Tuesday, October 19, 2010

Breast cancer research is emphasizing prevention as a priority.

Oct. 03--When Amy Matzek's mother got breast cancer, her own risk for the disease doubled automatically. Now she's fighting every day to even the odds.

Matzek works out. She pops flax seed capsules and vitamins, and she gathers her food from the produce aisle.

"I remember my mother having breast cancer. I remember her lying on the couch, being in pain," said Matzek, a 36-year-old mother of three.

"I didn't want this to be me, and I didn't want it to be my daughters."

The regimen this Kansas City woman is putting herself through may seem like wishful thinking to some. But it's backed by science, and the evidence is mounting.

Prevention has become an urgent priority among breast cancer researchers, and with good cause.

After taking a nose dive early in the decade -- most likely because huge numbers of menopausal women abandoned risky hormone replacement therapy -- rates of new breast cancer cases have stayed stubbornly constant.

Prevention researchers are investigating everything from conventional drugs to things typically found in health food stores: soy protein, green tea, grape seed extract and fish oil.
And, yes, the vitamin D and flax seed that Matzek is taking.

In the United States, two dozen prevention studies at places such as Stanford University, Columbia University and the University of Kansas Medical Center are enrolling patients.
The good news is that women can do plenty to significantly lower their risk of breast cancer, doctors said.

"If we did all the things that we know, we could dramatically reduce breast cancer in this country," said Powel Brown, chairman of the clinical cancer prevention department at MD Anderson Cancer Center in Houston.

Lifestyle counts
For some women at high risk, the best prevention is tough: Years of drug therapy or even surgery to remove their breasts before cancer appears.

But women with an average or moderately elevated cancer risk may improve their odds just by doing what they know they should: Cutting back on alcohol consumption, losing weight, eating a healthful diet, getting regular exercise -- things we've been told to do to avoid maladies such as heart disease and diabetes.

"Lifestyle changes may be all we need, and they're good things we all should be doing anyway," Brown said.

Women at higher risk -- those with a family history of breast cancer and lab findings of pre-cancerous cells in their breasts, for example -- may need stronger medicine.
It's a matter of hormone control.

Up to 80 percent of breast cancers are fueled by the female hormone estrogen. The drugs tamoxifen and raloxifene block estrogen from binding to breast tissue cells. In large, long-term studies, women who took one or the other of the drugs for five years cut their risk of breast cancer by as much as half.

But the drugs cause severe side effects -- hot flashes, cold sweats, blood clots, weight gain, endometrial cancer -- that make women highly skeptical.

"The problem is nobody wants to take these drugs," said Carol Fabian, a doctor and breast cancer researcher who runs a prevention program at the University of Kansas Cancer Center.
"They don't want to get hot flashes. You consult with these ladies and they say, 'You know, I'll just let you follow me.' How can you argue with them?"

Another category of drugs now being studied as a preventive measure also is problematic, Fabian said.

Aromatase inhibitors, which block estrogen production in post-menopausal women, are being used to keep breast cancer from returning after women have undergone treatment. But the drugs cause fatigue, aches and pains, and can lower sex drive.

"Unless they're extremely high risk, I don't think people would be any more likely to take it (for prevention) than tamoxifen," Fabian said.

Drug alternatives
Fabian and her KU colleagues have been looking for more palatable prevention measures that are reasonably inexpensive and can make women healthier even if they don't stop them from getting breast cancer.

Take exercise, for example. Breast cancer is less common among women who stay active. And exercise reduces inflammatory chemicals in the body that promote the survival of precancerous cells.

Fabian put 25 women on a 1,200 calorie-a-day diet and an exercise regimen of six hours or more of walking every week.

The women not only lost weight, they ended up with fewer precancerous cells in their breasts.
Unfortunately, many of the women in the study had gained back their weight a year later. A follow-up study Fabian is planning will include counseling to help women keep the weight off.
This summer, Fabian and a research team at the University of Texas-Austin received a $4.5 million grant from Susan G. Komen for the Cure to conduct a nationwide study on whether flax seed supplements can reduce the risk of breast cancer in pre-menopausal women.
Flax seeds contain estrogen-like chemicals called lignans that appear to dampen the effect of the body's estrogen. In countries where people eat plenty of flax seeds or other foods high in lignans such as sesame seeds, rye bread, cabbage and broccoli, breast cancer risks are about 50 percent lower.

"In the U.S. we do not eat a lot of unprocessed fruits and vegetables with lots of lignans in them," Fabian said.

In a small pilot study, Fabian found that women who took concentrated flax seed extract capsules showed reduced growth of precancerous breast cells. Fabian's new study will enroll a total of 200 women at eight universities.

"Even if it reduces risks by just 10 or 20 percent, that's better than something more effective that no one will use," Fabian said.

Weighing risks
Brown of MD Anderson thinks more women would take the drug option for breast cancer prevention if they assessed the risks and benefits the way they do for other kinds of drugs.
Statins to lower blood cholesterol, for example.

"Statins do have side effects, yet most of us take these medicines without worrying. We assess our risk of heart disease," Brown said.

"It's the exact same thing with cancer, but for whatever reason, the media message for preventing cancer is something about changing your behavior."

One group with greater motivation to take preventive drugs is women with a genetic susceptibility to breast cancer. Less than 1 percent of women have mutations in either their BRCA1 or BRCA2 gene, but they have a 60 percent chance of developing breast cancer. Their risk of ovarian cancer also is higher. The lifetime breast cancer risk for all women is about 12 percent.

Women who test positive for the gene mutations face the decision whether to have their ovaries removed and undergo preventive mastectomies and reconstructive surgery.

"Each patient has to decide how aggressive she wants to be," said John Shook, a cancer surgeon at St. Luke's Hospital.

Women may postpone surgery until after they have children, he said. They may take years to decide.

But eventually, most women do choose surgery, Shook said.

Amy Matzek hasn't been tested for the gene mutations. "I think it puts you in a dilemma about some radical choices," she said.

But, as a patient in Fabian's prevention program at KU, Matzek is vigilantly monitoring her health. She has a breast exam every six months and a mammogram every year.
Matzek is a nurse and a hospice administrator. She has seen women in their 40s and 50s whose breast cancer was diagnosed too late.

"I think something has to jump-start you into doing something about breast cancer," Matzek said. "For me, I think it was less the fear of breast cancer than the fear of not seeing my children grow up."
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New tools and techniques are increasing the survival rates for those with breast cancer.

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