Clue hints at how breast cancer spreads

LONDON - Scientists who watched tumor cells spread in living mice said on Sunday they had found a gene signal controlling how cancer cells move, which could help companies design new drugs to fight the disease.

Scientists working for Cancer Research UK used hi-tech imaging techniques to watch how breast cancer cells spread in mice. They found that a genetic signal, known as TGF-beta, was crucial to whether cells moved as single entities or in clumps.

TGF-beta signaling is only active in singly moving cells, not in collectively moving cells. And in singly moving cells, the signal is on when they move and off when they stop in a new place to grow, they reported in the journal Nature Cell Biology.

"The results helped us to find the set of genes that are behind the spread of breast cancer -- and that the genes need to be first turned on and then off in order for single cancer cells to be able to relocate," said Erik Sahai, head of the tumor cell biology lab at Cancer Research UK's London institute.

He said several pharmaceutical firms were investigating how to stop TGF-beta from functioning, but stressed they were "very much in the development phase."

"As yet there is no new drug in the pipeline," said Sahai, "But because we now know what these cancer cells are actually doing, it gives us lots of new ideas about how to stop them."

A study published in May 2007 in the Journal of Clinical Investigation found that treating cancer with surgery, chemotherapy or radiation raised levels of TGF-beta and could actually cause tumors to spread.

But as yet, relatively little has been known about how cancer cells spread through the body because it is very difficult to track them when they are moving.

"In a medium-sized tumor there could be a billion cells — and only a small proportion might break away and spread. So it is like trying to find, and understand, a moving needle in a very big haystack," said Sahai.

Sahai and his team used two groups of fluorescently labeled breast cancer cells inside live mice and tracked them with a technique called multiphoton confocal microscopy.

When the TGF-beta signal was blocked, the tumor spread via clumps of cells in the lymphatic system — limiting how far it could go, the researchers said.

But cells that could receive the TGF-beta signal moved as single entities, and the TGF-beta signal was first turned on — allowing the cells to spread through the blood, and then turned off — allowing them to grow again in a new location.

"It seems they can't multitask," said Sahai. "They can't move and grow at the same time, they can only do one or the other."

Suzanne Somers questions chemo in new book

Suzanne Somers is at it again.

Less than a year after the former sitcom actress frustrated mainstream doctors (and cheered some fans) by touting bioidentical hormones on "The Oprah Winfrey Show," she's back with a new book. This one's on an even more emotional topic: Cancer treatment. Specifically, she argues against what she sees as the vast and often pointless use of chemotherapy.

Somers, who has rejected chemo herself, seems to relish the fight.

"Cancer's an epidemic," said the 63-year-old actress in an interview in a Manhattan hotel a day before Tuesday's release of "Knockout," her 19th book. "And yet we keep going back to the same old pot, because it's all we've got. Well, this is a book about options.

"I'm 'us'," Somers adds. "I'm not them. I've been on the other side of the bed. And it's powerful to have information."

"I am very afraid that people are going to listen to her message and follow what she says and be harmed by it," says Dr. Otis Brawley, the organization's chief medical officer. "We use current treatments because they've been proven to prolong life. They've gone through a logical, scientific method of evaluation. I don't know if Suzanne Somers even knows there IS a logical, scientific method."

More broadly, Brawley is concerned that in the United States, celebrities or sports stars feel they can use their fame to dispense medical advice. "There's a tendency to oversimplify medical messages," he says. "Well, oversimplification can kill."

Though she may be one of the most visible, Somers is hardly the only celebrity who's advocated alternative treatments recently.
Celebrity-endorsed health tips
Radio host Don Imus says he's eating habanero peppers and taking Japanese soy supplements to help treat his prostate cancer. The late Farrah Fawcett underwent a mix of traditional and alternative treatments, and made a poignant plea for supporting alternative methods in her film, "Farrah's Story." Actress Jenny McCarthy advocates a special dietary regime, supplements, metal detox and delayed vaccines to treat autism.

The issue goes beyond alternative medicine. Tennis great John McEnroe has been advocating widespread screening for prostate cancer, which Brawley and others say is not necessarily wise.

And comedian Bill Maher has made no secret of his disdain for flu shots, questioning why you'd let someone "stick a disease into your arm." He also said pregnant women shouldn't get the new swine flu vaccine, contradicting U.S. health officials who say pregnant women especially need it because they are at high risk for flu complications.

While it's hard to imagine a comedian like Maher influencing public health decisions, there have been cases where celebrities have been seen to influence the public, says Barron Lerner, a doctor who's looked at celebrity illnesses through history.

He recalls how some desperately ill cancer patients took their cues from Steve McQueen, the rugged actor who turned to unorthodox cancer treatment in 1980. When conventional medicine failed to halt his mesothelioma, a cancer of the lung lining, McQueen traveled to Mexico, where he was treated with everything from coffee enemas to laetrile, the now debunked remedy involving apricot pits.

"It's difficult to quantify his influence, but there was a lot of traffic to Mexico of end-stage cancer patients after his death," says Lerner, author of "When Illness Goes Public."

Celebrity-endorsed health tips
Radio host Don Imus says he's eating habanero peppers and taking Japanese soy supplements to help treat his prostate cancer. The late Farrah Fawcett underwent a mix of traditional and alternative treatments, and made a poignant plea for supporting alternative methods in her film, "Farrah's Story." Actress Jenny McCarthy advocates a special dietary regime, supplements, metal detox and delayed vaccines to treat autism.

The issue goes beyond alternative medicine. Tennis great John McEnroe has been advocating widespread screening for prostate cancer, which Brawley and others say is not necessarily wise.

And comedian Bill Maher has made no secret of his disdain for flu shots, questioning why you'd let someone "stick a disease into your arm." He also said pregnant women shouldn't get the new swine flu vaccine, contradicting U.S. health officials who say pregnant women especially need it because they are at high risk for flu complications.

While it's hard to imagine a comedian like Maher influencing public health decisions, there have been cases where celebrities have been seen to influence the public, says Barron Lerner, a doctor who's looked at celebrity illnesses through history.

He recalls how some desperately ill cancer patients took their cues from Steve McQueen, the rugged actor who turned to unorthodox cancer treatment in 1980. When conventional medicine failed to halt his mesothelioma, a cancer of the lung lining, McQueen traveled to Mexico, where he was treated with everything from coffee enemas to laetrile, the now debunked remedy involving apricot pits.

"It's difficult to quantify his influence, but there was a lot of traffic to Mexico of end-stage cancer patients after his death," says Lerner, author of "When Illness Goes Public."

Though his alternative treatments didn't work, the actor, who embodied a sense of rebellion and individualism, gave voice to an emerging feeling that mainstream medicine might not be enough, Lerner says.

Fast forward to the 21st century, where Somers, who played the ditzy blonde in TV's "Three's Company," has written a series of books making that point. In "Ageless," she argued that doctors don't understand women's bodies, especially those going through menopause.

With so-called "bioidentical" hormones — compounds that are custom-mixed by special pharmacies — Somers argued that women can restore youthfulness and vitality, energy and vigor, not to mention their sex drive.

The problem, for many doctors: These custom-compounded products are not approved by the Food and Drug Administration.

Oprah's support
Somers, whose hormone regimen involves creams, injections and some 60 supplements daily, got a huge boost earlier this year from Oprah Winfrey. "Many people write Suzanne off as a quackadoo," Winfrey said when Somers appeared on her show. "But she just might be a pioneer."

Yet Winfrey's tacit support of Somers gave her some of the worst press of her career. "Crazy Talk," Newsweek headlined an article on the talk show host earlier this year. Another headline, on Salon.com: "Oprah's Bad Medicine."

Winfrey responded in a statement that her viewers know that "the medical information presented on the show is just that — information — not an endorsement or prescription." But many doctors feel Winfrey has more of a responsibility to her viewers.

"Oprah, how could you? That's all I can say," says Dr. Nanette Santoro, a hormone specialist at the Albert Einstein College of Medicine in New York.

Somers is now hoping for a return invitation to Winfrey's hugely influential stage to discuss her cancer book. Her theories on chemotherapy did get one bit of attention she could have done without, though: The actress had to apologize recently when her offhand comment that chemo had likely killed actor Patrick Swayze, rather than his pancreatic cancer, made tabloid headlines.

"I shouldn't have said anything," Somers says now. "I apologized to his family. But she adds: "We all know that chemotherapy does nothing for pancreatic cancer."

In fact, Somers does view chemotherapy as effective for some cancers, but not for the most common, including lung and breast cancer. Diagnosed with breast cancer a decade ago, she had a lumpectomy and radiation, but declined chemotherapy, as she did more recently when briefly misdiagnosed with pervasive cancer.

One criticism sure to come up with Somers' cancer book is its reliance on several doctors who have controversial histories, including Dr. Stanislaw Burzynski in Houston, who has devised his own alternative cancer treatments and has had protracted legal battles with the FDA.

But Somers defends him passionately, as she does the other doctors interviewed in her book. As for herself, she says, she is at ease with her role as celebrity health guru.

"Celebrities are easy to pick on," Somers says. "But I don't have an agenda. I'm just a passionate lay person. And I'm using my celebrity to do something good for people."

Panel backs second cervical cancer vaccine

ATLANTA - A federal vaccine advisory panel has voted to recommend a second kind of vaccine against cervical cancer for girls and young women.

The government last week licensed the vaccine, Cervarix from GlaxoSmithKline, for marketing in the United States. Merck & Co. has had the vaccine Gardasil on the market since 2006.

The committee voted Wednesday to recommend Cervarix as an alternative. It did not state a preference of one vaccine over the other. But officials noted that while both protect against forms of the virus that cause cervical, vaginal and vulvar cancers, the older Merck vaccine also protects against forms that cause genital warts. Both shots are a three-dose series. The Merck series costs about $390 and Glaxo's costs about $385.

The CDC still has to adopt the new recommendation for it to become official.

Thousands race in Egypt to fight breast cancer

CAIRO - Thousands of runners and walkers have participated in the Middle East's first-ever international Race for the Cure to raise awareness about breast cancer.

Saturday's event took place near Egypt's legendary Great Pyramids at Giza and included participants from all over the world.

The event was organized by the Susan G. Komen for the Cure foundation and the Breast Cancer Foundation of Egypt.

The two groups said in a press release that the incidence of breast cancer is rising in Egypt and other countries in the Middle East and North Africa.

Family of teen who fled chemo wants court out

MINNEAPOLIS - The parents of a southern Minnesota teenager who once fled the state to avoid chemotherapy went before a judge Monday and asked for the court’s role in the case to end, saying they are following the advice of doctors and making sure their son gets the best medical care.

Daniel Hauser, 13, is undergoing radiation treatments for childhood Hodgkin’s lymphoma. He finished chemotherapy in early September, and his father said there is no sign of cancer.

“In all reality, he’s been in remission for quite some time already,” Anthony Hauser said in a telephone interview Monday. “I hope he stays in remission — that’s No. 1. And hopefully we can live our lives normally again.”

During a hearing in Brown County District Court, Judge John Rodenberg said that as long as no new issues arise, he would close the case after Daniel completes his 12 recommended sessions of radiation — which are expected to end Nov. 6, according to Joseph Rymanowski, an attorney for the parents.

“It’s time to let these people be. They’ve been through enough,” said Rymanowski, who was at Monday’s hearing in New Ulm.

Daniel, of Sleepy Eye, was diagnosed with childhood Hodgkin’s lymphoma in January and stopped chemotherapy after one round because it made him sick. He said it was poison, and his family opted instead for alternative treatments inspired by American Indian traditions. The issue ended up in court as a medical neglect case because doctors said Daniel’s type of cancer is highly curable with chemotherapy.

A judge ordered in May that Daniel see an oncologist and follow the recommended treatment. Daniel and his mother fled Minnesota and became subject of a search that extended into Mexico. They returned after about a week and said they would follow the court’s order.

Daniel resumed chemotherapy and the family also used alternative therapies, such as massage, herbs and other remedies, to complement the medical treatment, according to court documents. His tumor responded well and he finished chemo earlier than expected.

Family postponed radiation treatment
Doctors wanted Daniel to start radiation in the beginning of October, but the family postponed it to seek additional medical opinions. The Hausers had expressed fear that radiation would “melt” Daniel’s thyroid or cause thyroid cancer.

The family spoke with three more doctors, including two pediatric oncologists who agreed radiation was the best course.

“We did initially oppose radiation because of the concerns of the long term effects we sought second opinions to ensure Danny receive the best medical care,” Colleen Hauser wrote in a court affidavit. “We never opposed radiation on moral, ethical or religious grounds.”

She said the family will continue to follow doctors’ recommendations.

“What we will not do, is blindly follow one particular doctor’s advice ... without research and ... second opinions,” Colleen Hauser wrote.

Brown County Attorney James Olson said before Monday’s hearing that he sees no reason to keep the case open once Daniel finishes radiation. Phone messages left with a court-appointed attorney for Daniel and with attorneys for the guardian ad litem were not immediately returned.

Daniel has gained some weight but is skinnier than he was before he started chemo, his father said. His hair is growing back and he seems to be tolerating his daily radiation treatments. One change: Daniel now needs eyeglasses, which his dad attributes to effects of chemo.

“He’s more upbeat. When it’s over he’s going to really feel a lot better,” Anthony Hauser said.

When the radiation is done, Daniel plans to celebrate by going deer hunting.

Breast cancer stigma endangers poorer women

WASHINGTON - Nurses were training women in rural Mexico to examine their breasts for cancer when one raised her hand to object. If she lost her breast, Harvard public health specialist Felicia Knaul recalls the woman saying, "My man would leave me" — and with him, the family's income.

International cancer specialists meet this week to plan an assault on a troubling increase of breast cancer in developing countries, where nearly two-thirds of women aren't diagnosed until it has spread through their bodies.

Adding to the problem, some worrisome data suggests that breast cancer seems to strike women, on average, about 10 years younger in poor countries than it does in the U.S. No one knows why.

Younger women at risk
"Today in most developing countries you see a huge bulge of young, premenopausal women with breast cancer," says Knaul, who heads Harvard's Global Equity Initiative and was herself diagnosed at age 41 while living in Mexico.

"We should help them to know what they have and to fight for their treatment."

But from Mexico to Malawi, stigma like Knaul witnessed a few weeks ago may prove as big a barrier as poverty.

"One of the trainers said, 'If he'd leave you for that, he's not worth having,'" says Knaul. But she acknowledged that will be a hard message for some women's economic realities.
"It's not a trivial consideration," agrees Dr. Lawrence Shulman of the Dana Farber Cancer Institute, who is part of a team working to begin cancer care in parts of Africa where "the women are often seen as really either vessels for producing children or as sex slaves."

But some success in treating HIV and tuberculosis in those areas has him "hopeful we can make a difference. I don't think it's a pipe dream."

Tuesday, Knaul and Shulman bring together international task force of health specialists and prominent charities to begin planning a two-pronged approach.

First, train midwives and other rural health providers to perform regular breast exams, using the power of touch in places where mammography machines simply are too expensive. That won't catch the very smallest tumors, but specialists agree it could improve diagnosis dramatically in some areas.

Second, the task force will start negotiating lower prices for generic chemotherapy for poor countries, following the same model that has helped transform AIDS care in parts of Africa.

You don't need in-country cancer specialists to administer that chemo, says Shulman — just a network of oncologists who can provide help or instruction to local health officials by e-mail or phone, as he has advised colleagues in Malawi.

Considered a problem for the wealthy
Breast cancer long has been considered a cancer mostly of wealthier countries. Indeed, about 192,000 new cases are expected in the U.S. this year, where long-term survival is high thanks in part to good screening.

The true prevalence in most developing countries is unknown, because of poor diagnosis and bad record-keeping. But new Harvard research estimates they'll be home to 55 percent of the world's 450,000 expected breast cancer deaths this year.

The report predicts the poorest countries will experience a 36 percent jump in breast cancer by 2020.

One problem: In wealthy countries, earlier diagnosis can lead to breast-saving surgery instead of breast removal. Even countries like Rwanda and Malawi have clinics that perform mastectomies if patients can travel to the capitals, Shulman says. But few have radiation equipment, making breast-conserving surgery there not an option yet. (He is hunting a radiation unit for Rwanda but says that's in the very earliest stages of planning.)

Mexico is a mixed situation, with radiation, other treatments and diagnostic mammography available in some places. That's how Knaul — whose husband is a former health minister of Mexico — was diagnosed, early enough that mastectomy and chemotherapy give her good odds.

But she fumes that while Mexico's poor and rural women often get Pap smears to check for cervical cancer, "no one even suggests they check your breasts" at the same visit. She founded an advocacy group — Cancer de Mama — to help, noting that Mexico's insurance program for the poor covers breast cancer care but they must get diagnosed first.

Low cholesterol may ward off prostate cancer

A new study suggests that men may be able to lower their risk of getting the most aggressive form of prostate cancer by keeping their cholesterol in a healthy range.

Men whose cholesterol was under 200 had less than half the risk of developing high-grade prostate tumors compared to men with high cholesterol, researchers report. The information comes from about 6,000 men who were in a big federal cancer prevention study.

Doctors say it is premature to advise men to take statin drugs like Lipitor or Crestor in the hope of preventing prostate cancer, but these medicines are already widely used to ward off heart disease.

The new research is published in the journal Cancer Epidemiology Biomarkers & Prevention.