Posts

Cutting down on cancer surgeries

/0 Comments/in /by

New microscopy technique could reduce repeat surgeries for breast cancer patients

Engineers at the Optical Imaging Laboratory led by Caltech’s Lihong Wang have developed an imaging technology that could help surgeons removing breast cancer lumps confirm that they have cut out the entire tumor — reducing the need for additional surgeries.

About 300,000 new cases of invasive breast cancer are discovered annually. Of these, 60 to 75 percent of patients underwent breast-conserving surgery.

Breast-conserving surgeries, or lumpectomies, attempt to remove the entire tumor while retaining as much of the undamaged breast tissue as possible. (In contrast, a mastectomy removes the entire breast.) The extracted tissue is then sent to a lab where it is rendered into thin slices, stained with a dye to highlight key features, and then analyzed. If tumor cells are found on the surface of the tissue sample, it indicates that the surgeon has cut through, not around, the tumor — meaning that a portion of the tumor remains inside the patient, who will then need a follow-up surgery to have more tissue removed.

After a week or two waiting for lab results, 20 to 60 percent of patients find out that they must return for a second surgery to have more tissue removed. But, asks Wang, “what if we could get rid of the waiting? With 3D photoacoustic microscopy, we could analyze the tumor right in the operating room, and know immediately whether more tissue needs to be removed.” Wang is a Bren Professor of Medical Engineering and Electrical Engineering in Caltech’s Division of Engineering and Applied Science. His lab invented 3D photoacoustic microscopy.

Photoacoustic microscopy, or PAM, excites a tissue sample with a low-energy laser, which causes the tissue to vibrate. The system measures the ultrasonic waves emitted by the vibrating tissue. Because nuclei vibrate more strongly than surrounding material, PAM reveals the size of nuclei and the packing density of cells. Cancerous tissue tends to have larger nuclei and more densely packed cells.

Indeed, as described by Wang and his team in a paper publishing in the journal Science Advances on May 17, PAM produces images capable of highlighting cancerous features, with no slicing or staining required.

Wang conducted this research while the Optical Imaging Laboratory was located at Washington University in St. Louis. He moved the lab to Caltech’s Andrew and Peggy Cherng Department of Medical Engineering in January 2017.

Although Wang’s team has focused primarily on breast cancer tumors, his work has potential applications for any analysis of excised tumors — from melanoma to pancreatic cancer. In a proof-of-concept scan described in the new paper, PAM analyzed a sample in about three hours. Comparable traditional microscopy takes about seven hours to achieve the same results. However, Wang says that PAM’s analysis time could be cut down to 10 minutes or less with the addition of faster laser pulse repetition and parallel imaging. This would make the technology useful for clinical applications.

“Because the device never directly touches a patient, there will be fewer regulatory hurdles to overcome before gaining FDA approval for use by surgeons,” Wang says. “Potentially, we could make this tool available to surgeons within several years.”

Story Source: Materials provided by California Institute of Technology.

URL: https://www.sciencedaily.com/releases/2017/05/170517154728.htm

Things you need to know about Breast Cancer – Dr. Thomas Varughese

/0 Comments/in /by

In general, breast cancers could fall into 4 categories based on the presentation:

1. With no external signs but picked up on screening with mammography or ultrasound.They are non palpable,pre clinical.

2. This group present with symptoms mostly a lump in the breast mostly upper outer quadrant,but there is no hard and fast rule.

3. Group is called locally advanced where the swelling has gone beyond an operable stage(over 5 cms or with skin ulcers or tethering or massive lymph nodes ulcerating or not but with no features of dissemination)

4. These are the patients in whom the disease has spread to Liver,Lung,Brain ,Bones,Viscera or any other organs.Hence the signs and symptoms differ.

In general AJCC (American Joint Committee on Cancer) describes it in the following way.
According to the American Cancer Society, any of the following unusual changes in the breast can be a symptom of breast cancer:
– Swelling of all or part of the breast
– Skin irritation or dimpling
– Breast pain
– Nipple pain or the nipple turning inward
– Redness, scaliness, or thickening of the nipple or breast skin
– A nipple discharge other than breast milk
– A lump in the underarm area

These changes also can be signs of less serious conditions that are not cancerous, such as an infection or a cyst. It’s important to get any breast changes checked out promptly by a doctor.
One should practice self examination.All those who are having menstruation should examine breasts during mid cycle and post menopausal women on any fixed day of the month regularly.

Do not ignore warning signs

Many a time it save lives. As a surgical oncologist and re constructive surgeon,and a specialist in breast diseases,and an ardent believer or breast preservation treatment protocols(Cosmetic oncology). I feel over 99% of the times breast preservation is possible without jeopardising oncological benefits,in those whom early detection is done.
Please remember,breast cancer is a younger lady’s problem.

Share this information,it may help another person too.

– Dr. Thomas Varughese
MS, FICS (Onco) FACS
Oncologist & Surgeon (Specialized in Reconstructive Surgery)
Kerala

Contact Dr. Thomas Varughese

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Good News! Blood test can effectively rule out breast cancer, regardless of breast density

/0 Comments/in /by

With over a 99 percent negative predictive value, a liquid biopsy test can help clinicians manage difficult-to-diagnose dense breast patients

A new study published in PLOS ONE demonstrates that Videssa® Breast, a multi-protein biomarker blood test for breast cancer, is unaffected by breast density and can reliably rule out breast cancer in women with both dense and non-dense breast tissue. Nearly half of all women in the U.S. have dense breast tissue.

“Women who have dense breasts are at a double disadvantage. Not only are they at higher risk of developing breast cancer, but dense breast tissue can decrease the reliability of imaging and increase the chances of a false finding.” said Judith K. Wolf, MD, Chief Medical Officer of Provista Diagnostics, Inc. “This study shows that, with an over 99 percent negative predictive value (NPV), clinicians can confidently use Videssa Breast to detect cancer in women with dense breasts and better determine when biopsy is truly warranted to assess suspicious findings.”

The study, “Breast Density Does Not Impact the Ability of Videssa Breast to Detect Breast Cancer in Women Under Age 50” evaluated the performance of Videssa Breast among 545 women, ages 25 to 50, with abnormal or difficult-to-interpret imaging (BI-RADS 3 and 4). The sensitivity and specificity in the dense breast group was 88.9 percent and 81.2 percent respectively, and 92.3 percent and 86.6 percent in the non-dense group. The differences were not statistically significant. The NPV was 99.1 percent in women who had dense breasts and 99.3 in women with non-dense tissue, providing confirmation that when a woman receives a negative test result, she does not have breast cancer.

The challenges of diagnosing breast cancer in women with dense breasts has drawn national attention in recent years. Driven by patient advocacy groups such as Are You Dense Inc. and Are You Dense Advocacy, Inc., 32 states have enacted legislation to ensure women are informed of their breast density status and the associated diagnostic challenges.

A study published earlier this year in Clinical Breast Cancer proved the utility of Videssa Breast as a diagnostic complement to imaging for women with abnormal findings and demonstrated it could potentially reduce use of biopsy by up to 67 percent. “Using biomarkers for cancer detection is an important advance in managing women with dense breasts and navigating many diagnostic challenges. As a clinician, the ability to identify who will benefit most from further imaging and follow-up, and rule out breast cancer in women, when they receive suspicious findings, is tremendous,” says Elayne Arterbery, MD, radiation oncologist at St. Mary’s of Saginaw, who was a principal investigator on the Provista studies. “This study also validates the scientific promise and the growing role biomarkers have in addressing diagnostic challenges for women with dense breasts, and the merits of further research to help expand how we put that science to work to benefit women.”

Videssa Breast has been studied in two prospective, randomized, multi-center and blinded clinical trials, in more than 1,350 patients ages 25 to 75. The data featured in the current PLOS ONE publication is taken from the first study and cohort one of the second study. Videssa Breast is currently available for use by ordering healthcare providers for patients with abnormal imaging findings.

Source: https://www.sciencedaily.com/releases/2017/10/171025150623.htm

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Breast cancer ‘can return 15 years after treatment ends’

/0 Comments/in /by

Breast cancer can resurface after remaining dormant for 15 years following successful treatment, a study has found.
Women with large tumours and cancer that had spread to the lymph nodes had the highest 40% risk of it coming back.
Researchers writing in the New England Journal of Medicine said extending treatment with hormone therapy could reduce the risk of it recurring.
Scientists analysed the progress of 63,000 women for 20 years.
All had the most common form of breast cancer.
This is a type fuelled by the hormone oestrogen which can stimulate cancer cells to grow and divide.
Every patient received treatments such as tamoxifen or aromatase inhibitors which block the effects of oestrogen or shut off the hormone’s supply.
Although after five years of treatment their cancers had gone, over the next 15 years a steady number of women found that their cancer spread throughout their body – some up to 20 years after diagnosis.
Women who originally had large tumours and cancer that had spread to four or more lymph nodes were at highest risk of the cancer returning the next 15 years, the study said.
Women with small, low-grade cancers and no spread to the lymph nodes had a much lower 10% risk of cancer spread over that time.

‘Remarkable’

Lead researcher Dr Hongchao Pan, from University of Oxford, said: “It is remarkable that breast cancer can remain dormant for so long and then spread many years later, with this risk remaining the same year after year and still strongly related to the size of the original cancer and whether it had spread to the (lymph) nodes.”
Doctors have long known that five years of tamoxifen reduces the risk of recurrence by about a third in the five years after stopping treatment.
Recent research has suggested that extending hormone therapy to 10 years may be more effective at preventing breast cancer recurrence and death.
Aromatase inhibitors, which only work for post-menopausal women, are believed to be even more effective.
But there are side effects with hormone treatments which can affect patients’ quality of life and cause them to stop taking the pills.
These include menopausal symptoms, osteporosis, joint pain and carpal tunnel syndrome.
Prof Arnie Purushotham, senior clinical adviser at Cancer Research UK, which funded the study, said that since the research began, new drugs had been used to treat breast cancer and those worked in different ways to tamoxifen.
He said: “It’s vital that work continues to better predict which cancers might return.
“We also need to know what the difference for women might be in taking hormone therapies for 10 years instead of five, the side effects and how this affects patients’ quality of life.”
Sally Greenbook, from charity Breast Cancer Now, said it was essential that women discussed any changes in treatment with their doctor.
“We would urge all women who have had treatment for breast cancer not to be alarmed, but to ensure they are aware of the signs of recurrence and of metastatic breast cancer, and to speak to their GP or breast care team if they have any concerns.”

Source: http://www.bbc.com/news/health-41928647

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

This robot-assisted digital 360 degree breast thermography device may help detect breast cancer at an early stage

/0 Comments/in /by

Keeping a watch on the crab is the only way to eliminate it before it hits you hard. A regular breast cancer screening—whether by self-examining the breast or undergoing radiological tests—is the only way to detect the most common cancer in women at an early stage.

Breast cancer ranks number one cancer among Indian women. One in 28 women gets breast cancer and one in two die due to late detection. But despite many breast cancer awareness programmes, doctors say that not many women come for screening on a regular basis.

They say there could be three reasons for it: many women may weigh harmful radiations they get exposed to during mamography vs the benefit of screening, especially when they don’t have a family history. Some women find mammography a very painful process. Then there are women who feel uncomfortable exposing their breasts for screening.

The new thermography device–Illumina 360 by Cura Health– might address all three inhibitions a woman generally have while going for a regular breast cancer screening.

The breast is a highly complex and one of the most difficult- to- image human organs as it varies in symmetry, density, size and morphology. The breast tissue is unique due to the mechanism of the mammary vessels and skin temperatures. Substantial changes could occur in a woman’s breast during hormonal changes at different stages of life.

Measurement and studying of breast skin temperature and its response to hot and cold challenges in a controlled environment, plays an important role in early detection of breast anomalies.

Thermography can detect the subtle physiologic changes in the breast that usually occur in case of cancer, fibrocystic disease, or an infection

Thermography can detect the subtle physiologic changes in the breast that usually occur in case of cancer, fibrocystic disease, or an infection. “A tissue’s temperature rises in case of an infection or tumour. It is the first change to take place in case of an abnormality. In many cases, it alerts a person months in advance,” says Dr Sandeep Jaipurkar, consultant radiologist, Vijaya hospital, Chennai.

Though it is not a new technique, the new device—Illumina 360—is an improvised version. Designed, developed and manufactured in India with the support of Department of Biotechnology, the government of India, it has more accuracy.

“The accuracy of earlier thermography machines was hardly 60 percent, the camera used to focus on the breast from one angle, thus missing the changes happening in the denser and deeper tissues. Illumina 360 is 96 per cent accurate,” says M Bala Subhramanium, CEO, Cura Health.

The new device consists of a table which has a small hole that allows breast to suspend freely downwards. A rotatory camera fitted below the table then takes pictures of the breast at every 15 degree. It provides 360 degree view of the breast.

It also takes into account the temperature of the surroundings, which may have an effect on the results in case of a conventional thermography machine. The new test is done in a thermally insulated room to avoid any temperature variation during the test.

The technique has other added benefits too: it is radiation free; doesn’t require any compression of breast; provides privacy.

Since mammography is prescribed for above 45 years age, thermography may help detecting breast cancer in younger women.

Source: http://www.healthpost.in/medley/This-robot-assisted-digital-360-degree-breast-thermography-device-may-help-detect-breast-cancer-at-an-early-stage-611

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Indian scholar helps break ground on research for breast cancer vaccine

/0 Comments/in /by

Over 11, 500 kilometers away from her hometown in Kerala, PhD student Juby Mathew is seen neck-deep in work at the laboratory of Ferrier Research Institute in Wellington, New Zealand.

Juby is the only Indian in Professor Gavin Painter’s research group that is works on discovering vaccines to life-threatening illnesses. Juby in particular is involved with the development of a breast cancer vaccine candidate.

The research on breast cancer vaccine has been underway since 2013, and recently the institute was able to conduct the vaccine trials on animals. Over $5,00,000 are being invested on vaccine research.

“Professor Gavin Painter’s group has done leading-edge research in the field of cancer vaccines. To be part of such a highly experienced team is invaluable. I am also part of a wider ecosystem of people, which includes interactions with immunologists at the Malaghan Institute and lots of different high-tech start-ups that are situated on the Callaghan Innovation site. I hope to make a world where no one dies of cancer,”Juby told dna.

Worldwide, more than 500,000 women died of breast cancer in 2011, and incidence rates are increasing in most countries including India. The Indian Council of Medical Research (ICMR) estimates that there were 1.5 lakh new cases of breast cancer in India in 2016. Some 70,000 indian women estimatedly died due to breast cancer in 2012 and that number will increase to 76,000 by 2020.

The institute says that before conducting the trials on humans, they ought to be absolutely convinced about it’s potential safety and efficacy and hence more research is required before trials on humans are undertaken.

The vaccine has been trialled on several animals and how it works is well understood within these animal models. It has triggered significant reduction in tumour size over an extended period of time. It has also been used in vitro (outside of the human body) with human blood and has shown promising results. Patients with malignant breast cancer who have not undergone any recent treatment that may influence the results of the trials. Current treatments like chemotherapy and radiation are harsh on patients.

“The vaccine has been successful in several different animal species and the next step is clinical trials on humans. To be given permission for human clinical trials is a big step; it means that there is a high likelihood that the treatment will be effective for humans because permission is only given in cases which show significant potential and an expected high probability of success. Although all the cell types are the same in humans as in these animal trials, cell distribution and prevalence is different and therefore, more research must be done to collect more evidence that the vaccine would have the same efficacy in humans as in other animal species,”said a spokesperson from the institute.

The vaccine will trigger activation of natural killer T-cells that directly destroy the tumour cells, according to the team’s hypothesis.

“The vaccine is based on ‘Immunotherapy,’approach, which works by helping the body’s immune system recognise cancer cells and to fight them. Immunotherapy vaccines introduce chemicals to the body which activate the immune response, allowing the body to effectively fight off the cancer by itself,”the spokesperson further said.

Casualties
70,000

Indian women died of the cancer in 2012

76,000

Number of women estimated to fall victim to it by 2020

Source: http://www.dnaindia.com/health/report-indian-scholar-helps-break-ground-on-research-for-breast-cancer-vaccine-2577035

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Chemotherapy treatment for breast cancer may increase heart failure risk

/0 Comments/in /by

The American Heart Association (AHA) has warned that breast cancer treatment which involves chemotherapy and radiation can increase the risk of developing cardiovascular diseases.

While the advances in treatment have witnessed a growth in survival rate among breast cancer patients, survivors crossing the age of 65, were more likely to die from heart disease than breast cancer, the new study showed.

HER-2 and other breast cancers use targeted therapies which could weaken the heart muscle – a condition known as heart failure, it said.

Other therapies could also affect the heart arteries and cause the development of coronary artery disease or blockages, the study added.

Prompting attention to the fact that during treatment not only one’s breast health but also general health, including that of the heart, should be considered, the researchers suggested.

“Any patient who is going to undergo breast cancer treatment, whether they have heart disease at the beginning or not, should be aware of the potential effects of the treatments on their heart,” said Indian-origin Laxmi Mehta, Associate Professor at The Ohio State University in the US.

However, it should not deter or scare patients from undergoing the cancer treatment, instead, allow them to make informed decisions with their doctor on the best option available, Mehta added, in the statement published in the journal Circulation.

In some cases, post cessation of the treatment and/or the addition of heart medicines can improve heart function.

Administering Doxorubicin – a chemotherapy drug – used in breast cancer therapy can also lead to the damage of heart cells, but, giving the drug slowly, rather than all at once, may lower the risk of heart failure.

Doctors were also developing more-targeted radiation to reduce risks, the statement said.

Adherence to a number of ideal heart health behaviours including being physically active, achieving and maintaining a healthy body weight could help.

Besides, eating a healthy diet, avoiding tobacco, maintaining healthy levels of blood pressure, cholesterol and blood sugar may help prevent or minimise the damage.

Source: http://zeenews.india.com/health/chemotherapy-treatment-for-breast-cancer-may-increase-heart-failure-risk-2078290

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Early-stage breast cancer patients may not require chemotherapy, says new study

/0 Comments/in /by

There’s good news for cancer patients. A new study done by Montefiore Medical Center in New York says that most women with early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease.

The landmark study is the largest ever done of breast cancer treatment and used genetic testing to gauge each patient’s risk. The results are expected to spare patients the ordeal and expense of the chemo drugs. “The impact is tremendous. Most women in this situation don’t need treatment beyond surgery and hormone therapy,” said the study leader Dr Joseph Sparano of Montefiore Medical Center in New York.

The study was funded by the National Cancer Institute, some foundations and proceeds from the US breast cancer postage stamp. Results were discussed at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine.

Moving away from chemo

Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favour of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it’s sometimes for shorter periods or lower doses than it once was.

For example, another study at the conference found that Merck’s immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects. The breast cancer study focused on cases where chemo’s value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fuelled by estrogen or progesterone) and is not the type that the drug Herceptin targets.

The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill stray cancer cells. Doctors know that most don’t need it, but evidence is thin on who can forego it.

What the study found

About 17% of women had high-risk scores and were advised to have chemo, while 16% women with low-risk scores skipped chemo, based on earlier results from this study. The new results are on the 67% of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo. After nine years, 94% of both groups were still alive, and about 84% were alive without signs of cancer, so adding chemo made no difference.

Some of the women aged 50 or younger did benefit from chemo. Slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.

Women should get gene testing to guide their care, said Dr Richard Schilsky, chief medical officer of the oncology society. Testing solved a big problem of figuring out who needs chemo, said Dr Harold Burstein of the Dana-Farber Cancer Institute in Boston. “Many women think ‘If I don’t get chemotherapy, I’m going to die, and if I get chemo, I’m going to be cured’, but the results show there’s a sliding scale of benefit and sometimes none,” he said.

Source: https://www.hindustantimes.com/health/good-news-for-breast-cancer-patients-many-may-not-require-chemotherapy/story-Zz20ypuV5WlaqIzEicpnUP.html

(Picture for representation)

iMedWorks Ask Platform Links below:

1. Get a Medical Second Opinion
2. Search doctors and Request Appointment

Routine Mammography May Cut Breast Cancer Deaths by 40 Percent, 3 Dietary Habits to Reduce the Risk

/0 Comments/in /by

Breast cancer is one of the leading and most common forms of cancers affecting women all across the world. Early diagnosis and preventive measures can go a long way in spotting and treating breast cancer before it assumes a life threatening character. One of the easiest ways to prevent or keep a check on breast cancer development would be to go for regular breast examination and a routine mammography after the age of 40. If “women choose to start annual screening mammography starting at age 40, over the long term, this would be significant because fewer women would die from breast cancer”, said Elizabeth Kagan Arleo from the New York-Presbyterian Hospital in New York City.
As per a recent report published in the journal Cancer, when annual screening were started at the age 40, it resulted in greatest reduction in breast cancer-specific deaths with a nearly 40 per cent reduction in deaths. The study therefore suggests routine mammography initiation for women as early in their life to rule out or timely diagnose the possibility of any cancerous development.

While simple screenings – most involving imaging tests – are one of the best ways to monitor health against the risk of cancer, maintaining a healthy diet and an active lifestyle can also go a long way in staving off the risks. Not just in prevention but during the course of the illness as well, a balanced diet may facilitate speedier recovery and better response to the ongoing treatment. “Our results suggest that a dietary intervention can increase the effectiveness of a targeted cancer therapy,” Vincent Cryns, professor of medicine at the University of Wisconsin School of Medicine and Public Health in the US was quoted by IANS.

What you eat on a regular basis plays a vital role in determining your health and potential risk of developing any lifestyle ailment. We take a look at three simple dietary habits that can help you cut down risk of developing breast cancer.

Load up on fibre

Experts at the Harvard T.H Chan School of Public Health found out that girls who consumed more fresh fruits and veggies during their adolescence were at lesser risk of developing breast cancer. With an additional 10 grams of fibre added to their daily diet, the risk of breast cancer in the girls reduced by 13%.

Say no to all-things processed

Processed sugar tops the list. A diet rich in refined items and low in fibre has been associated with upping the risk of pre-menopausal breast cancer, found experts from the University of California. High dependence on junk food, refined and processed food items may trigger obesity, one of the leading causes of lifestyle diseases including cancer.

Monitor your Vitamin D

Vitamin D receptors may help prevent tumour growth and keep them from expanding. “Vitamin D receptors are not lost until a tumour is very advanced. This is the reason for better survival in patients whose vitamin D blood levels are high,” Cedric F Garland from the Department of Family and Preventive Medicine, University of California was quoted by PTI.


Source: http://www.ndtv.com/food/routine-mammography-may-cut-breast-cancer-deaths-by-40-percent-3-dietary-habits-to-reduce-the-risk-1740514

iMedWorks Ask Platform Links below:

1.  Get a Medical Second Opinion
2.  Search doctors and Request Appointment