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International experts issue plea for better research and education for advanced breast cancer

Breast cancer experts around the world have issued a plea to researchers, academics, drug companies, funders and advocates to carry out high quality research and clinical trials for advanced breast cancer, a disease which is almost always fatal and for which there are many unanswered questions.
 
In the latest international consensus guidelines for the management of advanced breast cancer, published simultaneously in the leading cancer journals The Breast and Annals of Oncology, the experts say that further research and clinical trials are “urgently needed” to find the best treatments for

- patients with breast cancer that has spread to the liver, or the space around the lungs (pleural cavity) or the skin;
- patients with HER2 positive advanced breast cancer who relapse during or shortly after adjuvant treatment with trastuzumab;
- patients with stage IV disease (where the cancer has spread to other parts of the body), regarding whether or not surgery to remove the primary tumour improves survival and quality of life;
- men with advanced breast cancer who need to receive aromatase inhibitors (such as anastrozole, exemestane, letrozole);

In addition, there are a number of other areas in advanced breast cancer that require more and better research and international, multidisciplinary clinical trials. There also needs to be greater effort made to educate health professionals to apply existing knowledge in their treatment of breast cancer patients. 

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Smokers who consume too much sodium at greater risk of developing rheumatoid arthritis

A new study published online in the journal Rheumatology today indicates that the interaction between high sodium intake and smoking is associated with a more than doubled risk of developing rheumatoid arthritis (RA).
 
The study, carried out by Björn Sundström and colleagues from the Department of Public Health and Clinical Medicine, Rheumatology at Umeå University, Sweden, was carried out to see whether recent animal and human cell study results that showed a link between a high sodium intake and RA would yield similar results in a nested case-control study of data from the Västerbotten Intervention Programme (VIP). It focused on 386 individuals who had stated their dietary habits as part of a community intervention programme a median of 7.7 years before the onset of RA symptoms. For comparison, 1886 matched controls were identified from the same database and co-analysed. 

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Sustaining a desire for a child after failed fertility treatment is linked to worse mental health

Women who have difficulty accepting the fact that they can’t have children following unsuccessful fertility treatment have worse long-term mental health than women who are able to let go of their desire for children, according to new research.

The study published online in Human Reproduction, one of the world’s leading reproductive medicine journals, is the first to look at a large group of women (over 7,000) to try to disentangle the different factors that may affect women’s mental health over a decade after unsuccessful fertility treatment. These factors include whether or not they have children, whether they still want children, their diagnosis and their medical treatment.

Dr Sofia Gameiro, the lead author, said: “It was already known that people who have infertility treatment and remain childless have worse mental health than those who do manage to conceive with treatment. However, most previous research assumed that this was due exclusively to having children or not, and did not consider the role of other factors.”

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Latest research shows rates of heart disease and stroke continue to decline in Europe, but more people are hospitalised

Deaths from heart disease and stroke are declining overall in Europe, but at differing rates, according to research published online today (Wednesday) in the European Heart Journal.
 
The research, which provides an update for 2014 on the burden of cardiovascular disease (CVD) in Europe, shows that death rates from cardiovascular disease (diseases of the heart and blood vessels) vary enormously. For some eastern European countries, including Russia and Ukraine, the death rate from coronary heart disease for 55-60 year olds is greater than the equivalent rate in France for people 20 years older.
 
The age adjusted cardiovascular disease (CVD) death rates for men and women of all ages were six-fold higher in Russia than in France. In 2010 in Russia 915 men and 517 women died per 100,000 of the population, whereas the equivalent rates in France were 150 and 87 per 100,000 respectively.
 
In the UK the CVD death rates for 2010 were 205 and 129 per 100,000 men and women respectively.
 
Overall, CVD remains the single, greatest cause of death among Europeans than any other disease, and, in many countries causes twice as many deaths as cancer. However, the researchers, led by Dr Melanie Nichols, a Research Associate from the British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention at the University of Oxford (UK) and senior research fellow at Deakin University, Australia, found there were some countries where cancer was now causing more deaths than heart disease in men (Belgium, Denmark, France, Israel, Luxembourg, The Netherlands, Portugal, Slovenia, Spain and San Marino). For the first time, cancer has also overtaken CVD as the main cause of death among women in a European country: Denmark.
 
Co-author, Dr Nick Townsend, senior researcher at the BHF Centre on Population Approaches for Non-Communicable Disease Prevention, said: “The reason why cancer has overtaken cardiovascular disease as the main cause of death in these countries is due to the fact that fewer people develop cardiovascular disease and, in those who do, fewer die from it. This is probably due to improvements in the behavioural risk factors associated with CVD, such as decreases in the number of people smoking tobacco, along with better treatments, including preventive ones, such as the increasing use of statins. However, increases in some risk factors, such as rising levels of obesity, suggest that these decreasing trends may be in danger of reversing.”
 
Dr Nichols and her colleagues in the Oxford research group looked at trends in deaths from CVD over a period of ten years to the most recent year available, (2010 to 2012 for most countries), for 52 out of 53 European countries (there were no data for Andorra). They looked at the total number of deaths for all ages, and also at those that could be classified as “premature”: those before the age of 65 and those before the age of 75.
 
Data from the latest available year showed that there were just over four million deaths (1.9 million men and 2.2 million women) from CVD, close to half of all deaths in Europe. This was made up of 1.8 million deaths from coronary heart disease, one million from cerebrovascular disease (stroke) and 1.2 million from other cardiovascular diseases.
 
Just under a million men died before the age of 75 and half a million before the age of 65. Half a million women died before the age of 75 and just over 200,000 before the age of 65. Three in every ten deaths of Europeans aged under 65 were caused by CVD, as were 37% of all deaths occurring before the age of 75
 
Dr Townsend said: “The proportion of women who die from cardiovascular disease is much greater than men: 51% of women died compared to 42% of men. This difference is driven mainly by a higher rate of stroke and other cardiovascular diseases among women. There was very little difference in the rates of coronary heart disease between men and women: 20% versus 21% respectively.”
 
Overall, the researchers say that CVD death rates are declining in most, but not all European countries. Trends have also been downwards for what are known as “case fatality rates” – the percentage of people who are diagnosed with a condition and die from the illness within a given period. In the 25 countries for which there were data, there was an average annual reduction in people dying after being admitted to hospital with a heart attack of five per cent in the past five years. On the other hand, the rates of people hospitalised for CVD have increased, probably reflecting the impact of increasing numbers of elderly people in the population.
 
In their paper, the authors conclude: “Worldwide, there have been few moments in history during which NCDs [non-communicable diseases] have enjoyed such a prominent place in the world’s attention, with cardiovascular disease at the forefront of the activity. Despite this, there has been little commitment at the national or regional level to greater monitoring and reporting of risk factors and outcomes for cardiovascular disease. It is clear that in many countries of Europe, CVD mortality has continued to decrease substantially in recent years, and will make a large contribution to achieving this goal. In these (predominantly high income) countries, a ‘tipping point’ is rapidly approaching, when cancer deaths will outnumber cardiovascular disease deaths, particularly among men. In many other countries, however, the CVD burden dwarfs that of cancer, and a large proportion of the populations will lose their lives prematurely to heart disease and stroke.”
 
This study is the authors’ second consecutive report on CVD in Europe, with the previous one being published last year. A total of 18 countries have provided updated mortality data since last year’s report: Belgium, Croatia, Czech Republic, Estonia, France, Germany, Greece, Hungary, Israel, Luxembourg, Norway, Republic of Moldova, Serbia, Spain, Ukraine, Latvia, Armenia, and Denmark.

Fukushima’s Legacy: Biological effects of Fukushima radiation on plants, insects and animals

Following the 1986 Chernobyl nuclear power plant meltdown, biological samples were obtained only after extensive delays, limiting the information that could be gained about the impacts of that historic disaster. Determined not to repeat the shortcomings of the Chernobyl studies, scientists began gathering biological information only a few months after the disastrous meltdown of the Fukushima Daiichi power plant in Japan in 2011. Results of these studies are now beginning to reveal serious biological effects of the Fukushima radiation on non-human organisms ranging from plants to butterflies to birds.

A series of articles summarizing these studies has now been published in the Journal of Heredity. These describe widespread impacts, ranging from population declines to genetic damage to responses by the repair mechanisms that help organisms cope with radiation exposure.

“A growing body of empirical results from studies of birds, monkeys, butterflies, and other insects suggests that some species have been significantly impacted by the radioactive releases related to the Fukushima disaster,” stated Dr. Timothy Mousseau of the University of South Carolina, lead author of one of the studies.

Most importantly, these studies supply a baseline for future research on the effects of ionizing radiation exposure to the environment.

Common to all of the published studies is the hypothesis that chronic (low-dose) exposure to ionizing radiation results in genetic damage and increased mutation rates in reproductive and non-reproductive cells.

One of the studies (Hayashi et al. 2014) documented the effects of radiation on rice by exposing healthy seedlings to low-level gamma radiation at a contaminated site in Fukushima Prefecture. After three days, a number of effects were observed, including activation of genes involved in self-defense, ranging from DNA replication and repair to stress responses to cell death.

“The experimental design employed in this work will provide a new way to test how the entire rice plant genome responds to ionizing radiation under field conditions,” explained Dr. Randeep Rakwal of the University of Tsukuba in Japan, one of the authors of the study.

Another team of researchers (Taira et al. 2014) examined the response of the pale grass blue butterfly, one of the most common butterfly species in Japan, to radiation exposure at the Fukushima site. They found size reduction, slowed growth, high mortality and morphological abnormality both at the Fukushima site and among laboratory-bred butterflies with parents collected from the contaminated site.

Multiple sources of exposure were included in the butterfly study. “Non-contaminated larvae fed leaves from contaminated host plants collected near the reactor showed high rates of abnormality and mortality,” explained Dr. Joji Otaki of the University of the Ryukyus in Okinawa, Japan. Some of their results suggested the possible evolution of radiation resistance in Fukushima butterflies as well.

A review of genetic and ecological studies for a range of other species at both Chernobyl and Fukushima (Mousseau 2014) revealed significant consequences of radiation. Population censuses of birds, butterflies, and cicadas at Fukushima showed major declines attributable to radiation exposure. Morphological effects, such as aberrant feathers on barn swallows, were also observed. The authors suggest that long-term studies at Chernobyl could predict likely effects in the future at the Fukushima site.

All of these studies highlight the need for early and ongoing monitoring at sites of accidental radiation release. “Detailed analyses of genetic impacts to natural populations could provide the information needed to predict recovery times for wild communities at Fukushima as well as any sites of future nuclear accidents,” Mousseau said. “There is an urgent need for greater investment in basic scientific research of the wild animals and plants of Fukushima.”
 
About the American Genetic Association Journal of Heredity: Established in 1903, Journal of Heredity, covers organismal genetics across a wide range of disciplines and taxa. Articles include such rapidly advancing fields as conservation genetics of endangered species, population structure and phylogeography, molecular evolution and speciation, molecular genetics of disease resistance in plants and animals, genomics and bioinformatics.