My days at this conference are filled with both new reports of scientific research and symposia and plenary discussions that provide overviews of a particular topic.
Breast Cancer Stem Cells
A very interesting symposia, and one that I predict will eventually change our approach to breast cancer treatment, focused on tumor stem cells. The breast is the only organ that is not fully developed at birth. As such, it has a lot of stem cells. These cells probably sit under the nipple and then grow when puberty gives the appropriate signals. When a pregnancy occurs, the stem cells kick in again to get the breast ready to produce milk. Then, after a woman finishes breast-feeding, the stem cells kick in again, to help the breast return to itâ€™s normal non-lactating state. Some scientists have hypothesized that these stem cells, which have the ability to clone themselves and to make daughter cells, can be mutated and be the source of cancer. Previously, the theory was that any cell in the breast had the ability to turn into a cancer cell. If this new hypothesis is correct, and if it is true that there are only a finite number of cells that can generate a tumor, it may be easier to find and destroy them. Itâ€™s also possible that only the tumor stem cellsâ€”and not any of the other cancer cells inside the tumorâ€”are capable of metastasizing. (Sort of like how, in a beehive, only the queen can start a new hive, although the worker bees make up the bulk of the hive.) Since these cells live in the milk ducts, this may be a perfect approach for intraductal therapy. Not ready for prime time, but itâ€™s likely to be important in the future.Â
Exercise and Breast Cancer On the clinical front, Leslie Bernstein, MD, a professor of preventive medicine at the University of Southern California in Los Angeles spoke about exercise and breast cancer. Dr. Bernstein has been studying exercise for decades, and her research has demonstrated that not only can exercise help prevent breast cancer but it may also help prevent a recurrence as well. In fact, a recent publication confirmed that it is better to be fit and fat than thin and a couch potato. So, start exercisingâ€“whether that means going for a walk, a swim, taking the stairs instead of the elevator, or joining a gym! And itâ€™s good for your bones and heart, too!
HRT and Breast Cancer Risk
Researchers discussed the HRT story and what we have learned from that experience. As someone who started talking about the potential dangers of hormones early on (and before it was popular to do so) it was both dramatic and comforting to hear how in the year after the Womenâ€™s Health Initiative was stopped, the incidence of ER-positive breast cancer went down 7% in women over 50. This finding has now been confirmed by other studies both in the U.S. and in other countries. In addition, it also seems to be true regardless of what estrogen and progestin combination you took. Estrogen alone (which is used by women who no longer have a uterus) may not be as dangerous. Scientists are still trying to understand why this appears to be true.
Treatment Side Effects
Charles L. Loprinzi, MD, an oncologist at the Mayo Clinic College of Medicine in Rochester, Minnesota, who has conducted extensive research on the best way to treat breast cancer treatment side effects provided an update on what is known and what is now being studied. He reviewed the current recommendations for vaginal dryness and then talked about a randomized trial he is starting that is testing the effectiveness of pilocarpine, a drug currently used to treat glaucoma, that earlier studies have suggested might be effective.
Finding a way to increase libido has not been easy. Dr. Loprinzi said that their trial of transdermal testosterone found that there was a significant improvement in libido of 5-9% whether women were taking the drug or the placebo. Maybe just being in a study is the answer!
Dr. Loprinzi has been the leader in looking at the use of antidepressants to reduce hot flashes. A recent study he conducted on Venlafaxine (brand name Effexor) found that women who took 75 mg/day reported it reduced their hot flashes by about 40-60%.
He also reported that there is data suggesting that ginseng may be beneficial for fatigue, and that is being studied further. And although it sounds somewhat counterintuitive, studies have found that exercise appears to be the best treatment for fatigue. Yet another reason to get off the couch and build up a sweat!
Lastly, he reported that a few studies have found that vitamin E may be useful for treating neuropathy, a side effect that is especially common in women who have had a chemotherapy regimen that includes a taxol.
The news about ginseng and vitamin is especially significant because it shows that there is finally is growing interest in addressing the collateral damage of our breast cancer treatmentsâ€” and not just with new drugs! This is great!
More to comeâ€¦.