Eating pomegranates or drinking pomegranate juice may help prevent and slow the growth of some types of breast cancer. A new study shows a group of phytochemicals called ellagitannins found in abundance in pomegranates inhibited the growth of estrogen-responsive breast cancer in laboratory tests.

The abstract of the study says “Estrogen stimulates the proliferation of breast cancer cells and the growth of estrogen-responsive tumors. The aromatase enzyme, which converts androgen to estrogen, plays a key role in breast carcinogenesis. The pomegranate fruit, a rich source of ellagitannins (ET), has attracted recent attention due to its anticancer and antiatherosclerotic properties. On consumption, pomegranate ETs hydrolyze, releasing ellagic acid, which is then converted to 3,8-dihydroxy-6H-dibenzo[b,d]pyran-6-one (“urolithin”) derivatives by gut microflora. The purpose of this study was to investigate the antiaromatase activity and inhibition of testosterone-induced breast cancer cell proliferation by ET-derived compounds isolated from pomegranates. A panel of 10 ET-derived compounds including ellagic acid, gallagic acid, and urolithins A and B (and their acetylated, methylated, and sulfated analogues prepared in our laboratory) were examined for their ability to inhibit aromatase activity and testosterone-induced breast cancer cell proliferation. Using a microsomal aromatase assay, we screened the panel of ET-derived compounds and identified six with antiaromatase activity. Among these, urolithin B (UB) was shown to most effectively inhibit aromatase activity in a live cell assay. Kinetic analysis of UB showed mixed inhibition, suggesting more than one inhibitory mechanism. Proliferation assays also determined that UB significantly inhibited testosterone-induced MCF-7aro cell proliferation. The remaining test compounds also exhibited antiproliferative activity, but to a lesser degree than UB. These studies suggest that pomegranate ET–derived compounds have potential for the prevention of estrogen-responsive breast cancers.”

Researchers say the ellagitannins in pomegranates work by inhibiting aromatase, which is a key enzyme used by the body to make estrogen and plays a key role in breast cancer growth.

“We were surprised by our findings,” Chen says. “We previously found other fruits, such as grapes, to be capable of the inhibition of aromatase. But phytochemicals in pomegranates and in grapes are different.”

Researchers say pomegranates have recently been hailed for their potential anti-cancer and heart healthy benefits thanks to their high antioxidant content. But they say this is the first study to look at their effects on aromatase and breast cancer growth.

In the study, published in Cancer Prevention Research, researchers examined the impact of 10 ellagitannin-derived compounds from pomegranates on aromatase activity and breast cancer cell growth in laboratory tests.

The results showed that of those 10 compounds, urolithin B most significantly inhibited breast cancer cell growth.

Experts say further studies will be needed to determine whether eating or drinking pomegranate-derived products will have the same effect in humans, but these results are promising.

“More research on the individual components and the combination of chemicals is needed to understand the potential risks and benefits of using pomegranate juice or isolated compounds for a health benefit or for cancer prevention,” Powel Brown, MD, PhD, chairman of the clinical cancer prevention department at the University of Texas M.D. Anderson Cancer Center. Brown was not associated with the study.

Until then, researchers say people may consider eating more pomegranates to protect against cancer in the breast and perhaps other tissues and organs.

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 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.

Doctors also inserted titanium clips in the tissue of both breasts during the operations, and next month she will receive five days of targeted radiation. Heinz contended that younger women should continue undergoing mammograms despite a federal panel’s recent recommendation to reduce their frequency.

“Chemotherapy is serious,” she said. “It also costs a lot of money. It’s very painful. And it’s very destructive of people’s—most people’s—lives, for a while anyway. So why put people through that instead of just having a test that’s done, and it’s done? So that’s why I was so upset about that decision of this panel.”

Heinz has been a significant contributor to nonprofit organizations within the valley, including a $325,000 donation in 1992 from the Heinz Family Foundation to purchase and preserve Galena Lodge, a popular Nordic skiing destination north of Ketchum. Heinz was also the keynote speaker at the 2006 Sun Valley Sustainability Conference.

Women who took a commonly used class of osteoporosis drugs called bisphosphonates had significantly fewer invasive breast cancers than women not using the bone-strengthening pills, according to a new analysis of data from the Women’s Health Initiative.

The analysis from a segment of the more than 150,000 generally healthy post-menopausal women in the WHI study found that those taking Merck & Co’s Fosamax, or other bisphosphonates, had 32 percent fewer cases of invasive breast cancer than women who did not use the osteoporosis medicines, researchers found.

Fosamax is now available in generic form as alendronate. Other commonly used medicines from the class include Roche’s Boniva and Actonel, which is sold by Procter & Gamble Co.

“The idea that bisphosphonates could reduce breast cancer incidence is very exciting because there are about 30 million prescriptions for these agents written annually in the United States targeting bone health, and more could easily be used to counteract both osteoporosis and breast cancer,” Dr. Rowan Chlebowski, the study’s lead investigator and chief oncologist from the Los Angeles Biomedical Research Institute, said in a statement.

It was the landmark WHI research program that in 2002 found a link between long-term use of hormone replacement therapy by post-menopausal women and increased risk of breast cancer and heart attacks – findings that have been used as the basis for thousands of lawsuits against the makers of those drugs.

The latest findings from the observational study were presented at the San Antonio Breast Cancer Symposium on Thursday.

The impetus for looking at the connection between bisphosphonates and breast cancer came from data from a clinical trial in which breast cancer patients who were given Novartis’ bisphosphonate Zometa intravenously every six months had fewer contralateral breast cancers, Chlebowski explained.

“It appeared to make bone less hospitable to breast cancer,” Chlebowski said.

Contralateral breast cancer is typically a second new case of cancer in the other breast, rather than the spread of the originally detected breast cancer. Studying 2,816 participants who were using bisphosphonates when they entered the WHI program, researchers found that only 64 women developed breast cancer. That translates into 32 percent fewer breast cancers in women using bisphosphonates compared with women who did not use them, researchers said.

Researchers cautioned that this was an observational study that does not necessarily carry the same scientific weight as a blinded clinical trial.

However, they said, several ongoing breast cancer trials evaluating oral and intravenous bisphosphonates will be available in the near future to provide randomized clinical trial evidence regarding their influence on new contralateral breast cancer risk.

“This is not a definitive finding,” Chlebowski said in an interview. “But I think it could influence the decision making of women who are deciding whether to take a bisphosphonate or not.”

Cancer experts fear new U.S. breast imaging guidelines that recommend against routine screening mammograms for women in their 40s may have their roots in the current drive in Washington to reform healthcare.

Critics of the guidelines, issued on Monday by the U.S. Services Task Force, an independent panel sponsored by the U.S. Agency for Healthcare Quality, say the new guidelines are a step backward and will lead to more cancer deaths.

Here are some of their concerns.

• Dr Carol Lee, chairwoman of the American College of Radiology Breast Imaging Commission, said she fears insurers — both private and public — will use them to pare back health costs.

“These new recommendations seem to reflect a conscious decision to ration care,” Lee said in a statement. She said since the onset of regular mammogram screening in 1990, the death rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.

• Dr Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the influential group will not change recommendations for routine mammograms for women starting at age 40.

But he is worried that women will become so confused by the conflicting recommendations they will stop getting mammograms altogether. “Frankly, from our point of view that would be the worst possible outcome,” Lichtenfeld said in a telephone interview.

• Lichtenfeld and other doctors are worried that insurance companies and government insurers will seize on the recommendations as a way to control rising health costs.

“What is going to happen is insurers are going to say, ‘The U.S. Preventive Services Task Force doesn’t support screening. We’re not going to pay for it,’” said Dr Daniel Kopans, professor of radiology at Harvard Medical School and a senior radiologist at Massachusetts General Hospital in Boston.

“There were no new data to assess. One has to wonder why these new guidelines are being promulgated at a time when healthcare is under discussion and I am afraid their decision is related to saving money rather than saving lives,” Kopans said.

• “The USPSTF recommendations are a step backward and represent a significant harm to women’s health,” Dr W. Phil Evans, president of the Society of Breast Imaging, said in a statement.

“At least 40 percent of the lives saved by mammographic screening are of women aged 40-49. These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs. Unfortunately, many women may pay for this unsound approach with their lives.”

October is officially tagged “Breast Cancer Awareness Month”. Of recent, there have been a lot of medical breakthroughs in the detection and treatment of Breast Cancer. Scientists have identified more accurate tools for screening younger women who are more likely to get the most dangerous forms and new strategies have also been developed for the treatment of newly diagnosed pregnant women.  Advanced research has led to the development of better, less toxic drugs to guard against recurrences.

In the Western world, breast cancer deaths have plummeted and survival rates are soaring. Research has made more headway in the fight against breast cancer than any other form of cancer. These milestone achievements are as a result of the constant campaigns, awareness creation and fundraising activities directed toward the cause. Early detection and a study which showed that hormone replacement therapy in postmenopausal women strongly contributed to the development of breast cancer are greatly responsible for the lower incidence rates.

In breast cancer, some cells in the breast for reasons poorly understood start growing abnormally, dividing more rapidly than normal cells and may spread (metastatize) to adjascent tissue, lymph nodes or other parts of the body.The most common type begins in the milk producing ducts while otherforms occur in other breast tissue. It is known that 5 to 10% of breast cancer cases areinherited. There is usually a defect in one of two genes namely BRCA1 and BRCA2 (Breast Cancer Genes 1 and 2).

Most genetic mutations related to breast cancer are not inherited and develop during one’s lifetime such as exposure to polycyclic aromatic hydrocarbons found in tobacco and charred meats and radiation exposure.

Newer drugs such as Herceptin and Tamoxifen that are specifically targeted for the treatment of pathologically different cancer types has greatly reduced deaths as a result of breast cancer. In the past, one drug was used to treat all forms of breast cancer with less than satisfactory results.

Types of Breast Cancer:

The majority of tumours (about 60%) are hormone sensitive and are stimulated by the female sex hormones oestrogen and progesterone. About 25% of cases are the deadlier form associated with an excessive amount of the protein known as HER2.

Some cancers are both hormone sensitive and HER2 positive. There is a form of breast cancer more likely to occur in younger women known as Triple Negative Breast Cancer because it is neither oestrogen sensitive, progesterone sensitive nor HER2 positive. Fortunately, there have been developments in treatments to help all three forms.

Hormone Responsive Cancer is usually treated with Tamoxifen which is given after surgery to suppress hormones that stimulate tumour growth. Tamoxifen has serious side effects such as vaginal bleeding, hot flashes, an increased risk of uterine cancer and the development of blood clots. There are newer oestrogen-blocking aromatase inhibitors namely Femara, Arimidex and Aromasin which have been found to offer the same or even better results.

HER2 Cancer due the HER2 protein triggering the growth of cancer cells is an aggressive form of cancer.

The drug Herceptin is used to stop the action of this protein and is combined with chemotherapy. Tykerb, also a protein suppressor, will be on the market in 2007 and has shown excellent results when combined  with the chemotherapeutic agent, Xeloda.

Triple Negative Cancer is tackled with the use of a colon cancer drug known as Avastin and is combined with chemotherapy with promising results.

In the past, a pregnant woman found to have breast cancer had to make the difficult decision of having to save her own life or the life of the unborn child. New treatment guidelines allow women to have a mastectomy or a breast conserving lumpectomy and commence chemotherapy as early as the second trimester. Some studies have shown that there have been little or no adverse effects on the foetus while others have shown that the development of the foetus may be affected by chemotherapy. Radiation and oestrogen therapy may  harm the foetus and should be delayed until after the birth of the child.

More than 75% of cases of breast cancer occur in women aged over 50 years. Other risk factors include having a first degree relative (mother, daughter, sister) who has had breast cancer, having had breast cancer previously, an abnormal biopsy result, a mutation in the breast cancer genes, postmenopausal obesity, hormone replacement therapy and prolonged exposure to oestrogen such as reaching puberty before the age of 12 years, starting menopause after age 55 years and having children after the age of 30 or not having children at all.

Women are advised to have routine mammograms once they reach age 40. MRI’s are useful for locating difficult to identify tumours.The risk of developing breast cancer may be reduced by checking breasts monthly for lumps, getting regular exercise which boosts immune function and cuts the risk in half, watching your weight as obesity encourages further storage of oestrogen in fatty tissue. Women who are about 30kg overweight are up to 3 times more likely to develop advanced metastatic cancers than women who are not overweight. Exposure to oestrogen should be minimized thus hormone replacement therapy should be dicouraged.

It should be noted that men may also develop breast cancer. As a matter of fact, a male case was the first I was presented with as a medical student. In men, like women, the most common sign of breast cancer is a lump (often painless) or thickening of breast tissue. Other signs include change in the size or contour of the breast, clear or bloody nipple discharge, retraction or indentation of the nipple, flattening or retraction of the skin overlying the breast and redness or pitting of the skin overlying the breast.

It is a fact unknown to many. For every 100 cases of breast cancer diagnosed in women, there is one case detected in men. Physicians warn that in recent years the number of men with this problem is growing alarmingly. To diagnose this type of cancer, the patient’s breast has to be analyzed for hard lumps, growth and swelling of the glands. Often the symptoms confuse physicians due to its similarity to gynecomastia – male breast growth caused by the accumulated fat.

According to doctors, usually the tumor is found by the patient or his partner. Along with the appearance of lumps, it is common for patients to have complaints of nipple discharge, signs of local dissemination with the retraction of the nipple and ulcers.The treatment is similar to that of a woman – it depends on the stage of the disease and the health status of the individual. The earlier the treatment, the better the results.

First the biopsy takes place, then perhaps a mastectomy is performed, followed by radiation therapy or chemotherapy. Breast cancer is more prevalent in men over 35 years of age and the risk increases with age. The disease is related to the same risk factors in women such as: family history, the appearance of malignant tumors in the past, excess weight and high-fat diet.

The American Cancer Society estimates that this year 1,910 new cases of invasive breast cancer will be diagnosed among men in the United States. About 440 men will die in 2009 due to this disease.

“The earlier it is diagnosed, the better the prognosis. Just like in women, the survival rates for early diagnosis is about 80 to 90 percent, whereas, if discovered later, this index falls dramatically, reaching only 10 to 20 percent,” according to Dr. Renato Santos, a surgeon/oncologist at the São Luiz Hospital and Maternity in Sao Paulo, Brazil. In turn, Carvalho believes his quality of life is better today than in the past.”You will ask why? Now I respect my limits more, the limits of my body, and I know that serious diseases do not only affect other people. A disease can knock on our door too,” he said.

Carvalho said that even among his friends there is a preconceived notion about this disease. “When I was asked what I had and I responded ‘breast cancer,’ I noticed that people did not believe me or for some reason thought I was the only case in the world. This ignorance is dangerous and is bad,” he said.

One of the people that has helped spread awareness of breast cancer among men is Peter Criss. The original drummer of the band Kiss was diagnosed with breast cancer in 2008 and escaped major complications due to early detection. “In ‘08, I was diagnosed with breast cancer, but with (early detection) my great doctor Alex Swistel & staff and the Lord above, who always looks over me, I am cancer free today! I wanted to let you know men get it like women do. Don’t be afraid to let someone know if you have a lump. Do the right thing for you and your loved ones and get it checked. Man or woman, there is no discrimination with breast cancer … we all don’t have nine lives,” wrote Peter Criss on his official website.

Four years after the cancer diagnosis, Carvalho said he is slowly returning to his lifestyle. “I have no hurry, I take life as it is … Beautiful and difficult to face, but is the only real asset that we have. So, now I live and allow those close to me to live,” said the carpenter, who also had to readjust at work after the breast surgery.

UK’s drug watchdog National Institute for Clinical Excellence (NICE) has advised against public funding of Tyverb® (lapatinib) on grounds of cost. The drug is a treatment for an aggressive form of advanced breast cancer (ErbB2-positive). Drug makers GSK say they are considering an appeal against the decision.

Lapatinib (in combination with Xeloda® [capecitebine]) offers a new treatment option for women whose disease has returned despite treatment with standard chemotherapies and Herceptin® (trastuzumab).

There are very few treatment options available for these women and lapatinib offers a chance of additional time without their disease progressing. Lapatinib is the only licensed ErbB2 targeted treatment for these patients. Lapatinib can halve the speed of growth of breast cancer in one in five women with an aggressive form of the disease.

It could potentially help about 2,000 women a year with HER2 positive cancer who have run out of options, including the wonder drug Herceptin. But NICE says the NHS cannot afford the cost at £1,600 a month for each patient and lapatinib, also known as Tyverb, should be used only in clinical trials.

The drug makers GlaxoSmithKline (GSK) is giving the first three months of treatment free, with the NHS picking up the bill for those who respond and need it for longer.

Simon Jose, General Manager, GSK UK commented; “We disagree with the NICE decision and believe Tyverb is a valuable and important treatment for eligible women. In recognition of the cost effectiveness challenges with drugs that treat patients with a short life expectancy, we offered the Tyverb Patient Access Programme to help ensure it was made available on the NHS. It is difficult to comment without the appearance of self interest. However, there is clearly more work to be done by all parties when flexible access programmes from industry and the recent changes by NICE for patients with a short life expectancy still fail to give them access to valuable medicines.”

GSK proposed the patient access programme in the UK when NICE indicated early on in its review that it did not consider lapatinib to be cost effective in treating this patient population. In an effort to achieve a positive outcome for patients and greater value to the NHS, GSK bears the cost of lapatinib, for all eligible patients under the scheme, for up to the first 12 weeks of treatment. The NHS would commence payment only for the patients who continue to receive clinical benefit beyond 12 weeks.  GSK will continue to honour the patient access programme for NHS trusts in the UK.

During the lapatinib assessment, NICE proposed new advice for the assessment of treatments in small patient populations with a short life expectancy. Lapatinib is licensed for a particular type of breast cancer that affects around 2000 women a year. Therefore lapatinib qualified for review under the new advice.

GSK submitted a sub-group analysis that met the overall survival (OS) criterion of this new NICE advice. However NICE concluded that whilst the data analysis could be useful in guiding future research, as it stands it would not change their conclusions.

NICE’s decision reflects the difficulty in demonstrating significant survival benefits in patients at this advanced stage of disease, the drug-makers said Furthermore, trials are often halted early for ethical reasons to allow patients to cross over to the active arm because of the effectiveness demonstrated by the medicine under study, as in the case of lapatinib.

In its final appraisal determination, NICE acknowledges that lapatinib is a clinically effective option, noting that lapatinib plus capecitabine demonstrated improved time to progression (TTP) and progression free survival (PFS) –  significantly delaying the progression of the cancer and controlling the disease.

GSK’s NICE submission demonstrated that lapatinib, in conjunction with the patient access programme, could actually save the NHS money in patients who would have received trastuzumab (Herceptin®) containing regimens. NICE acknowledged this is the majority (>50%) of eligible patients, however NICE concluded that trastuzumab is not likely to be cost effective in this setting and therefore lapatinib plus capecitabine would not be cost effective.

Inspirational fundraiser Jane Tomlinson, who died in September 2007 aged 43, was among hundreds of British women who got the drug thanks to an ‘expanded access’ programme paid for by GSK. Mrs Tomlinson lost her seven-year battle with cancer after raising more than £1.75 million for charity in gruelling endurance events, including three London Marathons. Mrs Tomlinson’s widower Mike condemned the ban when it was first proposed earlier this year, saying Nice had failed the ‘acid test’.

He said ‘We know what a difference it made to Jane. Initially she was refused the drug so by the time she got it, she was desperately ill but we saw the benefits and the good effects’. Jane would be absolutely furious about this and it seems illogical. Considering the small number of women who would be eligible, it’s a small price to pay.

‘This drug is routinely used in other European countries. Have they got it wrong or do they have better healthcare than us?’

Dr Alison Jones, medical oncologist at the University College London Hospital and the Royal Free Hospital, said ‘I am disappointed for all the women who would have benefited from lapatinib on the NHS. ‘I have witnessed myself that lapatinib can extend the lives of these women. We are now left with very few effective treatment options in cases where Herceptin has stopped working.’

The decision from NICE is the final stage of its consultation process and, subject to appeal, guidance will be issued later this year.