Active Living After Cancer program improves physical functioning of breast cancer survivors

Breast cancer survivors who participated in Active Living After Cancer, an evidence-based 12-week group program, markedly increased their physical activity and ability to accomplish the basic pursuits of daily life, researchers from The University of Texas MD Anderson Cancer Center reported today in Cancer.

The results show the program could serve as a model to deliver a community-based physical activity program to minority and medically underserved cancer survivors.

“After a cancer diagnosis, survivors’ physical functioning declines much faster than their peers of the same age and gender who don’t have cancer, which can ultimately affect their ability to remain independent and mobile,” said Karen Basen-Engquist, Ph.D., professor of Behavioural Science and senior author of the paper.

“We’ve shown this evidence-based program can be successfully implemented through a community model to help diverse populations of cancer survivors improve physical functioning after completing cancer treatment.”

The program measured changes in participants’ six-minute walk and 30-second sit-to-stand test results from baseline to completion of the program. These physical functioning tests measure activities essential to daily life.

Mean sit-to-stand repetitions increased 19%, from 12.5 to 14.9; and mean six-minute walk distance increased 10%, from 428 meters to 470 meters. Self-reported physical activity nearly doubled, from a mean of 172.8 minutes of moderate to vigorous physical activity per week at baseline to 344.6 minutes at the 12-week follow-up.

Participants also reported an 8% increase in physical quality of life and a 6% improvement in mental health, as measured by a health-related quality of life outcomes questionnaire.

Active Living After Cancer is not a supervised exercise program.

Facilitators from community organisations follow a 12-week curriculum that introduces a different low-impact exercise, cognitive/behavioural skill and survivorship resource each week to help participants increase their physical activity at home, learn how to build healthier habits and cope with the challenges of survivorship.

“One reason this model is successful is that we focus on meeting people where they are, teaching them the skills to develop their own goals and allowing them to go at their own pace,” Basen-Engquist said. “We know that not everyone is ready for or interested in going to a gym.

We need models to deliver these services to all cancer survivors, especially to people with less access. Active Living After Cancer provides a soft start to get people thinking about how active living benefits them and incorporating physical activity into their everyday lives.”

The findings reported in Cancer were based on 127 breast cancer survivors who completed the program between 2014 and 2017. During this time, 34 Active Living After Cancer groups (12-week sessions with the same cohort) were completed at health care organisations, community organisations and churches across the greater Houston area.

The research team focused on recruiting minority and medically underserved cancer survivors because these populations tend to exercise less and have less access to physical activity resources. The program is free and was offered to breast cancer survivors who had completed primary cancer treatment.

The recruitment rate for the program was 45%, similar to other exercise programs for cancer survivors. Of the 187 participants who enrolled in the program, 74% completed at least half the sessions. The 68% who completed the 12-week intervention were included in the outcome analysis.

Participants were all women, with a mean age of 59.6 years, and 65% were minority and/or medically underserved breast cancer survivors. Participants were 30.6% white, 31.2% Black, 26.9% Hispanic and 11.1% other.

Some classes were held in Spanish to accommodate the 15.5% of Spanish-speaking participants. Nearly half had private insurance, while 51% were covered by Medicare, Medicaid, Harris County’s Gold Card health care financial assistance program or were uninsured.

Researchers from MD Anderson developed the curriculum, trained facilitators from community organisations to lead the sessions and measured program results.

“It was important to work with community partners to provide a way to disseminate the program more broadly,” Basen-Engquist said. “We try to work with organisations that have a track record of working within that community and can make it relevant to the people they serve.”

The program builds on a lifestyle physical activity intervention that the team previously tested in a randomised study. Since 2017, Active Living After Cancer has expanded to include survivors of all cancer types and broadened to serve the El Paso, Beaumont and Tyler, Texas communities.

Due to the COVID-19 pandemic, Active Living After Cancer has been delivered virtually since March 2020, and more than 1,000 cancer survivors have now completed the program.

“We’ve learned a lot about exercise and benefits for cancer survivors over the past 20 years, and now our job is to implement that knowledge,” Basen-Engquist said. “We hope that Active Living After Cancer will be a model to deliver these services to all cancer survivors, especially to people with less access to resources for healthy living.”

Source: The University of Texas MD Anderson Cancer Center

Black women face three-fold increased risk of triple negative breast cancers

An analysis of nearly 200,000 patients who received mammograms between 2006 and 2015 across three U.S. health systems underscores the importance of understanding the heterogeneity of breast cancer risk factors for women of differing races, ages, and disease subtypes.

The study, led by researchers in the Perelman School of Medicine at the University of Pennsylvania, were published in Cancer Medicine.

The cohort included 29,822 (15 percent) Black women — a group historically understudied in cancer research.

Most strikingly, the researchers found that Black women had nearly a three-fold increased risk of triple negative breast cancers, which have a poor prognosis.

While it is known that Black women have a higher risk of this type of breast cancer, the magnitude of the risk found in this study was impactful, given its comprehensive adjustment for breast cancer risk factors in a screened population.

Additionally, the researchers found that triple negative breast cancers were less likely to be screen detected and more likely than other subtypes to be diagnosed as interval cancers.

Higher breast density was associated with increased risk of all four tumour subtypes, with a stronger association among premenopausal women for ER/PR+HER2- and TNBC.

In a separate study led by the same group, the researchers looked further at risk factor among Black women.

They found that breast density was more strongly associated with TNBC than other subtypes, and obesity was associated with greater risk of TNBC among this group.

Those findings were published in Breast Cancer Research and Treatment.

“The risk prediction models available are about 60 percent accurate for predicting risk of breast cancer,” said Anne Marie McCarthy, PhD, an assistant professor of Epidemiology at Penn. “In our studies, we see clear differences in risk factors across these types of breast cancers, and we need to do a better job of identifying how we can accurately predict risk for women, particularly for women of colour.”

Source: University of Pennsylvania School of Medicine

Breast cancer now most common form of cancer: WHO taking action

Breast cancer has now overtaken lung cancer as the world’s mostly commonly-diagnosed cancer, according to statistics released by the International Agency for Research on Cancer (IARC) in December 2020.

The global cancer landscape  is changing, according to WHO  experts, on the eve of World Cancer Day 2021. 

So on World Cancer Day, WHO will host the first of a series of consultations in order to establish a new global breast cancer initiative, which will launch later in 2021. This collaborative effort between WHO, IARC, the International Atomic Energy Agency and other multi-sectoral partners, will reduce deaths from breast cancer by promoting breast health, improving timely cancer detection and ensuring access to quality care.

WHO and the cancer community are responding with renewed urgency to address breast cancer and to respond to the growing cancer burden globally that is straining individuals, communities and health systems.

In the past two decades, the overall number of people diagnosed with cancer nearly doubled, from an estimated 10 million in 2000 to 19.3 million in 2020. Today, one in 5 people worldwide will develop cancer during their lifetime. Projections suggest that the number of people being diagnosed with cancer will increase still further in the coming years, and will be nearly 50% higher in 2040 than in 2020.

The number of deaths from cancer has also increased, from 6.2 million in 2000 to 10 million in 2020. More than one out of every six deaths is due to cancer.

While changes in lifestyle, such as unhealthy diets, insufficient physical activity, use of tobacco and harmful use of alcohol, have all contributed to the increasing cancer burden, a significant proportion can also be attributed to increasing longevity, as the risk of developing cancer increases with age. This reinforces the need to invest in both cancer prevention and cancer control, focusing on actionable cancers like breast, cervical and childhood cancers.

WHO prequalifies first biosimilar medicine to increase life-saving breast cancer treatment

The World Health Organization (WHO), on Wednesday, prequalified its first biosimilar medicine – trastuzumab – in a move that could make this expensive, life-saving treatment more affordable and available to women globally.

Breast cancer is the most common form of cancer in women. 2.1 million women contracted breast cancer in 2018. 630 000 of them died from the disease, many because of late diagnosis and lack of access to affordable treatment.

Trastuzumab – a monoclonal antibody – was included in the WHO Essential Medicines List in 2015 as an essential treatment for about 20% of breast cancers. It has shown high efficacy in curing early stage breast cancer and in some cases more advanced forms of the disease.

“WHO prequalification of biosimilar trastuzumab is good news for women everywhere,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Women in many cultures suffer from gender disparity when it comes to accessing health services. In poor countries, there is the added burden of a lack of access to treatment for many, and the high cost of medicines. Effective, affordable breast cancer treatment should be a right for all women, not the privilege of a few.”

The global average cost of trastuzumab from originator companies is $20 000, a price that puts it out of reach of many women and healthcare systems in most countries. The biosimilar version of trastuzumab is generally 65% cheaper than the originator. With this WHO listing, and more products expected in the prequalification pipeline, prices should decrease even further.

The medicine, supplied by Samsung Bioepis NL B.V. (Netherlands), was assessed by WHO and found comparable to the originator product in terms of efficacy, safety and quality. That means it is eligible for procurement by United Nations agencies and for national tenders.

Biotherapeutic medicines, which are produced from biological sources such as cells rather than synthesized chemicals, are important treatments for some cancers and other non-communicable diseases. Like generic medicines, biosimilars can be much less expensive versions of innovator biotherapeutics while keeping the same effectiveness. They are usually manufactured by other companies once the patent on the original product has expired.

A few biosimilars of trastuzumab have come to market in the last five years, but none had been prequalified by WHO before today. WHO prequalification gives countries the assurance that they are purchasing quality health products.

A recent study of breast cancer in sub-Saharan Africa found that of 1325 women surveyed in three countries, cancer treatment had not been initiated within one year of diagnosis for 227 (17%) women and for 185 (14%) women with stage I-III disease. Self-reported treatment barriers confirmed treatment costs as a major contributor to not receiving treatment.

WHO’s International Agency for Research on Cancer estimates that by 2040 the number of diagnosed breast cancers will reach 3.1 million, with the greatest increase in low- and middle-income countries.

“We need to act now and try to avoid more preventable deaths,” says Dr Mariângela Simão, WHO Assistant Director General for Medicines and Health Products. “The availability of biosimilars has decreased prices, making even innovative treatments more affordable and hopefully available to more people.”

Overall cancer mortality continues to decline in the US

Cancer death rates continued to decline in men, women, and children in the United States from 1999 to 2016, according to the latest Annual Report to the Nation on the Status of Cancer.

According to the National Institute of Health, overall cancer incidence rates, or rates of new cancers, decreased in men from 2008 to 2015, after increasing from 1999 to 2008, and were stable in women from 1999 to 2015. In a special section of the report, researchers looked at cancer rates and trends in adults ages 20 to 49.

The annual report is a collaborative effort among the National Cancer Institute (NCI), part of the National Institutes of Health; the Centers for Disease Control and Prevention (CDC); the American Cancer Society (ACS); and the North American Association of Central Cancer Registries (NAACCR). The report appeared in the Journal of the National Cancer Institute on May 30, 2019.

“We are encouraged by the fact that this year’s report continues to show declining cancer mortality for men, women, and children, as well as other indicators of progress,” said Betsy A. Kohler, executive director of NAACCR. “There are also several findings that highlight the importance of continued research and cancer prevention efforts.”

The special section shows a different picture for cancer incidence and mortality among men and women ages 20 to 49 than among people of all ages. In the main report, from 2011 to 2015, the average annual incidence rate for all cancer sites combined was about 1.2 times higher among men than among women, and from 2012 to 2016, the average annual death rate among men (all ages) was 1.4 times the rate among women. However, when the researchers looked only at men and women ages 20 to 49, they found that both incidence and death rates were higher among women.

The authors reported that, in the 20–49 age group from 2011 to 2015, the average annual incidence rate for all invasive cancers was 115.3 (per 100,000 people) among men, compared with 203.3 among women, with cancer incidence rates decreasing an average of 0.7% per year among men and increasing an average of 1.3% per year among women. During the period from 2012 to 2016, the average annual cancer death rate was 22.8 (per 100,000 people) among men and 27.1 among women in this age group.

The most common cancers and their incidence rates among women ages 20 to 49 were breast (73.2 per 100,000 people), thyroid (28.4), and melanoma of the skin (14.1), with breast cancer incidence far exceeding the incidence of any other cancer. The most common cancers among men ages 20 to 49 were colon and rectum (13.1), testis (10.7), and melanoma of the skin (9.8).

“The greater cancer burden among women than men ages 20 to 49 was a striking finding of this study,” said Elizabeth Ward, Ph.D., lead author of the study and a consultant at NAACCR. “The high burden of breast cancer relative to other cancers in this age group reinforces the importance of research on prevention, early detection, and treatment of breast cancer in younger women.”

Other notable findings about cancer mortality from the report include that from 2012 to 2016:

• Overall death rates decreased 1.8% per year in men and 1.4% per year in women.
• Among men, death rates decreased for 10 of the 19 most common cancers but increased for 6 cancers, with the steepest increases for liver cancer, oral cavity and pharynx cancer, and non-melanoma skin cancer.
• Among women, death rates decreased for 13 of the 20 most common cancers, including the 3 most common cancers (lung and bronchus, breast, and colorectal), but increased for 5 cancer types, with the steepest increases for cancers of the uterus and liver.

For cancer incidence, from 2011 to 2015:

• Incidence rates for all cancers combined were stable in women and decreased 2.1% per year in men.
• Among men, rates of new cancers decreased for eight of the 17 most common cancers, increased for seven cancers, and were stable for two cancers.
• Among women, rates of new cancers decreased for six of the 18 most common cancers, increased for nine cancers, and were stable for three cancers.

Older biologic age linked to elevated breast cancer risk

NIH scientists use epigenetics to help predict disease development.

If a woman’s biologic age is older than her chronologic age, she has an increased risk of developing breast cancer. NIEHS

Biologic age, a DNA-based estimate of a person’s age, is associated with future development of breast cancer, according to scientists at the National Institutes of Health.

Biologic age was determined by measuring DNA methylation, a chemical modification to DNA that is part of the normal aging process. The study showed for every five years a woman’s biologic age was older than her chronologic or actual age, known as age acceleration, she had a 15 percent increase in her chance of developing breast cancer. The study was published online Feb. 22 in the Journal of the National Cancer Institute.

Scientists from the National Institute of Environmental Health Sciences (NIEHS), part of NIH, speculate that biologic age may be tied to environmental exposures. If so, it may be a useful indicator of disease risk. They used three different measures, called epigenetic clocks, to estimate biologic age. These clocks measure methylation found at specific locations in DNA. Researchers use these clocks to estimate biologic age, which can then be compared to chronologic age.

The researchers used DNA from blood samples provided by women enrolled in the NIEHS-led Sister Study, a group of more than 50,000 women in the U.S. and Puerto Rico. The study was specifically designed to identify environmental and genetic risk factors for breast cancer. The research team measured methylation in a subset of 2,764 women, all of whom were cancer-free at the time of blood collection.

“We found that if your biologic age is older than your chronologic age, your breast cancer risk is increased. The converse was also true. If your biologic age is younger than your chronologic age, you may have decreased risk of developing breast cancer,” said corresponding author Jack Taylor, M.D., Ph.D., head of the NIEHS Molecular and Genetic Epidemiology Group. “However, we don’t yet know how exposures and lifestyle factors may affect biologic age or whether this process can be reversed.”

Lead author Jacob Kresovich, Ph.D., a postdoctoral fellow in the Taylor group, had read studies that used epigenetic clocks to predict age-related mortality. Since age is the leading risk factor for breast cancer, he hypothesized that age acceleration may be associated with higher breast cancer risk.

“If you look at a group of people who are all the same age, some may be perfectly healthy while others are not,” Kresovich said. “That variability in health may be better captured by biologic age than chronologic age.”

Kresovich suggests that using DNA methylation to measure biologic age may help scientists better understand who is at risk for developing cancer and other age-related diseases. This research is an example of epigenetics, a field that studies how biochemical processes turn individual genes on or off, without affecting the DNA sequence.

The Taylor group plans to continue using epigenetic data, along with information on genetics, environment, and lifestyle to better understand how these factors interact and contribute to disease risks.

This press release describes a basic research finding. Basic research increases our understanding of human behavior and biology, which is foundational to advancing new and better ways to prevent, diagnose, and treat disease. Science is an unpredictable and incremental process— each research advance builds on past discoveries, often in unexpected ways. Most clinical advances would not be possible without the knowledge of fundamental basic research.

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The National Institute of Environmental Health Sciences (NIEHS): NIEHS supports research to understand the effects of the environment on human health and is part of the National Institutes of Health.

The National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.

NIH scientists find that breast cancer protection from pregnancy starts decades later

Breast cancer risk remains elevated 20-30 years after childbirth.

The study suggests breast cancer protection from pregnancy may not begin until as many as 30 years after the last pregnancy.NIEHS

In general, women who have had children have a lower risk of breast cancer compared to women who have never given birth. However, new research has found that moms don’t experience this breast cancer protection until many years later and may face elevated risk for more than 20 years after their last pregnancy.

Scientists at the National Institutes of Health, along with members of the international Premenopausal Breast Cancer Collaborative Group, found breast cancer risk increases in the years after a birth, with the highest risk of developing the disease about five years later. The findings, which appeared online in the Annals of Internal Medicine, suggest breast cancer protection from pregnancy may not begin until as many as 30 years after the birth of the last child. 

According to senior author Dale Sandler, Ph.D., head of the Epidemiology Branch at the National Institute of Environmental Health Sciences (NIEHS), part of NIH, a few prior studies reported an increase in breast cancer risk after childbirth. However, most of what researchers knew about breast cancer risk factors came from studies of women who have gone through menopause. Since breast cancer is relatively uncommon in younger women, it is more difficult to study.

Researchers combined data from approximately 890,000 women from 15 long-term studies across three continents, to understand the relationship between recent childbirth and breast cancer risk in women age 55 and younger.

“We were surprised to find that an increase in breast cancer risk lasted for an average of 24 years before childbirth became protective,” said Sandler. “Before this study, most researchers believed that any increase in risk lasted less than 10 years.” 

The scientists also found that the association between recent childbirth and breast cancer risk was stronger for women who were older at first birth, had more births, or had a family history of breast cancer. Breastfeeding did not appear to have any protective effect, even though it is generally thought to reduce breast cancer risk. Many of these additional factors were not addressed in earlier studies, underscoring the statistical power of this larger project.

Sandler and first author Hazel Nichols, Ph.D., of the University of North Carolina Lineberger Comprehensive Cancer Center, started the study when Nichols was a research fellow at NIEHS. Nichols explained that childbirth is an example of a risk factor that is different for younger women than older women.

“This difference is important because it suggests that we may need to develop tools for predicting breast cancer risk that are specific to young women,” Nichols said. “Doing so would help women talk to their health care providers about when they should start mammography screening.”

Nichols and Sandler both stressed the importance of keeping these findings in perspective.  Breast cancer is uncommon in young women. An increase in the relative risk of breast cancer in women under age 55 translates to a very small number of additional cases of breast cancer per year. 

Anthony Swerdlow, D.M., D.Sc., Ph.D., and Minouk Schoemaker, Ph.D., scientists at the Institute of Cancer Research, London, co-led the study with Sandler and Nichols.