ONE IN THREE by ADAM WISHART

BREAST CANCER INCIDENCE DROP

The sharp drop in breast cancer rates in the United States reported last week is astonishingly good news. It is the first major reduction in the incidence of a malignancy that strikes more than 200,000 American women every year — and kills some 40,000 annually.

This is extraordinary news. For the first time incidence in breast cancer is declining massively, by 7 per cent. It seems likely that is linked to the declining use of hormone replacement therapy. Which all goes to show that if we can understand the causes, then we can begin to tackle this disease.

Link: A big drop in breast cancer.

Please do not try this at home

If ever anyone needs any reminder that we've come a long way in cancer medicine since the 19th century, just look at this strange patent. Its intention was to stop breast lumps, in the hope that preventing them growing. It just looks bonkers.

LINK

Another Breast Cancer Gene

Today the Guardian announces that

"Cancer specialists will announce today that they have discovered a gene which may hold the key to a treatment for up to 10% of all breast cancers. The development could - in time - lead to treatments that would make chemotherapy unnecessary."

I have very mixed feelings about the spate of these kind of stories. On the one hand this is clearly a great triumph for science. At last we are beginning to understand all of the piece of the cancer puzzle. Are ability to do so will definitely make it easier to design specific therapies in the future. Just our ability to unravel the complexity of cancer amazes me.

And yet these stories often come with a promise of an imminent therapeutic intervention. In the last few years, there have been all manner of these stories. Yet in fact the drugs have been much slower in arriving than they promise. Its not surprising, both Herceptin and Gleevec too about a decade from the identification of the gene to the discovery of the drug. But there is another point in all of this, and that is that stories like this seem to characterise cancer as the problem of a single gene. Now that is not true. And the real problem for researchers will be trying to identify and treat the clusters of genes that go to causing a single cancer. Its going to be complicated stuff, much more complicated than these kind of news stories make out.

Link: Scientists find genetic key to some breast cancers.

Red Meat and Breast Cancer

More bad news for red meat eaters. Not only is it bad for cancers of the gut, but it also seems to increase breast cancer risk.

Women who eat red meat every day are almost twice as likely to develop certain types of breast cancer, a long-term study published today has found.

Scientists who monitored 90,000 women for more than a decade found that those who ate a high meat diet were much more prone to developing the hormonally reactive breast cancers, which account for more than half of all breast cancers.

The scientists suggest that synthetic hormones used in meat production could be behind the trend.

The message is getting clearer and clearer.

Link.
Original Article.

BREAST CANCER SCREENING

Today there is much hoopla about a new report from the nordic cochrane collaboration. The Press Association tells us that "thousands of women in England could be undergoing unnecessary and potentially devastating treatment for suspected breast cancer".

A vaccine, at last

Late in September 1970, many in the US cancer establishment were promising that a vaccine for cancer was imminent. They thought they had found virus particles in a whole variety of cancers. They thought that cancer would succumb to human endeavour just as Polio had a decade or so before.

In the end, cancer turned out to be a more intractable problem. Yet there was one cancer were a virus was pretty clearly the cause. That was cervival cancer.

In the 36 years since the virus cancer fad of the early 1970s, much has been done. And finally last week, the US FDA announced that it had licensed a vaccine for cervical cancer. What a result?

Link

Our strange ideas about drugs

So at last the National Centre for Clinical Excellence has recommended that a new class of breast cancer drugs be allowed on the NHS. This news has taken a long time in coming. There has been some clinical trials that have shown the benefits of these newer and more expensive drugs for years.

What I find interesting is how aromatase inhibitors have been treated differently to Herceptin. The latter was hailed as a wonder drug. Tens of patients have been campaigning for their 'life-saving' drug. There has been a massive media campaign.

Yet arguably, aromotase inhibitors will save many more lives. The Daily Mail said they'd save 1000 lives a year in the UK. Of course, unlike Herceptin they are not based on the wonders of genetic manipulation. And they are only an improvement of an existing sort of drug - Tamoxifen has been working in a roughly similar way for twenty years. And as a consequence, they have sort of given a lower priority.

Its little wonder that patients find it so difficult to navigate the treatment choices - when the coverage in the newspapers is so lopsided.

Fat or Fiction

H Gilbert Welch and his colleagues describe wonderfully the problems of assessing the effects of dietary fat in The Washington Post

"The best data to date suggesting the potential for diet -- or any lifestyle alterations -- to affect cancer risk is limited. The single notable exception is smoking: There is no doubt that not smoking dramatically lowers cancer risk.

The effect of diet on cancer is likely to be small for most people because diet is so heterogeneous and the effect of any given food may depend on its interaction with other foods. And the smaller the effect, the harder it is to demonstrate statistically. So it is really not surprising that results of research about diet and cancer flip-flop. Low-fat diets probably do lower the risk of breast cancer -- but the effect on risk is small -- particularly for women with no prior history of the disease. Changing diet to reduce breast cancer -- or any other cancer -- is a personal decision, not an imperative."

Its very counter-intuitive. All the five-a-day campaigning is partly premised on the idea that better diet will reduce cancer risk. Yet the evidence about dietary fat is not quite there.

The trouble is that there is a gulf between what we know for certain and what we might presume. That said, few doctors would advise their patients anything other than switching to healthier diets for the prevention of a range of other diseases as well as cancer.