” said Brown, professor of medicine and cancer prevention and clinical cancer prevention department chairman at the University of Texas M. D. Anderson Cancer Center.

“This study is promising and suggests that additional animal studies need to be done before translation to humans,” he said. “We may want to further test AFP for its cancer prevention activity.”

Jacobson and colleagues are currently conducting studies in which they have isolated a small piece of AFP molecule and are working to convert it into a breast cancer preventative agent.

For more information, visit: www.aacr.org.

Encouraging Home Test Kits Could Increase HPV Detection

 

More high risk cases of human papilloma virus (HPV) could be detected by offering home testing kits to women who do not come forward for cervical screening, according to research published online in the British Medical Journal.

While cervical cancer screening programs in Western countries (U.S.) have contributed to a decrease in deaths from cervical cancer, one of the major drawbacks remains the number of women who do not come forward for smears.

Researchers in the Netherlands, led by Professor Chris Meijer from the VU University Medical Centre, investigated whether home testing kits would improve HPV detection rates. It has long been established that some strains of HPV are found in most cases of cervical cancer so early discovery is important.

As part of the Dutch cervical screening program, PROHTECT, the authors identified 28,073 women who had not responded to two invitations for screening.

Meijer and his team invited 27,792 of these women to use the Delphi Screener device to collect a cervical fluid sample at home and return it to the researchers. The remaining 281 women were recalled for a conventional cervical screening test.

The results show that over a quarter (26 percent) of the self-sampling group fulfilled the request, compared with only 1 in 7 (16 percent) of the recall group.

Participants in both groups whose samples were HPV positive were referred for further tests.

The authors conclude that using home testing kits for detecting HPV is an effective way to target women who do not attend for cervical screening and that it would lead to twice as many cases of cervical cancer being diagnosed compared with the regular screening program.

For more information, visit: www.bma.org.

Breast Surgeons Society Holds Annual Meeting, CME Credits Offered

 The American Society of Breast Surgeons will be holding the 11th Annual Meeting at the Bellagio Hotel, Las Vegas, NV April 28 to May 2.

“This is an exciting time in breast cancer history. Techniques in surgery and radiation are evolving and major advances are being made in personalized cancer therapy. We have assembled a stimulating program that covers many of those recent advances, as well as the controversies in breast disease management,” said Dr. Funda Meric-Bernstam, 2010 Annual Meeting Program Chair.

The American College of Surgeons designates this educational activity for a maximum of 38.5 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity, the Society said.

Research will be discussed on:

*** Obese women diagnosed with later stage, more aggressive breast cancers;

*** The choice to rebuild a breast: examining the factors that influence post-mastectomy breast reconstruction;

*** Who is reading your mammogram? Specially trained breast surgeons qualified to perform exam interpretation; and

*** Recent partial breast radiation cancer therapy guidelines that exclude women who can benefit.

Other topics to be taught and discussed are: breast cancer risk assessment and prevention; MRI – appropriate use and interpretation; preventing and reacting to lawsuits; coding and reimbursement; etc.

For more information on registration, courses offered and the presenters, visit: www.breastsurgeons.org/educational/2010PrelimProg.pdf.

Lasofoxifene Helps Reduce Risk of Bone Fractures, Breast Cancer And Other Postmenopausal Conditions

Low doses of the medication lasofoxifene can reduce the risk of vertebral and non-vertebral fractures, ER-positive breast cancer, coronary heart disease and stroke in postmenopausal women with osteoporosis, according to the findings of a new study in the latest issue of the New England Journal of Medicine.

Lasofoxifene is a non-steroidal selective estrogen receptor modulator (SERM) that has been shown to decrease bone loss and bone weakening, and reduce cholesterol levels, all common problems in postmenopausal women. However, its impact on other health issues for this population was not well understood.

“This is the first SERM that reduces the risk of all of these conditions at once,” says Steven Cummings, M.D., of the San Francisco Coordinating Center at the California Pacific Medical Center (CPMC) Research Institute, and the lead author of the study. “Not only did it reduce vertebral fractures, which was not unexpected, it also reduced the risk of non-vertebral fractures – injuries to the arms, legs, ribs, hips – that are the most common injuries to people with osteoporosis and the main causes of disability.”

The researchers followed 8,556 women, ages 59 to 80, over the course of 5 years. Two thirds of the women were given a daily dose of lasofoxifene (either 0.25mg or 0.5mg) and the other third were given a placebo.

The women were given lateral spine radiographs at 12, 24, 36, and 60 months to measure bone density and identify possible fractures. The women also underwent annual mammograms and clinical breast exams to detect breast cancer.

At the end of the five years patients who took lasofoxifene experienced fewer vertebral fractures than the placebo group – a 58 percent reduction in the patients taking 0.5mg a day and 31 percent in the lower dose group – and non-vertebral fractures (24 percent and 10 percent respectively). Those taking lasofoxifene also experienced increases in bone density compared to the placebo group.

Patients taking lasofoxifene experienced a reduction in their risk of estrogen receptor (ER) positive breast cancer (81 percent and 48 percent respectively), and a reduction in LDL (the so-called bad) cholesterol of around 16 percent.

The researchers say the results were not all positive. Patients taking lasofoxifene were at higher risk of experiencing a venous thromboembolic event or blood clot.

“We know that other SERMs, such as raloxifene, also increase a person’s risk of blood clots, so this finding was not a surprise to us,” says Dr. Cummings. “Even so, we have never found a treatment that has the array of beneficial effects as lasofoxifene with fewer serious side effects. With other treatments, such as Tamoxifen and estrogen, we have seen an increased risk for women of endometrial cancer but in lasofoxifene we did not see that at all.”

While the study results are promising the drug is unlikely to be available to women in the U.S. any time soon. The FDA recently rejected pharmaceutical company Pfizer’s request for approval, meaning that while it is approved and available in Europe, it is not available here in the U.S.

Dr. Cummings and several of the other researchers involved in this study received consulting grants from Pfizer, the manufacturer of lasofoxifene. However, to reduce questions about conflict of interest or bias an independent scientific advisory committee, consisting of investigators not employed by Pfizer, oversaw the study design and analysis, and wrote the paper and approved it for publication, said CPMC.

For more information, visit: www.cpmc.org.

Project Homeless Connect Offers Free Mammograms to Homeless Women

Poor and low income women with no health insurance were able to get a mammogram and the medical care they needed, at the Project Homeless Connect (PHC) event on Wednesday, February 24th.

“Losing your home, your job or your health insurance shouldn’t mean you end up losing your life because you can’t afford a breast cancer screening,” said Judith Klain, Director of Project Homeless Connect. “That’s why being able to offer women who are homeless a mammogram is so important. It says to them your health is important, your life is important.”

California Pacific Medical Center (CPMC), which is sponsoring the PHC event for the fourth time, is offering free mammograms, and follow-up care if necessary, to women at the event and scheduling future mammogram appointments for other women who sign up.

“Part of our job as a community-based hospital is to help fill in the gaps in care in our community,” said Warren Browner, MD, MPH, CEO of CPMC. “Government budget cuts mean that many programs that offer free mammograms for uninsured women are no longer able to do so. We’re happy to be able to step in and help those women get the screenings they need to protect their health.”

Last year alone Project Homeless Connect helped more than 10,300 poor and homeless San Franciscans gain access to services ranging from housing, SSI and General Assistance, to medical, dental and vision care. More than 1,000 clients were able to get their state DMV ID’s through PHC.

It is not just clients who get a lot out of the event; volunteers say taking part in PHC is tremendously rewarding for them. This time the volunteers got something extra. As part of its ‘Give a Day, Get a Disney Day’ program, Disney is offering a free one-day ticket to either Disneyland or Disneyworld, for anyone who volunteered for one day with Project Homeless Connect in 2010.

The program, which began in San Francisco five years ago, has become the model for more than 220 similar programs in other cities around the U.S., said CPMC.

For more information contact Kevin McCormack or go to www.projecthomelessconnect.com