Given at 20th Annual Congress on Women's Health

		IMAGE: This is the design for the 20th Annual Congress on Women’s Health. Click here for more information.

New Rochelle, NY -- Vivian W. Pinn, MD will be awarded the inaugural Bernadine Healy Award, to be presented at the 20th Annual Congress on Women's Health, March 16-18, 2012 in Washington, DC. Physicians, nurses, and allied healthcare providers from across the country will gather at the Congress to learn practical, clinical information, cutting-edge therapeutic protocols, advances in diagnosis and management, and innovative translational research advances that impact women's health care. Complete information is available on the Congress website.

The Bernadine Healy Award was created in honor of the work and memory of Bernadine Healy, MD, former National Institutes of Health (NIH) Director, Founding Editor of Journal of Women's Health, and a renowned advocate for women's health. Through her tireless passion and leadership, Dr. Healy encouraged discourse and exchange of information among health care professionals with the ultimate goal of promoting women's health as a high national priority.

Dr. Pinn recently retired as the first permanent director of the Office of Research on Women's Health (ORWH) at NIH, and has long been active in efforts to improve health and career opportunities for women and minorities and to raise awareness in the scientific community about the importance of sex and gender factors in basic science, clinical research, and health care. She most recently spearheaded a national effort to reexamine priorities for the women's health agenda for the 21st Century, involving advocates, scientists, policy makers, educators, and health care providers in a series of scientific meetings across the country that ultimately informed the ORWH's new strategic plan.

"There is no better way to honor Dr. Healy's memory than to recognize the contributions of Vivian Pinn, a truly visionary leader who has advanced women's health immeasurably," says Congress Co-Chair Wendy S. Klein, MD, Senior Deputy Director Emeritus of the VCU Institute for Women's Health and Deputy Editor of Journal of Women's Health.

The 20th Annual Congress on Women's Health is hosted by the VCU Institute for Women's Health and Journal of Women's Health, in collaboration with NIH Office of Research on Women's Health and National Cancer Institute. Dr. Klein and Co-Chair Susan G. Kornstein, MD, Executive Director of the VCU Institute for Women's Health and Editor-in-Chief of Journal of Women's Health, will bring together outstanding faculty of the highest caliber for an array of informative sessions focusing on the most clinically relevant topics in women's health including cardiology, oncology, endocrinology, menopause, infectious disease, reproductive health, bone health, psychiatry, and common clinical conditions.

The Congress will offer up to 24.5 credit hours for physicians, nurse practitioners, nurses, family physicians, and allied health care professionals. This activity is jointly sponsored by Global Education Group and Institute for Professional Education.

The retrospective study was presented in the CTRC-AACR San Antonio Breast Cancer Symposium's press briefing by Benjamin Smith, M.D., assistant professor in the Department of Radiation Oncology, and in the meeting's scientific session by Grace Smith, M.D., Ph.D., a resident in MD Anderson's Department of Radiation Oncology and the study's first author.

"Our study compared the two radiation therapy techniques available to women with early-stage breast cancer. We found that women treated with accelerated partial breast irradiation therapy have a two-fold increased risk for subsequent mastectomy, most likely because of tumor recurrence or local complications, as well as an increased risk for post-operative and radiation-related complications," said Ben Smith, the study's senior author.

There are numerous types of APBI; the MD Anderson study only looked at the brachytherapy technique, in which a form of radiation treatment involving insertion of a catheter containing a radioactive source to kill breast cancer cells that may remain after lumpectomy surgery. A specialized catheter is surgically inserted into the cavity left behind after tumor removal. APBI brachytherapy is performed a few weeks after a lumpectomy, twice daily over a course of five to seven days.

APBI brachytherapy has grown in popularity over the past decade, since earlier studies showed generally low cancer recurrence rates, though most prior studies have not directly compared the outcomes of APBI brachytherapy to traditional radiation therapy, explained Ben Smith.

The first commercially-available single catheter to deliver partial breast irradiation was approved by the FDA in 2002, escalating APBI's use, said Ben Smith.

The MD Anderson study was based on analysis of claim forms filed by 130,535 Medicare beneficiaries nationwide, who were diagnosed with cancer between 2000 and 2007.

"In our study of Medicare patients, we found a consistent increase in APBI brachytherapy, from less than 1 percent in 2000 to 13 percent in 2007. It's our guess that this trend has continued," said Smith.

There are benefits to the practicality APBI offers women, noted Ben Smith.

"For whole breast irradiation, the standard treatment time is between five and seven weeks, but studies have shown that some women experience delays or have obstacles completing their course of radiation. Treatment delays and incompletion are known to increase the risk of cancer recurrence in the breast. APBI brachytherapy is attractive because it has the potential to address those issues, because treatment only lasts one week."

However, it's also an invasive procedure with the greater potential for side-effects that are not associated with a non-invasive therapy, such as WBI, noted Smith.

For the retrospective population-based study, the MD Anderson team used Medicare claims to examine the treatment history of 130,535 women age 66 and older diagnosed with early-stage, invasive breast cancer between 2000 and 2007. All of the women were treated with breast-conserving surgery followed by either APBI, delivered by brachytherapy, or traditional radiation therapy.

The researchers analyzed for effectiveness of radiation (defined as the need for a later mastectomy), post-operative complications (infectious and non-infectious), and post-radiation complications (breast pain, fat necrosis and rib fracture).

At five years, the incidence of mastectomy was statistically significantly higher in the APBI brachytherapy-treatment group compared to that of the WBI, 4 percent and 2.2 percent, respectively. APBI brachytherapy was also found to be associated with a higher incidence of acute and late toxicities, compared to those of WBI - infectious complications, 16 and 10 percent, respectively; non-infectious complications, 16 percent and 8 percent, respectively; - and post-radiation complications - five-year incidence of rib fracture, 4 and 4 percent, respectively; fat necrosis, 9 and 4 percent, respectively; and breast pain, 15 percent and 12 percent, respectively.

The researchers note the study's limits, including that it was not randomized, the relatively-short follow up of patients and limited details regarding tumor characteristics were available.

Given the findings, communication between the patient and her physician is paramount so that a woman with breast cancer can make an informed, personalized decision, said Thomas A. Buchholz, M.D., professor and head of the Division of Radiation Oncology at MD Anderson.

"This is a very important, well-designed study in a large cohort of patients and provides the first comparison of these two popular radiation techniques after breast-conserving surgery," said Buchholz, also an author on the study. "It's important to note that in both groups, we found a relatively low risk of recurrence. Still, we have a responsibility to discuss potential risks and benefits with our patients, while we await definitive results from randomized trials."

National randomized trials comparing APBI brachytherapy to WBI are ongoing. MD Anderson will continue offering APBI to interested patients in the context of ongoing institutional and multi-institutional clinical protocols, says Buchholz.

		IMAGE: This is Michael P. Lisanti, M.D., Ph.D., Professor and Chair of Stem Cell Biology & Regenerative Medicine at Thomas Jefferson University. Click here for more information.

PHILADELPHIA -- Researchers at the Kimmel Cancer Center at Jefferson have identified cancer cell mitochondria as the unsuspecting powerhouse and "Achilles' heel" of tumor growth, opening up the door for new therapeutic targets in breast cancer and other tumor types.

Reporting in the online Dec.1 issue of Cell Cycle, Michael P. Lisanti, M.D., Ph.D., Professor and Chair of Stem Cell Biology & Regenerative Medicine at Thomas Jefferson University, and colleagues provide the first in vivo evidence that breast cancer cells perform enhanced mitochondrial oxidative phosphorylation (OXPHOS) to produce high amounts of energy.

"We and others have now shown that cancer is a 'parasitic disease' that steals energy from the host -- your body," Dr. Lisanti said, "but this is the first time we've shown in human breast tissue that cancer cell mitochondria are calling the shots and could ultimately be manipulated in our favor."

Mitochondria are the energy-producing power-plants in normal cells. However, cancer cells have amplified this energy-producing mechanism, with at least five times as much energy-producing capacity, compared with normal cells. Simply put, mitochondria are the powerhouse of cancer cells and they fuel tumor growth and metastasis.

The research presented in the study further supports the idea that blocking this activity with a mitochondrial inhibitor -- for instance, an off-patent generic drug used to treat diabetes known as Metformin -- can reverse tumor growth and chemotherapy resistance. This new concept could radically change how we treat cancer patients, and stimulate new metabolic strategies for cancer prevention and therapy.

Investigating the Powerhouse

Whether cancer cells have functional mitochondria has been a hotly debated topic for the past 85 years. It was argued that cancer cells don't use mitochondria, but instead use glycolysis exclusively; this is known as the Warburg Effect. But researchers at the Jefferson's KCC have shown that this inefficient method of producing energy actually takes place in the surrounding host stromal cells, rather then in epithelial cancer cells. This process then provides abundant mitochondrial fuel for cancer cells. They've coined this the "Reverse Warburg Effect," the opposite or reverse of the existing paradigm.

To study mitochondria's role directly, the researchers, including co-author and collaborator Federica Sotgia, Assistant Professor in the Department of Cancer Biology, looked at mitochondrial function using COX activity staining in human breast cancer samples. Previously, this simple stain was only applied to muscle tissue, a mitochondrial-rich tissue.

Researchers found that human breast cancer epithelial cells showed amplified levels of mitochondrial activity. In contrast, adjacent stromal tissues showed little or no mitochondrial oxidative capacity, consistent with the new paradigm. These findings were further validated using a computer-based informatics approach with gene profiles from over 2,000 human breast cancer samples.

It is now clear that cancer cell mitochondria play a key role in "parasitic" energy transfer between normal fibroblasts and cancer cells, fueling tumor growth and metastasis.

"We have presented new evidence that cancer cell mitochondria are at the heart of tumor cell growth and metastasis," Dr. Lisanti said. "Metabolically, the drug Metformin prevents cancer cells from using their mitochondria, induces glycolysis and lactate production, and shifts cancer cells toward the conventional 'Warburg Effect'. This effectively starves the cancer cells to death".

Personalized Treatment

Although COX mitochondrial activity staining had never been applied to cancer tissues, it could now be used routinely to distinguish cancer cells from normal cells, and to establish negative margins during cancer surgery. And this is a very cost-effective test, since it has been used routinely for muscle-tissue for over 50 years, but not for cancer diagnosis.

What's more, it appears that upregulation of mitochondrial activity is a common feature of human breast cancer cells, and is associated with both estrogen receptor positive (ER+) and negative (ER-) disease. Outcome analysis indicated that this mitochondrial gene signature is also associated with an increased risk of tumor cell metastasis, particularly in ER-negative (ER-) patients.

"Mitochondria are the 'Achilles' heel' of tumor cells," Dr. Lisanti said. "And we believe that targeting mitochondrial metabolism has broad implications for both cancer diagnostics and therapeutics, and could be exploited in the pursuit of personalized cancer medicine."

Employers need to be more aware of the capabilities of women affected by breast cancer and provide them with better support, backed by employment directives and occupational health policies, according to a paper in the November issue of the European Journal of Cancer Care.

A review carried out by Dr Maggi Banning, from Brunel University, Uxbridge, UK, also showed that healthcare professionals need to provide breast cancer patients and survivors with better information about the best time to return to work.

Dr Banning reviewed ten studies on the employment experiences of 1,181 women affected by the disease from the USA, Canada, UK, Sweden and Denmark published between 1991 and 2010.

"Employment is an important factor in the lives of people with cancer as a return to work is often associated with a return to normality" says Dr Banning, a senior lecturer in clinical practice at the University.

"But it is clear that there are considerable differences in women's experiences of returning to work. Some positive working practices were reported, but other organisations were guilty of a culture of ignorance. Many of the negative experiences centred on the unrealistic expectations and inflexibility of some employers, lack of support from colleagues and mistaken assumptions about the woman's physical appearance."

Key findings of the study included:

Some women felt that returning to work was a welcome distraction from life as a cancer patient and provided a sense of normality, structure to their day, belonging, identity and social connections. However, others were apprehensive because of low perceptions of their physical fitness and work capacity after treatment and concerns about what their employer would expect of them.

Financial pressures were a common driver, with studies estimating that half the women could no longer afford to remain off work. Some women even missed scheduled treatment sessions as it would have meant taking time off work. Lack of sick pay and concerns about losing their job were also common.

While many women felt positive about returning to work, some reported that they had re-evaluated their lives after their diagnosis and felt that work no longer held the same importance it used to. The work aspirations of some women were also reduced.

Coping with cancer or the side effects of treatment, such as fatigue and sickness, often had an impact on the women's health. Loss of confidence and emotional issues also proved problematic for some women.

Women reported that employers' expectations of their work capacity varied, and while some studies found examples of supportive employers and colleagues, this was not always the case. Women in Europe appeared to have a more supportive work environment than those in the USA and Canada.

Some women took up different positions or were able to reduce their working hours so that they could receive treatment and recover from the side effects. However, in some cases, work modifications were refused and employers were openly hostile, insisting that they should resign from their jobs or retire.

A number of employers judged women by their physical appearance, not realising that up to a quarter of women experience residual fatigue for many months after treatment. Colleagues were also misled by women's physical appearance and this could to lead to lack of sympathy and work-related support.

Dr Banning has come up with a number of recommendations as a result of her review:

Employers need to be better educated to avoid the culture of ignorance that exists within some organisations when it comes to the capabilities of women affected by breast cancer.

There is room for improvement in the way that healthcare professionals and employers manage the return to work process.

Occupational health departments need to ensure that all cancer survivors have a fitness to work assessment before returning and need to provide managers with realistic guidelines of what they can expect from their employee.

Directives are also needed to influence and change welfare and employment policies to better support and manage the return to work process, including time off to attend treatments and follow-up appointments.

Few patients in Canada undergo breast reconstruction after mastectomy, despite its safety as a procedure and the positive psychological benefits, states a review article in CMAJ (Canadian Medical Association Journal).

The article reviews rates of breast reconstruction and factors that influence the practice of immediate reconstruction in patients with early stage breast cancer. However, information is lacking on the current rate and factors that influence this procedure in Canada.

Rates in Canada have been historically low, with a reconstruction rate of 7.7% in Ontario (1994/95) and 3.8% in Nova Scotia from 1991. In contrast, rates were higher in Australia (9.9%, 1982), Denmark (14%, 1999) and England (16.5%, 2006). In the United States, rates for breast reconstruction have increased from as low as 3.4% in 1985 to a high of 42% from 1997 in a network of tertiary cancer centres. Use of immediate reconstruction at the same time as mastectomy has also increased in the US, in part due to a recommendation by the Commission on Cancer of the American College of Surgeons in 2001 to incorporate this practice in the treatment of early stage breast cancer.

In general, older age, ethnicity, socioeconomic status and geography affect the use of breast reconstruction. Women older than 50 years are less likely to undergo reconstruction. This may be secondary to concerns of increased complications or comorbidities, although a US study found that the negative relationship between advanced age and decreased breast reconstruction remained significant after controlling for patient comorbidities. Women of lower socioeconomic status were less likely to have reconstruction. Women living in large urban centres were more likely to undergo breast reconstruction. For example, there were 10 reconstructions per 100 mastectomies in the Toronto area compared with 4.3 per 100 mastectomies in the rest of Ontario in 1994/1995. Other modifiable barriers to breast reconstruction in Canada include knowledge gaps and misperceptions held by referring physicians.

The stage of breast cancer is the most predictive clinical factor associated with reconstruction, because patients with advanced stage disease are significantly less likely to undergo reconstructive surgery than those with early stage disease.

"Although higher stage disease is not a contraindication for breast reconstruction, women or their physicians, or both, may not perceive this restorative procedure as a high priority compared with treatment," writes Dr. Toni Zhong, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, with coauthors.

"The optimal rate of breast reconstruction is not currently known for any jurisdiction, and the absence of such a benchmark limits useful research in this area," write the authors. "However, given the broad array of factors that influence the rate of breast reconstruction and the low rate of breast reconstruction in Canada compared with other jurisdictions, it is unlikely that our current practice has achieved an optimal rate."

The authors suggest that having a better understanding of the current rates of breast reconstruction and the different factors that influence access to breast reconstruction in Canada is key to addressing our current knowledge gap.