The discovery that a protein which triggers milk production in women may also be responsible for making breast cancers aggressive could open up new opportunities for treatment of the most common and deadliest form of cancer among women.
Found in all breast cells, the protein ELF5 tries to activate milk production even in breast cancer cells, which does not work and then makes the cancer more aggressive, according to scientists in Australia and Britain.
"The discovery opens up new avenues for therapy and for designing new markers that can predict response to therapy," said lead author Professor Chris Ormandy from the Garvan Institute of Medical Research in Sydney.
In 2008, Ormandy's work linked ELF5 to milk production.
The latest research by Ormandy and his team, published in the journal PLOS Biology on Friday, went a step further to find the link between ELF5 and breast cancer.
"Cancer cells can't respond properly (to ELF5), so they ... acquire some characteristics ... that make the disease more aggressive and more refractory (resistant) to treatment with existing therapies," Ormandy said by telephone.
Ormandy and his team grew human breast cancer tissues, genetically manipulated to contain high amounts of ELF5, in petri dishes and saw how the protein proliferated aggressively.
Findings may help targeted therapy
Breast cancer is the most commonly diagnosed cancer and the top cause of cancer death among women, accounting for 23 percent of total cancer cases and 14 percent of cancer deaths in women.
To decide on treatment, doctors normally need to find out if the cancer has receptors for the hormones estrogen and progesterone, which, in the case of breast cancer patients, promote growth in their tumors.
Two-thirds of breast cancers are usually positive for estrogen receptors, which then require anti-hormonal therapies that lower estrogen levels in the patient or block estrogen from supporting the growth of the cancer.
For the remaining one-third of patients, their cancers do not have receptors, which means they won't benefit from hormonal therapies. Such patients are usually given other treatments, such as chemotherapy.
Ormandy's team found that cancers with these receptors had low levels of ELF5, while those without receptors had significantly higher levels of the protein.
"What we have shown in this paper is high ELF5 tumors are dependent on ELF5 for their proliferation and if we block ELF5 in high ELF5 tumors, we will block proliferation and that will treat the tumor," Ormandy said.
"If we can develop a drug that targets ELF5, it will be very useful for that group of women," he said.
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Evan Agostini / AP
TV personality Star Jones launched a campaign that reflect an emerging trend among African American women: Finding creative ways to combat the obesity epidemic that poses a threat to their longevity.
Nicole Ari Parker was motivated by frustration. For Star Jones, it was a matter of life or death. Toni Carey wanted a fresh start after a bad breakup.
All three have launched individual campaigns that reflect an emerging priority for African-American women: finding creative ways to combat the obesity epidemic that threatens their longevity.
African-American women have the highest obesity rate of any group of Americans. Four out of five black women have a body mass index above 25 percent, the threshold for being overweight or obese, according to the Centers for Disease Control and Prevention. By comparison, nearly two-thirds of Americans overall are in this category, the CDC said.
Many black women seem to not be be bothered that they are generally heavier than other Americans.
Calorie-rich, traditional soul food is a staple in the diets of many African-Americans, and curvy black women are embraced positively through slang praising them as "thick" with a "little meat on their bones," or through songs like the Commodore's "Brick House" or "Bootylicious" by Destiny's Child. A study by the Kaiser Family Foundation and The Washington Post earlier this year found that 66 percent of overweight black women had high self-esteem, while 41 percent of average-sized or thin white women had high self-esteem.
Still, that doesn't mean black women reject the need to become healthier.
Historically black, all-female Spelman College in Atlanta is disbanding its NCAA teams and devoting those resources to a campus-wide wellness program. In an open letter announcing Spelman's "wellness revolution," president Beverly Daniel Tatum cited a campus analysis that found many of Spelman's 2,100 students already have high blood pressure, Type 2 diabetes or other chronic ailments.
"Spelman has an opportunity to change the health trajectory of our students and, through their influence, the communities from which they come," Tatum's letter said.
Jones, who underwent open heart surgery in 2010 at age 47 and now urges awareness about heart disease among black women, was met by an overflow crowd earlier this year when she convened a Congressional Black Caucus Foundation panel on black women and obesity.
"We have to get ourselves out of being conditioned to think that using soft words so we don't hurt peoples' feelings is doing them any favor," Jones said. "Curvy, big-boned, hefty, full-figured, fluffy, chubby. Those are all words designed to make people feel better about themselves. That wasn't helpful to me."
Jones once embraced being large and fabulous, at 5 feet 5 inches tall and 300 pounds. But under that exterior, she said, she was morbidly obese, suffering from extreme fatigue, nausea, lightheadedness, heart palpitations and blurred vision. The attorney and TV personality also had gastric bypass surgery in 2003.
Now, she advises women to make simple changes such as reducing salt intake, exercising 30 minutes a day, quitting smoking, controlling portion sizes and making nutritious dietary choices.
Nutritionist and author Rovenia M. Brock, known professionally as Dr. Ro, agrees with Jones. She said getting active is only about 20 percent of the fight against obesity. The rest revolves around how much people eat.
"Our plates are killing us," she said.
Brock said "food deserts," or urban areas that lack quality supermarkets, are a real obstacle. She suggested getting around that by carpooling with neighbors to stores in areas with higher-quality grocery options or buying food in bulk. She also suggested growing herbs and vegetables in window-box gardens.
"Stop focusing on what's not there, or what you think is not there," Brock said. "We have to get out of this wimpy, 'woe is me' mentality."
While first lady Michelle Obama has encouraged exercise through her "Let's Move" campaign targeting childhood obesity, the spark for this current interest among black women may have been comments last year by Surgeon General Regina Benjamin, who observed publicly that women must stop allowing concern about their hair to prevent them from exercising.
Some black women visit salons as often as every two weeks, investing several hours and anywhere from $50 to hundreds of dollars each visit — activity that, according to the Black Owned Beauty Supply Association, helps fuel a $9 billion black hair care and cosmetics industry.
In an interview during a health conference in Washington last week, Benjamin said the damage sweat can inflict on costly hairstyles can affect women's willingness to work out, and she hopes to change that. She goes to beauty industry conferences to encourage stylists to create exercise-friendly hairdos.
"I wouldn't say we use it as an excuse, we use it as a barrier," Benjamin said. "And that's not one of the barriers anymore. We're always going to have problems with balancing our lives, but we could take that one out."
Parker, an actress who starred in "A Streetcar Named Desire" on Broadway earlier this year, understands this dilemma well. Out of personal frustration over maintaining both her workout and her hair, she created "Save Your Do" Gymwrap — a headband that can be wrapped around the hair in a way that minimizes sweat and preserves hairstyles.
"Not just as a black woman, but as a woman, since the beginning of time, beauty has been our responsibility," Parker said in an interview. Because of that, she said, exercise has become linked with vanity instead of health.
"We've turned exercise into a weight-loss regimen," Parker said. "No. Exercise is about being grateful for the body you have and sustaining the life you have. ... Take all the hype out of the exercise and think of it as brushing your teeth."
With their mutual family histories of diabetes and high blood pressure in mind, Carey, 28, and her sorority sister Ashley Hicks, 29, co-founded the running club Black Girls Run. Carey also considered it a new beginning after a bad breakup and a move across country. Since 2009, Black Girls Run has amassed 52,000 members who serve as a support system for runners.
Black Girls Run has about 60 groups nationwide that coordinate local races in Atlanta, New York, San Francisco, Washington, D.C, Houston and Greensboro, N.C. Most groups run at least five times a week. Next month, the national running club will take its first "Black Girls Run — Preserve the Sexy" tour to cities with high obesity rates. The tour includes health and fitness clinics with information on nutrition, hair maintenance and running gear.
"We found that when you want to get healthy and when you want to be active, it's intimidating," Carey said. "You don't know where to start. There's a little coaxing that has to go along with that."
Parker said once African-American women place value on their bodies and longevity, everything else will follow. It costs her nothing, she said, to walk around an outdoor track with her husband, actor Boris Kodjoe, or run up and down stairs at home with her headphones.
"One good step breeds another one," Parker said. "You're going to have one less margarita, one less scoop of Thanksgiving macaroni ... and yet you're not doing anything fanatical or dramatic."
Breast cancer patients who take the drug tamoxifen for 10 years instead of just the recommended five can further cut their chances of having the disease come back or kill them, researchers reported on Wednesday.
The surprise findings could change treatment, especially for younger women. Earlier research suggested that taking the hormone-blocking drug for longer than five years didn't help and might even be harmful.
In the new study, researchers found that women who took tamoxifen for 10 years lowered their risk it would come back by 25 percent. They were 29 percent less likely to eventually die of breast cancer compared to those who took the pills for just five years.
In absolute terms, continuing on tamoxifen kept three additional women out of every 100 from dying of breast cancer within five to 14 years from when their disease was diagnosed. When added to the benefit from the first five years of use, a decade of tamoxifen can cut breast cancer mortality in half during the second decade after diagnosis, researchers estimate.
Some women balk at taking a preventive drug for so long, but for those at high risk of a recurrence, "this will be a convincer that they should continue," said Dr. Peter Ravdin, director of the breast cancer program at the University of Texas Health Science Center in San Antonio.
He reviewed results of the study, which was being presented Wednesday at a breast cancer conference in San Antonio and published by the Lancet medical journal.
About 50,000 of the roughly 230,000 new cases of breast cancer in the United States each year occur in women before menopause. Most breast cancers are fueled by estrogen, and hormone blockers are known to cut the risk of recurrence in such cases.
Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors — sold as Arimidex, Femara, Aromasin and in generic form — do the job with less risk of causing uterine cancer and other problems.
But the newer drugs don't work well before menopause. Even some women past menopause choose tamoxifen over the newer drugs, which cost more and have different side effects such as joint pain, bone loss and sexual problems.
The new study aimed to see whether longer treatment with tamoxifen could help.
Dr. Christina Davies of Britain’s University of Oxford and other researchers assigned 6,846 women who already had taken tamoxifen for five years to either stay on it or take dummy pills for another five years.
They saw little difference in the groups five to nine years after diagnosis. But beyond that time, 15 percent of women who had stopped taking tamoxifen after five years had died of breast cancer versus 12 percent of those who took it for 10 years. Cancer had returned in 25 percent of women on the shorter treatment versus 21 percent of those treated longer.
Tamoxifen had some troubling side-effects: Longer use nearly doubled the risk of endometrial cancer. But it rarely proved fatal, and there was no increased risk among premenopausal women in the study — the very group tamoxifen helps most.
"Overall the benefits of extended tamoxifen seemed to outweigh the risks substantially," Dr. Trevor Powles of the Cancer Centre London wrote in an editorial published with the study.
The study was sponsored by cancer research organizations in Britain and Europe, the United States Army, and AstraZeneca PLC, which makes Nolvadex, a brand of tamoxifen, which also is sold as a generic for 10 to 50 cents a day. Brand-name versions of the newer hormone blockers, aromatase inhibitors, are $300 or more per month, but generics are available for much less.
The results pose a quandary for breast cancer patients past menopause and those who become menopausal because of their treatment — the vast majority of cases. Previous studies found that starting on one of the newer hormone blockers led to fewer relapses than initial treatment with tamoxifen did.
Another study found that switching to one of the new drugs after five years of tamoxifen cut the risk of breast cancer recurrence nearly in half — more than what was seen in the new study of 10 years of tamoxifen.
"For postmenopausal women, the data still remain much stronger at this point for a switch to an aromatase inhibitor," said that study's leader, Dr. Paul Goss of Massachusetts General Hospital. He has been a paid speaker for a company that makes one of those drugs.
Women in his study have not been followed long enough to see whether switching cuts deaths from breast cancer, as 10 years of tamoxifen did. Results are expected in about a year.
The cancer conference is sponsored by the American Association for Cancer Research, Baylor College of Medicine and the UT Health Science Center.
Robert Sullivan / AFP - Getty Images
For those with heart disease, even moderate drinking is linked to atrial fibrillation, a new study suggests.
NEW YORK — People with heart disease who drink, even moderately, may have a slightly increased risk of a common heart rhythm problem, a new study suggests.
The study is not the first to link moderate drinking to the heart arrhythmia, known as atrial fibrillation (AF). But it's still not clear that the habit, itself, is the problem.
Doctors have long known that a drinking binge can trigger an episode of AF, in which the heart's upper chambers begin to quiver chaotically instead of contracting normally.
Things get murky, though, when it comes to moderate drinking.
In general, it's thought that having one or two drinks per day is protective against coronary heart disease — where cholesterol-containing "plaque" builds up in the arteries.
But modest drinking hasn't been linked to a decreased risk of AF — and the new findings suggest that when people already have heart issues, moderate drinking is actually tied to more AF cases.
The study, reported in the Canadian Medical Association Journal, included more than 30,000 older adults who either had clogged arteries, a history of stroke or diabetes complications such as kidney disease. Most had coronary heart disease.
Over about five years, people who drank occasionally or not at all developed AF at a rate of about 1.5 percent each year. For moderate drinkers, the rate was 1.7 percent, and for heavy drinkers, it was 2.1 percent.
The researchers looked at other factors, too - like age, weight and smoking habits. But moderate drinking was still linked to a 14-percent increase in the risk of AF.
"Recommendations about the protective effects of moderate alcohol intake in patients at high risk of cardiovascular disease may need to be tempered with these findings," write the researchers, led by Dr. Yan Liang, of McMaster University in Hamilton, Ontario.
Still, a researcher not involved in the work doubted the link between moderate drinking and AF.
One problem is separating out the effects of binge drinking, according to Dr. Kenneth J. Mukamal, of Harvard University and Beth Israel Deaconess Medical Center in Boston.
Liang and colleagues did do a separate analysis where they excluded people who reported a history of binge drinking — having more than five drinks at a time. And the results were similar.
But, Mukamal said in an email, the study did not repeatedly measure binge drinking habits over the five-year follow-up. So it's impossible to know if moderate drinkers' AF episodes were related to binges.
"The majority of binge-drinking episodes nationwide occur among otherwise moderate drinkers," Mukamal noted.
What's more, he said, the current study included patients who were involved in two clinical trials testing blood pressure drugs.
That's a narrow group of people. "In large studies of general populations — much more representative than these clinical trial participants — AF only appears higher among heavy drinkers," Mukamal said.
Atrial fibrillation arises from a problem in the heart muscle's electrical activity. It's not immediately life-threatening, and in some cases, an AF episode is short-lived and goes away on its own.
But in some people, AF becomes recurrent or permanent, raising their risk of heart failure and blood clots that can travel to the brain and cause a stroke.
The known risk factors for AF include older age, high blood pressure, diabetes, obesity and hyperthyroidism.
According to Mukamal, it's not surprising that moderate drinking seems to offer no protection against AF.
The ways in which alcohol might cut the risk of coronary heart disease — through better "good" cholesterol levels and less blood clotting — don't affect the risk of developing AF.
About 2.7 million Americans have atrial fibrillation, according to the American Heart Association (AHA). But coronary heart disease, the nation's number-one killer, is a much more common cause of death.
In general, experts say that if you're already a moderate drinker (up to one drink a day for women, and two for men), it's probably okay to keep it up.
But for people with certain chronic health problems, the new results may question that guidance, the researchers said.
"Our findings suggest that older individuals with cardiovascular disease or diabetes should probably limit their alcoholic beverages to no more than 1 drink per week," Liang told Reuters Health in an email.
"And binge drinking should be avoided, even if you drink infrequently."
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