In this Breastcancer.org podcast, Brian Wojciechowski, M.D., Breastcancer.org medical adviser, discusses some of the research that was presented at the 2014 San Antonio Breast Cancer Symposium. Listen to the podcast to hear Dr. Wojciechowski explain:
- results of a study that found that Aromasin plus ovarian suppression reduced recurrence risk better than tamoxifen plus ovarian suppression in some women diagnosed with early-stage, hormone-receptor-positive disease
- research that underscored the long-term benefits of tamoxifen for reducing risk in women with a higher-than-average risk of breast cancer who’ve never been diagnosed
- a study showing that Faslodex worked better than Arimidex as a first treatment for women newly diagnosed with advanced-stage breast cancer
- research conducted in part by Breastcancer.org that shows that breastfeeding, even for a short time, reduces breast cancer risk more than previously thought
- why a low-fat diet improved survival in women diagnosed with hormone-receptor-negative breast cancer
Running time: 16:01
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Show Full Transcript
Jamie DePolo: Hello everyone. This is Jamie DePolo. I'm the senior editor here at Breastcancer.org, and my guest today to talk about some of the research that was presented over the last few days at the San Antonio Breast Cancer Symposium is our medical adviser, Dr. Brian Wojciechowski. Welcome, Dr. Brian. How are you today?
Dr. Brian Wojciechowski: I'm very well. How are you, Jamie?
Jamie DePolo: I'm doing well. So, we have quite a few studies to talk about today. I think we're going to talk about five or six, so we'll just get right to it. There was lots of research that came out or that was presented at San Antonio at the Symposium this year. One of the biggest ones, I think, that got the most media coverage, there was a study that looked at using the aromatase inhibitor Aromasin along with ovarian suppression in premenopausal women who were diagnosed with early-stage breast cancer. And if I'm remembering correctly, it looked like the researchers found out that using Aromasin plus ovarian suppression reduced the risk of recurrence more than using tamoxifen plus ovarian suppression, and some people have said that this could be practice-changing. Can you explain why this might be and what the benefits might be?
Dr. Brian Wojciechowski: Yeah. So, this study was very interesting, and I do agree that the results can be practice-changing. Basically, when a premenopausal woman has breast cancer, we know that if she gets chemo and her ovaries stop functioning, meaning she goes into a premature menopause, she actually does better in terms of breast cancer survival. And that's because the ovaries have shut down the production of estrogen -- which, estrogen feeds ER/PR-positive tumors. So with this knowledge, the investigator said, “Well, what if we suppress the woman's ovarian function and therefore, make them postmenopausal with medication or by taking out their ovaries or doing radiation to get rid of the ovaries.” Okay? So, that's what they did, and we're going to treat some women with tamoxifen and ovarian suppression and some with Aromasin and ovarian suppression. And Aromasin, of course, is more appropriate for postmenopausal women. And some women just got tamoxifen and no ovarian suppression.
And what we found out was that there were basically two groups of women in the study. One that seemed to benefit from ovarian suppression and one that did not benefit. The group that did not benefit were premenopausal women who were a little bit older and who had low-risk tumors and who doctors felt that chemotherapy was not indicated. Those women did not benefit from the ovarian suppression. The group that did benefit, however, were younger women with breast cancer who did have higher-risk disease that they were felt to benefit from chemotherapy. So after those women got chemotherapy, if their ovaries were still functioning, they suppressed the ovaries and gave the women either tamoxifen or Aromasin. And they found out that the women who got tamoxifen and ovarian suppression did better than tamoxifen alone, and the women who got Aromasin and ovarian suppression did better than the women who got tamoxifen and ovarian suppression. They did significantly better.
So, I think for the young group of patients who have high-risk breast cancer for whom chemotherapy is important who then go on to keep their ovaries functional, that this will be practice-changing for that group of women, because then they should have their ovary suppressed by either surgery, radiation, or medication, and they should get Aromasin, not tamoxifen.
Jamie DePolo: And are these women then taking Aromasin, is it for 5 years, is it the normal course of hormonal therapy? Do we know?
Dr. Brian Wojciechowski: So, I think in this study, they took it for 5 years. So, I think if I was… And actually the follow-up for this study is only 5 years, so we don't know what's going to happen in the next 5 years with the patients. I think in my patients who are in this situation, based on this data, I would probably start with 5 years of Aromasin and then put them on tamoxifen for 5 years after that.
Jamie DePolo: Okay. Okay. That's good to know. That's good to know. And I know one thing, too, the investigators said they were going to continue the study, continue to follow the women and look at quality of life and side effects, too, because as we all know, there are side effects associated with both tamoxifen and the aromatase inhibitors. In some women, the side effects are so severe they stop taking the medicine. So that will be interesting to see those results as well as this study continues.
Dr. Brian Wojciechowski: Right. You worry about thinning of the bones and that sort of thing in this younger population.
Jamie DePolo: Okay. So that was some very, very interesting research. There was another study that, actually, Breastcancer.org was involved in. Dr. Marisa Weiss, our president and founder, presented this study as a poster. And this study looked at breastfeeding and its ability to reduce the risk of breast cancer. And I do know that it was a meta-analysis, so it looked at a lot of different studies, and it found that breastfeeding actually reduced the risk of breast cancer more than other studies had found. So, that's something that certain women can do if they are so inclined, and the benefits may be greater than have been seen before.
Dr. Brian Wojciechowski: Right. And I think we've known about the benefit of breastfeeding in terms of breast cancer. But this is a very large, very good study, and as you said, the result was better than expected. And breastfeeding, for women who've had children, it's free, there's benefits for the mom and the kids, and -- I looked at one statistic where in Great Britain, only about 1% of women who were having babies were breastfeeding for the recommended 6-month period of time. And I think anything that is so inexpensive and has such an upside really needs to be encouraged. And there's weird social stigma about it, and I'd just like to see us all get past that and just encourage more women to breastfeed if they can.
Jamie DePolo: Definitely. And I think the other thing that was interesting that came out of this research, it was really the first time that research has shown and confirmed that breastfeeding -- even for a short time, so even if women did not breastfeed for the recommended length -- they still got benefit from it. So, even breastfeeding for a short time is better than not breastfeeding at all, according to these results.
Dr. Brian Wojciechowski: Agree totally.
Jamie DePolo: Another study… Now, this study confirms, I think, what we've already known, and that was that tamoxifen offers long-lasting risk reduction for women. It kind of confirms what we've known that if you are a woman who has a higher than average risk of breast cancer and you decide to take tamoxifen to reduce that risk, these benefits are going to be very long-lasting. I believe it was up to 20 years, according to the study.
Dr. Brian Wojciechowski: Yeah. And the great thing about it is, a woman's only taking tamoxifen for 5 years, and this study really confirms that the affect lasts much, much longer than that. So, the way I'll use this in my discussions with women regarding prevention with tamoxifen is it's the gift that keeps on giving, and even after you're done taking the medication, the effect lasts really long. So yeah, I'm very excited about this study.
Jamie DePolo: That's great. And that confirms, too, that for women who are taking tamoxifen, they may be at high risk, that you can feel good about what you're doing, because you're really helping yourself in that way.
Dr. Brian Wojciechowski: Yeah.
Jamie DePolo: Okay. And sort of sticking with hormonal therapy, then there was another study looking at women who had been diagnosed with advanced-stage breast cancer, and it found that for these women, for the first treatment, when they've just been diagnosed with advanced-stage disease, that Faslodex seemed to offer better survival than Arimidex.
Dr. Brian Wojciechowski: Right. Right.
Jamie DePolo: Now, is that surprising or have we kind of known that?
Dr. Brian Wojciechowski: I'm a little surprised by it. So, when a woman is diagnosed with metastatic breast cancer and she hasn’t been treated yet, we usually start her on hormonal therapy. And that could be Aromasin, Femara, Arimidex. And the general consensus has been that one is not better than the other. So now, we have the phase II study, which, granted, is an early study and needs to be confirmed by a larger study, but we have this phase II study suggesting that actually, Faslodex may be better. And I think that could be a very big change and could definitely impact the way we treat women with metastatic breast cancer.
Now, you know, if a woman has life-threatening metastatic breast cancer, say, in her lungs or her liver, then she'll start with chemotherapy. So, we're talking about most women who have metastatic breast cancer who do not have disease that is life-threatening or galloping out of control, we can start hormonal therapy out front. And I will definitely await the results of the upcoming phase III trial for confirmation here, but if the phase III trial confirms the results, it will definitely change practice for me.
Jamie DePolo: Okay. And do we have any idea why Faslodex seems to be working better? Does it have a different mechanism of action?
Dr. Brian Wojciechowski: Yeah. It does have a slightly different mechanism of action than the other hormonal therapies, the aromatase inhibitors, so that might have something to do with it.
Jamie DePolo: Okay. Okay. Well that's good to know. And then the last study that we are going to talk about is again looking… Well, not again, but it's actually looking at diet. And there was a study -- we've written about the results of this study several times on this site. It's the WIN study, and it's basically Women's Innovation Nutrition study, which is what WIN stands for. And it's looking at a low-fat diet and its effects on breast cancer, breast cancer risk reduction, risk of recurrence, all those things. And in San Antonio this year, we found out that eating a low-fat diet improves survival in some women diagnosed with early-stage breast cancer. And it seemed that it was much more effective in women who had… was it… what do I want to say… Hormone-receptor-negative breast cancer, not hormone-receptor-positive. So, it seemed like it was really a benefit in these women. And I guess, my question is… I think this is great, anything that improves survival is great. But do we know, can we tease out whether it was actually eating the low-fat diet? Or was it because these women were eating a low-fat diet, and they almost all lost weight on this diet, was it the weight loss or was it actually the low-fat diet that improves survival?
Dr. Brian Wojciechowski: I think it's very hard to know for sure. I will say that the results are somewhat counterintuitive. We know that obesity increases the levels of estrogen in your body, and that would, I would think, contribute to worse outcomes for ER/hormone-receptor-positive cancer. So, it's a little surprising that the women who decreased their fat intake had more of a benefit for hormone-receptor-negative cancer.
Jamie DePolo: That is interesting.
Dr. Brian Wojciechowski: So, that could be an effect of weight. That could be an effect of lower fat intake. It could also be an effect of just generalized better health when you lose weight, because we know that obesity is associated with heart disease, diabetes, hypertension, some of which could also potentially contribute to the development of breast cancer. But the bottom line is we all should be eating a healthy diet and trying to get down to a healthy weight, and the benefits go way beyond breast cancer prevention, too.
Jamie DePolo: Right. Yeah, when you say that, that is very interesting that the effect was more pronounced in women diagnosed with hormone-receptor-negative disease, because yeah, fat does store estrogen. That's very interesting.
Dr. Brian Wojciechowski: Yeah. I'm scratching my head about it right now, but hopefully when we see the full publication they might tease that out for us.
Jamie DePolo: Yeah. Maybe they'll talk about it. I do know that the women lost about 6 pounds on the diet. So, I mean, for anybody out there who’s thinking, “Oh, you know, it's impossible to lose weight, it's really hard,” according to this study… And tell me if I'm wrong, Brian, I mean, it sounds like you don't even have to lose that much weight, it's just that…
Dr. Brian Wojciechowski: Well, honestly Jamie, 6 pounds is not a lot of weight, and I'm more inclined to think that if you're losing an average of only 6 pounds, that's negligible. And so I'd be tempted to say it probably wasn't the weight loss and probably the low-fat diet.
Jamie DePolo: So okay. So maybe it was the…
Dr. Brian Wojciechowski: Based on that. I mean, that's not a scientific conclusion, but that's a gut feeling I have.
Jamie DePolo: Okay. So maybe there's something about the fat that's affecting it. I don't know. And then, of course, we could go into, “Well, what kind of fat were they eating,” we don't know. So, I always have all these questions about nutritional and food studies, because it's never as easy as it sometimes appears on the surface. But it is good to know that this low-fat diet did seem to improve survival, and, as Dr. Brian said, we will await the full publication of this so maybe we can get some of our questions answered.
Dr. Brian Wojciechowski: Yeah. It will be nice to reexamine that when it comes out.
Jamie DePolo: Right. Well, thank you so much, Dr. Brian. That's been our wrap-up from San Antonio this year. There're several interesting studies, and definitely stay tuned. We'll probably be talking about a few more as more results come out on our January Research News podcast. So again, Dr. Brian, thank you so much, and we will talk to you again next month.
Dr. Brian Wojciechowski: Okay. Very good. Take care, Jamie.
Jamie DePolo: Okay. You, too.