Politics & Policy

Cure At Hand

Science has made great strides in breast-cancer treatment and prevention.

For three decades, people festooned with pink ribbons have been walking, running, and racing for the cure for breast cancer–especially this month; October is Breast Cancer Awareness Month. The U.S. Postal Service has issued stamps that implore us to “fund the fight, find the cure.” Dozens of national organizations, including the Susan G. Komen Breast Cancer Foundation, have raised hundreds of millions of dollars in search of “the cure.” We “think pink,” but we are led to believe that a cure is something ephemeral, always just out of reach–although still our goal.

But wait: A front-page article in USA Today this week describes just how drastically drug innovations have reduced the threat of breast cancer–and quotes the National Cancer Institute’s Jo Anne Zujewski as saying new drugs already constitute a cure: “I am using the ‘cure’ word.”

So: Is it possible that a cure for breast cancer is already at hand and that a prevailing societal resistance to good news (particularly advances by the reviled pharmaceutical industry) has kept the fact a well-guarded secret?

Dictionaries define the word cure as: “to make healthy again”; “recovery or relief from a disease”; “no sign of disease in the body and an adequate amount of time has passed so that the chances of recurrence of the disease are small”; or intervention such that “a person has about the same life expectancy as if they had never had cancer.”

Assessing the current statistics on breast-cancer survival, we may indeed be meeting the definition of cure:

Close to 100 percent of women who are diagnosed in the earliest stage of invasive breast cancer will survive ten or more years (presumably much longer, to be confirmed as new data comes in) and, with the new treatments and medication now available, only about three-four percent, perhaps less, will suffer a recurrence of breast cancer in the affected breast or experience a new tumor in the other breast. That is about as close to a “cure” as one can get.

How We’re Curing Breast Cancer

How did this miraculous state of affairs come about? There are three factors that have brought us closer to curing breast cancer:

1. Early detection of breast cancer through mammography. More and more women in the United States are undergoing screening for breast cancer after age 40 or 50. A larger and larger percentage of the breast tumors that are being detected are found in their earliest stage–Stage 0, which is technically a pre-cancer such as “breast cancer in situ,” or Stage 1, which is an invasive cancer at a single location, a size under 3/4 of an inch, that has not spread to the auxiliary lymph nodes or sites distant from the breast.

2. The treatment of Stage 1 breast cancer has been perfected to the point that it fits comfortably into the definition of “cure.” With surgery (most often a lumpectomy) to remove the tumor and surrounding tissues, the chances of survival soar and the probability of recurrence plummets.

With the addition of radiation therapy, survival rates increase further, and recurrence rates fall even more. And adding on a “radiation boost” following what is usually six weeks of radiation, the numbers look even better. Data now indicate that this additional dose of radiation at the site of the removed cancer reduces the overall rate of a local recurrence by nearly 50 percent–with recurrence rates in a five-year period around three percent.

(Newer research is suggesting that shorter radiation schedules may be just as effective as the standard six-week protocol following a lumpectomy. Six years following treatment, 2.8 percent of women who received a 22-day schedule had a recurrence, compared with 3.2 percent of women who received the traditional number of days.)

3. Adding yet another component to the treatment, hormonal therapy, brought the “cure” within reach. Since the early 1980s, women with early-stage breast cancer followed up their surgery and radiation with tamoxifen (Nolvadex), which lowered recurrence rates to less than six-ten percent in a five-year period. Tamoxifen is associated with some negative side effects, though, including an increased risk of uterine cancer, hot flashes, and blood clots.

But a new category of drugs, aromatase inhibitors, has now replaced tamoxifen as the drug of choice after surgery and radiation–offering even more protection from recurrence and fewer side effects.

Aromatase inhibitors reduce the levels of estrogen in the body. By name, these drugs are Arimidex (Anastrozole), Femara (Letrozole), and Aromasin (Exemestane). They inhibit 97-99 percent of a woman’s estrogen production, thus cutting off the hormone that might feed the tumor or create new ones. (This class of drugs is approved for women with hormone-receptor-positive breast cancer, which represents most of cases of breast cancer.)

Last month’s Lancet published an extensive article on aromatase inhibitors for breast cancer, reporting that using these new drugs after two years of tamoxifen resulted in yet another 40-percent reduction in breast-cancer recurrence–as opposed to simply taking tamoxifen for another three years. These and similar data have now elevated the aromatase inhibitors to the position of “drug of choice” either after two years of tamoxifen treatment, or simply for use right after surgery and radiation. As one physician said of aromatase inhibitors: They are “as revolutionary to the treatment of breast cancer as statins have been to cardiovascular disease or antibiotics to infections.” And we have the pharmaceutical industry (specifically, Pfizer, AstraZeneca, and Novartis) to thank for these new life-saving therapies.

Aromatase inhibitors are generally well-tolerated by women, but they do increase the risk of bone loss (osteoporosis), and women using them are advised to monitor their bone density levels and use calcium, Vitamin D, and possibly osteoporosis drugs.

Adding Prevention to Treatment

We therefore have in hand treatments that reduce the risk of recurrence when diagnosed in Stage One to three-four percent. That, for all practical matters, is a cure for breast cancer.

And as if this good news about the cure being at hand is not enough, there is more: Aromatase inhibitors have the potential to prevent breast cancer from occurring in the first place, for healthy, high-risk women.

We know that this class of drugs, to use the words of the researchers, “profoundly” reduces the risk of recurrence in women who have already been diagnosed and treated for breast cancer. And we know that these drugs reduce the chance of cancer developing in the other breast by almost 80 percent.

As a result of these encouraging findings, American and Canadian scientists are now recruiting thousands of healthy postmenopausal women who are at high risk to participate in a study of what may be a super-drug that can prevent breast cancer. Indeed, the study’s director, Dr. Paul Goss from Harvard, has stated that he hopes that this will show that the drug Aromasin cuts the breast-cancer rate by some 70 percent–making aromatase inhibitors a form of “chemo-prevention.”

Still Focusing on the Bad

The bottom line is that oncologists now have methods of upping the odds of surviving breast cancer–and in most cases, they are actually able to cure the disease. Indeed, progress in the field in the past decade has been nothing short of phenomenal. What is perplexing, then, is a) why so few people seem to know about these unprecedented breakthroughs, and b) why the media divert our attention from the strides made in treatment and prevention to bogus “cancer” risks such as pesticide residues in food, environmental contaminants like DDT, and everyday consumer products containing trace levels of chemicals (such as phthlates in cosmetics).

The Breast Cancer Research Foundation runs ads advocating efforts to “Erase Breast Cancer for Good” through “prevention and cures.” Meanwhile, the more radical group Breast Cancer Action dismisses talk of a cure already existing as “outrageous.” Progress, however, has been made–wrapped in pink ribbon. It’s about time the pink-ribbon groups trumpet it. It’s exactly the news their supporters have been waiting to hear.

Dr. Elizabeth M. Whelan is president of the American Council on Science and Health.

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