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Posts Tagged ‘breast cancer’

Catchy title isn’t it. News releases, magazine articles, books, lectures and Sunday sermons all have one thing in common: catchy titles. They serve two purposes: one to get readers or listeners, the other to make the content believable. Sometimes, more believable than it really is.

Mathes, Malone, Davis, Lucas, Porter, and Li [1] released their findings in an article entitled, Migraine in Postmenopausal Women and the Risk of Invasive Breast Cancer, in the journal Cancer Epidemiology, Biomarkers, and Prevention earlier this month. Ever since, such reputable sites as Scientific American and MSNBC and the National Headache Foundation Newsletter have carried the news story. Is this finding worth all the media hype?   

Maybe not.
Unfortunately, for most of us, news reporters do just that: report the news. I guess it isn’t up to them to interpret it or analyze it, just report it. That leaves interpretation to those for whom it is important. Watchdogs and Migraine bloggers. I am one of the latter, although I hope, one day to be both. I have several questions and I will address them in turn.

Why is this big news?
     I have to admit it, but when I first read the article, I told my DH, “Ok, that’s interesting, but so what? What is the big deal? This doesn’t necessarily help manage or explain Migraine disease and women can’t “catch” Migraine disease to lower their risk of breast cancer. It doesn’t help women who already have breast cancer. Why is everyone so excited??” I don’t find this kind of research very helpful.

Why did this story hit the mainstream papers before the ink was dry on the journal article?
     I asked my DH this question and he answered, “Follow the money.” Good idea; no, a great idea. This is what I found.
     The researchers received a grant from National Cancer Institute, which is under the umbrella of the National Institutes of Health. I remember that, in March, Teri Robert and the Alliance for Headache Disorders were encouraging Migraineurs to send email to our represetatives to press the NIH for research funding for Migraine Disease. Well, it seems that they have granted our request. Not only that, but research on breast cancer, too. Two with one blow. If this is what the NIH considers valuable research, I am disappointed.
In addtion, the authors suggested hormone treatments for Migraineurs:
Although not typically used as a first-line treatment for menstrual-associated migraine, hormonal treatments, particularly those administered during the hormone-free week of oral contraceptive users, may have a beneficial effect on female migraineurs unless there is a contraindication for estrogen supplementation.

In light of this statement, it is important to note that Lucas, one of the authors, has a connection to GlaxoSmithKline, Merck, Pfizer, Ortho-McNeil. Each of these drug manufacturers make either medications for Migraine (GlaxoSmithKline, Merk, and Pfizer) or oral contraceptives (Ortho-McNeil). Interesting association. Readers can form their own conclusions.

 Study results

Mathes et al. stated:

 

Our results suggest that a history of diagnosed migraine may be associated with a reduced risk of breast cancer in postmenopausal women and particularly with a reduced risk of ER+ tumors. These reductions were observed in women with either IDC or ILC tumors and did not vary by history of prescription migraine medication use or age at migraine diagnosis.

The big question is as to the reason why there is an association between Migraine disease and lowered risk of breast cancer.  The authors first established that incidence of migraine attacks is associated with changes in estrogen levels (menses, pregnancy and menopause). They then noted “the well established postive association between endogenous circulating hormones and risk of hormone receptor positive breast cancer.  Therefore,

…it is plausible that migraine is associated with a reduced risk of IDC [invasive ductal carcinoma] and ILC [invasive lobular carcinoma] through hormonal pathways. Several studies have observed an association between hormonally associated events (i.e., menarche, menses, pregnancy, and menopause) and migraine frequency and severity.

What do the statistics mean?  

Statistics are peculiar. It all depends on how they are portrayed. Researchers can make a smal number look big. For example, 30 is a pretty big number, but .3 is a small number. Researchers can make .3 look big by changing it to 30%. Now the number looks big, but it really is small.
Now, what does 30% less risk mean? Thirty percent less than what? I have to know my baseline. My current lifetime risk of breast cancer is 10%. Now that I have Migraine Disease, I can lower it by 30% to 7%. Not a huge decline, in my book.

Are the results believable?

To me, this line of reasoning is not believable. For this line of reasoning to be accurate, the incidence and frequency of migraine attacks must be associated with lower circulating endogenous hormones. The authors do not show that this is the case. In fact, in the introduction, they stated that rather the withdrawl of estrogen precipitated a migraine attack and that stable estrogen levels are “inversely associated with migraine frequency.

In addition, every woman experiences these types of estrogen fluctuations. But not all have Migraines nor do all get breast cancer.

Headache experts are also dubious of these results. Dr. Ellen Drexler is one of them. The associate director of the Division of Neurology at Maimonides Medical Center explains:
 Migraine brains are more sensitive to many exogenous and endogenous factors, of which falling estrogen levels are an important one for many female migraineurs. However, female migraineurs are not known to have consistently lower levels of estrogen than are non-migraineurs. [as cited in 2]
Conclusion

Authors Mathes et al. have established that there is some kind of relationship between Migraine disease and breast cancer. Despite what they claim, hormones are probably not the cause. What is the bottom line? Is this information helpful to women who are at high risk for hormone sensitive cancer? Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, says no. He stated:

There is a decreased risk for women with migraines to develop breast cancer. But in practical implications — what should a woman do differently — there is no action a woman or her health-care professional would take as a result of this report.

[1] Mathes, R. W., Malone, K. E., Daling, J. R., Davis, S., Lucas, S., Porter, P., & Li, C. (2008). Migraine in postmanopausal women and the risk of invasive breast cancer. Cancer Epidemiology, Biomarkers, and Prevention, 17, 3116-3122.
[2] Reinberg, S. (2008, November 6). Migraine might lower breast cancer risk. HealthDay. Retrieved December 4, 2008 from http://www.healthday.com/Article.asp?AID=621050
 

 

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I am taking a break from Migraine Disease and shifting to “what is really important” A very close friend died yesterday of metastatic breast cancer. She almost made the 5 year remission mark when it came back. It is amazing that she was able to control the tumors for nearly 8 years. She lived to see all of her children (Aaron, Jared, and Patrick) graduate from high school. Aaron and Jared have graduated from college. Kathy lived to see Aaron and Liz get married. This is only short of amazing.

Kathy’s decline started last November with painful surgeries to keep fluid from accumulating in her lungs. I saw Kathy in July after she had had a significant turn for the worse. It was obvious that she was losing her battle. And yet, she remained cheerful. We talked about life and what had happened since we last met. And then came the $64,000 question: “How do you reconcile your condition with a loving God?” Her answer was profound: “Whatever happens, I have to believe that God is good.” It is that simple. She was not afraid to die and she knew that she would go to heaven because she knew Jesus Christ as her Saviour.

Her relationship with God was solid and as a therapist, she touched many lives, including mine. At the end, she taught me what is truly important: first, my relationship with God. When she passed into eternal life, that is all Kathy had. This is what she could take with her: Not a beautiful body, not a “6-pack”, not a beautiful home, not perfect happiness, not success, nor anything else I would think was important. The second is my relationship with others. Kathy left behind a loving husband, Ed, and three children whom she loved. This is what life boils down to: love.

“But now faith, hope, love, abide these three; but the greatest of these is love.” (I Corinthians 13:13)

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