Women's Imaging News

Are Mammograms Always Safe?
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The thought of getting breast cancer strikes fear in most women. Mammograms and breast self-exams (BSEs) are usually recommended to reduce the chances of getting breast cancer. At one point, it was recommended that women 40 and older get a mammogram every other year, then every year starting at age 50. However, the current consensus among most professionals is to recommend various time frames depending on factors such as breast size, medical history, and whether or not the patient has implants. As with many medical areas, there are fears associated with mammograms and their potential effectiveness. These include: 1. The Radiation in Mammograms Often, women will ask about the possibility of mammograms causing cancer, and whether it is safe to get a mammogram on a regular basis. However, a recent study that compared 100,000 women in the 40-74 age range found the rate of radiation-based cancer to be roughly 125 women, with 16 deaths. The same study found that over 960 lives were saved by the screening, so the benefits far outweighed the risks involved with the radiation. In women with larger breasts, it is sometimes recommended that they get a mammogram every other year until age 74—when most doctors agree that mammograms can stop altogether—instead of every year. This is because larger breasts require more x-ray views than women with normal-sized breasts. A regular mammogram uses two views, but women with larger breasts usually require four views—which means they are exposed to more radiation during a mammogram. In this case, many doctors are now telling women with large breasts to get a mammogram every other year, unless there is a family history of breast cancer or some other high-risk factor. Women with normal-sized breasts can get regular mammograms every year from age 50 to 74. 2. Mammograms and Sagging Breasts Women also may worry about mammograms causing sagging breasts, but there has been no research to support this. Saggy breasts have been associated with many things, including a high-fat diet, smoking, aging, and regular sun-tanning; however, having mammograms does not make your breasts sag. Some women try exercises to increase their breast size and firm up their breasts, but since breasts are made completely of fat, this doesn’t help much. If you are looking to prevent saggy breasts, exercises to strengthen the underlying chest muscles can give the appearance of upright breasts, so these types of exercises are not a bad idea. Just don’t expect your breasts to look perfect just because you’re exercising them! 3. Mammograms and Breast Implants Women may also think that, because they have breast implants, they can forgo their mammograms—but that is simply not the case. Of course, your doctor may recommend the every-other-year rule if you have implants, just as they do for women with large breasts, but whether you have implants or not, mammograms are essential to most women. Even for women who have had a mastectomy, it is recommended that they have regular mammograms to view the remaining underlying breast tissue. 4. Some Final Thoughts Most women should not be afraid to get mammograms, but if you have any questions about your particular situation, it is highly recommended that you speak to your ... Read more

FDA Approves 3MP X-ray Display for Mammography…

A 21.3-inch display with a brightness of 1,700 cd/m˛ and contrast of 1400:1 is tailored for all conventional X-ray applications and examinations of the thorax. Furthermore, the display supports independent subpixel driving (ISD), which raises the resolution by three.  “This is the reason for the mammography approval from the US Food and Drug Administration [FDA],” explained marketing manager, medical displays at Totoku, Marcel Herrmann. With the new grayscale display MS35i2 , Totoku (Tokyo, Japan) extends his range of light-emitting diode (LED) products with a 3 megapixel (MP) display. The MS35i2 also comes with the new LED backlight. The heir of the cold cathode fluorescent lamp (CCFL) technology is based on semiconductors.  “The benefits are both ecological as well as financial and qualitative nature. Compared to CCFL monitors, LED displays, save up to 20% electricity and have a longer life span by approximately30%. This has a positive effect on the budget of the user. Furthermore, the CO2 emissions decrease due to reduced energy production. Specifically, the MS35i2 display will use 15% less power than its predecessor, at the same time almost doubles the lifetime, and disposal is much more environmentally friendly, since LEDs do not contain critical elements such as mercury,” commented Herrmann. While the CCFL was positioned horizontally behind the display, the LED offers a considerably higher number of light sources. Because of this, they can be individually managed and controlled, resulting in an optimized consistency. All new i2 models feature the new display port interface. This allows the user to connect not only to DVI signals or video cards, but also with the most recent display port cards from numerous vendors, for instance Matrox, ATI, and NVIDIA.  Another advantage from display port is the enhanced greyscale duplication. For the very first time the display port offers true 10-bit grayscales on a color display and true 11-bit for the grayscale ... Read more

New Imaging Technology Could Lead to Greater Precision …

A novel imaging techonolgy, referred to as phase contrast x-ray imaging has allowed researchers from TH Zurich, the Paul Scherrer Institute (PSI) and the Kantonsspital Baden to conduct mammographic imaging that leads to higher accuracy in the ... Read more

Overestimation of Radiation Exposure Causes Women to …

According to a recent study, misconceptions and misinformation regarding the risks connected with ionizing radiation have led to a heightened public concern and fear, the outcome of which may lead to avoiding mammography screenings that can detect ... Read more

New Canadian Mammography Study Sparks Controversy…

A recent report from the Canadian National Breast Screening Study (CNBSS) determined that mammography screening does not reduce deaths from breast cancer. The findings reignited the much heated debate that started in 2009 when the U.S. Preventive ... Read more

Risk of Developing Lung Cancer for Breast Cancer …

According to a recent study, women who undergo radiotherapy treatment for breast cancer have a small but significantly increased risk of developing a primary lung tumor following treatment, to which further research has confirmed that this risk increases with the amount of radiation absorbed by the tissue over time.   The study’s findings were presented by Dr Trine Grantzau, M.D., at the 33rd conference of the European Society for Radiotherapy and Oncology (ESTRO33) in Vienna: "We found that for each Gray delivered to the lung as part of radiotherapy for a breast tumor, the relative risk of developing a subsequent primary lung cancer increased. This increased risk was similar to the reported increased risk of heart disease after radiotherapy for breast cancer.”   "Our findings suggest that any reduction in the dose of radiation to the lung would result in a reduction in the risk of radiation-induced subsequent lung cancers. With the advances in breast cancer treatment and the introduction of breast cancer screening, a growing number of women are becoming long-term survivors, and so we need to have an increased awareness of treatment-induced second cancers and take steps to reduce those risks by using radiotherapy techniques that spare normal tissue as much as possible." Grantzau, who is a doctor in the department of experimental clinical oncology at Aarhus University Hospital , Aarhus, Denmark, and her colleagues examined the occurrence of second primary lung cancers, a new lung cancer and not a secondary tumor that has spread from the original breast cancer, in a group of 23,627 women in Denmark who had been treated with post-operative radiotherapy for early breast cancer between 1982 and 2007. Among this large group of women, 151 (0.6%) were diagnosed with a new lung cancer (the case group) and were matched with 443 women who had not developed lung cancer (the control group). A prior study including the 23,627 irradiated women and, additionally, 22,549 unirradiated breast cancer patients, results showed that the risk of developing a radiation-induced second lung cancer was around one in every 200 women treated with postoperative radiotherapy.  "In the current study, we wanted to see if there was a dose-response correlation for second primary lung cancer after breast cancer irradiation. We further wished to estimate the excess relative risk per delivered Gray to the lung. As smoking is strongly correlated to lung cancer, we also looked into the effect of radiation and smoking," explained Grantzau. The researchers attained radiotherapy records of the previous breast cancer radiation treatment, including the delivered dose, field size and treatment technique, together with the smoking habits for all cases and controls. For the case group they also acquired radiographic images of the lung cancers. With this data they were able to recreate the ways that the women had been treated for the original breast cancer and to determine the amount of radiation that was delivered to the part of the lung where the tumour subsequently developed. They tested the accuracy of their calculated radiation doses on a model, or "phantom", and made the necessary adjustments to take into consideration the higher doses that they found were actually delivered to areas outside the main field of radiation. The average age of the women when they were first diagnosed with breast cancer was 54 (with a range of 34-74) and the average age when a second primary lung cancer was diagnosed was at 68 (range 46-90). Seventy percent of the lung cancers were diagnosed five or more years following radiotherapy for breast cancer, ranging from five to 26 years. The majority (91%) of the lung cancer cases were smokers, whereas 40% of the controls were smokers. The average dose of radiotherapy during breast cancer treatment that had been delivered to the site of the lung tumor was 8.7 Gy, while it was 5.6 Gy to the comparable site in the women who had not developed lung cancer. Even though the absolute risk of developing a second lung cancer is tiny, the researchers demonstrated that among women who had survived breast cancer for at least five years, the relative risk of subsequently developing a lung cancer increased by 8.5% per delivered Gy to the lung. "These results show that the risk of second lung cancer after radiotherapy in early breast cancer patients is associated with the delivered dose to the lung. It is, however, important to place the risk of getting a radiation-induced second lung cancer in a perspective that is balanced with the known benefits of radiotherapy in the adjuvant treatment of breast cancer. Post-operative radiotherapy in breast cancer patients decreases the likelihood of breast cancer recurrence and improves overall survival. The challenge for radiation oncologists is to reduce the delivered dose of radiotherapy in a way that minimizes the dose to the normal tissue to avoid radiation-induced malignancies, without compromising its efficacy in the cancerous breast tissue," said Grantzau.  "Furthermore, clinicians should be continually advising breast cancer patients to quit smoking in order to reduce their risk of developing lung cancer. It's important to emphasize that the risk of getting a tobacco-induced lung cancer is much higher than the risk of getting a radiation-induced second lung cancer,” she added. "This research shows the importance of monitoring the safety of radiotherapy procedures so that we can use the information gained to achieve a good balance between the risks and benefits of a particular treatment. Reducing the radiation dose to normal tissue is always beneficial, and knowing the exact target and the best radiation dose will help to reduce any long-term side-effects of a therapy that research has long shown to be instrumental in helping to save the lives of women with breast cancer. Dr Grantzau's research suggests there is a small increased risk of lung cancer in the years after radiotherapy for breast cancer, particularly in women who smoke. This underlines the importance to women of not smoking, as this increases the risk of a range of diseases. We, as radiation oncologists, will continue to work to monitor and improve the safety and efficacy of our therapies,” noted President of ESTRO and a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, Professor Vincenzo ... Read more

New Minimal-invasive Treatment, Y-90 Safer for …

Based on research that was presented at the Society of Interventional Radiology's 39th Annual Scientific Meeting, minimally invasive treatment that delivers cancer-killing radiation directly to tumors shows major promise in treating breast cancer ... Read more

Dense Breast Tissue No Challenge for Molecular Breast …

According to a recent study, molecular breast imaging (MBI) has been discovered to detect cancer independently and regardless of breast tissue density. This ground-breaking data was collected from over 300 breast cancer patients who underwent the MBI/BSGI procedure. The same high rate of 95% of breast cancer detection was confirmed for women with or without breast density.  This significant discovery has since been published in the issue of the American Journal of Roentgenology by a group of radiologists and surgeons at the George Washington University Medical Center (Washington DC, USA). “This study indicates that breast tissue density is simply a non-issue for MBI/BSGI. This is great news for patients who have an inconclusive mammogram due to breast density, implants, or scarring,” said vice president for science and technology at Dilon Technologies (Newport News, VA, USA), a developer of MBI systems, Douglas Kieper. Dilon Technologies, Inc. is a developer of diagnostic imaging with the Dilon molecular imaging systems, high-resolution, small field-of-view general-use imaging cameras, optimized to perform molecular breast imaging (MBI/BSGI) and localization for MBI-guided breast biopsy. Dilon’s surgical imaging products, the Navigator probes, are one of the most widely used gamma probes for cancer surgery. The gamma probes offer an upgrade option for three-dimensional (3D) tumor imaging and navigation with SurgicEye’s (Munich, Germany) declipseSPECT (single photon emission computed tomography) camera.  Dilon is the exclusive international distributor of Digirad’s (Atlanta, GA, USA) Cardius cardiac and ergo general molecular imaging cameras that provide excellent image quality and increased patient comfort with a compact, open design.  A variety of studies has demonstrated that mammography is less effective in patients with dense breast tissue, missing as much as 50% of breast cancers. Breast MRI is known to be more sensitive than mammography or ultrasound in women with dense breasts, however at a much higher cost per scan. On the other hand, MBI, also referred as breast-specific gamma imaging (BSGI), is an imaging protocol that has been shown in several clinical studies to be more effective than mammography or ultrasound for detecting breast cancer, especially in women with dense breasts. Furthermore, the MBI/BSGI procedure can be performed at one-third of the cost of an MRI and it can be provided to patients who cannot undergo an MRI scan, such as women with pacemakers, those who are on dialysis, or are claustrophobic.  For years, women who have dense breasts were usually unaware of their breast density or of the chance that their negative mammogram might be missing cancers. That is until recently, as several states in the United States have passed legislation requiring breast centers to inform patients with dense breasts that their mammogram might be inconclusive. The state of Oregon new breast density law includes BSGI as one of the technology alternative that should be considered for patients who receive a dense-breast notification from their doctor. The state of Indiana goes beyond that by requiring state employee-health plans to cover additional medical examination for women with high breast ... Read more

Cognitive Behavioral Therapy and Hypnosis Lessens …

Based on a study recently published in the Journal of Clinical Oncology, breast cancer patients receiving radiotherapy showed significantly reduced fatigue as a result of cognitive behavioral therapy in addition to hypnosis (CBTH). The study, titled, "Randomized Controlled Trial of a Cognitive-Behavioral Therapy Plus Hypnosis Intervention to Control Fatigue in Patients Undergoing Radiotherapy for Breast Cancer," was headed by Guy Montgomery, PhD, Associate Professor and Director of the Integrative Behavioral Medicine Program in the Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai. The study’s results of a randomized controlled trial of 200 patients revealed that the treatment group had considerably decreased fatigue than a control group both during treatment and for a follow-up period of six months afterwards. The mean patient in a treatment group had less fatigue than 79 percent of patients in a control group at the end of radiotherapy (RT). Six months following the end of RT, the mean patient in a treatment group had less fatigue than 95 percent of patients in a control group. "These results support CBTH as an evidence-based complementary intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH works to reduce fatigue for patients who have few other treatment options. It is also noninvasive, has no adverse side-effects, and its beneficial effects persist long after the last intervention,” said Montgomery. Furthermore, patients also mentioned that participating in CBTH was both soothing and useful. "This study is important because it shows a new intervention that helps to improve patients' quality of life during taxing course of breast cancer radiotherapy and for long after," said ... Read more

Mammography Saves No Lives, Study Shows…

Based on a 25 year follow-up data study from a Canadian screening facility, yearly mammography failed to diminish breast cancer mortality rates in women ages 40 to 59, as opposed to physical examination or standard care. Women screened on an annual basis by mammography for 5 years had had a breast cancer mortality propensity of 1.05 as opposed to the control group during the screening period. During follow-up for an average of 22 years, the mammography group had a breast cancer mortality propensity of 0.99 compared to the control group. However, neither value was statistically significant. Following 15 years of follow-up, the mammography group had a surplus of 106 breast cancers associated to overdiagnosis, as reported in BMJ Open. "Although the difference in survival after a diagnosis of breast cancer was significant between those cancers diagnosed by mammography alone and those diagnosed by physical examination screening, this is due to lead time, length of time bias, and overdiagnosis," Anthony B. Miller, MD, of the University of Toronto School of Public Health, and colleagues said of their findings. "At the end of the screening period, an excess of 142 breast cancers occurred in the mammography arm compared with the control arm, and at 15 years, the excess remained at 106 cancers. This implies that 22% (106 of 484) of the screen-detected cancers in the mammography arm were overdiagnosed. The findings suggest a need to reassess the value of screening mammography,” they added. The publication garnered a swift and strong response from the American College of Radiology (ACR) and the Society of Breast Imaging (SBI). In a shared statement, officials of the two organizations described the results as "an incredibly misleading analysis based on the deeply flawed and widely discredited Canadian National Breast Screening Study (CNBSS)." Taking into account that  the 32% rate of cancer detection by mammography, the ACR and SBI said "this extremely low number is consistent with poor-quality mammography. Mammography alone should detect twice that many cancers,” they added. The organizations mentioned that a former outside review of the CNBSS verified the poor quality of mammography in the study. The joint statement also called the randomization process used by CNBSS into question, highlighting that all women had a clinical breast examination prior to allocation, providing investigators with advance knowledge about which patients had breast lumps or enlarged lymph nodes. “The findings should come as no surprise,” said Richard C. Wender, MD, of the American Cancer Society (ACS). “The CNBSS has been an "outlier" from the initial report, and the lack of benefit with mammography wouldn't be expected to change with additional follow-up.” Miller and colleagues reported 25-year follow-up data from the CNBSS, which started in 1980. All women, ages 50 to 59, had yearly clinical breast examinations, as did women 40 to 49 in the mammography arm. Younger women in the control arm had a clinical breast exam at enrollment, followed by standard care. The study included 89,835 women registered at 15 centers in six Canadian provinces. During the 5-year mammographic-screening period, 666 invasive cancers were diagnosed in the mammography arm and 524 in the control group. Moreover, 180 women randomized to mammography died of breast cancer, as did 171 in the control group. The hazard ratio (HR) for breast cancer-specific mortality during the screening period was 1.05 for mammography compared to control. During the whole study, 3,250 women in the mammography group developed breast cancer as opposed to 3,133 in the control group, and 500 breast cancer deaths occurred in the mammographically screened patients as opposed to 505 in the control group, leading to an HR of 0.99. The authors of an accompanying editorial noted that some evidence suggests that improved treatment, rather than breast cancer screening, has propelled the decline in breast cancer mortality in recent years. Regardless of the rates found in different studies, overdiagnosis represents a larger problem. "The real amount of diagnosis in current screening programs might be even higher than that reported in the Canadian study, because ductal carcinoma in situ, which accounts for one in four breast cancers detected in screening programs, was not included in the analysis. We agree with Miller and colleagues that 'the rationale for screening by mammography be urgently reassessed by policymakers," said Mette Kalager, MD, of the University of Oslo in Norway, and colleagues. In a response to the ACR/SBI comments, Miller called the statement "deeply flawed and misleading, as it ignores all our previous clarifications on the issues raised." To the claim of poor mammographic quality, Miller said “the study demonstrated an excellent cancer detection rate, participating centers used modern (for the time) imaging machines, and technologists were trained in accordance with prevailing standards for North America.” "The randomization in the trial was assessed by two internationally recognized epidemiologists and was deemed to comply fully with accepted standards," Miller added in an e-mail. "Other commentators have agreed and regarded our study as high quality." In planning the trial, researchers overestimated the number of breast cancer deaths that would occur, a reflection of the care the patients received. "We had to postpone our first definitive analysis for 2 years so that sufficient events would accumulate. However, our long-term follow-up has resulted in sufficient events so that we can state with a high degree of confidence that mammography screening does not result in a reduction of breast cancer mortality,” said Miller. In direct reference to the ACR and SBI, Miller said the study's outcome "has to be unwelcome to this highly financially conflicted group, but which will be of substantial interest to policy makers in considering the future of screening for breast cancer." Recognizing the powerful emotions essential viewpoints on mammography, Wender said the issues will continue to be debated. ACS plans to review its mammography recommendations this year, and the United States Preventive Services Task Force (USPSTF) has implied that a panel may review the organization's recommendations later this year. "My own sense is that we did not learn a lot from the Canadian study. These numbers have been out for a long time. Maybe the one new thing we learned is that if you go out 25 years, the number of cases in the screening and control groups were pretty similar,” said Wender. A main issue often gets overlooked or lost in the debate over statistics and methodology. "There is unanimity of opinion among the major guidelines groups that attempt to synthesize all of the data. That is, mammography reduces age-adjusted mortality rates. It does avert/prevent premature breast cancer death, not just in women over 50 but in women in their 40s. Ultimately, the guideline groups are charged with balancing the benefits and risks of screening, and there is no perfect way to do that,” said Wender. As of now the final word on the issue according to Wender is that the ACS and USPSTF recommendations, possibly the best known in the U.S., are more similar than different. "I think we all look at the ... Read more

New Study Reveals Breast Dense Tissue Propels Early …

According to a new study conducted by researchers from the University of Manchester in the U.K., believe that a key biological apparatus may provide an explanation for the first time on why women with dense breast tissue have a higher risk of contracting breast cancer. The University of Manchester research team has been collaborating with IBM Research in the US and Cyprus over the course of the study, which was funded by one of the UK's leading breast cancer charities and research organizations, Breakthrough Breast Cancer. "We know that high breast density can greatly increase a woman's breast cancer risk as well as other factors such as aging, family history and presence of mutations in genes such as BRCA 1 and BRCA 2, " said Prof. Michael Lisanti, from the University of Manchester. "What no one has fully appreciated before are the underpinning mechanisms at play. Using a bioinformatics approach, we have identified the relevant signaling pathways that make dense breast tissue more favorable for tumor formation,” Lisanti added. Utilizing structural cells called fibroblasts from high-density breast tissue to produce a "molecular signature," the researchers discovered that a cell communication network called JNK1 demonstrated more activity in fibroblasts from high-density breast tissue than in lower-density breast tissue. Cells are instructed by this network to release chemicals that cause inflammation, which can spur on the formation of tumors. “Research expands on the early work by the London surgeon Stephen Paget, who proposed the 'seed and the soil' hypothesis, now over 125 years ago. In this paradigm, the 'seeds' are the cancer cells and the 'soil' is the tissue in which they grow,” said joint-senior author on the paper, Dr. Federica Sotgia. "Our research has identified the right soil for seeds to flourish by looking at the micro-environment in the breast and examining the mechanisms at play. This can help us with designing new preventative trials, to develop and test new therapies, which might prevent progression on to cancer. Current cancer treatment often focuses on targeting cancer cells, but is not focused on targeting the fibrotic connective tissue, that may develop first, before you have cancer,” she added. Therefore, the team believes that using drugs to mark this network and obstruct it from communicating with cells could offer a possible treatment for women with breast cancer. This theory is supported by the researchers' finding that the molecular signature of the fibroblasts from high-density breast tissue matches the signature of fibroblasts from breast tumors. In the next phase of their work, the researchers will consolidate with other "world-leading" experts in cancer signaling, including Prof. Nic Jones, director of the Manchester Cancer Research Centre (MCRC) and Cancer Research UK chief scientist, who heads the Cell Regulation Laboratory, and breast density specialist Prof. Tony Howell. "At least 50% of cancer risk is genetic, but activated cell stress signaling could potentially be reduced by dietary or lifestyle intervention. This research should help with a cancer prevention strategy, rather than waiting to treat the cancer once it arrives,” said Howell. "This analysis of breast density provides a new framework for additional experimental exploration in breast cancer research. This has important clinical and translational implications for stratified medicine and breast cancer prevention,” noted ... Read more

ASTRO and SSO Issue Guidelines on Margins for …

In a joint effort, the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO) have recently announced the publication of the consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer.   The guideline document demonstrates a rigorous collaboration among experts in the radiation oncology and surgical oncology fields, led by associate professor of the Department of Therapeutic Radiology at Yale School of Medicine in New Haven, Conn., Meena S. Moran, MD, on behalf of ASTRO, and Monica Morrow, MD, SSO former president, breast cancer surgeon and Chief of Breast Surgery at Memorial Sloan-Kettering Cancer Center in New York, co-chairs of the Margin Consensus Panel (MCP).   Furthermore, when determining the idyllic margin width that minimizes the risk of ipsilateral breast tumor recurrence (IBTR), the guideline also charts an evidence-based surgical treatment plan that could significantly diminish avoidable surgery for patients.   Society of Surgical Oncology-American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer makes use of the results of a meta-analysis of margin width and IBTR from a painstaking review of 33 research studies from MEDLINE and evidence-based medicine published from 1965 to January 2013, in the context of outcomes from contemporary trials.   The featured studies cover 28,162 patients with stage I or II invasive breast cancer who were treated with whole-breast irradiation and with a minimum average follow-up time of four years. Patients treated with neoadjuvant chemotherapy or patients with pure ductal carcinoma in situ (DCIS) breast cancer were excluded in the research for the guideline.   The consensus guideline was made possible by a research grant from the Susan G. Komen Foundation and underwent extensive peer review prior to approval by the SSO Executive Council and ASTRO's Board of Directors in October 2013. Additionally, the American Society of Breast Surgeons and the American Society of Clinical Oncology (ASCO) have both supported the guideline.   The consensus guideline also consists of eight clinical practice recommendations:   1. Positive margins, defined as ink on invasive cancer or DCIS, are associated with at least a two-fold increase in IBTR. This increased risk is not nullified by delivery of a boost, delivery of systemic therapy or favorable biology;   2. Negative margins (no ink on tumor) optimize IBTR. Wider margin widths do not significantly lower this risk;   3. The rates of IBTR are reduced with the use of systemic therapy. In the event that a patient does not receive adjuvant systemic therapy, there is no evidence suggesting that margins wider than no ink on tumor are needed;   4. Margins wider than no ink on tumor are not indicated based on biologic subtype;   5. The choice of whole-breast irradiation delivery technique, fractionation and boost dose should not be dependent on margin width;   6. Wider negative margins than no ink on tumor are not indicated for invasive lobular cancer. Classic lobular carcinoma in situ (LCIS) at the margin is not an indication for re-excision. The significance of pleomorphic LCIS at the margin is uncertain;   7. Young age (?40 years) is associated with both an increased risk of IBTR after breast-conserving therapy (BCT) and an increased risk of local relapse on the chest wall after mastectomy and is more frequently associated with adverse biologic and pathologic features. There is no evidence that increased margin width nullifies the increased risk of IBTR in young patients; and   8. An extensive intraductal component (EIC) identifies patients who may have a large residual DCIS burden after lumpectomy. However, there is no evidence of a link between increased risk of IBTR and EIC when margins are negative. "Our hope is that this guideline will ultimately lead to significant reductions in the high re-excision rate for women with early-stage breast cancer undergoing breast-conserving surgery. Based on the consensus panel's extensive review of the literature, the vast majority of re-excisions are unnecessary because disease control in the breast is excellent for women with early-stage disease when radiation and hormonal therapy and/or chemotherapy are added to a women's treatment plan," said Moran. "A significant portion of breast cancer surgeries in the United States are performed by surgical oncologists, and the definition of an adequate margin has been a major controversy. Therefore, it was only natural that we decided to create a definitive guideline that helps to minimize unnecessary surgery while maintaining the excellent outcomes seen with lumpectomy and radiation therapy. We are proud to provide this pivotal document to the oncology community, which will improve the lives and treatment of patients touched by this disease,” said Morrow. "We appreciate the dedicated efforts of Drs. Moran and Morrow for leading an exemplary team to produce this valuable guideline from both specialty organizations. Society of Surgical Oncology-American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer is an essential tool for every practice to provide the necessary context and variables in order to provide high quality, patient-centered care,” said chair of ASTRO's Board of Directors, Colleen A.F. Lawton, MD, FASTRO. As of today, it is available to the public online as a PDF document at http://www.redjournal.org and will be published in the March 1, 2014 print issue of the International Journal of Radiation Oncology • Biology • Physics(Red Journal), the official scientific journal of ASTRO; the March 2014 print issue of Annals of Surgical Oncology, the official journal of SSO; and the March 10, 2014 issue of the Journal of Clinical Oncology, the official journal of ... Read more

Virus Designed to Attack Triple Negative Breast Cancer …

According to a recent study, scientists have discovered a possible cure for one of the most aggressive and least treatable forms of breast cancer called "triple negative breast cancer." In laboratory test experiments involving human cancer cells, scientists used a virus comparable to the one that helped terminate smallpox to cajole cancer cells to produce a protein which makes them susceptible to radioactive iodine. The discovery was published in the February 2014 issue of The FASEB Journal. However, the scientists specifically emphasize that human clinical trials are necessary before any final claims of a cure can be made and treatments can be made available. "We hope that the recent advances in virology, genetic engineering and targeted radiotherapy will soon translate into an entire class of novel oncolytic, virotherapies for the treatment of deadly cancers," said Yuman Fong, M.D., a researcher involved in the work from the Department of Surgery at Memorial Sloan-Kettering Cancer Center in New York, NY. In order to make such a novel discovery, Fong and colleagues successfully infected and killed TNBC cells using a vaccinia virus. Moreover, the researchers were also able to utilize the virus to cause infected cancer cells to produce a cell surface protein called hNIS that usually is used to concentrate iodine in thyroid cells. The hNIS protein, delineated in thyroid cancer, is why most thyroid cancers can be cured or successfully treated with a small dose of radioactive iodine (which kills thyroid cancer cells exhibiting hNIS). Now with the ability to force TNBC cells to produce this protein, researchers have uncovered a way to deliver anticancer therapies to this fatal and resistant form of cancer. "This is an important and significant discovery that basically combines proven cures for two other diseases. Even more exciting is that the effects of this virus and radioactive iodine are well known in people, hopefully reducing the amount of time it will take for it to reach the clinic,” said Editor-in-Chief of The FASEB Journal, Gerald Weissmann, ... Read more
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