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New Day, New Hope

Exciting advances in breast cancer treatment and research have given women reason for optimism. Though many questions remain, the future looks bright.


Leave it to the outspoken breast surgeon Susan Love to sum up the state of breast cancer treatment these days. "If you think you know what's going on, you don't."

It's been that kind of year in the field of breast cancer. Several major announcements of promising prevention avenues and treatments have given patients and doctors something to celebrate--and much to absorb. And, with additional advancements on the horizon, things will continue to be confusing for a while.

Over the years, it was Love who reminded everyone of the dismal state of breast cancer treatment by referring to surgery, radiation and chemotherapy as "slash, burn and poison."

The recent advances, however, would appear to escape that tart description. They include a new medication for women with severe breast cancer (Herceptin) and evidence that two medications already available may work to prevent breast cancer (tamoxifen and raloxifene).

Moreover, there is major research aimed at understanding the genetic underpinnings of breast cancer that could lead to additional new treatments within just a few years, says Dr. Dennis Slamon, director of the Revlon/UCLA Women's Cancer Research Program and a principal investigator of Herceptin.

"In the next 24 to 48 months, how we treat many of our cancers is going to change dramatically," Slamon says.

Increasingly, researchers are unlocking the secrets of particular genes that play a role in the development of breast cancer, says Anna Wu, a research scientist at the Beckman Research Institute at City of Hope National Medical Center in Duarte.

"We are on the verge of an explosion in understanding these genes," says Wu, who predicts there will be a range of "biologically based therapies," those based on the role genes play, within the next five to 10 years.

However, with each new discovery, researchers become more enlightened and confounded by the genes involved in cancer development. Some genes, called oncogenes, are involved in unregulated cell growth, while tumor suppressor genes are involved in regulation of cell growth.

Herceptin, the drug approved by the Food and Drug Administration last month, is based on the idea that a protein called HER-2/neu causes the unchecked growth of cancer cells. Another exciting area of research involves medications that address angiogenesis, which can cause a tumor to develop new blood cells, allowing it to grow and spread.

Random Mutation Complicates Things

"Cancer is a disease of unregulated growth," Wu says. "Of key importance in the development of cancer is the presence of cells that decide to divide or not to divide. But there are so many genes involved. It's very complex. That is why there is no one cure. One hundred women with breast cancer will have 100 different pathways of disease because of random mutations of genes."

Thus, there is no talk these days of a "cure" for cancer. Indeed, there may be many ways to contain the disease and limit cells from growing and metastasizing, which is when the cancer spreads from its site of origin to other organs of the body.

"I think we're moving into a new paradigm of breast cancer," says Love, adjunct professor at the UCLA School of Medicine and the author of several women's health books. "The new idea is to control cells instead of kill them. It's a shift of mind-set."

But where does that leave women with breast cancer--or those at high risk for the disease--now?

"All this news is exciting, but a lot of women are faced with questions," Love says. "So much of this is a work in progress."

With each new advance, she adds, "People say, 'This is the answer.' But these aren't the answers. This is our best guess at the moment. So stay tuned, because there is a lot of stuff going on."

For now, women and their doctors need to be aware that there are more options in fighting the disease--and that there is a greater need than ever before to keep pace with current thinking.

One of the most urgent controversies in breast cancer now centers on whether women who are at high risk for the disease should begin taking either tamoxifen or raloxifene to prevent the disease.

Tamoxifen (Nolvadex is the brand name) has long been used to treat women with breast cancer. A five-year study to examine whether it could prevent the disease in high-risk women was halted this year--one year early--after collecting ample evidence that the drug reduced the risk of breast cancer by 49%. This is the first study to show that a drug may be effective in preventing the disease.

Last month, an FDA advisory panel urged the agency to approve tamoxifen for prevention. The FDA, however, has not ruled on the matter, and controversy over tamoxifen's role in prevention is very much alive.

Experts have raised such questions as:

* Do the risks of tamoxifen outweigh the potential benefits? The drug increases the risk of blood clots and uterine cancer, although uterine cancer is considered easier to successfully treat than breast cancer.

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