WEDNESDAY, Dec. 26 (HealthDay News)-- Chemotherapy drugs known as anthracyclines help boost survival for women with HER2-positive breast cancer who have undergone surgery, but they may not offer any survival benefit for those with HER2-negative tumors.

That's the conclusion of a wide-ranging analysis that pooled the results of eight randomized trials that compared the drugs with non-anthracyclines and took into account the women's HER2 status.

HER2-positive cancers test positive for a protein called human epidermal growth factor receptor 2 (HER2) and tend to grow quickly, the researchers said.

Since anthracyclines (such as doxorubicin and epirubicin) were introduced in the 1980s, they have been widely used as supplementary chemotherapy for breast cancer, said Dr. Alessandra Gennari, a medical oncologist at the National Cancer Research Institute in Genoa, Italy, and lead author of the study.

But the new analysis may change that, Gennari said. "Our study provides convincing statistical evidence that the added benefit of adjuvant chemotherapy with anthracyclines is confined to women who have breast tumors in which HER2 is overexpressed or amplified," she said.

"Since only about 25 to 30 percent of all breast cancers are HER2-positive, the vast majority of patients, with HER2-negative disease, may be spared unnecessary toxicities related to the use of this class of agents," she added.

The study findings were published online Dec. 25 in the Journal of the National Cancer Institute.

Anthracyclines have been associated with an increased risk of heart damage in some patients -- a risk doctors have known about for some time. An increased risk of leukemia, which can strike years later, is also associated with use of the drugs.

But, Gennari said, anthracyclines came into widespread use despite these risks, because a previous meta-analysis found they improved overall survival. "As a result, anthracyclines-based regimens have been long regarded as the standard therapeutic option in the vast majority of early breast cancer patients. However, when individual trials are taken into account, the absolute magnitude of this benefit is not consistent across studies," she added.

The new study suggests the drugs work best for those women whose tumors are HER2-positive. Of the 6,564 patients reviewed, 5,354 had HER2 status information available. In those women with tumors that were HER2-positive, the anthracyclines produced a greater reduction in risk of relapse or death than non-anthracycline regimens, the study found.

For women with HER2-negative tumors, however, there was no difference in survival between the chemotherapy regimens.

But, in an accompanying editorial in the journal, Dr. Charles Geyer Jr. and his colleagues from the National Surgical Adjuvant Breast and Bowel Project in Pittsburgh, said that it may not be as simple as determining who should get anthracyclines based just on HER2 status.

That's because other research has suggested that the overexpression of another gene called topoisomerase II alpha (or topo2) may also play a role in how well anthracyclines work. "The topo2 gene is thought to be the real target of the anthracyclines," said Geyer, director of medical affairs for the NSABB project. And it may or may not be overexpressed along with the HER2 gene, he said.

The new study's conclusions, Geyer added, provide another example of therapies becoming more and more tailored to the specific type of breast cancer.

In another study in the same issue of the journal, researchers reported that women with breast cancer getting chemotherapy and tamoxifen had reduced risk of getting cancer in the healthy breast. Chemotherapy reduced the risk for at least 10 years and tamoxifen for five years, the study said.

More information

To learn more about anthracyclines and other chemotherapy drugs, visit the American Cancer Society  .

FRIDAY, Dec. 21 (HealthDay News) -- Screening tests for breast and cervical cancer for under- or uninsured low-income U.S. women cost about $150 annually per woman screened, according to a new government analysis.

The total cost per woman each year, including administrative, quality assurance, education and outreach is about $555, according to the analysis of the National Breast and Cervical Cancer Early Detection Program.

"This program basically does more than just screening -- it also provides funds for outreach, data collection, quality assurance, professional development, case management and evaluation," said one of the study's authors, James Gardner, a public health analyst at the U.S. Centers for Disease Control and Prevention.

The cost of treating a cancer detected by this screening program averaged $10,566 for breast cancer and $13,340 for cervical cancer.

"The thing you can take away from this study is that you can actually penetrate into a group of uninsured people, provide the care, get them into the system and treat them in a very cost-effective manner," said Dr. Otis Brawley, chief medical officer for the American Cancer Society. "This program is doing a world of service, and this is a government program that needs to be expanded, not contracted."

This cost analysis comes on the heels of another study from the American Cancer Society that found women who are uninsured are more likely to die from cancer than are women with health insurance. Just 10 percent to 15 percent of privately insured women are diagnosed with late-stage (stage III or IV) breast cancer, compared to 20 percent to 30 percent of women who lack health insurance, that study reported Thursday.

It's not clear from the new analysis what the cost-savings might be if women who were screened were compared to women who weren't screened and were later found to have cancer. But, Brawley said, the potential for health-care savings is enormous. He said that women who don't get screened will likely not be diagnosed until they have a much more advanced cancer. "They end up so sick that somebody ends up giving them health care, and, at that point, it's a lot more expensive," he said.

Results of the analysis are published in the Feb. 1, 2008, issue of the journal Cancer.

"It's society's decision about what we want to spend on prevention and screening," said Dr. Julia Smith, director of the Lynne Cohen Breast Cancer Preventive Care Program at New York University Cancer Institute and Bellevue Hospital.

"If you diagnose at stage 0 or an early stage 1, you're talking about surgery, and you may be talking about radiation or hormone therapy," Smith said. "But the big savings come from the fact that early detection may prevent recurrences. Those recurrences cost a fortune and are technically not curable. There are patients that may have a long run, but you're treating the whole time and will have spent many hundreds of thousands of dollars."

The new analysis included information from nine of the 68 National Breast and Cervical Cancer Early Detection programs (NBCCEDP) across the United States. Data was collected from July 2003 through June 2004. The researchers hoped to be able to quantify the program's costs to be able to better allocate limited resources and to assist the state programs in planning and implementing cost-effective activities.

The researchers found that almost 60 percent of the programs' resources was spent on screening and diagnostic follow-up. The remaining 40 percent was spent on non-screening activities, such as public education and outreach, data collection and management, professional education and quality assurance.

The average cost of breast cancer screening alone was $94, according to the analysis. The average cost of screening for cervical cancer was $56.

The analysis authors wrote that this information will "provide a framework for establishing the minimum number of NBCCEDP-eligible women who can be screened given the resources available."

More information

To learn more about the National Breast and Cervical Cancer Early Detection Program and to find out if you qualify for low-cost services or free services, visit the U.S. Centers for Disease Control and Prevention.

THURSDAY, Dec. 20 (HealthDay News) -- Women who've had a miscarriage or an abortion are much more likely than women who haven't to experience a low-birthweight or premature baby in the future, new research shows.

A team at Virginia Commonwealth University looked at data on more than 45,500 mother-and-child pairs enrolled in the United States Collaborative Perinatal Project.

About 40 percent of the mothers had one or two children, and almost two-thirds of the mothers were between ages 20-29. The researchers found that rates of low-birthweight (under 2,500 grams or 5.5 pounds) and premature babies (less than 37 weeks gestation) were highest among women who were black, young or old, poorly educated, and unmarried.

The study also found that women who'd had one, two, or three or more miscarriages or abortions in the past were almost three, five and nine times, respectively, more likely than normal to have an underweight baby.

Women who'd had one miscarriage or abortion were 67 percent more likely to have a premature baby, while women who'd had three or more miscarriages or abortions were more than three times as likely to have a premature baby, compared to women who hadn't had a miscarriage or an abortion.

The study is published in the Journal of Epidemiology and Community Health.

The researchers noted that previous studies have been inconclusive, with some reporting no increased risk and others identifying a significantly increased risk of low-birthweight or premature babies among women who've had a miscarriage or abortion. Despite the conflicting evidence, women and doctors need to be aware of the potential risks, the authors concluded.

More information

The March of Dimes has more about low birthweight  .

TUESDAY, Dec. 18 (HealthDay News) -- One bone mineral density test can accurately predict a woman's chance of spinal fractures 15 years down the line, new research shows.

And, according to the largest and longest prospective study of osteoporosis ever, women who had a spinal fracture at the beginning of the study had four times the risk of sustaining another fracture later on.

The bottom line: "Women need to talk to their doctors about the risk of osteoporosis," according to Jane Cauley, lead author of the study and professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

Her team published the findings in the Dec. 19 issue of the Journal of the American Medical Association.

"I agree with the guidelines that all women after the age of 65 have bone density tests, and Medicare will pay for that," Cauley said. "Women who are postmenopausal, 50 to 64 years of age, should consider having a bone density test if they have other risk factors for osteoporosis or if they want to know what their bone density is before they consider any other treatment."

The findings don't change current standard practice, experts said, and they don't change the basic message to women: Don't ignore bone health, especially in middle and old age.

"The only really major advance here is that it's a longer term study. Mostly studies are five years typically. This one went out 15 years," said Paul Brandt, associate professor of neuroscience and experimental therapeutics at Texas A&M Health Science Center College of Medicine in College Station. "Women need to get their bone mineral density tested after they start menopause and if they stay on hormone replacement therapy or an anti-osteoporotic treatment." he said.

Postmenopausal women are particularly vulnerable to fractures resulting from osteoporosis, a degenerative weakening of the bones. Some 10 million Americans, including one in five American women over the age of 50, suffer from osteoporosis, which is the most common type of bone disease.

Spinal fractures are the most common type of fracture resulting from osteoporosis, affecting 35 percent to 50 percent of women over 50 (about 700,000 vertebral fractures annually in the United States).

But many, if not most, of these fractures go undetected. "Osteoporosis is sometimes called the silent thief," Cauley said. "It basically robs the skeleton of strength and resources, and women don't really know about it. About 75 percent of all spine fractures actually occur silently."

"Identifying risk factors for spine fractures is less well developed. You have to systematically look for them by repeated X-rays," Cauley continued.

The findings from this study are based on bone mineral density data from 2,300 women over the age of 65 who enrolled in the Study of Osteoporotic Fractures (SOF), initiated in 1986.

After 15 years of follow-up, it was evident that 25 percent of women who had low BMD at the beginning of the study developed fractures of the spine, compared with only 9 percent of women with normal BMD.

"It was pretty much a strong gradient of risk," Cauley explained. "If you had normal bone density when you entered and did not have an [existing] fracture, the risk of having a new spine fracture was about 9 percent, compared to a risk of 56 percent in women who had osteoporosis and who had an existing fracture. So, the range of risk varied dramatically depending on bone density and previous spine fractures."

According to Brandt, one interesting finding from the study is that a previous vertebral fracture topped even bone mineral density as a predictor for future fracture.

This indicates that women with an existing vertebral fracture should be treated for osteoporosis regardless of their BMD, the authors reported.

"People think osteoporosis is an inevitable consequence of aging, but it is preventable and treatable," she said.

More information

There's more on age-linked bone loss at the U.S. National Library of Medicine.