Widely hailed as the next frontier in medical advances, the promise of individualized medicine is becoming a reality thanks to progress in understanding the molecular basis of diseases such as breast cancer. Scientists can now develop treatments that are tailored to individual genetic profiles, as well as tests to predict how a patient will respond to existing therapies. Today, some women with early-stage breast cancer and their physicians can make more informed treatment decisions with the Oncotype DX Breast Cancer Assay. This service provides quantitative information about genes from a woman's individual tumor to generate a Recurrence Score between zero and 100, indicating whether she is at high, intermediate or low risk for her cancer returning after treatment. Oncotype DX is intended for patients with node-negative, estrogen receptor-positive breast cancer who are likely to be treated with hormonal therapy. Approximately half of the 230,000 patients diagnosed with breast cancer in the United States each year fall into this category, and are frequently offered treatment with chemotherapy, a widely used treatment with considerable side effects. Clinical studies show that chemotherapy improved patient survival rates in only 4 out of 100 patients, yet thousands of women continue to elect this costly and toxic treatment with only limited information about whether they might respond to it. A recent study demonstrated that women with high Recurrence Scores are more likely to benefit from chemotherapy, whereas women with lower scores derive only minimal benefit. Further, only 25% of women fell into the high-risk group, compared to 50% in the low-risk group, indicating that this common treatment is not appropriate for every patient. Elizabeth Sloan of New York City is one of the many breast cancer patients not likely to respond to chemotherapy. An active mother with two young boys, Elizabeth was considering having another child when she was diagnosed at just 40 years old. She wanted to avoid chemotherapy, with its disruptive, short-term side effects and potentially serious long-term implications, but also wanted to be absolutely certain that it wouldn't help her. Working with her doctor, Ruth Oratz, M. D., at NYU Medical Center, Elizabeth decided to have the Oncotype DX assay, and was delighted when her Recurrence Score turned out to be low-indicating that she may not benefit significantly from chemotherapy. "No two women with breast cancer are exactly alike. Oncotype DX provides information that goes beyond standard measures, like age, tumor size and tumor grade, in determining the likelihood of disease recurrence," says Dr. Oratz. "Oncotype DX gave Elizabeth and me added confidence and peace of mind in selecting the most fitting treatment for her." For Susan Bakken of Denver, Colorado, Oncotype DX provided a different kind of peace of mind. Susan's Recurrence Score indicated that she was at high risk of cancer recurrence, and would likely benefit significantly from chemotherapy-to both her surprise and her doctor's. "Based on the other tests I had, my doctor said he wouldn't have otherwise recommended chemotherapy. I was shocked to find out my result, but I was so glad I did because I believe this test basically saved my life," explained Susan. Elizabeth Sloan is also grateful for the information she gained from Oncotype DX. "Not all cancers are the same, so why treat everyone the same way with something so toxic?" she said. "It's so remarkable that finally, doctors can distinguish one person's cancer from another-I'm just so thankful." Oncotype DX is a simple test that can only be ordered by a physician. It is performed on a small amount of breast tumor tissue removed during a standard lumpectomy, mastectomy or biopsy, meaning no additional procedure is required.
Cancer that grows in the prostate gland is called prostate cancer. Prostate cancer is the second leading cause of cancer deaths among men in the U. S. About one man in six will be diagnosed with prostate cancer during his lifetime, but only one man in 34 will die of the disease. In the early stages, surgery and radiation may be used to remove or attempt to kill the cancer cells or shrink the tumor. Doctors will usually advice you to undergo a surgical operation. You will then be given some medications to take. Many studies have shown that this combination reduces the pains experienced by men to a great extent especially if the prostate cancer has spread to the bones. The cancer will not totally disappear nor will you live longer. Seek medical advice too and you would be in a better position to decide according to your own health and your personal values. Medications can have many side effects, including hot flashes and loss of sexual desire. Urinary incontinence can be a possible complication of surgery. Also a form of treatment used for early stage cancer is high intensity focused ultrasound (HIFU). This procedure is carried out under anesthesia (or using a local spinal anesthetic) and a probe is placed into the prostate gland through the rectum. A beam of high intensity focused ultrasound is them used to raise the temperature in the area of focus and thus to kill the cancer cells Another prostate cancer treatment option is radiation therapy. This prostate cancer treatment includes the use of radiation of high energy from protons, neutrons, gamma rays and x-rays, as well as other sources to kill the cancerous cells and to shrink any existing tumors. There are two ways that radiation therapy can be administered as prostate cancer treatment. The first is from a machine that is located outside your body called external beam radiation therapy, or you may have material that is radioactive that is placed in your body near where the cancer is located. This is referred to as internal radiation therapy. A relatively new technique, which is still being evaluated, is known as cryosurgery. During cryosurgery, which is carried out under anesthesia, cooling probes are guided into the prostate using ultrasound and the cancer cells are killed by freezing them. The form of treatment used for early stage cancer is high intensity focused ultrasound (HIFU). This procedure is carried out under anesthesia (or using a local spinal anesthetic) and a probe is placed into the prostate gland through the rectum. A beam of high intensity focused ultrasound is them used to raise the temperature in the area of focus and thus to kill the cancer cells For late stage prostate cancer hormone therapy is used and this is designed not to attack the cancer itself but to target the male hormones (in particular testosterone), which the cancer cells need to grow. In cases where hormone therapy proves ineffective, systematic radiation therapy or chemotherapy may be recommended. The outcome of prostate cancer varies greatly; mostly because the disease is found in older men who may have a variety of other complicating diseases or conditions, such as cardiac or respiratory disease, or disabilities that immobilize or greatly decrease their activities. Whatever the stage of your cancer it is important to consider all of the options carefully and weigh the advantages, disadvantages and risks of each carefully before choosing the treatment that is best for you.
Breast cancer occurs due to the irrepressible growth of cells in the breast that invades the nearby tissues and spreads throughout the body. These collections of irrepressible growth of tissue are called tumors or malignant tumors. However, not all tumors are cancerous. Breast cancer has been diagnosed in large numbers in North America and Europe. In 2001, about 200,000 cases of breast cancer were diagnosed in the United States alone. Every woman has a 1 in 8 risk of developing breast cancer, but the risk of dying from breast cancer is much lower, barely 1 in 28. The risk of getting breast cancer is generally higher among older women, women with a family history or previous history of breast cancer, women who had radiation therapy in the chest region, women who started their periods before 12 years old, women who had menopause after 50 years old, women who never had children or had them age 30 or older, or women with genetic mutation. In recent times genetic mutations for breast cancer have become a hot topic of research. The breast cancer tumor has the following symptoms: lump or thickening that appears on the breast or underarm, changes in the breast's shape, nipple turned inwards followed by colorless discharge, red or scaled skin or nipple, or ridges on the breast skin. If a woman experiences any of these symptoms, it does not necessarily mean she has breast cancer. In such a case she should undergo a breast cancer personal check-up. It is estimated that 95% of breast cancer is detected through personal check-up. The breast cancer personal check-up includes checking for lumps in the breasts after each menstrual period, puckering the skin, and checking for nipple retraction or discharge. For consistent result, every woman should do a breast cancer personal check-up at the same time every month. Various other techniques such as mammography, thermography, ultrasonography, computerized tomography scan etc, can also help detect breast cancer. Breast cancer treatments include surgery that removes cancerous tissues, with breast conservation therapy (BCT) being one such surgery. Other breast cancer treatments include chemotherapy, radiotherapy, hormonal therapy and biologic therapy. Radiotherapy is a common breast cancer treatment, and radiation treatment and chemotherapy may follow surgery to ensure the destruction of the stray cancer cells. Even after undergoing many or all of these breast cancer treatment measures, unfortunately almost half the women suffer from a recurrence of the disease.
A US study of 13,000 patients showed Tamoxifen reduced the rate of expected cancers from one in 130 to one in 236 - a cut of about 45%. The American researchers ended their trial early when they said the drug's benefits became overwhelmingly obvious. Other studies found that tamoxifen AND chemotherapy improved survival improved survival rates by about 40–50% compared to taking one treatment or the other. Should women taking tamoxifen avoid pregnancy? Yes. Tamoxifen may make premenopausal women more fertile, but doctors advise women on tamoxifen to avoid pregnancy because animal studies have suggested that the use of tamoxifen in pregnancy can cause fetal harm. Women who have questions about fertility, birth control, or pregnancy should discuss their concerns with their doctor. Does tamoxifen cause a woman to begin menopause? Tamoxifen does not cause a woman to begin menopause, although it can cause some symptoms that are similar to those that may occur during menopause. In most premenopausal women taking tamoxifen, the ovaries continue to act normally and produce estrogen in the same or slightly increased amounts. Do the benefits of tamoxifen in treating breast cancer outweigh its risks? The benefits of tamoxifen as a treatment for breast cancer are firmly established and far outweigh the potential risks. Patients who are concerned about the risks and benefits of tamoxifen or any other medications are encouraged to discuss these concerns with their doctor. Tamoxifen ( ta-MOX-i-fen) is a medicine that blocks the effects of the estrogen hormone in the body. It is used to treat breast cancer in women or men. It may also be used to treat other kinds of cancer, as determined by your doctor. Tamoxifen also may be used to reduce the risk of developing breast cancer in women who have a high risk of developing breast cancer. Women at high risk for developing breast cancer are at least 35 years of age and have a combination of risk factors that make their chance of developing breast cancer 1.67% or more over the next 5 years. Your doctor will help to determine your risk of developing breast cancer.
How long should a patient take tamoxifen for the treatment of breast cancer? Patients with advanced breast cancer may take tamoxifen for varying lengths of time, depending on their response to this treatment and other factors. When used as adjuvant therapy for early stage breast cancer, tamoxifen is generally prescribed for 5 years. However, the ideal length of treatment with tamoxifen is not known. How Often Should I Take Tamoxifen? Two studies have confirmed the benefit of taking adjuvant tamoxifen daily for 5 years. These studies compared 5 years of treatment with tamoxifen with 10 years of treatment. When taken for 5 years, the drug reduces the risk of recurrence of the original breast cancer and also reduces the risk of developing a second primary cancer in the other breast. Taking tamoxifen for longer than 5 years is not more effective than 5 years of therapy. What is Tamoxifen Tamoxifen is an oral selective estrogen receptor modulator which is used in breast cancer treatment, and is currently the world's largest selling breast cancer treatment. It is used for the treatment of early and advanced breast cancer in pre - and post-menopausal women. It is also approved by the FDA for the reduction of the incidence of breast cancer in women at high risk of developing the disease. It has been further approved for the reduction of contralateral (in the opposite breast) breast cancer. Tamoxifen and Cancer Tamoxifen is used to reduce the risk of breast cancer for women who: 1. are at high risk of breast cancer but have no personal history of the disease 2. have non-invasive, hormone-receptor-positive breast cancer, or DCIS (ductal carcinoma in situ) 3. have hormone-receptor-positive invasive breast cancer at any stage. Tamoxifen is sometimes used to treat gynecomastia in men. Tamoxifen is also used by bodybuilders in a steroid cycle to try and prevent or reduce drug-induced gynecomastia caused by steroids that are used in the same cycle. Tamoxifen is also used to treat infertility in women with anovulatory disorders. A dose of 10-40 mg per day is administered in days 3-7 of a woman's cycle.
There is only one drug in the world so well known that it's called "the Pill." For more than forty years, more people have taken "the Pill" than any other prescribed medicine in the world. Sex, pregnancy, and contraception have been hot topics for millennia. It wasn't until the U. S. government approved the birth control pill in 1960 that possibilities for contraception changed dramatically. The majority of women -- and plenty of men -- welcomed "the Pill". The birth control pill was the first medication ever designed for purely social, rather than therapeutic purposes. At the height of the drugs popularity, U. S. Senate hearings focused the nations attention on potentially deadly health risks posed by the high-dose Pill. As a result of the hearings, pharmaceutical companies lowered the dosages and doctors advised women who were obese, smoked, had high blood pressure or a family history of blood clots against taking the Pill. In the 1980s, the high dosage 10-milligram pill was removed from the market and biphasic and triphasic oral contraceptives were introduced. Today, women can get a prescription for a Pill containing 1 milligram of progestins, one tenth of the original dose, and containing as little as 20 micrograms of estrogen. From the very beginning, a significant number of women complained of discomfort from the Pill and switched to other methods. When women wanted to discuss the side effects with their doctors, they often met with frustration. It was common for their complaints to be dismissed as exaggerated. In other cases their ailments were just considered the price that women had to pay in return for such an effective contraceptive. The problem was compounded by that fact that female patients were not always informed about the potential for strokes, heart attacks or blood clots while on the Pill. For the most part sharing "the Pills" risk has become a part of the information provided by health care practitioners who prescribe the Pill. Today, the safety of the Pill is assumed. However, it is important to remember that the pill contains identical hormones to those found in Hormone Replacement Therapy (HRT). HRT has come under question because of the Women's Health Initiative Study showing an increase in breast cancer and heart disease for those women who were on HRT. In October 20, 2004 headlines read "Birth Control Pill Cuts Cancer, Heart Disease Risk: Study - A new study, yet to be published, suggests women who use oral contraceptives have lower risks of heart disease, stroke, and cancer." This study has now been denied as accurate by the WHI. Analyses by the WHI have made it clear that the recent findings were not correct? The low dose pill today although deemed to be safe has never undergone a large government-funded study similar to the WHI study on HRT. According to Dr. John R. Lee in his book "What Your Doctor May Not Tell You About Breast Cancer" women up to age 21 who use the Pill increase their lifetime risk of Breast Cancer by 600%. Caution when considering the use of Birth Control Pill should still be used.
Modern medicine is based upon the notion of battle. We battle germs and fight for life. As soon as we feel pain or discomfort, we immediately try to stop it from happening and look for some way to soothe what we are going through. We feel we must change our illness or problems, overpower them with our expertise. This orientation leads to a never ending battle with all that impinges upon us. After one illness or problem is conquered, another arises. We live in a state of constant insecurity where there is little room for ease of mind. Healing from within brings inner peace with it. It arises from a different orientation towards all the experiences of life. We are taught to stop, pay attention and respect all that comes to us. It is as if we were re-focusing a camera, receiving our experience through a different lens. Usually there is a deep sense that pain is bad, and must be removed at any cost. Pain is not bad. Pain arises from lack of balance and contains much information. It brings many messages along with it. When we see our pain as a messenger and learn how to respect and listen to it, healing begins in all kinds of ways. The first step in healing from within is to learn how to see pain as an ally, to learn how to "dialogue" with it. For most of us this seems almost unthinkable. At first this requires a complete turn around. Instead of tensing up and gearing for battle, we learn how to pause and understand there is a lesson that we have to learn. When we do this we find the pain or problem often comes holding a gift in its hands. Illness often comes when we feel defeated. We may not wish to struggle anymore. Some people become ill when they are overly exhausted. The illness is the only way they can give themselves permission to stop, rest, and make much needed changes in their lives. Each illness has it's own story. The same is true with psychological or personal problems that grow strong, demanding our attention. When someone is in physical pain and suddenly understands what is troubling them, the physical pain often subsides. For full healing to take place it may be essential to make changes in one's total life. Cancer can be suppressed for many years, and then it returns. When it reappears we must ask, "Why not? What is going on in my total life?" "We become sick becomes we act in sickening ways," Louis Jourard We are all experts at brushing things under the carpet. Then the carpet begins to roll up at the corners, and we feel we are coming unglued. During illness the body is rebelling. It is demanding that we pay attention to all that has been unattended. We may have been pushing ourselves for too long. Now our body is fed up. Stop and listen to me, it pleads. When we learn how to listen and how to reply, an entirely new life begins. Then pain and illness become an opportunity for vital change. Learning To Listen We usually listen only to part of ourselves. The rest is rejected. But no matter what we are rejecting, soon or later we must come up against it and face it straight on. Rejecting something over and over never makes it go away. In fact, it will come back time and again, just for you to accept it. Everything needs to be loved and accepted, including our illness and pain. The best way is to make friends with the pain. Fighting intensifies it. If we can relax into it for a little while and explore it, many possibilities arise. Natural healing is always available in all situations, but it can be cut off by fighting and fear. When we let go, and allow ourselves to speak to the pain, and to listen to what it has to say, incredible changes can happen. To do this, we simply close our eyes, stop fighting, and ask our pain what it is saying to us, what does it need from us right now? Then we become very quiet and listen deeply. An answer may not come right away. Patience is needed. As we do this process over and over, fear diminishes and we begin to hear. Answers come in different ways. Some hear answers within. Others see images, some have dreams. We learn to be open to all that comes and in this openness, we learn. Exercise Look at your illness or problem now. Picture it within and give it some kind of shape. What does it look like to you? Describe or draw it. Now, look more deeply at what the image really means. What is this image saying to you about yourself and the life you are leading? Listen carefully. Next, ask the image any questions you may have and let it answer you. (Ask what it wants from you and what it would need to go away). See if you can give it what it needs. This attitude is called making friends with the pain. When we do this illness does not become something foreign and frightening. We become better able to understanding what the true causes are. For example, if we are sad for too long and have not done enough crying, our bodies may begin to cry for us through the illness we are going through. If we feel that life is meaningless, our bodies can start to express this by shriveling up and dying. If we have held onto difficult attitudes, our bodies will bear the burden of them. Persistent negative attitudes become wounds upon our entire selves. Our attitudes are messages we give our body. Though we may not be aware of it, if we feel life is a dirty battle, we are telling our body to tense up with shame all day long. Once we begin the crucial work of taking responsibility for and changing our attitudes, our entire body can begin to experience on-going ease instead of dis-ease. We must look at the basic attitudes we live with and ask ourselves if they are conducive to our health, or do they contain the very seeds of pain? In order to heal from within, it is essential to handle these long standing patterns, to see them and change them to attitudes and patterns that are productive of well-being. Health comes with learning to say "yes" to all of our experience, in being willing to experience it just as it is. Wellness emerges out of the balance and harmony of all parts of ourselves. When we are well, we feel whole, accepting and in harmony with ourselves and the entire world we live in. Like a fresh water stream flowing, this state of being brings continual refreshment and healing day by day. Cc/Dr. Brenda Shoshanna/2005
If your mother had breast cancer, you have an increased chance of developing it yourself. Knowing your family history, understanding your personal risk, getting appropriate screening tests and making lifestyle choices are important steps toward good breast health, according to the Susan G. Komen Breast Cancer Foundation. "If breast cancer runs in your family, understanding your risk and how to approach your breast health is important to both your physical and emotional well-being," says Cheryl Perkins, M. D., senior clinical advisor for the Komen Foundation. Family History and Increased Risk If your mother, sister or daughter has breast cancer, your risk of developing the disease is two to three times greater than a woman without this family history. However, being at increased risk for breast cancer does not guarantee you will develop the disease. Talk to your provider to discuss your personal risk and his/her recommendations for regular screening. Regular screening usually includes mammography, clinical breast exams and breast self-exam. Additional screening may be recommended depending on your personal risk. Gene Mutations and Genetic Testing Only 5 to 10 percent of all breast cancer is due to heredity. Genetic testing can determine if you inherited the mutated BRCA1 or BRCA2 genes, which are key in the development of some breast cancers. However, having a mutated gene does not guarantee that you will get breast cancer. If you have concerns about your family history and personal risk, talk with your doctor about whether genetic testing is right for you. Taking Preventive Steps-Making Healthy Lifestyle Choices Many factors can increase a woman's chance of getting breast cancer. While some risks, such as being a woman and getting older, are out of your control, others can be managed. For example, risk factors such as consuming alcohol, lack of exercise and being overweight are all factors that you can modify. Helping Your Mother Through Breast Cancer If your mother is diagnosed with breast cancer, she needs your support. From diagnosis through treatment and beyond, your mother's co-survivor network of family and friends will be a vital part of her support system.
More than 215,000 women are diagnosed with breast cancer every year. For many of them, surgery to remove the tumor is just the first step in the battle against the disease, often followed by radiation and/or chemotherapy. After that, these women may need to decide with their doctor whether to have "adjuvant therapy"-medication to help prevent their cancer from coming back. When a woman's breast cancer does come back or spreads to other parts of the body, she may be at greater risk of dying from the disease. Women whose breast cancer is detected in the nearby lymph nodes at diagnosis and those who receive chemotherapy after surgery are considered to be at increased risk for breast cancer recurrence. Postmenopausal women whose early-stage breast cancer is hormone-sensitive have a new option as their first hormone therapy following surgery. The U. S. Food and Drug Administration recently approved Femara® (letrozole tablets) on December 28, 2005 for this type of use. This approval was based on a median of 24 months of treatment. The study is still ongoing to determine the long-term safety and efficacy of Femara. Already a leading breast cancer treatment, Femara is now the only medicine in a group called aromatase inhibitors that is approved for use both immediately following surgery and after five years of tamoxifen. The FDA granted Femara a priority review, a distinction reserved for medications that could potentially offer a significant improvement compared to products currently on the market. A panel from the American Society of Clinical Oncology, the country's leading group of oncologists, recommends aromatase inhibitors, such as Femara, be part of the optimal adjuvant treatment for this group of women. "One of the greatest fears confronted by women who have been treated for early breast cancer is that their cancer will come back. With Femara, we now have an option that can help address that fear early on, even in patients who we know face the greatest risk of recurrence," said Matthew Ellis, MD, PhD, FRCP, director of the Breast Cancer Program at Washington University in St. Louis. In a large clinical study of post-surgery breast cancer treatment, researchers compared the effectiveness of Femara and tamoxifen, another drug prescribed after surgery. An analysis performed after 26 months showed that Femara reduced the risk of breast cancer coming back by 21% over the reduction offered by tamoxifen. Patients taking Femara also showed a 27 percent reduction in the risk of the cancer spreading to distant parts of the body. In this study, women at increased risk of recurrence experienced the greatest benefit from Femara. Femara lowered this risk by 29 percent in women whose breast cancer had already spread to the lymph nodes at the time of diagnosis and by 30 percent in women who had prior chemotherapy. The results also showed that in these high-risk women, Femara reduced the risk of cancer spreading to distant parts of the body by 33 percent and 31 percent, respectively. In this study, Femara was generally well tolerated with the most common side effects including hot flashes, joint pain, night sweats, weight gain and nausea. Tips for Living Healthy Discuss postsurgery treatment options with an oncologist. Whether you're one, five or 10 years beyond your diagnosis, taking care of your overall health and well-being can also reduce your risk of cancer coming back and give you the energy to do the things in life that you love. • Practice good nutrition • Exercise regularly • Tap into a support network • Take time out for yourself Editors Note: Important safety information Femara® (letrozole tablets) is approved for the adjuvant (following surgery) treatment of postmenopausal women with hormone receptor−positive early breast cancer. The benefits of Femara in clinical trials are based on 24 months of treatment. Further follow-up will be needed to determine long-term results, safety and effectiveness. Talk to your doctor if you're allergic to Femara or any of its ingredients. You should not take Femara if you are pregnant as it may cause fetal harm. You must be postmenopausal to take Femara. Some women reported fatigue and dizziness with Femara. Until you know how it affects you, use caution before driving or operating machinery. There was an increase in cholesterol in patients on Femara versus tamoxifen (5.4% vs. 1.2%). In the adjuvant setting, commonly reported side effects were generally mild to moderate. Side effects seen in Femara versus tamoxifen included hot flashes (33.7% vs. 38%), joint pain (21.2% vs. 13.5%), night sweats (14.1% vs. 13.5%), weight gain (10.7% vs. 12.9%) and nausea (9.5% vs. 10.4%). Other side effects seen were bone fractures and osteoporosis.