Research Article Summaries
The following summaries are provided by staff with the Young Women's Breast Cancer Program. Summaries describe reseach relevant to young women with breast cancer that has appeared in scholarly journals. Links for the full text are provided. For a copy of any article, contact Kim Selig at 314-747-7156 or firstname.lastname@example.org.
Study Shows Drug May Help Preserve Fertility for Young Women with Hormone-Receptor-Negative Breast Cancer
Posted June 2014
Phase III trial (Prevention of Early Menopause Study [POEMS]-SWOG S0230) of LHRH analog during chemotherapy (CT) to reduce ovarian failure in early-stage, hormone receptor-negative breast cancer: An international Intergroup trial of SWOG, IBCSG, ECOG, and CALGB (Alliance) (http://meetinglibrary.asco.org/content/129172-144)
In a small study of premenopausal women with hormone-receptor-negative breast cancer, the drug Goserelin, or Zoladex, which temporarily shuts down the ovaries and is commonly used as a hormonal therapy for breast cancer, was found to protect against the more permanent premature menopause that can be caused by chemotherapy. Specifically, women who received Goserelin injections with chemotherapy had less ovarian failure and gave birth to more babies than women who received only chemotherapy. Researchers believe that by shutting down the ovaries, Goserelin may help protect them from the damage caused by chemotherapy.
Two years after starting chemotherapy, only 8% of women receiving monthly Goserelin injections had ovarian failure, compared to 22% of women who didn't receive the drug. Twenty-one percent of women receiving Goserelin became pregnant and 15% had babies, while only 11% of women receiving only chemotherapy became pregnant and 7% gave birth.
Study Highlights Young Breast Cancer Survivors' Concerns about Fertility
Posted April 2014
Prospective Study of Fertility Concerns and Preservation Strategies in Young Women with Breast Cancer, Ruddy KJ, et al. Journal of Clinical Oncology, 2014, http://jco.ascopubs.org/content/32/11/1151.
As breast cancer is the most commonly diagnosed cancer in women of reproductive age and infertility may result from breast cancer treatments, the authors wanted to find out if young women with breast cancer have higher levels of worry about fertility and how these concerns affect treatment decisions and use of fertility preservation strategies. Prior research has shown that many people with cancer have concerns about fertility at diagnosis, but don't receive information about treatment-related risks to fertility and preservation options.
The findings in this article are based on data collected from 620 young women with breast cancer, median age 37 years. The majority of the study participants were white, married, and had children at the time of diagnosis. 425 women (68%) reported discussing fertility issues with their physicians before starting treatment. 230 women (37%) reported that before their breast cancer diagnosis, they'd wanted to have a child or more children, and 160 (26%) reported they wanted to have a child or more children at the time of the survey.
Regarding fertility concerns, 301 women, or almost half, reported no concern about fertility, 83 (13%) were a little concerned, 88 (14%) were somewhat concerned, and 148 (24%) were very concerned. These concerns affected treatment decisions a lot for 52 women (8%), somewhat for 53 (9%), a little for 55 (9%), and not at all for 456 (74%). Specifically, 4 women (1%) chose not to receive chemotherapy, 12 (2%) chose one chemotherapy over another, 6 (1%) considered not receiving endocrine, or hormone, therapy, and 71 (11%) considered receiving endocrine therapy for less than the recommended 5 years. Overall, the study found more concern about fertility to be associated with receiving chemotherapy, being less than 35 years old, nonwhite race, and not having children.
Regarding future fertility, only 65 women (10%) used fertility preservation strategies. This means that nearly 75% of women who reported fertility concerns at diagnosis didn't pursue preservation. The authors suggest this may be due to concerns about the safety or effectiveness of current preservation techniques, or to lack of awareness about or access to these techniques. The authors also suggest women, and physicians, may worry their cancer will recur due to hormonal increases during ovarian stimulation, pregnancy, or by delays in cancer therapy.
These findings support the need for addressing fertility concerns at diagnosis. Almost one-third of the women in this study didn't remember talking with their physician about the impact of cancer therapy on their fertility before starting treatment. Young women facing a breast cancer diagnosis deserve to know their fertility risks and options for preservation, and to receive the support they need to make informed fertility- and treatment-related decisions.
Study Finds Differences in Breast Cancer Death Rates for Black and White Women Living in Large US Cities
Posted March 2014
Increasing Black:White Disparities in Breast Cancer Mortality in the 50 Largest Cities in the United States, Hunt BR, et al. Cancer Epidemiology, 2013, http://dx.doi.org/10.1016/j.canep.2013.09.009.
This article explores survival differences between Black and White women diagnosed with breast cancer and living in the 50 largest US cities. Previous research has shown that while White women are more likely to be diagnosed with breast cancer, Black women are more likely to die from it.
The authors looked at data over a 20-year period (1990-2009) in 41 of the 50 largest US cities (data not available for 9 cities). The findings from this study support prior research: Black women suffered much higher breast cancer death rates than White women in many of the cities. In addition, the Black:White differences in breast cancer death rates worsened in most of the cities, and the US as a whole, over the 20-year period because the death rate for Black women remained about the same while the death rate for White women declined dramatically. To put this in perspective, the authors note that on any given day during the latest period of time explored in the study, 2005-2009, almost five more Black women died from breast cancer.
The authors offer four possible factors contributing to Black:White differences in breast cancer death rates: 1) differences in access to screening; 2) quality of the screening process; 3) differences in access to treatment; and, 4) quality of treatment. For all of these factors, the authors suggest that White women may have had better access to screening and treatment and received higher quality care during the period of time covered by the study due to socioeconomic and insurance status, In a previous study, the authors found median household income and racial segregation were significant predictors of differences in rates of breast cancer deaths.
In closing, the authors note that while a small proportion of the difference in death rates may be a result of the higher rates of triple-negative breast cancer for Black women, this factor, or any known genetic factor, can't explain the city by city differences they observed. Instead, the authors suggest we must address the four factors noted above to ensure all women have equal access to screening and treatment, and to survival.
Depressive Symptoms among Young Breast Cancer Survivors: The Importance of Reproductive Concerns
Posted June 2013
Multiple studies have shown that young breast cancer survivors have unique concerns, including those related to fertility and pregnancy, and higher levels of anxiety, distress, and need for social support. Beyond the first year from diagnosis, when depressive symptoms are associated more with diagnosis and treatment, personal and psychosocial characteristics, rather than those related to disease and treatment, tend to predict higher levels of depressive symptoms and anxiety.
This study explored if concerns about reproduction after breast cancer treatment contribute to long-term depressive symptoms in young women. 131 women diagnosed with early stage breast cancer at age 40 or younger participated. Most were enrolled 1.5 years post-diagnosis and followed for approximately 10 years.
The authors found that more reproductive concerns, as measured by participant responses on the Reproductive Concerns Scale (RCS), less social support, and poorer physical functioning were associated with higher depressive symptoms, and that higher levels of reproductive concerns predicted higher levels of depressive symptoms, even after controlling for social support and physical health. This suggests that reproductive concerns are uniquely associated with depression, regardless of level of social support or physical functioning. Other factors that associated with higher depressive symptoms included not having children, not having given birth before diagnosis, not avoiding pregnancy after diagnosis, treatment-related ovarian damage, and menopausal status.
These findings underscore the need for providing information and support to young survivors regarding reproductive issues. Oncology providers are in the best position to begin this discussion, and to refer to fertility specialists and psychosocial professionals for ongoing support.
Breast Cancer Research & Treatment, September 2010, Volume 123, pp. 477-485
To read the article, visit http://link.springer.com/content/pdf/10.1007%2Fs10549-010-0768-4.pdf
Expert Panel Recommends Breast Cancer Drugs for Healthy High-Risk Women
Posted May 2013
An expert panel from the United States Preventive Services Task Force has recommended that physicians caring for healthy women ages 40 to 70 assess the odds of their developing breast cancer and for those who have above-average risk prescribe either tamoxifen, commonly used to prevent recurrence in women who’ve already had breast cancer, or raloxifene, most often prescribed to prevent fractures in women with osteoporosis. The panel stated that doctors must also assess women’s risk of developing blood clots and strokes and only prescribe these drugs for women with low risk since blood clots and strokes can be serious side effects of both drugs. Other side effects include hot flashes and vaginal dryness and pain, and tamoxifen can also lead to cataracts and uterine cancer. The task force considered women who had at least 3 percent higher odds of developing breast cancer in the next five years as most likely to benefit from taking these drugs.
The panel estimated that out of 1,000 women with increased risk of breast cancer, there would be 23.5 cases of invasive breast cancer over five years. If these women took either tamoxifen or raloxifene, seven to nine cases of breast cancer would be prevented. Research has shown the drugs could reduce the incidence of invasive breast cancer by 30 to 68 percent and that tamoxifen may be more effective than raloxifene – but also more likely to cause blood clots and uterine cancer, especially in women over 50. Researchers noted that younger women who had biopsies positive for atypical hyperplasia may be among the best candidates for taking either drug and that a five-year course of treatment could have protective effects even after the drugs were stopped.
However, the panel noted that out of this same 1,000 women over five years, four to seven would develop blood clots, and four of those taking tamoxifen would develop uterine cancer. The panel recognized that both drugs have been recommended for years for women with above-average risk and that many women have opted not to take them due to the harmful and unpleasant side effects. The task force stated that the take-home message for women in this age group is to have a conversation with their physician about their breast cancer risk and preventive options.
The task force recommendations are published in draft form and are open for public comment until May 13 at www.uspreventiveservicestaskforce.org.
Click here to read a New York Times article on the topic.
New Study Finds Small Increase in Incidence of Advanced Breast Cancer in Young Women
Posted March 2013
Incidence of Breast Cancer With Distant Involvement Among Women in the United States, 1976 to 2009, Johnson R et al. JAMA. 2013;309(8):800-805.
In this study, the authors examined breast cancer incidence, incidence trends and survival rates in relation to age and extent of disease at diagnosis. Data was obtained from three U.S. National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registries. SEER defines localized disease as confined to the breast; regional disease as spread to adjacent organs or systems, such as lymph nodes or the chest wall; and distant disease as remote metastases, such as in the bone, brain and lung.
The findings show that since 1976, there's been a steady increase in the incidence of distant disease for 25- to 39-year-olds, from 1.53 per 100,000 women in 1976 to 2.90 per 100,000 in 2009. This represents an average increase of 2.07 percent over 34 years, a relatively small but significant increase. The authors noted no other age group or extent of disease subgroup of the same age range experienced a similar increase in incidence.
In this age group, there was increased incidence in distant disease for all races and ethnicities included in the SEER data, especially non-Hispanic white and African-American women. Incidence for women with estrogen receptor-positive disease increased more than women with estrogen receptor-negative disease. No differences in incidence were found for women living in metropolitan and nonmetropolitan areas.
To read the article, visit http://jama.jamanetwork.com/article.aspx?articleid=1656255.
Taking Tamoxifen for 10 Years May Further Reduce Recurrence and Mortality for Women With ER+ Early Breast Cancer
Posted February 2013
Long-term Effects of Continuing Adjuvant Tamoxifen to 10 Years Versus Stopping at Five Years After Diagnosis of Oestrogen Receptor-Positive Breast Cancer: ATLAS, a Randomized Trial, The Lancet, early online publication, Dec. 5, 2012.
This major study found that treatment with tamoxifen for women with ER+ breast cancer for 10 years, rather than the standard five, further reduces recurrence and mortality rates. In the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial, approximately 13,000 women with early breast cancer who had completed five years of treatment with tamoxifen were randomly assigned to continue tamoxifen to 10 years or stop at five. Among the study participants who had ER+ breast cancer (n=6,846), 18 percent of the five-year group and 19 percent of the 10-year group were 45 or younger when diagnosed.
The findings showed that compared to the five-year group, women taking tamoxifen for 10 years had fewer breast cancer recurrences during years five to 14 after diagnosis (21.4 versus 25.1 percent); lower mortality from breast cancer during years five to 14 (12.2 versus 15 percent); and lower overall mortality during years five to 14 (639 versus 722 deaths). The greatest improvements from 10-year tamoxifen use were shown in the second decade after diagnosis, or after year 10.
To read the article, visit www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61963-1/fulltext.
Larger Social Networks Associated With Longer Survival
Posted January 2013
Social Networks, Social Support and Burden in Relationships and Mortality After Breast Cancer Diagnosis in the Life After Breast Cancer Epidemiology (LACE) Study, Breast Cancer Research & Treatment, November 2012, Volume 137, pp. 261-271.
Social networks are commonly defined as the web of social relationships surrounding a person, and, for the purposes of this study, included spouse/intimate partner, religious/social ties, friendship ties, community ties and number of first-degree female relatives. This study included social network data from women in the LACE study who were diagnosed with early-stage invasive breast cancer. Study participants with larger social networks had higher levels of physical activity, lower alcohol intake, never smoked and were more likely to be married, have children and be involved in religious, social and community activities.
While previous research has shown larger social networks are associated with better survival after a breast cancer diagnosis, this study found that the impact of social networks on survival depends on the levels of social support and burden in relationships, or the quality of relationships. Overall, socially isolated women had higher risk of death but not from breast cancer. And only women with small social networks and low levels of support had a significantly higher risk of death from any cause. Women with small networks but high levels of support had no higher risk of death than women with large networks and high levels of support. Among study participants with low levels of family support, those with community and/or religious ties appeared to have better health outcomes.
Regarding the finding that smaller social networks and low levels of support were related to higher all-cause mortality but not to breast cancer-specific mortality, the authors suggest that social networks may play an important role in general health outcomes, particularly related to cardiovascular health. Specifically, since some breast cancer treatments can be cardiotoxic, it's possible that supportive social networks may help protect against cardiovascular problems, through reductions in cardiovascular reactivity and inflammation, and the benefits of stress reduction and increased physical activity related to social participation.
To read the article, visit http://link.springer.com/content/pdf/10.1007%2Fs10549-012-2253-8.
View Summaries From 2012