Answering breast cancer

That's what Sean Halpin was aiming for when the auto industry designer set out to make prosthetic breasts for women who've gone through mastectomies but who didn't -- or couldn't -- have breast reconstruction.

Inspired by the death of his parents from cancer, Halpin used his talents in design and plastic molding to help others with the disease.

He founded Proud Mary Prosthetics a little over a year ago and began selling the silicone prostheses this year in stores in Michigan and a few other states. He hopes to ramp up production and begin hiring more workers soon.

Halpin was already an entrepreneur. He has owned his own auto design business for 15 years, including Halpin Design, which he began in 2001.

Born in Troy, he earned a master's degree in manufacturing at the University of California-Los Angeles and worked in the aerospace industry in the 1980s.

In the early 1990s, he returned to Michigan to help his parents and ended up working on General Motors' newly launched Saturn operations. He eventually founded his own business.

His company -- Halpin Design -- works with suppliers and automakers, helping interpret what the engineers and designers want on a project. His company has also done work for Fisker Automotive and Chrysler. In general terms, his team takes a designer's work -- perhaps through a clay model -- and translates it into technical terms for engineers to build the product.

"I can be at almost any intersection and see someone ... pulling a steering wheel or pushing buttons on an instrument panel that we did," Halpin said.

As the economy began to darken, Halpin felt the company needed to diversify.

Teresa Heinz undergoes surgery for breast cancer

Teresa Heinz, 71, the widow of Sen. John Heinz, heir to the Heinz ketchup fortune, is reportedly receiving treatments for her breast cancer.

Heinz, wife of Sen. John Kerry, the 2004 Democratic presidential nominee, underwent lumpectomies on both breasts at Massachusetts General Hospital in early October after she found out that she had cancer in her left breast.

Heinz will receive radiotherapy in January 2010. But she has not decided whether she is going to undergo any chemotherapy even though the treatment doctors claim would raise her survival odds to 99 percent, given her age and the side effects of the treatment.

Breast cancer is diagnosed in more than 170,000 women each year in the United States and the disease kills about 50,000 annually.

Women in the United States where the cancer incidence is much higher than poor countries are advised to receive the mammogram screening starting age 40. But the U.S. Preventive Services Task Force recommended last month that women should start receiving this screening at age 50 to reduce both the medical cost and side effects of the procedure.

Medical groups and many breast cancer survivors oppose the recommendations saying mammogram screenings save life.

Studies have shown that mammogram screenings can find most cases of breast cancer for sure. But there are some problems. First, the procedure may result in false negative cases. Second, it can result in false positive cases which will lead to further biopsies and damaging breast tissue. Third, the procedure cannot reduce the cancer mortality as the current treatments can't help much in many cases of aggressive breast cancer and patients die no matter how early the disease is found.

Recommendations for cancer screening are under review

You'd think there could be no downside to widespread screening for cancer. But that's not always the case. Studies on Pap smears, for example, show that atypical cells can disappear if they're left alone, while interventions can cause scarring and interfere with later fertility. And many prostate cancers are so slow-growing that they won't affect a man's health, whereas cancer treatments come with adverse health effects.

Faced with the pluses and minuses, doctors often don't agree on how to screen for cancer. "Organizations send us their guidelines hoping for our endorsement," says Dr. Doug Campos-Outcalt, who heads the development of clinical practice guidelines for the American Academy of Family Physicians, an organization representing about 94,000 primary-care doctors. Those guidelines, he notes, are frequently in conflict with one another.

The American Academy of Family Physicians, for its part, tends to follow the recommendations of the U.S. Preventive Services Task Force, the group that recently advised against routine mammograms for women in their 40s. Why? Because compared with advocacy groups or specialists organizations, the task force has a far superior guideline development process that is evidence-based, not experience-based, Campos-Outcalt says.

"Evidence-based methodology is the best," he says. "The least dependable method -- and the most likely to change -- is current practice and expert opinion."

Here's a closer look at current recommendations for breast, cervical, colorectal and prostate cancer.

Breast Cancer

Screening test: Mammogram.

Recommendation: Women ages 40 and older should be screened annually, says the American Cancer Society. The American Academy of Family Physicians says every one to two years, and the American College of Obstetricians and Gynecologists says every one to two years before age 50, and annually after that.

Cost: ranges from $90 to $150, according to Medicare and California Health Benefits Review Program.

Number of people one needs to screen to save one life:2,000 women, according to a 2009 review by the Cochrane Collaboration, an international group of experts that reviews clinical trial evidence. The recent U.S. Preventive Services Task Force analysis broke it down by age group: 1,904 women ages 40 to 49 and 1,339 women ages 50 and older.

Adverse effects: Unnecessary biopsies or diagnosing abnormalities as aggressive cancer when they're not can lead to unnecessary treatment with surgery, radiation or drugs.

Proposed changes, if any: Women ages 50 to 75 should get screened every other year and women ages 40 to 49 should not be routinely screened, according to the U.S. Preventive Services Task Force.

Special cases: Women at higher risk for breast cancer -- such as those with a mother, sister or daughter having had breast cancer, or who began menstruating before 12, or haven't borne children until age 30 (or not at all) or who have had previous breast abnormalities -- should consider getting screened in their 40s.

Teresa Heinz fighting breast cancer

Teresa Heinz, a part-time Wood River Valley resident for more than 30 years, has announced that she is being treated for breast cancer, but has a 95 percent chance of recovery.

Heinz, 71, and her husband, Massachusetts Sen. John Kerry, the 2004 Democratic presidential nominee, own a house just north of Ketchum along the Big Wood River.

On Wednesday, Heinz—the widow of Sen. John Heinz, heir to the Heinz ketchup fortune—told the Associated Press that she found out in late September that she had cancer in her left breast after having her annual mammogram.

In early October, she underwent lumpectomies on both breasts at a Washington hospital after doctors also discovered what they thought was a benign growth on her right breast.

That diagnosis was initially confirmed in post-operative pathology, but two other doctors later found it to be malignant. In November, Heinz had another pair of lumpectomies performed at Massachusetts General Hospital.

Beer warding off prostate cancer

An ingredient of beer may someday help ward off prostate cancer, new animal experiments suggest.

The compound in question, xanthohumol, is found in hops — the bitter flavoring agent in beer — and is known to block the male hormone testosterone, which plays a role in the development of prostate cancer.

“We hope that one day we can demonstrate that xanthohumol prevents prostate cancer development, first in animal models and then in humans, but we are just at the beginning,” said lead researcher Clarissa Gerhauser, group leader of cancer chemoprevention in the division of epigenomics and cancer risk factors at the German Cancer Research Center in Heidelberg.
HRT news

The incidence of breast cancer in the United States declined 7 percent between 2002 and 2003, but only part of that decrease can be attributed to reduced use of hormone replacement therapy by menopausal women, researchers say.

HRT use declined after the 2002 release of The Women's Health Initiative study, which concluded that hormone therapy increases the risk of breast cancer. Other studies have confirmed the link.

“We found that the change in hormone therapy use only accounted for a decline (in breast cancer) of about 3 percent, so there's another 4 percent that is being caused by something we do not yet know,” study leader Brian Sprague said in a news release.

Further research is needed to identify the other reasons for the decrease in breast cancer cases, Sprague said.

Scientists unlock genetic code in major cancer breakthrough

The entire genetic codes of two common types of cancer have been cracked, according to scientists, who say the breakthrough could unlock a new era in the treatment of deadly diseases.

Scientists at the UK-based Wellcome Trust Sanger Institute catalogued the genetic maps of skin and lung cancer and have pinpointed the specific mutations within DNA that can lead to dangerous tumors.

Researchers predict these maps will offer patients a personalized treatment option that ranges from earlier detection to the types of medication used to treat cancer.

The genetic maps will also allow cancer researchers to study cells with defective DNA and produce more powerful drugs to fight the errors, according to the the study's scientists.

"The knowledge we extract over the next few years will have major implications for treatment," Peter Campbell from the Wellcome Trust Sanger Institute said.

"By identifying all the cancer genes we will be able to develop new drugs that target the specific mutated genes and work out which patients will benefit from these novel treatments."

Scientists found that the DNA code for skin cancer contained nearly 30,000 errors and lung cancer DNA contained more than 23,000.

"These are the two main cancers in the developed world for which we know the primary exposure," Mike Stratton, from the Cancer Genome Project said.

Oncotype Dx® Predicts Chemotherapy Benefit in Node-positive Breast Cancer

Researchers affiliated with The Breast Cancer Intergroup of North America have reported that the Oncotype Dx® test identifies a subset of women with node-positive, hormone receptor-positive breast cancer who do not appear to benefit from adjuvant anthracycline-based chemotherapy. The details of this retrospective analysis of a randomized trial were presented at the 2009 San Antonio Breast Cancer Symposium and were also published early online on December 19, 2009 in Lancet Oncology.

Oncotype Dx is a genomic test that previously has been shown to predict the likelihood of cancer recurrence in women with early-stage, estrogen receptor-positive breast cancer that is treated with hormonal therapy. Women with a low risk of recurrence derive little benefit from chemotherapy. Oncotype Dx evaluates 21 genes from a sample of the patient’s cancer to determine the patient’s Recurrence Score. The Recurrence Score ranges from 0 to 100, with a higher score indicating a greater risk of recurrence. Oncotype Dx has been added to U.S. medical guidelines for early-stage breast cancer.

Oncotype Dx was initially validated among women with node-negative breast cancer, but the test also appears to provide important information about women with node-positive breast cancer. To further assess the test among women with node-positive, hormone receptor-positive breast cancer, researchers evaluated information from 367 patients. One-hundred forty-eight patients received adjuvant therapy with tamoxifen [Nolvadex®] alone (T), and 219 received tamoxifen plus cyclophosphamide, doxorubicin and 5-FU (CAF-T). Patients were divided into groups based on nodal status (1-3 or 4+T).

* Statistically significant breast cancer specific survival (BCSS) was not observed in CAF-T treated patients with low (<18)>31) Recurrence Score.
* The 10-year BCSSs were 92% for T and 87% for CAF-T for women with a low Recurrence Score.
* The 10-year BCSSs were 70% for T and 81% for CAF-T for women with an intermediate Recurrence Score.
* The 10-year BCSSs were 54% for T and 73% for CAF-T for women with a high Recurrence Score.
* These results were similar for women with one three or four or more positive lymph nodes.

Comments: These results suggest that anthracycline-based chemotherapy may not benefit women with node-positive, hormone receptor-positive breast cancer and a low Oncotype Dx Recurrence Score. For patients with an intermediate Recurrence Score, the trend was for a benefit from CAF. A prospective study is proposed to confirm these findings. In addition, currently used taxane-based adjuvant regimens may yield the same results as CAF.

References:

Albain KS, Barlow WE, Shak S et al. Prediction of 10-year chemotherapy benefit and breast cancer-specific survival by the 21-gene Recurrence Score (RS) assay in node-positive, ER-positive breast cancer—An update of SWOG-8814 (INT0100). Presented at the 32nd CTRC-AACR San Antonio Breast Cancer Symposium. December 9-13, 2009. San Antonio, TX. Abstract 112.

Albain KS, Barlow WE, Shak S et al. Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised clinical trial. Lancet Oncology [early online publication].