Dignicap for prevention of chemotherapy alopecia

The top cancer treatment breakthroughs of 2017

It’s fair to say that 2017 was a very good year in the field of cancer research, with a great many breakthroughs and developments – and now is as good a time as any to take a look back at what happened over the last year.

Palbociclib and Ribociclib finally approved by the NHS

After haggling over the price, the NHS finally gave 8,000 or so British cancer patients an extra edge in their battle by introducing two new treatments. Palbociclib – a first-line treatment for sufferers of oestrogen receptor positive breast cancer – has been medically proven to slow down the progression of cancer by inhibiting the proteins CDK 4 and 6. Ribociclib works along the same lines, but has been designed for women who have gone through the menopause.

Side-effects appear to be minimal: women who were involved in the trials for both medications reported that slight fatigue was the only negative, and they appear to be very manageable treatments, allowing users to live as high a quality of life as possible. And the British medical community are very keen to see both treatments rolled out, as they slow down the growth of tumours for nearly a year, delaying the need for chemotherapy.

The MammaPrint test: it could prevent unnecessary chemo

A report this summer from the University of California announced the development of a new test for cancer survivors, which can indicate which women are at a low risk for reoccurring cancers, allowing them to avoid unnecessary chemotherapy.

The MammaPrint test looks for up to seventy gene variants in blood and saliva which are known to increase the risk of cancers flaring up again, examining how active certain genes are, how the activity levels of the genes are affecting the behaviour of the cancer, and how likely it is to grow and spread. The result would allow doctors to factor in the age and general health of the patient, as well as the size and grade of the cancer, giving both doctor and patient a better shot at working out a more effective treatment plan.

The DigniCap cooling system

While chemotherapy is still seen by the medical community as the best weapon against cancer, the side-effects are still hard for many to bear – particularly the distress and trauma brought on by chemo-induced alopecia. However, a development approved by America’s Food and Drug Administration in 2017 could help keep hair intact.

The DigniCap Cooling System – a computer-controlled cap which circulates liquid that cools the scalp – is designed to minimise the hair loss brought on by chemo treatment for patients with solid tumours – was tested earlier this year, and studies of women with breast cancer who used the cap while undergoing chemotherapy demonstrated that more than 66% of them reported losing less than half of their hair.

AI used to detect breast cancer

Scientists at the Massachusetts Institute of Technology revealed a new and highly effective screening system for high-risk breast lesions this summer – using artificial intelligence.

The machine learning system was tested on 335 lesions, looking for patterns among data points including demographics, family history, biopsy results and pathology reports – and it correctly diagnosed 97% of them as malignant, reducing the number of unnecessary surgeries by more than 30%.

Because current cancer diagnostic tools are so inexact, the medical community has become prone to overscreening. And while techniques such as mammograms play a crucial role in detecting cancers, they still throw up a lot of false positives, leading to pointless surgeries.

While the American medical community feels that this is an important development, it may not be so crucial in the UK, as British medical policies are less inclined towards surgery than in the US. But the self-learning capabilities of AI mean that this system is predicted to come on in leaps and bounds in the near future.

breast cancer screening and obesity

Should overweight women be screened more often?

If you need a reason – another reason – to keep tabs on your weight, a recent study from Sweden has provided just that: according to the report, cancerous breast lumps are less likely to be detected in overweight or obese women before the tumour becomes large, sparking a call for more breast cancer screening in the form of frequent mammograms.

The study – carried out by the Karolinksa Institute in Stockholm – involved 2,012 women who developed breast cancer between 2001 and 2008, who had been receiving mammograms every 18 months to two years – the standard length of time in Sweden. The researchers examined the size of the tumours at diagnosis, as well as the women’s body mass index (BMI), a measure of obesity.

The research team’s conclusions were that women who were overweight were more likely to have a larger tumour when detected either at their mammogram or between screenings, but the reason for this was wasn’t clear-cut. It may be because their breasts were larger – and therefore the tumour was harder to find – or because their weight gain had caused their tumours to grow at a faster rate.

The pros and cons of more breast cancer screening

As we know, larger tumours tend to carry a much higher danger, so the results of this research have serious consequences. However, the jury is still out on the need for a reduced length between breast screenings, with certain experts claiming that more evidence is needed.

Dr Fredrik Strand, the lead author of the study, claimed that the research proved a need for more screening. “Our study suggests that when a clinician presents the pros and cons of breast cancer screening to the patient, having high BMI should be an important ‘pro’ argument. In addition, our findings suggest that women with high BMI should consider shorter time intervals between screenings.”

However, Sophia Lowes, speaking on behalf of Cancer Research UK, pointed out that it wasn’t as simple as that. “Breast screening has harms as well as benefits,” she claimed, in an interview with BBC News. “It saves lives by helping detect breast cancer at an early stage, but harms include some women being diagnosed with a cancer that would never have caused them problems in their lifetime. The time between screening is designed to help the benefits outweigh the harms overall.”

The facts on fat and breast cancer

According to the World Health Organisation, roughly six out of ten women in Britain are classified as overweight or obese, and it’s becoming a problem for many reasons, as another study released this month makes clear. According to the study, which has been published in The Lancet, researchers at Imperial College London concluded that about 800,000 new cancer cases per year are caused by being overweight or diabetic – and overweight women are twice as likely to develop cancer as overweight men, with breast cancer being the most common incidence of cancer. So if you feel you’re carrying a bit too much weight, here’s your incentive to get your diet and exercise regime right for 2018.

Breast Cancer Drugs

Palbociclib and Ribociclib finally approved by the NHS

The big medical news of last month was the green-lighting by the NHS of two new drugs designed to treat advanced breast cancer, meaning that approximately 8,000 sufferers in the UK will be given an extra edge in their fight against the disease. After negotiating prices for the treatments – after feeling the initial pricings were too high – the National Institute for Health and Care Excellence (NICE) finally approved the use of palbociclib and ribociclib. But what are they?

Palbociclib

Otherwise known as Ibrance, palbociclib is a first-line treatment for sufferers of oestrogen receptor positive breast cancer, which has been medically proven to slow down the progression of cancer by inhibiting two proteins – CDK 4 and 6.

They’re designed to be taken alongside an aromatase inhibitor, a hormone therapy which blocks the production of oestrogen, in order to stop certain breast cancers from developing.
It is estimated that palbociclib treatment can delay the progression of breast cancer by up to 10 months, allowing patients to continue day-to-day activities without the condition worsening. One cycle of palbociclib – a pack of 21 capsules, one taken daily – will cost the NHS £2,950.

Ribociclib

Otherwise known as Kisqai, ribociclib works along the same lines as palbociclib – but is recommended for women who have gone through the menopause. It can be used in collaboration with letrozole, anastrosole or exemestane, giving oncologists a wider choice in selecting the therapy most suitable for a particular patient. Ribociclib is also a lot cheaper than palbociclib – that same £2,950 will buy the NHS 63 tablets.

Are there any side effects to these cancer drugs?

Women who were involved in the trail for both medications have reported that – bar slight fatigue – palbociclib and ribociclib are both very manageable treatments, allowing them to live as high a quality of life as possible. And the British medical community are very keen to see both treatments rolled out.

“(Palbociclib and Ribociclib) are one of the most important breakthroughs for women with advanced breast cancer in the last two decades,” claimed Nicholas Turner, professor of molecular oncology at the Institute of Cancer Research in London, and consultant medical oncologist at the Royal Marsden, who led the clinical trials for the drugs.”

Professor Carole Longson, the director of the centre for health technology evaluation at NICE, was similarly impressed. “The committee heard that by postponing disease progression, palbociclib and ribociclib may reduce the number of people who are exposed to the often unpleasant side effects of chemotherapy, and delay the need for its use in others. We are pleased therefore that the companies have been able to agree reductions to the price of palbociclib and ribociclib to allow them to be made routinely available to people with this type of breast cancer.”

The final word goes to Professor Turner: “Palbociclib and ribociclib have made a huge difference to women’s lives – slowing down tumour growth for nearly a year, and delaying the need for chemotherapy with all its potentially debilitating side-effects. These drugs have allowed women to live a normal life for longer.”

hair dye and breast cancer

Hair dye and breast cancer: is there a link?

A recent study conducted by a London-based surgeon has attracted a lot of attention in the medical community, and caused alarm amongst anyone who has put a tint in their hair. According to the study, frequent hair-dyeing has been linked to an increased risk of developing breast cancer – with an estimated 14 percent rise in the rates of contracting it.

The study, conducted by Professor Kefah Mokbel of the Princess Grace Hospital in Marylebone, advises that women dye their hair no more than two to five times a year – and also recommends using as many natural hair-dye products on their hair as possible, including henna, beetroot or rose hip.

“What I find concerning is the fact that the industry recommends women should dye their hair every four to six weeks,” Professor Mokbel pointed out. “Although further work is required to confirm our results, our findings suggest that exposure to hair dyes may contribute to breast cancer risk.”

Could hair dyes really cause cancer?

The short answer is: it’s complicated. Over 5,000 different chemicals have been used in hair dye products, some of which have been reported to cause cancer in animals (and subsequently eliminated from use). A combination of the huge array of ingredients, the constant changing of those ingredients in hair dye products and the large proportion of people – both male and female – who regularly dye their hair has caused no end of confusion for scientists looking for a link.

However, there have been studies that have drawn a link between hair product chemicals and an increased risk in cancer. A 2007 study claimed to detect an increased risk of bladder cancer in hairdressers and barbers, while a report from the International Agency for Research on Cancer concluded that some of the chemicals these workers are exposed to occupationally are “probably carcinogenic to humans”. Furthermore, some studies have claimed there is a link between personal use of hair dyes and certain blood and bone marrow cancers, while others have denied that such a link exists.

While it is not known whether current hair dye products can cause cancer, the sheer numbers of people around the world that regularly use these products mean that any increase in risk – however small – would have a sizeable public health impact.

What can I do to reduce the risk?

It’s worth remembering that Professor Mokbel took great pains to make clear that the link is merely a correlation. “The positive association between the use of hair dyes and breast cancer risk does not represent evidence of a cause-effect relationship,” he wrote.

He also spelled out the following opinions on social media:

  • Women are advised to reduce exposure to synthetic hair dyes to 2-6 times per year and undergo regular breast screening from the age of 40
  • It would be preferable to choose hair dyes that contain the minimum concentration of aromatic amines such as PPD (less than 2%)
  • It is reasonable to assume that hair dyes that consist of natural herbal ingredients such as rose hip and rhubarb are safe
  • Further research is required to clarify the relationship between hair dyes and breast cancer risk in order to better inform women

For more information on potential risks of cancer or to arrange a private breast cancer diagnosis or treatment, call 0800 612 9490 or email us at
info@thamesbreastclinic.com.

breast cancer detection

AI used to detect breast cancer in the US

We’ve heard a lot about the dangers of artificial intelligence and the negative impact it could have on our lives, but research from the US demonstrates that it could have seriously positive effects when it comes to breast cancer detection.

The research, conducted by scientists at Harvard Medical School, the Massachusetts Computer Science and Artificial Intelligence Lab, and Massachusetts General Hospital, deployed AI through a machine learning system to predict whether breast lesions identified from a biopsy will turn out to cancerous.

The machine learning system was programmed to analyse information about breast lesions, forcing it to look for patterns among a range of data points, such as demographics, family history, biopsies and pathology reports. So far, it’s been tested on 335 high-risk lesions – and it correctly diagnosed 97% of them as malignant, which reduced the number of unnecessary surgeries by more than 30%.

False positives create fiscal negatives

Fifty-thousand women are diagnosed with breast cancer in the UK each year, but when cancers are found early enough they can often be cured. Mammograms can play a crucial role in detecting cancers early on, but the downside is that they also throw up false positives, such as ‘high-risk’ lesions that appear suspicious on mammograms and have abnormal cells when tested by needle biopsy.

Potentially, patients could undergo painful, expensive, scar-inducing surgeries to have lesions removed, even though they turn out to be benign 90% of the time.

“Because diagnostic tools are so inexact, there is an understandable tendency for doctors to over-screen for breast cancer,” claims Regina Barzilay, MIT’s Delta Electronics Professor of Electrical Engineering and Computer Science – who also happens to be a breast cancer survivor. “When there’s this much uncertainty in data, machine learning is exactly the tool that we need to improve detection and prevent over-treatment.”

Could AI breast cancer detection work over here?

According to Constance Lehman, professor at Harvard Medical School and chief of the Breast Imaging Division at MGH’s Department of Radiology, the results from the study have been very encouraging. “To our knowledge, this is the first study to apply machine learning to the task of distinguishing high-risk lesions that need surgery from those that don’t. We believe this could support women to make more informed decisions about their treatment, and that we could provide more targeted approaches to health care in general.”

However, it needs to be pointed out that this new technology may not travel well over the Atlantic. Debashis Ghosh – a consultant breast surgeon based at the Royal Free London hospital – stated that while the benefits of the technology were obvious, it may not be as effective over here. “Here we have less than 5% of patients who have these surgeries, whereas it is 30% in the US. We try to make a definite diagnosis before we operate but this technology is definitely useful where there is a lack of expertise.”

Obviously, we’re at the very beginning of the learning curve when it comes to AI as a diagnostic tool, so we await further developments with interest.

yoga and breast cancer treatment

Can yoga reduce the side-effects of breast cancer treatment?

We’re all aware of the beneficial effects of yoga: that it’s been clinically proven to reduce the risk of heart disease and hypertension, as well as having the ability to lessen symptoms of depression, headaches and diabetes. But is there anything in the idea that it can benefit cancer survivors, too?

A recent study conducted by the University of Pennsylvania which was published in the International Journal of Radiation Oncology, Biology and Physics last month seems to point towards a positive outcome. The study, which covered 68 sufferers of prostate cancer who were undergoing radiation therapy, split the participants into two groups: one which participated in twice-weekly yoga sessions, and one which didn’t.

Bend, but don’t break

After a 15-month period, the results were clear: the yoga participants started to report less fatigue than the non-yoga group after four to five weeks of activity, along with a greater ability to deal with the demands of day-to-day life. While the people behind the study have taken great pains to point out that the results are more of an emotional and physical bent than actually curing anything, it’s clear that something good is happening to people who partake in yoga.

But can yoga do anything for those who are fighting breast cancer? According to a 2014 study conducted by Ohio State University, there’s a lot to recommend the activity. Aware of the statistic that a third of breast cancer survivors complain that fatigue interferes with day-to-day activities, the study – which covered 200 breast cancer survivors of all ages – had a similar result: a lower level of fatigue and markers of inflammation in yoga participants compared to those who lived a more sedentary lifestyle.

How can yoga help?

There are three clear signifiers that have been pointed out by health experts:

  1. Yoga helps manage negativity: Research conducted in 2013 concluded that a yoga regime which incorporated yogic breathing was a vital aid to enriching the respiratory system, which in turn regulated nerves and instilled a feeling of calmness – something that is sorely needed by people who have had their lives disrupted and threatened by cancer.
  2. Yoga increases the production of endorphins: Just like any other form of exercise, yoga can jack up the production of endorphins – the mood-improving brain chemical which boosts our mood and keeps us feeling positive.
  3. Yoga can help cope with physical pain: Even a gentle exercise routine has been proven to reduce pain and stress, and entry-level yoga is the textbook definition of ‘gentle exercise’.

The other great thing about yoga is that it can be performed alone, but also as a group activity – and community support has been proven to be a huge aid to people in remission, whether you’re going it with fellow survivors or not.

obesity and breast cancer

Is there a link between obesity and breast cancer?

We all know about the obesity crisis and its myriad knock-on effects to both our personal health and national economy. And we’re particularly aware of the link between obesity and cancer. But what about breast cancer?

There are three reasons why obesity causes cancer which are commonly agreed upon by the medical community.

Obesity increases oestrogen levels

As well as being the primary female sex hormone, which helps develop and regulate the female reproductive system, oestrogen also acts as a medication, a mood-booster, an appetite-suppressant, an anti-inflammatory, and a key factor in bone development and maintenance of bone mineral density – in both men and women.

However, another thing that oestrogen can do is make certain cells in the body divide when they shouldn’t – and uncontrolled cell division is effectively what cancer is. Post-menopause, the ovaries – the prime producer of oestrogen – shut down. But if you’re piling on the pounds and gaining weight, your fat cells take over and becomes the main source of oestrogen production.

Obesity disrupts the metabolism

As you can imagine, the metabolism – the network of body-regulating transformations which convert food to energy – is an incredibly complicated set-up, and one which can be easily upset by obesity and the extra fat cells it produces. When we take on extra fat cells, there is a risk that they can snuff out our metabolism’s ability to process glucose – and scientists have drawn a link between high glucose levels and an increased risk of cancer.

Obesity increases inflammation

One reaction our bodies experience when we take on extra fat is to summon specialised immune cells called macrophages to deal with dead and dying fat cells. The downside to that is that they release cytokines – a cocktail of chemicals which ultimately causes a condition called chronic inflammation, which causes cells to divide, and can bring on ailments such as pancreatitis and Crohn’s disease, which can increase the risk of cancer.

Obesity and breast cancer

However, when it comes to breast cancer, things become complicated. Certain studies claim that being overweight or obese before menopause actually modestly decreases the risk of breast cancer when compared to women with a leaner body shape. However, after menopause, being overweight or obese increases the risk of breast cancer and we have to factor into these findings that most instances of breast cancer occur after menopause.

In short, we know that there is a clear link between obesity and a higher risk of cancer – the jury is still out on how it does it exactly, but it’s worth remembering that cancer is just one of the many life-threatening ailments brought on by obesity, which includes heart disease, diabetes and strokes.

breast cancer screening

Should yearly mammograms start at 40?

Here in the UK, women aren’t usually invited to take regular mammograms until they reach the age of 50, and it’s been that way for years. However, a recent study from New York makes a solid case for women to start breast screening at a much earlier age.

According to the study, conducted by Weill Cornell Medicine and New York-Presbyterian, yearly mammograms for women between the ages of 40 and 80 could cut breast cancer deaths by 40% – which compares with a reduction of 23 to 31% with current screening recommendations that call for less frequent screening which start at an older age.

“Screening annually starting at age 40 is the best strategy to prevent an early breast cancer death,” said Dr Elizabeth Arleo, the leader of the study, which was published in the journal Cancer.

Why 50 in Britain?

Over two million women in the UK undergo mammograms, and the NHS Breast Screening Programme invites women to undergo a screening every three years from the age of 50. Why so late? Because the risk of breast cancer in women under that age is considered to be very low, and certainly too low for a public health service to spend money on in financially-strapped times – which is also why they tend not to issue an automatic invitation to women over 70.

This is not a new theory: an argument that annual, earlier mammograms save more lives has been going on across the Atlantic for a while. Groups such as the American Cancer Society and the US Preventive Services Task Force – a government-backed panel – acknowledge that screening beginning at age 40 will catch more breast cancers, but believe that screenings taken at this age also produce the most false positive results.

According to Dr Otis Brawley, Chief Medical Officer of the American Cancer Society, yearly mammograms starting at 40 would also lead to the most women being called back to doctors’ offices for false alarms and biopsies that turn out to be negative. In other words, for a 40-year-old woman who starts mammography now, the odds of having a false positive are ‘very high’ while the odds that the test will save your life ‘are very small’.

To screen or not to screen?

It’s only when women reach the age of 47 or 48 that the risk/benefit ratio begins to change, and the benefits of screening outweigh the risk of overdiagnosis, claims Dr Brawley. This is reflected in the suggestion by the American Cancer Society that yearly mammograms should start at the age of 45, moving to every other year by the time women reach the age of 55. The US Preventive Services Task Force, on the other hand, recommends that screening should occur every two years from the age of 50.

And it looks like the tide may be turning over here, with some parts of England running a trial where women aged 47 to 73 are being invited to commence or extend a breast screening programme.

At Thames Breast Clinic, we offer a one-stop breast diagnosis clinic for women who wish to go down the private route to seek diagnosis and reassurance.

male breast cancer

Male breast cancer FAQ

Breast cancer in men is a rare occurrence: recent figures demonstrate that while 1 in 8 women can develop breast cancer, only 1 in 1,000 men is likely to contract it over their lifetime. However, due to the stigma associated with contracting something that is typically – and erroneously – seen as a ‘female’ ailment means that men who do contract breast cancer are far less likely to get themselves checked out early enough to get it successfully treated.

While there have been significant advances in encouraging men to be open and aware of other cancers, especially prostate and testicular cancer, the stigmas around breast cancer still persist. It seems that certain men are unaware that, yes, they have breast tissue too, and they need to be as aware of changes in that area as women are. So, let’s break down some of the facts about male breast cancer.

What are the symptoms of male breast cancer?

These can include:

  • A hard, painless lump in the breast area
  • A nipple that has inverted
  • Nipple discharge which may or may not be streaked with blood
  • Soreness and/or a rash around the nipple

Please bear in mind that male breast cancer is an extremely rare condition, but it’s always wise to get checked out by your GP if you suffer from any conditions – particularly if you have a lump in the breast area, have nipple discharge and have a close family history of breast cancer.

What are the causes of male breast cancer?

Due to the rare nature of the condition, it has proven difficult to pinpoint clear links between certain behaviours and male breast cancer. However, there are certain clear links, which include;

  • Family history and genes, namely in instances where faulty versions of genes known as BRCA1 and BRCA2 have been inherited, which increase the risk of breast cancer
  • The taking of medicines that increase the amount of oestrogen taken into the body, such as hormone treatments which are sometimes used to treat prostate cancer
  • Lifestyle habits that increase oestrogen levels, particularly obesity and developing cirrhosis through drinking
  • Previous exposure to radiotherapy in the chest area

What are the treatments for male breast cancer?

If you are diagnosed with male breast cancer, there are a range of treatments, depending on how advanced the condition is. Possible treatments include a mastectomy, which will remove the affected breast tissue and nipple, and certain glands in the armpit, radiotherapy, and chemotherapy.

Is male breast cancer survivable?

Like other cancers, the answer is yes – as long as the cancer is detected early enough. If caught at an early stage, a full recovery is possible. If the cancer isn’t detected until it has spread beyond the breast, a cure becomes more complicated

The two things that any man needs to take away from this information is that male breast cancer is far rarer than the female variety, and that an awareness of any changes in the area and a willingness to report it to a clinic are absolutely crucial.

Dignicap for prevention of chemotherapy alopecia

Spreading the word about cooling caps

It may be termed as a side-effect amongst the medical community at best – and a necessary evil at worst – but there’s no denying the distress and trauma that is caused by chemotherapy alopecia. Research published by the United States National Library of Medicine found that almost 50 per cent of women named hair loss as the most traumatic aspect of their chemo treatment and for a lot of women, it could even be the step too far that puts them off getting the treatment they desperately need.

Cooling caps or cancer cold caps have been around since the 1970s but recent news from America’s Food and Drug Administration further raises awareness of this hair loss prevention method that many women are unaware exists.

The announcement from the FDA involves something called the DigniCap Cooling System, which aims to minimise chemotherapy alopecia for patients with solid tumours. The FDA granted marketing authorisation of the DigniCap for use in patients with breast cancer in 2015 – and studies of women with breast cancer who used the cap while undergoing chemotherapy demonstrated that more than 66 per cent of them reported losing less than half of their hair.

It pays to keep a cool head

The DigniCap Cooling System is a computer-controlled system used during chemotherapy. A cap worn on the head circulates liquid to cool the scalp during treatment, and the cap is covered by a second cap made from neoprene to hold the cooling cap in place and insulate against cooling loss.
The goal of scalp-cooling is to constrict the blood vessels in the scalp, in order to reduce the amount of chemotherapy that reaches the cells in the hair follicles. Cold temperature also decreases the activity of the hair follicles and slows down cell division, making them less affected by chemotherapy. And although the FDA took pains to point out that the DigniCap may not work with some chemotherapy regimens, it’s a very hopeful development.

If the cap fits…

To back up these claims, another American study found that the use of scalp cooling was associated with reduced hair loss at four weeks after the last dose of chemotherapy among women undergoing non–anthracycline-based chemotherapy for early-stage breast cancer. According to the results, two-thirds of patients reported hair loss of 50 per cent or less in a scalp cooling group when compared to patients who didn’t use the cap, as well as reporting quality-of-life benefits for the scalp cooling group.

However, there were side-effects, including cold-induced headaches and neck and shoulder discomfort, chills, and pain associated with wearing the cooling cap for an extended period of time. It was also noted that the cap may not be appropriate for patients with cold sensitivity or susceptibility to cold-related injuries. The risk of the chemotherapy drug missing an isolated grouping of cancer cells in the scalp because of the cooling cap is rare, the FDA noted, adding that long-term effects of scalp cooling and risk of scalp metastasis have not been fully studied.

The treatment is used approximately 30 minutes before each chemo session, and at certain points during the recovery period. Most patients report that they can tolerate the feeling of a DigniCap session very well, as – after the initial shock of the temperature decrease – the cap gradually ‘defrosts’ back to room temperature, and the temperature never drops below freezing.