September 2007

Dear Friends,

Welcome to the first annual Breast Cancer Symposium, a new peer-reviewed scientific and educational meeting. This meeting emphasizes multidisciplinary research on clinical and translational breast cancer research and is co-sponsored by the American Society of Clinical Oncology (ASCO), the American Society of Breast Disease, the American Society of Breast Surgeons, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology.

To help inform people about progress in cancer, ASCO publishes Cancer Advances, a series of consumer information resources. Breast Cancer Advances: News for Patients from the Breast Cancer Symposium provides the latest information about breast cancer care and treatment. The information in this issue was presented at the 2007 Breast Cancer Symposium held in San Francisco, California, from September 7-8, 2007.

I am enthusiastic about the new developments in breast cancer. For more news and information from the Breast Cancer Symposium, visit ASCO's patient website, People Living With Cancer (www.plwc.org) and read the ASCO Expert Corner: Research Highlights from the 2007 Breast Cancer Symposium or listen to a special PLWC Podcast.

Sincerely,

Nancy Davidson, MD
ASCO President

Women who do not fill most of their prescriptions for tamoxifen (Nolvadex) are at greater risk of death from breast cancer, a new study shows. Tamoxifen is a hormone therapy proven to reduce the return of breast cancer in women with cancers that are fueled by estrogen (called estrogen receptor-positive breast cancer). Doctors generally recommend that women take it for five years. However, some women experience menopausal symptoms, such as hot flashes, that are bothersome enough to cause them to stop taking this medication.

In this study, researchers reviewed the records of 2,080 women in Scotland treated for breast cancer between 1993 and 2002. Most women (79%) were prescribed tamoxifen after surgery. Pharmacy records were used to find out the proportion of tamoxifen prescriptions that had been filled. The women in the study took tamoxifen for an average of nearly two and one-half years (this time is lower than five years because when the study started there was no consensus about the best length of treatment). The researchers found that 10% of women picked up 70% or fewer of their tamoxifen prescriptions over the time that their doctors had prescribed the drug. These women had a 16% increase in the risk of death compared with women who picked up all of their tamoxifen prescriptions.

"While an occasional missed tablet is not a great worry, once you take tamoxifen less than 70% of the time, your survival significantly decreases," said Alastair Thompson, MD, Professor of Surgical Oncology at the University of Dundee, and the study's lead author.

What This Means for Patients

This study emphasizes the importance of taking all of the prescribed medication after surgery for breast cancer. Women are encouraged to talk with their doctors if they experience side effects from the medication that are disruptive enough to cause them to stop taking the medication. Often, these side effects can be treated, or the doctor can prescribe a different medication.

Black women in the United States are more likely than white women to have a subtype of breast cancer, called estrogen receptor (ER)-negative, that is more aggressive and more difficult to treat, according to a large study from the University of Michigan. ER-negative cancers tend to grow faster and are harder to treat because hormone therapy, such as tamoxifen (Nolvadex), is not effective for these cancers.

Although white women are more likely to develop breast cancer than black women, black women are more likely to die from breast cancer. Also, black women tend to be diagnosed with breast cancer at younger ages and at later stages of disease than white women. These differences are usually attributed to socioeconomic factors, such as access to screening and adequate cancer care, but this analysis suggests that the biology of breast cancer may also be involved.

In this study, researchers analyzed data on 170,079 cases of breast cancer included in the National Cancer Data Base (NCDB), a multi-institutional tumor registry that collects cancer data from 1,600 hospitals in all 50 states. Black women made up 10% of these records; white women accounted for 90% of the records. Of the women with invasive cancer, ER-negative cancer was identified in 39% of black women, compared with 22% of white women. In addition, black women were diagnosed at a younger age (57) than white women (62). Fewer black women (29%) were diagnosed at an early stage (stage I) than white women (42%), and black women also had larger tumors at diagnosis, two factors that can lower breast cancer survival.

What This Means for Patients

"Differences in tumor biology affect survival," said M. Catherine Lee, MD, Clinical Lecturer in the Department of Surgery at the University of Michigan Comprehensive Cancer Center in Ann Arbor. "The fact that breast cancers in black women are more biologically aggressive suggests that we need to focus more of our research energy on developing better treatments for ER-negative tumors. These findings also point to a need for improved cancer education and screening in black women, particularly those in younger age groups."

An analysis of a clinical trial showed that 13% of women taking aromatase inhibitors (AIs) for breast cancer quit treatment because of side effects to the bones and/or joints. Overall, 42% of women in the clinical trial experienced these side effects. AIs are a class of drugs that lower the amount of estrogen in postmenopausal women and are given to women with estrogen receptor (ER)-positive breast cancer after surgery to lower the risk of the cancer coming back.

This study of 100 women was part of the National Institutes of Health-funded Consortium on Breast Cancer Pharmacogenomics (COBRA). The women in the study were diagnosed with early-stage, ER-positive breast cancer and were starting AI treatment. Some women received exemestane (Aromasin) and others received letrozole (Femara), although the study did not compare the rate of side effects between these two drugs.

The women answered questionnaires about pain and difficulty with daily activities. Researchers found that 42% of women experienced bone and joint problems. More detailed information about specific side effects was available for 38 of the 42 women who reported bone and joint problems. The most common side effects were osteoarthritis (pain, swelling, and loss of motion of the joints) in 12 women, carpal tunnel syndrome (swelling, pain, and weakness in the wrist and hand) in nine women, and rotator cuff tendonitis (irritation and swelling of the tendons in the shoulder) in eight women. Of the women who discontinued the clinical trial, 13 did so because of bone and joint side effects.

What This Means for Patients

"Patients who have these symptoms should tell their oncologists rather than stopping the drugs on their own," said N. Lynn Henry, MD, PhD, Clinical Lecturer at the University of Michigan Comprehensive Cancer Center in Ann Arbor, and the study's lead author. "Pain medication may help ease symptoms in some women, but in those with severe symptoms, doctors should consider discontinuing their therapy temporarily until symptoms improve and then switching them to a different medication, such as tamoxifen."