report of BCRF symposium 2005
"Change the disease, change the survival!"
Quality of Life Research is Center Stage
"We've changed the natural history of breast cancer through better detection and treatment," said Pamela Goodwin, MD, Professor of Medicine, Mt. Sinai Hospital, University of Toronto. Her remark as a panelist at the medical Symposium that preceded the annual BCRF Luncheon underscored the changes that research has brought to breast cancer and complemented Jill Rose Awardee Dr. Patricia Ganz's explanation of what question drives a new generation of research: "What is the impact of primary breast cancer treatments on women's health?"
The Symposium panel consisted of five top, female breast cancer researchers including Ganz, an oncologist who heads the Division of Cancer Prevention & Control at UCLA's Jonsson Cancer Center; Goodwin; Annette Stanton, PhD
, Professor of Psychology and Psychiatry/Behavioral Sciences at UCLA; Electra Paskett, PhD
, Professor of Cancer Research in the School of Public Health at the Ohio State University, and Edith Perez, MD
, Professor of Medicine at Mayo College of Medicine in Rochester, Minnesota.
In their nearly two-hour discussion followed by a Q & A session, the five scientists, led by Ganz's opening summary of the field of quality of life research, revealed important insights:
--Treatment for breast cancer has been shortened to 2-9 months over the past 20 years, but recovery often takes 2 years or more.
--Women are primarily concerned with the risk of death due to breast cancer, making them willing to undergo difficulties associated with long courses of chemotherapy.
--Breast cancer patients are resilient women. However, high-risk groups include: young women whose fertility is jeopardized by treatment, and women who lack family or social support while undergoing treatment.
--Remarkably, many patients experience a measurable positive growth as a result of their cancer, reframing life priorities.
--Incremental return to pre-cancer activities is vital in the early survivorship stage.
Goodwin explained that women's weight is an indicator of recurrence. "Overweight and obesity have proven to be adverse qualities in breast cancer," she said. Her studies have revealed that "insulin resistance syndrome" is a possible indicator that breast cancer risk and recurrence have increased. Goodwin advocates greater awareness about weight as a risk factor and changing lifestyle through food and exercise to reduce the risk.
Edith Perez described her project of tracking women taking the drug Herceptin for evidence of risk factors for cardiac disease. "There is a small but real risk," says Perez, "and now we know how to carefully monitor and redirect those who will not respond well to the drug." Perez and her colleagues made news in 2005, when the National Cancer Institute released the results of two large clinical trials showing that Herceptin given with chemotherapy reduced recurrence of breast cancer in women with HER-2 positive breast cancer by 52 percent. Perez was the principal investigator for one of those trials.
Stanton has helped identify "islands of disruption" that breast cancer survivors experience. Her research extends Ganz's findings in determining risk groups among survivors. "Breast cancer is not the same experience for all women," said Stanton. ""Women who adopt an active approach to their experience fare particularly well, while others are at risk for depression." She and her colleagues focus on strategies for supporting survivors with different psychological needs.
By sifting through the Young Breast Cancer Survivor Cohort Study to determine overlooked factors in breast cancer survival, Electra Paskett has learned that nearly 30 percent suffer chronic lymphedema-post-surgical swelling in the arms, due to removal of the lymph nodes in many breast cancer surgeries. Now, using data from the historic Women's Health Initiative Study she is striving to understand how lymphedema might be prevented or reduced. "With such a high incidence of lymphedema in survivors, we must work on improving this chronic condition," she told the audience.
BCRF's Symposium and Scientific Retreat engaged scientific and non-scientific attendees alike in vigorous discussion about breast cancer as a collection of diseases with increasingly manageable outcomes. Dr. Norton observed that breast cancer research is revealing new insights in other areas of women's health, such as heart disease, obesity, menopause and post-menopause. As quite a few attendees pointed out, the research gains of scientists in the U.S. and other developed nations supported by BCRF must someday be translated across the globe. Breast cancer is international, and its improved treatments should be, too.