Tag: breast cancer

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The Spirit of Giving Shines at PinkDrive’s Christmas in July Fundraiser

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Koo Govender, Non-Executive Board Member and CEO of Publicis Groupe

The spirit of Christmas was alive and well at PinkDrive’s annual Christmas in July fundraiser dinner, recently held at the Indaba Hotel in Johannesburg. Twinkling fairy lights, festive décor, generous giving and heartfelt stories created an atmosphere of hope, reminding guests that the greatest gift anyone can give is the chance to save a life.

Supported by long-standing corporate partners, the themed ‘Night of Giving Back’ once again united business, cancer survivors and the community behind PinkDrive’s mission to make early cancer detection accessible to more South Africans.

Each year, this non-profit organisation (NPO) makes a measurable difference to thousands of lives.  Relying on donations, corporate sponsorships and community support, it’s dedicated to the early detection of gender-related cancers in underserved communities. PinkDrives mobile units travel across the country, offering screenings such as mammograms, clinical breast examinations, pap smears, and PSA testing directly to people who might otherwise have limited access to healthcare.

The evening struck a thoughtful balance between festive celebration and meaningful reflection, honouring cancer survivors while remembering those who lost their lives to the disease. One of the most moving moments came through a testimonial video featuring women whose lives were saved thanks to PinkDrive’s mobile screening units. Their stories vividly illustrated the impact of accessible healthcare and reinforced the organisation’s commitment to taking cancer screening to communities where it is needed most.

The message was echoed by guest speaker Nicole Fuller, elite athlete and cancer survivor, who shared her personal journey following an early diagnosis that enabled her to avoid chemotherapy and radiation treatment. Inspired by her own experience, Fuller has since become the first South African to receive specialist training in cancer recovery and rehabilitation. Encouraging guests to prioritise regular screenings, she highlighted how early detection, combined with appropriate rehabilitation and physical activity, can significantly improve both recovery and long-term wellbeing.

An address by Koo Govender, Non-Executive Board Member and CEO of Publicis Groupe, spoke to the strength of PinkDrive’s leadership and the collective expertise steering its mission. Sound governance and committed partnerships, she noted, are what allow the NPO to keep expanding its reach and deepening its impact.

Closing the formal programme, PinkDrive founder and CEO Noelene Kotschan took guests back to where it all began: a single mobile screening unit, and a mission to reach those that healthcare so often overlooks. From that modest start, she traced PinkDrive’s growth into a nationally recognised force in cancer awareness and early detection. She closed with heartfelt thanks to all those whose continued support keeps that mission alive.

The fundraiser’s philanthropic spirit continued throughout the evening with raffle draws and a lively auction at the end.  Guests bid enthusiastically for luxury prizes including diamond earrings and dream holiday experiences, helping to raise significant funds for PinkDrive’s awareness, education and mobile screening programmes.

To add to the Christmas spirit, spot prizes and hampers, generously sponsored by PinkDrive’s corporate partners, sent guests home with some festive spoils too. And as part of its ongoing support, Lee-Chem Laboratories, through its Mandy’s brand, ensured every guest received a generously filled Mandy’s goodie bag, adding another thoughtful touch to an evening centred on generosity, hope and community.

For Lee-Chem, that generosity runs deeper than a gesture on the night.

“You can’t put a price on the moment someone gets the all-clear because they were screened in time. That’s what keeps us partnering with PinkDrive year after year, and why we’re proud to stand with so many others who believe in that same mission,” says Bhavna Sanker, Marketing Manager at Lee-Chem Laboratories.

Because while Christmas may only appear on the calendar once a year, the spirit of giving and the opportunity to change someone’s future are always in season.

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Breast Cancer Screening in South Africa: Balancing Early Detection with Appropriate Care

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By Dr Fatima Hoosain, specialist surgeon and Principal of Apffelstaedt, Hoosain & Associates, with a clinical focus on breast and endocrine surgery.

Photo by National Cancer Institute on Unsplash

When people think about breast cancer screening, the conversation often begins and ends with one message: screen more women.

As clinicians, we know it is not quite that simple.

There is no question that screening saves lives. Regular mammography reduces breast cancer mortality and gives us the opportunity to diagnose disease when it is smaller, more treatable and associated with significantly better outcomes. Few interventions in medicine demonstrate such a clear benefit.

The challenge is that good breast care is not defined simply by how many mammograms we perform. It is defined by the quality of the decisions that surround them.

This was the focus of my presentation at the recent Board of Healthcare Funders (BHF) Conference, where we explored how clinicians can balance the burden of breast cancer with evidence-based screening decisions while remaining mindful of both underdiagnosis and overdiagnosis.

Those competing risks are encountered by every clinician involved in breast care.

We all worry about the patient whose cancer is diagnosed later than it should have been. Earlier diagnosis frequently means less extensive surgery, more treatment options and, ultimately, better outcomes. The survival difference between early-stage and advanced disease is substantial, making timely diagnosis one of the most important contributors to long-term prognosis.

At the same time, screening is not without consequences.

Not every abnormality detected on imaging will become life-threatening, yet every suspicious finding understandably creates anxiety. Additional imaging, biopsies and sometimes treatment may follow. Our responsibility is therefore not simply to detect abnormalities, but to interpret them appropriately within the context of each patient’s overall clinical picture.

This is why breast screening should never be approached as a uniform process. Risk matters.

A woman with an inherited genetic mutation or a strong family history should not necessarily follow the same screening pathway as someone at average risk. Likewise, imaging should answer a clinical question. Mammography remains the cornerstone of breast screening, but dense breast tissue, patient age and individual risk factors may require supplementary investigations such as ultrasound or MRI. More imaging is not automatically better medicine. Appropriate imaging is.

These decisions have become even more complex within the South African healthcare environment. International guidelines provide an excellent evidence base, but they do not remove the practical realities we face every day. Access to imaging differs between regions. Advanced investigations may not always be readily available. Medical scheme funding, co-payments and affordability inevitably influence what is possible for many patients. These factors cannot be ignored when discussing best practice because they form part of the reality in which clinical decisions are made.

Fortunately, the treatment landscape continues to evolve.

Advances in oncoplastic surgery, targeted therapies, immunotherapy and modern radiation techniques have transformed outcomes for many patients diagnosed with breast cancer. These developments are encouraging, but they should not distract us from one fundamental principle: the earlier we diagnose clinically significant disease, the greater the opportunity to offer patients treatments that are both effective and less invasive.

Diagnosis, however, is only the beginning of the journey.

Long-term follow-up remains an essential part of breast cancer care. Ongoing surveillance, adherence to endocrine therapy where appropriate, management of treatment side effects and supporting patients through the psychological and financial impact of a cancer diagnosis all influence outcomes. Good breast care extends well beyond the operating theatre or oncology unit.

As our healthcare system continues to face increasing clinical and financial pressures, I believe we need to move beyond simplistic conversations about screening uptake alone.

The more important discussion is whether we are making consistently good clinical decisions. Are we identifying the patients who stand to benefit most? Are we investigating appropriately? Are we avoiding unnecessary intervention when the evidence suggests it is unlikely to improve outcomes?

Those are not easy questions, but they are the ones that matter.

Ultimately, breast cancer screening is not about doing more. It is about doing what is right for the patient sitting in front of us. That remains the most important clinical judgement we make.

Categories : CancerTags :

UP Professor Pioneers Novel Approach to Advance Precision Treatment for Aggressive Breast Cancer

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UP Vice-Principal: Research, Innovation and Postgraduate Education Prof Sunil Maharaj, OMT chair Rebecca Oppenheimer, Prof Mike Sathekge, head of the Department of Nuclear Medicine at UP and Steve Biko Academic Hospital, as well as President and CEO of NuMeRI, UP Vice-Chancellor and Principal Prof Francis Petersen and OMT CEO Tracey Webster.

Breast cancer is the leading type of cancer among women in South Africa, and globally. Too often it is discovered too late – but a new approach promises a radical change in survivability for patients.

The solution, called theranostics, stems from the field of nuclear medicine. It holds the potential to turn the tide against breast cancer and, like the fight against HIV/Aids, change it from an outright killer to a manageable disease.

Behind this initiative is world-renowned nuclear medicine specialist Professor Mike Sathekge, head of the Department of Nuclear Medicine at the University of Pretoria and Steve Biko Academic Hospital, and president and CEO of the South African Nuclear Medicine Research Infrastructure (NuMeRI), a globally leading, not-for-profit imaging facility situated at the hospital.

He has been presented the 2025 Harry Oppenheimer Fellowship Award, a R3-million grant from the Oppenheimer Memorial Trust (OMT) to complete his research and develop a way to make it widely available.

“Theranostics, brings diagnosis and treatment together, is a combination of early diagnosis with treatment that is personalised and precise down to mere cells, which allows us to exactly detect and assess tumours, devise specific treatment regimens and assessment of treatment response over time,” says Sathekge.

“The earlier the breast cancer is detected, the more accurately it is assessed and the more precise the treatment, the exponentially better the patient’s prognosis.”

In South Africa, however, this is too often not the outcome. A comprehensive study into the availability of breast cancer services in the public healthcare sector, published recently in the South African Medical Journal, found that 67% of patients had late-stage breast cancer at diagnosis. In other words, their cancer had metastasised and spread to other parts of their bodies, and their prognosis was poor.

The study also noted that South Africa is expected to face a substantial rise in cancer cases over coming decades, driven by population growth, ageing and changing disease patterns. Sathekge’s Harry Oppenheimer Fellowship Award nomination was one of 80 received by OMT, covering a wide range of academic fields. Finalists shortlisted included proposals on a system for measuring the environment, air and our health; frost exposure in tropical Africa; a model for testing modified gravity; conversion of CO2 into useful products (such as fertilisers); and tissue T-cell response profiling of tuberculosis. “There were so many excellent applicants for this year’s award, touching on vital issues impacting the world we live in, and worthy of further research and development,” says OMT chairperson Rebecca Oppenheimer.

“This made our selection panel’s final decision all the more challenging, but I believe we have made an exciting choice that will have far-reaching, positive ramifications for South Africa’s public healthcare system and the people who use it.

“In developing a technology that makes diagnosing and treating cancers more effective, affordable and available, Prof Sathekge and his colleagues hold in their hands the potential for a quantum leap forward in improving South African patients’ health outcomes and human dignity, as well as for beating breast cancer globally. OMT is proud to support his endeavours.”

Sathekge’s solution is, essentially, one whose time has finally come. First conceived around 15 years ago, it capitalises on a protein called trophoblast cell-surface antigen 2, or Trop2. This molecule, found in high levels in breast cancers (and others, including cervical, pancreatic and lung cancers), helps the cancer multiply and makes it stubborn to treat.

Although Trop2 is already recognised as an important target in several cancers, there is still no widely established, clinically scalable way to show exactly where Trop2 is present across a patient’s entire cancer burden.

The answer may lie in nanobodies: tiny, engineered antibody fragments that are designed to bind specifically to Trop2. Their small size allows them to reach tumours rapidly and clear from the bloodstream faster than conventional antibodies, making them particularly attractive for same-day PET imaging.

Through a long-standing collaboration with Prof Frederik Cleeren, assistant professor in the Laboratory for Radiopharmaceutical Research, in the Department of Pharmaceutical and Pharmacological Sciences, and his team at KU Leuven in Belgium and the Joint Research Centre (JRC) in Karlsruhe, who bring expertise in nanobody engineering and radiolabelling, Sathekge’s team is combining these strengths with South Africa’s capabilities in molecular imaging, actinium-225 radiopharmaceutical development and targeted radionuclide therapy.

Together, the collaborators are developing a Trop2-targeted theranostic approach that links diagnosis with treatment. The first step uses a tiny targeting protein, known as a nanobody, designed to bind specifically to Trop2 on cancer cells. This nanobody is labelled with fluorine-18, a short-lived radioactive tracer that allows doctors to visualise Trop2-positive tumours on a PET/CT scan.PET/CT is an advanced imaging method that uses a small amount of radioactive tracer to show biological activity inside the body. In this case, it could help clinicians map Trop2 expression across a patient’s full cancer burden, including disease that may not be accessible for repeated biopsy. It may also allow doctors to monitor changes in the target and treatment response over time.

Where imaging confirms sufficient Trop2 expression, the same targeting strategy can be developed for treatment using actinium-225, a powerful alpha-emitting isotope. Actinium-225 can deliver highly localised radiation over a very short distance, with the aim of concentrating treatment in Trop2-positive cancer cells while limiting radiation exposure to surrounding healthy tissue.

The ambition is to move beyond treating patients based on limited information from a single biopsy, towards a more personalised approach: seeing the target throughout the body, selecting patients more accurately, and laying the foundation for future Trop2-targeted alpha therapy.

Sathekge’s work puts South Africa at the forefront of worldwide research into effective responses to breast cancer, says the University of Pretoria’s Vice-Chancellor and Principal, Prof Francis Petersen.

“South Africa urgently needs better ways to detect, understand and treat aggressive breast cancer. Too many patients still present late, when the disease is more difficult to manage and treatment options are limited.

“Prof Sathekge’s work at NuMeRI brings together advanced imaging, radiopharmaceutical science and targeted treatment in a way that could help doctors make more informed, patient-specific decisions. The research aims to improve how cancer is identified, how treatment is selected and how response is monitored over time.

“It also demonstrates the depth of scientific talent, innovation and academic rigour in South Africa. Through work of this calibre, African researchers are not only responding to local health challenges, but helping to shape the global future of cancer care. We look forward to seeing this research strengthen South African capacity and contribute to better outcomes for patients here and internationally,” says Petersen.

For Sathekge, the most exciting element of his work is how it centres on the patient, giving them dignity and the opportunity to live long and fulfilling lives.

Provided by The University of Pretoria

Categories : CancerTags :

Which Genes Contribute to Early-onset Breast Cancer in Black Women?

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Photo by National Cancer Institute

Black women experience disproportionately elevated risks of developing and dying from early-onset breast cancer. New research published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, reveals the genes that are most likely to be mutated to contribute to these increased risks.

In the study of 686 young Black women diagnosed in Florida and Tennessee with invasive breast cancer at age 50 or younger in 2005–2018, genetic testing showed that 15.3% of the women carried a gene variant with a suspected link to breast and/or ovarian cancer, with most occurring in the BRCA1 and BRCA2 genes and fewer in PALB2, ATM, and other genes. A family history of breast cancer was common in women with mutations in BRCA1, BRCA2, and PALB2. Triple-negative breast cancers (one of the most aggressive forms) were most often seen in women with BRCA1 mutations. Also, most of the women with BRCA1 mutations were diagnosed at or below age 40, whereas the age at diagnosis was more evenly distributed up to age 50 for women with variants in the other genes.

The study’s findings point to the importance of breast cancer genetic testing for young Black women, a group that is less likely to receive such screening compared with other racial and ethnic groups. Such tests could identify women most likely to benefit from more frequent screening and preventive measures to safeguard their health.

“We must test at-risk women across all populations – testing is essential to personalise treatment strategies and enable life-saving prevention for future cancers, and it may empower at-risk family members to get tested so they too can benefit from this information,” said senior author Tuya Pal, MD, of Vanderbilt University Medical Center. “Equitable access to inherited cancer testing ensures that all women, regardless of race, can benefit from precision medicine and take control of their genetic health.”

Source: Wiley

Categories : CancerTags :

Low Vitamin D Levels Linked to More Pain After Breast Cancer Surgery

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Patients with vitamin D deficiency may benefit from supplements before operations

Photo by Tima Miroshnichenko on Pexels

Vitamin D deficiency is associated with more moderate to severe pain following breast cancer surgery and an increased consumption of opioid drugs, finds research published online in the journal Regional Anesthesia & Pain Medicine. Breast cancer patients with low levels of vitamin D (below 30nmol/L) may benefit from taking supplements before undergoing a radical mastectomy, suggest researchers.

There is emerging evidence suggesting that vitamin D helps control how pain is felt and processed by the body. This is likely due to its anti-inflammatory effects and action on the immune system. Vitamin D deficiency is also commonly reported among patients with breast cancer. A team of researchers set out to examine the relationship between vitamin D deficiency and postoperative pain in patients undergoing breast cancer surgery.

Their prospective observational study, carried out at Fayoum University Hospital in Egypt between September 2024 and April 2025, included 184 breast cancer patients who were scheduled to undergo surgical removal of one entire breast.

Half of the patients were classified as vitamin D deficient (below 30 nmol/L) and half were classified as vitamin D sufficient (above 30nmol/L). Both groups had similar characteristics with an average age of 44 in the vitamin D deficient group and 42 in the vitamin D sufficient group.

Patients were managed according to the hospital’s routine protocol both during and after surgery. Clinical staff involved in their care were unaware of the patients’ vitamin D levels.

The opioid fentanyl was administered during the operation to manage acute pain. Following surgery, all patients were given paracetamol through a drip every 8 hours. In addition, patients could control how much tramadol (another opioid analgesic) they were given by directly pressing a button.

Patients reported their pain levels at zero, 6 hours, 12 hours, 18 hours and 24 hours after surgery. Nausea and vomiting, sedation score and days in hospital following surgery were also recorded.

Patients with vitamin D deficiency were three times more likely to report moderate to severe postoperative pain at any time point during the first 24 hours than those with sufficient vitamin D levels, the study found.

The researchers noted, however, that no patient in either group reported severe pain (7 or over on a scale of 0 to 10) so the difference was due entirely to a reduction in moderate pain (4-6 on the pain scale).

Vitamin D deficient patients received, on average, 8 μg more fentanyl during surgery, which the researchers described as a modest difference.

However, the study found those in the vitamin D deficient group used substantially more tramadol (112mg) after surgery than those who had sufficient vitamin D levels. This strong opioid was controlled directly by the patient up to a maximum dose of 50mg per hour.

Opioid drugs can cause a number of side effects including nausea, vomiting, drowsiness and confusion, while also carrying risks of dependency and addiction.

Postoperative nausea was more common in the vitamin D deficient group, and vomiting occurred only in that group, although the difference in vomiting was small and not statistically significant.

The study had some limitations. It was observational and conducted at a single centre, so no firm conclusion can be drawn about cause and effect. The researchers also did not assess inflammatory markers so could not explore the mechanisms underlying the relationship between vitamin D and pain. Data was also not collected on anxiety, depression, cancer stage, treatment or sleep disturbance before the surgery was carried out.

Nevertheless, the researchers conclude, “Vitamin D deficiency is associated with a higher occurrence of moderate to severe postoperative pain and increased opioid consumption in patients undergoing unilateral modified radical mastectomy.”

They suggest, “Preoperative vitamin D supplementation in breast cancer patients with vitamin D levels below 30 nmol/L may have a role in modulating postoperative pain.”

Source: The BMJ Group

Categories : Cancer GeneticsTags :

Gene Analysis Predicts Breast Cancer Response to Chemotherapy

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Photo by National Cancer Institute on Unsplash

A new study from Karolinska Institutet shows that gene analysis of breast cancer tumours can identify patients who do not benefit from chemotherapy given before surgery. The findings, published in the journal Nature Communications, could in the long term contribute to more personalised treatment.

The study included 179 patients with hormone dependent, HER2 negative breast cancer who took part in the Swedish PREDIX LumB trial. Before surgery, all patients received both treatments, but in different sequences. They were given either chemotherapy followed by hormone blocking therapy together with the drug palbociclib, which slows the division of cancer cells, or the reverse sequence.

When the researchers analysed the results, they found that the treatments led to similar reductions in tumour size overall. Survival was also similar regardless of whether treatment started with chemotherapy or with palbociclib and hormone blocking therapy.

Not all tumours responded

At the same time, the analyses showed that there was a subgroup of tumours with a poorer response to chemotherapy but a better response to palbociclib in combination with hormone‑blocking therapy.

To understand why some tumours did not respond to chemotherapy, the researchers analysed tumour gene expression, how active different genes are in the tumour, in tissue samples taken before treatment started. Based on these analyses, they developed a model called CDKPredX, which can identify tumours that respond poorly to chemotherapy but better to palbociclib combined with hormone blocking therapy.

“Today, we lack reliable ways to determine in advance which patients will actually benefit from chemotherapy before surgery. Our results show that tumour gene expression can provide important information in this respect,” says first author Alexios Matikas, docent at the Department of Oncology‑Pathology, Karolinska Institutet. 

The model is based on patterns of gene expression in the tumour, including genes involved in cell division, hormone signalling and the immune system. When the researchers tested the model in other patient groups, they observed similar patterns.

Further studies are needed

“In the longer term, this type of analysis could help patients avoid treatments that do not benefit them, such as chemotherapy, and instead receive treatment that has a better chance of working. At the same time, further studies are needed before the method can be used in clinical practice,” says senior author Theodoros Foukakis, professor at the same department. 

The researchers emphasise that the study is exploratory and that the genetic analysis is not yet ready for clinical use. Nevertheless, the results provide new insights into why different tumours respond differently to treatment.

Source: Karolinska Institutet

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One‑week Radiotherapy Course Effective for Early‑stage Breast Cancer

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New UK research has found that a one-week course of post-surgery radiotherapy is just as safe and effective as the traditional three-week course for people with early-stage breast cancer. 

The FAST-Forward trial, led by Keele’s Professor Murray Brunt and sponsored by The Institute of Cancer Research, London, followed more than 4000 patients for a decade after their treatment.  

The 10-year results of this phase III randomised trial, funded by the National Institute for Health and Care Research (NIHR) and published in the Lancet Oncology, show that a shorter, five-day radiotherapy schedule provides the same level of cancer control as the traditional three-week treatment.  

These findings build on previous five-year results that have already driven a shift in clinical practice. Since 2020, it is estimated that tens of thousands of people in the UK have already benefited from the shorter course on the NHS. Researchers expect this approach will also reduce the burden on people undergoing treatment for breast cancer worldwide and expand access to life-saving radiotherapy.  

Breast cancer is one of the most common cancers globally, and radiotherapy plays a critical role in reducing the risk of recurrence after surgery. A shorter treatment course is not only more convenient for patients – it also reduces hospital visits and eases pressure on radiotherapy services, making treatment more accessible.  

The research team compared the traditional schedule of 15 treatments over three weeks with two shorter schedules that used five treatments over one week. The two shorter courses gave slightly different amounts of radiation to allow the research team to work out the best dose.   

After 10 years, cancer coming back in the treated breast was very low in all three groups: 3.6% for the standard three-week treatment, 2.9% with the one-week treatment with a slightly higher dose, 2.1% with the one-week treatment with a slightly lower dose.   

The lower dose one-week treatment had side effects that were very similar to the standard approach, with no increase in long-term breast or chest wall changes. Because of this, this dose and schedule are now the recommended option.  

Professor Murray Brunt, chief investigator of the FAST-Forward study and Professor of Clinical Oncology at Keele University, said: “These 10-year results provide definitive long-term evidence that one-week radiotherapy given at an appropriate dose to the breast is a safe, effective, and more practical option for people with breast cancer. 

“By reducing treatment from 15 sessions to just five, we can offer patients the same excellent cancer control with fewer hospital visits, less disruption to their daily life, and reduced pressure on healthcare services. This approach has already transformed practice in the UK and has the potential to improve access to life-saving treatment for people with cancer worldwide. 

“Hearing patients talk about how much it helps to only need one week of radiotherapy has been really encouraging for everyone involved.”  

Professor Judith Bliss, Professor of Clinical Trials at The Institute of Cancer Research, London, who co-led the trial, said: “The FAST-Forward trial is transforming cancer treatment by reducing standard breast radiotherapy from 3 weeks to just one week, without compromising effectiveness.  

“The streamlined schedule has made radiotherapy more accessible, particularly for people who find it difficult to attend hospital and those in lower-income countries.”  

“The FAST-Forward trial is part of a long-term programme of research into improving breast cancer radiotherapy at The Institute of Cancer Research (ICR).  

“These final 10-year results mark a significant milestone in breast cancer treatment and reinforce the growing shift toward more efficient radiotherapy approaches. The success of FAST-Forward has led to the ongoing NIHR-funded FAST-Forward Boost trial, which is investigating whether more extensive radiotherapy – including an additional ‘boost’ dose for some patients – can also safely be delivered in five days.  

Professor Anthony Gordon, Director for NIHR’s Health Technology Assessment (HTA) Programme, added: “The legacy of the FAST-Forward trial is clear to see, with thousands of women benefiting from shorter courses of radiotherapy and fewer hospital visits, helping the health and care sector to achieve more effective and efficient use of resources. The new 10-year results show the benefit of investing in high-quality, long-term research to improve the health and wealth of the nation.  

“NIHR’s research aims to tackle the most urgent health and social care challenges, targeting the areas of greatest need and where the most significant impact can be made. The findings from the FAST-Forward trial have already made a considerable difference to the treatment regimens that breast cancer patients undergo, making them more efficient, while at the same time, easing pressure on NHS services.”

Source: Keele University

Categories : CancerTags :

New Drug with Fewer Side Effects Reduces Breast Density

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Photo by National Cancer Institute on Unsplash

Low doses of the investigational medicinal product endoxifen reduce breast density to the same extent as the standard treatment tamoxifen, but without causing such troublesome side effects. These are the findings of a new study from Karolinska Institutet which appears in the Journal of the National Cancer Institute. The results may have implications for future preventive treatment of breast cancer.

Tamoxifen is a well-established drug that has been used for more than 40 years to reduce the risk of recurrence in patients with breast cancer. The drug is also approved for prevention of breast cancer in women at increased risk.

However, the side effects of tamoxifen are a major problem. Many women experience menopausal-like symptoms, such as hot flushes, which means that many do not complete the treatment.

Endoxifen is the most active metabolite formed when tamoxifen is broken down in the body. The new study investigated whether endoxifen in tablet form could provide the same biological impact and a more predictable effect than tamoxifen.

A total of 240 healthy, premenopausal women were randomised to receive a placebo or 1 or 2 mg of endoxifen daily for six months. The researchers then measured mammographic breast density. High mammographic density can contribute to an increased risk of breast cancer but a reduction during treatment can be a good measure of therapeutic outcome.

”Both 1 and 2 milligrams of endoxifen resulted in a clear reduction in breast density compared with the placebo,” says Mattias Hammarström, co-author and PhD candidate at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet.

The results show that 1mg of endoxifen reduced breast density by an average of 19% and 2mg by 26%. Data from a previous study show that 20mg of tamoxifen reduces density by approximately 18.5%. The effect of low-dose endoxifen thus corresponded to that seen with tamoxifen.

Participants who received 2mg of endoxifen reported a greater worsening of hot flushes and night sweats compared with the lower-dose group, whilst the 1 mg group had a safety profile similar to that of the placebo with respect to serious side effects and biomarkers.

”Our results suggest that a lower dose may be sufficient to affect breast density, whilst also appearing to be better tolerated,” says Mattias Hammarström.

The study is a so-called proof-of-concept trial, meaning it is designed to demonstrate that a treatment produces the expected biological effect before larger and longer trials are conducted. However, the study cannot show whether endoxifen reduces the risk of breast cancer or recurrence.

Source: Karolinska Institutet

Categories : Cancer Surgeries & ProceduresTags :

Method Spots Early Signs of Infection in Post-mastectomy Reconstruction

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Rapid detection, treatment of infections could avoid complications, additional surgeries after mastectomy

Many of those women opt to have their breasts surgically reconstructed, most commonly with implants, but a relatively high percentage develop infections after implant surgery, requiring intravenous antibiotics and often removal of the implant. This can lead to additional surgeries, delays in cancer care and increased costs, as well as added emotional distress for women already under strain from cancer diagnosis and treatment.

To address this problem, researchers at Washington University School of Medicine in St. Louis have developed a new tool to detect reconstruction-related infections early, before they cause symptoms. This method, reported in the Journal of Clinical Investigation, could allow for preemptive treatment that preserves implants, improves patient outcomes and reduces the psychological and financial burden on patients.

Led by Jeffrey P. Henderson, MD, PhD, a WashU Medicine professor, the study identified biomarkers of infection in fluid drained from reconstruction patients’ breasts days or even weeks before symptoms appeared. This represents a major opportunity for improvement over existing diagnostic methods, which rely heavily on clinical symptoms, such as redness and inflammation, that take time to appear and can overlap with normal reactions to surgery.

The findings are available online and will publish in print Feb. 16 in the Journal of Clinical Investigation.

“The ability to identify with a molecular signature early on that a patient will go on to have an infection opens up the possibility of surveillance as part of standard care,” Henderson said. “This has the potential to enable earlier treatment that would be far more effective – and potentially curative – in patients who would otherwise progress to prolonged courses of treatment and surgery, or even implant removal and reconstructive failure.”

Small molecules, big impact

The study originated when Henderson’s WashU Medicine colleague Margaret A. Olsen, PhD, a retired professor of medicine in the Division of Infectious Diseases who studies hospital infections, noticed high rates of infection among US patients who had reconstruction with implants after mastectomy. The discovery prompted Henderson and Olsen, a co-author on the study, to ask WashU Medicine plastic surgeons who performed breast reconstruction what they would need to improve outcomes in these patients. Their answer was simple: a clear yes/no test for infection.

To develop such a test, Henderson and lead author John A. Wildenthal, an MD/PhD student, leveraged their expertise in metabolomics, the study of metabolites that are created or broken down during cellular processes in the body. Metabolites can indicate the presence of an infection because they include byproducts of both the body’s response to pathogens and the metabolic activity of the pathogens themselves. By analysing changes in metabolite levels, scientists can identify patterns that are characteristic of infections, enabling early diagnosis.

Henderson and colleagues coordinated with WashU Medicine plastic surgeons to obtain fluid samples from 50 patient volunteers during several routine follow-up visits after surgery. The patients included women who later developed infections after post-mastectomy reconstruction and those who did not.

The researchers analysed the samples for differences between the two groups and identified metabolites that were significantly associated with infection and that appeared days to weeks before clinical signs and symptoms of infection. Further, they found that the presence of certain metabolites indicated more serious infections that might require more aggressive treatment.

“Originating from clinical intuition and validated through a clinical study, the evidence in this paper now supports proactive, targeted interventions to predict and address infections before they become clinically significant,” said Justin M. Sacks, MD, a co-author on the paper. “Such interventions can substantially reduce the burden of complications, implant loss and reconstructive failures in these patients.”

For instance, the findings could lead to the development of a point-of-care test that could be provided during a woman’s routine post-operative visits, noted co-author Terence M. Myckatyn, MD, a professor of surgery at WashU Medicine, who performs plastic and reconstructive surgery for breast cancer patients.

“If the test is positive, antibiotics can be started preemptively in these select patients to thwart infection,” Myckatyn said. “And perhaps just as important, we would not give antibiotics to those with a negative test, thereby adhering to a thoughtful approach for antibiotic stewardship.” Such careful use of antibiotics is important for preventing antibiotic resistance, he said.

In the near term, the team is planning additional studies to validate the results. Then a diagnostic tool could be developed and tested in clinical practice. In the future, the broader metabolomic findings about the development of tissue infection in humans could allow physicians to more selectively target a variety of post-surgical infections, for example, by revealing new drug targets.

“While better techniques are always being sought, the reality is that infections still occur despite a meticulous surgical approach,” said Myckatyn. “To be able to identify biomarkers that can portend an infection days before it develops is huge.”

Source: Washington University

Categories : Lab Tests and ImagingTags :

Study Shows Low-Field MRI Is Feasible for Breast Screening

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Mass General Brigham’s evaluation of low-field MRI performance lays potential groundwork for this technology to be a lower-cost, accessible option for breast imaging

Photo by National Cancer Institute on Unsplash

Researchers at Mass General Brigham have demonstrated the technical feasibility of using ultra-low field (ULF) magnetic resonance imaging (MRI) for breast imaging. With further refinement and evaluation, the technology could offer an alternative to existing breast cancer screening methods and may reduce barriers to screening. Results are published in Scientific Reports.

“These results are a very encouraging proof of principle, though larger studies are needed to establish diagnostic performance,” said project principal investigator and co-senior author Matthew Rosen, PhD, an associate professor of Radiology and director of the Low Field MRI laboratory in the Athinoula A. Martinos Center for Biomedical Imaging in the Mass General Brigham Department of Radiology. “They motivate our continued pursuit of safe, comfortable, lower-cost screening approaches that can expand access for patients.”

Current U.S. guidelines recommend screening mammography for women aged 40 to 74 years. Unlike mammography, ULF MRI doesn’t require breast compression, which many patients find uncomfortable. Another benefit of ULF MRI is that it doesn’t use ionizing radiation.

While higher risk patients may receive MRI screening for breast cancer, standard MRI machines are not used in routine breast cancer screening because they are expensive and not widely available. ULF MRI systems cost less than 5% of the price of standard MRI systems and have lower long-term operating costs.

In this study, ULF MRI scans were performed on 14 participants, including 11 women with no history of breast cancer, two women with a prior breast cancer diagnosis, and one woman with a benign mass.

When interpreting the ULF MRI scans, three radiologists could reliably identify essential breast features and distinguish fibroglandular tissue from adipose tissue. The authors note that discrepancies were likely related to the novelty of ULF MRI and may be reduced with additional training and experience.

“This early evidence suggests that ULF MRI can detect essential breast features and some abnormalities without radiation or injected contrast,” said co-first author Neha Koonjoo, PhD, an investigator at the Martinos Center. “These findings point to the potential for ULF MRI as an option that could complement existing screening tools in the future.”

“Even at very low magnetic field, the radiology team was able to make observations about the breast,” said co-principal investigator and co-senior author Kathryn E. Keenan, PhD, from the US National Institute of Standards and Technology. “We attempted this study in hopes that the breast features would be visible, but you don’t always have success. We’re very motivated by this study to continue our work on ultra-low-field MRI for breast screening.”

The researchers note that further study is needed to determine the diagnostic accuracy of ULF MRI for breast cancer screening, including studies in larger cohorts that include patients with benign and malignant lesions. They also emphasize that further refinements in ULF MRI technology are needed to meet clinical resolution standards for breast cancer screening.

“These results will guide the next engineering steps to improve image quality and enable a more comfortable exam and help bring screening to more settings and more patients,” said co-first author Sheng Shen, PhD, of the Martinos Center for Biomedical Imaging.

Source: Mass General Brigham