A particularly fast-growing form of breast cancer should be treated aggressively after surgery even when tumors are very small, according to new research that could dramatically alter treatment for one in five women diagnosed with breast cancer.

The research, reported on Friday at the San Antonio Breast Cancer Symposium, focuses on the 15 percent to 20 percent of women with breast cancer who test positive for an amplification of the HER2 gene, which is typically among the most aggressive forms of the disease. Read more…

Years ago, a friend and co-worker of mine with ovarian cancer lost all of her blonde hair during treatment. She donned a red wig and declared, “I’m going to do cancer as a redhead!”

Her upbeat nature made it easier on the rest of us to accept her illness, so it was that much more shocking the day I walked into the newsroom to see a pink wreath on her desk.

Senator Kennedy has appeared upbeat after a cancer diagnosis. (Neil Hamburg/Reuters)

I was reminded of my friend when I read the article “When Thumbs Up Is No Comfort” by my colleague Jan Hoffman, who writes about our cultural expectations of cancer patients to be upbeat, stoic and ready for battle. But often the reality is that people with cancer are scared, sad and depressed — and rightly so.

“That optimism reassures anxious relatives, the public and doctors, regardless of whether it accurately reflects the patient’s emotional state,” Jan writes. But she asks whether the game face maintained by high-profile cancer patients, such as Senator Edward M. Kennedy, really inspires others or simply reinforces unrealistic expectations that everyone should approach cancer with stoicism and courage. Read more…

Breast density, which is increasingly used as a marker of breast cancer risk, is associated with the use of multivitamins, a new study shows.

Regular mammograms may be especially important in women with dense breasts. (Mary Haggerty/The New York Times)

The report, published this month in The American Journal of Clinical Nutrition, raises questions about advice routinely given to women to take a multivitamin. However, because the study is not a randomized clinical trial, it’s not clear if multivitamin use contributes to a woman’s breast density. It may be that the type of woman who takes multivitamins is more likely to have other risks factors linked to dense breasts. Read more…

Even a benign lesion on a mammogram makes women and doctors nervous, and doctors sometimes recommend a biopsy anyway. But new data show that waiting six months for a follow-up mammogram is a safe option.

A repeat mammogram can be a better option than a biopsy. (C.M. Glover for The New York Times)

Researchers tracked more than 45,000 women who were given six-month follow-up mammograms after an initial scan found lesions that were “probably” benign. In most cases, they were. Only about one in 100 women were eventually diagnosed with cancer six to 12 months later, according to the study, which appears in the May issue of the American Journal of Roentgenology.

“Because the probability of cancer is so low, we don’t want to put the patient through an unnecessary biopsy, which is an invasive procedure that increases both patient anxiety and medical costs,” said Erin J. Aiello Bowles, lead author of the study from the Group Health Center for Health Studies in Seattle. “At the same time, we want to closely monitor these patients, because changes in ‘probably benign’ lesions occasionally mean cancer, and we want to detect the cancers as early as possible.”

Cancer patients and their doctors often focus on beating the disease first. But new research shows they also benefit by early monitoring for lymphedema, a devastating side effect of cancer treatment that can show up years later.

Lymphedema is a painful swelling of an arm or leg that can occur months or even years after cancer treatment. Breast cancer patients, who often have lymph nodes removed during diagnosis and treatment, are particularly susceptible. But any cancer patient whose lymphatic system has been damaged by radiation or the removal of lymph nodes is vulnerable. That includes patients treated for prostate and gynecological cancers, head and neck cancers, testicular cancer, bladder cancer, colon cancer and melanoma.

The lymphatic system normally helps transport body fluids, but in someone with a compromised system, fluid can build up in an arm or leg, depending on where the lymph nodes were removed. If lymphedema sets in, a limb can swell far out of proportion to the rest of the body, and if not treated quickly, the condition can be irreversible. Read more…

Several studies have shown a link between exercise and lower cancer risk. However, the message often isn’t well received by patients who think it blames the victim by suggesting they wouldn’t have cancer had they just been more active.

That’s what I learned this week when I blogged about a new study suggesting cancer patients don’t exercise any more than the rest of us. The finding is troubling because some studies suggest exercise improves cancer survival, signaling that cancer patients have much to gain from exercising after a diagnosis.

But more than 100 readers responded to the article, and many of them complained that it was judgmental and blamed cancer patients for their plight. They added that exercise and calorie-counting are not priorities to a cancer survivor. I invited Leslie Bernstein, a noted cancer and exercise researcher from the City of Hope cancer center in Duarte, Calif., to talk about it.

To listen to our conversation, click below.

Listen to the Podcast (mp3)

On the left, a normal digital mammogram; a normal mammogram from traditional X-ray film is on the right. (Magee-Women’s Hospital of UPMC)

Despite reading and writing much about breast health in recent years, I was surprised to see the dramatic difference in the images that accompanied today’s front-page story about digital mammograms.

The pictures show a mammogram of the same normal breast, taken two different ways using digital and film-based mammography. The story, by my colleague Denise Grady, talks about how women who last had a mammogram from traditional X-ray film may receive a call back if their doctor switches to the newer digital technology. As Denise writes:

Comparing past and present to look for changes is an essential part of reading mammograms. But the digital and film versions can sometimes be hard to reconcile, and radiologists who are retraining their eyes and minds may be more likely to play it safe by requesting additional X-rays — and sometimes ultrasound exams and even biopsies — in women who turn out not to have breast cancer.

The reason for this is obvious when you look at the images above, which show the striking differences between the two mammography methods. To read the complete story, click here.

Should cancer spending be focused on the most common cancers? Or the most deadly cancers?

That’s the dilemma for the cancer research community as it struggles to divvy up limited funds. After news yesterday that actor Patrick Swayze had been diagnosed with pancreatic cancer, several readers questioned the nation’s cancer funding priorities. I decided to look at the numbers.

The National Cancer Institute has proposed a $6 billion budget in the war on cancer, allocating some funds for general cancer research and some for studies of specific cancers. But a review of the N.C.I.’s 2006 funding for five of the biggest cancers showed a wide disparity in the amounts of money spent relative to each cancer death and each new case of cancer. The data offer only a partial snapshot of public cancer spending in this country, as other government offices, such as the U.S. Department of Defense, also fund breast and prostate cancer research.

The big loser in the cancer funding race is lung cancer. It is the biggest cancer killer in the country, yet on a per-death basis receives the least N.C.I. funding among major cancers. In 2006, the N.C.I. spent $1,518 for each new case of lung cancer and $1,630 for each lung cancer death, according to data from the institute and the American Cancer Society. Read more…

Among the many unanswered questions about hormones prescribed for menopause is whether a woman’s health risks change after she stops taking the pills. A new study shows that virtually all the benefits disappear but that a slightly higher risk for breast and other cancers persists for at least three years after stopping the drugs.

The data come from a major study by the Women’s Health Initiative that looked at more than 16,000 women who used the estrogen and progestin combination drug Prempro, made by Wyeth. Reporting in The Journal of the American Medical Association, the study’s investigators urge caution in interpreting the results, noting that a woman’s individual risk remains small. The excess cancer risk among former hormone users translates to an added annual risk of 0.3 percent for an individual woman, or three additional cases of breast or other cancers a year among 1,000 women.

The findings don’t change current recommendations for hormone use, which advise that women consider using hormones only if they have moderate to severe hot flashes and other symptoms, and only at the lowest dose and for the shortest possible time.

“What we found in the study is quite consistent with the current guidelines,” said Gerardo Heiss, the report’s lead author and a professor of epidemiology from the University of North Carolina, Chapel Hill. “There is no reason for alarm. The absolute risk is of small magnitude.” Read more…

Among the many challenges women with breast cancer face, here’s one most people don’t pay attention to: a smaller paycheck.

Breast cancer may take a toll in the form of missed work and lost wages. (C. M. Glover for The New York Times)

A new report, published online in The Journal of the National Cancer Institute, highlights the financial toll breast cancer takes on women. The study focused on 459 Canadian women who were working at the time they were diagnosed with early-stage breast cancer. It found that the women lost, on average, more than a quarter of their typical income during the first 12 months after their diagnosis.

The researchers, from Laval University in Quebec City, note that while many studies have assessed the economic impact of breast cancer on the overall health system, few studies have examined the impact the disease has on the financial status of patients and their families. Read more…

The Internet is filled with unreliable health information and bogus claims. But sites dedicated to breast cancer information appear to have a high level of accuracy, a new study shows.

Texas researchers recently analyzed 343 Web pages, retrieved using search engines that consumers are likely to use when seeking information about breast cancer. The study, published online today in the medical journal Cancer, turned up 41 inaccurate statements on 18 of the Web sites, or an error rate of just 5.2 percent.

Previous studies of cancer-oriented Web sites have found a high prevalence of false or misleading information online, the authors noted. Although breast cancer Web sites have a surprisingly good track record for accuracy, the downside is that there is no reliable way for consumers to determine which sites contain accurate information, the researchers found. Web sites displaying complementary and alternative medicine were 15 times more likely to contain false or misleading health information than more conventional medical sites, the researchers said. Read more…

Vitamin use is common among the nation’s 10 million cancer survivors, despite little evidence that supplements help and worries that some may actually fuel the disease.

Researchers at the Fred Hutchinson Cancer Research Center in Seattle reviewed 32 studies conducted between 1999 and 2006. The investigators found that 64 percent to 81 percent of cancer survivors overall reported taking extra vitamins or minerals (excluding multivitamins). In the general population, only 50 percent of American adults reported taking dietary supplements.

The findings, published this month in The Journal of Clinical Oncology and funded by the National Cancer Institute, are worrisome because little is known about how megadoses of vitamins affect cancer. Some lab studies have suggested that antioxidants can improve the effectiveness of cancer treatments. But many more studies raise questions about the use of these supplements. A 1995 report in The Journal of Biological Chemistry showed that cancer cells in a petri dish thrive in the presence of vitamin C.

The American Cancer Society says use of vitamins and supplements during cancer treatments should be avoided. Read more…

Whether a woman receives radiation treatment after breast cancer surgery may be influenced by the gender of her surgeon, according to a new report from The Journal of the National Cancer Institute.

The gender of your surgeon may impact your treatment. (Fred Conrad/The New York Times)

The study, from researchers at Columbia University, set out to determine why breast cancer treatment still varies among similar patients. In particular, they looked at radiation treatment given to women after lumpectomy. The treatment is considered a standard of quality cancer care and has been shown to reduce breast cancer recurrence and mortality. However, many women still don’t receive it.

Earlier studies have suggested that demographic characteristics influence whether a woman receives postsurgical radiation. A patient’s race, age and how far she lives from a radiation therapy facility all are factors that affect her chance of receiving the treatment.

But the latest report looked at the doctors behind the decisions. Read more…

A doctor reviewing film from a patient’s mammogram. (C.M. Glover for The New York Times)

The risk posed by certain gene mutations linked to breast cancer may be lower than commonly believed, a new study shows.

Many women fear that breast cancer is inevitable if they are found to carry mutations in the genes BRCA1 and BRCA2. Genetic counselors and health organizations like the American Society of Breast Surgeons maintain that a woman has about an 80 percent lifetime risk of developing breast cancer if she carries one of the mutations.

But researchers at the Memorial Sloan-Kettering Cancer Center have found that a carrier’s risk of developing breast cancer by age 70 ranges from 36 percent to 52 percent, according to a report published today in the Journal of the American Medical Association. Read more…

Mammograms can detect even small breast tumors, which are sometimes aggressive. (C.M. Glover for The New York Times)

Some tiny breast tumors may require more treatment than most doctors prescribe.

That’s the finding of a new study from the Mayo Clinic in Jacksonville, Fla., which found that small breast tumors which haven’t appeared to spread still can be highly aggressive. The research, presented this weekend at the San Antonio Breast Cancer Symposium, is important because aggressive cancers are more likely to recur, and many women with a small tumor that hasn’t spread receive very little extra treatment. That’s because most doctors believe small tumors less than 1 centimeter (0.4 inches) in size usually aren’t much to worry about, and most research focuses on women with larger tumors.

To be sure, news that a tumor is small and hasn’t spread to the lymph nodes is still good news for women diagnosed with breast cancer. Often women with small tumors undergo lumpectomy to have the tumor removed. After that, however, treatment varies. Some women may have chemotherapy or whole breast radiation, some may have local radiation and others may just forego additional treatment and opt for close monitoring. Currently, there are not broad guidelines for treating small tumors because so little data exists. How and whether to treat small breast tumors is left to the discretion of the physician.

However, the Mayo study shows that certain types of small tumors may require more vigilant treatment. Read more…