Continuing the tradition started by his mother, the late Barbara Johnson, Nassau County Legislator Craig Johnson and his father, Stuart, sponsored an educational forum on breast cancer for the community on Sunday, Oct. 15. The seminar, entitled "Recent Developments in the Treatment of Breast Cancer," featured two experts outstanding in the field: Dr. Larry Norton, head of the Division of Solid Tumor Oncology at Memorial Sloan-Kettering Cancer Center, and Dr. George Raptis, assistant professor, head of the Clinical Breast Cancer Program, and oncology associate at the Gerald H. Ruttenberg Cancer Center at the Mount Sinai School of Medicine. To a packed audience at the Elks Hall, both doctors expressed strong optimism based on real scientific progress in the battle against breast cancer.
Both physicians first paid tribute to the woman who founded this series four years ago, the late Barbara Johnson, whom the doctors knew both as a patient and as a personal friend. "It is an extraordinary honor to continue this series," said Dr. Norton. "She was an extraordinary woman." Both cited her exceptional courage, and her efforts to share information, at her own expense, that might help others.
From the seminar's opening, Dr. Norton made clear that there is "reason for everyone -- from those who have the disease to those who are afraid of it -- to feel tremendous hope, and it is very realistic." This optimism is based on the rapid advancement of knowledge and the addition of new drugs. "It is very realistic to expect very dramatic changes in the next few years," he said. Dr. Raptis was equally positive in outlook, stating, "We will be preventing and curing breast cancer in the next ten years," thanks to advancements like individualized therapies, and drugs that show great promise in prevention, like Tamoxifen and Raloxifene.
The physicians, both articulate and compassionate, answered questions from the mostly-female audience; the first was whether estrogen replacement therapy (ERT), commonly used to relieve the symptoms of menopause, also increases the rate of breast cancer. Dr. Norton explained that it is universally agreed that estrogen in post-menopausal women does increase the risk of breast cancer, and that increase "is not tiny." "There are safer ways to treat almost all the symptoms of menopause," he continued, and feels it is a myth that estrogen supports mental functioning and memory. He solidified his case against ERT by citing two studies that found an increase in heart attacks and strokes among ERT-users. And Dr. Raptis feels the alternatives to ERT are growing; these so-called "designer estrogens" might eventually have no negative side effects at all.
In the area of cancer prevention, Dr. Raptis described an important study of more than 13,000 participants with an elevated risk of getting breast cancer. One-half were given Tamoxifen, while the other half were given a placebo (often, a sugar pill). The study was halted four and a half years later because Tamoxifen was clearly found to cut the rate of breast cancer in half. The drug is now approved for use for breast cancer prevention. It is not without its risks, however; there is a slight increase in uterine cancer incidence with Tamoxifen. The medical community is also interested in the use of Raloxifene, a drug initially developed to prevent osteoporosis, in cancer-prevention. One study cited by the doctors found that Raloxifene halved the risk of breast cancer in post-menopausal women, and did not increase the uterine cancer risk. A research program, the Study of Tamoxifen and Raloxifene (known as STAR), is currently under way. High risk women are receiving either Tamoxifen or Raloxifene; researchers hope to find that one is even better than the other at cancer prevention, and has fewer side effects.
Dr. Norton also described other promising research at Memorial Sloan-Kettering, in the war against breast cancer. An enzyme known as aromatase converts other hormones into estrogen in the body, he explained. They are studying an aromatase-inhibitor, which would starve cancer cells, in people with metastatic disease. It might also have potential to prevent the illness.
The pace at which progress is made is heavily affected by the testing of new drugs on people, known as clinical trials. Thus, Dr. Norton and colleagues promote increased participation in these tests. "To help women, go into clinical trials," he advised.
In response to other participants' questions, the experts spoke about prophylactic surgery in cases of strong genetic and family histories of the disease. Children have genes from both parents, so breast cancer is not a certainty even if one side has a history of the illness, they emphasized. Genetic counseling might be very helpful to test for the specific gene and to develop a cancer prevention program for those with a family history. In addition, there are treatments other than prophylactic surgery to consider. Dr. Raptis stated that for women at higher risk, prophylactic mastectomy will decrease the risk 90 percent or more. It is not yet known whether Tamoxifen is as effective for women with a genetic predisposition to breast cancer as it seems for other high risk women.
Audience members also learned that five years of Tamoxifen, taken to prevent a recurrence of breast cancer, seems to be the optimal time frame, and that taking synthetic thyroid hormone does not increase one's risk of the disease. What is associated with increased risk is a mid-life weight gain, Dr. Norton made clear. Likewise, the long-term, uninterrupted use of birth control pills appears to heighten the risk.
The physicians also answered questions about nutritional and environmental factors and breast cancer. The doctors were not yet able to endorse soy products for reduction of breast cancer risk. Soy "may in general have a benefit, but we don't yet know," said Dr. Raptis. Dr. Norton shared one study's finding that even denizens of parts of China where no soy is ingested had the same low breast cancer rates as people who reside in high soy-consumption areas.
Toward the meeting's close, one audience member called out to ask, "Barbara Johnson was fearless. But what about those of us who are afraid of knowing?" Dr. Raptis replied, "We are all at risk. How do we live with that? As best we can. Barbara Johnson was a champion for cancer research. We must live our lives to the fullest, enjoy every day, and contribute back to society ... Barbara Johnson did that." Dr. Norton added his thoughts, "Barbara Johnson knew the enemy of fear is knowledge. The more you know, the less you fear."