Exercise and its relationship to patient quality of life, cancer prevention, and impact on treatment and recurrence have been studied extensively in several types of cancer. Regular physical activity may help improve overall health and well-being as well as treatment outcomes. Experts have recommended that cancer patients and survivors continue to stay active.[2]

In order to examine the association between physical activity and cancer survival, researchers reviewed 45 studies (between 1950 and 2011) that evaluated the relationship between physical activity and mortality and/or cancer biomarkers among cancer survivors. They found consistent evidence that physical activity is associated with reduced mortality in breast and colon cancer patients and survivors (and this refers to mortality associated to any cause, not just the cancer). The studies that included biomarker endpoints provided evidence that exercise might result in beneficial changes in the circulating level of insulin, insulin-related pathways, inflammation, and possibly, immunity; however, the researchers point out that more evidence is required to make any conclusions.

The strongest evidence associated with a benefit from exercise was in breast cancer survivors, with colorectal cancer coming in a close second. Most studies showed a significant reduced risk of breast cancer mortality associated with exercise. Because the studies were so diverse, it is not possible to provide specific recommendations regarding the type and duration of exercise; however, the evidence is clear—exercise provides benefit.

References:

Infections with certain viruses, bacteria, and parasites have been identified as strong risk factors for specific cancers. To examine the link between infections and cancer, researchers performed a systematic analysis of the proportion of cancer cases attributable to infection in 2008. They used data on cancer incidence from the GLOBOCAN project along with epidemiological data regarding the causal effects of infection on cancer. The data included information on 27 types of cancer from 182 countries.

They found that of the 12.7 million new cancer cases that occurred worldwide in 2008, 16 percent—or roughly two million—were attributable to infections. The rate of infection-related cancer was about three times higher in developing countries. For example, 3.3 percent of cancers in Australia and New Zealand were infection related, whereas 32.7 percent of cancers in sub-Saharan Africa were attributable to infections. The four main infections associated with cancer were human papillomavirus, hepatitis C, hepatitis B, and Helicobacter pylori. These infections were responsible for approximately 1.9 million cancer cases in 2008, mainly gastric, liver, and cervical cancers.

Cervical cancer accounted for about half of the infection-related cancers in women. Liver and gastric cancers accounted for more than 80 percent of the infection-related cancers in men.  About 30 percent of infection-related cancers occurred in people younger than 50 years. It’s important to note that it takes decades of chronic infection before an infection progresses to cancer.

Based on the statistics, the researchers noted that approximately two million cancer cases each year might be preventable with better public health methods for preventing infection. In an accompanying editorial, Dr. Goodarz Danaei, an assistant professor of global health at Harvard School of Public Medicine in Boston, noted that vaccines for HPV and hepatitis B are effective and that increasing their availability should be a priority for higher risk countries.[2] He suggests that increasing vaccine coverage could reduce the global burden of cancer.

References:

On May 9, 2012 at 7:00PM EST you will have the opportunity to ask the expert, Dr. David Hyams, about treatment options available for DCIS and how recent advances could impact treatment decision making. Dr. Hyams is a world-renowned authority in this area. He has been actively involved in clinical research and continues to lead innovative studies designed to make personalized cancer medicine a reality.

The Web Chat is in two parts: the live Q&A will follow Dr. Hyams’ presentation. Click here to submit a question to Dr. Hyams that will be answered during the Live Web Chat. Please note, we will do our best to respond to all questions during the 30-minute live Q&A portion of the program. Thank you for your participation.

This program is sponsored by Genomic Health, Inc. Please visit Oncotype DX to learn more.

Silicone gel-filled breast implants are implanted under breast tissue or chest muscle for breast augmentation or reconstruction. They have a silicone outer shell that is filled with silicone gel and come in different sizes.

Breast reconstruction may refer to a primary reconstruction to replace breast tissue that has been removed or revision surgery to correct the result of a primary reconstruction surgery.

The FDA based its approval of Sientra’s implant on 3 years of clinical data from 1,788 participants. Complications and outcomes reflected those found in previous studies of other breast implants and included tightening of the area around the implant (capsular contracture), reoperation, implant removal, an uneven appearance (asymmetry), and infection.

Sientra’s post-approval studies will include:

• An additional 7 years of follow-up of the 1,788 clinical trial participants in their pre-market study
• A 10-year study of 4,782 women receiving Sientra silicone gel-filled breast implants to collect information on long-term local complications such as capsular contracture, as well as less common disease outcomes, such as rheumatoid arthritis and breast and lung cancer
• Five case-control studies that will evaluate the association between Sientra’s silicone gel-filled breast implants and five rare diseases: rare connective tissue disease, neurological disease, brain cancer, cervical/vulvar cancer, and lymphoma.

With the addition of Sientra’s approval, there are now three FDA-approved silicone gel-filled breast implants on the market in the U.S.

Silicone gel implants have generated a fair amount of controversy regarding their safety because of the question as to whether they can trigger certain connective tissue and autoimmune diseases. In 1992, the FDA restricted the use of silicone implants in order to evaluate whether they were indeed associated with autoimmune conditions. Clinical trials have continued and the data continues to indicate that the implants are safe.

It’s important to remember that breast implants are not lifetime devices and long-term monitoring is imperative.

Reference:

FDA approves new silicone gel-filled breast implant [FDA News Release]. U.S. Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm295437.htm”>http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm295437.htm

How does cancer treatment affect fertility in men?

Chemotherapy: Chemotherapy can temporarily—and in some cases, permanently—stop sperm production by the testes.[1] The extent to which chemotherapy affects sperm production depends on several factors, including the type and dose of chemotherapy.

Radiation: Radiation to the abdomen or pelvis can also reduce or eliminate sperm production by the testes.

Surgery: Surgery that involves the removal of both testicles (an option for some men with prostate cancer) eliminates sperm production, but other types of surgery can also affect a man’s fertility. Some types of pelvic surgery, for example, can change or eliminate ejaculation.

Options for preserving fertility in men

Although many men are able to conceive naturally after cancer treatment, others are not.

If possible, men should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

Sperm banking is the most well-established method of preserving fertility in men.[2] It involves the collection and storage of sperm, ideally before cancer treatment begins. The samples are kept frozen at a lab or sperm bank until they are needed. Sperm can be stored in this way for many years. After being thawed, the sperm can be used for intrauterine insemination (IUI) or in vitro fertilization (IVF). During IUI, sperm are placed directly into a woman’s uterus. During IVF, mature eggs are removed from a woman’s ovary and mixed with the sperm in the lab. Embryos that result from IVF can then be placed in a woman’s uterus or frozen for later use.

If a sample contains very few viable sperm (or if a man has already undergone cancer treatment and has a low sperm count), another approach may be used to fertilize an egg. Intracytoplasmic sperm injection (ICSI) requires only a small number of healthy sperm, along with mature eggs that have been collected from a woman’s ovary. A single sperm is injected directly into each egg. The embryos that develop can then be placed in a woman’s uterus or frozen for later use.

If it is not possible to collect sperm from ejaculate, it may in some cases be possible to collect sperm directly from the testicles. This approach is still investigational.

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. During radiation therapy, for example, it may be possible to shield the testes in order to preserve sperm production.

Pregnancy after cancer

In the event that your fertility is not affected by cancer treatment (or recovers quickly or unexpectedly), you and your partner should use birth control if you do not wish to have a child. If you are trying to conceive a child naturally, your doctor may advise you to wait for several months after treatment; this allows for the elimination of sperm that may have been damaged during treatment.

In general, the risk of birth defects in children born to cancer survivors appears to be similar to the risk in the general population.[3] If your cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), your children may inherit the gene mutation responsible for your family’s increased risk of cancer. Talking with a genetic counselor may be helpful.

Other options for parenthood

Not all men have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all men will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for men who want to father a child but cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, you may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Donor Sperm: Donor sperm is readily available from sperm banks and can be used for either intrauterine insemination or in vitro fertilization.

Individual decisions within a larger community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.  To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More information?

Discuss with others…. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

How does cancer treatment affect fertility in women?

Chemotherapy: Many chemotherapy drugs are toxic to the egg cells (oocytes) in the ovaries. If the number of remaining oocytes in the ovaries reaches a critically low point during treatment, women experience “acute ovarian failure.” This means that the ovaries stop functioning during or shortly after cancer treatment. If oocytes are lost during treatment but do not reach this critically low point, women are at risk for early menopause but may still be able to get pregnant for some time after treatment.

Radiation: Radiation to the pelvis can also destroy oocytes. Radiation to the pelvis can also affect uterine growth and blood flow, particularly if received before puberty.[1] A poorly developed uterus may make a woman more likely to have a miscarriage, or more likely to have a preterm or low-birthweight infant.

Surgery: Some cancers require surgical removal of the uterus, the ovaries, or both.

The effects of cancer treatment on fertility can vary substantially by age. Younger women, who have a larger pool of oocytes when they start cancer treatment, are more likely than older women to be able to get pregnant after treatment.[2]

Options for preserving fertility in women

If possible, women should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

One of the most established approaches for preserving fertility among female cancer patients is embryo freezing.[3] Before starting cancer treatment, a woman would be given hormones to stimulate the development of eggs in her ovaries. Mature eggs would be removed and fertilized with the sperm of her husband, partner or a sperm donor. The embryos that result from these fertilized eggs would be frozen for later use.

Although embryo freezing is an established approach to helping women become pregnant after cancer, there are downsides. A woman may not currently have a male partner and may be unwilling to use an anonymous sperm donor. It’s also important to be aware that embryo freezing takes approximately two weeks after the start of a woman’s period. If a woman needs to begin cancer treatment immediately, she may not be able to go through this process. Finally, this approach is only an option for women of childbearing age; stimulating the ovaries to produce mature eggs is not an option for girls who develop cancer during childhood.

Several other options are still in the experimental phase. One approach being explored is the freezing of unfertilized eggs.3 Once again, the ovaries would be stimulated to produce mature eggs before cancer treatment begins. The eggs would then be frozen without being fertilized by sperm. Currently, freezing unfertilized eggs is less likely to result in pregnancy than freezing embryos, largely because unfertilized eggs are less likely than embryos to survive the process of freezing and thawing. Nevertheless, it may be an option for women who do not have a male partner at the time of their cancer diagnosis, and it avoids the difficult issue of what to do with unused embryos.

Another promising but still experimental approach is to freeze all or a part of an ovary before cancer treatment.[4] After treatment, the ovarian tissue is implanted either back in the woman’s pelvis or in another location (such as under her skin). If this process is successful, the ovarian tissue will begin producing eggs. A safety concern with this approach is the possibility of reintroducing cancer cells along with the ovarian tissue, and the tissue will need to be carefully screened for cancer before it is transplanted.4

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. For example, shielding the ovaries during radiation, or moving the ovaries out of the radiation field, may protect them from the effects of radiation. Scientists are also exploring whether using drugs to suppress the activity of the ovaries during chemotherapy will make the ovaries less susceptible to damage by chemotherapy.[5] For women with certain types of cervical or ovarian cancer, fertility-preserving surgery may also be an option.[6] It’s important to understand that only specific subsets of patients will be candidates for these approaches, and that some of the methods are still in the early stages of evaluation.

Pregnancy after cancer

In addition to having concerns about their ability to get pregnant, women may have concerns about whether pregnancy after cancer treatment will be safe for themselves and their children. While there is a limited amount of information about these topics, the news is generally good.

The risk of cancer recurrence during or after pregnancy has been most studied in women with breast cancer, and these studies generally have reported that pregnancy does not increase the risk of breast cancer recurrence. [7] Many doctors, however, suggest waiting for a period of time after treatment before becoming pregnant. [8]

If chemotherapy or radiation therapy has damaged her heart or lungs, a woman may also have concerns about the strain that pregnancy will put on her body. Studies of breast cancer survivors suggest that long-term heart problems are uncommon after chemotherapy or radiation therapy, [9] but a woman may wish to talk with her doctor about her current health status and the likely effects of pregnancy.

Children born after their mother’s cancer treatment do not appear to be more likely than other children to have birth defects or cancer.[10] If a woman’s cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), her child may inherit the gene mutation responsible for her family’s increased risk of cancer. Talking with a genetic counselor may help clarify the child’s risk.

When planning for pregnancy, be aware that some cancer treatments may cause you to have an early menopause even if your periods resume after treatment. Also be aware that you may be capable of conceiving even if your periods do not resume; continue to use birth control if you do not wish to become pregnant.

Other Options for Parenthood

Not all women have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all women will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for women who want to become pregnant and cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, women may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Egg Donation: Women who still have a uterus may be able to become pregnant using an egg donated by another woman. Through in vitro fertilization, the donated egg would be fertilized by the cancer survivor’s male partner or a sperm donor, and implanted in her uterus. Alternatively, another couple may donate a frozen embryo that could be implanted in her uterus.

Gestational Carrier or Surrogate: Women who do not have a uterus, or who are otherwise unable to sustain a pregnancy, may be able to have another woman carry a pregnancy for them. If the cancer survivor has functioning ovaries, her own egg can be fertilized by her male partner’s sperm and transferred to the uterus of another woman. In this case, the woman who carries the pregnancy is known as a gestational carrier. If the cancer survivor does not have functioning ovaries, another woman can both donate an egg and carry the pregnancy. This is the arrangement traditionally known as surrogacy.

Individual Decisions Within a Larger Community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.

To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More Information?

Discuss with others….. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

Different groups of experts have reached different conclusions about when mammographic screening should begin and how often it should be performed. The U.S. Preventive Services Task Force (USPSTF) recommends that routine screening of average-risk women begin at age 50 and be performed every two years. In contrast, the American Cancer Society (ACS) recommends annual screening beginning at age 40.

The 2009 USPSTF screening recommendation to delay screening until age 50 created enormous controversy. Sometimes, screening average-risk women in their 40s can cause more harm than benefit and can result in false-positive test results and overdiagnosis. However, some women do benefit from earlier screening. These new studies were designed to identify women who might benefit from beginning screening at age 40—and they represent a shift away from the one-size-fits-all approach and toward personalized screening recommendations.

In the first study, researchers conducted a comprehensive review of 66 studies in addition to analyzing new data from over 380,000 women in order to evaluate breast cancer risk for women in their 40s. They found that women who have a mother or sister with breast cancer have double the risk of developing the disease. What’s more—those with more than one first-degree relative with breast cancer have nearly four times the risk of developing the disease.

The study also found that women with dense breasts—meaning the breasts have substantially more glandular tissue than fat—are twice as likely to develop breast cancer in their 40s. The researchers identified other risk factors as well: women who have had breast biopsies that turned out to be benign have an 80% greater risk of getting the disease in their 40s; women on oral contraceptives have a 30% increased risk; women who have never given birth have a 25% greater risk; and women who had their first child after age 30 have a 20% increased risk.

The second study was designed to identify the threshold of risk necessary in order for the benefits to outweigh the harms in screening women in their 40s. The researchers analyzed data from screening average-risk women aged 50 to 74 in order to determine the rate of false-positives and deaths averted by screening. Next they used four independent simulation models for women ages 40 to 49. They found that the benefits and harms from screening mammograms every two years for women 40-49 with a twofold increase in breast cancer risk are similar to those for average-risk women who begin biennial screening at age 50. Women with a fourfold increased risk benefited from yearly screening starting at age 40.

The bottom line—one size does not fit all when it comes to breast cancer screening. By determining a woman’s risk of developing the disease, doctors can create personalized screening recommendations and ensure the benefits of screening outweigh the harms.

References:

Breast cancer is the most commonly diagnosed type of cancer (other than skin cancer) in US women. Each year, roughly 227,000 women are diagnosed with breast cancer and close to 40,000 die of the disease. Treatment of early breast cancer may include breast-conserving surgery, radiation, and (when appropriate) systemic therapies such as chemotherapy and hormonal therapy.

After treatment, some survivors experience long-term adverse effects, including prolonged, disabling fatigue—referred to as cancer-related fatigue or CRF. There is no clear understanding of the underlying causes of CRF and there are no effective prevention or treatment strategies.

Researchers from Australia studied CRF in a cohort of 218 women who received some sort of adjuvant treatment for early breast cancer. The women were enrolled in the study after surgery and were observed at 1, 3, 6, 9, and 12 months as well as 5 years. At each interval, the women underwent structured interviews and responded to questionnaires about their physical and psychological health.

Immediately after treatment, 31% of women experienced CRF; however, the rate of CRF dropped to 11% six months after treatment and 6% one year after treatment. Women who were still experiencing persistent fatigue after six months were evaluated to rule out other causes such as low thyroid levels or depression.

The researchers noted that CRF was associated with significant disability and healthcare utilization. It was not clear why some women remained fatigued for months after treatment. There is speculation that inflammation could be a factor or that some patients may have a genetic predisposition that creates an exaggerated response to chemotherapy. As of yet, there is no data to support these theories.

The researchers concluded that CRF is common among women treated for early breast cancer, but generally fades over time. Women who suffer from CRF might benefit from following a healthy diet and getting regular exercise and sleep.

Reference:

Goldstein D, Bennett BK, Webber K, et al. Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. Journal of Clinical Oncology. Published early online: April 16, 2012. doi:10.1200/JCO.2011.34.6148

A mammogram is an X-ray of the breast. Screening mammography is performed in a woman without breast symptoms in order to detect breast cancer at an early stage when it is most easily treated. Different groups of experts have reached different conclusions about when mammographic screening should begin and how often it should be performed. The U.S. Preventive Services Task Force recommends that routine screening of average-risk women begin at age 50 and be performed every two years. The American Cancer Society recommends annual screening beginning at age 40.

Although screening mammography can reduce the risk of death from breast cancer (due to early detection), disease screening in healthy individuals can also lead to false-positive test results. A false-positive result suggests that cancer may be present even though the person is actually cancer-free. False-positive results can lead to anxiety and unnecessary additional testing.

Women with false-positive mammography results are usually referred back for routine screening; however, it is unknown whether these women have a higher long-term risk for breast cancer compared to women who initially test negative.

In order to determine if women with false-positive mammography results have a higher risk of developing breast cancer than those who test negative, researchers from the University of Copenhagen evaluated data from a population-based mammography program in Copenhagen, Denmark from 1991-2005. They used the data to measure the risk of breast cancer and ductal carcinoma in situ (DCIS) in 58,003 women between the ages of 50-69 who had received false-positive test results.

The results indicated that women who had tested negative for breast cancer had an absolute cancer rate of 339 per 100,000 person-years at risk, whereas women had tested false-positive had an absolute rate of 583 per 100?000 person-years at risk. Six or more years after the test, the relative risk of breast cancer in women with false-positive results was statistically significantly higher than women who tested negative; however, those statistics lowered when new screening technology was introduced in the year 2000.

It’s important for women to discuss screening options with their physician in order to determine their optimal screening protocol for breast cancer. Based on the results of this study, women with false-positive mammography results may benefit from close monitoring and continued regular screening.

Reference:

A mammogram is an X-ray of the breast. A screening mammogram is a mammogram that is performed in a woman without breast symptoms. The goal of screening mammography is to detect breast cancer at an early stage when it is most easily treated.

Different groups of experts have reached different conclusions about the optimal way to screen for breast cancer. Women at high risk of breast cancer may benefit from shorter screening intervals as well as supplemental screening with ultrasound and/or magnetic resonance imaging (MRI). MRI uses radio waves and a magnet to create detailed images of the inside of the body. For the detection of breast cancer, MRI tends to be more sensitive than mammography. The American Cancer Society recommends breast cancer screening for high-risk women include MRI and mammography.

To evaluate the benefit of supplemental screening, researchers conducted a multi-center study that included 2,662 women at an elevated risk for breast cancer. The women underwent annual mammography and ultrasound screening at 0, 12, and 24 months. In order to be eligible for the MRI sub-study, women had to have completed the third round of annual ultrasound/mammography screenings and agreed to undergo contrast-enhanced breast MRI within 8 weeks of the 24-month screening mammogram.

During the 3-year study, a total of 110 women were diagnosed with breast cancer. One woman was diagnosed with two separate breast cancers in the first and third year, resulting in a total of 111 breast cancer events. Of these, 33 were detected by mammography only, 32 by ultrasound only, 26 by both, and 9 by MRI after mammography plus ultrasound; 11 were not detected by any of the imaging tests.

The MRI sub-study included 612 women, 16 of whom were diagnosed with breast cancer. Nine of these 16 cancers were seen only on MRI after negative mammography and ultrasound results. Two invasive cancers that were detected by ultrasound but not mammography were also detected by MRI.

The results indicated that MRI significantly increased detection of early breast cancer compared to mammography alone or mammography plus ultrasound. There was a 56 percent absolute increase in cancer detection in the MRI sub-study compared to a 34 percent absolute increase in cancer detection with the addition of ultrasound to mammography.

The researchers concluded that the addition of screening ultrasound or MRI to mammography in high-risk women may result in a higher cancer detection rate; however, because these supplemental screening tests come with higher false-positive rates and a higher cost, they may not be appropriate for everyone. It’s always important to discuss optimal screening protocol with your physician. Depending on your risk for breast cancer, supplemental screening could provide some benefit.

Reference: