Preliminary studies using a new technology that dramatically enhances scientists’ ability to detect cancer cells in blood (CCIB) have been conducted by UVM/Fletcher Allen oncology surgeon David Krag. Cancer cells shed into the bloodstream; consequently, the presence of postoperative CCIB after the expected clearing of cells suggests the cancer has metastasized, or spread to other sites in the body. Breast cancer patients who have CCIB 30 days after removal of the primary tumor will be monitored for at least five years to help determine if CCIB is a significant predictor of recurrence and disease-free survival.

Cell Pathways

Cyclin-D: Recent evidence suggests that cyclin-D, a protein produced at inordinately high levels in many breast cancer patients, may interact with estrogen receptors in a manner that allows tumor cells to grow even in the absence of estrogen. Pathologist James Koh hopes to determine why cyclin-D is so important to tumor growth and whether the proliferation of cyclin-D may render the cancer-preventive drug tamoxifen less effective.

Kinase-C: Sue Jaken, associate director for basic research at the Vermont Cancer Center (VCC), is studying the biochemical pathways involved in tumor growth and progression and the potential of these pathways as future targets for chemotherapeutic agents. At the VCC’s 15th Regional Research Symposium in March, she reported her findings that too much of a cell protein known as kinase-C (PKC) encourages the spread of breast cancer cells, while reducing PKC levels seems to halt the spread of the disease.

Coping Strategies

Psychologists Bruce Compas and Linda Luecken are studying how women with breast cancer cope with the stress of their diagnosis and treatment and how psycho-social factors impact their immune systems. Women newly diagnosed with the disease are participating in two types of support groups — one focused on expressing emotions in a supportive environment, and a second emphasizing stress-management and coping skills. Measures of psychological adjustment and quality of life, along with blood levels of cortisol, a hormonal indicator of stress, T-cells, which regulate immune response, and natural “killer cells” thought to fight cancer, provide the physiological data.

Genetics

Seeking genes that may cause breast cancer and examining the family histories of women with a high probability of inheriting the disease are among genetic studies led by UVM/Fletcher Allen oncologist Marie Wood, whose research encompasses high-risk breast cancer screening, prevention, and the psycho-social impact of genetic testing on patients and their families. Pending is another project that would educate primary care physicians about cancer genetics.

Sentinel Node Therapy

Dr. David Krag and his colleagues led a multi-institutional study that accurately measured the spread of cancer to lymph nodes in 97% of patients using a procedure that makes it possible to identify and trace the sentinel lymph nodes, in the chest and armpit, where metastatic cells from a tumor would spread first. Krag’s pioneering procedure was launched this summer as a long-term national trial, in which breast cancer patients will undergo sentinel node therapy or axillary lymphadenectomy (in which the lymph nodes around the breast and armpit are removed to assess the spread of cancer) to compare the effectiveness of the two methods as measured in overall and disease-free survival.

Tamoxifen and Raloxifene

A national five-year study of tamoxifen and raloxifene (STAR) announced in May, and coordinated throughout Vermont by UVM/Fletcher Allen oncology surgeon Seth Harlow, is enlisting healthy local women at increased risk of breast cancer to compare the effects of two cancer-fighting drugs. Tamoxifen has been shown to reduce the chance of breast cancer in at-risk women by 50 percent, but the drug also increases risks of developing uterine cancer and blood clots in the lungs. Raloxifene is an osteoporosis-prevention drug believed to have the potential to prevent breast cancer with fewer side effects than tamoxifen.

Tumor-Targeted Therapies

Dr. David Krag is leading studies to develop a guidance molecule that would target chemotherapeutic drugs directly to breast cancer cells without destroying normal cells. The first step was to construct libraries of 20 million different, small, natural molecules called peptides. Within these libraries researchers have — and will continue to search for — peptides that bind specifically to breast tumor cells. The first clinical trials of this tumor-targeted therapy on breast cancer patients will be launched at UVM in the near future.

Ultrasound

In the most comprehensive study of its kind, oncologist Seth Harlow is using ultrasound as a guide to excise breast cancers that are not palpable. To date, the procedure has yielded positive results in 62 women who have undergone ultrasound concurrently with surgery. Results of the study will be published in September.

Dr. Harlow also is using ultrasound, which makes most invasive tumors visible, in a second study: Here the procedure functions as a tool to reduce further surgeries in patients with cancer found in the sentinel nodes.

Vermont Mammography Registry

The Vermont Mammography Registry, a component of the Vermont Breast Cancer Surveillance System, collects data from all breast imaging and breast pathology facilities in Vermont. As of April of this year, more than 112,000 Vermont women, 301,000 mammograms, and 2,465 breast cancers were included in the registry’s database. Data are used to provide quality assurance feedback to radiologists and facilities and for a variety of research studies. The Vermont Breast Cancer Surveillance System, an NCI funded cooperative agreement led by Berta Geller in the Office of Health Promotion Research, is one of nine sites in the National Cancer Institute’s Breast Cancer Surveillance Consortium.

Resources

National Breast Cancer Coalition
NBCC seeks to be inclusive and advocates for more research money, legislation to cover uninsured women; publishes quarterly newsletter. 202-296-7477; Web: http://www.natlbcc.org.

 

Look Good — Feel Better
Sponsored by the national Cosmetology Association and American Cancer Society to help people with cancer look and feel better during cancer therapy. See local directory for address and telephone number.

 

National Cancer Institute
Cancer Information Service: (accurate, up-to-date information on cancer) 800-422-6237; Web: http://cancernet.nci.nih.gov (can get list of NCI-designated Cancer Centers).

 

National Coalition for Cancer Survivorship, 1010 Wayne Ave., 5th floor, Silver Springs, MD 20910

 

PDQ (Physician Data Query)
Computerized listing of latest types of cancer treatments, clinical trials and organizations and doctors caring for people with cancer. 800-422-6237

Breast cancer and related Web sites

http://www.breastcancer.net/
News, free e-mail newsletter, links to many other sites

 

http://www.erinet.com/fnadoc/brest.htm
Understandable information, photos, diagrams

 

http://www.healthfinder.gov
Many links, good, basic information

 

http://wwwicic.nci.nih.gov/
Official National Cancer Institute’s Cancer net. New information will appear here first. Includes many other sites.

 

http://www.nejm.org/collections/breastcancer/TOC/1.htm
The New England Journal of Medicine’s Breast Cancer Collection — articles since 1992

 

http://www.commonwealhealth.org/choicescontents.html
Michael Lerner’s book Choices in Healing, a good source of information about complementary therapies.