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| health > cancer > story page |         |
Chat transcript: Komen Foundation spreads word about breast cancerJune 2, 1999 (CNN) -- The following is an edited transcript of a chat about breast cancer with Susan Braun, CEO/president of the Susan G. Komen Breast Cancer Foundation, held Friday, May 28, 1999. Chat Moderator: We want to welcome Susan Braun to our chat room. Welcome, Susan! Susan Braun: Hello! Chat Moderator: We are also pleased to welcome CNN Medical Correspondent Dan Rutz, who reports on developments in breast cancer research. Could you tell us a little about the foundation and its role in breast cancer detection and treatment? Susan Braun: The Komen Foundation has the mission to eradicate breast cancer by advancing research, education, screening and treatment. We fund research, and we also do outreach programs to help people better understand what they can do about breast cancer today and how we can find a cure for tomorrow. Chat Participant: Is tamoxifen still used to treat breast cancer when a hysterectomy was performed? I was under the impression that tamoxifen was an estrogen blocker, and if ovaries are not present, then what estrogen does it block? Susan Braun: First, I have to let you know that I am not a doctor. Yes, tamoxifen is still used if a woman has had a hysterectomy (removal of the uterus) or oopherectomy (removal of the ovaries). There is still some estrogen in the body, because estrogen can also be produced by other tissues. It is best to talk to a doctor about how it would work, and if it would work for you individually. Chat Participant: At what age should women start getting mammograms on regular basis? Susan Braun: The Komen Foundation recommends a woman have a baseline mammogram by age 35 and begin regular screening by age 40. If there is any reason, however, for her to think she may need a mammogram or be at risk, she should talk to her doctor about an earlier mammogram. Chat Participant: Are there any new medications that are close to having approval for use? Susan Braun: There are many drugs being tested for the treatment and the prevention of breast cancer. Some of the exciting work is also in the area of biologic therapies that can target a specific tumor. Selective Estrogen Receptor Modifiers (SERMS) are getting a lot of attention right now, because they seem to have very high potential to lower the risk of getting breast cancer. Dan Rutz, Medical Correspondent: How confused do you think American women are over the controversy, in recent years, on the age at which to begin mammography screening? Susan Braun: There has been confusion about the right age to begin screening. Data about to be released by the Centers for Disease Control show that there was a drop in the number of women in their 40s getting mammograms beginning in the early 1990s, when the controversy began. The questions come from whether or not mammography is accurate in younger women, who often have more dense breast tissue, which is harder to "read" on a mammogram. We're excited about the potential for newer technologies that will be more accurate, but still recognize the importance of mammography as a widely available and effective screening tool. Chat Moderator: Can you tell us a little about the STAR trial? It sounds like a promising one. Susan Braun: The STAR trial is the Study of Tamoxifen and Raloxifene. It is being funded by the National Cancer Institute and being conducted by a cooperative cancer research group at several hundred hospitals, clinics and cancer centers around the country. It will test the effectiveness and safety of raloxifene compared to tamoxifen, both of which are SERMS, to prevent breast cancer. Komen serves as a member of the trial's steering committee in a patient advocacy role. Chat Moderator: How many women are going to be involved? Susan Braun: The study design calls for 22,000 women to be enrolled. About half will receive tamoxifen, and about half will receive raloxifene. Chat Participant: I had breast cancer three years ago. My doctor has started me on raloxifene for my osteoporosis. Susan Braun: Raloxifene is a drug approved in the United States for the prevention of osteoporosis. In studies of osteoporosis, it showed some value in reducing the risk of breast cancer. That is why it is being tested in this large study. Chat Participant: What's the current thinking on tamoxifen as a preventive strategy for women in their 30s who have some history of breast cancer in their family? Susan Braun: I can't really comment on this, because most of the data are on women over the age of 35. It is best for woman to discuss this with a specialist with a good deal of experience with breast cancer risk and the drug tamoxifen. Dan Rutz, Medical Correspondent: How would you advise women about keeping their risk of breast cancer in proportion, since surveys show many people overestimate their personal risk? Susan Braun: This is absolutely essential to point out. Women DO often overestimate their risk of breast cancer; in fact, women are much more likely to die from heart disease and from lung cancer than from breast cancer. We think it is critical for women who think they may be at risk to consult with someone who can perform a risk evaluation that is based upon the risk factors that we know of today. It is also very important for women to know that women at increased risk do NOT necessarily get breast cancer, and women with a low risk profile may still get breast cancer. We have a lot more to learn. Chat Participant: Is this study for pre- or postmenopausal women? Susan Braun: The STAR trial is only for postmenopausal women. This is not because prevention is unimportant or irrelevant for younger women, but because raloxifene has not been adequately studied for safety in pre-menopausal women. Chat Participant: How does a woman know if she is at high risk? Susan Braun: There is a model that has been validated by the National Cancer Institute, called the Gail Model, that is used by many doctors (and also by the doctors and centers participating in the STAR trial), that is fairly simple and that calculates her estimated risk based on questions about her personal and family history. Chat Participant: Does the Komen Foundation recommend genetic testing in cases of strong family histories? I was 24 years old when diagnosed with breast cancer. My daughter is now 23 and would like to know, but I am afraid she will have difficulty with insurance coverage in the future. Susan Braun: We do not make a specific recommendation one way or another, as this is a very personal decision. What we do recommend is that if a person decides to be tested they are aware of what legal protection there is or is not about that information and that the testing be accompanied by genetic counseling. Chat Participant: Why is there a big study being done when both drugs are available and doctors can prescribe them to women if they want to? Susan Braun: Doctors may prescribe a drug that has been approved by the Food and Drug Administration (FDA) for either the "labeled indication" or for "unlabeled indications." Usually doctors only prescribe a drug for unlabeled indications when there have been good studies done to show that the drug would work for that patient but the FDA has not yet finished its work to approve it. Tamoxifen has been studied and labeled both for the treatment of breast cancer and to reduce the risk of getting breast cancer. Raloxifene has been studied and labeled for the prevention of osteoporosis in postmenopausal women. During the study, it was observed that women who received raloxifene were less likely to get breast cancer than women who did not receive the drug. It also appeared that raloxifene had fewer side effects than tamoxifen, specifically regarding endometrial cancer. So, long story short, yes, doctors can prescribe either drug for women who have an increased risk of breast cancer. But the large study is being done to find out which drug would be better to take to lower the risk of breast cancer. Only a very large trial will be able to show not only a difference in how well each drug works, but also if one drug has fewer side effects than the other. When one drug has been shown to be effective, as tamoxifen has been shown to be for the reduction of risk of breast cancer, and another drug could be just as effective but safer, the way to prove that is to have a large study of the two drugs in a controlled setting, that is in a randomized, controlled clinical trial. Chat Participant: What are the most recent findings on the correlation between nutrition and risk of breast cancer? Susan Braun: There are some studies that suggest that a high-fat diet may be a risk, but they are not certain. It does seem that weight gain after menopause is a risk factor, and the weight gain could be caused by a high-fat diet. There are also some studies that indicate that a large volume of alcohol consumption (more than 14 drinks per week) is related to breast cancer. On the prevention side, there has been a lot of talk about phytoestrogens and their possible effects, but large studies are just beginning. Chat Participant: Susan, what initially got you interested in this disease in the first place? Susan Braun: My college roommate died of breast cancer when we were both young mothers. I was a fairly well-educated woman and was shocked when I realized how little I knew about the disease; I actually didn't think she could die. It was sort of a promise I made to her daughter and to other young moms and daughters. Chat Participant: A friend of mine was diagnosed with a form of breast cancer that was said to be "in situ," not likely to spread. And yet she was advised to undergo, and did undergo, a full mastectomy for that breast. Why? If it was not likely to spread, why couldn't they just remove the cancer and keep a watch on it? Susan Braun: Again, I have to remind you that I'm not a doctor, so I'll just tell you about what some information tells. There are two kinds of in situ carcinoma that you hear about in breast cancer: lobular carcinoma in situ, which is not really cancer but a precancerous condition that makes a woman much more likely to get breast cancer, and ductal carcinoma in situ (DCIS), which is most likely what your friend had. It is a cancer, but experts disagree a bit about whether it will spread. It certainly makes the woman at high risk for an invasive cancer, which is one of the reasons mastectomy is often performed. Also, DCIS is being studied more all the time for the very best treatments. Dan Rutz, Medical Correspondent: I have found there are many excellent programs for helping women sort out their individual cancer risks so as not to become obsessed by the thought of breast cancer. But since the known risk factors explain only a (relatively) small proportion of breast cancer cases, it is prudent, don't you think, for all women to practice those early-detection measures we're aware of, including a pattern of self-checking, regular professional examination, and mammography screening? Susan Braun: Absolutely!! We recommend that a woman perform monthly self breast exams (at the same time each month) and that she have an annual mammogram after the age of 40, or earlier if there are concerns, and that she have a physical breast exam by an experienced health practitioner yearly. She should know that anything that seems unusual for herself or her own breasts is something to take seriously. She should also know, though, that most breast lumps are benign, or not cancerous. Chat Participant: Do you think there is too much "scare tactics" used on women about their chances of getting breast cancer? My sister was diagnosed with it 12 years ago, had a lumpectomy and was told if she didn't undergo chemotherapy that she'd be dead in six months. She didn't, and she's still alive and well. Susan Braun: I think we have to walk a fine line between making sure women are educated about breast health and breast cancer, and not being obsessed or overly fearful. I believe that most responsible doctors tell a patient what her options are when she is diagnosed and what the data show is likely to occur in someone with a breast cancer similar to hers. They tell her about treatment options, both the benefits and the risks. Then they work with her to make the best decision. I don't think anyone can tell us if we will be alive or dead in six months, breast cancer or not. Dan Rutz, Medical Correspondent: At a recent breast health educational event I attended, women were urged to, as you say, examine themselves at monthly intervals, but to also (for the first couple months) check their breasts at different stages of their menstrual cycles, so as to become familiar with THEIR own bodies; that is, which lumps and bumps -- which are clearly not cancerous -- might be present, again, depending on the time of their cycle. The rationale being that women should become very familiar with their own bodies so they will be better able to pick up any unexpected change that might warrant further investigation by a doctor. Susan Braun: This is very important for women -- to know what her body is like -- her body -- not anyone elses. She can tell best if things are changing. Also, many women have lumpy breasts, which is common and perfectly normal. If she checks her breasts regularly, she can tell if things are changing. Also, because our breasts do change thoughout the month because of hormonal changes, it is important that she check her breasts at the same time each month, and generally just after she has finished her menstrual cycle. Chat Moderator: Do you have final thoughts for us, Susan? Susan Braun: Yes. That we continue to work to keep women -- and men, because they, too, get breast cancer -- aware of the disease, and know that if breast cancer is detected in its earliest stages, there is a 95 percent or better chance of being alive five years later. If it's diagnosed later, the survival is lower. That's why we keep stressing the importance of early detection. It can save lives TODAY. But early detection is not the only answer. We must continue to support research that will provide answers to why we get breast cancer, how we cure it, and how we prevent it. The Komen Foundation has affiliates in 105 cities around the United States that are working to help raise funds and awareness for today and tomorrow; and we invest those funds in research and in early detection. Dan Rutz, Medical Correspondent: Thanks for allowing me to listen in and share in this discussion. Susan, I appreciated your thoughtful and insightful comments. Susan Braun: And I your excellent questions. Chat Moderator: Thank you, Susan and Dan, for joining us today. And thank you, chatters, for your great questions. RELATEDS AT  :
Breast Cancer RELATED STORIES: High-dose chemotherapy may increase breast cancer survival RELATED SITES: Susan G. Komen Breast Cancer Foundation
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