 Angelina Jolie is no stranger to the spotlight. She's been an A-list movie star for nearly two decades. She's married to Brad Pitt, arguably the most famous actor of his generation. She's graced the cover of every magazine. When she speaks, people listen. So her Op-Ed in today's New York Times obviously got people talking. Jolie underwent a prophylactic mastectomy after finding that she is a carrier of an alteration in the BRCA1 gene. Her mother died of breast cancer at 56, and doctors estimated that Jolie had an 87 percent risk of developing breast cancer.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.
Jolie's essay is extremely powerful and illuminating. You should read the whole piece here. For people who have a strong family history of cancer, our multi-specialty team at the University of Arizona Cancer Center can assess cancer risk, determine if genetic testing is appropriate, interpret testing results, and counsel regarding the options for cancer risk management. The UACC is the only cancer care facility in Tucson with certified genetic counselors. To find out more, visit our web page or call (520) 694-0800. Read more about prophylactic mastectomy.
 Victor Gonzalez, MD University of Arizona Cancer Center physicians are on the cutting edge of developing safer, more targeted therapies for breast cancer patients undergoing radiation therapy for their disease. With recent studies showing potentially dangerous links between breast cancer patients who undergo radiation therapy and develop heart problems later in life, the development of targeted therapies is among the top priorities of today’s radiation oncologists. Last week, we spoke to Baldassarre Stea, MD, PhD, FASTRO, the UA Cancer Center’s Head of Radiation Oncology, about the department's use of a technique known as respiratory gating, a technology that enables clinicians to track a tumor’s position in relation to the patient’s respiratory cycle. This targeted therapy technique spares the heart and focuses the radiation beam specifically on cancerous cells. Read that story on the UA Cancer Center's official website. Today, Victor Gonzalez, MD, discusses the UA's ongoing efforts to protect breast cancer patients.
This study is important for several reasons. On one hand, it shows us how far radiation techniques have advanced in breast cancer. The doses of radiation to the heart with modern techniques are dramatically lower than they were twenty years ago, when most of the women in this study were treated.
At the same time, it emphasizes the need for continued improvement and ongoing research. Right now, we don’t know what dose of radiation is 100 percent safe for the heart. We can assume that the risk to the heart is going to be less with modern techniques, but we don’t know if that will be enough to completely eliminate the risk.
Techniques offered at the UACC to reduce radiation doses to the heart include intra-operative radiation therapy (where just a single dose of radiation is given to the tumor bed at the time of surgery), prone treatment (where the patient lies face down for the treatment and breast hangs down away from the heart), and respiratory gated treatment.
Patients who may see the greatest risk for treatment are women with left-sided tumors and women who require radiation to the lymph nodes close to the heart. In this situation, the heart can temporarily be moved away from the ribcage by having the patient take a deep breath, moving the ribcage and the breast away from the heart. Special cameras located in the radiation treatment room track the patient’s breathing cycle, which is displayed to the patient on special video goggles. The radiation beam is automatically turned on only after the heart had moved safely out of the way.
Dr. Gonzalez emphasized that the UACC is the only center in Tucson, and among only a handful of Cancer Centers in the United States, with this technology.
It is important to point out that the risk of heart injury from breast radiation is still small. As an example, 4-5 of every 100 women who are 50 years old and without any risk factors for heart disease would have a heart attack by age 80 without radiation. If this same group of 100 women received a typical course of breast radiation, one additional patient would have a heart attack. For comparison, smoking, diabetes and obesity each increased the risk of heart disease more than radiation therapy.
We have to balance the potential risks of treatment with the known benefits. After breast cancer surgery, radiation cuts the odds of the cancer returning in half. For most women, that’s going from a 30 percent chance of cancer without radiation to a 15 percent chance of cancer with radiation. There is no doubt that radiation therapy for breast cancer is a life-saving treatment. Overall, the benefits far outweigh the risks.
 Mark your calendars for Oct. 6, as one of the University of Arizona Cancer Center's most important educational conferences is coming back. ¡VIDA! The Seventh Annual Mujer Latina Breast Cancer Conference will be held at Apollo Community School (265 W. Nebraska St., Tucson) from 8 a.m. to 1 p.m. Topics will include cancer screening, understanding risk factors, treatment options and survivorship, with presentations delivered in Spanish and English. This year's program features the addition of new workshops for men, including cancer prevention for men and when your loved one has cancer, and for adolescent girls, body image and cancer prevention, as well as an extensive educational program on breast health. Admission is free, but advanced registration is suggested. Register online at vida.arizona.edu or by calling Angela Valencia at 520-626-0331. Breakfast and lunch will be served. The conference, founded and directed by Ana María López, MD, MPH, associate dean of outreach and multicultural affairs and professor of medicine and pathology at the University of Arizona and the University of Arizona Cancer Center, has as its goal “to bring free bilingual breast health information to the Latino community,” says Dr. López. Although the incidence of breast cancer in Latinas appears to be lower than in non-Latinas in the United States, the rate appears to be increasing. Breast cancer has surpassed cervical cancer as the No. 1 cancer killer of women. • ¡VIDA! The Mujer Latina Breast Cancer Conference• Like ¡VIDA! on Facebook• The University of Arizona Cancer Center En Español
 Robert Livingston, MD Robert Livingston, MD, is among the nation's top experts on clinical trials and clinical research. He is lending his 30-plus years of international clinical research experience in breast cancer to a study that may lead to an improved treatment option for women with metastatic breast cancer. Dr. Livingston is among roughly a dozen cancer researchers involved with a cutting-edge study based at the University of California-Irvine, which is evaluating "a combination of two anti-estrogen drugs: anastrozole and fulvestrant." When taken together, early studies show that it can extend the median survival time of women with "Stage 4 hormone receptor-positive metastatic breast cancer by more than six months" compared to those who underwent standard treatment with anastrozole alone. The findings of this study appeared in the Aug. 3 issue of the New England Journal of Medicine.Lead oncologist Rita Mehta, MD, said the results of the Phase 3 trial are particularly exciting because "these patients have not had a new treatment that gave them an overall survival benefit in more than a decade." • Drug combo better for common type of metastatic breast cancer, UCI-led study finds ( EurekAlert, Aug. 1, 2012)
 Everyone knows how important regular exercise is when it comes to maintaining a healthy and happy lifestyle, but some folks find the idea to be a little overwhelming. Perhaps you used to exercise, but fell out of a routine for any number of reasons and you've struggled to get back into the swing of it. Perhaps you find the idea of a gym to be a bit too intimidating. Perhaps you think you don't have enough time in your busy schedule.Recent studies have shown that no exercise at all poses the greatest health risk. Even mild physical activity has numerous health benefits, including a reduction in the risk of breast cancer. Substantial weight gain, on the other hand, will almost certainly negate these benefits. A new analysis done by University of North Carolina at Chapel Hill researchers has found that physical activity - either mild or intense and before or after menopause - may reduce breast cancer risk.
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