The Right Questions The New Answers: Advancements in breast cancer research and treatment

BY Stephanie Miller


E-mails arrive weekly from friends and family; attached are warnings of newly discovered causes of breast cancer. One e-mail claims that placing water bottles in the freezer causes breast cancer. Johns Hopkins University is listed as the source of that information. A click away is the Johns Hopkins Web site which shows the information to be a hoax.


“Thousands of articles get published a year on breast cancer ” says surgical oncologist Dr. Elizabeth Weinberg of Coastal Surgery Specialists. “You really have to make sure what you’re reading is backed up by solid scientific evidence.” Such solid scientific evidence comes after looking at patients after the two- five- and 10-year marks which means that even legitimate sources may not have all the data necessary for women to make the most informed decisions.


The questions then for women here on the Azalea Coast are: Where does the average woman go to stay up-to-date and what’s new in Wilmington that has this kind of heavy-hitting research behind it?


RADIATION ADVANCES


Local oncologists are eagerly awaiting the imminent arrival of a MammoSite device for use in some women undergoing a lumpectomy. This internal radiation therapy delivery system — a spherical balloon catheter inserted into the cavity created by surgical removal of the breast tumor — is an option for breast conservation therapy. During a five-day course of therapy a tiny radioactive seed attached to a wire is inserted into the balloon delivering predetermined levels of radiation under precise computer control to the targeted tissue surrounding the cavity. No source of radiation remains in the woman’s body between treatments or after the final procedure.


“Radiation takes place for five days in one week rather than once a day for 25 or 30 treatments ” says Dr. Patrick Maguire of the Zimmer Cancer Center and New Hanover Radiation Oncology Center. This type of treatment partial breast irradiation (PBI) minimizes the amount of radiation to the healthy portion of the breast tissue.


“The preliminary data shows that the local recurrence rate is going to be as good as whole-breast radiation ” says Dr. Weinberg. “But we do not have the five-year data on that. The jury is still not quite in yet on that.”


CUTTING-EDGE MEDICATION


And on the national scene just in are results from the STAR (Study of tamoxifen and raloxifene) trial a massive breast cancer trial which began in 1999 throughout North America. The results released in June of this year provide a very exciting piece of the puzzle in the fight against breast cancer. The NSABBP (National Surgical Adjuvant Breast and Bowel Project) study examined the effects of tamoxifen and raloxifene on prevention of cancer in postmenopausal women at high risk of breast cancer (examples of women at high risk are women who have precancerous changes on a biopsy or close family members with breast cancer).


The study concludes that raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer with fewer side effects including risk of stroke. Although the FDA has not yet approved raloxifene for use in cancer its approval is imminent.


“Thus while not all high risk women choose to take a medication for prevention nor are all women candidates for this strategy both of these agents give us options for prevention of breast cancer ” says Dr. Kenneth Kotz oncologist at Hanover Medical Specialists.



GENETICS COUNSELING


Some Wilmington-area physicians don’t need a national study to make a change. Less than a year ago Dr. Weinberg’s patients had to travel to Chapel Hill Duke or East Carolina University for genetics counseling. Now Dr. Weinberg does this work in her office. Women with a strong family history of breast cancer and a physician’s referral are candidates for genetics counseling. The procedure is straightforward enough with a simple blood withdrawal. More important is what women do with this information.


“A lot of women don’t want to know. They think they are tempting fate with this information but doctors are becoming more aware that you need to look into a patient’s family history because that can drastically alter the type of treatment she is going to receive ” says Dr. Weinberg. “If you test positive for mutation there is up to an
80 percent chance of developing breast cancer in your lifetime and a very high risk of developing one on the other side. So a lot of those women may choose a bilateral mastectomy and a lot of them will end up choosing bilateral
oophorectomy (removal of the ovaries) as there is up to a 40 percent chance of ovarian cancer too.”



DIGITAL DETECTION


Detection is also making advances in the form of digital mammograms. A 2005 study of more than 40 000 women shows digital mammograms to be more accurate than traditional film-based X-rays in diagnosing breast cancer in women under 50. Though Dr. Etta Pisano director of the Biomedical Research Imaging Center at the University of North Carolina in Chapel Hill writes that this doesn’t mean women should “rush out to get a digital.”


Additionally new computer software has revolutionized the way information gets to the patient. Dr. Kotz uses Web-based programs to illustrate to his patients how the cure rate changes with or without chemotherapy. “For many patients the fear of chemotherapy could be balanced by a better understanding of the benefits of chemotherapy ” says Dr. Kotz.


Using these programs the oncologist enters the patient’s age and other information about her health and her particular breast cancer. “An interesting feature of these programs is their ability to show in numerical fashion how a patient’s age and other medical problems affect the decision-making process. For example a person with a serious heart condition may decide against chemotherapy to help cure her breast cancer if her chance of dying from heart disease and old age significantly outweighs the danger from the cancer.”


TAILORx


According to Dr. Cyrus Kotwall director of the Zimmer Cancer Center at New Hanover Regional Medical Center chemotherapy itself is being examined under a microscope. A trial launched in May 2006 TAILORx — the Trial Assigning IndividuaLized Options for Treatment (Rx) — will examine whether genes that are frequently associated with the risk of recurrence if and when found in women with early-stage breast cancer can be used to assign patients to the most appropriate and effective treatment. Sponsored by the National Cancer Institute it is one of the first trials to examine a methodology for personalizing cancer treatment. The trial will enroll more than 10 000 women at 900 sites in the United States and Canada.


“This trial will help us tailor who we give therapy to ” says Dr. Kotwall. Chemotherapy doesn’t benefit every woman in the same way. This trial aims to find out who benefits and who may not. TAILORx may spare women the morbidity and costs of chemotherapy if it does not substantially benefit them.


Other researchers are reviewing an entirely different method of treatment from chemotherapy. They are looking at ways to attack the blood vessels that feed the cancer. One such drug bevacizumab is already on the market and approved by the FDA for colon and lung cancer. “Although not approved for breast cancer ” says Dr. Kotz “it is anticipated that this drug will be used with increasing frequency for breast cancer treatment in the future.”



RETHINKING RECONSTRUCTION


The final piece to the puzzle is in the area of breast reconstruction. Plastic surgeons in Wilmington have been making huge strides in this area over the past year.


One of these important strides is the release of permanent silicone implants to the general public says Dr. Charles Kays of Wilmington Plastic Surgery. “Prior to six to seven months ago they were available as part of a study.”


The silicone is softer has a more natural feel and ripples less than saline implants he adds. The silicone is now made of a cohesive gel. “If you chopped it (the implant) in half with a big meat cleaver and you held it up ” says Dr. Kays “the gel would not leak out of the implant.” This solves the earlier problems of silicone leaking into the breast tissue or outside of the implant.


Many women are still choosing reconstruction flaps rather than implants. The newest of these techniques DIEP (deep inferior epigastric perforator) flap surgery is being done at large university medical centers like Duke due to the requirement for a large team of doctors to work on the microsurgery. The DIEP flap uses skin fat and blood vessels rather than muscle to recreate the breast.


Plastic surgeons often discuss cosmetic options along with all the other options before the patient even goes in for surgery. Today’s patients most often get a diagnosis before they enter the operating room. “It makes for better care when the circumstances allow for patients to know their diagnosis before they go in for definitive treatment ” says Dr. Weinberg.


Although things do not change drastically in one year today’s breast cancer patients are getting better care than ever before. “The future of oncology is exciting ” says Dr. Kotz. With all these advances breast cancer survivors are looking and feeling better than ever.






Somebody to lean on


Lump to Laughter provides support and raises awareness of the spiritual and emotional journey through breast cancer sharing stories of hope faith and grace that sing victory not death. They meet the last Tuesday of the month at the Fox Run Farms community clubhouse off College Road from 7-9 p.m. For more information contact Connie Hill at (910) 617-4455 or visit www.lumptolaughter.com.



Started by Amy Mathews after she was diagnosed with breast cancer at age 35 — she’s 39 now with a 5-year-old at home — The Girls meet on the second Tuesday of the month at different locations usually for dinner. “We might talk about the latest advancements in breast cancer treatment ” Amy says “or we might just laugh about life and how excited we are to live it.” For more information contact Amy at (910) 799-6684 or e-mail her at [email protected].






Pretty (Impressive) in Pink


With your help New Hanover Regional Medical Center President and CEO Jack Barto will wear a pink suit.


The New Hanover Health Network is the ninth largest health care system in North Carolina with a dedicated team of 4 700 employees 490 physicians and 760 active volunteers. It encompasses the New Hanover Regional Medical Center Cape Fear Hospital and Pender Memorial Hospital and offers many specialty centers and services a partial list of which includes Emergency/Level II Trauma Children’s Health Behavioral Health Rehabilitation Community Outreach Orthopedics Heart Imaging/X-ray-CT-PET Women’s Health and Cancer. Positioned at the very top of this imposing and important health care pyramid is Jack Barto president and CEO.


Barto has been in Wilmington for just 3 ½ years. He came from a Catholic health care system in Illinois and rapidly fell in love with the Azalea Coast. “I have been unbelievably impressed with the quality of the professionals the physicians and the staff that work at the hospital. It’s a talented talented group of physicians you don’t find in a community this size. And the people I’m blessed to work with on a day-to-day basis the nurses the technicians the food service people the housekeepers the support folks my staff … they all do a remarkable job.”


Cape Fear Hospital is in its 50th year of operation and New Hanover Regional Medical Center has been in its current location for 40 years. Since 1967 365 days a year 24 hours a day year after year the hospital doors have never closed. To manage this vast round-the-clock operation Barto calls on his 25 years of health care administration experience none of which has ever included wearing a pink suit … until now.


Among the most important fundraisers within the New Hanover Health Network system is the Pink Ribbon Breakfast Lunch and Dinner. Since its inception in 1998 the Pink Ribbon has raised more than $700 000 and provided more than 3 200 “Comfort Bags” to area women as they undergo treatment for breast cancer. Distributed by the Zimmer Cancer Center and local physician groups the Pink Ribbon Comfort Bags are designed to bring comfort to women as they travel the demanding physical and emotional road of their cancer journey.


“We provide bags which hold inspirational materials information that they need during their fight to each newly diagnosed individual who has breast cancer ” Barto says. “That’s the purpose of the Pink Ribbon to help raise awareness and funds for the fight. We are also very actively involved with our mobile cancer screening van with which we provide mammography screenings to low-income women throughout southeast North Carolina.” In 2006 in fact the Pink Ribbon funds provided screenings for more than 280 women.


What does all this have to do with the pink suit?


Last year because of its popularity and overwhelming success a breakfast was added to the existing luncheon and dinner and the Pink Ribbon event raised more than $117 000. Frances Weller came up with the idea that if the New Hanover Regional Medical Center Foundation raised $10 000 Barto would wear a pink suit not just to the event but all day long to work as well as to all the Pink Ribbon events.


“Frances is our Mistress of Ceremonies ” Barto says “and does a wonderful job and she was being playful and came up with this idea and I said I’d be happy to do it. Everyone always shows up in such gorgeous shades of pink that day I said ‘If we raise the money next year I would be happy to wear a pink suit.’ Someone put up $2 000 and it’s up to the foundation now to go out and find some more people to assist. My staff I’m sure will get involved in helping to do that.”


A local producer offered to supply a costume designer to assist with creating a pink suit for Barto and numerous supporters have offered to help rent a pink ensemble if one can’t be created. “There are definitely opportunities for me to wear a pink suit ” the CEO says with one of his customary smiles.


“With breast cancer being such a devastating disease — outside of the skin diseases clearly the most prevalent cancer for women — anything we can do to help in that fight that’s what we have to do ” Barto says from his heart. “It’s always a wonderful experience and it’s probably the most uplifting event I go to on an annual basis just because so many individuals who have fought the disease and are winning and have won sit in that room in bright colors and it’s just truly symbolic of the spirit that’s out there.”


The incredible success of the Pink Ribbon event has not only provided early diagnosis opportunities and emotional comfort to many area women but has helped raise community awareness as well.


Barto explains that everyone involved with breast cancer is forced to leave their comfort zone at some point along the way and for him the pink suit represents the step outside of that comfort zone.


“For me to wear a pink suit that day to bring attention to this disease and the brave people who are fighting it and the hardworking professionals who are helping to treat it if I help one person in that process even remotely it’s been the most successful day I’ve had in a long time.”


The 10th annual Pink Ribbon Breakfast Luncheon and Dinner will be held this year on October 11 at the Holiday Inn SunSpree on Wrightsville Beach. To help Jack Barto put the pink suit on contact the New Hanover Regional Medical Center Foundation at (910) 815-5042.






What’s in the Comfort Bag?


• Love Medicine and Miracles an inspirational book by Bernie Siegel MD.


• There’s No Place Like Hope a guide to beating cancer by Vickie Girard.


A small pillow sewn by volunteers from the New Hanover County Senior Center for use as an armrest during chemotherapy and as a cushion between the seat belt and chest after surgery.


A Pink Ribbon Daytimer calendar to keep track of appointments and write down questions for the doctor.


A soft toothbrush and starlight peppermints to help prevent mouth sores during chemotherapy.


A satin pillowcase for comfort after hair loss.


An herbal eye pillow to help with relaxation.


• The Satin Pillow a book of helpful nonclinical information and resources.