Editor's Note: Julie Silver, MD, contributes to the LIVESTRONG.COM blog through her new column, "Have You Heard?"
The media is flooded with information about breast cancer, especially in October—breast cancer awareness month. The attention that breast cancer gets is terrific and helps many women (and men!) who are survivors. However, sometimes there is so much information that it’s hard to figure out what is really new, relevant and important. I asked one of my colleagues, Dr. Ken Miller, who is an oncologist at Dana-Farber Cancer Institute and the author of the book "Choices in Breast Cancer Treatment," about three of the most important advances in breast cancer care in the past year. Here’s Dr. Miller’s top three list:
1) Some very interesting data emerged on the role of the bisphosphonate drugs. A study was conducted on two groups of women. In women who are premenopausal and received ovarian suppression (Lupron or Zolodex) we learned that Tamoxifen or Arimidex added to that were equivalent but in both groups of women the addition of Zometa (Zoledronic acid) reduced the risk of recurrence by over 30%. The interesting thing here is that Zometa as a bone active drug might reduce the risk of bone metastases and also reduce the risk of metastasis to other parts of the body.
2) We have learned even more about the role of exercise and a low fat diet in reducing the risk of recurrence. There was a belief that having a leaner bodyweight would benefit women who have estrogen receptor positive breast cancer because the fatty tissue would theoretically be increasing estrogen levels. In actuality we saw that the effect of weight loss on recurrence was greater in ER-/PR- breast cancer and now we are wondering about the role of the insulin growth factor and growth factor receptor.
3) Many new drugs are being developed for women who have Her 2 Neu positive breast cancer. Herceptin and Lapatinib are on the market. Several new drugs are in clinical trials including one named "TDM1." One drug uses an antibody to hone in on the Her 2 Neu positive cells and deliver with it a second drug which is very toxic to those breast cancer cells. This is like a Trojan Horse!
Over the past 12 months, I've focused on working with hospitals to add cancer rehab to the care continuum. In November 2009, I worked with a team of experts to develop the STAR Program, a multidisciplinary program that helps hospitals and cancer centers quickly and efficiently develop excellent cancer rehab programs. Breast oncologists tend to be very “cutting edge” in their approach to cancer treatment, so it’s no surprise that many of them are recognizing the need to help cancer survivors heal optimally after toxic surgeries and other treatments. We are still a long way from establishing cancer rehab as the standard of care for cancer survivors, but this past year there have been gains in not only prolonging more survivors’ lives but also paying attention to helping them to have the best quality of life possible.
I have personally had the opportunity to work with oncology and rehab teams in many states implementing the STAR Program. Some of the hospitals I have worked with over the past year include Johns Hopkins (Maryland), Glens Falls Hospital (New York), Jupiter Hospital (Florida) and Virginia Baptist and Lynchburg General Hospitals (Virginia). I’ve also worked with hundreds of physical therapists (and occupational and speech therapists) who have become STAR Clinician Certified and are truly experts in cancer rehab. I've seen advancements in Alaska (keep up the great work, Irene Jordet), Connecticut (Wendy Faren Price is certified in both cancer rehab and Pilates—a terrific combination of skills), Georgia (Phillip Palmer is an Associate Professor in the Department of Physical Therapy at North Georgia College and State University) and Kansas (Lisa VanHoose is about as dedicated a clinician as you’ll ever find—the American Physical Therapy Association is lucky to have her as one of their leaders in oncology rehab).
There isn’t enough room to call out all of the clinicians I've been lucky enough to collaborate. These men and women are dedicated to helping survivors recover their health and their lives. This year was filled with many wonderful advances in breast cancer care. I’m looking forward to the amazing things that I’ll be able to report in October 2011. Twelve months isn’t such a long time, but a lot can happen between now and then. Stay tuned!
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