Breast Cancer | Cancer.Net

Transcript: Breast Cancer with Lynn Schuchter, MD
October 16, 2003, 2:00 – 3:00 PM ET

Moderator: On behalf of the American Society of Clinical Oncology (ASCO), welcome to the Cancer.Net chat on breast cancer, a live question-and-answer session hosted by Lynn M. Schuchter, MD.

During this hour, Dr. Schuchter will answer as many questions as time permits. Some questions may be adapted so that Dr. Schuchter's answers can help as many people as possible.

Dr. Schuchter will take questions from 2:00 to 3:00 PM ET. As you prepare your questions, please keep in mind that she is unable to give individual medical advice in this setting.

In answering questions about specific methods, her comments will focus on the state of current research and clinical trials.

The chat is governed by all terms and conditions of the Cancer.Net website.

Good afternoon and welcome. Thank you for joining us. Dr. Schuchter will now begin taking questions.

Dr. Schuchter is an oncologist at the Abramson Cancer Center of the University of Pennsylvania and an Associate Professor at the School of Medicine. Her clinical research interests include skin and breast cancers, including new, targeted therapies and vaccine trials.

Dr. Schuchter is a board member of Living Beyond Breast Cancer, a Philadelphia-based education and support organization for women affected by breast cancer. She also chairs the Public Policy Committee and is past chair of the Cancer Communications Committee for ASCO.

Dr. Schuchter is the recipient of numerous awards and honors and has edited and published more than 60 peer-reviewed textbooks and articles.

Dr. Schuchter, thank you for taking the time to join us today.

Guest26: Dr. Schuchter, I heard the results about letrozole (Femara), a new hormone treatment. Can you provide more information?

Dr. Schuchter: First, I would like to welcome you all to this chat and I hope we answer as many questions as possible.

Great first question.

This week, there was major news about the use of hormonal treatment for women with hormone receptor breast cancer–that is, women whose breast cancer expresses the estrogen receptor or progesterone receptor (ER and PR). Five thousand (5,000) women with early stage breast cancer were enrolled in the study after they had completed five years of tamoxifen (Nolvadex).

Half of the women took a new form of hormonal treatment called letrozole (Femara), a drug known as an aromatase inhibitor, and the other half received a placebo, or sugar pill. Early results show that those women taking letrozole (Femara) had a better outcome, with fewer recurrences of their breast cancer and a decrease in new breast cancers in the opposite breast.

The therapy was well tolerated. Patients who are postmenopausal, who have been on tamoxifen (Nolvadex) for five years, may now be considered for treatment with medicines like letrozole (Femara).

Pumpkin: If you do not have a history of breast cancer in your family, should you still get yearly mammograms? I've heard of many women not having a history of breast cancer but still developing breast cancer.

Dr. Schuchter: Another great question. Most women who are diagnosed with breast cancer do not have a family history of breast cancer.

So, yes, women should continue to get annual mammograms. The data are clear that woman over 50 should receive annual mammograms.

There is controversy in younger woman about the role of mammograms. I recommend mammograms in women 40 and older.

Guest278: Under what circumstances would you recommend to one of your patients genetic testing for abnormalities in BRCA genes? If an abnormality is found, what recommendations would you make?

Dr. Schuchter: I recommend genetic testing in women with a strong family history of breast cancer (meaning many relatives with breast cancer, for example, a mother, aunt, and cousin), or women diagnosed with breast cancer at a young age, women with a family history of ovarian cancer, and, depending on the ethnic background, Ashkenazi Jewish women with a family history are at increased for carrying an abnormal gene.

Guest140: Are there any clinical trial results available (even just preliminary results) on trastuzumab (Herceptin) for stage III breast cancer? Is any particular drug combined with trastuzumab (Herceptin) showing more promise?

Dr. Schuchter: Trastuzumab (Herceptin) is a new treatment for breast cancer, if the breast cancer expresses the HER2neu protein.

There are clinical trials combining trastuzumab (Herceptin) with chemotherapy, such as paclitaxel (Taxol) and vinorelbine (Navelbine), which appear promising.

joolz: Is there any progress being made on a breast cancer vaccine for treatment?

Dr. Schuchter: There is a lot of research going on in developing breast cancer vaccines. The trials are all early on so we do not have definite results yet. One advantage of this approach is that vaccines are well tolerated with few side effects.

I anticipate many more clinical trials in the future testing this innovative approach.

Guest84: If you don't mind speaking more about the letrozole (Femara) study ... what are the reported side of effects from letrozole (Femara)? Are they different from tamoxifen (Nolvadex)?

Dr. Schuchter: The side effects are different. Letrozole (Femara) is associated with muscle cramps, stiffness, and weight loss. The main concern is the risk of osteoporosis, so woman taking letrozole (Femara) should have bone density tests performed (Dexa scan).

There does not appear to be a risk of blood clots or cancer of the uterus, which does occur with tamoxifen (Nolvadex), so letrozole (Femara) may be a safer medicine.

Guest399: My mother is scheduled to have a left-side radical mastectomy. How can lymphedema following mastectomy be prevented?

Dr. Schuchter: The lymphedema occurs because of the lymph node surgery. Your mother might be a candidate for a sentinel lymph node biopsy instead of a complete lymph node dissection, which is not associated with lymphedema.

If a lymph node dissection is required, then I recommend following the surgeon's guidelines and seeing a physical therapist early on.

Pumpkin: Is there substantial evidence that women taking hormone replacement therapy (HRT) have a higher risk of breast cancer?

Dr. Schuchter: Yes, I think there is now clear evidence that hormone replacement therapy (HRT) does increase the risk of breast cancer, though that increase is low. Whether to take HRT is complicated and has to with many issues and involves weighing the risks and benefits.

Guest37: Since completing radiation therapy in March 2003, I have had five different occasions when I became ill. The symptoms were chills, fever, and pain in my breast. One breast was hot and became inflamed. Have you heard of anything like this, and could it be the result of the radiation treatment?

Dr. Schuchter: It is hard to say. This could be something called cellulitis, which is an infection and requires antibiotics—sometimes a prolonged course. Fever is not usually a side effect of radiation therapy. These symptoms should be brought to the attention of your doctor.

Guest172: How effective is targeted drug therapy in the treatment of breast cancer?

Dr. Schuchter: Targeted drug therapy is broad and, for breast cancer, we have to include tamoxifen (Nolvadex), aromatase inhibitors such as anastrozole (Arimidex) and letrozole (Femara), and trastuzumab (Herceptin)—are all examples of highly effective targeted therapies.

Other new agents that target other key components of breast cancer are currently undergoing evaluation. Early results are mixed depending upon the target in question.

New drugs like trastuzumab (Herceptin) are being developed and look very promising.

Moderator:Transcripts of today's chat will be available on Cancer.Net tomorrow by 12:00 PM ET. More information about receiving transcripts will be provided at the end of the chat.

Guest387: My dearest friend was just diagnosed at age 35 with breast cancer. How can I best show her my support?

Dr. Schuchter: What a great question. There are many ways to help. Accompanying her to her visits to the doctor, as having more ears listening to the complex medical information is helpful. Organizing meals to be delivered to the house is a huge help. If your friend has children, help with carpooling, after school activities, etc. Allowing your friend to focus on her treatment, rather than all of the routine day-to-day activities will help her a lot. And finally, listening to her.

Guest103 Can you speak about complementary and alternative medicine methods to prevent/treat breast cancer? What are your thoughts on flax seeds, Chinese herbal (mushroom) therapy, hyperthermal treatment, acupuncture, etc.?

Dr. Schuchter: First, you must be cautious. Some alternatives contain estrogen-like substances, which would not be good for a woman with breast cancer or at risk for breast cancer.

Secondly, some alternative therapies can interfere with chemotherapy or radiation therapy and should not be taken while undergoing treatment. I have many patients who had great success with acupuncture and some Chinese herbs to help with nausea and fatigue associated with chemotherapy or radiation therapy.

Youngone: Does menstrual history or birth control use affect my breast cancer risk?

Dr. Schuchter: This is a complicated question. Prolonged use of birth control pills, particularly the older kind, is linked to an increased risk of breast cancer.

The issue of menstrual history is complicated. There are some studies in younger women who exercise a lot and have fewer periods, which is associated with a reduced risk of breast cancer.

TabbyCat: What type of medical team do I need for the most accurate diagnosis and treatment? How can someone find a qualified breast cancer specialist?

Dr. Schuchter: There are four types of doctors involved in the diagnosis and treatment of breast cancer. The radiologist reads the mammogram, which often diagnoses the breast cancer.

The surgeon performs the biopsy and any other surgery that is required. It is important that your surgeon have expertise in breast cancer surgery. The medical oncologist plans the overall treatment and will determine if chemotherapy is needed and what kind. He or she will also determine if hormonal therapy is indicated and if radiation therapy is necessary.

The radiation oncologist delivers the radiation therapy to the breast or other areas if indicated. Generally, the team is comprised of the surgeon, medical oncologist, and a radiation oncologist.

You should speak with your physicians regarding how often they treat breast cancer patients, and consider an evaluation at a comprehensive cancer center, which are designated by the National Cancer Institute (NCI).

Guest261: What about the recent news reports that suggest getting a magnetic resonance imaging (MRI) scan is more effective than mammography?

Dr. Schuchter: You guys are hitting on all the important topics!

This is still controversial—some setting MRI superior, others setting it complementary. For now, I would say that MRI should not be used for routine screening.

I recommend MRI for some patients with complex breast examinations, difficult to read mammograms, and for some women who are at very high risk for breast cancer.

Guest308: Can a specific diet help prevent breast cancer?

Dr. Schuchter: There is no evidence that any diet can prevent breast cancer.

Guest434: How can women with breast cancer reduce their risk of osteoporosis?

Dr. Schuchter: Alendronate (Fosamax), which is approved by the U.S. Food and Drug Administration (FDA) for the treatment of osteoporosis, is a great choice for women with a history of breast cancer, where estrogen therapy would not be a good idea.

Bisphosphonates (like alendronate [Fosamax]) may also help prevent a recurrence of breast cancer, which is being studied in ongoing clinical trials.

Guest301: What are the risks versus benefits of sentinel lymph node biopsy?

Dr. Schuchter: The sentinel biopsy is a new technique that allows the surgeon to remove one or two lymph nodes in the axilla (armpit) instead of doing a complete lymph node dissection.

Lymph node sampling is done to determine the risk of recurrence and, therefore, to plan appropriate adjuvant therapy. It is important the surgeon be highly skilled in this technique so that it is done correctly.

The advantage of the sentinel node procedure is that if the node is negative for breast cancer, then a complete lymph node dissection is not done, which significantly reduces the risk of lymphedema.

Guest114: Where can I go for reliable information about breast cancer?

Dr. Schuchter: In addition to Cancer.Net, I recommend Living Beyond Breast Cancer, and breastcancer.org.

Moderator:The chat is now ending. Thank you for your thoughtful questions. We hope this discussion has been valuable, and we regret not being able to answer every question. We want to thank Dr. Schuchter for lending us her time and expertise.

TRANSCRIPTS: The full text of today's chat will be available on Cancer.Net (www.cancer.net) tomorrow by 12:00 PM ET. To receive a copy of the transcript by e-mail, please send a message to contactus@cancer.net.

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Dr. Kris is Chief of the Thoracic Oncology Service, Division of Solid Tumor Oncology and Associate Chairman, Clinical Trials, Department of Medicine, at Memorial Sloan-Kettering Cancer Center and Attending Physician at Memorial Hospital for Cancer and Allied Diseases, New York, New York.

He is Professor of Medicine at the Weill Medical College of Cornell University and serves as Co-Leader of Memorial Sloan-Kettering's Multidisciplinary Thoracic Disease Management Team.

Dr. Kris is author and coauthor of 130 original scientific publications and 70 reviews and monographs. As a lung cancer specialist and clinical investigator, his research includes the evaluation of new anticancer agents, the development of treatments targeting lung cancer, multimodality therapy, and management of symptoms to improve the care of all persons with cancer.

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