Breast Cancer Treatment: Have We Made Progress?
We can't help but be encouraged by recent advances in breast cancer
treatment, but do these
new drugs bring hope or hype? Better Health asked Gwen Darien,
Editor-in-Chief of MAMM -
the magazine for reproductive cancers - to put it all in perspective
for us.
Better Health: The news stories published in April of this year
marked the first time that a lot of
people had ever heard of tamoxifen. Can you tell us what it is and
how it works?
Gwen Darien: Tamoxifen is a hormonal therapy that has been used as a
treatment for women
diagnosed with breast cancer. It blocks estrogen receptors in some
breast cancer cells and thus
slows and/or inhibits the growth and metabolism of these cells.
BH: Put this drug in perspective for us. If this drug is as
effective as the National Cancer
Institute (NCI) studies suggest, then how significant is that for
high-risk women?
GD: There are two very different uses for tamoxifen. The first,
which is quite effective, is a
treatment for women who been diagnosed with treated for breast
cancer. The second, to which
I believe you are referring, is as a preventative for breast cancer
for women who have not been
diagnosed but are thought to be at high risk, is much more
problematic. Tamoxifen is highly toxic
and there are serious life-threatening side effects that we know
about. If the ultimate aim of
chemoprevention is to prevent death, the results of the study are
disappointing-there was only
one more death among the women taking the placebo in the study.
BH: European researchers have cast doubts on the NCI studies. Is
there reason to believe one
group of scientists over the other?
GD: What the European researchers have said is that there simply
isn't enough evidence to draw
meaningful conclusions about the drug's value as a preventive. They
have not cast doubts on the
potential for the drug, rather they want a longer study.
BH: The other preventive drug in the news this year is raloxifene.
Early reports suggest it may be
even more effective than tamoxifen as a preventive drug. Can you
give us an update on
raloxifene clinical trials and what the early evidence shows?
GD: Again, the reports are too preliminary to make any assessment
about the long-term efficacy
of raloxifene as a preventative.
BH: Can you talk about Herceptin for a moment? This is a new drug
that seems to represent an
important advance in the treatment of at least some types of breast
cancer.
GD: Herceptin was approved by the FDA on September 25 for treatment
of women whose
breast cancer has spread beyond the breast and lymph nodes. The drug
has been shown to slow
time to disease progression in women with advanced breast cancer.
There are, however, some
serious risks with the treatment including congestive heart failure.
BH: In addition to Herceptin, are there any other new treatments on
the horizon worth
mentioning?
GD: As far as I know, there are no other treatments that are close
to FDA approval.
BH: If you look historically at breast cancer diagnosis and survival
rates, you could argue that
not much progress has been made in the areas of prevention or
treatment over the past half
century. And yet, many of these new therapies that we're discussing
give an appearance of great
progress. Are we on the cusp of some real breakthroughs or is are we
just being taken in by
media hype?
GD: Cancer is not a simple disease, curable if only we could find
that one elusive antidote.
Cures will probably involve many drugs: Some will be used with
existing therapies; others will
replace current protocols. New therapies show promise, however,
finding a cure will most likely
take years of research, and treatments will almost definitely be
refined over and over again.
BH: Let's shift gears a bit and talk about politics and advocacy.
Ten years ago, breast cancer
didn't register on the radar screens of many of the politicians in
Washington. Now, it's getting
some long overdue attention and funding. What's been the difference?
GD: Grass roots advocacy has been extremely effective in mobilizing
women and men across
the country to demand the allocation of funding. Politicians listen
to their constituencies and their
constituencies have been vocal and tenacious.
BH: What do breast cancer groups have to do to maintain these
hard-won legislative and
funding gains? Is there a risk of losing some momentum?
GD: There is no risk of losing momentum among the advocates until
breast cancer is eradicated.
Advocates know that they must continue to make their voices heard.
It is hard to find anyone
whose life has not been touched by cancer; funding for cancer
research should not be a
controversial request.
BH: What's the best single piece of advice you can give a woman
newly diagnosed with breast
cancer?
GD: Know your treatment options and don't be afraid to question your
doctor's advice. Insist
that your doctor explain the risks and benefits of every treatment
she recommends and make
sure that you feel comfortable with your decisions.
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