Transcript Slide 1
Why can’t we prevent breast cancer? • Actually, we can … • The treatment can be worse than the disease – The preventative can be worse than the risk • Topics – Chemoprevention as a case study – The role of advocates – Current prevention research Outline of Today’s Session • John Park – Brief introduction to breast cancer prevention issues – Brief introduction to breast cancer advocacy at UCSF • Hannah Klein Connolly – Advocate’s perspective • Jeff Tice – Risk factors and risk assessment – Diet and other lifestyle factors • Mary Beattie – Hereditary risk – Hormones Chemoprevention = use of drug treatment for disease prevention - In breast cancer, chemoprevention has been based on the well established importance of estrogen pathways in disease pathogenesis OCH 2 CH 2 N CH 3 CH 3 N O O S OH Tamoxifen Raloxifene NSABP-P1 Breast Cancer Prevention Trial • 13,388 women – > 35 yo without any breast cancer history – “High risk”, i.e. Gail risk >1.7% 5-yr • Randomized to 20 mg tamoxifen vs. placebo • Stopped after average of 4 yrs Tamoxifen reduced risk at all ages Placebo Tamoxifen Rate per 1,000 8 6 4 2 0 ≤49 50 - 59 Age (years) ≥ 60 Fisher, et al. JNCI 1998;90:1371 Multiple Outcomes of Raloxifene Evaluation (MORE) • 7,705 postmenopausal women with osteoporosis • 60 or 120 mg raloxifene vs. placebo • Followed 4-6 years S Cummings Raloxifene reduces the risk of invasive breast cancer % of participants 2.0 1.5 Placebo 72% P<.00001 1.0 0.5 Raloxifene 0 0 1 2 3 Years 4 5 Cummings, et al JAMA 2000 Cumulative Incidence of Invasive and Noninvasive Breast Cancer Vogel, V. G. et al. JAMA 2006;295:2727-2741. Copyright restrictions may apply. Why don’t we prevent breast cancer? • Level 1 evidence with two approved drugs: tamoxifen, raloxifene • Other drugs: aromatase inhibitors? • Toxicities are modest in the cancer treatment setting • Bottom line: chemoprevention is highly problematic for most women Advocacy Core Advocacy Core Mission • Mission: Provide peer advocacy support to the SPORE researchers, breast cancer patients, and the community at large by supporting and advancing projects that promote translational research. Bay Area Breast SPORE 10 Advocacy Core Core Areas of Focus • Education & Outreach – Forums & community groups that promote communication, education, and awareness between researchers, patient advocates, and the public • Tissue Core – Review of the use of the tissue collected from breast cancer patients – Representation at Tissue/Outcomes Core Meetings • Clinical Trials – Protocol/consent review & development – I-SPY II Trial • Policy Issues & Strategic Planning – Discussions with investigators involving ethics in research and future directions Bay Area Breast SPORE 11