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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Doctors Ordering Transfusions to Get Patients into Drug Trials

Canadian researchers say they've noticed a disturbing trend: Cancer doctors ordering unnecessary blood transfusions so that seriously ill patients can qualify for drug trials. In a letter published recently in the New England Journal of Medicine, the researchers report on three cases during the last year in Toronto hospitals in which physicians ordered blood transfusions that could make the patients appear healthier for the sole purpose of getting them into clinical trials for chemotherapy drugs. The practice raises both medical and ethical concerns, the authors say.

"On the physician side, you want to do the best for your patients," said co-author Dr. Jeannie Callum, director of transfusion medicine and tissue banks at Sunnybrook Health Sciences Centre in Toronto. "If these patients have no other options left to them, you want to do everything you can to get them into a clinical trial," she said. "But the patient is put in a horrible position, which is, 'If you want in to the trial, you have to have the transfusion.' But the transfusion only carries risks to them," she added.

A particularly serious complication of blood transfusions is transfusion-related acute lung injury, which occurs in about one in 5,000 transfusions and usually requires the patient to go on life support, said Callum. But besides the potential for physical harm, enrolling very sick people in a clinical trial can also skew the study's results making the drug perform worse than it might in patients whose disease was not as far along. The unnecessary transfusions were discovered by the Toronto Transfusion Collaboration, a consortium of six city hospitals formed to carefully review all transfusions as a means of improving patient safety, Callum said.

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Depression, Anxiety May Raise Surgery Risks

People with depression and anxiety have a slightly increased risk of death after undergoing surgery, a new study suggests. U.S. researchers analyzed data from 35,539 surgical patients admitted to intensive care units between Oct. 1, 2003 and Sept. 30, 2006. Of those patients, 8,922 had an existing psychiatric condition, including 5,500 with depression, 2,913 with post-traumatic stress disorder, 2,473 with anxiety, 793 with bipolar disorder, and 621 with psychosis. Initial analysis showed that the death rates within 30 days after surgery were similar for patients with and without psychiatric illness 3.8 percent and 4 percent, respectively.

when the researchers adjusted for other factors, the death rate was higher for patients with a psychiatric condition, according to the report in the October issue of the journal Archives of Surgery. Further analysis showed that the increased risk of death was associated with depression and anxiety, but not any other psychiatric condition. Also, death rates were higher among patients with psychiatric conditions who had respiratory or digestive system surgery, but not for those who had surgery involving the circulatory, nervous or musculoskeletal systems.

"Several potential mechanisms exist to explain these findings," Dr. Thad E. Abrams, of the Iowa City Veterans Affairs Medical Center and University of Iowa Carver College of Medicine in Iowa City, and colleagues wrote in a news release from the journal's publisher. "First, studies indicate that patients with depression frequently do not adhere to medical recommendations for underlying medical conditions," the study authors noted. "It is therefore plausible that such undertreated conditions may affect postoperative care and outcomes. Second, patients with existing psychiatric comorbidity may be more likely to undergo surgery by a lower-quality surgeon or hospital. Third, pre-existing psychiatric comorbidity may serve as an indicator for greater severity of surgical risk."

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