Breaking Research News from sources other than Breastcancer.org
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Yes, marijen, others do, and some of us even contribute a link from time to time as well.
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Thanks JuniperCat! Cross posting where it is appropriate is always an option too.
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I also read the Breaking News and am thankful for those who share
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I do and thank the posters for scouring the www for the articles. I can barely get my head around doing research these days.
On opioid use, a friend has been taking Vicodin for years due to extreme knee pain. He is an ex cocaine addict and has been able to responsibly manage the Vicodin use (he has random blood tests to check he is actually taking the pills and not seeking them). He recently changed insurance providers and they will not pay for the Vicodin and have offered fentnyl instead! Isn’t it highly addictive? My guess it is less expensive
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Fentnyl is one of the culprits, it’s strong but comes as a patch. I don’t know why an insurance company would do that but it may help his pain better. I doubt it’s less expensive.
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Researchers identify genetic 'seeds' of metastatic breast cancer
https://medicalxpress.com/news/2018-03-genetic-seeds-metastatic-breast-cancer.html0 -
I have just discovered this thread and reviewed it in its entirety this morning. Thanks so much for collecting this research and posting it here!
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Cancer stem cells—allies of the tumor, enemies of the patient
https://medicalxpress.com/news/2018-03-cancer-stem...Thx Lauren, Amelia, Dodgersgirl. It’s nice to know there are people watching and reading!
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marijen,thank YOU for the research and sharing. Many of these stories have been printed and shared with my MO
Really appreciate your time
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That’s interesting. What does your MO say about them? Mine is not happy to get them unfortunately.
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Thanks a bunch for all the links, Lumpie!
A late question regarding asperagine, what are some vegetarian sources of protein if one eliminates legumes, nuts, seeds & soy?
It feels like I've been in the minority every step of the way with my cancer stuff so it's unlikely that I'll radically change my diet based on this study. Still, I am curious about how one gets sufficient protein when the list of foods to avoid includes so many protein-rich options.
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FDA Approves First Home Test for Breast Cancer Genes
https://cancercompass.com/cancer-news/article/6092...
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Marijen— my MO appears interested in the stories I have shared.
Interesting link about first home test for breast xancet
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Science Diction: The Origin Of The Word 'Cancer'
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Do any of you get the Hopkins monthly BC research report - it’s called Artemis? I’ve been getting it monthly for several years and it’s a nice collection of all BC-related research publications that month. here’s the link to this month’s edition. you can also sign up to get it via email.
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Thanks Lauren, the feature article is a great one. No I hadn’t heard of The monthly Hopkins report.
Here’s another great website and artcle I found today.
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Thank you very much, dear Lauren, for that useful Artemis link. Best wishes for you. G
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Not good news...
US cancer treatment guidelines 'often based on weak evidence'
March 7, 2018, British Medical Journal
Cancer treatment guidelines produced by the US National Comprehensive Cancer Network (NCCN) are often based on low quality evidence or no evidence at all, finds a study published by The BMJ today.
The researchers, led by Dr Vinay Prasad at Oregon Health & Science University, say their findings "raise concern that the NCCN justifies the coverage of costly, toxic cancer drugs based on weak evidence."
NCCN guidelines are developed by a panel of cancer experts who make recommendations based on the best available evidence.
These recommendations are used by US private health insurers and social insurance schemes to make coverage decisions, and guide global cancer practice, but it is not clear how the evidence is gathered or reviewed.
In the US, the Food and Drug Administration (FDA) approves all new drugs and grants new indications for drugs already on the market. The NCCN makes recommendations both within and outside of FDA approvals, but patterns of NCCN recommendations beyond FDA approvals have not been analysed.
So Dr Prasad and his team compared FDA approvals of cancer drugs with NCCN recommendations in March 2016 for a contemporary sample of drugs. When the NCCN made recommendations beyond the FDA's approvals, the evidence used to support those recommendations was evaluated.
A total of 47 new cancer drugs were approved by the FDA for 69 indications over the study period, whereas the NCCN recommended these drugs for 113 indications, of which 69 (62%) overlapped with the 69 FDA approved indications and 44 (39%) were additional recommendations.
Only 10 (23%) of these additional recommendations were based on evidence from randomised controlled trials, and seven (16%) were based on evidence from phase III studies. Most relied on small, uncontrolled studies or case reports, or no offered evidence.
And almost two years after their analysis, the researchers found that only six (14%) of the additional recommendations by the NCCN had received FDA approval.
"The NCCN frequently makes additional recommendations for the use of drugs beyond approvals of the FDA and when it does so, it often fails to cite evidence or relies on low levels of evidence," write the authors.
"Few of these additional recommendations subsequently lead to drugapproval," they add. "If there is additional evidence in support of these recommendations the NCCN should improve its process and cite all evidence used."
This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers point to some limitations. However, they say, given that NCCN endorsement is linked to reimbursement by many commercial insurers and social insurance schemes, "our results suggest that payers may be covering cancer drugs with varying and scientifically less robust justification."
Finally, they point out that 86% of NCCN guidelines members have financial ties to the pharmaceutical industry, with 84% receiving personal payments and 47% receiving research payments.
"The presence of conflicted physicians has been shown to lead to more optimistic conclusions regarding disputed practices," they say. "Thus our findings raise concern about the nature of the recommendations offered by these individuals."
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Plasma 25-hydroxyvitamin D concentration and subsequent risk of total and site specific cancers in Japanese population: large case-cohort study within Japan Public Health Center-based Prospective Study cohort
BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k671 (Published 07 March 2018)Cite this as: BMJ 2018;360:k671Abstract
Objective To evaluate the association between pre-diagnostic circulating vitamin D concentration and the subsequent risk of overall and site specific cancer in a large cohort study.
Design Nested case-cohort study within the Japan Public Health Center-based Prospective Study cohort.
Setting Nine public health centre areas across Japan.
Participants 3301 incident cases of cancer and 4044 randomly selected subcohort participants.
Exposure Plasma concentration of 25-hydroxyvitamin D measured by enzyme immunoassay. Participants were divided into quarters based on the sex and season specific distribution of 25-hydroxyvitamin D among subcohorts. Weighted Cox proportional hazard models were used to calculate the multivariable adjusted hazard ratios for overall and site specific cancer across categories of 25-hydroxyvitamin D concentration, with the lowest quarter as the reference.
Main outcome measure Incidence of overall or site specific cancer.
Results Plasma 25-hydroxyvitamin D concentration was inversely associated with the risk of total cancer, with multivariable adjusted hazard ratios for the second to fourth quarters compared with the lowest quarter of 0.81 (95% confidence interval 0.70 to 0.94), 0.75 (0.65 to 0.87), and 0.78 (0.67 to 0.91), respectively (P for trend=0.001). Among the findings for cancers at specific sites, an inverse association was found for liver cancer, with corresponding hazard ratios of 0.70 (0.44 to 1.13), 0.65 (0.40 to 1.06), and 0.45 (0.26 to 0.79) (P for trend=0.006). A sensitivity analysis showed that alternately removing cases of cancer at one specific site from total cancer cases did not substantially change the overall hazard ratios.
Conclusions In this large prospective study, higher vitamin D concentration was associated with lower risk of total cancer. These findings support the hypothesis that vitamin D has protective effects against cancers at many sites.
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If it pans out, this should vastly reduce arguments about BP and LE:
https://www.medscape.com/viewarticle/893564?nlid=1...
Smartphone Device May Allow Finger Touch Blood Pressure Reading
Marcia Frellick
March 07, 2018
A device that can be attached to the back of a smartphone and paired with an app has been found in a small study to take real-time blood pressure (BP) readings with accuracy similar to that of a finger cuff and a standard arm cuff, according to a paper published today in Science Translational Medicine.
One expert says the work is promising and is significantly different because it takes the smartphone BP reading technology a step further with an attachment. However, he cautions against drawing firm conclusions from the work and urges a formalized validation study.
The device, developed by Anand Chandrasekhar, a doctoral student in the Department of Electrical and Computer Engineering at Michigan State University in East Lansing, and colleagues, works through a three-dimensional printed phone case that contains an optical sensor over a force sensor. When a user presses down on the sensor with a finger, using the oscillometric method that the cuff usually provides, the device measures the pressure in an artery. The phone gives visual feedback to direct the amount of finger pressure to apply and calculates instant diastolic and systolic readings through the app.
According to the paper, the device yielded bias and precision errors of 3.3 and 8.8 mm Hg, respectively, for systolic BP over a 40 to 50 mm Hg range of blood pressure. The bias and precision errors were −5.6 and 7.7 mm Hg for diastolic BP.
Seth Martin, MD, MHS, a cardiologist and assistant professor of medicine at Johns Hopkins Medicine in Baltimore, Maryland, told Medscape Medical News, "It's a cool, exciting proof of concept study. It is exciting to see innovation towards easier measurement outside the clinic."
However, he cautions that the study is small, with just 30 participants, and that there were very few hypertensive people included. He notes that in future studies, a wider range of BPs and a wider age range should be tested, especially including older participants.
"This is a classic kind of situation that happens often with early testing of such devices," Martin said. "You test them on a bunch of normal, healthy people."
Martin was part of a team that conducted a formal validation study of the popular Instant Blood Pressure smartphone app (IBP; AuraLife), which they found to be "highly inaccurate." Four of five people who were hypertensive got a reading of normal from that app, he said, which used only the phone without an attachment. The app was removed from the market in 2015.
Other Technologies Are in Development
The authors of the current study acknowledge other cuffless technologies are being developed, but so far, many developing solutions have problems with either convenience or accuracy, they write.
The smartphone technology described in the current article has a couple of primary advantages, they say.
First, it can independently measure systolic and diastolic blood pressure without calibration. It also offers convenience.
People in settings with few resources may not have access to cuffs, and others may have to go to pharmacies and other locations to get them. Even if people own a cuff, they are unlikely to carry it with them wherever they go, but they would likely carry a phone.
The researchers note that about 3 billion people globally are expected to have smartphones by 2020, and widespread use in low-income nations is expected as marketplace competition increases.
"Screening for hypertension may be the main clinical application of the device, especially in the 20- to 50-year-old segment of the population who are often technology savvy and health conscious but may be at risk for early development of hypertension," the authors write.
Some limitations mentioned in the study are that the device can't take nighttime readings and may not be usable for people who lack fine motor skills.
In addition, the researchers did not test the device with the Association for the Advancement of Medical Instrumentation data collection protocol, "which involves a subject population that covers a prescribed range of BP values."
Trials Suggest It's Easy to Use
The device does appear to be relatively easy to use, according to data from the study. Each of the 30 users in the study was allowed practice trials to learn how to place the finger correctly and maintain applied pressure.
Participants had an average age of 39 years (range, 21-60 years) and 67% were women. They had not previously used the technology and had no cardiovascular disorders other than hypertension, and no problems with fine motor control.
"About 90% of the users learned the finger actuation after one or two trials," the authors report.
The user presses a finger against the sensor to steadily increase pressure on the artery just as a cuff presses the artery against the bone. After enough finger pressure is applied, the measurement ends and the device displays a reading. If there are problems with the reading, it asks the user to try again.
The researchers said when users got the "try again" message, it was a usually a computational error and not user error.
Benefits and Potential Dangers
Martin said if the Chandrasekhar et al device were properly validated it could be a big help in letting people know they have an abnormal reading and encourage them to get into a physician's office to get a medical-grade reading to prevent heart attacks and strokes.
"If you're really good at picking up high blood pressures in people who otherwise would not get that tested because you make it so easy for them, that could be really valuable," Martin said. "Unfortunately this study doesn't really tell us that."
The authors note that only about 55% of people with hypertension in developed nations and 45% of hypertensives in developing nations know they have the condition.
"The worry I have is that it could do harm if it falsely reassures someone who truly has hypertension and a blood pressure of 180 and this device tells them they're blood pressure is 130 and they don't need to worry and it discourages someone from paying attention," Martin said.
He added, "I hope to see more work on this device that will allow me to draw firmer conclusions about how well it works."
This work was supported by the National Institutes of Health and the Michigan State University Office of the Vice President for Research and Graduate Studies. Three coauthors are inventors on patent application PCT/US2017/020739 submitted by Michigan State University and the University of Maryland that covers the oscillometric finger-pressing method. The patent has been exclusively licensed to Digitouch Health LLC. They also provided initial, unpaid consulting to transition the method to the company. All other authors and Martin have disclosed no relevant financial relationships.
Sci Trans Med. Published online March 7, 2018. Article
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Re: the linked article from BMJ re: Dr. Prasad's research: While the findings are interesting, it's important to have context. Dr. Prasad is a real iconoclast and is constantly looking (in my opinion) for new targets. I take everything he publishes with at least one grain of salt. Second, consider the publication, the British Medical Journal. While I have a fair amount of respect for England's NHS, I also know that it's much more restrictive in covering drugs and practices that we may take for granted here and that the issue of costs to the system plays a huge role in that. Therefore, I suspect that the British medical establishment is also more conservative in that regard and would be more likely to publish an article such as this which tends to support that view point.
What I'm taking away from this statement "However, they say, given that NCCN endorsement is linked to reimbursement by many commercial insurers and social insurance schemes, "our results suggest that payers may be covering cancer drugs with varying and scientifically less robust justification." " is that NCCN endorsement is tied to insurer coverage of drugs that we may, at some point, need to use as a last ditch effort and that, absent that endorsement, we would be paying out of pocket for those drugs. If, indeed, that is the case I have no quarrel with NCCN endorsement, provided that our doctors are upfront about the potential benefit (or lack thereof) of these medications.
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I agree Prasad is a bit of a sh.. disturber but apart from pointing out the obvious financial biases and possible influence, I found the information regarding lack of actual evidence for many of the recommendations very concerning.
I think we're still far from evidence based medicine.0 -
There may be useful off-label or idiosyncratically useful medications that haven't yet been studied in a way that would build an evidence base. I agree it's important to push for research, yet clinical observation may be an important precursor to this.
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A discovery sheds light on how cancerous cells differ from healthy ones, and could lead to the development of new strategies for therapeutic intervention for difficult-to-treat cancers in the future.
An international team of investigators found a "stop sign"–a modified protein researchers named a PIP-stop–inside cells that are overused by cancerous cells that effectively prevents healthy ones from sorting material in the way they were designed to.
"We have discovered that breast cancer, leukemia, lymphoma and neuroblastoma cells have too many PIP-stops. This would upset protein function, and opens up a new avenue for developing drugs that block PIP-stop formation by kinase enzymes," said Michael Overduin, a University of Alberta cancer researcher and professor of biochemistry, who led the research project.
The team named the modification a PIP-stop because it stops proteins from interacting with lipid molecules called PIP.
Before making their discovery, the researchers first solved the 3-D structure of a sorting nexin protein, which is key to sorting proteins to their proper locations within the cell. Powerful magnets in the U.K. and in the National High Field Nuclear Magnetic Resonance Centre (NANUC), Canada's national magnet lab based in Edmonton, were then used to detect signals from within individual atoms within the protein structure.
By focusing on the protein structure, the team was able to discover the PIP-stop and see how it blocked the protein's function. The PIP-stop is a phosphate which is added to the protein surface that binds the PIP lipid, and normally controls how proteins attach to membranes.
Samples from cancer patients have too many PIP-stops, which could lead to the unregulated growth seen in tumour cells. Similar PIP-stops were found to be overused in a large number of other proteins involved in other cancer types, where they could also influence tumour growth.
"Our goal now is to design inhibitors for the overactive kinases that create PIP-stops, and to use this information to design drug molecules that block the progression of cancers, particularly those which lack effective treatments," said Overduin.
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The study was published in the journal Nature Communications and was carried out using grants from Alberta Innovates and funders in the U.K. and Switzerland.
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Thank you Lauren for the Artemis link! Those articles are VERY helpful. Has anyone else been a little bit panicked by the information about asparagine? The Artemis article is the third article I have come across that references this and my feeling is that means it is something to pay attention to. Although I can easily see living my life without asparagus as part of my diet, the rest of the list proves to be slightly more challenging: dairy, whey, beef, poultry, eggs, fish, seafood, asparagus, potatoes, legumes, nuts, seeds, soy and whole grains. They don't call out coffee in this article, but I have seen it in others. Has anyone else been seeing this become a bigger issue in medical articles?
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This might be of interest to higher minds.
http://cancerres.aacrjournals.org/content/77/2/545
Therapeutics, Targets, and Chemical Biology
Breast Cancer Resistance to Antiestrogens Is Enhanced by Increased ER Degradation and ERBB2 Expression
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Lumpie, I saw the axillary
lymph node study in Sciencedaily. But I'm wondering what are the implications? The abstract says that the cells don't spread further from the lymph nodes, but it also said, in the preceding paragraph: "The study showed that tumor cells are spread from the breast tumor to the axillary lymph nodes and to other organs such as the skeleton and the brain. Metastases then often spread from the first organ to other organs in the next stage." Are we to believe that once breast cancer cells are in the lymph nodes they just stay there? Isn't this contrary to everything we've thought? And isn't this why so many women have several nodes removed? I think this is big news but I'm confused by it.I have not tried to find the actual study, assuming that it would be above my head but I mentioned it to an OT I'm seeing who is a specialist in treating lymphedema and I'll be interested to learn what her take away was.
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A recent email from Johns Hopkins lists several upcoming events of potential interest:
Hi Everyone,
We wanted to let you know about three exciting events coming up.
Breast Cancer Survivorship Day
On Saturday April 28th, we will be hosting our annual Breast Cancer Survivorship Day at the BWI Marriott in Linthicum, MD. This event is free and open to all patients (regardless of where treatment was received), caregivers, children (ages 5-12), and providers. Please find the brochure and flyer attached.
To register for Survivorship Day, visit https://breastcancerevents.johnshopkins.edu
Endocrine Therapy and Breast Cancer Webinar
Our next webinar will be on April 19th from 12-1pm with Karen Lisa Smith, MD MPH on the topic of Endocrine Therapy and Breast Cancer. During this webinar, we will discuss the types of endocrine therapies, how these treatments work, who benefits most from treatment, suggested duration of various therapies, side effect management, potential interactions, and what is new and upcoming in this field. This online seminar is open to patients, caregivers, and providers. Preregistration is required. The flyer is attached.
To register for this webinar, visit http://bit.ly/JHCancerSurvivorshipWebinars
Pathway to Wellness Study for Young Breast Cancer Survivors
We are currently recruiting for a study to see how well two different types of group programs—mindfulness-meditation classes and survivorship education classes meet the needs of young survivors. You may be eligible to participate in this study if you were diagnosed with non-metastatic breast cancer before age 50 and are within five years of your diagnosis. Three institutions are collaborating on this project: University of California, Los Angeles, Dana-Farber Cancer Institute, and Johns Hopkins University (flyer attached). Study cohorts will be offered in the Spring and Fall with the next group beginning in April. For more information, please contact:
DFCI
Phone: 617-582-9706
Email: PathwaysToWellness@partners.org
UCLA
Phone: 310-825-2520 or 310-794-5818
Email: bkahnmills@ucla.edu or v.williams@ucla.edu
JHU
Phone: 410-614-1361
Email: HopkinsBreastTrials@jhmi.edu
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aterry I agree that is confusing. My Breast Surgeon, who works at a major research hospital/university and stays very current on research believes the next major shift in BC surgery will be non-removal of lymph nodes. She believes research has for awhile been pointing that they are a symptom and not a cause of spread, that removal doesn't significantly impact metastases. They will be positive if it has spread, but that they would leave them in place and rely on chemo and radiation (as they also do today anyway) to clean up the rest of your body.
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Maybe removing lymph nodes makes things worse because the drainage of lymph is blocked it seeps into the tissues carrying bacteria, infection, andcancer cells(?) with it?
From cancer.net
Lymphedema is the abnormal buildup of fluid in soft tissue due to a lymphatic system blockage. The lymphatic system helps fight infection and other diseases by carrying lymph throughout the body. Lymph is a colorless fluid containing white blood cells. Lymph may also be called lymphatic fluid.
Lymph travels through the body using a network of thin tubes called vessels. Small glands called lymph nodes filter bacteria and other harmful substances out of this fluid. But when the lymph nodes are removed or damaged, lymphatic fluid collects in the surrounding tissues and makes them swell.
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