Breast Cancer

Legislation introduced in the U.S. House of Representatives would require that women be informed of their breast density when they receive their mammogram results, and that those with denser breasts be advised that they could benefit from additional screening.

The Breast Density and Mammography Reporting Act of 2011 (H.R. 3102), introduced in October by Rep. Rosa DeLauro (D-Conn.) and Rep. Steve Israel (D-N.Y.), is modeled after laws enacted in Connecticut in 2009 and in Texas earlier this year. Similar legislation was recently passed by the California legislature, but was vetoed by the governor.

Bills on breast density are also slated to be introduced in at least six other states next year, according to the consumer advocacy group Are You Dense.

The movement to pass these bills has grown largely from the outrage of women who have received years of normal mammogram results only to find out that they have an advanced-stage breast cancer that went undetected because of their dense breast tissue.

That was the experience of Are You Dense founder Nancy M. Cappello, Ph.D., who successfully lobbied lawmakers to enact the Connecticut legislation.

Although information on breast density is available on the mammography report sent to referring physicians, it’s not mentioned in the "lay letter" received by women, Dr. Cappello said. That leaves most women in the dark about the fact that dense breasts can make mammograms more difficult to read, and that women with extremely dense breasts are at a higher risk for breast cancer, she said.

"It’s a hoax in some respects, a cruel hoax," she said.

Are You Dense and its supporters around the country have been working state by state to enact laws that require that women be notified of their breast density and their options for additional screening. They are also working at the federal level to change either the law or the regulations surrounding mammography.

Dr. Cappello said that trying to legislate the change wasn’t her first choice, but without a national cancer organization or physician group stepping up to educate women, she doesn’t have a better option for standardizing the communication on breast density.

On Nov. 4, Dr. Cappello will take her case to the Food and Drug Administration’s National Mammography Quality Assurance Advisory Committee. She plans to ask the committee, which provided nonbinding advice to the FDA, to recommend changing the federally mandated lay letter to include information on breast density.

So far, Dr. Cappello’s efforts have failed to gain support from major physician groups and patient advocacy organizations. Susan G. Komen for the Cure and the American Cancer Society both stayed on the sidelines during the recent legislative debate in California. The California chapter of the American College of Obstetricians and Gynecologists and the California Medical Association opposed the bill.

"It was a very difficult bill for us to oppose," said Dr. Philip Diamond, a San Diego ob.gyn. and chair of ACOG District IX in California.

The problem was that the bill went beyond notifying women about their density and on to suggest that they speak with their physician about supplemental screening. The bill’s language on supplemental screening goes beyond the existing evidence, Dr. Diamond said, and raised a host of concerns about what the cost of screening would mean for state-funded health programs.

"In the absence of a guideline nationally by either the cancer society or the radiology society or anyone, it’s impossible to be able to figure out who needs supplement screening and who doesn’t," he said.

A big concern in California, Dr. Diamond said, is that such legislation would lead to the automatic ordering of supplemental ultrasounds and MRIs, regardless of the individual risk factors of the women involved.

That’s exactly what has happened after the Connecticut law was enacted, according to New Haven ob.gyn. Howard Shaw, vice chair for the Connecticut section of ACOG.

Although the law has probably raised some awareness of the breast density issues for women, it has also sparked a reflexive ordering of supplemental testing for any women with dense breasts, he said, adding that the ordering is largely driven by liability concerns.

"There is a feeling by many that we’re just going to order it because if we don’t order it and something happens, we’re going to have a problem," said Dr. Steven Fleischman, associate chief of ob.gyn. at Yale–New Haven Hospital and the legislative chair of ACOG District I.

Another problem with the Connecticut law is that there’s a lack of data on how it’s working, he said. Because there was no tracking component built into the law, there are many lingering questions about the number of supplemental tests, the additional costs, and whether more cancers are being detected earlier, he said.

"It’s not just about cost; it’s about ‘Are we getting more cases, and are we getting them earlier,’ " Dr. Fleischman said.

Legislation introduced in the U.S. House of Representatives would require that women be informed of their breast density when they receive their mammogram results, and that those with denser breasts be advised that they could benefit from additional screening.

The Breast Density and Mammography Reporting Act of 2011 (H.R. 3102), introduced in October by Rep. Rosa DeLauro (D-Conn.) and Rep. Steve Israel (D-N.Y.), is modeled after laws enacted in Connecticut in 2009 and in Texas earlier this year. Similar legislation was recently passed by the California legislature, but was vetoed by the governor.

Bills on breast density are also slated to be introduced in at least six other states next year, according to the consumer advocacy group Are You Dense.

The movement to pass these bills has grown largely from the outrage of women who have received years of normal mammogram results only to find out that they have an advanced-stage breast cancer that went undetected because of their dense breast tissue.

That was the experience of Are You Dense founder Nancy M. Cappello, Ph.D., who successfully lobbied lawmakers to enact the Connecticut legislation.

Although information on breast density is available on the mammography report sent to referring physicians, it’s not mentioned in the "lay letter" received by women, Dr. Cappello said. That leaves most women in the dark about the fact that dense breasts can make mammograms more difficult to read, and that women with extremely dense breasts are at a higher risk for breast cancer, she said.

"It’s a hoax in some respects, a cruel hoax," she said.

Are You Dense and its supporters around the country have been working state by state to enact laws that require that women be notified of their breast density and their options for additional screening. They are also working at the federal level to change either the law or the regulations surrounding mammography.

Dr. Cappello said that trying to legislate the change wasn’t her first choice, but without a national cancer organization or physician group stepping up to educate women, she doesn’t have a better option for standardizing the communication on breast density.

On Nov. 4, Dr. Cappello will take her case to the Food and Drug Administration’s National Mammography Quality Assurance Advisory Committee. She plans to ask the committee, which provided nonbinding advice to the FDA, to recommend changing the federally mandated lay letter to include information on breast density.

So far, Dr. Cappello’s efforts have failed to gain support from major physician groups and patient advocacy organizations. Susan G. Komen for the Cure and the American Cancer Society both stayed on the sidelines during the recent legislative debate in California. The California chapter of the American College of Obstetricians and Gynecologists and the California Medical Association opposed the bill.

"It was a very difficult bill for us to oppose," said Dr. Philip Diamond, a San Diego ob.gyn. and chair of ACOG District IX in California.

The problem was that the bill went beyond notifying women about their density and on to suggest that they speak with their physician about supplemental screening. The bill’s language on supplemental screening goes beyond the existing evidence, Dr. Diamond said, and raised a host of concerns about what the cost of screening would mean for state-funded health programs.

"In the absence of a guideline nationally by either the cancer society or the radiology society or anyone, it’s impossible to be able to figure out who needs supplement screening and who doesn’t," he said.

A big concern in California, Dr. Diamond said, is that such legislation would lead to the automatic ordering of supplemental ultrasounds and MRIs, regardless of the individual risk factors of the women involved.

That’s exactly what has happened after the Connecticut law was enacted, according to New Haven ob.gyn. Howard Shaw, vice chair for the Connecticut section of ACOG.

Although the law has probably raised some awareness of the breast density issues for women, it has also sparked a reflexive ordering of supplemental testing for any women with dense breasts, he said, adding that the ordering is largely driven by liability concerns.

"There is a feeling by many that we’re just going to order it because if we don’t order it and something happens, we’re going to have a problem," said Dr. Steven Fleischman, associate chief of ob.gyn. at Yale–New Haven Hospital and the legislative chair of ACOG District I.

Another problem with the Connecticut law is that there’s a lack of data on how it’s working, he said. Because there was no tracking component built into the law, there are many lingering questions about the number of supplemental tests, the additional costs, and whether more cancers are being detected earlier, he said.

"It’s not just about cost; it’s about ‘Are we getting more cases, and are we getting them earlier,’ " Dr. Fleischman said.

Legislation introduced in the U.S. House of Representatives would require that women be informed of their breast density when they receive their mammogram results, and that those with denser breasts be advised that they could benefit from additional screening.

The Breast Density and Mammography Reporting Act of 2011 (H.R. 3102), introduced in October by Rep. Rosa DeLauro (D-Conn.) and Rep. Steve Israel (D-N.Y.), is modeled after laws enacted in Connecticut in 2009 and in Texas earlier this year. Similar legislation was recently passed by the California legislature, but was vetoed by the governor.

Bills on breast density are also slated to be introduced in at least six other states next year, according to the consumer advocacy group Are You Dense.

The movement to pass these bills has grown largely from the outrage of women who have received years of normal mammogram results only to find out that they have an advanced-stage breast cancer that went undetected because of their dense breast tissue.

That was the experience of Are You Dense founder Nancy M. Cappello, Ph.D., who successfully lobbied lawmakers to enact the Connecticut legislation.

Although information on breast density is available on the mammography report sent to referring physicians, it’s not mentioned in the "lay letter" received by women, Dr. Cappello said. That leaves most women in the dark about the fact that dense breasts can make mammograms more difficult to read, and that women with extremely dense breasts are at a higher risk for breast cancer, she said.

"It’s a hoax in some respects, a cruel hoax," she said.

Are You Dense and its supporters around the country have been working state by state to enact laws that require that women be notified of their breast density and their options for additional screening. They are also working at the federal level to change either the law or the regulations surrounding mammography.

Dr. Cappello said that trying to legislate the change wasn’t her first choice, but without a national cancer organization or physician group stepping up to educate women, she doesn’t have a better option for standardizing the communication on breast density.

On Nov. 4, Dr. Cappello will take her case to the Food and Drug Administration’s National Mammography Quality Assurance Advisory Committee. She plans to ask the committee, which provided nonbinding advice to the FDA, to recommend changing the federally mandated lay letter to include information on breast density.

So far, Dr. Cappello’s efforts have failed to gain support from major physician groups and patient advocacy organizations. Susan G. Komen for the Cure and the American Cancer Society both stayed on the sidelines during the recent legislative debate in California. The California chapter of the American College of Obstetricians and Gynecologists and the California Medical Association opposed the bill.

"It was a very difficult bill for us to oppose," said Dr. Philip Diamond, a San Diego ob.gyn. and chair of ACOG District IX in California.

The problem was that the bill went beyond notifying women about their density and on to suggest that they speak with their physician about supplemental screening. The bill’s language on supplemental screening goes beyond the existing evidence, Dr. Diamond said, and raised a host of concerns about what the cost of screening would mean for state-funded health programs.

"In the absence of a guideline nationally by either the cancer society or the radiology society or anyone, it’s impossible to be able to figure out who needs supplement screening and who doesn’t," he said.

A big concern in California, Dr. Diamond said, is that such legislation would lead to the automatic ordering of supplemental ultrasounds and MRIs, regardless of the individual risk factors of the women involved.

That’s exactly what has happened after the Connecticut law was enacted, according to New Haven ob.gyn. Howard Shaw, vice chair for the Connecticut section of ACOG.

Although the law has probably raised some awareness of the breast density issues for women, it has also sparked a reflexive ordering of supplemental testing for any women with dense breasts, he said, adding that the ordering is largely driven by liability concerns.

"There is a feeling by many that we’re just going to order it because if we don’t order it and something happens, we’re going to have a problem," said Dr. Steven Fleischman, associate chief of ob.gyn. at Yale–New Haven Hospital and the legislative chair of ACOG District I.

Another problem with the Connecticut law is that there’s a lack of data on how it’s working, he said. Because there was no tracking component built into the law, there are many lingering questions about the number of supplemental tests, the additional costs, and whether more cancers are being detected earlier, he said.

"It’s not just about cost; it’s about ‘Are we getting more cases, and are we getting them earlier,’ " Dr. Fleischman said.

Women who undergo radiotherapy to the conserved breast after breast-conserving cancer surgery can expect a reduction in the rate of recurrence (locoregional or distant) of approximately 50% and a reduction in the rate of death from breast cancer of about one sixth. Those are the latest findings from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), published online in The Lancet.¹

The EBCTCG report updates earlier analyses of individual patient data from randomized trials of radiotherapy after breast-conserving therapy. It adds follow-up data from nine of 10 trials analyzed earlier. It also includes information from seven new trials (six of them in low-risk women). Overall, it boosts the total number of women analyzed by almost 50%.¹

The EBCTCG performed a meta-analysis using individual patient data from 10,801 women in 17 randomized trials of radiotherapy versus no radiotherapy after breast-conserving surgery. Of these women, 8,337 had pathologically confirmed lymph node status (7,287 with negative nodes and 1,050 with positive nodes).

Among the findings:

• Women randomized to radiotherapy had an average annual rate of any first recurrence 50% lower than the women who underwent surgery alone (rate ratio, 0.52; 95% confidence interval [CI], 0.48–0.56), with the greatest reduction seen in the first year after treatment (rate ratio, 0.31; 95% CI, 0.26–0.37). The reduction in the rate of recurrence persisted during years 5–9 (rate ratio, 0.59; 95% CI, 0.50–0.70).
• Women allocated to radiotherapy had a reduction in the risk of death from breast cancer of about 17% (rate ratio, 0.82; 95% CI, 0.75–0.90).
• Women who had negative nodes experienced a reduction in the average annual recurrence rate of about 50% during the first decade (rate ratio, 0.46; 95% CI, 0.41–0.51), lowering the 10-year-risk of any first recurrence from 31.0% to 15.6%, an absolute reduction of 15.4% (95% CI, 13.2–17.6; 2p<.00001).
• For women who had positive nodes, randomization to radiotherapy reduced the 1-year risk of recurrence from 26.0% to 5.1%, a fivefold reduction (rate ratio, 0.20; 95% CI, 0.14–0.29)
• Overall, one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10.

“The overall findings from these trials show that radiotherapy after breast-conserving surgery not only substantially reduces the risk of recurrence but also moderately reduces the risk of death from breast cancer,” the investigators write. “These results suggest that killing microscopic tumor foci in the conserved breast with radiotherapy reduces the potential for both local recurrence and distant metastasis.”

We want to hear from you!  Tell us what you think.

Women who undergo radiotherapy to the conserved breast after breast-conserving cancer surgery can expect a reduction in the rate of recurrence (locoregional or distant) of approximately 50% and a reduction in the rate of death from breast cancer of about one sixth. Those are the latest findings from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), published online in The Lancet.¹

The EBCTCG report updates earlier analyses of individual patient data from randomized trials of radiotherapy after breast-conserving therapy. It adds follow-up data from nine of 10 trials analyzed earlier. It also includes information from seven new trials (six of them in low-risk women). Overall, it boosts the total number of women analyzed by almost 50%.¹

The EBCTCG performed a meta-analysis using individual patient data from 10,801 women in 17 randomized trials of radiotherapy versus no radiotherapy after breast-conserving surgery. Of these women, 8,337 had pathologically confirmed lymph node status (7,287 with negative nodes and 1,050 with positive nodes).

Among the findings:

• Women randomized to radiotherapy had an average annual rate of any first recurrence 50% lower than the women who underwent surgery alone (rate ratio, 0.52; 95% confidence interval [CI], 0.48–0.56), with the greatest reduction seen in the first year after treatment (rate ratio, 0.31; 95% CI, 0.26–0.37). The reduction in the rate of recurrence persisted during years 5–9 (rate ratio, 0.59; 95% CI, 0.50–0.70).
• Women allocated to radiotherapy had a reduction in the risk of death from breast cancer of about 17% (rate ratio, 0.82; 95% CI, 0.75–0.90).
• Women who had negative nodes experienced a reduction in the average annual recurrence rate of about 50% during the first decade (rate ratio, 0.46; 95% CI, 0.41–0.51), lowering the 10-year-risk of any first recurrence from 31.0% to 15.6%, an absolute reduction of 15.4% (95% CI, 13.2–17.6; 2p<.00001).
• For women who had positive nodes, randomization to radiotherapy reduced the 1-year risk of recurrence from 26.0% to 5.1%, a fivefold reduction (rate ratio, 0.20; 95% CI, 0.14–0.29)
• Overall, one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10.

“The overall findings from these trials show that radiotherapy after breast-conserving surgery not only substantially reduces the risk of recurrence but also moderately reduces the risk of death from breast cancer,” the investigators write. “These results suggest that killing microscopic tumor foci in the conserved breast with radiotherapy reduces the potential for both local recurrence and distant metastasis.”

We want to hear from you!  Tell us what you think.

Women who undergo radiotherapy to the conserved breast after breast-conserving cancer surgery can expect a reduction in the rate of recurrence (locoregional or distant) of approximately 50% and a reduction in the rate of death from breast cancer of about one sixth. Those are the latest findings from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), published online in The Lancet.¹

The EBCTCG report updates earlier analyses of individual patient data from randomized trials of radiotherapy after breast-conserving therapy. It adds follow-up data from nine of 10 trials analyzed earlier. It also includes information from seven new trials (six of them in low-risk women). Overall, it boosts the total number of women analyzed by almost 50%.¹

The EBCTCG performed a meta-analysis using individual patient data from 10,801 women in 17 randomized trials of radiotherapy versus no radiotherapy after breast-conserving surgery. Of these women, 8,337 had pathologically confirmed lymph node status (7,287 with negative nodes and 1,050 with positive nodes).

Among the findings:

• Women randomized to radiotherapy had an average annual rate of any first recurrence 50% lower than the women who underwent surgery alone (rate ratio, 0.52; 95% confidence interval [CI], 0.48–0.56), with the greatest reduction seen in the first year after treatment (rate ratio, 0.31; 95% CI, 0.26–0.37). The reduction in the rate of recurrence persisted during years 5–9 (rate ratio, 0.59; 95% CI, 0.50–0.70).
• Women allocated to radiotherapy had a reduction in the risk of death from breast cancer of about 17% (rate ratio, 0.82; 95% CI, 0.75–0.90).
• Women who had negative nodes experienced a reduction in the average annual recurrence rate of about 50% during the first decade (rate ratio, 0.46; 95% CI, 0.41–0.51), lowering the 10-year-risk of any first recurrence from 31.0% to 15.6%, an absolute reduction of 15.4% (95% CI, 13.2–17.6; 2p<.00001).
• For women who had positive nodes, randomization to radiotherapy reduced the 1-year risk of recurrence from 26.0% to 5.1%, a fivefold reduction (rate ratio, 0.20; 95% CI, 0.14–0.29)
• Overall, one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10.

“The overall findings from these trials show that radiotherapy after breast-conserving surgery not only substantially reduces the risk of recurrence but also moderately reduces the risk of death from breast cancer,” the investigators write. “These results suggest that killing microscopic tumor foci in the conserved breast with radiotherapy reduces the potential for both local recurrence and distant metastasis.”

We want to hear from you!  Tell us what you think.

A preplanned interim analysis of the phase III BOLERO- 2 trial in women with advanced hormone-resistant, estrogen receptor– positive (ER+) breast cancer showed that everolimus (Afinitor) combined with the aromatase inhibitor exemestane increased progression-free survival (PFS), by local assessment, from a median of 2.8 months with exemestane alone to 6.9 months—a 57% risk reduction (hazard ratio [HR], 0.43; P = 1.4 × 10–15). The results were presented at the recent 2011 European Multidisciplinary Cancer Congress in Stockholm, Sweden.¹

Based on central assessment, the everolimus-exemestane combination produced a 64% reduction in the risk of progression or death (10.6 months vs 4.1 months; HR = 0.36; P = 3.3 × 10–15), according to lead investigator José Baselga, MD, PhD, of the Massachusetts General Hospital Cancer Center in Boston.

The researchers evaluated everolimus because the mammalian target of rapamycin (mTOR) pathway is activated in hormone therapy–resistant advanced breast cancer. Phase II everolimus trials have suggested that the mTORC1 inhibitor could reverse resistance to endocrine therapy.2

The group enrolled 724 postmenopausal women (median age, 62 years) with advanced ER+, human epidermal growth factor receptor 2–negative (HER2–) breast cancer who were refractory to letrozole or anastrozole. Previous treatment also included chemotherapy for metastatic disease in roughly 68% of the patients, tamoxifen in 48%, and fulvestrant (Faslodex) in about 16%. The patients were randomized to treatment with everolimus 10 mg/d or placebo, with both arms receiving exemestane 25 mg/d. Treatment was continued until disease progression or unacceptable toxicity occurred. The primary endpoint was PFS, as assessed by the investigators; secondary endpoints included survival, response rate, and safety. The preplanned interim analysis was performed and reviewed by an independent data monitoring committee after observing 359 PFS events.

* For a PDF of the full article, click in the link to the left of this introduction.

A preplanned interim analysis of the phase III BOLERO- 2 trial in women with advanced hormone-resistant, estrogen receptor– positive (ER+) breast cancer showed that everolimus (Afinitor) combined with the aromatase inhibitor exemestane increased progression-free survival (PFS), by local assessment, from a median of 2.8 months with exemestane alone to 6.9 months—a 57% risk reduction (hazard ratio [HR], 0.43; P = 1.4 × 10–15). The results were presented at the recent 2011 European Multidisciplinary Cancer Congress in Stockholm, Sweden.¹

Based on central assessment, the everolimus-exemestane combination produced a 64% reduction in the risk of progression or death (10.6 months vs 4.1 months; HR = 0.36; P = 3.3 × 10–15), according to lead investigator José Baselga, MD, PhD, of the Massachusetts General Hospital Cancer Center in Boston.

The researchers evaluated everolimus because the mammalian target of rapamycin (mTOR) pathway is activated in hormone therapy–resistant advanced breast cancer. Phase II everolimus trials have suggested that the mTORC1 inhibitor could reverse resistance to endocrine therapy.2

The group enrolled 724 postmenopausal women (median age, 62 years) with advanced ER+, human epidermal growth factor receptor 2–negative (HER2–) breast cancer who were refractory to letrozole or anastrozole. Previous treatment also included chemotherapy for metastatic disease in roughly 68% of the patients, tamoxifen in 48%, and fulvestrant (Faslodex) in about 16%. The patients were randomized to treatment with everolimus 10 mg/d or placebo, with both arms receiving exemestane 25 mg/d. Treatment was continued until disease progression or unacceptable toxicity occurred. The primary endpoint was PFS, as assessed by the investigators; secondary endpoints included survival, response rate, and safety. The preplanned interim analysis was performed and reviewed by an independent data monitoring committee after observing 359 PFS events.

* For a PDF of the full article, click in the link to the left of this introduction.

A preplanned interim analysis of the phase III BOLERO- 2 trial in women with advanced hormone-resistant, estrogen receptor– positive (ER+) breast cancer showed that everolimus (Afinitor) combined with the aromatase inhibitor exemestane increased progression-free survival (PFS), by local assessment, from a median of 2.8 months with exemestane alone to 6.9 months—a 57% risk reduction (hazard ratio [HR], 0.43; P = 1.4 × 10–15). The results were presented at the recent 2011 European Multidisciplinary Cancer Congress in Stockholm, Sweden.¹

Based on central assessment, the everolimus-exemestane combination produced a 64% reduction in the risk of progression or death (10.6 months vs 4.1 months; HR = 0.36; P = 3.3 × 10–15), according to lead investigator José Baselga, MD, PhD, of the Massachusetts General Hospital Cancer Center in Boston.

The researchers evaluated everolimus because the mammalian target of rapamycin (mTOR) pathway is activated in hormone therapy–resistant advanced breast cancer. Phase II everolimus trials have suggested that the mTORC1 inhibitor could reverse resistance to endocrine therapy.2

The group enrolled 724 postmenopausal women (median age, 62 years) with advanced ER+, human epidermal growth factor receptor 2–negative (HER2–) breast cancer who were refractory to letrozole or anastrozole. Previous treatment also included chemotherapy for metastatic disease in roughly 68% of the patients, tamoxifen in 48%, and fulvestrant (Faslodex) in about 16%. The patients were randomized to treatment with everolimus 10 mg/d or placebo, with both arms receiving exemestane 25 mg/d. Treatment was continued until disease progression or unacceptable toxicity occurred. The primary endpoint was PFS, as assessed by the investigators; secondary endpoints included survival, response rate, and safety. The preplanned interim analysis was performed and reviewed by an independent data monitoring committee after observing 359 PFS events.

* For a PDF of the full article, click in the link to the left of this introduction.

Women who don’t carry their family’s BRCA1 or BRCA2 mutation showed no increase in breast cancer risk in a study of 3,047 population-based families reported online Oct. 31 in the Journal of Clinical Oncology.

"These results support the standard clinical practice of advising noncarriers that they do not have any increase in breast cancer risk attributable to the family-specific BRCA mutation and, in the absence of other strong risk factors, should follow general population guidelines for breast cancer screening," said Dr. Allison W. Kurian of Stanford (Calif.) University and her associates.

Some recent studies have suggested that noncarriers of a family-specific mutation may have a two- to fivefold increase in risk of developing breast cancer, compared with the general population. While lower than the 5- to 20-fold increase in risk for carriers of the mutation, this rate would still be high enough to warrant breast cancer surveillance. Other studies have found no increase in risk among noncarriers.

To clarify the issue, Dr. Kurian and her colleagues assessed breast cancer risk using population-based cancer registries in the United States, Australia, and Canada. They identified 3,047 families in which one woman (the proband) was diagnosed as having breast cancer at a relatively young age, in most cases during 1996-2000, and she and her female first-degree relatives underwent genetic testing for BRCA1 and BRCA2 mutations.

Women in all three countries showed a similar prevalence of the mutations, similar rates of breast and ovarian cancer, and similar ages of onset for the malignancies. Overall, 160 families had BRCA1 mutations and 132 had BRCA2 mutations, the investigators reported (J. Clin. Oncol. 2011 Oct. 31 [doi:10.1200.JCO.2010.34.4440]).

Among noncarriers of family-specific mutations, the risk of developing breast cancer was not significantly higher than the risk among women in families without any BRCA1 or BRCA2 mutations. This relative risk was 0.39.

It is possible that previous studies reporting an increased risk in noncarriers have overestimated this risk, because they compared study subjects with women in the general population rather than women whose relatives have breast cancer. The latter group undergoes more frequent screening and consequently has more frequent diagnoses of breast cancer than women in the general population, Dr. Kurian and her associates noted.

Their study, in which 292 families with BRCA1 or BRCA2 mutations were compared with 2,755 families without such mutations from the same populations, "represents the largest analysis to date of breast cancer risk to noncarriers of family-specific mutations," they added.

The study was supported by the National Cancer Institute, the National Institutes of Health, Cancer Care Ontario, Cancer Prevention Institute of California, and the University of Melbourne. No financial conflicts of interest were reported.

Women who don’t carry their family’s BRCA1 or BRCA2 mutation showed no increase in breast cancer risk in a study of 3,047 population-based families reported online Oct. 31 in the Journal of Clinical Oncology.

"These results support the standard clinical practice of advising noncarriers that they do not have any increase in breast cancer risk attributable to the family-specific BRCA mutation and, in the absence of other strong risk factors, should follow general population guidelines for breast cancer screening," said Dr. Allison W. Kurian of Stanford (Calif.) University and her associates.

Some recent studies have suggested that noncarriers of a family-specific mutation may have a two- to fivefold increase in risk of developing breast cancer, compared with the general population. While lower than the 5- to 20-fold increase in risk for carriers of the mutation, this rate would still be high enough to warrant breast cancer surveillance. Other studies have found no increase in risk among noncarriers.

To clarify the issue, Dr. Kurian and her colleagues assessed breast cancer risk using population-based cancer registries in the United States, Australia, and Canada. They identified 3,047 families in which one woman (the proband) was diagnosed as having breast cancer at a relatively young age, in most cases during 1996-2000, and she and her female first-degree relatives underwent genetic testing for BRCA1 and BRCA2 mutations.

Women in all three countries showed a similar prevalence of the mutations, similar rates of breast and ovarian cancer, and similar ages of onset for the malignancies. Overall, 160 families had BRCA1 mutations and 132 had BRCA2 mutations, the investigators reported (J. Clin. Oncol. 2011 Oct. 31 [doi:10.1200.JCO.2010.34.4440]).

Among noncarriers of family-specific mutations, the risk of developing breast cancer was not significantly higher than the risk among women in families without any BRCA1 or BRCA2 mutations. This relative risk was 0.39.

It is possible that previous studies reporting an increased risk in noncarriers have overestimated this risk, because they compared study subjects with women in the general population rather than women whose relatives have breast cancer. The latter group undergoes more frequent screening and consequently has more frequent diagnoses of breast cancer than women in the general population, Dr. Kurian and her associates noted.

Their study, in which 292 families with BRCA1 or BRCA2 mutations were compared with 2,755 families without such mutations from the same populations, "represents the largest analysis to date of breast cancer risk to noncarriers of family-specific mutations," they added.

The study was supported by the National Cancer Institute, the National Institutes of Health, Cancer Care Ontario, Cancer Prevention Institute of California, and the University of Melbourne. No financial conflicts of interest were reported.

Women who don’t carry their family’s BRCA1 or BRCA2 mutation showed no increase in breast cancer risk in a study of 3,047 population-based families reported online Oct. 31 in the Journal of Clinical Oncology.

"These results support the standard clinical practice of advising noncarriers that they do not have any increase in breast cancer risk attributable to the family-specific BRCA mutation and, in the absence of other strong risk factors, should follow general population guidelines for breast cancer screening," said Dr. Allison W. Kurian of Stanford (Calif.) University and her associates.

Some recent studies have suggested that noncarriers of a family-specific mutation may have a two- to fivefold increase in risk of developing breast cancer, compared with the general population. While lower than the 5- to 20-fold increase in risk for carriers of the mutation, this rate would still be high enough to warrant breast cancer surveillance. Other studies have found no increase in risk among noncarriers.

To clarify the issue, Dr. Kurian and her colleagues assessed breast cancer risk using population-based cancer registries in the United States, Australia, and Canada. They identified 3,047 families in which one woman (the proband) was diagnosed as having breast cancer at a relatively young age, in most cases during 1996-2000, and she and her female first-degree relatives underwent genetic testing for BRCA1 and BRCA2 mutations.

Women in all three countries showed a similar prevalence of the mutations, similar rates of breast and ovarian cancer, and similar ages of onset for the malignancies. Overall, 160 families had BRCA1 mutations and 132 had BRCA2 mutations, the investigators reported (J. Clin. Oncol. 2011 Oct. 31 [doi:10.1200.JCO.2010.34.4440]).

Among noncarriers of family-specific mutations, the risk of developing breast cancer was not significantly higher than the risk among women in families without any BRCA1 or BRCA2 mutations. This relative risk was 0.39.

It is possible that previous studies reporting an increased risk in noncarriers have overestimated this risk, because they compared study subjects with women in the general population rather than women whose relatives have breast cancer. The latter group undergoes more frequent screening and consequently has more frequent diagnoses of breast cancer than women in the general population, Dr. Kurian and her associates noted.

Their study, in which 292 families with BRCA1 or BRCA2 mutations were compared with 2,755 families without such mutations from the same populations, "represents the largest analysis to date of breast cancer risk to noncarriers of family-specific mutations," they added.

The study was supported by the National Cancer Institute, the National Institutes of Health, Cancer Care Ontario, Cancer Prevention Institute of California, and the University of Melbourne. No financial conflicts of interest were reported.

Is there a future for antiangiogenic therapy with hormone therapy in hormone receptor-positive breast cancer? Dr. Hope Rugo discusses a failed sorafenib trial in the last of 3 video commentaries from the European Multidisciplinary Cancer Congress in Stockholm.

Is there a future for antiangiogenic therapy with hormone therapy in hormone receptor-positive breast cancer? Dr. Hope Rugo discusses a failed sorafenib trial in the last of 3 video commentaries from the European Multidisciplinary Cancer Congress in Stockholm.

Is there a future for antiangiogenic therapy with hormone therapy in hormone receptor-positive breast cancer? Dr. Hope Rugo discusses a failed sorafenib trial in the last of 3 video commentaries from the European Multidisciplinary Cancer Congress in Stockholm.

The probability that a breast cancer patient’s life was saved by mammography screening is always less than 25%, according to various "plausible estimates" of the risk of developing and dying from breast cancer published online Oct. 24 in the Archives of Internal Medicine.

In fact, given that the most recent data "confirm that the current benefit of screening mammography is disappointingly small," the probability that a typical woman whose breast cancer was detected by screening mammography owes her life to that procedure "is now likely to be well below 10%," said Dr. H. Gilbert Welch and Ms. Brittney A. Frankel of the Dartmouth Institute for Health Policy and Clinical Practice, Hanover, N.H.

Courtesy Rhoda Baer/National Cancer Institute (NCI)

More people are likely to personally know a cancer survivor than ever before, as the proportion of survivors in the general U.S. population has more than doubled in recent years and now stands at 4%. "Breast cancer survivors are particularly common: they now represent approximately 2.5 million, or one-fifth of the current survivor population."

And "survivor stories" feed the public’s presumption that every survivor whose cancer was detected by mammography has had her life saved by that screening. Most people don’t realize that in many cases, the cancer would have been equally treatable if it hadn’t been detected until it presented clinically. And in many other cases, the malignancy was "overdiagnosed" – it would never have caused symptoms or death if it had been left undetected and untreated.

"It is important to acknowledge that these alternatives exist," they wrote.

They calculated the probabilities that a screening mammography saved a patient’s life using the National Cancer Institute’s DevCan 6.5.0, a tool that helps compute the risks of developing and of dying from cancer at specific ages, based on detailed national epidemiologic data. "The risk of having screen-detected cancer was estimated simply as the product of the risk of developing breast cancer and the proportion of breast cancers found by mammography," they said.

"The absolute risk reduction in mortality due to mammography, or mortality benefit, was calculated as the difference between the estimated 20-year risk of death without mammography and the 20-year risk of death observed currently. The probability that a woman with screen-detected breast cancer has avoided breast cancer death because of screening was the ratio of the mortality benefit and the probability of having screen-detected breast cancer," they noted.

Their results show the estimated relative risk reduction in breast cancer mortality at ages 40, 50, 60, and 70 years, under a variety of conditions.

For example, assuming that screening mammography reduces the risk of breast cancer death by 20% for a 50-year-old woman, the probability that such a 50-year-old woman with a mammography-detected breast cancer has avoided a death from breast cancer is 13%.

The probability that a typical woman whose breast cancer was detected by screening mammography owes her life to that procedure "is now likely to be well below 10%."

If one of the underlying assumptions is changed – for example, assuming that screening mammography reduces the risk of breast cancer by 25% rather than 20% – this probability rises to 17%. If one assumes that screening mammography instead reduces the risk of breast cancer by only 5%, this probability falls to 3%.

The researchers discovered that "the most dramatic" effect of screening mammography on survival occurs in the 70-year-old age group, "because the proportion of screen-detected cancers in this age group is relatively low (52%)." Nevertheless, even in this group the probability that screening mammography saves a woman from breast cancer death remained under 25%.

"All analyses yielded probability estimates below 25%," Dr. Welch and Ms. Frankel noted (Arch. Intern. Med. 2011 Oct. 24 [doi:10.1001/archinternmed.2011.476]).

The benefit of screening mammography has declined over time, in part because women present earlier when they find a breast lump on their own and in part because treatment of such cancers has improved. "Consequently, we believe that readers should focus on the values toward the low end (5%-10%) and recognize that the probability that a woman with screen-detected breast cancer has, in fact, avoided a breast cancer death because of screening mammography is now likely to be well below 10%," they added.

It is important to use this information "to put cancer survivor stories in their proper context," the investigators said.

No financial conflicts of interest were reported.

The probability that a breast cancer patient’s life was saved by mammography screening is always less than 25%, according to various "plausible estimates" of the risk of developing and dying from breast cancer published online Oct. 24 in the Archives of Internal Medicine.

In fact, given that the most recent data "confirm that the current benefit of screening mammography is disappointingly small," the probability that a typical woman whose breast cancer was detected by screening mammography owes her life to that procedure "is now likely to be well below 10%," said Dr. H. Gilbert Welch and Ms. Brittney A. Frankel of the Dartmouth Institute for Health Policy and Clinical Practice, Hanover, N.H.

Courtesy Rhoda Baer/National Cancer Institute (NCI)

More people are likely to personally know a cancer survivor than ever before, as the proportion of survivors in the general U.S. population has more than doubled in recent years and now stands at 4%. "Breast cancer survivors are particularly common: they now represent approximately 2.5 million, or one-fifth of the current survivor population."

And "survivor stories" feed the public’s presumption that every survivor whose cancer was detected by mammography has had her life saved by that screening. Most people don’t realize that in many cases, the cancer would have been equally treatable if it hadn’t been detected until it presented clinically. And in many other cases, the malignancy was "overdiagnosed" – it would never have caused symptoms or death if it had been left undetected and untreated.

"It is important to acknowledge that these alternatives exist," they wrote.

They calculated the probabilities that a screening mammography saved a patient’s life using the National Cancer Institute’s DevCan 6.5.0, a tool that helps compute the risks of developing and of dying from cancer at specific ages, based on detailed national epidemiologic data. "The risk of having screen-detected cancer was estimated simply as the product of the risk of developing breast cancer and the proportion of breast cancers found by mammography," they said.

"The absolute risk reduction in mortality due to mammography, or mortality benefit, was calculated as the difference between the estimated 20-year risk of death without mammography and the 20-year risk of death observed currently. The probability that a woman with screen-detected breast cancer has avoided breast cancer death because of screening was the ratio of the mortality benefit and the probability of having screen-detected breast cancer," they noted.

Their results show the estimated relative risk reduction in breast cancer mortality at ages 40, 50, 60, and 70 years, under a variety of conditions.

For example, assuming that screening mammography reduces the risk of breast cancer death by 20% for a 50-year-old woman, the probability that such a 50-year-old woman with a mammography-detected breast cancer has avoided a death from breast cancer is 13%.

The probability that a typical woman whose breast cancer was detected by screening mammography owes her life to that procedure "is now likely to be well below 10%."

If one of the underlying assumptions is changed – for example, assuming that screening mammography reduces the risk of breast cancer by 25% rather than 20% – this probability rises to 17%. If one assumes that screening mammography instead reduces the risk of breast cancer by only 5%, this probability falls to 3%.

The researchers discovered that "the most dramatic" effect of screening mammography on survival occurs in the 70-year-old age group, "because the proportion of screen-detected cancers in this age group is relatively low (52%)." Nevertheless, even in this group the probability that screening mammography saves a woman from breast cancer death remained under 25%.

"All analyses yielded probability estimates below 25%," Dr. Welch and Ms. Frankel noted (Arch. Intern. Med. 2011 Oct. 24 [doi:10.1001/archinternmed.2011.476]).

The benefit of screening mammography has declined over time, in part because women present earlier when they find a breast lump on their own and in part because treatment of such cancers has improved. "Consequently, we believe that readers should focus on the values toward the low end (5%-10%) and recognize that the probability that a woman with screen-detected breast cancer has, in fact, avoided a breast cancer death because of screening mammography is now likely to be well below 10%," they added.

It is important to use this information "to put cancer survivor stories in their proper context," the investigators said.

No financial conflicts of interest were reported.

The probability that a breast cancer patient’s life was saved by mammography screening is always less than 25%, according to various "plausible estimates" of the risk of developing and dying from breast cancer published online Oct. 24 in the Archives of Internal Medicine.

In fact, given that the most recent data "confirm that the current benefit of screening mammography is disappointingly small," the probability that a typical woman whose breast cancer was detected by screening mammography owes her life to that procedure "is now likely to be well below 10%," said Dr. H. Gilbert Welch and Ms. Brittney A. Frankel of the Dartmouth Institute for Health Policy and Clinical Practice, Hanover, N.H.

Courtesy Rhoda Baer/National Cancer Institute (NCI)

More people are likely to personally know a cancer survivor than ever before, as the proportion of survivors in the general U.S. population has more than doubled in recent years and now stands at 4%. "Breast cancer survivors are particularly common: they now represent approximately 2.5 million, or one-fifth of the current survivor population."

And "survivor stories" feed the public’s presumption that every survivor whose cancer was detected by mammography has had her life saved by that screening. Most people don’t realize that in many cases, the cancer would have been equally treatable if it hadn’t been detected until it presented clinically. And in many other cases, the malignancy was "overdiagnosed" – it would never have caused symptoms or death if it had been left undetected and untreated.

"It is important to acknowledge that these alternatives exist," they wrote.

They calculated the probabilities that a screening mammography saved a patient’s life using the National Cancer Institute’s DevCan 6.5.0, a tool that helps compute the risks of developing and of dying from cancer at specific ages, based on detailed national epidemiologic data. "The risk of having screen-detected cancer was estimated simply as the product of the risk of developing breast cancer and the proportion of breast cancers found by mammography," they said.

"The absolute risk reduction in mortality due to mammography, or mortality benefit, was calculated as the difference between the estimated 20-year risk of death without mammography and the 20-year risk of death observed currently. The probability that a woman with screen-detected breast cancer has avoided breast cancer death because of screening was the ratio of the mortality benefit and the probability of having screen-detected breast cancer," they noted.

Their results show the estimated relative risk reduction in breast cancer mortality at ages 40, 50, 60, and 70 years, under a variety of conditions.

For example, assuming that screening mammography reduces the risk of breast cancer death by 20% for a 50-year-old woman, the probability that such a 50-year-old woman with a mammography-detected breast cancer has avoided a death from breast cancer is 13%.

The probability that a typical woman whose breast cancer was detected by screening mammography owes her life to that procedure "is now likely to be well below 10%."

If one of the underlying assumptions is changed – for example, assuming that screening mammography reduces the risk of breast cancer by 25% rather than 20% – this probability rises to 17%. If one assumes that screening mammography instead reduces the risk of breast cancer by only 5%, this probability falls to 3%.

The researchers discovered that "the most dramatic" effect of screening mammography on survival occurs in the 70-year-old age group, "because the proportion of screen-detected cancers in this age group is relatively low (52%)." Nevertheless, even in this group the probability that screening mammography saves a woman from breast cancer death remained under 25%.

"All analyses yielded probability estimates below 25%," Dr. Welch and Ms. Frankel noted (Arch. Intern. Med. 2011 Oct. 24 [doi:10.1001/archinternmed.2011.476]).

The benefit of screening mammography has declined over time, in part because women present earlier when they find a breast lump on their own and in part because treatment of such cancers has improved. "Consequently, we believe that readers should focus on the values toward the low end (5%-10%) and recognize that the probability that a woman with screen-detected breast cancer has, in fact, avoided a breast cancer death because of screening mammography is now likely to be well below 10%," they added.

It is important to use this information "to put cancer survivor stories in their proper context," the investigators said.

No financial conflicts of interest were reported.