<< Ann's NOTE: The emphasis above was added by me. It is important to note that
sacrificing one's lymph nodes has life-long implications.  >><BR><BR>

For sure...as I sit here with my arm bandaged for lymphedema...I don't know if
I would have gotten it anyway since I am guessing I most likely have some type
of chest wall/axillary node recurrence.  I wore the standard Jobst sleeve
initially.   The lymphedema got worse.  I got both a custom Elvorax sleeve for
day use and a custom Circaid sleeve for night use.  The lymphedema got worse.
I then got another custom Elvorax day sleeve and a Reid sleeve for night.  The
lymphedema continued to worsen.  I went back to bandaging--worked for the most
part--but now even with bandaging it worsens.  Lymphedema is NOT fun...  My
only saving grace is that it was on my right side, and I am left-handed...

Hi Deliscious and Kaye

I will never for my oncologists one line comment about lymphedema.  "I
know nothing about lymphedema."

With new diagnostic tools, such as PET/CATS and even with the growing
accuracy of biospy tools such as the small needle biopsy, I can never
understand why it is that doctors continue to just wholesale yank lymph
nodes out.

Also wanted to share a new item just released a week ago:

Molecular Test Can Predict Both the Risk of Breast Cancer Recurrence
and Who Will Benefit From Chemotherapy

FOR IMMEDIATE RELEASE
Friday, December 10, 2004

CONTACT:
NCI Press Office
301-496-6641

A new test can predict both the risk of breast cancer recurrence and
may identify women who will benefit most from chemotherapy, according
to research supported by the National Cancer Institute (NCI), part of
the National Institutes of Health, and performed in collaboration with
the National Surgical Adjuvant Breast and Bowel Project (NSABP) and
Genomic Health Inc. These results suggest that almost half of 43,000
U.S. women diagnosed with estrogen-dependent, lymph-node negative
breast cancer every year are at low risk for recurrence and may not
need to go through the discomfort and side effects of chemotherapy.

The test is based on levels of expression (increased or decreased) of a
panel of cancer-related genes. This panel is used to predict whether
estrogen-dependent breast cancer will come back, according to a study
that will be published online in the New England Journal of Medicine on
Friday, December 10, 2004*. Scientists on this study also will present
new results on that day at San Antonio Breast Cancer Symposium
indicating that the same test can predict which women benefit most from
chemotherapy. Women with low risk of breast cancer recurrence-about
half of the women in the recent study-do not appear to derive much
benefit from chemotherapy.

The researchers used tissue samples and medical records from women
enrolled in clinical trials of the cancer drug tamoxifen, which blocks
the effect of estrogen on breast cancer cells. These women had a kind
of breast cancer defined as estrogen receptor-positive, lymph
node-negative. Each year, 43,000 women are diagnosed with this kind of
breast cancer, which needs estrogen to grow but has not spread to the
lymph nodes. Currently, many women with this type of breast cancer in
the United States do receive chemotherapy in addition to hormonal
therapy.

Using samples from 447 patients and a collection of 250 genes in three
independent preliminary studies, 16 cancer-related genes were found
that worked best. The scientists created a formula that generates a
"recurrence score" based on the expression patterns of these genes in a
tumor sample. Ranging from 1 to 100, the recurrence score is a measure
of the risk that a given cancer will recur**.

Prior to this research, analysis of the expression of genes was
performed on tumor specimens that were frozen rather than tissue
prepared for routine pathologic evaluation (fixed and embedded). The
expression analysis depended on measurement of RNA (the molecule
necessary for the translation of a gene into a protein), and RNA is
altered when tissues are fixed and embedded. Frozen tissues are
generally not readily available in routine practice. Researchers at
Genomic Health, Inc. developed a method for performing these analyses
on tissues embedded in paraffin wax. Their method allows them to use
the altered RNA that is found in fixed tissue.

The results published in the New England Journal of Medicine validate
the ability of the recurrence score to predict risk of recurrence.
Using biopsy tissue and medical records from another NSABP tamoxifen
trial, researchers divided 668 women into low, intermediate, and high
risk of recurrence groups. Fifty-one percent were in the low risk group
(with a score of less than 18); 22 percent were at intermediate risk
(recurrence score 18 or higher but less than 31); 27 percent were at
high risk (a score of 31 or higher).

These risk group divisions correlated well with the actual rates of
recurrence of breast cancer after 10 years. There was a significant
difference in recurrence rates between women in the low and high risk
groups. In the low risk group, there was a 6.8 percent rate of
recurrence at 10 years; in the intermediate and high risk categories
these rates were 14.3 and 30.5 percent, respectively. Up to a
recurrence score of 50, rates of recurrence increased continuously as
the recurrence score increased. These trends held across age groups and
tumor size.

* Print version: Paik S, Shak S, Wolmark N, et al. A multigene assay to
predict recurrence of node-negative, estrogen-receptor-positive breast
cancer in tamoxifen-treated patients. New England Journal of Medicine,
351(27). December 30, 2004.

** This technology is called the Oncotype DX™.

and another one hat may be of interest...................

New Breast Cancer Risk Genes Found -Study

Reuters Health

Thursday, December 16, 2004

WASHINGTON (Reuters) - Tiny differences in genes linked to the hormone
estrogen can strongly influence a woman's risk of developing breast
cancer, U.S. researchers reported on Wednesday.

They found two variations of a gene called ESR1 that predisposed a
woman to breast cancer. One, rare in black women, was associated with
the disease only in women over age 50. Another was linked with breast
cancer in Ashkenazi Jewish women -- those of European descent -- over
age 50.

Writing in the journal Cancer Research, the researchers said their
findings add to a growing list of genes, including BRCA1, BRCA2 and
p53, that have mutations associated with breast cancer.

They also found three genetic variations in the ESR1 gene that
protected against breast cancer in all ethnic and age groups.

"We were pleasantly surprised to discover that some women have some
genetic protection from breast cancer," said Bert Gold of the National
Cancer Institute, who led the study.

All the differences are known as single nucleotide polymorphisms, or
SNPs, which are one-letter changes in the genetic code.

Working with the Memorial Sloan-Kettering Cancer Center, Celera
Diagnostics SAIC-Frederick Inc., Applied Biosystems, the Massachusetts
Institute of Technology and Vanderbilt University School of Medicine,
the researchers looked at DNA samples from 1,006 women with breast
cancer and 613 without.

In addition to the ESR1 variants, they also found differences
associated with cancer in a related gene called ESR2.

"We know that half of familial breast cancer is due to genetic factors
other than BRCA1 and BRCA2," said Dr. Kenneth Offit, a cancer
geneticist at Memorial Sloan-Kettering in New York who worked on the
study.

"These findings suggest that genetic variants in estrogen receptor
pathways may be one of many such risk factors."

The findings could lead to new treatments for breast cancer, which
affects 1.2 million women and some men globally and kills 40,000 a year
in the United States alone.

"We hope pharmaceutical developers will take our results into account
as they develop new drugs that modulate the effects of estrogen on
breast cancer cells," said the National Cancer Institute's Dr. Michael
Dean.

----------------

Take care Kaye - don't be a stranger :-)
Pat O'Connor
Lymphedema People
http://lymphedema.omno.org