Report Back from San Antonio Breast Cancer Symposium
Every year, several women from SHARE attend the San Antonio Breast Cancer Symposium, the world's premier breast cancer meeting, in mid December. In January, SHARE reports back on the highlights of what was presented at the conference, letting our participants know what is on the horizon when it comes to breast cancer research and treatment.
This year was no different. SHARE women attended the December conference, and on January 21st, SHARE hosted our "Report-Back," providing both a medical and patient advocate perspective on the conference. Rick Michaelson, MD, Chief Medical Officer for Oncology at Saint Barnabas Medical Center offered the medical perspective. A two-time breast cancer survivor and Executive Director of SHARE, I offered the advocate perspective along with Sara Messina, breast cancer survivor and participant in the Alamo Breast Cancer Advocates' program.
What follows is a description of the highlights from the symposium as we reported on January 21st. For more information about what happened at the symposium, you can view all abstracts and posters from the conference at www.sabcs.org.
There were no presentations at the Symposium that would lead to significant changes in the way oncologists practice.
- The markers that have been developed to help determine what a woman's prognosis is and whether she will benefit from chemotherapy (Mammoprint and Oncotype DX) continue to be used by physicians but evidence is still not definitive on some issues, e.g. how reliable Oncotype Dx is for women with positive nodes.
- While breast cancer incidence is increasing worldwide, there continues to be only proposed explanations for this including increased weight, decreasing exercise, fewer births, less breast feeding. Little was said about the impact of environmental factors on this increasing incidence and how much of this increase was invasive versus in situ disease (DCIS).
A few age-old research issues appeared to be resolved and should have closure.
- The issue of optimal endocrine therapy for post menopausal women with estrogen positive disease and in particular, the use of an aromatase inhibitor, like Arimidex, Aromasin or Femara, and or tamoxifen. While the research has shown that aromatase inhibitors have a slight advantage over tamoxifen, taking into account the individual, and her quality of life, is necessary and required to personalize the choice. Other issues remain including how long a woman should take an aromatase inhibitor, why aromatase inhibitors cause joint pain, and determining whether tamoxifen metabolism (which can be affected by one's genetics and certain drugs) affects its efficacy.
Several presentations focused on lifestyle issues.
- Obesity is associated with increased risk of postmenopausal breast cancer. Obese women who are diagnosed have a greater risk of distant metastases and a higher risk of dying of breast cancer. It was not clear whether this was related to estrogen levels or, in an interesting presentation, related to insulin levels. It was suggested that obese women may be diagnosed at a later stage and treatment dosage may be insufficient.
- Alcohol use and increased risk of recurrence continues to be looked at. However, the question of whether other issues like poor nutrition or lack of exercise in these women may be the critical factors in this increased risk, was raised.
There are exciting new ways that scientists are approaching breast cancer research.
- Breast cancer is not one disease, but a series of diseases or sub-types. Even within sub-types, the tumor biology is individual. Therefore, treatments will be more or less effective depending upon the type of breast cancer that is identified.
- Identifying not only the type of breast cancer but the most effective treatment by working with the tumor sample before providing systemic treatment, presents a new paradigm in the research community.
- Looking at not just the cancer cell itself but the abnormalities in the pathways is critical to determining interventions.
- Residual cells in the body may be "stem cells" which are biologically different from regular cancer cells and more resistant to treatment. Identifying them opens opportunities for targeting treatments to them. Might this eventually be a "cure"?
- Identifying biological biomarkers as a future method for screening and diagnosis was an exciting issue.
- The expanding use of neoadjuvent (before surgery) chemotherapy or endocrine therapy increases researchers' ability to get study results in a much shorter time, using fewer people.
Take a look at the sabcs.org website and read those abstracts that hold some interest. There are also daily reviews that were provided. More discussion about these and other issues will be forthcoming on the SHARE website.
Anunciado 26 enero 2010.
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