Beating The Odds
Finely tuned diagnoses and targeted drugs are creating optimism about surviving breast cancer
Heraleen Broome's breast cancer had spread to her lungs by 2003, and chemo wasn't working. "I was packing up everything to give it away," the 68-year-old remembers. "And then I decided to unpack and keep my stuff." She joined a trial of Avastin, and 11 tumors in her lungs became three. Every three weeks she drives from her home in Oakland, Calif., to San Francisco for treatment, and the people there are so familiar that it has become a social event.
Related News
It's not yet clear whether Avastin will ultimately improve survival rates in breast cancer, but the early reduction in recurrence reminds some of early data on Herceptin. The drug will also be studied in patients with earlier disease. In those early stages, it's not a case of throwing everything at a patient and seeing if it works. For one thing, chemo already has severe side effects. Even the new advance, docetaxel, increases the risk of diarrhea and mouth sores, though it produces less nausea and vomiting. And targeted drugs have their own downsides. Herceptin, for example, can cause heart problems in a small percentage of patients. That's important, since statistically many women who might take the drug would very likely have their cancer driven away by chemotherapy and surgery alone.
Lifestyle changes. The inevitable risk and expense of drugs explain why doctors were excited about another study, one that suggested for the first time that for some women a low-fat diet might actually reduce the odds that cancer will return. This is the first time that diet has been identified as a tool that survivors can use to protect themselves against the return of cancer; another study showed that even a little exercise can also extend survival (though a healthy lifestyle is no guarantee of beating the disease). "In general, I'm saying to a survivor: There's good data that you should clean up your act after a diagnosis," says Susan Love, a surgeon at the University of California-Los Angeles medical school and author of Dr. Susan Love's Breast Book. "Eat a low-fat diet with lots of fruits and vegetables that's low in animal fat." And unlike drugs, there are no potentially hazardous side effects. It's an easy thing for women to do. "To me, it's a no-brainer," says Larry Norton, deputy physician in chief for breast cancer programs at Memorial Sloan-Kettering Cancer Center in New York.
The flood of good news brings complexity to the field of breast cancer and to patients, making early detection and good care crucial. Right from the beginning, it's important to make sure that women have access to screening and proper treatment, says Lichtenfeld. There is also confusion for women struggling to figure out what it all means. Even beyond biology, says Weiss, every woman's breast cancer diagnosis is unique--who she is, how old she is, her social status, her education, her religious beliefs. Her style of making decisions is different, her insurance access is different, and her team of doctors is different.
With all the developments, "you now need an up-to-date doctor who knows the pros and cons of all these therapies," says John Mendelsohn, president of the M. D. Anderson Cancer Center in Houston. News filters down fast, but Weiss urges newly diagnosed patients to make sure their tumors are tested for hormone receptors and for HER2. Take the time to figure out the best course of treatment for your disease. "There is some sense of urgency, but you don't have to decide overnight what to do," says Weiss. And get a second opinion, suggests Rebecca McMenamin, 43, diagnosed with breast cancer last fall. "Even if you have a great doctor, it's reassuring to hear someone else tell you the same thing."
advertisement
