HEALTH NEWS

It is not consistent to stop screening women after age 50 because the risk of cervical cancer - even after several negative smear results - is similar to that at younger ages, concludes a study published on bmj.com.
Ever since the first organised cervical screening programmes started in Europe more than 40 years ago, discussion about the upper age limit for effective screening has been ongoing.
Evidence suggests that repeating smear tests in women aged 60-65 whose previous tests have been normal has little, if any, benefit, and some researchers have proposed that the age limit should be lowered to 50.
So researchers at the Erasmus Medical Center in The Netherlands and the University of Copenhagen in Denmark compared levels of cervical cancer after several negative smears at different ages.
Using data from a national cervical cancer register in The Netherlands (PALGA), they identified 219,000 women aged 45-54 years and 445,000 women aged 30-44 years after their third consecutive negative smear test. The women were then tracked for 10 years, during which time cases of cervical cancer were recorded.
During follow-up, both age groups had similar levels of screening. After 10 years, the incidence of cervical cancer was similar in both groups (41 per 100,000 in the younger group and 36 per 100,000 in the older group), suggesting that among well-screened women without previous abnormalities the risk of developing cervical cancer is independent of age.
Based on these results, it is reasonable to assume that after several consecutive negative results the screening efficiency in terms of detection and prevention of cervical cancer is at the same level around age 50 as it is at younger ages, say the authors.
Whether the observed incidence rates warrant continued screening should be determined by subsequent analysis, but the study suggests that it would not be consistent to stop screening these women while not also relaxing the screening policy for younger women with similar screening histories.
In this respect, our study lends support to the current cervical cancer screening guidelines in England and other developed countries, which do not discriminate women by age up to 65 years, they conclude.
In an accompanying editorial, Björn Strander, Director of cervical screening at Sahlgren's University Hospital in Sweden, suggests we have to pay close attention to developments in invasive cancer in age groups above the cut-off point for screening and be prepared to adjust the screening ages as we learn more.
With modern computer technology we could tailor screening invitations to the individual, he says. Resources could then be allocated away from women who would not benefit from additional smears within a certain number of years to those who would, and the question of whether to screen above the age of 60 could then be answered - yes, for those who benefit the most from it.

Immigrant women in Ontario are not screened for cervical cancer as often as native-born Canadians, with the lowest rates being among older, poorer South Asians, new research shows.
Only one in five -- 21.9 per cent -- of South Asian immigrants over the age of 50 living in low-income neighbourhoods had had a recent Pap test, according to a study led by doctors at St. Michael's Hospital.
In contrast, 79 per cent of Canadian-born women living in the highest-income neighbourhoods and who had a primary care doctor were up-to-date with their cervical cancer screening. In Canada, federal and provincial guidelines call for a Pap test at least once every three years.
The study compared cervical cancer screening rates for immigrant and Canadian-born women living in urban areas of Ontario between 2006 and 2008. Overall, of the 2.9 million women ages 18 to 69 whose medical billing records were compared, 61.3 per cent were up-to-date.
The study, led by family physician Dr. Aisha Lofters, appeared in a recent edition of the journal Preventative Medicine.
"We need to reach out to the South Asian immigrant community and let them know the importance of the test," said Dr. Lofters, who is with the hospital's Center for Research on Inner City Health.
Dr. Lofters said the low screening rates for poorer, older South Asians may have a lot to do with culture and their experience in their homelands. Cervical cancer screening rates in many South Asian countries are quite low -- only 1 per cent in Bangladesh, even for those in the highest income strata.
"These women may not be coming from a culture where this is normal or practiced protocol," she said. "Some women were not even aware that they needed the test."
The length of time spent in Canada had little effect on a woman's screening rates. Even those who had been living in Canada for 10 or more years had rates similar to those who had recently immigrated, suggesting low patterns continue after immigration. Many of the women may be reluctant to see male doctors, Dr. Lofters said.
Cervical cancer is the second most common cancer among women worldwide. Rates are almost twice as high in the less developed world than the more developed world, where more people have Pap tests. The World Health Organization estimates that 95 per cent of women in less developed countries have never been screened and that screening every 5 to 10 years could significantly reduce deaths worldwide from cervical cancer.

Gynaecological screening tests for cervical cancer have been available to all women in Sweden for almost four decades. Despite this, many immigrant women have a higher risk of developing the disease than Swedish-born women, according to a new study from Karolinska Institutet.
This is particularly the case for women from other Nordic countries and Central America, the differences being linked to, amongst other things, variation in the incidence of the Human Pappiloma Virus (HPV) around the world. HPV is a significant risk factor for cervical cancer.
"But there are other risk factors too, such as smoking, sexual habits and not taking screening tests, which make it interesting to compare cervical cancer rates between different groups of immigrant women in Sweden and native Swedes," says Professor Pär Sparén, who has led the study at the Department of Medical epidemiology and Biostatistics.
The study included more than 750,000 resident immigrant women from different countries, all of whom are registered on Karolinska Institutet’s national database of women’s health. During the period under study (1968 to 2004) there were 1,991 cases of cervical cancer in this group. Compared with Swedish-born women in general, this represents a slightly higher risk of developing the disease (10 per cent). Also, the incidence proportion of cervical cancer amongst women who had immigrated to Sweden was lower than amongst women in their respective countries.
However, the study also shows wide variation between the immigrant groups. Women from east Africa generally were five times less likely to develop cervical cancer than Swedish-born women, while women from southern Asia were half as likely. Conversely, the risk was much higher for women from Norway and Denmark (70 per cent and 80 per cent, respectively) and Central America (150 per cent).
Professor Sparén’s team also observed that the risk of cervical cancer increased with the age of entry into Sweden, but declined during their period of residency in their new homeland. Professor Sparén believes that his findings are important for the more effective prevention of cervical cancer through, for example, targeted screening programmes.
"We need to introduce targeted screening for the prevention of cervical cancer amongst high-risk groups, particularly women over 50 during their first ten years in Sweden," he says.
The study, which was funded with a grant from the Swedish Council for Working Life and Social Research (FAS) and the National Health Care Sciences Postgraduate School at Karolinska Institutet, was a joint project with Tehran University of Medical Sciences in Iran and Mälardalen University.

Immigrant women in Ontario are not screened for cervical cancer as often as native-born Canadians, with the lowest rates being among older, poorer South Asians, new research shows.Only one in five -- 21.9 per cent -- of South Asian immigrants over the age of 50 living in low-income neighbourhoods had had a recent Pap test, according to a study led by doctors at St. Michael's Hospital.
In contrast, 79 per cent of Canadian-born women living in the highest-income neighbourhoods and who had a primary care doctor were up-to-date with their cervical cancer screening. In Canada, federal and provincial guidelines call for a Pap test at least once every three years.
The study compared cervical cancer screening rates for immigrant and Canadian-born women living in urban areas of Ontario between 2006 and 2008. Overall, of the 2.9 million women ages 18 to 69 whose medical billing records were compared, 61.3 per cent were up-to-date.
The study, led by family physician Dr. Aisha Lofters, appeared in a recent edition of the journal Preventative Medicine.
"We need to reach out to the South Asian immigrant community and let them know the importance of the test," said Dr. Lofters, who is with the hospital's Center for Research on Inner City Health.
Dr. Lofters said the low screening rates for poorer, older South Asians may have a lot to do with culture and their experience in their homelands. Cervical cancer screening rates in many South Asian countries are quite low -- only 1 per cent in Bangladesh, even for those in the highest income strata.
"These women may not be coming from a culture where this is normal or practiced protocol," she said. "Some women were not even aware that they needed the test."
The length of time spent in Canada had little effect on a woman's screening rates. Even those who had been living in Canada for 10 or more years had rates similar to those who had recently immigrated, suggesting low patterns continue after immigration. Many of the women may be reluctant to see male doctors, Dr. Lofters said.
Cervical cancer is the second most common cancer among women worldwide. Rates are almost twice as high in the less developed world than the more developed world, where more people have Pap tests. The World Health Organization estimates that 95 per cent of women in less developed countries have never been screened and that screening every 5 to 10 years could significantly reduce deaths worldwide from cervical cancer.

Scientists at the Kimmel Cancer Center at Thomas Jefferson University in Philadelphia have made a key discovery about the mechanism of breast cancer metastasis, the process by which cancer spreads. Focusing on a gene dubbed "Dachshund," or DACH1, they are beginning to pinpoint new therapeutic targets to halt the spread of cancer.
Reporting their findings in the Proceedings of the National Academy of Sciences, researchers led by Richard Pestell, M.D., Ph.D., director of the Kimmel Cancer Center at Jefferson and professor and chair of Cancer Biology at Jefferson Medical College, showed that breast cancer cells secrete a common inflammatory protein, IL-8. When the scientists blocked the protein in mice with an antibody, they found that it completely halted the spread of breast cancer to the lungs.
In addition, the team found that the DACH1 gene normally blocks the production of IL-8.
DACH1 is frequently lost or inactive in invasive breast cancer and can prevent the migration and invasion of breast cancer cells. The finding suggests that IL-8 is a potential target for new therapies to block breast cancer spread.
"This is a very important study by Dr. Pestell and his colleagues that demonstrates that the protein dachshund blocks metastasis in a mouse model and that this occurs through reduced production of the chemokine IL-8," says Max Wicha, M.D., director of the University of Michigan Comprehensive Cancer Center in Ann Arbor. "Interestingly reduced dachshund and increased IL-8 are associated with aggressive metastatic breast cancer in women. Our laboratory has found that IL-8 regulates breast cancer stem cells and that these cells mediate metastasis. Dr Pestell's work suggests that dachshund is a key regulator of this process."
DACH1 normally regulates eye development and development of other tissues, playing a role in determining the fate of some types of cells. In previous work, Dr. Pestell and his co-workers showed that DACH1 can commandeer cancer-causing genes and return them to normal. The team found evidence from more than 2,000 breast cancer patients that the more the gene is expressed in breast cancer, the better the patient did, enabling it to predict an individual's prognosis.
Because the researchers knew that DACH1 is lost in such invasive breast cancers that carry poor prognoses, they investigated its potential role in the cancer cells' ability to migrate and invade, the prelude to metastasis. They focused on its effects on cancer-causing oncogenes, such as Ras and Myc.
In a series of experiments, the scientists, led by Dr. Pestell and first author Kongming Wu, Ph.D., assistant professor of Cancer Biology at Jefferson Medical College, looked at the effects of adding DACH1 to breast cells made cancerous by various oncogenes. When they added DACH1 to Ras-induced breast cancer cells, for example, they saw a greater than 75 percent reduction in cell migration. Cells turned cancerous by the oncogene ErbB2 showed a 50 percent drop in migration. Cells made cancerous by Myc also had 50 percent less migration.
The researchers performed a proteomic analysis, testing the expression of many proteins at once to see which might be regulated by DACH1. They found that IL-8 is a critical target of DACH1 that helps regulate breast cancer cell migration and metastasis. In mouse studies, they showed that DACH1 lowered the levels of IL-8 genetic material (mRNA) by approximately 90 percent in cancers caused by Ras.
According to Dr. Wu, the gene for IL-8 is also a known target of Ras, helping recruit the formation of new blood vessels to feed a developing cancer -- a process called angiogenesis. He notes that it's well known that tumors with high levels of IL-8 have a poorer clinical prognosis.
"The findings suggest an important role for IL-8 in blocking the progression of cancer and metastasis," says Dr. Wu. "Because IL-8 is a commonly found protein, it's possible to use this to block metastasis, perhaps eventually as a target for gene therapy."

Scientists at the Kimmel Cancer Center at Thomas Jefferson University in Philadelphia have shown that the activity of a gene that commandeers other cancer-causing genes, returning them to normal, can predict the prognosis of an individual with breast cancer.
The gene, Dachshund, normally regulates eye development and development of other tissues, in essence playing a role in determining the fate of some types of cells. Richard Pestell, M.D., Ph.D., director of the Kimmel Cancer Center at Jefferson and professor and chair of cancer biology at Jefferson Medical College, and co-workers looked at cancer cells from more than 2,000 breast cancer patients and found that this commandeering or "organizing" ability is increasingly lost in cancer cells and associated with the progression of disease. The more the gene is expressed in breast cancer, the researchers saw, the better the patient did. The scientists report their findings in October in the journal Molecular and Cellular Biology.
"This is a new type of gene in cancer that commandeers the cancerous genes and returns them to normal," says Dr. Pestell. "The standard cancer treatment strategy has been to block the proliferation of cancer cells or cause them to die. This is quite different. We've shown that the Dachshund gene reverts the cancerous phenotype and turns the cell back to a pre-malignant state. Cells don't die, but rather, they revert.
"It's a bad prognostic feature if you lose this organizer gene," he says, adding that it could be used as a prognostic marker for breast cancer.
In the work, the researchers showed that Dachshund could block breast cancer growth in mice and also could halt breast cancer from invading other tissues in cell culture. They also found that the gene inhibits the expression of the cyclin D1 gene, a cancer-causing gene that is overexpressed in about half of all breast cancers.
The group used microarray technology -- silicon chips containing ordered selections of genetic material upon which sample material can be tested -- to analyze Dachshund expression during the development of breast cancer. The scientists compared normal breast cells, pre-cancerous "in situ" cells and more than 2,100 breast cancer cell samples. Dachshund gene expression was "significantly reduced" in breast cancer.
The average survival was almost 40 months better in women in whom their breast cancer continued to express Dachshund.
Dr. Pestell notes that the expression of Dachshund correlates with tumor size, stage and metastasis, with its expression greatly reduced in metastatic breast cancer cells. Dr. Pestell's team is examining other cell fate-determining genes in an attempt to identify new therapeutics for breast cancer and metastasis.

A new study sheds light on why individuals who inherit a particular family of mutations have a high risk of developing a very aggressive form of breast cancer. The research, published by Cell Press on February 4th in the journal Cell Stem Cell, shows that breast tissue cells from these individuals make abnormal cell-fate decisions even before cancer develops and provides exciting new insights into the mechanisms behind one of the most lethal types of breast cancer.
There are many forms of human breast cancer. Mutations in the BRCA1 tumor suppressor gene are associated with the development of the "basal-like" subtype of breast cancer which exhibits a very poor prognosis. "Recent evidence has indicated that BRCA1 might regulate breast cell differentiation," explains senior study author Dr. Charlotte Kuperwasser, Associate Professor in anatomy and cellular biology from Tufts University School of Medicine and member of the Sackler School of Graduate Biomedical Sciences at Tufts. "We wanted to examine whether BRCA1's role in differentiation was associated with the increased development of basal-like breast cancer."
Dr. Kuperwasser's group examined disease-free breast tissues from patients with normal or mutant BRCA1 genes. Using an ingenious strategy that allowed them to mimic the environment of intact human breast tissue, they transplanted the human cells into mice and looked at the types of tumors that formed after the cells were exposed to additional cancer-promoting signals. Although the cells with normal BRCA1 grew into different kinds of breast cancer, the cells from women with BRCA1 mutations mostly formed the aggressive basal-like tumors. Importantly, molecular analysis of disease-free breast cells with mutated BRCA1 revealed that even before tumors developed, the mutant cells were more likely to remain immature and contain elevated levels of a protein called Slug. The researchers showed that when Slug is present in the breast, cells are unable to undergo proper maturation and are stalled in a premature state of development. This premature state of development is subsequently retained in basal-like breast cancers.
These findings show that BRCA1 mutations significantly impact breast cell maturation even before the patients manifest an increased risk for breast cancer. In a sense, the BRCA1 mutation "stacks the deck" towards a basal-like tumor phenotype by biasing differentiation towards this state. "Future studies will be necessary to fully dissect the precise domains and mechanisms by which BRCA1 regulates breast epithelial differentiation," concludes Dr. Kuperwasser. "In addition, further experiments will be needed to determine whether certain mutations in BRCA1 affect differentiation and regulate cell fate differently and whether different mutations alter the propensity for the development of basal-like tumors."

Gliomas are among the most common and most malignant brain tumors. These tumors infiltrate normal brain tissue and grow very rapidly. As a result, surgery can never completely remove the tumor.
Now, the neurosurgeons Dr. Darko S. Markovic (Helios Klinikum Berlin-Buch) and Dr. Michael Synowitz (Charité) as well as Dr. Rainer Glass and Professor Helmut Kettenmann (both Max Delbrück Center for Molecular Medicine, MDC, Berlin-Buch), have been able to show that glioma cells exploit microglia, the immune cells of the brain, for their expansion.
Microglial cells are the immune cells of the brain/central nervous system. They constantly screen the brain environment. On their surface they use sensors to detect changes in their environment due to brain damage or infections. An important family of these sensors are Toll-like receptors (TLR).
However, microglia do not attack glioma cells. On the contrary: they support the growth of the tumor and, thus, make the disease worse. Together with researchers in Warsaw, Poland, Amsterdam, The Netherlands, and Bethesda, USA, the researchers in Berlin have been able to show how the immune cells promote the tumor growth.
Microglial cells are attracted toward the glioma cells and gather in and around the tumor in large numbers. Interestingly, gliomas consist of up to 30 per cent of microglia, especially at the tumor edge.
Gliomas release certain enzymes, metalloproteases, which digest the extracellular matrix, and also dissolve the ties between cells. However, the metalloproteases are produced and released as inactive precursor protein which need to be cleaved to be activated. This cleavage is accomplished by another enzyme, which is produced by the microglial cells.
This enzyme is anchored in the membrane and was therefore named membrane type 1 metalloprotease (MT1-MMP). MT1-MMP activates the metalloproteases which clear the way for the glioma cells and allows them to infiltrate normal brain tissue and expand very rapidly.
Normally, microglial cells do not produce MT1-MMP. However, the glioma cells manipulate the microglial cells by stimulating microglial TLR which trigger the expression of MT1-MMP.
The researchers could confirm their data from petri dish in mice. "Those mice, in which we had knocked out the MT1-MMP gene or a crucial gene for TLR signalling, did attract fewer microglial cells and the tumor grew much more slowly", explains Professor Kettenmann.
They could also demonstrate that MT1-MMP was present in tissue from glioma patients. Remarkably, the gliomas with high level of microglial MT1-MMP were also more aggressive. Moreover microglial cells were more abundant in tissue sample from the tumor edge as compared to the center of the tumor.
Glioma cells themselves do not produce MT1-MMP. However, when the researchers experimentally over expressed MT1-MMP in glioma cells, they died.
The researchers hope, that interfering with TLR receptors or their intracellular pathways might reduce the rapid expansion of glioma cells. Professor Kettenmann: "Microglia are a new target for glioma researchers."

Glioma is the most common and most serious form of brain tumors that affect adults. It has not yet been determined which specific type of cell in the brain is the source of the tumor, but now a research team at Uppsala University can show that glioma can start from immature support cells. The findings are published in the scientific journal Oncogene.
In recent years it has been discussed more and more often that it is neural stem cells in the brain that are transmuted into cancer cells and can then develop into glioma.
“But our results show that immature support cells can function as the source cells for the tumor. We can thus establish that it does not have to be stem cells that cause glioma,” says Nanna Lindberg, a doctoral candidate at the Department of Genetics and Pathology, who is carrying out the study.
She says that patients with malignant glioma often die within a year of being diagnosed, since the tumor cells rapidly infiltrate normal brain tissue and are difficult to treat. It is also common for the tumor to recur after treatment. With a better understanding of the genesis and growth of brain tumors, researchers will be able to identify new targets for treatment and ultimately will enhance the chances of survival.
To study tumors, various models are used, often animal models where the tumor both looks and behaves as it would in a human. In the present study a model is described that Nanna Lindberg created together with Associate Professor Lene Uhrbom and is used specifically for studying how glioma arises in a certain type of support cells. In this model tumors are formed that in many ways are similar to glioma in humans.
“Combining knowledge from other models where tumors arise from other cell types, with our model we can examine how the source cell affects the genesis and growth of the tumor. We can also compare how tumors of various origin differ from each other,” says Nanna Lindberg, adding that the model can later be used for preclinical treatment studies.

Rice University bioengineers and physician-scientists at Baylor College of Medicine and Texas Children's Hospital have successfully destroyed tumors of human brain cancer cells in the first animal tests of a minimally invasive treatment that zaps glioma tumors with heat. The tests involved nanoshells, light-activated nanoparticles that are designed to destroy tumors with heat and avoid the unwanted side effects of drug and radiation therapies.The results of the new study are available online in the Journal of Neuro-Oncology. The researchers reported that more than half of the animals that received the nanoshell treatment for glioma tumors had no signs of cancer more than three months after treatment.
"This first round of in vivo animal tests suggests that photothermal therapy with nanoshells may one day be a viable option for glioma patients," said study co-author Jennifer West, the Isabel C. Cameron Professor of Bioengineering at Rice and chair of Rice's Department of Bioengineering. West cautioned that follow-up work in the laboratory is needed before any human testing of the therapy can begin. She said human clinical trials of nanoshell phototherapy for glioma are likely at least a year away.
Glioma is among the most aggressive and difficult-to-treat of all brain cancers. Fewer than five percent of glioma patients survive beyond five years. The disease is particularly difficult to treat because glioma tumors are often highly invasive and inoperable.
Study co-authors include pediatric oncologist Susan Blaney, deputy director of Texas Children's Cancer Center and Baylor College of Medicine professor and vice chair for research in the department of pediatrics, and Rebekah Drezek, professor in bioengineering at Rice. West, Blaney, Drezek and colleagues tested mice with abdominal tumors of human glioma cells. The researchers injected the mice with nanoshells and waited 24 hours for the nanoparticles to accumulate in the tumors. A laser of near-infrared light -- which is harmless to healthy tissue -- was shined at the tumor for three minutes. The nanoshells converted the laser light into tumor-killing heat. All seven animals that received the nanoshell treatment responded, but cancer returned in three. The other four remained cancer-free 90 days after treatment.
"The results of this study are encouraging, and we are cautiously optimistic that this process may bring us closer to finding a cure for glioma," said Blaney, also associate director for clinical research at Baylor College of Medicine's Dan L. Duncan Cancer Center and co-director of The Institute for Clinical and Translational Research. "This is very exciting, especially given the poor prognosis of the disease and the importance of finding brain tumor treatment alternatives that have minimal side effects."
Gold nanoshells, which were invented by Rice researcher Naomi Halas in the mid-1990s, are smaller than red blood cells. Nanoshells are like tiny malted milk balls that are coated with gold rather than chocolate. Their core is nonconducting, and by varying the size of the core and thickness of the shell, researchers can tune them to respond to different wavelengths of light.
Houston-based biomedical firm Nanospectra Biosciences, which holds the license for medical use of Rice's nanoshell technology, began the first human clinical trial of nanoshell phototherapy in 2008.
West, a co-founder and director of Nanospectra Biosciences, said the new glioma study is part of a larger ongoing effort within the Texas Medical Center to adapt nanoshell phototherapy for use against a variety of cancers. Researchers at Rice, Texas Children's Hospital, M.D. Anderson Cancer Center, Baylor College of Medicine and other institutions are working to develop nanoshell-based treatments for prostate cancer and pancreatic cancer.
The glioma study was funded by the National Science Foundation, the National Institutes of Health and Hope Street Kids.

Patients with lung cancer that has spread to mediastinal lymph nodes -- located between the chest, breastbone and spine -- who receive radiation after surgery and chemotherapy live twice as long as patients who do not receive radiation after surgery, according to a study presented at the plenary session November 6, 2006, at the American Society for Therapeutic Radiology and Oncology's 48th Annual Meeting in Philadelphia.
The study was part of a larger randomized study, ANITA 1, which examined the effectiveness of chemotherapy after surgery in 840 non-small cell lung cancer patients and found that additional chemotherapy after surgery improves overall survival in cancer that has spread to the lymph nodes. In this study, radiation was not randomized nor mandatory but only recommended for patients whose disease had spread to the lymph nodes. 232 lung cancer patients received radiation after undergoing surgery to remove their tumor with or without chemotherapy.
Researchers found that additional radiation after chemotherapy benefited patients whose cancer had spread to mediastinal lymph nodes. At that stage, those who underwent chemotherapy and radiation after surgery lived almost two years longer (47 versus 24 months) than those patients who had only chemotherapy after surgery.
"This is the first time that a clinical trial has examined the effectiveness of radiation after surgery for lung cancer," said Jean-Yves Douillard, M.D., Ph.D., lead author of the study and a medical oncologist at the Centre Rene Gauducheau in St Herblain, France. "The results show that radiation treatment should be considered for resected non-small cell lung cancer with involved mediastinal lymph nodes in addition to chemotherapy. The data observed in this study, however, needs to be confirmed in a prospective randomized trial of radiation, in addition to chemotherapy."

Cancer scientists have designed the first molecular test to predict which bladder cancer patients may have cancer involvement in their lymph nodes at the time of surgery -- which could help doctors determine which patients are good candidates for pre-surgical, or neo-adjuvant, chemotherapy.The test analyzes 20 genes on tumor biopsies, according to a paper published online Jan. 20, 2011, in Lancet Oncology.
"Randomized clinical trials have shown that giving neo-adjuvant chemotherapy extends patient lives, but only 5 to 15 percent of patients benefit," says urologic surgeon Dan Theodorescu, MD, PhD, director of the University of Colorado Cancer Center and lead author of the study. "Patients who have cancer in the lymph nodes at time of diagnosis are likely to benefit the most."
The study analyzed patient tumor samples from the United States, Canada and Germany. It was funded by the National Cancer Institute.
"Today, only about 2 percent of people with invasive bladder cancer have pre-surgical chemotherapy because it's quite difficult to get through and there is fear of delaying surgery," Theodorescu says. "We need a better way to predict who will benefit, and that's what this test does by identifying patients with a high likelihood of lymph node involvement before surgery."
By the time a third of people are diagnosed, bladder cancer has invaded from the bladder lining into the bladder muscle. Gold-standard treatment includes surgical removal of the bladder and the surrounding lymph nodes; some people also undergo radiation treatment. Even with these treatments, the cancer will recur and spread in about half the people -- which is almost always fatal.
Bladder cancer is diagnosed during a procedure called a transurethral resection -- essentially a biopsy of the bladder. Using the new test, pathologists can determine the levels for the 20 genes in the diagnostic tissue sample and indicate whether the patient has cancer in the lymph nodes.
"We validated the test's ability to predict lymph node spread of the cancer in a large sample of patients from a randomized trial," said Theodorescu. "The predictive ability held up. If this new test is used to guide neo-adjuvant chemotherapy, we hope it will both help people with positive nodes live longer and keep people with negative nodes from being overtreated."
A clinical trial of using the test as a treatment guide is being planned.
Incidence of bladder cancer is increasing in the United States, with about 70,530 new cases diagnosed in 2010 according to the American Cancer Society. About 500,000 people are bladder cancer survivors today. Bladder cancer is the fourth most common cancer diagnosed in American men, who are three times more likely to be diagnosed with the disease than women.

Insulin-like growth factor-I (IGF-I) is upregulated in human pancreatic cancer tissues but is not expressed in surrounding non-cancerous tissues. Serum level of IGF-I is elevated in pancreatic cancer patients. Histological analysis has shown that IGF-I receptor (IGF-IR) is positive in the membrane of pancreatic cancer tissues.
These facts suggest that IGF-I acts as a growth factor for pancreatic cancer and inhibition of its action might be a good candidate for molecular therapy of pancreatic cancer. A possible problem is that not all pancreatic cancers produce IGF-I, which might be a reason for ineffective results of its clinical application.
A research team from Japan have proved that inhibition of IGF-IR activity results in a decrease in proliferation and motility of pancreatic cancer cell lines. Their study will be published on April 21, 2010 in the World Journal of Gastroenterology.
Their study indicated that IGF-IR was expressed and played a role in proliferation and motility of pancreatic cancer cell lines. Further analysis of this phenomenon could unveil a new role for a growth factor receptor and its downstream pathway in cancer. One possible mechanism would be that the downstream pathway stimulates its upstream receptor via some unknown molecule, like a retrograde flow.

MIT cancer biologists have identified a subpopulation of cells that can give rise to pancreatic cancer. They also found that tumors can form in other, more mature pancreatic cell types, but only when they are injured or inflamed, suggesting that pancreatic cancer can arise from different types of cells depending on the circumstances.
There are few good treatment options for pancreatic cancer, which kills an estimated 35,000 Americans per year -- making it the country's fourth-leading cause of cancer death. Learning more about the origins of pancreatic cancer cells could help scientists develop better treatments and tools for early diagnosis.
"By the time pancreatic disease is typically diagnosed, it's already very advanced and non-curable. Our new findings can help scientists focus their drug development efforts and lead them to new ways to detect the disease in early stages," says Sharon Friedlander, a postdoctoral associate at MIT's David H. Koch Institute for Integrative Cancer Research and lead author of a paper describing the work in the Nov. 3 issue of Cancer Cell.
The team found that in mice, tumors originate from a subpopulation of pancreatic cells that express a protein called pdx1. This protein plays a critical role in pancreas development and differentiation, a process of specialization that normally occurs during embryonic development but can also occur later in life. This suggests that under normal conditions, pancreatic cancer may arise from a type of adult stem cell that can differentiate into mature pancreatic cells, says Friedlander.
When the cancer-promoting gene K-ras, commonly activated in tumors, was turned on in the pdx1-expressing cells, they became cancerous. However, mature pancreatic cells, such as insulin-secreting cells, became cancerous only when they expressed K-ras and also suffered from chronic inflammation. Under these conditions, the insulin-secreting cells became another cell type, a condition that appears necessary before they can initiate pancreatic cancer.In future studies, the MIT researchers plan to use their mouse models to follow the molecular events that take place during pancreatic cancer development and identify potential targets for drug treatments and protein markers for early diagnosis. These new mouse models could also help researchers test potential pancreatic cancer treatments.

Scientists at Johns Hopkins have deciphered the genetic code for a type of pancreatic cancer, called neuroendocrine or islet cell tumors. The work, described online in the Jan. 20 issue of Science Express, shows that patients whose tumors have certain coding "mistakes" live twice as long as those without them.
"One of the most significant things we learned is that each patient with this kind of rare cancer has a unique genetic code that predicts how aggressive the disease is and how sensitive it is to specific treatments," says Nickolas Papadopoulos, Ph.D., associate professor at the Johns Hopkins Kimmel Cancer Center and director of translational genetics at Hopkins' Ludwig Center. "What this tells us is that it may be more useful to classify cancers by gene type rather than only by organ or cell type."
Pancreatic neuroendocrine cancers account for about five percent of all pancreatic cancers. Some of these tumors produce hormones that have noticeable effects on the body, including variations in blood sugar levels, weight gain, and skin rashes while others have no such hormone "signal."
In contrast, hormone-free tumors grow silently in the pancreas, and "many are difficult to distinguish from other pancreatic cancer types," according to Ralph Hruban, M.D., professor of pathology and oncology, and director of the Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins.
For the new study, the team investigated non-hormonal pancreatic neuroendocrine tumors in 68 men and women. Patients whose tumors had mutations in three genes -- MEN-1, DAXX and ATRX -- lived at least 10 years after diagnosis, while more than 60 percent of patients whose tumors lacked these mutations died within five years of diagnosis.
The Johns Hopkins team, which previously mapped six other cancer types, used automated tools to create a genetic "map" that provides clues to how tumors develop, grow and spread.
Within the code are individual chemicals called nucleotides, which pair together in a pre-programmed fashion to build DNA and, in turn, a genome. Combinations of these nucleotide letters form genes, which provide instructions that guide cell activity. Changes in the nucleotide pairs, called mutations, can create coding errors that transform a normal cell into a cancerous one.
In the first set of experiments, the Johns Hopkins scientists sequenced nearly all protein-encoding genes in 10 of the 68 samples of pancreatic neuroendocrine tumors and compared these sequences with normal DNA from each patient to identify tumor-specific changes or mutations.
In another set of experiments, the investigators searched through the remaining 58 pancreatic neuroendocrine tumors to determine how often these mutated genes appeared.
The most prevalent mutation, in the MEN-1 gene, occurred in more than 44 percent of all 68 tumors. MEN-1, which has been previously linked to many cancers, creates proteins that regulate how long strands of DNA are twisted and shaped into dense packets that open and close depending on when genes need to be activated. Such a process is regulated by proteins and chemicals that operate outside of genes, termed "epigenetic" by scientists.
Two other commonly mutated genes, DAXX and ATRX, which had not previously been linked to cancer, also have epigenetic effects on how DNA is read. Of the samples studied, mutations in DAXX and ATRX were found in 25 percent and 17.6 percent, respectively. The proteins made by these two genes interact with specific portions of DNA to alter how its chemical letters are read.
"To effectively detect and kill cancers, it may be important to develop new diagnostics and therapeutics that take aim at both epigenetic and genetic processes," says Kenneth Kinzler, Ph.D., professor of oncology at the Johns Hopkins Kimmel Cancer Center and co-director of the Ludwig Center at Johns Hopkins.
The Johns Hopkins team also found that 14 percent of the samples studied contained mutations in a gene family called mTOR, which regulates cell signaling processes. Papadopoulos says that patients with tumors containing such alterations in the mTOR pathway could be candidates for treatment with mTOR inhibitor drugs.
"This is a great example of the potential for personalized cancer therapy," says Hruban. "Patients who are most likely to benefit from a drug can be identified and treated, while patients whose tumors lack changes in the mTOR pathway could be spared the side effects of drugs that may not be effective in their tumors."
Papadopoulos, Kinzler, and co-authors Bert Vogelstein, Luis Diaz, and Victor Velculescu are co-founders and members of the scientific advisory board of Inostics, a company that is developing technologies for the molecular diagnosis of cancer. They own Inostics stock, which is subject to certain restrictions under the Johns Hopkins University's conflict of interest policy. Kinzler, Vogelstein and Velculescu are entitled to shares of any royalties received by the University on sales of products related to genes described in this manuscript.
Major funding for the study was provided by the Caring for Carcinoid Foundation, a nonprofit foundation which funds research on carcinoid cancer, pancreatic neuroendocrine cancer, and related neuroendocrine cancers. Additional funding was from the Lustgarten Foundation for Pancreatic Cancer Research, the Sol Goldman Pancreatic Cancer Research Center, the Joseph Rabinowitz Fund for Pancreatic Cancer Research, the Virginia and D.K. Ludwig Fund for Cancer Research, the Raymond and Beverly Sackler Research Foundation, the AACR Stand Up to Cancer's Dream Team Translational Cancer Research Grant and the National Institutes of Health.

For many young adults, the serious health consequences of tanning have been shown to have little impact on their behavior when it comes to sun exposure. But with spring break around the corner, dermatologists are urging people -- particularly young adults -- to practice proper sun protection and understand the importance of early detection of skin cancer, the most common type of cancer.
Speaking February 4 at the 69th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Brett M. Coldiron, MD, FAAD, clinical associate professor of dermatology at the University of Cincinnati in Cincinnati, Ohio, presented new statistics pointing to an increase in non-melanoma skin cancer and why young people are at an increased risk of developing this disease.
Dr. Coldiron reported that in a recent analysis of Medicare claims, data showed that treatment performed for non-melanoma skin cancers in the United States nearly doubled from 1994 to 2006. Specifically, the total number of new non-melanoma skin cancers in 2006 was estimated to be more than 3.5 million.
"While the American Cancer Society estimates more than 2 million new skin cancers will be diagnosed this year, our research shows that the annual incidence in 2008 could actually have been 3.7 million," said Dr. Coldiron. "This is especially troubling as our estimate only includes Medicare patients, which means this could be even higher when young people are included in the count."
While both basal cell and squamous cell carcinomas can be easily treated if detected early, Dr. Coldiron noted that the long-established culture of tanning for the sake of vanity often includes annual spring break vacations to sunny climates that glamorize tanning. The fact is that ultraviolet (UV) light exposure (both natural and artificial) has been proven to be the most preventable risk factor for skin cancer.
"As dermatologists, we know that it is hard to change behavior, even in the face of proven scientific evidence," said Dr. Coldiron. "Attitudes about tanning are no different, as studies have shown that even though people know that overexposure to ultraviolet light can lead to skin cancer, they still tan. We need young people to realize that tanning for cosmetic reasons now will ultimately negatively affect their appearance later and even increase their risk for skin cancer."
To minimize your risk of skin cancer, the Academy recommends that everyone Be Sun Smart®:

• Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. "Broad-spectrum" provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply every two hours, even on cloudy days, and after swimming or sweating.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
• Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.
• Protect children from sun exposure by playing in the shade, wearing protective clothing, and applying sunscreen.
• Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.
• Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a UV-free self-tanning product, but continue to use sunscreen with it.
• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

ScienceDaily (Feb. 5, 2011) — An unexpected immune protein exacerbates cancer due to sun exposure, report researchers in the January 27th issue of Nature. The study suggests that drugs blocking the protein might halt tumor growth in skin cancer patients.
Cutaneous melanoma, an aggressive form of skin cancer, appears to be on the rise. And mortality rates from this difficult-to-treat disease are some of the highest in cancer. Severe sunburns at an early age raise a person's risk of cutaneous melanoma, but the way in which those burns lead to cancer has remained elusive.
In order to discover new ways of treating melanoma, Edward De Fabo, a research professor of in the department of Microbiology, Immunology, and Tropical Medicine at George Washington University Medical Center in Washington, D.C. and a co-corresponding author on the current paper, has been examining the pathway between ultraviolet (UV) rays and melanoma for over a decade. "We ultimately want to figure out what goes wrong so that we can fix it," De Fabo says.
In 2004, he and his collaborators confirmed suspicions that UV-B radiation, as opposed to UV-A, triggered melanoma. And in the current Nature study, they find that UV-B causes white blood cells called macrophages to migrate higher in the skin of mice and release an immune protein, interferon-ÿ. Instead of protecting the body like most interferon proteins do, interferon-ÿ allowed tumors to grow by preventing the body's natural immune response.
"We didn't expect to see interferon-ÿ aiding the tumor, instead of killing cancerous cells," De Fabo says. Interferons, named for the way they interfere with viruses, are traditionally thought to fight tumors. In fact, skin cancer is occasionally treated with another type of interferon, interferon-ÿ, but with limited success.
In exposing an unforeseen dark-side of these immune proteins, the report points to a new direction in drug development. Blocking interferon-ÿ prevented melanoma cancerous skin cells from growing into tumors in mice. A drug that intercepts interferon-ÿ, or its effects, might therefore be used to treat melanoma patients. Indeed, the team found that 70% of cancerous cells from melanoma patients contained high levels of the interferon-ÿ protein.
De Fabo and his colleagues made their discovery thanks to a new set of tools, which will aid melanoma researchers for years to come.
At George Washington University, De Fabo developed a high-tech UV radiation device able to shine a precise UV-A or UV-B beam onto several mice simultaneously. Meanwhile, Glenn Marino at the National Cancer Institute in Bethesda, Maryland collaborated with GW researcher Frances Noonan, to engineer mice that could develop the type of melanoma people have, in which cancerous skin cells, or melanoctes, occur near the epidermis. Together, with Raza Zaidi from Merlino's lab, the team made melanocytes glow by labeling them with a green fluorescent protein, so that the hidden cells could be readily extracted from the mice for further experimentation. De Fabo and Noonan's work was supported in part by the National Cancer Institute at the U.S. National Institutes for Health and the Melanoma Research Foundation.
"One real highlight of this study is our unique methodology, both in UV radiation technology and the creation of a mouse melanoma model that resulted from a really neat collaboration," De Fabo says. "These wonderful tools will help melanocyte biology --and hence melanoma studies -- hugely."

Listed here are cancer support services offered by Boulder Community Hospital and other community groups. We encourage you to explore these groups and agencies to find those that best suit your particular needs and preferences.
Some of these services are free, while others are offered on a fee basis. Please be sure to ask if there is a charge at the time you inquire about a service.

SUPPORT GROUPS AVAILABLE IN THE BROADER COMMUNITY
These groups are not overseen by RMCC or BCH, therefore please contact the facilitator listed to reconfirm meeting times, locations, and whether or not the group would be a good fit for you.

Breast Cancer Self Help Group (Longmont)
Meets once per month at First Evangelical Lutheran Church, Fireside Room, 803 3rd Ave (3rd and Terry), Longmont CO. 
For information call Barb: 303.651.3229

Head and Neck Cancer (Denver)
Support group for survivors of head and neck cancers and their families. 
Meets last Tuesdays of the month from 6:30-8pm at Porter Adventist Cancer Care Center, Denver. 
Please contact Jeanny Curry, RN MN prior to attending the group: 303.778.5832

Ovarian Cancer - "Nicki's Circle" (Denver/Lafayette)
Ovarian cancer support groups offered at three locations:
1st Mondays, 11:30-1 at St. John's Cathedral in central Denver
3rd Wednesdays, 6:15-7:45pm at Swedish Medical Center in south Denver
4th Mondays, 11:30-1pm at Good Samaritan Medical Center in Lafayette
Please contact Susan Hess, MA LPC prior to attending the group: 303.246.5162
More information available at: www.colo-ovariancancer.org

Prostate Cancer - Man to Man Education and Support Group (Boulder)
Meets 6:00-8:00pm on the 4th Monday of every month.
Gene Wilson Conference Room, BCH Broadway Campus, 1155 Alpine Ave, Boulder
sponsored by the American Cancer Society
For information call Rick Powers: 303.442.5679

General Cancer - "Ani's Hope" (Boulder)
General drop-in support group for men and women affected by any type or stage of cancer.
Meets Wednesdays 9:30-11:00am at the Atonement Lutheran Church, 685 Inca Pkwy, Boulder
Facilitator: Joe Gillan, MA LPC
For information call: 720.270.1505

General Cancer Support Group (Longmont)
Support group for patients, family members, supporters.
Meets every Wednesday 6:00-7:30pm at Hope Cancer Care Center (north side of Longmont United Hospital)
Please call Dr. Carol Jean Good for more information: 303.447.8227

Kids Alive (Denver)
Monthly meetings/events for kids ages 6-16 to help them cope with a parent's diagnosis with cancer.  Meets at Porter Adventist Hospital in Denver. 
Contact Jeanne Currey, RN MN at 303.778.5832 or Madelyn Case, PhD at 303.985.4788 for information.

Cancer Care.org
http://www.cancercare.org/ or 1-800-813-HOPE (4673)
Offers professionally facilitated telephone and online support groups for patients and loved ones dealing with various kinds of cancer.  See the website for more information.

Cancer Support Community                        
www.cancersupportcommunity.org
Offers professionally facilitated online support groups for patients and caregivers dealing with various kids of cancers.  See the website for more information.

Look Good ...Feel Better™ A program for cancer patients to help them maintain their appearance while undergoing chemotherapy.
Colorado Breast Cancer Resources Directory
This comprehensive directory compiled by the Colorado Breast Cancer Task Force lists cancer support groups in the state, product suppliers, exercise services and online information resources and more.

For a free copy of the directory go to www.breastcancercolorado.org or call 303-692-2331.
Boulder Community Hospital HomeCareBoulder Community Hospital HomeCare provides skilled nurses, therapists and personal care aides for the homebound patient. 24-hour nursing care is available.
Phone 303-441-0444
Lifeline ServiceThis personal emergency response system enables individuals to live alone at home, yet have access to 24-hour medical assistance at the touch of a button.
Phone 1-800-372-3695
Meals on WheelsNutritious, hot lunches are delivered Monday through Friday to people who are homebound. Special diets are available and the program accepts food stamps.
Boulder 303-441-3908
Lafayette/Louisville 303-665-5165
Longmont 303-772-0504
RSVPSenior volunteers provide handyman/fix it services, companionship calls and visits, grocery shopping for shut-ins, and Medicare counseling to seniors (over 55 years of age) in need.
Phone 303-443-1933
Special Transit Service Low cost, door to door transportation for anyone unable to drive, especially the elderly and handicapped.
For Boulder area scheduling, call 303-447-9636
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Online Resources
American Cancer Society
Colorado HealthNet This non profit organization provides access to information, support services and medical resources for people with chronic medical conditions, including cancer
Healthfinder A service of the US Department of Health and Human Services, this site is a gateway to reliable consumer health information on a multitude of topics
National Cancer Institute For information on cancer for both health professionals and patients, be sure to view the NCI's Cancernet section
National Institutes of Health Information on NIH health resources includes consumer health publications, clinical trials, health hotlines and MEDLINE, the National Library of Medicine's database for helping consumers research their health questions.
Oncolink The University of Pennsylvania Cancer Center Resource provides cancer patients and health care professionals with accurate cancer related information.
Susan G. Komen Breast Cancer Foundation The Foundation is dedicated to advancing research and education about breast cancer and its treatment.
Other Resources
Cancer Answerline
This 24-hour, toll-free service offered by the American Cancer Society provides the latest information and education on cancer prevention, diagnosis, treatment and rehabilitation 1-800-ACS-2345.
Grillo Health Information Center
Provides free assistance in researching health information. The Grillo Center is located in the Tebo Family Medical Pavilion, on the Foothills Campus of Boulder Community Hospital.  Call for more information: 720.854.7293 or visit the website: www.grillocenter.org.
Breast Cancer Network of Strength Hotline (formerly Y-Me)
This hotline answers all types of questions about breast cancer. Call 1-800-221-2141 for information in English, and 1-800-986-9505 for information in Spanish.
Hospice of Boulder County
Hospice offers several support groups for individuals of all ages dealing with terminal illness and grief.
Phone 303-449-7740

BCH is fully committed to providing the most comprehensive, multidisciplinary breast cancer program in Colorado.  Breast cancer is the most common form of cancer afflicting Boulder County women. Luckily, breast cancer is also highly treatable if detected early.
Our approach to breast cancer care incorporates the most advanced diagnostic and treatment technologies available, as well as a high level of communication and coordination between our physicians. In addition, we offer invaluable emotional support services through our wide range of in-house specialists and programs. 
Comprehensive Diagnostic Resources
BCH is at the forefront of the latest advances in diagnostic technology for breast cancer. We were first to offer state-of-the-art digital mammography in Boulder County.  Available at Boulder Community Foothills Hospital, Community Medical Center, Boulder Medical Center and Medical Imaging Center of Broomfield, this groundbreaking diagnostic technology is key to the fight against breast cancer. Digital mammography produces quicker results and uses less radiation than standard film mammography. Patients benefit from more accurate detection of abnormalities, shorter exam times, and reduced need for repeat mammograms.
BCH also features the most advanced technology currently available for Magnetic Resonance Imaging (MRI) of the breast.  With an MRI, doctors can non-invasively determine what the inside of the breast looks like without having to do surgery or flatten the breast (as in a mammogram). Each exam produces hundreds of images of the breast, cross-sectional in three directions, and no radiation is involved. Breast MRI screenings can detect small breast lesions sometimes missed in a traditional mammogram, and can successfully visualize breast implants and the dense breast tissue common in younger women.
Our Women’s Imaging Center at Foothills Hospital has a breast-specific gamma camera, one of only two available in all of Colorado. The gamma camera provides clear, extremely precise images that help distinguish cancer tissue from non-cancer tissue in the breast.  The camera can thoroughly examine exceptionally dense breast tissue and ultra-small tumors that are less than 10 millimeters.
Another important diagnostic tool in the fight against breast cancer is stereotactic breast biopsy. This outpatient, non-surgical procedure is used to determine if breast abnormalities are cancerous or non-cancerous. Physicians can make a rapid, accurate and conclusive cancer diagnosis without surgery. For the patient, a biopsy causes minimal scarring and involves less trauma, pain, time and expense than surgery.
We’re proud that three of our imaging facilities -- Boulder Community Hospital, Boulder Community Foothills Hospital and Boulder Medical Center -- have been designated “Breast Imaging Centers of Excellence” by the American College of Radiology (a national organization dedicated to advancing the science of radiology and improving patient care). After thorough peer review evaluations, each of these BCH imaging locations were determined to have superior practice standards in image quality, personnel qualifications, equipment, quality control procedures and quality assurance programs.
Coordinated Care

An integral part of our breast cancer program is the high level of communication and coordination between our physicians. Our doctors work closely together to develop comprehensive individualized treatment plans that meet each patient’s specific needs. Each week, doctors specializing in medical oncology, radiation oncology, radiology, surgery, plastic surgery and pathology meet to jointly plan care for every newly diagnosed breast cancer patient. They are joined by other members of our breast care team, including social workers, physical therapists, physician assistants specializing in cancer care, imaging technologists and clinical trial coordinators, along with our breast health navigator, cancer registrar and director of cancer care services. The collective expertise and experience of all these clinical professionals helps ensure that each patient receives optimal care.

Full Range of Treatments

The decision to pursue breast cancer treatment—surgery, then perhaps radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy—can be emotionally overwhelming. As a breast cancer center of excellence, Boulder Community Hospital is committed to providing the technology and expertise to guide patients through the entire continuum of care. 
We offer inpatient cancer care at Boulder Community Foothills Hospital. Experienced and specially trained nurses provide personalized care to acutely ill cancer patients and their families. In addition, we designed the Tebo Family Medical Pavilion to provide optimal access to outpatient cancer treatments. Whether you’re at Tebo or in the hospital, all breast cancer patients have access to an extensive range of treatment services, including cutting-edge cancer fighting equipment, advanced radiation therapy and clinical trials of new cancer fighting drugs.
Breast cancer patients also benefit from the Tebo Pavilion’s Center for Integrative Care, where they can take advantage of many complementary therapies, such as massage, acupuncture, and healing touch. We believe it’s vitally important that patients receive added physical, emotional and spiritual support to help them through the healing and recovery process.
Additional Support Services
Breast cancer patients have access to other valuable resources offered by BCH, including the Breast Health Navigator,  extensive rehabilitation services and emotional support groups.
Cancer Support Specialists
Our Breast Health Navigator, Nanna Christensen, is an experienced oncology nurse who provides services solely for breast cancer patients and their families. She offers patients much needed educational and emotional support and provides personalized guidance through breast cancer treatment, from diagnosis to recovery and beyond. BCH was the first hospital in Boulder County to offer patients this valuable resource.  For more information, call Nanna at 720.854.7057.
Emotional Support
In addition to the Breast Health Navigator, BCH offers a variety of valuable programs for enhanced emotional support. We offer The Seven Levels of Healing® a seven-week educational program that helps patients, family members and loved ones navigate the journey through cancer as skillfully and effectively as possible. We also offer a range of support groups for breast cancer patients and their families.
Rehabilitation Services
Rehabilitation can decrease swelling and pain and help patients regain their range of motion more quickly. BCH offers one of the best post-mastectomy programs available, with skilled therapists providing one-on-one care to help ensure a successful recovery. The hospital also has an extensive outpatient rehabilitation services program to support the physical, social and vocational needs of breast cancer patients.

Boulder Community Hospital is committed to providing our community with local access to an expansive range of up to date treatments for cancer.
The hospital provides the highest quality inpatient care for acutely ill cancer patients and their families.
A comprehensive range of outpatient diagnostic and treatment services are available at the Tebo Family Medical Pavilion at Foothills Hospital. Outpatient services include the latest in diagnostic technologies, comprehensive medical and radiation therapies and access to the broadest range of clinical trials available in Colorado. The center also houses the Center for Integrative Care, which offers a host of complementary therapies (massage, acupuncture, healing touch, Reiki, nutrition consults) designed to help the whole person—body, mind and spirit.
Diagnostic Radiology
The Imaging Department plays a vital role in diagnosing and treating cancer. The hospital's radiologists have state of the art equipment to use in making diagnoses, including:

• PET Scanner
• Magnetic Resonance Imaging (MRI)
• CT scans
• nuclear medicine
• ultrasound
• stereotactic breast biopsy
• mammography
• BSGI (Breast Specific Gamma Imaging)

Enterostomal Therapy (Colostomy Care)
The hospital's enterostomal therapist works with patients who have bowel or bladder cancers to teach them ostomy care and wound and skin care.
Cancer Registry
Boulder Community Hospital maintains a cancer registry for Boulder and the surrounding areas. All cases of cancer that are diagnosed and treated are documented and entered into the registry database. Patient confidentiality is always maintained.
The cancer registry information is sent periodically to the State of Colorado. Physicians and researchers have access to this information to determine cancer incidence rates, treatment methods and cure rates in our local community, the state and the nation.

Pathology
Board certified clinical and surgical pathologists in the hospital's laboratory analyze tissue samples to help physicians with tumor diagnosis and cancer care. Tissues received from surgery are analyzed for malignancy or premalignant conditions. For highly specialized tests, the hospital's pathologists have access to the major reference laboratory affiliated with the Mayo Clinic.
The BCH Laboratory is accredited by the College of American Pathologists.
Nutrition
Depression and physical problems caused by cancer or its treatment often make eating properly difficult. Good nutrition is essential for cancer patients to minimize weight loss and to improve their ability to withstand the physical stress of treatment.
Registered dietitians assess patients' nutritional needs and develop and monitor individualized nutrition programs.
Pharmacy Services
Cancer patients have a designated pharmacist who reviews and monitors each patient's medical profile to ensure that drugs and dosages are appropriate. The pharmacist also reviews patient records to guard against potential problems, such as allergic reactions and drug interactions.
The staff pharmacist works closely with patients' physicians and serves as a drug information resource, helping to educate patients and family members about chemotherapy and special medications.
Pastoral CareTo help people adjust to the changes cancer brings to their lives, chaplains offer spiritual and emotional support, including prayer, sacraments and counseling. Upon request, the hospital chaplains coordinate with individual ministers, priests or rabbis in the community.
Post Mastectomy
For information, click here program for the recovery of breast cancer patients
Rehabilitation Services
The hospital's Mapleton Center offers a comprehensive range of inpatient and outpatient rehabilitation services to help cancer patients with their recovery. Patients may receive therapy from one or more disciplines.
The staff assist patients with a variety of conditions, such as weakness related to lymphoma, neurological deficits caused by brain or spinal cord tumors, and speech deficits caused by tumors in the throat. Oncology patients who are significantly limited by pain have access to the Mapleton Center's Pain Management Program.
Social Work
Clinical social workers assist with emotional, economic and social needs associated with cancer treatment and help find available community resources.
Breast Health Navigator
To contact the BCH Breast Health Navigator
Nanna Bo Christensen, RN720-854-7057nchristensen@bch.orgThe Breast Health Navigator helps breast cancer patients and their families maneuver successfully through the health care system. Our Breast Health Navigator is a trained oncology nurse who provides emotional support and helps guide patients through their breast cancer treatment, from diagnosis to recovery and beyond.
The Breast Health Navigator serves as a personal advocate for patients, helping to guide them through all the treatment options available. He or she also stays in constant communication with the patient’s primary care physician, oncologist, radiologist and surgeon throughout the treatment process.
The navigator also is a support and resource provider for patients with breast cancer, available to provide emotional support for both patients and families. The navigator also leads and facilitates support groups for patients and their families. The Breast Health Navigator can recommend resources and provide referrals to social workers, psychologists, support and medical staff.
Much of the Breast Health Navigator’s time is spent on patient education, explaining the advantages and disadvantages of various treatment options. The navigator serves as a triage manager to assess the patient’s educational and social needs and to refer the patient to the proper resources.
The Breast Health Navigator provides this same resource for physicians and nurses, educating other medical personnel about benign and malignant diseases and their treatment as well as about the patients’ emotional and social recovery. The navigator also gives public lectures on early detection of breast disease and breast exam skills.