Gay Men More Likely to Have Had Cancer

A new study finds that homosexual men are twice as likely as other males to have been diagnosed with and then survive a cancer, shining a light on the unique medical risks that gay people may face. It's not the first time that researchers have noted differences in health risks linked to sexual orientation. Gay men, of course, are at higher risk of becoming infected with HIV, while lesbians may be more likely than heterosexual women to get breast cancer. Both gay men and lesbians have higher rates of tobacco use than the general population, and research has shown that lesbians drink more and are more prone to obesity than other women.

The new study adds to existing knowledge, but "there's a painful dearth of data about lesbian, gay, bisexual and transgender health in general," noted Liz Margolies, executive director of the National LGBT Cancer Network, who's familiar with the new research. In the new study, published online May 9 in Cancer, researchers examined surveys involving more than 122,000 California residents from 2001, 2003 and 2005. Among other things, the surveys asked about sexual orientation and whether the participants had ever been diagnosed with cancer. About 8 percent of the gay men in the group reported having had cancer almost double the rate among the heterosexual and bisexual men surveyed.

Lesbians didn't have a higher rate of cancer than other women, but lesbian cancer survivors were about twice as likely to report that they had fair or poor health compared to heterosexual women. The study can't say whether gays and lesbians are more likely to develop cancer in the first place, since it doesn't include people who have died from the disease or may be too ill to answer questions, stressed study author Ulrike Boehmer, an associate professor of community health sciences at Boston University School of Public Health. Experts already believe that gay men face a higher risk of anal, lung, testicular and immune-system cancers, she said. For their part, lesbians are thought to possibly be at higher risk of breast cancer, perhaps because many of them don't give birth.

Payment Rates May Affect Breast Cancer Treatment

Use of a costly breast cancer therapy called intensity-modulated radiation therapy is strongly influenced by what Medicare will pay for the treatment and where radiation oncologists practice, according to a new study. Researchers analyzed Medicare data for 26,163 women with localized breast cancer who had surgery and radiation therapy between 2001 and 2005. During that time, Medicare billing for the treatment, called IMRT, increased more than 10-fold (from 0.9 percent to 11.2 percent of patients).

The average cost for radiation treatment within the first year after breast cancer diagnosis was $7,179 without IMRT and $15,230 with it. Billing for IMRT was five times higher in regions of the country where the treatment was covered by local Medicare carriers than it was in areas where it was not covered, the researchers said. They also found that billing for IMRT was more common among patients treated in freestanding radiation treatment centers (7.6 percent) than among those treated in hospital-based outpatient clinics (5.4 percent).

The findings "suggest that with respect to breast radiation therapy, much of the variation in cost can be directly attributed to inconsistent treatment definitions and reimbursement rates authorized by Medicare and its intermediaries," concluded Dr. Benjamin D. Smith, of the M.D. Anderson Cancer Center in Houston, and his colleagues. The study is published in the April 29 online edition of in the Journal of the National Cancer Institute.

Nervous System Imbalance May Cause Fatigue in Breast Cancer Survivors

The persistent fatigue and exhaustion plaguing some breast cancer survivors after successful treatment stems from a tug of war between the "fight-or-flight" and "resting" parts of the autonomic nervous system, with the former working overtime and the other unable to rein it in, a new study suggests. Researchers from Ohio State University split 109 women who had completed breast cancer treatment up to two years earlier into two groups those who did and didn't report long-term fatigue and tested their blood for a baseline level of norepinephrine, a stress hormone. Participants were then asked to give a five-minute speech and do a series of verbal math problems, both tasks aimed at increasing their stress levels.

As expected, further blood tests showed that levels of norepinephrine associated with the "fight-or-flight" sympathetic nervous system rose in both groups after the stressful experience, researchers said. However, breast cancer survivors who experienced persistent fatigue had higher levels than those who weren't chronically tired. The study, released online in advance of publication in an upcoming print issue of the journal Psychoneuroendocrinology, was partially funded by the U.S. National Institutes of Health and the American Cancer Society.

The findings are the most recent from a 30-year-long study about the effects of stress on the human body. The researchers used earlier data from a larger ongoing study looking at whether yoga can ward off continuing fatigue in breast cancer patients. "We're not sure if the fatigue is stress-induced. But certainly cancer is an extremely stressful life event," said study author Christopher Fagundes, a postdoctoral fellow at Ohio State University's Institute of Behavioral Medicine Research. "So those stressors might be contributing to those autonomic system changes."

Tissue Analysis May Help Predict Breast Cancer Outcome

An analysis of breast tissue may help doctors better predict outcomes for women with breast cancer, a new study reports. Researchers analyzed what they describe as "highways" of connective tissue in breast cancer tumors, and found that the way collagen fibers the main component of connective tissue are arranged may aid in a patient's diagnosis and help determine treatment. Collagen not only surrounds most body organs and helps provide structure for the body, it also tells cells how to behave, the study authors noted. Normally, a close-up of collagen resembles a jumbled path or a plate of cooked spaghetti.

In the new study, the researchers analyzed tumor cells from 200 patients with invasive breast cancer. The investigators found signs that the collagen began to act differently as the tumors progressed. "We think the cancer cells start to pull on the collagen and straighten it out, forming a track or highway on which the cells can migrate," study senior author Patricia Keely, an associate professor of cell and regenerative biology at the University of Wisconsin-Madison School of Medicine and Public Health, said in a university news release. As the highways became more developed, the prognoses for patients worsened, the study found.

"We have identified a novel collagen-signature system that may become a very useful addition to the tools clinicians use to determine a breast cancer patient's prognosis," Keely explained. The research is published in the March issue of the American Journal of Pathology. Commenting on the study, Dr. Priscilla A. Furth, a professor of oncology and medicine at Georgetown University's Lombardi Comprehensive Cancer Center, described it as an example of "valid basic research." However, "before any new prognostic test can go into practice it must be extensively validated. This publication is a first step that might trigger additional research to examine the utility of this type of analysis in different settings and by different groups," said Furth, who was not involved with the study.

Drop in Breast Cancer Among White Women May Have Stalled

Many American women abandoned hormone replacement therapy after a 2002 study found the treatment was tied to higher breast cancer risk. A sharp drop in breast cancer incidence among whites was observed soon after. However, a new study suggests that the 2002-2003 decline in breast cancer incidence among white women did not continue through 2007. The data suggests that the drop in breast cancers linked to women abandoning hormone replacement therapy (HRT) has now bottomed out.

Breast cancer rates among U.S. white women fell by about 7 percent between 2002 and 2003 after the release in 2002 of findings from the Women's Health Initiative study that linked HRT with an increased risk of breast cancer. To examine whether that trend has continued, American Cancer Society and U.S. National Cancer Institute (NCI) researchers reviewed breast cancer data collected from 2000 to 2007 by NCI Surveillance, Epidemiology and End Results (SEER) registries across the country.

The analysis revealed that the sharp decline in breast cancer rates among white women that occurred between 2002 and 2003 did not continue between 2003 and 2007. Instead, breast cancer rates among white women remained relatively stable from 2003 to 2007. "Postmenopausal hormone replacement therapy certainly had accounted for an increase in the incidence of developing a breast cancer. The use of postmenopausal HRT had sharply declined after multiple reports proved this relationship," noted one expert, Dr. Sharon M. Rosenbaum-Smith, a breast cancer specialist and surgeon at the Comprehensive Breast Center at St. Luke's-Roosevelt Medical Center in New York City.

Breast Cancer Treatment May Lead to Hip Fracture

Middle-aged breast cancer survivors face an increased risk for hip fractures, a condition normally uncommon in women younger than 70, a new study has found. Researchers at Northwestern University in Chicago say that this may be because early menopause caused by breast cancer treatment and the effects of breast cancer drugs could weaken the bones by the time women reach middle age. The finding came from a study of six women who had survived breast cancer and, in their early 50s, were being treated for hip fractures.

Most of the women did not have osteoporosis, but they did have lower-than-normal bone mineral density (osteopenia). This suggests that rapid changes in bone architecture caused by chemotherapy, early menopause and adjuvant breast cancer therapy may not be detected on a bone mineral density test, said Dr. Beatrice Edwards, an associate professor of medicine and orthopedic surgery and director of the bone health and osteoporosis program Northwestern University's Feinberg School of Medicine, who led the research.

The women had been diagnosed with early-stage breast cancer, and their treatments had included lumpectomy, radiation therapy and chemotherapy with cytoxan and adriamycin for one to four years before they broke a hip. All of the women were perimenopausal at the time of the fracture. In four of the women, their breast cancer had grown in response to estrogen, and their cancer therapy had included aromatase inhibitors to prevent their bodies from making estrogen. Recent research has linked aromatase inhibitors with possible bone loss in women.

Breast Cancer Outcome: Your Doctor Matters

How doctors choose to treat their breast cancer patients and whether those treatment choices follow established recommendations may play a larger role in whether a cancer returns than experts have believed. In a new analysis looking at 994 women with ductal carcinoma in situ, the most common type of noninvasive breast cancer, researchers found treatment variations from surgeon to surgeon are significant, and may account for up to 30 percent of recurrences.

"Treatment variation is a troubling but well-known phenomenon in health care," said study author Andrew W. Dick, a researcher at RAND Corp. in Pittsburgh. The report is published online Jan. 3 and in the Jan. 19 print issue of the Journal of the National Cancer Institute. "The reason it is surprising in this case is that the variation is quite large, and related to factors that are very important in health outcomes," Dick said.

Those factors include having "negative margins" meaning that cancer cells are more than 2 millimeters away from the removed tissue's edge and getting radiation therapy after breast-conserving surgery. The variation by surgeon in treatments accounted for 15 percent to 35 percent of cancer occurring in the opposite breast in the next five years and 13 percent to 30 percent of recurrences over 10 years, the investigators found.

Keeping Holiday Drinking in Check May Counter Cancer

Though holiday partying often includes alcohol consumption, cancer experts are urging partiers to partake moderately. "Research shows that drinking even a small amount of alcohol increases your chances of developing cancer, including oral cancer, breast cancer and liver cancer," Clare McKindley, clinical dietician in the Cancer Prevention Center at the University of Texas M.D. Anderson Cancer Center, said in a news release from the center.

"Researchers are still trying to learn more about how alcohol links to cancer," she added. "But convincing evidence does support the fact that heavy drinking damages cells and increases the risk for cancer development." To reduce risk, experts say, drinkers can do a number of things. First, stick to the recommended serving size. A drink is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor. Women should have no more than one drink a day and men should have no more than two drinks a day, according to the U.S. National Cancer Institute.

Try to avoid high-calorie drinks. Many popular alcoholic drinks are loaded with calories, especially those mixed with soda, fruit juice or cream. A one-cup serving of eggnog, a holiday staple, has about 340 calories. Being overweight or obese is also associated with an increased risk for cancer. Researchers believe that it is the ethanol or alcohol in beer, wine and liquor that increases cancer risk. Check the ethanol percentage numbers on bottle labels and stay away from 100-proof liquor.

Bone Drug Zometa Flops Overall as Breast Cancer Treatment

The bone drug zoledronic acid, considered a potentially promising weapon against breast cancer recurrence, has flopped in a new study involving more than 3,360 patients. The drug, long used to combat bone loss from osteoporosis, did not appear to prevent breast cancer from returning or to boost disease free survival overall. British researchers presented the disappointing findings Thursday at the San Antonio Breast Cancer Symposium in Texas.

"As a whole, the study is negative," study author Dr. Robert Coleman, a professor of medical oncology at the University of Sheffield in England, said during a Thursday news conference on the findings. "There is no overall difference in recurrence rates or survival rates, except in older patients, defined as more than five years after menopause." That was a possible bright spot in the results.

"In that population, there is a benefit," Coleman said. The older women had a 27 percent improvement in recurrence and a 29 percent improvement in overall survival over the five-year follow-up, compared to those who didn't get the drug. "There was tremendous hope that this [drug] approach would be a major leap forward," Coleman noted. "There have been other trials that suggest this is the case." In one previous study, the use of the drug was linked with a 32 percent improvement in survival and lowered recurrence in younger women with breast cancer.

Weight-Lifting After Breast Cancer Won't Cause Lymphedema

Contrary to conventional wisdom, lifting weights doesn't cause breast cancer survivors to develop the painful, arm-swelling condition known as lymphedema, new research suggests. There's a hint that weight-lifting might even help prevent lymphedema, but more research is needed to say that for sure, the researchers said. Breast cancer-related lymphedema is caused by an accumulation of lymph fluid after surgical removal of the lymph nodes and/or radiation. It is a serious condition that may cause arm swelling, awkwardness and discomfort.

"Lymphedema is something women really fear after breast cancer, and the guidance has been not to lift anything heavier even than a purse," said Kathryn H. Schmitz, lead author of the study to be presented Wednesday at the San Antonio Breast Cancer Symposium. " to tell women to not use that affected arm without giving them a prescription for a personal valet is an absurdist principle," she added. A previous study done by the same team of researchers found that exercise actually stabilized symptoms among women who already had lymphedema.

"We really wanted to put the last stamp on this to say, 'Hey, it is not only safe but may actually be good for their arms," said Schmitz, who is an associate professor of family medicine and community health at the University of Pennsylvania School of Medicine and a member of the Abramson Cancer Center in Philadelphia. "It's almost like a paradigm shift," said Lee Jones, scientific director of the Duke Cancer Institute's Center for Cancer Survivorship in Durham, N.C. "Low-volume resistance training does not exacerbate lymphedema."

Many With Terminal Cancer Still Getting Routine Screens

Many patients with incurable cancer are still being screened for common cancers, although these tests are unlikely to provide any benefit, researchers from Memorial Sloan-Kettering Cancer Center in New York City have found. Specifically, many patients diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal or breast cancer are still undergoing the ordeal of routine breast, prostate and colon cancer screening, said the researchers. Not only might these patients suffer from invasive procedures like colonoscopies near the end of life, the researchers said, but they face the unnecessary risk of additional tests, biopsies and psychological distress resulting from the detection of new malignancies.

"For patients living with advanced cancer, cancer screening should not be a routine procedure," said lead researcher Dr. Camelia S. Sima, an assistant attending biostatistician. "Patients living with advanced malignancies and their doctors should engage in a realistic conversation about the risks and benefits associated with cancer screening in face of a severely limited life expectancy," she added. The report is published in the Oct. 13 issue of the Journal of the American Medical Association. For the study, Sima's team collected data on 87,736 Medicare patients aged 65 years or older with advanced lung, colorectal, pancreatic, gastroesophageal or breast cancer, whose data was reported in the Surveillance, Epidemiology, and End Results (SEER) tumor registries.

These patients were followed from their diagnosis, between 1998 and 2005, until they died or to the end of 2007. To compare the findings to a control group, the researchers also collected data on 87,307 similar Medicare patients without cancer, who were matched with the other individuals for age, race, sex and SEER data. In both patient groups, Sima's team looked at the rates of mammograms for breast cancer, Pap tests for cervical cancer, prostate-specific antigen (PSA) tests for prostate cancer and endoscopy for colon cancer. The investigators found that among women with advanced cancer, 8.9 percent had a mammogram, compared with 22 percent of those without cancer; and 5.8 percent of the cancer patients had a Pap test, compared with 12.5 percent of those without cancer.

Breast Reconstruction After Mastectomy: Now or Later?

Two new studies may help breast cancer patients and their doctors make treatment decisions involving immediate breast reconstruction after mastectomy. One study finds that about half of women who need radiation therapy after having had a mastectomy with immediate reconstruction develop complications that require additional surgery. Another study finds that chemotherapy does not affect complication rates after mastectomy and immediate reconstruction. Both reports are published in the September issue of the Archives of Surgery. The growing trend toward immediate reconstruction "has turned into a runaway train," said researcher Dr. Rodney Pommier, professor of surgery at Knight Cancer Institute, Oregon Health & Science University in Portland. Some women, he said, would be better off delaying it.

Pommier and his colleagues evaluated 302 women who had mastectomies; of these, 152 had reconstruction, including 131 immediately, and 100 had radiation after the mastectomy. Among those 100 who needed radiation, complications occurred in 44 percent of those who had immediate reconstruction, but only in 7 percent of those who did not have immediate reconstruction. Both scenarios having radiation after mastectomy and having reconstruction done immediately strongly predicted the risk of complications, Pommier's team found. Radiation tripled the risk, and immediate reconstruction increased the risk eightfold.

Implants had to be removed in 31 percent of patients who had radiation after mastectomy, compared to just 6 percent of those who did not have to have radiation, the researchers reported. "We were surprised that one in three lost implants," he said. His team was also surprised at the complication rates overall. "I think it was known that complication rates are fairly high, but I don't think they have been quantified," he noted. The results, Pommier said, have changed his thinking. He now suggests that having a biopsy of the sentinel lymph node before deciding whether to have immediate reconstruction would be wise. "If the sentinel node is negative, there is a low probability they would get radiation," he explained.

Radiation Exposure Raises Likelihood of Second Cancer

Radiation exposure increases the risk that cancer survivors will go on to develop another malignancy, finds a new study. It was known that radiation exposure can cause cancer but it wasn't known whether it increases a person's risk of developing more than one. In order to find out, American and Japanese researchers analyzed data from more than 10,000 survivors of the atomic bomb attacks on Hiroshima and Nagasaki who developed primary cancers. "We found that radiation exposure increased the risks of first and second cancers to a similar degree," study first author Dr. Christopher Li, a breast cancer epidemiologist and a member of the Public Health Sciences Division at the Fred Hutchinson Cancer Research Center in Seattle, said in a center news release.

"People exposed to radiation who developed cancer also had a high risk of developing a second cancer, and the risk was similar for both solid tumors and leukemias in both men and women," Li said. The link between radiation exposure and second cancers was especially strong for radiation-sensitive cancers such as leukemia and tumors of the lung, colon, breast, thyroid and bladder. The study appears in the Sept. 15 issue of the journal Cancer Research. "Our findings suggest that cancer survivors with a history of radiation exposure should continue to be carefully monitored for second cancers," Li said. He also thanked his Japanese colleagues for their collaboration. "Through innumerable publications, [they] have transformed the tragedy of the atomic bombings to fundamental scientific advancements that have impacted radiation protection standards and policies worldwide," Li said.