Gay Men More Likely to Have Had Cancer

A new study finds that homosexual men are twice as likely as other males to have been diagnosed with and then survive a cancer, shining a light on the unique medical risks that gay people may face. It's not the first time that researchers have noted differences in health risks linked to sexual orientation. Gay men, of course, are at higher risk of becoming infected with HIV, while lesbians may be more likely than heterosexual women to get breast cancer. Both gay men and lesbians have higher rates of tobacco use than the general population, and research has shown that lesbians drink more and are more prone to obesity than other women.

The new study adds to existing knowledge, but "there's a painful dearth of data about lesbian, gay, bisexual and transgender health in general," noted Liz Margolies, executive director of the National LGBT Cancer Network, who's familiar with the new research. In the new study, published online May 9 in Cancer, researchers examined surveys involving more than 122,000 California residents from 2001, 2003 and 2005. Among other things, the surveys asked about sexual orientation and whether the participants had ever been diagnosed with cancer. About 8 percent of the gay men in the group reported having had cancer almost double the rate among the heterosexual and bisexual men surveyed.

Lesbians didn't have a higher rate of cancer than other women, but lesbian cancer survivors were about twice as likely to report that they had fair or poor health compared to heterosexual women. The study can't say whether gays and lesbians are more likely to develop cancer in the first place, since it doesn't include people who have died from the disease or may be too ill to answer questions, stressed study author Ulrike Boehmer, an associate professor of community health sciences at Boston University School of Public Health. Experts already believe that gay men face a higher risk of anal, lung, testicular and immune-system cancers, she said. For their part, lesbians are thought to possibly be at higher risk of breast cancer, perhaps because many of them don't give birth.

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Payment Rates May Affect Breast Cancer Treatment

Use of a costly breast cancer therapy called intensity-modulated radiation therapy is strongly influenced by what Medicare will pay for the treatment and where radiation oncologists practice, according to a new study. Researchers analyzed Medicare data for 26,163 women with localized breast cancer who had surgery and radiation therapy between 2001 and 2005. During that time, Medicare billing for the treatment, called IMRT, increased more than 10-fold (from 0.9 percent to 11.2 percent of patients).

The average cost for radiation treatment within the first year after breast cancer diagnosis was $7,179 without IMRT and $15,230 with it. Billing for IMRT was five times higher in regions of the country where the treatment was covered by local Medicare carriers than it was in areas where it was not covered, the researchers said. They also found that billing for IMRT was more common among patients treated in freestanding radiation treatment centers (7.6 percent) than among those treated in hospital-based outpatient clinics (5.4 percent).

The findings "suggest that with respect to breast radiation therapy, much of the variation in cost can be directly attributed to inconsistent treatment definitions and reimbursement rates authorized by Medicare and its intermediaries," concluded Dr. Benjamin D. Smith, of the M.D. Anderson Cancer Center in Houston, and his colleagues. The study is published in the April 29 online edition of in the Journal of the National Cancer Institute.

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Nervous System Imbalance May Cause Fatigue in Breast Cancer Survivors

The persistent fatigue and exhaustion plaguing some breast cancer survivors after successful treatment stems from a tug of war between the "fight-or-flight" and "resting" parts of the autonomic nervous system, with the former working overtime and the other unable to rein it in, a new study suggests. Researchers from Ohio State University split 109 women who had completed breast cancer treatment up to two years earlier into two groups those who did and didn't report long-term fatigue and tested their blood for a baseline level of norepinephrine, a stress hormone. Participants were then asked to give a five-minute speech and do a series of verbal math problems, both tasks aimed at increasing their stress levels.

As expected, further blood tests showed that levels of norepinephrine associated with the "fight-or-flight" sympathetic nervous system rose in both groups after the stressful experience, researchers said. However, breast cancer survivors who experienced persistent fatigue had higher levels than those who weren't chronically tired. The study, released online in advance of publication in an upcoming print issue of the journal Psychoneuroendocrinology, was partially funded by the U.S. National Institutes of Health and the American Cancer Society.

The findings are the most recent from a 30-year-long study about the effects of stress on the human body. The researchers used earlier data from a larger ongoing study looking at whether yoga can ward off continuing fatigue in breast cancer patients. "We're not sure if the fatigue is stress-induced. But certainly cancer is an extremely stressful life event," said study author Christopher Fagundes, a postdoctoral fellow at Ohio State University's Institute of Behavioral Medicine Research. "So those stressors might be contributing to those autonomic system changes."

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Tissue Analysis May Help Predict Breast Cancer Outcome

An analysis of breast tissue may help doctors better predict outcomes for women with breast cancer, a new study reports. Researchers analyzed what they describe as "highways" of connective tissue in breast cancer tumors, and found that the way collagen fibers the main component of connective tissue are arranged may aid in a patient's diagnosis and help determine treatment. Collagen not only surrounds most body organs and helps provide structure for the body, it also tells cells how to behave, the study authors noted. Normally, a close-up of collagen resembles a jumbled path or a plate of cooked spaghetti.

In the new study, the researchers analyzed tumor cells from 200 patients with invasive breast cancer. The investigators found signs that the collagen began to act differently as the tumors progressed. "We think the cancer cells start to pull on the collagen and straighten it out, forming a track or highway on which the cells can migrate," study senior author Patricia Keely, an associate professor of cell and regenerative biology at the University of Wisconsin-Madison School of Medicine and Public Health, said in a university news release. As the highways became more developed, the prognoses for patients worsened, the study found.

"We have identified a novel collagen-signature system that may become a very useful addition to the tools clinicians use to determine a breast cancer patient's prognosis," Keely explained. The research is published in the March issue of the American Journal of Pathology. Commenting on the study, Dr. Priscilla A. Furth, a professor of oncology and medicine at Georgetown University's Lombardi Comprehensive Cancer Center, described it as an example of "valid basic research." However, "before any new prognostic test can go into practice it must be extensively validated. This publication is a first step that might trigger additional research to examine the utility of this type of analysis in different settings and by different groups," said Furth, who was not involved with the study.

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Drop in Breast Cancer Among White Women May Have Stalled

Many American women abandoned hormone replacement therapy after a 2002 study found the treatment was tied to higher breast cancer risk. A sharp drop in breast cancer incidence among whites was observed soon after. However, a new study suggests that the 2002-2003 decline in breast cancer incidence among white women did not continue through 2007. The data suggests that the drop in breast cancers linked to women abandoning hormone replacement therapy (HRT) has now bottomed out.

Breast cancer rates among U.S. white women fell by about 7 percent between 2002 and 2003 after the release in 2002 of findings from the Women's Health Initiative study that linked HRT with an increased risk of breast cancer. To examine whether that trend has continued, American Cancer Society and U.S. National Cancer Institute (NCI) researchers reviewed breast cancer data collected from 2000 to 2007 by NCI Surveillance, Epidemiology and End Results (SEER) registries across the country.

The analysis revealed that the sharp decline in breast cancer rates among white women that occurred between 2002 and 2003 did not continue between 2003 and 2007. Instead, breast cancer rates among white women remained relatively stable from 2003 to 2007. "Postmenopausal hormone replacement therapy certainly had accounted for an increase in the incidence of developing a breast cancer. The use of postmenopausal HRT had sharply declined after multiple reports proved this relationship," noted one expert, Dr. Sharon M. Rosenbaum-Smith, a breast cancer specialist and surgeon at the Comprehensive Breast Center at St. Luke's-Roosevelt Medical Center in New York City.

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Breast Cancer Treatment May Lead to Hip Fracture

Middle-aged breast cancer survivors face an increased risk for hip fractures, a condition normally uncommon in women younger than 70, a new study has found. Researchers at Northwestern University in Chicago say that this may be because early menopause caused by breast cancer treatment and the effects of breast cancer drugs could weaken the bones by the time women reach middle age. The finding came from a study of six women who had survived breast cancer and, in their early 50s, were being treated for hip fractures.

Most of the women did not have osteoporosis, but they did have lower-than-normal bone mineral density (osteopenia). This suggests that rapid changes in bone architecture caused by chemotherapy, early menopause and adjuvant breast cancer therapy may not be detected on a bone mineral density test, said Dr. Beatrice Edwards, an associate professor of medicine and orthopedic surgery and director of the bone health and osteoporosis program Northwestern University's Feinberg School of Medicine, who led the research.

The women had been diagnosed with early-stage breast cancer, and their treatments had included lumpectomy, radiation therapy and chemotherapy with cytoxan and adriamycin for one to four years before they broke a hip. All of the women were perimenopausal at the time of the fracture. In four of the women, their breast cancer had grown in response to estrogen, and their cancer therapy had included aromatase inhibitors to prevent their bodies from making estrogen. Recent research has linked aromatase inhibitors with possible bone loss in women.

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Breast Cancer Outcome: Your Doctor Matters

How doctors choose to treat their breast cancer patients and whether those treatment choices follow established recommendations may play a larger role in whether a cancer returns than experts have believed. In a new analysis looking at 994 women with ductal carcinoma in situ, the most common type of noninvasive breast cancer, researchers found treatment variations from surgeon to surgeon are significant, and may account for up to 30 percent of recurrences.

"Treatment variation is a troubling but well-known phenomenon in health care," said study author Andrew W. Dick, a researcher at RAND Corp. in Pittsburgh. The report is published online Jan. 3 and in the Jan. 19 print issue of the Journal of the National Cancer Institute. "The reason it is surprising in this case is that the variation is quite large, and related to factors that are very important in health outcomes," Dick said.

Those factors include having "negative margins" meaning that cancer cells are more than 2 millimeters away from the removed tissue's edge and getting radiation therapy after breast-conserving surgery. The variation by surgeon in treatments accounted for 15 percent to 35 percent of cancer occurring in the opposite breast in the next five years and 13 percent to 30 percent of recurrences over 10 years, the investigators found.

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Keeping Holiday Drinking in Check May Counter Cancer

Though holiday partying often includes alcohol consumption, cancer experts are urging partiers to partake moderately. "Research shows that drinking even a small amount of alcohol increases your chances of developing cancer, including oral cancer, breast cancer and liver cancer," Clare McKindley, clinical dietician in the Cancer Prevention Center at the University of Texas M.D. Anderson Cancer Center, said in a news release from the center.

"Researchers are still trying to learn more about how alcohol links to cancer," she added. "But convincing evidence does support the fact that heavy drinking damages cells and increases the risk for cancer development." To reduce risk, experts say, drinkers can do a number of things. First, stick to the recommended serving size. A drink is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor. Women should have no more than one drink a day and men should have no more than two drinks a day, according to the U.S. National Cancer Institute.

Try to avoid high-calorie drinks. Many popular alcoholic drinks are loaded with calories, especially those mixed with soda, fruit juice or cream. A one-cup serving of eggnog, a holiday staple, has about 340 calories. Being overweight or obese is also associated with an increased risk for cancer. Researchers believe that it is the ethanol or alcohol in beer, wine and liquor that increases cancer risk. Check the ethanol percentage numbers on bottle labels and stay away from 100-proof liquor.

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