Study: 1.3 Million Overdiagnosed Breast Cancers in 30 Years

Study: 1.3 Million Overdiagnosed Breast Cancers in 30 Years

Nick Mulcahy, Nov 21, 2012

In the past 30 years, an estimated 1.3 million American women had breast cancers that were "overdiagnosed," which means their screening-detected tumors would never have led to clinical symptoms, according to a study published in the November 22 issue of the New England Journal of Medicine.
In 2008 alone, breast cancer was overdiagnosed in an estimated 70,000-plus women, which was 31% of all breast cancers diagnosed that year, assert the study authors, Archie Bleyer, MD, from the Oregon Health and Science University in Portland, and H. Gilbert Welch, MD, MPH, from the Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire.
Overall, about one third of all breast cancers detected in the United States are overdiagnosed, they say.
The authors point out that the advent of widespread mammography screening in the United States led to a "substantial increase" in early-stage breast cancer, but only "marginally reduced" the rate of advanced cancers detected. "The imbalance suggests that there is substantial overdiagnosis."
However, breast screening expert Daniel B. Kopans, MD, from Harvard Medical School in Boston, Massachusetts, believes the study is "outrageous" and "should have never passed peer review."

Mammography does not cause 'overdiagnosis'.

"The paper...is another in a long line of scientifically unsupportable attacks on mammography," he told Medscape Medical News.
Dr. Kopans questioned the authors' methodology in his critique of the study. He also dismissed one of its central findings and ideas. "Mammography does not cause 'overdiagnosis'," said Dr. Kopans. "Unfortunately, pathologists are not yet able to distinguish cancers that will be lethal if left untreated from those that do not need treatment."
First Prerequisite Not Met
In their study, Drs. Bleyer and Welch state that "effective" cancer screening programs must increase the incidence of early cancers detected and decrease the incidence of late cancers detected. But mammography screening has not done the latter substantially, they say.
They used Surveillance, Epidemiology, and End Results (SEER) data to examine trends in the incidence of early-stage breast cancer (ductal carcinoma in situ [DCIS] and localized disease) and late-stage breast cancer (regional and distant disease) in women 40 years and older from 1976 to 2008.
They found that the introduction of screening doubled the number of early breast cancers detected annually.
Specifically, the incidence jumped from 112 to 234 cases per 100,000 women — an absolute increase of 122 cases per 100,000 women over the study period.
At the same time, the rate at which women present with late-stage cancer decreased by only a small amount (8%), from 102 to 94 cases per 100,000 women — an absolute decrease of 8 cases per 100,000 women.
However, only 8 of the 122 additional early-stage cancers diagnosed were expected to progress to advanced disease, say Drs. Bleyer and Welch, leaving a large imbalance between detected early-stage and late-stage cancers.
The data suggest that "mammography has largely not met the first prerequisite for screening to reduce cancer-specific mortality — a reduction in the number of women who present with late-stage cancer," the authors state.
The findings suggest that "screening is having, at best, only a small effect on the rate of death from breast cancer," they conclude.

Our study raises serious questions about the value of screening mammography.

"Our study raises serious questions about the value of screening mammography," say Drs. Bleyer and Welch. However, they note that their study does not answer a common question that women ask: "Should I be screened for breast cancer?"
Dr. Kopans suggests that the study delivers the message that screening is not worthwhile. And he sees Dr. Welch as part of a "small group of highly vocal individuals who have decided that they wish to end all screening for breast cancer."
"All responsible groups agree that mammography screening saves lives," said Dr. Kopans, referring to guidelines that recommend screening from major groups such as the US Preventive Services Task Force and the American College of Physicians.
Assumptions Questioned
Drs. Bleyer and Welch chose the 3-year period from 1976 to 1978 to obtain their estimate of the baseline incidence of breast cancer detected without mammography. "During this period, the incidence of breast cancer was stable and few cases of DCIS were detected," they write.
For each year after 1978, the authors calculated the absolute change in the incidence of early- and late-stage cancer relative to the baseline incidence. They then summed the data across the 3 decades.
However, they had a challenge for the years 1990 to 2005, during which many women used breast cancer-causing hormone replacement therapy. To remove the excess breast cancer incidence from that period, they "truncated" or lowered the incidence of the various types of breast cancers.
They estimated the current incidence of breast cancer on the basis of the 3-year period from 2006 to 2008. This was deemed a good time period because it is believed that the effect of hormone-replacement therapy ended at 2006.
Drs. Bleyer and Welch calculated 4 different estimates of the excess detection or "overdiagnosis" of breast cancer for the 30-year period. The estimates varied with regard to the "underlying incidence" of breast cancer, which is an estimate of the number of cases that would be found without mammography detection.
They calculated that the underlying incidence of breast cancer was increasing by 0.25% with each passing year. They describe this as a "best-guess" estimate, and used it as the basis for their conclusion that 1.3 million women had overdetected/overdiagnosed breast cancer. They also had an "extreme-assumption" estimate that assumed a 0.5% annual increase, resulting in an estimated 1.2 million overdiagnosed cases.
Dr. Kopans said that both of these estimates are too low. He explained that there has been an "underlying 1% per year increase in breast cancer incidence...that has been going on since at least 1940."
He also criticized other elements of the calculations. "They also underestimated the effects of lead time and ignored prevalence screening, which adds to incidence every year as new women begin screening. They also combined DCIS with early-invasive lesions in an effort to dilute the results," he noted.
Drs. Bleyer and Welch anticipated most of these criticisms.
"There has been plenty of time for the surplus of diagnoses of early-stage cancer to translate into a reduction in diagnoses of late-stage cancer — thus eliminating concern about lead time," they write.
They acknowledge that their best-guess estimate of the frequency of overdiagnosis — 31% of all breast cancers — did not distinguish between DCIS and invasive breast cancer. However, they say that invasive disease accounted for about half the overdiagnoses in their estimates, and that about 20% of invasive breast cancers were overdiagnosed. "These findings replicate those of other studies," they write.
They state that reliable estimates of overdiagnosis would "ideally" come from long-term follow-up after a randomized trial. One such trial from Sweden with that long-term follow-up supports these new findings, say the authors. "Among the 9 randomized trials of mammography, the lone example of this is the 15-year follow-up after the end of the Malmö Trial, which showed that about a quarter of mammographically detected cancers were overdiagnosed," they write.
Treatment Deserves Credit Too
Over the study period, "the rate of death from breast cancer decreased considerably," they note, citing other research.
They also cite other research to assert that among women 40 years or older, deaths from breast cancer decreased from 71 to 51 deaths per 100,000 women — a 28% decrease.
But screening is not the sole reason for this drop in the death rate, Drs. Bleyer and Welch note.
"This reduction in mortality is probably due to some combination of the effects of screening mammography and better treatment," they write.
The math suggests that early detection from screening is not the biggest reason for the reduction in disease-specific death, they say.
"Because the absolute reduction in deaths (20 deaths per 100,000 women) is larger than the absolute reduction in the number of cases of late-stage cancer (8 cases per 100,000 women), the contribution of early detection to decreasing numbers of deaths must be small," they write, combining incidence data from their study with those from a death rate study.
Better treatment for breast cancer lessens the need for screening, they suggest.
"Ironically, improvements in treatment tend to deteriorate the benefit of screening. As treatment of clinically detected disease (detected by means other than screening) improves, the benefit of screening diminishes. For example, since pneumonia can be treated successfully, no one would suggest that we screen for pneumonia," they argue.
Dr. Kopans also addressed this issue, saying that "early detection is the main reason that the death rate from breast cancer has declined by over 30% since screening became widely available." He noted that "therapy has improved, but therapy saves lives when cancers are found earlier."
The authors have disclosed no relevant financial relationships. Dr. Kopans reports receiving research support from GE Healthcare.
N Engl J Med. 2012;367:1998-2005. Abstract

Latest in Hematology-Oncology

Surgical Margins for Breast Cancer: Current Controversies in Oncology

20 Dec 2012 5:21 PM

Experts debate how to achieve both clear margins and the best cosmesis

Introduction
Anees B. Chagpar, MD, MSc, MA, MPH, FACS, FRCS(C)
Breast Center—Smilow Cancer Hospital at Yale-New Haven and Yale University School of Medicine

In a past column on ASCOconnection.org, I talked about a debate that had occurred in our tumor board in which a patient had a margin <1 mm from ink. While “technically negative,” it was a little too close for comfort for me; the surgeon whose case it was, however, argued based on evidence from the NSABP B-06 trial that if a tumor did not touch ink, outcomes were equivalent to the alternative of mastectomy—at least for survival. It brought up how we interpret data—and the difference between what we know and what we think we know; or as the comedian Stephen Colbert would put it, between “truth” and “truthiness.” We like to think that what we do is “evidence-based,” but we can almost always find data to support any position we wish to take.

My two good friends, Dr. Mel Silverstein and Dr. Mike Dixon, have duked out the margins debate in many public forums and settle the score here once and for all. Here is what we know for sure: (1) obtaining negative margins reduces local recurrence rates; (2) there is no consensus on what constitutes an adequate negative margin (although many would be happy with >1 mm); (3) radiation therapy continues to play a role in breast-conserving surgery (although there may be exceptions in tiny areas of estrogen receptor-positive ductal carcinoma in situ excised with widely clear margins); (4) there are ways to take out large segments of breast tissue without compromising cosmesis (although taking out less may yield excellent cosmetic outcomes without needing a contralateral symmetry procedure); and finally, (5) for the record, Mel is not a Republican (not that it matters).

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Dr. Chagpar is Director of the Breast Center at Smilow Cancer Hospital, Assistant Director for Diversity and Health Equity at Yale Comprehensive Cancer Center, Program Director of the Yale Interdisciplinary Breast Fellowship, and an Associate Professor in the Department of Surgery at Yale University School of Medicine. She currently serves on ASCO’s International Affairs Committee and is a columnist for ASCOconnection.org.

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Less Is More
J. Michael Dixon, BSc, MBChB, MD, FRCS, FRCS(Ed), FRCP(Hon)
Western General Hospital Edinburgh

More than 20 years after randomized trials demonstrated that breast-conserving surgery followed by post-operative radiotherapy has the same outcome as mastectomy, there still remains controversy as to how much of the breast should be excised when performing breast-conserving surgery. The aim of breast-conserving surgery is to excise the cancer to clear margins.^1,2

The controversy surrounds what constitutes a clear margin. The margin width is the distance from the cancer to the ink painted on the surface of the excision specimen. In surveys of surgeons and radiation oncologists, no one margin width was endorsed by more than 50% of respondents.^3-5 Thus, there is no consensus, and one consequence of this is that given a distance to the nearest margin of 1 mm, some surgeons and oncologists will accept this whereas others advise re-excision to achieve a wider margin.

A major problem in the published literature is that there are large numbers of single-center series that have all used different margin widths to define what constitutes complete excision.⁶ This allows any individual surgeon to quote a paper that supports his or her personal view.

The first review of surgical margins was conducted by Eva Singletary, MD, and published in the American Journal of Surgery in 2002.⁷ What Dr. Singletary established was that leaving disease at margins was unacceptable and significantly increased local recurrence rates. She established that wider margins did not reduce local recurrence rates and concluded that some of the best local recurrence rates were in series that had used a 1- to 2-mm margin width. This was endorsed by a more recent comprehensive review and meta-analysis of 21 retrospective studies.⁸ This analysis included 14,571 patients with breast cancer and demonstrated that a positive margin was associated with an odds ratio for local recurrence of 2.42. If the margin width was <1 mm this increased local recurrence by 1.8 times. There was, however, no statistical difference in local recurrence rates associated when comparing margin widths of >1 mm, >2 mm, and >5 mm when studies were adjusted for the use of radiation boost and endocrine therapy. The finding of this comprehensive meta-analysis was that a 1-mm negative margin is as good as a wider margin if patients receive optimal adjuvant therapy. The conclusion was that there is no justification for demanding margins greater than 1 mm.

Some have found difficulty in believing that recurrence rates are not reduced when margins are wider. This is in part because detailed whole-breast studies have shown disease extending 2 to 3 cm from the edge of the primary cancer.⁹ What a “clear 1-mm margin” indicates is not that there is no residual disease in the breast, but that any residual tumor burden is low and will be controlled with radiotherapy. Although mastectomy is offered to many patients, and patients choose it in the belief that this reduces local recurrence rates, mastectomy does not eliminate local recurrence. Randomized trials comparing mastectomy alone with breast-conserving surgery and radiotherapy have in fact shown similar local recurrence rates with both breast-conserving surgery followed by radiotherapy and mastectomy.¹⁰

Systemic treatment reduces local recurrence
The rates of local recurrence after breast-conserving surgery continue to fall.⁸ In NSABP B-06, the 20-year recurrence rate was 14.3%,1 whereas the NSABP trials conducted in the 1990s showed 10-year local recurrence rates ranging between 3.5% to 6.5%.¹¹ One of the major reasons for this is that systemic treatment reduces local recurrence significantly. In-breast recurrence was reduced in NSABP B-14 from 14.7% in the placebo group to 4.3% in patients receiving tamoxifen,¹² and in NSABP B-13, which included patients with ER-negative tumors, there was a 10-year recurrence rate of 13.4% in the no-treatment group compared with 2.6% in patients receiving chemotherapy.¹³

Studies from Edinburgh in more than 1,300 patients have confirmed that local recurrence rates do not fall with increasing margin width. In breast tumors, recurrence rates also did not increase when front and back margins were less than 1 mm, provided that full thickness of breast tissue was taken and radiotherapy boost was delivered. There were in fact no local recurrences at five years in patients who had a positive deep margin even though pectoral fascia was not removed routinely.

Importance of cosmetic outcome
It is important to limit the amount of breast tissue removed during breast-conserving surgery because the single most important factor affecting cosmetic outcome is the volume of breast tissue removed.¹⁴ Wider excisions remove more tissue and so produce significantly poorer cosmetic outcomes. There is a direct correlation between cosmetic outcome and psychological well-being—anxiety and depression scores, body image, sexuality, and self-esteem are reported as being significantly better in patients with excellent or very good cosmetic results; only patients who get a good cosmetic outcome gain the full benefits of breast-conserving surgery.¹⁵

The evidence shows that wider margins have no benefit in breast-conserving surgery. Wider margins have an adverse effect on the cosmetic outcome. Surgeons must abandon their obsession with wide margins and accept 1 mm as sufficient. Such a change will reduce health care costs, reduce the number of women having re-excisions, improve cosmetic outcomes, and thus significantly benefit patients.

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Dr. Dixon is a Professor of Breast Surgery and Consultant Surgeon, Edinburgh Breast Unit, Western General Hospital Edinburgh, UK. He currently serves on the editorial boards of Breast Cancer Management and Annals of Surgical Oncology and is Co-Chair of the Miami Breast Cancer Conference.

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References

1. Fisher B, Anderson S, Bryant J, et al. N Engl J Med. 2002;347:1233-41. PMID: 12393820.
2. Veronesi U, Cascinelli N, Mariani L, et al. N Engl J Med. 2002;347:1227-32. PMID: 12393819.
3. Vallasiadou K, Young OE, Dixon JM. Br J Surg. 2003;90:44.
4. Azu M, Abrahamse P, Katz SJ, et al. Ann Surg Oncol. 2010;17:558-63. PMID: 19847566.
5. Taghian A, Mohiuddin M, Jagsi R, et al. Ann Surg. 2005;241:629-39. PMID: 15798465.
6. Morrow M, Harris JR, Schnitt SJ. N Engl J Med. 2012; 367:79-82. PMID: 22762325.
7. Singletary SE. Am J Surg. 2002;184: 383-93. PMID: 12433599.
8. Houssami N, Macaskill P, Marinovich ML, et al. Eur J Cancer. 2010;46:3219-32. PMID: 20817513.
9. Holland R, Veling SH, Mravunac M, et al. Cancer. 1985;56:979-90. PMID: 2990668.
10. Morris AD, Morris RD, Wilson JF, et al. Cancer J Sci Am. 1997;3:6-12. PMID: 9072310.
11. Anderson SJ, Wapnir I, Dignam JJ, et al. J Clin Oncol. 2009;27:2466-73. PMID: 19349544.
12. Fisher B, Dignam J, Bryant J, et al. J Natl Cancer Inst. 1996;88:1529-42. PMID: 8901851.
13. Fisher B, Dignam J, Mamounas EP, et al. J Clin Oncol. 1996;14:1982-92. PMID: 8683228.
14. Dixon JM. “Breast-conserving surgery: the balance between good cosmesis and local control,” in A Companion to Specialist Surgical Practice: Breast Surgery. Ed. Dixon JM. Edinburgh: Elsevier, 2009.
15. Al-Ghazal SK, Blamey RW. Breast. 1999;8:162-8. PMID: 14731434.

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More Is Better
Melvin J. Silverstein, MD
Hoag Memorial Hospital Presbyterian; Keck School of Medicine, University of Southern California

In 1999, my colleagues and I published a paper in the New England Journal of Medicine showing that patients with ductal carcinoma in situ (DCIS) treated by excision alone had a very low local recurrence rate (about 5% at 10 years), if clear margins of 10 mm or more were achieved.¹

Following that paper and the presentation of those data at numerous meetings, word spread that I no longer used radiation therapy (even for invasive cancer), that I required 10-mm margins for all cases or I returned to the operating room for re-excision or mastectomy, and that I voted Republican. None of those were true. But somehow, erroneously, I became the guru for 10-mm margins without breast irradiation for all patients with breast cancer, both noninvasive and invasive.

So, let me set the record straight. I always recommend breast irradiation for patients with invasive cancer receiving breast-conserving therapy and for about half of my patients with DCIS. The exception, which follows NCCN guidelines,² are patients with DCIS with small, well-excised, low-grade lesions (low University of Southern California/Van Nuys Prognostic Index scores).^3-5 Moreover, I routinely accept 1 mm as a clear margin, and I do not require re-excision, if radiation therapy is going to be used. While I intuitively prefer wider margins, I’m willing to accept narrow but clear margins. With that said, can I prove that wider margins are better?

I admit that in 2001, while giving the Keynote Lecture at the American Society of Breast Surgeons Annual Meeting, I did say, “Margins are like money. More is better.” I still feel that way, but Mike Dixon is right. I cannot prove that 2 mm is better than 1 mm, nor that 3 mm is better than 2 mm. I cannot prove an incremental benefit because the precise measurement of margin width was not common until recently, and the prospective, level I evidence that would be required to prove an incremental benefit simply does not exist. Nevertheless, wider margins make sense, and most surgeons and radiation oncologists would prefer a wider margin, if there were no cosmetic cost.

For patients with DCIS treated with excision alone (no radiation therapy), wider margins correlate with less residual disease and a lower local recurrence rate.^6-8 Those benefits may not be so apparent for patients with invasive cancer because the value of wider surgical margins is blunted by both radiation therapy and the addition of other adjuvant treatments.

I do not want wider margins at significant cosmetic cost. What I do want is wider margins and better cosmesis. I want both. In support of that, and dating back to the 1980s and the Van Nuys Breast Center, I have always been a champion of oncoplastic breast conservation. I have always trained residents and breast fellows to believe that the appearance of the breast after breast preservation is important and that it should be equal or better than before the initial excision, if possible.

Gains from wider excisions
In an attempt to understand what is gained by wider excision, my colleagues and I recently analyzed 100 consecutive excisions using a simple ellipse and compared those cases with 100 consecutive excisions using an oncologically designed reduction mammoplasty, in which a larger amount of tissue could be removed while achieving a better cosmetic result.⁹ The data are outlined in the Table below:



In this series, when compared with a conventional elliptical excision, oncoplastic reduction routinely produced larger specimens, wider margins, a lower percentage of close or transected margins, and a lower re-excision rate. Oncoplastic reduction achieved all these benefits while routinely producing better cosmetic results.

When wider margins = better cosmesis

	Fig. 1: Preoperative (L); Two years postoperative (R): A patient with a large upper central left breast carcinoma treated with neoadjuvant chemotherapy and wide segmental resection, using a split reduction excision, followed by radiation therapy. Complete excision with wide margins as well as excellent cosmesis were achieved.

Figure 1 shows a woman with a large upper central left breast cancer. She would have been deformed with a standard excision, or, more likely, she would have been treated with a mastectomy and her reconstruction compromised by post-mastectomy radiation therapy. The use of neoadjuvant chemotherapy followed by an oncoplastic split reduction excision and radiation therapy yielded widely clear margins and a far superior cosmetic result (a win-win: wider margins and better cosmesis). Her long-term survival will be equivalent to standard lumpectomy or mastectomy, and she will be a far happier patient.

A reduction excision offers additional benefits. When clear margins are achieved during the first operative procedure, re-excision or conversion to mastectomy is eliminated, resulting in substantial cost savings and the elimination of the additional psychic trauma of a second procedure. The removal of excess breast tissue from the contralateral breast, while achieving symmetry, also appears to lower the overall risk of a future contralateral breast cancer.^10,11

I cannot prove to you that wider excision leads to a lower local recurrence rate when radiation therapy and modern adjuvant treatment is given, although I believe that it does, in a small fraction of patients; but it clearly leads to fewer re-excisions and fewer mastectomies. However, if wider excisions affect your cosmetic results negatively, then I agree, you should not be doing wider excisions. Perhaps you should not be doing breast surgery. After all, it is 2013.

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Dr. Silverstein is Director of the Hoag Breast Program at Hoag Memorial Hospital Presbyterian, and Clinical Professor of Surgery at the Keck School of Medicine, University of Southern California. He has served on ASCO’s Scientific Program Committee.

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References

1. Silverstein MJ, Lagios M, Groshen S, et al. New Engl J Med. 1999;340:1455-61. PMID: 10320383.
2. Carlson RW, Allred DC, Anderson BO, et al. NCCN Clincal Practice Guidelines in Oncology: Breast Cancer. 2008; nccn.org.
3. Silverstein MJ. Am J Surg. 2003;186:337-43. PMID: 14553846.
4. Silverstein MJ, Buchanan C. Breast. 2003;12:457-71. PMID: 14659122.
5. Silverstein MJ, Lagios M. J Natl Cancer Inst Monogr. 2010;41:193-96. PMID: 20956828.
6. Silverstein M. Women’s Health. 2008;4: 565-77. PMID: 19072459.
7. Silverstein MJ. “Margin width as the sole predictor of local recurrence in patients with ductal carcinoma in situ of the breast,” in Silverstein MJ, Recht A, Lagios M, eds. Ductal Carcinoma in Situ of the Breast. 2nd ed. Philadelphia: Lippincott, Williams and Wilkins; 2002.
8. Silverstein MJ, Lagios M, Lewinsky B, et al. Breast Cancer Res Treat. 1997;46:23.
9. Kopkash K, Savalia N, Silverstein MJ. A Comparison of Breast Conservation Methods: Ellipse Verses Reduction Excision. Submitted American Society of Breast Surgeons Annual Meeting 2013.
10. Boice J, Persson I, Brinton L, et al. Plast Reconst Surg. 2000;106:755-62. PMID: 11007385.
11. Brinton L, Persson I, Boice J, et al. Cancer. 2001;91:478-83. PMID: 11169929.

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The views and opinions expressed in Current Controversies in Oncology are those of the authors alone. They do not necessarily reflect the views or positions of the Editor or of the American Society of Clinical Oncology.

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Comments

Number of Comments: 1

Mehmet Copur

Wednesday, December 26, 2012 1:53 AM

Thank you for the nice review. Most references quoted involves patients treated 10 years or earlier and some large meta-analysis data. We need to remember that breast cancer care continuum is changing rapidly and constantly. Now we do more breast MRIs and MRI guided biopsises which can detect multifocal disease more frequently. There is also increasing use of partial breast radiation therapy despite the lack of consensus. The data quoted may not differentiate local recurrence versus recurrence from another focus/foci left behind and was not properly treated by radiation because of the partial breast irradiation. It would be nice to know how much of the recurences were true local recurrence versus growth of tumor from another focus left behind.

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 Lifestyle measures (FROM THE BRITISH HYPERTENSION GUIDELINES)

• Maintain normal weight for adults (body mass index 20-25 kg/m²)
• Reduce salt intake to < 100 mmol/day (< 6g NaCl or <2.4 g Na⁺/day)
• Limit alcohol consumption to ≤ 3 units/day for men and ≤ 2 units/day for women
• Engage in regular aerobic physical exercise (brisk walking rather than weightlifting) for ≥ 30 minutes per day, ideally on most of days of the week but at least on three days of the week
• Consume at least five portions/day of fresh fruit and vegetables
• Reduce the intake of total and saturated fat
  ============================================
  FOR BREAST CANCER PATIENTS, REDUCING CARBOHYDRATE INCREASES DISEASE FREE PROGRESSION MEANING ONCE YOU HAVE COMPLETED PRIMARY TREATMENT, YOU STAY FREE OF DISEASE LONGER IF YOU TAKE LESS CARBOHYDRATES.  THIS HAS BEEN VALIDATED!

Sons of the Sevenless

SONS OF THE SEVENLESS/Hypothesis for cancer Research

As we move forward here at CRBCM, we are increasingy  fond of one line of molecules;
first because of their name, and because we believe that their inhibitors could be the answer to the resistance
to some of the medications already in our armamentarium, namely Avastin,  Imatinib and Herceptin.  We believe that the Sons of The Sevenless which are regulator molecules switching on RAS would break resistance to Tyrosine Kinase resistance.  Sons of the Sevenless, what a name!  But don't you remember they say: "KILL THE SWITCH" AND DARK WILL COME.   THE SWITCH IS THE SONS OF THE SEVENLESS...BASAL CELL CANCER OF THE BREAST, THE CRBCM IS AFTER YOU...SINCE THE SUGGESTION THAT BASAL CELL CANCER OF THE BREAST IS LIKE OVARIAN CANCER BY ITS GENOME.  MARK MY WORD: KILLING THE SONS OF THE SEVENLESS OR KILLING THE SWITCH IS THE KEY TO TREATMENT.

ADDING TAXANE (or better yet an Anti-Kinesin) AFTER KILLING THE SWITCH (SONS OF THE SEVENLESS) WILL TURN ON THE MITOCHONDRIAL CASPASE BY AN INHERENT REFLEX MECHANISM WHICH WILL BYPASS BCL-2.  THAT'S HOW YOU LEAD TO CANCER CURE!

OH BY THE WAY,  ADDING STELAZINE TO AVASTIN MAY JUST DO THE TRICK FOR RECURRENT BRAIN TUMORS TOO. IT IS AN ANTI-CALMODULIN AFTER ALL!

RESEARCH IS ON AT CRBCM.  

Reflections at CRBCM

Reflections at CRBCM.

 Life has a way to complicate things
and people who dwell in politics do not know when to stop.
Science is strong when it is full of objectivity,
let the people who know how to do things, work free of politics.
It does not matter how big you are, if you are always wrong, you will become irrelevant to history,
will be brushed aside because the world will realize who you really are...
let people with the vision lead the way because human adventure will have to sustain itself through unwelcome noise and unfriendly  misadventure.  The vision remains the best protector of the adventure and of the place where the adventure tries to reach.   Don't get distracted, if a door is closed, keep looking for one that will open.  For as long as there is hope, the vision is possible. Just find a way to survive a little longer, until your door opens, until the opposition comes to its senses, until your voice is heard, until the critics realize you are not going away, until their bet fails, until they become irrelevant to the race.  Because it will happen without failing.  The truth always wins over falsification.  Politicians always get entangled in their own games.  Unless they speak the truth, they will keep on cheating until they unravel. Give them time to realize it!  If you conspire behind closed door, believe me, over time, those with you could one day change allegiance given shifting conditions of life, and whatever perfidy will come to light. You will lose control of the consequences and outcome.  History did not bring you to your position to fail, win by acting on your conscience and do things to improve the human condition, not reign by division and creating enemies.  I am saddened to meet people who proclaim as true the lies they have been fed, spreading division and blunt racism. Racism is the resort of those with no argument and intrinsic value.  There is no wrong in being proud of yourself as long as you do not impose those values on people who cannot see your positions and change to satisfy you.  Imposing an unfair burden on others is never right. Level the field and give to a chance to all. That is the American way!  

Affordable Mammograms NOW AVAILABLE!

If you have not yet had your yearly mammogram, now is the right time!

Many imaging services offer a special promotional rates for self-paying patients, and not only in October.

Call us for details on where and how much the mammograms are right now in El Paso:

Call us on 915-730-4535

Conference with the Cancer Survivor Dialogue Group

On October 9, 2012, the CRBCM had a chance to submit a comprehensive mission and plan of activities intended for implementation annually.  The plan was presented before the Dialogue Cancer Group, the largest Breast cancer survivors group in El Paso. Some members including a local physician were current patients undergoing chemotherapy.  We took that opportunity to conduct a small survey to detect perception by El Pasoans as to what would be the most frequent or predominant risk factors for Breast cancer.  Certainly, this was to tailor our education program for a potential primary prevention intervention. We asked  the participants to rank the first 10 risk factors by importance out of 28 risk factors documented by BreastCancer.org on their web page. The list was randomly proposed for this small study.  We have not concluded our analysis yet, but one can already suggest that 85% of survivors and current patients in El Paso feel that the 2 predominant Risk factors at equal rates were FAMILY HISTORY and GENETIC PREDISPOSITION.
This finding is striking because of the following reasons:
1.  The group under observation is made of people who discuss monthly about Breast Cancer.  Current patients speak with their Doctors almost everyday.  This is a group of people that is clearly very well informed about this topic. But they still believe that the disease is either hereditary or follows a Mendelian inheritance pattern. That somehow the family history determines who will get Breast Cancer. Te truth is that 85 percent of newly diagnosed Breast cancers happen in women who are the first in their family to have the disease. In other words, just because there is no family history of breast cancer, women should not feel protected against the disease. 

Take your mammogram if you are over 40 years of age: Please!

2. The consequence of the belief that "nobody in my family has it, so I am not at risk and so why would I want to go for a mammogram?"  clearly is one of the barriers to taking a screening mammogram.  Our Health Education material will feature it as a major objective to discuss in order to increase local rates of screening mammograms here in El Paso.
3. The Other truth is that most research literature suggests that only 5 to 10% of breast cancers (including BRCA 1 and BRCA 2) have a true genetic or familial hereditary or Mendelian inheritance pattern.  The rest is random!

                 TO BE CONTINUED