The Breast Cancer Research Foundation's 2008 Palm Beach symposium focused on risk factors, but the take-home message was the value of personalized treatments. Four respected BCRF researchers - Judy Garber, MD,; MPH; Clifford Hudis, MD; Marc Lippman, MD; and Walter Willett, MD, Dr. PH - updated attendees on everything from genetics to hormones to diet and lifestyle factors at the February 11 morning symposium held at the Flagler Museum.
Hudis opened the session by emphasizing the transformation in breast cancer understanding and treatment in the 25 years since the disease shifted from a feared, often fatal diagnosis, to a complex group of diseases with varied treatments and high rate of survival. "It is exciting how far we've come," he said. Willett, renowned for his work on the relationship between nutrition and cancer, suggested that perhaps the best means of warding off breast cancer through lifestyle changes - especially recurrence - is to stay as lean and active as possible. "Higher fat intake in mid-to-late life doesn't appear to increase breast cancer risk," he said, "but retained fat in the body is a clear risk factor in post-menopausal women." Other negative factors include moderate alcohol consumption and inadequate vitamin D in the body, both of which may be offset by supplements. The minimum recommended daily requirement of folic acid seems to mitigate light alcohol consumption, said Willett.
Dr. Garber described the search for additional genes in families with higher incidence of breast and ovarian cancer, especially those who do not test positive for the known BRCA1 and BRCA2 mutations. "If we can identify the genetics behind the various sub-types of breast cancer, such as the triple-negative ones, that would be a huge step forward for the field and predicting who is at risk for specific types of breast cancer."
Adding insights based on the fact that breast cancer is a complex group of diseases, Lippman cautioned that "we treat too many people, and often with chemotherapy that may not always be effective for every type of breast cancer." While chemotherapy may be the correct treatment for some, it is important that each patient be assessed individually, both in terms of her own health status and risk factors and everything that is known about the type of tumor she has, Lippman said. "Individualized medicine is the key," he added. Lippman also updated Palm Beach attendees about the findings from a 2006 National Cancer Institute-sponsored study that among post-menopausal women, raloxifene reduced risk of breast cancer at a rate of 72 percent compared with tamoxifen's 49 percent risk reduction rate, and with fewer side effects. Raloxifene, currently sold under the name Evista, has been marketed as an osteoporosis prevention drug.
In a summary of the wide-ranging facts and questions shared at the symposium, Dr. Hudis, who also served as the panel moderator, emphasized that in the large, prospective Women's Intervention Nutrition Study (WINS) study conducted between 1994 and 2001 with 2,437 breast cancer survivors, better outcomes were seen in the women who followed a low-fat diet. Willett added that regular exercise will benefit women with or without a low-fat diet, and that women must view breast cancer in the larger context of their overall health. "Many women who have had breast cancer now die of other things," he said. "This wasn't the case 25 years ago."