HIV Patients More Prone to 7 Kinds of Cancer

The weakened immune systems of people with HIV puts them at increased risk for at least seven types of cancer, but early diagnosis and treatment of HIV infection could help delay the onset of some of these cancers, a new study suggests.

French researchers examined the incidence of three AIDS-defining cancers (Kaposi's sarcoma, non-Hodgkin's lymphoma and cervical cancer) and four non-AIDS-defining cancers (Hodgkin's lymphoma, lung cancer, liver cancer and anal cancer) in 52,278 HIV-infected people.

The study authors also analyzed the association between immunodeficiency, viral load, antiretroviral treatment and the onset of the seven cancers. Overall, immunodeficiency increased the risk of all the cancers, and CD4 cell count was the most predictive risk factor for all the cancers except anal cancer. The cancer risk associated with viral load was lower than that associated with immunodeficiency, the researchers noted.

CD4 count was the only risk factor for Hodgkin's lymphoma, lung cancer and liver cancer, the study found. Increased risk of Kaposi's sarcoma and non-Hodgkin's lymphoma was associated with lower CD4 count, higher HIV viral load and a lack of combination antiretroviral therapy (cART).

A higher CD4 count was associated with a lower risk of cervical cancer, and patients taking cART were half as likely to develop cervical cancer. Anal cancer risk increased with the time during which CD4 count was less than 200 cells per microliter and viral load was greater than 100,000 copies per milliliter, according to the report.

The study appears online Oct. 7 in advance of publication in the November print issue of The Lancet Oncology.

"Our results suggest that cART would be most beneficial if it restores or maintains the CD4 count above 500 cells per microliter, thereby indicating an earlier diagnosis of HIV infection and earlier treatment initiation," the researchers wrote.

The study authors called for effective cancer-specific screening programs for HIV patients and said all HIV-positive women should be regularly offered cervical cancer screening.

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Novel Breast Tissue Feature May Predict Woman's Cancer Risk

The study shows that acini (AS-ih-nye), the small milk-producing elements in breast lobules, can be counted in sample biopsies. The percentage of acini present per lobule at a given age indicates cancer risk. Researchers say this method is more accurate in predicting risk for an individual than the Gail model (see National Cancer Institute).

"Aside from the predictors of heredity, there is no effective independent predictor of risk of breast cancer," says Lynn Hartmann, M.D., Mayo Clinic oncologist and senior author of the study. "This risk estimate model based on novel tissue in each individual may provide a reliable strategy."

Researchers studied the tissue structures in 85 patients with breast cancer and examined earlier, noncancerous breast biopsies from the same women. They compared them to 142 age-controlled samples from Mayo's Benign Breast Disease Cohort, a bio repository of benign biopsy tissues. Then, researchers developed the model and tested a risk prediction for each patient. For the same women, they used the existing Gail model to make five-year risk predictions for the same women. While helpful in determining increased risk in groups of women, the Gail model is only slightly better than a guess when it comes to predicting cancer for an individual, the researchers say.

"Women who were more likely to develop breast cancer had larger lobules with more acini," explains Dr. Hartmann.

Significance of the Findings

As women age, especially as they approach menopause, the risk of breast cancer declines because the lobules and acini disappear. This natural process, called involution, is at the core of this risk factor. Dr. Hartmann says if the lobules aren't largely gone by the time a woman is 55, her risk of breast cancer triples. By looking closely at the structures in a large sample of benign tissues, the researchers were able to note standard measurements for lobule size and number of acini in the lobules. This twofold approach led to development of accurate metrics on which to base individual risk. The team hopes this new model, combined with other patient information and assessments, will greatly improve a physician's ability to predict cancer risk for individual patients.

Others on the research team are Kevin McKian, M.D.; Carol Reynolds, M.D.; Daniel Visscher, M.D.; Aziza Nassar, M.D.; Derek Radisky, Ph.D.; Robert Vierkant; Amy Degnim, M.D.; Judy Boughey, M.D.; Karthik Ghosh, M.D.; Stephanie Anderson; Douglas Minot; Jill Caudill; Celine Vachon, Ph.D.; Marlene Frost, Ph.D.; and V. Shane Pankratz, Ph.D.; all of Mayo Clinic. The research was supported by the Department of Defense, Martha and Bruce Atwater, the National Institutes of Health, and the Katherine B. Anderson Foundation.

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Loneliness could heighten risk of breast cancer, study finds

Scientists in the United States who isolated cancer-prone mice found they developed larger tumours than animals with companions.

The socially deprived mice experienced gene activity changes in their mammary glands that were associated with cancer growth.

It is likely the findings have implications for human health – and not solely with regard to breast cancer, the researchers believe.

"This is a novel finding and may begin to explain how the environment affects human susceptibility to other chronic diseases such as central obesity, type 2 diabetes, hypertension (high blood pressure), etc," said study leader Dr Suzanne Conzen, from the University of Chicago.

The results suggest new targets for treatments that might reverse the effects.

Previous data from clinical trials have indicated that social support can improve the prospects of women with breast cancer.

Epidemiological studies suggest that social isolation increases death rates associated with several chronic diseases.

Dr Conzen's team took mice that were genetically predisposed to develop breast cancer and raised them in two different environments.

Mice from one group were kept on their own from the time they were first separated from their mothers. Those in the other group were allowed to mingle with other animals.

After the same amount of time, the isolated mice grew significantly larger mammary gland tumours.

They also showed signs of heightened stress, marked by raised levels of the stress hormone corticosterone.

"Despite the genetic similarity of the mice assigned to grouped versus isolated housing, living in the stressful environment was associated with greater tumour size, suggesting that the social environment may in fact alter the biology of cancer growth," said Dr Conzen.

Examination of DNA from the animals' mammary tissues revealed alterations in the activity of metabolism genes that were likely to fuel tumour growth.

These changes occurred even before tumour size differences were measurable.

The gene "expression patterns" indicated potential targets for preventive treatment.

"Given the increased knowledge of the human genome (genetic code map) we can begin to objectively identify and dissect the specific alterations that take place in cancer-prone tissues of individuals in at-risk environments and that will help us to better understand and implement cancer prevention strategies," said Dr Conzen.

Dr Caryn Lerman, deputy editor of the journal Cancer Prevention Research, which published the findings, said: "This study uses an elegant preclinical model and shows that social isolation alters expression of genes important in mammary gland tumour growth.

"It further elucidates the molecular mechanisms linking environmental stress with breast cancer development and progression."


Artist Luke Jerram's viral sculptures trap bacteria and viruses like Swine Flu, HIV and E-coli in glass
The artist with multiple personalities
Kindred Spirits

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Cervical cancer vaccinations resume

Family members confirmed the 14-year-old had been ill 'for some time' and said they were satisfied that the vaccine had not caused her death.

School and primary care trusts around the country had suspended their vaccination programmes while the batch involved was identified and sent back GlaxoSmithKline, the maker, for testing.
The recall was being carried out as a precaution, a spokesman for Glaxo said, and was instigated before results from the post mortem were available which showed the vaccine was 'unlikely' to have been related to the death.

Tens of thousands of doses of vaccine are involved in the recall and as a result some areas will not have had enough supplies to continue vaccinating, a spokesman for the Department of Health said.

Local arrangements were being put in place to share out batches of the vaccine unaffected by the recall and more stocks were being ordered.

Natalie Morton collapsed at Blue Coat School, in Coventry, on Monday hours after being given the Cervarix vaccine, against the humanpapilloma virus which causes 70 per cent of cervical cancers.

She died later in hospital and fears were prompted the vaccine may have been faulty or she may have suffered a reaction to it.

However last night a spokesman for Coventry PCT said post mortem results had found a 'serious underlying medical condition which was likely to have caused death'.

The vaccination programme there will resume on Monday and in other areas of the country the immunisations were being rescheduled.

A spokesman for Coventry PCT said: “It is an extremely rare health problem for a girl of Natalie’s age to suffer.”

Natalie’s stepfather, Andrew Bullock, said yesterday that she had been unwell for “some time” and that the family now believed the vaccine had not caused her death.

Mr Bullock said: “Natalie has been poorly for some time. She had not been to hospital but she was receiving medication and doctors have been involved.

“I don’t wish to say anything more about Natalie’s illness but let’s just say that sometimes things go on inside people’s bodies that we are not always aware of.

“We now believe that her death may not have been linked to the vaccine. We are waiting to hear the results of the post mortem to find out more.

“We are happy with the way the way that the school and the primary care trust have handled the situation. The school was not aware of Natalie's condition.

“We are now trying come to terms with our loss.”

A Department of Health spokesman said: "Preliminary results from the autopsy on Natalie Morton, who sadly died on Monday confirm that she had a rare and grave underlying medical condition that was likely to have caused her death.

"Before this was known, the vaccine manufacturer voluntarily initiated a recall of one batch of vaccine as a precautionary measure.

"We have been clear all along that there is no reason to suspend HPV immunisation - the programme against cervical cancer continues today.

"Some areas may have minor interruptions to the immunisation programme because they do not have sufficient stock of vaccine - this is a temporary situation following the precautionary batch recall by the manufacturer.

Others may have decided to pause to make sure parents and girls have all the facts they need, he added.

"We have one of the most successful immunisation programmes in the world

and have great confidence in the safety of them. Young girls can continue

to protect themselves against cervical cancer by having this vaccine.

"The Department of Health strongly recommends that local immunisation

continues as soon as possible

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Regular exercise 'can cut chance of developing breast cancer

Researchers found that older women who worked out for an hour a day, or just seven hours a week, could cut their chance of developing the disease by 16 per cent.

The exercise had to be of moderate to vigorous intensity but could include walking, hiking, swimming and some strenuous forms of gardening to have the protective effect.
The study looked at the exercise history of more than 110,000 women who had all who had gone through the menopause, the group most at risk of developing the disease.

They found that those who had exercised regularly for the last 10 years had cut their risk of developing breast cancer.

However, regular exercise at a younger age appeared to offer no protection from the disease.

The research team, from the American National Cancer Institute in Maryland, believe that the findings could indicate that exercise regulates sex hormones, which have been shown to drive growth in some cancers.

Breast cancer affects 37,000 women in Britain every year, and around 12,000 women die from the disease annually.

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Mastectomies on increase

In a stark reversal of a long-term trend, more early-stage breast cancer patients are choosing mastectomy, despite evidence that the aggressive, disfiguring surgery has the same survival rate as removing the malignant lump, new research shows.

The study by doctors at the Mayo Clinic in Rochester, Minn., suggests that a more detailed screening technique may have led additional women to have their breasts removed.But researchers also found a rise in mastectomies among women who weren't examined with the new magnetic resonance imaging technology. Some doctors say more women are opting to have their breasts removed because of an overwhelming fear the cancer will return.

"For some women, their quality of life is better with their breasts removed because you get rid of the concern, the anxiety" about recurrence, said Dr. Lisa Jacobs, a surgical oncologist with the Johns Hopkins Breast Center who was not affiliated with the study. "A lot of women come in and say, `I don't ever want to do this again.'"

Still, doctors worry that some patients are being treated too aggressively because many of the cancers spotted by ultra-sensitive MRI would never develop into dangerous tumors. There is also no research on whether the use of MRI improves overall survival.

The study found that 43 percent of breast cancer patients chose mastectomy at the Mayo Clinic in 2006 - up from 30 percent three years earlier. The 2006 rate was almost the same as the 45 percent of breast cancer patients who had mastectomies in 1997.

Fifty-two percent of women who had an MRI in 2006 had mastectomies, but so did 41 percent of women who didn't have an MRI.

Anecdotal evidence - and a recent study showing more breast cancer patients choosing prophylactic mastectomy in the cancer-free breast - suggests that the trend extends beyond the Mayo Clinic.

"Are we doing the right thing for women? Is converting a woman to mastectomy ... will that lead to a better clinical outcome?" said Matthew P. Goetz, assistant professor of oncology at the Mayo Clinic and one author of the study.

Goetz, who spoke to reporters yesterday, will present the paper May 31 at the American Society of Clinical Oncology's annual meeting in Chicago. The work was released yesterday along with nearly 5,000 other abstracts in advance of the conference.

The unusual data release occurred because some drug company stock prices fluctuated suddenly in past years between the time ASCO members got copies of the abstracts and the time they were publicly released. Some of the research papers involve trials of cancer drugs. To prevent a repeat, ASCO decided to release nearly all of the material at once this year.

Mastectomy rates began to decline nationwide soon after a 1990 National Institutes of Health Consensus Panel reported that breast conservation surgery - lumpectomy plus radiation therapy - was as effective as mastectomy for overall survival of most women with early-stage breast cancer. There was some increased risk of cancer recurrence when a breast was left behind, the group said.

The medical community began to view high mastectomy rates as a negative, counting against hospital rating scores, with the implication that a center with high rates wasn't up on new techniques and treatments.

There was a sense that paternalistic doctors were encouraging women to undergo major surgery when it wasn't necessary. But Jacobs said she thinks today's return to mastectomies is about something else.

"Before, it was felt the physicians were pushing it," she said. "It's the patients pushing it now."

Jacobs and other physicians also cited a new feeling of empowerment on the part of patients - mixed with more available treatment information, genetic testing and better breast reconstruction surgery.

"People want to have their breast cancer treated and reduce the chances that they'll have to face it again," said Dr. Stephen Grobmyer, a surgical oncologist at the University of Florida's Shands Cancer Center in Gainesville. "We see patients every week that are very educated and in many cases know what they want: It's mastectomy."

Jacobs said she always explains all of the options to her patients. Whenever appropriate, she starts the conversation with, "You are a perfect candidate for lumpectomy."

But a patient's concerns may go beyond that. Many women who get mastectomies don't need chemotherapy or radiation, eliminating the side effects and hardships of five-day-a-week radiation for six weeks after a lumpectomy.

An MRI does help find more cancers - about 3 percent in one study. But it is also associated with a high number of false-positive results - 75 percent in another study.

Doctors recommend an MRI for women who have a genetic trait associated with breast cancer or a family history of the disease. An MRI, which uses powerful magnetic fields, radio waves and a computer to produce detailed pictures, tends to work better than mammograms in detecting abnormalities in women with dense breast tissue.

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More women with breast cancer opt to remove healthy breast

A rising number of women are choosing to remove a healthy breast after being diagnosed with breast cancer -- even though there is little evidence that doing so improves survival, a new study found.

The research, which appears in Cancer, the journal of the American Cancer Society, examined data from 6,275 New York state women, who had prophylactic mastectomies -- removal of a non-cancerous breast as a preventive measure.

Researchers looked at women who had a healthy breast removed after the discovery of cancer in the other breast as well as woman without cancer who had both breasts removed, but had a strong family history of the disease or a gene making them more susceptible to it.

From 1995 to 2005, the number of women who had cancer in one breast and choose to have the other breast removed more than doubled. Those with no personal history of breast cancer who had both breasts removed also increased, but slightly.

While the number of these kinds of mastectomies remains small, they're rising and such surgery comes with risks. Other studies reveal increases in overal mastectomies, raising concerns that some women are being treated too aggressively and whether doctors are doing the right thing for patients.

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