What Is Stage-Zero Breast Cancer

Earlier this year, days before my parents embarked on a four-week cruise around South America, my mother sent an email to our family that included the line: “By the way, our wills are in the safe. Just in case we don’t make it.”

My parents—retired lawyers—have always been highly pragmatic about their end-of-life planning, so I brushed the comment aside. “Morbid much, Mom?” I wrote back. “Have a great trip!”

Not until after they had returned from their adventure did I realize her pessimistic aside could have meant something other than falling off the Lido deck. Within a few days of my parents’ homecoming, she called me to break the news: She had experienced bleeding from her breast that alarmed her the day before they were scheduled to depart, but had decided to continue with her plans rather than rush to the emergency room. When she returned, she went to the doctor, who sent her in for a biopsy.

 

The result? Cancer.

Confronted with the dreaded c-word, I immediately went into a tailspin of panic. I hoped and prayed that they had caught it early, but it still shook me to my core. I imagined my mother having to go through months of radiation or chemotherapy, a double mastectomy, and then, well, I didn’t even want to imagine what could happen next. On the other side of the country, she was feeling the same unnerving fears.

The doctors came back later with a complete diagnosis: ductal carcinoma in situ (DCIS), or stage zero—a form of cancer in which the cancerous cells are contained to the breast ducts and have not spread to the surrounding tissue.

I had heard of nascent cancer cells from my many years of pap smears—”changes to the cervix” was a phrase that my gynecologist had always warned me about. Friends had dealt with cancerous cervical cells using cryotherapy, literally freezing the offending cells off one-by-one.

But the fact that it can happen to breast tissue was news to me, despite the fact that it turns out to be quite common—the American Cancer Society expects 63,410 new cases of carcinoma in situ, or stage zero, to be diagnosed this year.

Naturally my mom was bombarded with questions. Mostly from me. What, exactly, is stage-zero cancer? Why had we never heard about it? What is the prognosis? How is it treated? What’s the chance of survival?

Susan Brown, M.S., R.N., senior director of health education at the Susan G. Komen Foundation, helped break it down for me, explaining that cancer equals any cells that are growing without control. In the case of stage zero, the duct tissue of the breast contains the abnormal cells. Once the cancer spreads to other areas, it’s redefined as stages 1 to 4. Only 40 to 50 percent of stage zero cases move on to more advanced stages after being detected. And, Brown says, researchers are developing new ways to detect which cases are most likely to progress into aggressive forms of cancer, and which forms can be treated with less aggressive treatments.

IT TURNS OUT TO BE QUITE COMMON—THE AMERICAN CANCER SOCIETY EXPECTS 63,410 NEW CASES OF STAGE ZERO TO BE DIAGNOSED THIS YEAR.

If caught at stage zero, the prognosis is excellent: Roughly 95 percent of patients are still living 10 years after their initial diagnosis. Then again, this form of cancer is typically too localized to generate any symptoms. My mother was alarmed because her main symptom—leakage from her breast—was alarming and hard-to-ignore. But usually stage zero would have to be detected on a routine mammogram.

Because of this, stage zero often goes unnoticed until it has moved into more advanced stages, particularly in younger women for whom mammograms are not generally recommended (their denser breast tissue leads to a higher risk of false positives). Even women in their 40s—who are usually covered for routine mammograms—have a false positive rate of roughly 16 percent, according to the University of California San Francisco. A false positive can lead to unnecessary anxiety or invasive testing procedures—but younger women are, of course, diagnosed with breast cancer every day.

Liz Buscema of Kearneysville, West Virginia, was 33 when she was diagnosed with stage zero breast cancer in 2009. She and her husband were trying for a second child when she felt a lump in her breast tissue accompanied by moderate pain. A nurse practitioner at one of her doctors’ offices said she was “too young to worry about it,” recalls Buscema. But months later the symptoms had not disappeared—in fact, they’d gotten worse. She says she still probably would have brushed it aside if not for the fact that her mother had been diagnosed with breast cancer the year before. She consulted a doctor, who sent her off for a mammogram.

“If it hadn’t been for my mom, I never would have thought of cancer at all,” Buscema says. It’s a good thing she did: Even though her cancer was caught at stage zero, tests indicated that the it was aggressive in nature. Due to her family history, Buscema’s doctors recommended a double mastectomy, and Buscema has now been cancer-free since her diagnosis eight years ago.

Doctors are getting better not only at detecting the stage of cancer, but the type, which creates better outcomes for patients. My mother opted for a lumpectomy, since her strain of cancer is non-aggressive. She’s currently recovering from surgery and is expected to continue her trips around the world as a retiree—she already has a vacation to Germany planned before she begins her radiation treatment. And because she was post-menopausal when she developed cancer, her doctors insist that it’s less likely to be due to an inherited pre-disposition, which means my own risk hasn’t risen.

For women under 40, like myself, the key is to not worry but to be vigilant if anything seems amiss. If you feel a bump, lump, or any other unusual changes to your breast, it’s always good to get it checked out. As my mom puts it, “Shit happens when you get to be my age”—and here’s to being more knowledgeable and empowered about our bodies along the way.



 

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Two new genes linked to Alzheimer’s risk

Date:July 17, 2017

Source:Cardiff University

Summary:Two genes that influence a person’s risk of developing Alzheimer’s disease have now been identified by a team of researchers.

A team of researchers led by Cardiff University has identified two genes that influence a person’s risk of developing Alzheimer’s disease.

The new finding, which builds on the team’s previous work of identifying 24 susceptibility genes, enables a better understanding of the mechanisms underlying the disease and offers further hope in developing new treatments.

 

 

Dr Rebecca Sims from Cardiff University’s School of Medicine said: “In addition to identifying two genes that affect the risk of developing Alzheimer’s disease, our new research reveals a number of other genes and proteins that form a network likely to be important in its development. These particular genes, which suggest that immune cells in the brain play a causal role in the disease, are also very good targets for potential drug treatment.”

Dr Rosa Sancho, Head of Research at Alzheimer’s Research UK, added: “The discovery of new genes is like finding puzzle pieces that biologists can start to fit together to build a complete picture of a disease.

Alzheimer’s Research UK is proud to be supporting scientists at the cutting edge of this work as they continue to make valuable discoveries that are shaping our understanding of the disease. There are currently no treatments to slow the progression of Alzheimer’s and increased investment in research is vital so that we can capitalise on new findings and drive progress for people with the condition and their families.”

The two novel genes, which were not previously considered candidates for Alzheimer’s risk, were identified during a study which compared the DNA of tens of thousands of individuals with Alzheimer’s with aged-matched people who are free from the disease.

There are currently around 850,000 people in the UK with Alzheimer’s. During the course of the disease, proteins build up in the brain to form structures called plaques and tangles. The connections between nerve cells are lost, and eventually the nerve cells die and brain tissue volume is reduced. People with Alzheimer’s also have a shortage of some important chemicals in their brain. These chemical messengers help to transmit signals around the brain. When there is a shortage of them, the signals are not transmitted as effectively.

Dr Doug Brown, Director of Research and Development at Alzheimer’s Society, said: “Over 60% of people with dementia have Alzheimer’s disease, yet despite its prevalence we still don’t fully understand the complex causes of the disease.

“The discovery of two new risk genes for Alzheimer’s is an exciting advance that could help to deepen our understanding of what happens in the brains of people with the disease. These genes reinforce a critical role for special cells in the brain — called microglia — that are responsible for clearing up debris including damaged cells and proteins. Insights like this are vital to help unravel the complexities of Alzheimer’s disease and show researchers where to focus their efforts in the search for new, effective treatments.

“As a funder of this research, we’re delighted to see important progress being made. The UK Dementia Research Institute centre at Cardiff will now build on this discovery to investigate in detail the role of microglia in dementia and ultimately accelerate our progress towards finding a cure.”


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With the click of a camera, USC professor tracks New York City’s transit development

Date:July 17, 2017

Source:University of Southern California

Martin Krieger took an unconventional approach to studying transit-oriented development around New York City Subway stations. He picked up a camera and snapped tens of thousands of photographs.

“The people who talk about transit-oriented development have a very lovely image of a little village where people would work and reside and shop, and there would be more walking and less automobile commuting — and there may be truth to that,” said Krieger, professor of planning at the USC Price School of Public Policy. “But I thought it would be useful to look at what the world was really like.”

He systematically visited the ends of the subway lines and several other carefully selected stations. He took photographs from elevated lines looking out over the neighborhoods and streets along the way, then walked through the stations’ nearby streets, documenting actual patterns of development.

“This was not what we call a statistical study,” he said. “It was largely meant to make people think twice.”

Diverse Development

Through the lens of his camera, he witnessed a tremendous diversity of development surrounding New York City Subway stations.

“One station at the end of the line has a golf course and a cemetery — I think that’s Woodlawn,” he said. “Another station in Flushing is an extraordinarily vital Asian-American shopping area. I even made a movie of a man chopping roast duck. Several of the lines end in industrial areas. They don’t look like transit villages, nor are they going to be. So it’s quite diverse.”

The photos will end up in the USC Libraries’ Digital Library, where they will serve as a visual record to inform other researchers in their analyses of development in New York City. He intends to embark on future photographic projects documenting development around large, complex transit systems in other major cities.

“People ask me, ‘Well, why don’t you write an article about transit-oriented development?’ Actually, my real work is to set up the information and the curiosity so others can do it,” he said.

Adding Perspective

Over the past two decades, Krieger has also systematically photographed aspects of Los Angeles’ urban landscape, including industrial areas, swap meets and storefront churches. These photographs are also preserved in the USC Libraries’ archives and are being digitized with support from a grant from the Haynes Foundation.

Krieger has also written about how systematic photographic documentation can inform urban planning in his book Urban Tomographies and in articles published in the Journal of Planning, Education and Research.

“‘Go look’ is my basic principle,” he said.

He’s extended this principle into his teaching. As part of his spring 2017 freshman seminar called “Los Angeles as a City,” he sent the students out to take photographs, record sounds and make videos of the transit-oriented development around Los Angeles’ Metro stations, as well as of other places and phenomena.

“I just want to get them to understand it’s worth going to look,” he said. “They would have never have gone to these places and, you know, these places and people are all interesting. And we have to learn to see the world as interesting.”


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Drinking coffee could lead to a longer life, scientist says

Whether it’s caffeinated or decaffeinated, coffee is associated with lower mortality, which suggests the association is not tied to caffeine

Date:July 16, 2017

Source:University of Southern California

Summary: Scientists have found that people who drink coffee appear to live longer. Drinking coffee was associated with lower risk of death due to heart disease, cancer, stroke, diabetes, and kidney disease. People who consumed a cup of coffee a day were 12 percent less likely to die compared to those who didn’t drink coffee. This association was even stronger for those who drank two to three cups a day — 18 percent reduced chance of death.

 

Here’s another reason to start the day with a cup of joe: Scientists have found that people who drink coffee appear to live longer.

Drinking coffee was associated with a lower risk of death due to heart disease, cancer, stroke, diabetes, and respiratory and kidney disease for African-Americans, Japanese-Americans, Latinos and whites.

People who consumed a cup of coffee a day were 12 percent less likely to die compared to those who didn’t drink coffee. This association was even stronger for those who drank two to three cups a day — 18 percent reduced chance of death.

Lower mortality was present regardless of whether people drank regular or decaffeinated coffee, suggesting the association is not tied to caffeine, said Veronica W. Setiawan, lead author of the study and an associate professor of preventive medicine at the Keck School of Medicine of USC.

“We cannot say drinking coffee will prolong your life, but we see an association,” Setiawan said. “If you like to drink coffee, drink up! If you’re not a coffee drinker, then you need to consider if you should start.”

The study, which will be published in the July 11 issue of Annals of Internal Medicine, used data from the Multiethnic Cohort Study, a collaborative effort between the University of Hawaii Cancer Center and the Keck School of Medicine.

The ongoing Multiethnic Cohort Study has more than 215,000 participants and bills itself as the most ethnically diverse study examining lifestyle risk factors that may lead to cancer.

“Until now, few data have been available on the association between coffee consumption and mortality in nonwhites in the United States and elsewhere,” the study stated. “Such investigations are important because lifestyle patterns and disease risks can vary substantially across racial and ethnic backgrounds, and findings in one group may not necessarily apply to others.”

Since the association was seen in four different ethnicities, Setiawan said it is safe to say the results apply to other groups.

“This study is the largest of its kind and includes minorities who have very different lifestyles,” Setiawan said. “Seeing a similar pattern across different populations gives stronger biological backing to the argument that coffee is good for you whether you are white, African-American, Latino or Asian.”

Benefits of drinking coffee

Previous research by USC and others have indicated that drinking coffee is associated with reduced risk of several types of cancer, diabetes, liver disease, Parkinson’s disease, Type 2 diabetes and other chronic diseases.

Setiawan, who drinks one to two cups of coffee daily, said any positive effects from drinking coffee are far-reaching because of the number of people who enjoy or rely on the beverage every day.

“Coffee contains a lot of antioxidants and phenolic compounds that play an important role in cancer prevention,” Setiawan said. “Although this study does not show causation or point to what chemicals in coffee may have this ‘elixir effect,’ it is clear that coffee can be incorporated into a healthy diet and lifestyle.”

About 62 percent of Americans drink coffee daily, a 5 percent increase from 2016 numbers, reported the National Coffee Association.

As a research institution, USC has scientists from across disciplines working to find a cure for cancer and better ways for people to manage the disease.

The Keck School of Medicine and USC Norris Comprehensive Cancer Center manage a state-mandated database called the Los Angeles Cancer Surveillance Program, which provides scientists with essential statistics on cancer for a diverse population.

Researchers from the USC Norris Comprehensive Cancer Center have found that drinking coffee lowers the risk of colorectal cancer.

But drinking piping hot coffee or beverages probably causes cancer in the esophagus, according to a World Health Organization panel of scientists that included Mariana Stern from the Keck School of Medicine.

Hearing from the WHO

In some respects, coffee is regaining its honor for wellness benefits. After 25 years of labeling coffee a carcinogen linked to bladder cancer, the World Health Organization last year announced that drinking coffee reduces the risk for liver and uterine cancer.

“Some people worry drinking coffee can be bad for you because it might increase the risk of heart disease, stunt growth or lead to stomach ulcers and heartburn,” Setiawan said. “But research on coffee have mostly shown no harm to people’s health.”

Coffee by the numbers

Setiawan and her colleagues examined the data of 185,855 African-Americans (17 percent), Native Hawaiians (7 percent), Japanese-Americans (29 percent), Latinos (22 percent) and whites (25 percent) ages 45 to 75 at recruitment. Participants answered questionnaires about diet, lifestyle, and family and personal medical history.

They reported their coffee drinking habits when they entered the study and updated them about every five years, checking one of nine boxes that ranged from “never or hardly ever” to “4 or more cups daily.” They also reported whether they drank caffeinated or decaffeinated coffee. The average follow-up period was 16 years.

Sixteen percent of participants reported that they did not drink coffee, 31 percent drank one cup per day, 25 percent drank two to three cups per day and 7 percent drank four or more cups per day. The remaining 21 percent had irregular coffee consumption habits.

Over the course of the study, 58,397 participants — about 31 percent — died. Cardiovascular disease (36 percent) and cancer (31 percent) were the leading killers.

The data was adjusted for age, sex, ethnicity, smoking habits, education, preexisting disease, vigorous physical exercise and alcohol consumption.

Setiawan’s previous research found that coffee reduces the risk of liver cancer and chronic liver disease. She is currently examining how coffee is associated with the risk of developing specific cancers.

Researchers from the University of Hawaii Cancer Center and the National Cancer Institute contributed to this study. The study used data from the Multiethnic Cohort Study, which is supported by a $19,008,359 grant from the National Cancer Institute of the National Institutes of Health.


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