We're pleased to announce that our very own Senator Sherrod Brown will be receiving an award from the National Breast Cancer Coalition for his leadership in advancing an agenda to end breast cancer.

For the 8th consecutive year, NOBCCF members will join other Ohio advocates in traveling to Washington DC for the National Breast Cancer Coalition's Annual Advocacy Conference & Lobby Day.

 

NOBCCF members attending this year include:

 

Liz Schulte - Brecksville, OH

Rachel Kirk - Brook Park, OH, Sisters Network NE Ohio

Deb Mohr -  Canton, OH, Woman to Woman

Mary Boron - Canton, OH, Woman to Woman

Becky Dangelo - Mt Vernon, OH, Knox Community Hospital

 

Follow the link below to learn what we'll be doing and the key issues we'll be lobbying for on Capitol Hill.

 

 

The National Toxicology Program (NTP), part of the National Institutes of Environmental Health Sciences, released a draft report today that says exposure to Bisphenol A (BPA) a chemical found in plastics may be linked to breast cancer, prostate cancer, early puberty in girls and such behavioral changes as hyperactivity. It urged further study.

 

This is a major departure from their previous findings, and shows some cause for concern. While we've heard many news stories recently about studies showing links to BPA and breast cancer, the NTP report lends validity to these concerns. The NIH has no power to regulate Bisphenol A, only the FDA and EPA can take action to ban or regulate its use.   There certainly would be no harm in avoiding the use of these products.

 

The NTP states that Bisphenol A (BPA) is a chemical produced in large quantities for use primarily in the production of polycarbonate plastics and epoxy resins.  Polycarbonate plastics have many applications including use in certain food and drink packaging, e.g., water and infant bottles, compact discs, impact-resistant safety equipment, and medical devices. Polycarbonate plastics are typically clear and hard and marked with the recycle symbol “7” or may contain the letters "PC" near the recycle symbol. Polycarbonate plastic can also be blended with other materials to create molded parts for use in mobile phone housings, household items, and automobiles. Epoxy resins are used as lacquers to coat metal products such as food cans, bottle tops, and water supply pipes. Its also used in dental sealants.

 

Read the NTP Report at the link below (information about studies of BPA effects in humans begins on p. 15) :

 

 

This report demonstrates the need to increase funding for research into environmental factors that cause breast cancer and other diseases.  Working with the National Breast Cancer Coalition, NOBCCF has advocated for the last several years for passage of the Breast Cancer & Environmental Research Act (BCERA), which would fund research into environmental causes of breast cancer.

 

Thanks to support from Sen. Sherrod Brown, the BCERA was recently passed out of the Senate HELP committee and is being considered for a floor vote.  Our effort now is focused on getting it through committee in the House.

 

NOBCCF members will be traveling to Washington DC later this month and will participate in the annual Lobby Day on April 29 to encourage our Ohio members of Congress to get this important bill passed in 2008.

 

 

 

 

 

Hillary Clinton announced her plan to eradicate breast cancer recently. It includes $300 million in increased funding for research and increased access to breast cancer screening and treatment.

 

She's also committed to funding research into the role that environmental factors play in causing breast cancer, including environmental pollutants and potential genetic and hereditary links.  Under her American Health Choices Plan, she ensures an array of health care choices that ensure all women have affordable access to health care regardless of pre-existing conditions, employement or marital status.

 

Her plan to end breast cancer also includes special programs like a Racial Disparities Research Project and Young Women's Breast Cancer Research and Outreach Project. 

 

Dr. Johnathon Ross's OpEd about Health Care Reform appeared in the Toledo Blade  April 5, 2008. He is an associate clinical professor of internal medicine at the University of Toledo and medical director of outpatient internal medicine at St. Vincent Mercy Medical Center. He also is past president of Physicians for a National Health Program. 

Note: Dr. Ross states that the health care plans of presidential candidates Hillary Clinton and Barack Obama mandate employers and individuals to purchase health care from private health insurance companies.  This is only partially correct.  Both candidates health care reform plans offer a choice between private insurance or new "public" health insurance plans similar to Medicaid.

 

National health care rising in popularity, but not among pols

By JOHNATHON ROSS

OUR health care system is broken.

An estimated 47 million people are without health insurance today; another 50.3 million are "underinsured."

We pay the most in the industrialized world, per capita, for health care, but have poorer health outcomes. Lack of insurance alone accounts for about 101,000 preventable deaths each year.

In Ohio, we waste $11.6 billion yearly on unnecessary administrative paper work and profits. This is more than enough to cover 1.2 million uninsured Ohioans.

We can do better, and we must...

More here

 

 

Journal of the National Cancer Institute Editorial

 

Should Observational Studies Be a Thing of the Past?

 

Kathleen I. Pritchard

 

Affiliation of author: Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada

 

Holmberg et al. (1) have presented, in this issue of the Journal, updated follow-up on their randomized HABITS (Hormonal Replacement Therapy After Breast Cancer-Is it Safe?) trial of the use of hormone replacement therapy (HRT) in breast cancer survivors. This topic has been extremely controversial. Before the initial publication of the HABITS trial (2), the only available data concerning the use of HRT in breast cancer survivors came from a series of observational studies and clinical case series, the results of which suggested that this practice was safe (3). A small, underpowered randomized trial also provided some reassurance (4).

 

Now, Holmberg et al.'s (1) follow-up of the HABITS trial suggests quite definitively that there is a statistically significantly increased risk of recurrence in women given HRT following a diagnosis of breast cancer (hazard ratio = 2.4, 95% CI = 1.3 to 4.2). Fewer than 500 randomly assigned patients were required to demonstrate a difference in the incidence of new breast cancer events at 5 years: that is, 22% in the hormone therapy arm vs 8% in the control arm of this trial. Although another study that was completed around the same time, the Stockholm Breast Cancer Study Group Trial (5), does not show as clear an effect, pooled data from the two studies still suggested a harmful effect from the use of HRT. Both the Stockholm and HABITS trials were terminated early because of these safety analyses (6).

 

Although randomized data concerning use of HRT for symptomatic intervention in breast cancer survivors are still sparse, it seems that the harmful side effects of HRT have finally been clearly demonstrated in what is, by today's standards, a small randomized trial, carried out in a few relatively small countries. Why did we wait so long?

 

The controversy in this area parallels a larger controversy relating to the use of HRT in healthy women. During the same time period that the HABITS trial was ongoing, a randomized trial designed to measure the overall health effects of HRT using estrogen alone in hysterectomized women and estrogen plus progesterone in women with an intact uterus was finally being carried out (7). This trial, as well, has contradicted 30 years of dogma concerning the use of HRT.

 

Before the publication of the Women's Health Initiative (WHI) Study (7), there was controversy regarding the benefits of such intervention. In general, it was agreed that HRT reduced hot flashes, improved general well-being, and protected bone in peri- and postmenopausal women. Randomized trials have not changed our understanding of these benefits, but virtually all other dogma concerning the use of HRT in healthy women has been turned topsy-turvy.

 

Before the WHI results, HRT, particularly estrogen, was believed to protect the heart and was widely hypothesized to improve cognition. HRT was believed to be associated with an increased risk of breast cancer, but this was thought to be similar whether progesterone was used or not. Now the WHI results have shown, with the robust methodology of a randomized trial, that estrogen alone does not clearly increase the risk of breast cancer. However, combined use of estrogen and progesterone clearly does. Furthermore, neither estrogen nor the combination of estrogen and progesterone improved cognition, and the combination increased the incidence of stroke and dementia. Coronary artery disease (CAD) was not reduced by the use of estrogen alone, and estrogen plus progesterone increased CAD. Could we have been more wrong?

 

Unanswered questions remain regarding the role of HRT in women with a previous diagnosis of breast cancer. Might the use of estrogen alone be safer than the use of estrogen combined with a progesterone? Can topical estrogen products such as the Estring or vaginal estrogen creams be used with safety? Additional randomized trials or additional mining of data from completed randomized trials may usefully increase the amount of reliable data. However, one wonders why we took the results of observational studies as seriously as we did.

 

Why did the observational studies so mislead us?
As Holmberg et al. (1) state in their current publication, "it is not surprising that the results from this randomized trial deviate from those in the observational series." The bias inherent in selecting breast cancer survivors for an HRT trial would seem obvious. Every clinician with a patient considering such therapy would be likely to have screened for the presence of undetected metastatic disease. In addition, women at lower risk for recurrence or women who had gone for long periods without recurrence would be more likely to be entered into such case series or observational studies. Attempts to adjust for the effects of these biases were clearly inadequate. It seems ridiculous to continue to impute effects from observational studies when the conduct of a relatively small randomized controlled clinical trial could clearly provide a definitive answer to the question under study.

 

There are situations in the management of breast cancer that are not amenable to a randomized clinical trial. For example, we rely on observational data to "help" us to advise women who wish to become pregnant following a diagnosis of breast cancer. Basic biology would suggest that pregnancy is risky in women with hormone-responsive disease. We use observational data from women who are clearly highly self- and doctor-selected for pregnancy to suggest that pregnancy is safe or perhaps even advantageous. This approach is methodologically flawed because the selection bias in this situation is probably even greater than in observational studies of the use of HRT in breast cancer survivors. However, we can do little else than use these data, together with an explanation of their potential inadequacies, in advising women because no randomized controlled trial of pregnancy following breast cancer diagnosis will ever be carried out.

 

In settings such as the HRT controversy, however, randomized trials such as HABITS were long overdue. It is to be hoped that we can learn from this experience to move quickly to interventional studies with robust controlled designs in settings in which observational data clearly have the potential to mislead us.

 

Memo To The Media

Journal of the National Cancer Institute

 

Hormone replacement therapy (HRT) for peri- and postmenopausal symptoms increases disease recurrence in breast cancer survivors, according to an article published online March 25 in the Journal of the National Cancer Institute.

 

Previous studies have shown that HRT increases breast cancer incidence in healthy women, but its impact on breast cancer survivors has remained obscure. Observational studies and one small randomized trial had suggested that HRT had no effect or even might reduce recurrence. However, two-year follow-up data from the randomized HABITS (Hormonal Replacement After Breast Cancer -Is It Safe?) trial indicated that survivors who took HRT were more likely to suffer disease recurrence than those who did not take HRT.

 

In the current analysis, Lars Holmberg, M.D., Ph.D., currently at King's College London and his mostly Scandinavian colleagues examined the breast cancer rates for women in the HABITS trial after a median follow-up of four years.

 

At the time of this analysis, 39 (17.6 percent) of the 221 women in the HRT treatment arm had developed breast cancer recurrence or a new breast cancer malignancy, compared with 17 (7.7

percent) of 221 women in the control arm. The estimated 5-year cumulative rate for disease recurrence was 22.2 percent for the HRT arm and 9.5 percent in the control arm, for an absolute increase in risk of 14.2 percent.

 

"The results of the HABITS trial indicate a substantial risk for a new breast cancer event among breast cancer survivors using [HRT]. The risk elevation is in line with the evidence from observational studies and randomized trials that [HRT] increases the risk of breast cancer in healthy women," the authors write.

 

In an accompanying editorial, Kathy I. Pritchard, M.D., of the Sunnybrook Odette Cancer Center in Toronto discusses the results of the HABITS trial and the Women's Health Initiative trial (which showed increased breast cancer risk among healthy

women) in the context of the much less worrisome findings from observational studies.

 

Observational studies, she writes, can be misleading because they have inherent biases, such as the types of patients selected for participation in the study. Although a randomized study from Stockholm found no increased risk of breast cancer recurrence among breast cancer survivors taking HRT, there may be key differences between this trial and the HABITS study, including the dosing schedule, the duration of treatment, and the type of hormones used-synthetic versus natural compounds. Those differences leave open several questions. Despite these issues, the data are clear.

 

"Although randomized data concerning use of HRT for symptomatic intervention in breast cancer survivors are still sparse, it seems that the harmful side effects of HRT have finally been clearly demonstrated," Pritchard writes.

 

From Science Digest

 

A study by researchers at two California research centers shows that Bisphenol A (BPA), a chemical that leaches into food and beverages from many consumer products can cause normal breast cells to express genes associated with aggressive breast cancer.  BPA is found in many plastic products such as drinking water bottles and baby bottles,linings of food product containers and dental sealants used to protect teeth from decay.  A 2004 study by the Centers for Disease Control showed 95% of people studied had the compound in their system, with women and children having the highest concentrations.

 

“This is a very common compound that most of us are exposed to on a regular basis, often without even being aware of it,” says William Goodson, M.D., Senior Clinical Research Scientist at the Institute and lead researcher on the study. “If it’s true that exposure to BPA can cause normal, non-cancerous human breast cells to behave in ways that are more characteristic of aggressive breast cancer cells, this is very worrying.”

 

The researchers did needle aspirations on eight consented women at high risk of breast cancer, or its recurrence, to remove a small sample of non-cancerous cells. The cells were exposed to BPA in the lab and then analyzed to see if the exposure had altered, in any way, the gene expression of the cells.

 

“We screened 40,000 genes in normal human cells that had been exposed to BPA and found a striking increase in the sets of genes that promote cell division, increase cell metabolism, and increase resistance to drugs that usually kill cancer cells, and prevent cells from developing to their normal mature forms,” says says Shanaz Dairkee, Ph.D., the Principal Investigator of this California State-funded project at CPMCRI, and the co-author of the study. “Breast cancer patients with this kind of gene expression tend to have a higher recurrence than other patients, and they have a worse survival rate.”

 

 

 

 

 

Great news in the effort to get access to quality health care for all! 

 

"More than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea, according to a survey published on Monday.

 

The survey suggests that opinions have changed substantially since the last survey in 2002 and as the country debates serious changes to the health care system.

 

Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program, while 32 percent said they opposed it, researchers reported in the journal Annals of Internal Medicine.

 

The 2002 survey found that 49 percent of physicians supported national health insurance and 40 percent opposed it.

 

"Many claim to speak for physicians and represent their views. We asked doctors directly and found that, contrary to conventional wisdom, most doctors support national health insurance," said Dr. Aaron Carroll of the Indiana University School of Medicine, who led the study.

 

"As doctors, we find that our patients suffer because of increasing deductibles, co-payments, and restrictions on patient care," said Dr. Ronald Ackermann, who worked on the study with Carroll. "More and more, physicians are turning to national health insurance as a solution to this problem."