Monthly Archives: December 2009

Hope

As most people do this time of year I’ve been spending the last few days thinking about the past year.  The pace of my life just seemed to accelerate with each month culminating with the last six weeks of non-stop activity and travel, as I took on a full-time job for the first time in 17 years.  I am commuting back and forth between Washington D.C. and Cincinnati as Director of Research Programs for the National Breast Cancer Coalition.  It has taken a toll, as my husband and three kids have had to adjust, and as I have felt the consequences of the stress.  I have to confess it would be easy to stop.   I’d have time again to go to the gym.  I would always be here for my kid’s concerts, games, and poetry slams.  I would not have to hear my daughter say “I don’t like it when you go away” as I am dragging my suitcase to the car, or my  son, “Are you leaving AGAIN?”

But like every one of you out there who has chosen to be a breast cancer advocate, I can’t stop.  We all make sacrifices because we have HOPE.  HOPE that what we are doing will help in some small way to lessen the suffering and ultimately lead to eradicating this disease.  Some of you use your vacation days to attend research or advocacy conferences.  You leave your families and arrange babysitters so you can be reviewers on breast cancer research panels.  You use your free time to serve on clinical trial review boards.  You follow the research and write newsletter articles.  You provide support and education for women and families in your communities.

We all have hope that things can change.  Breast cancer has continued to take a serious toll on families for way too long.  In some cases it is the disease, and in some cases it is the treatment for the disease that continues to lead to losses for too many.

I have a dream that in 2020, when we are looking back at the decade, we will be celebrating major progress in breast cancer.  Dramatic improvements have occurred with other diseases, like heart disease and cervical cancer.  Why not breast cancer?  We will look back at the decade and say, wow, breast cancer deaths were cut in half!

How do we get there?  By every one of us continuing to do what we do.  Getting informed.  Understanding the science.  Getting involved.  Pushing for innovation.  Advocating for the right research.

The first six weeks of my new job was dominated by the new screening guidelines.  There was such an incredible reaction and backlash.  Now it’s time to move on.  I’m dreaming that the passion and interest in breast cancer can be harnessed to drive real progress.  I’m hoping that we can all agree that our work is not yet done, that sometimes early detection is not enough, that too many women continue to die from breast cancer,  that we need much more progress to understand this complicated disease, and that we need much, much more than more mammography.

So in 2010, and through the next decade, I have hope that we will move the dialogue beyond screening and mammography, that we will push research in the right direction, that progress will be made, and that lives will be saved.

Happy New Year to all of you.

A Clue on How We Might Be Able to “Do Better”

So many times when we talk about breast cancer screening and treatment, we say “we need to do better.”  Today (Day 2 of the San Antonio Breast Cancer Symposium) I heard a presentation on microRNA’s that made me sit up and take notice – this could be how we do better.

MicroRNAs are a relatively newly defined type of genetic material, first named in 2001.  There has been a burst of research on them and several papers have been published in the last 18 months on circulating miRNAs and various diseases.  Research presented today was the first to look at miRNAs in breast cancer patients.

Dr. Heneghan of the National University of Ireland described her work on the search for miRNAs that could serve as biomarkers for breast cancer.  From blood samples of breast cancer patients compared with the blood from controls, Dr. Heneghan and her co-investigators identified two miRNAs that were significantly increased with breast cancer.  The two miRNAs together predicted breast cancer with a greater sensitivity than mammography.

One of the miRNAs, miR-195 was 12 times higher in those with breast cancer, and the other let-7a, was five times higher.  They both reverted to normal after the tumors were removed by surgery, suggesting this may not only be a tool for discovering breast cancer but also for monitoring of treatment.

The study was done on 148 patients.  Dr. Heneghan plans to continue the work, recruiting larger numbers of patients with different tumor types to investigate the possibility that the miRNAs could also predict the tumor type.

Very exciting line of research to follow.

Day 1 at the San Antonio Breast Cancer Symposium

Causes of Breast Cancer

When are the epidemiological studies on breast cancer going to catch up to the fact that breast cancer is not one disease?

Dr. Valerie Beral, gave the first presentation on “An epidemiological perspective on the causes and prevention of breast cancer.”  She made broad, sweeping generalizations on how to prevent breast cancer without acknowledging the different subtypes of breast cancer, which more than likely, have different causes.

She compared incidence rates across the world, showing that industrialized coutries have a 6.3% cummulative incidence by age 70, compared to 1% for rural, non-developed areas in Asia and South Africa.  She said that worldwide incidence is going up, but primarily in areas of the world that were less developed but are becoming more Westernized.

She concluded after presenting some historical data that “most if not all” of the international differences can be explained by differences in childbearing, lactation, and obesity.   She then went on to say that the goal to reduce the toll of breast cancer should be to develop a “hormonal vaccine” for early adulthood.

First of all, we now know there are at least five different subtypes of breast cancers and we can’t make broad generalizations about the causes and prevention of breast cancer without recognizing the different types, with different natural histories, and more than likely, different causes.

Secondly, we can’t really know what other factors might be responsible for differences between Westernized vs. non-Westernized areas of the world.  Could environmental factors such as estrogen disrupters in pollutants be a factor?  Could there be dietary factors responsible?

And third, some types of breast cancer are associated with EARLIER pregnancy, and particularly more aggressive types.  We wouldn’t want to give a vaccine that might actually increase the odds of some types of breast cancer.

We clearly need much more information and future epidemiological studies must take into account different types of breast cancer.

Hormonal Therapy

Lots of presentations with no real surprises.  TEAM trial results were presented showing that there was no difference in overall survival or disease free survival in taking tamoxifen and then switching to exemestane (Aromasin) or taking only exemestane.   Another study found that side effects from aromatase inhibitors had no predictive value on outcome after three years of follow-up.  One interesting study did look at premenopausal women who took tamoxifen for five years and then continued on with an aromotase inhibitor if they had become post-menopausal.  The study found a 10% absolute difference in disease free survival for those who took the AI vs those who took a placebo.

There continues to be an issue with these trials comparing AIs vs tamoxifen because they have not taken into account the growing consensus that 5-10% of women on tamoxifen have a polymorphism that is preventing the drug from being metabolized.  This hasn’t been addressed by any of the Pharma companies producing the AIs and presenting results of their trials.

Alcohol and Breast Cancer Recurrence

Results from a Kaiser Permanente study on over 1800 breast cancer survivors were presented showing an association with drinking more than 3-4 drinks a week and recurrence.   The association held after controlling for age, BMI, HR status, total folate intake, tamoxifen use, stage of disease, and lymph node status.  The association was strongest among post-menopausal women and obese women.  No association was found with drinking less than 3-4 drinks per week.

MRI and BRCA 1 and 2

A study in Canada has been following women with BRCA 1 and/or 2 mutations who are at a higher risk of breast cancer, and who are receiving annual MRI screening, and comparing them to women with BRCA 1 and/or 2 mutations who are receiving annual mammograms.  After 10 years they have found a stage shift with MRI screening.  Women who receive the MRIs are being diagnosed with more DCIS and Stage I breast cancer, but less Stage III and Stage IV breast cancer.  This indicates the possibility that MRIs could reduce mortality from breast cancer in women with BRCA 1 and 2 mutations.  Further research is needed in this area.

Bisphosphonates

Bisphosphonates have traditionally been given to women to treat or prevent osteoporosis.  However, interest in the effect of these drugs on breast cancer risk and breast cancer recurrence has increased after some surprise findings that the drugs appear to have an impact on recurrence.  Two observational studies were presented this year that looked at the relationship between oral bisphosphonate use and breast cancer risk.  One study was the large Women’s Health Initiative and the other was a study from Israel.  Both studies found an association with bisphosphonate use and a decrease in breast cancer incidence.  The association held up in both studies after controlling for several factors including bone mineral density and age.

San Antonio Breast Cancer Symposium

I am excited to be on my way down to Texas this afternoon for the largest national meeting on breast cancer research, the 32nd annual San Antonio Breast Cancer Symposium.  The meeting brings together over 9,000 researchers, physicians, and advocates, all in one room, to hear and discuss the latest research (including my own oncologist – what are the odds I’ll run into him??).

The symposium is a collaboration of the Cancer Therapy & Research Center (CTRC) at UT Health Science Center San Antonio, the American Association for Cancer Research (AACR) and the Baylor College of Medicine.

I’m heading down a day early because the National Breast Cancer Coalition will be holding a continuing education program for advocates before the symposium begins, with a focus on screening, early detection, and where we need to go from here.  We will have the opportunity to hear from some well known researchers in epidemiology and nanomedicine, and then hear what promises to be a lively panel of advocates discuss the current screening controversy.

I’m looking forward to hearing the science, asking questions, learning more, seeing old advocate friends and meeting new ones.

Over 200 advocates from around the world attend each year including about 40 who receive scholarships from the Alamo Breast Cancer Foundation (ABCF).  ABCF was approached by the founders of the symposium many years ago and together they developed a phenomenal program to welcome and include advocates in the meeting.  The advocates attend sessions and write a summary or report on an assigned topic, once they get back home.  ABCF also sponsors mentoring sessions in the evening with renowned physicians and researchers giving their interpretation of the day’s scientific sessions.   To learn more click here.

To learn more about the topics being presented at this year’s symposium take a look at the schedule.