Bone Health and Managing Bone Metastases
ARLINE KALLICK: Thank you. Hello everyone, and welcome to the Y-ME ShareRing Network National Teleconference. The call will begin tonight with our speaker, Dr. Charles Shapiro. Dr. Shapiro is Professor of Medicine in the Department of Internal Medicine at the Ohio State University College of Medicine in Columbus. Dr. Shapiro received his medical degree at the State University of New York in Buffalo, and completed an internship and residency in internal medicine at Temple University Hospital in Philadelphia. And he completed his postdoctoral training with a fellowship in medical oncology at the Dana-Farber Cancer Institute in Boston. Dr. Shapiro is currently serving as the principle investigator of the Lance Armstrong Survivorship Center of Excellence at the Ohio State University College of Medicine, and is the Director of the Symptom Intervention Committee of the Cancer and Leukemia Group B. His research interests include treatments related toxicities of cancer therapy, and Phase I and II clinical evaluation of new drugs for the treatment of breast cancer.
Our topic tonight is: ”Bone Health and Managing Bone Metastases.” The presentation will be followed by a question and answer session, and then we will end with small group discussions. We realize it’s difficult to answer everyone’s question in a one-hour teleconference, so if your question does not get presented during the question and answer portion or the group discussion, please contact Y-ME Hotline at (800) 221-2141. The hotline is answered by certified peer counselors who are breast cancer survivors, and it is available to you 24/7. When presenting a question to Dr. Shapiro, please be courteous to other callers by keeping your question brief and realizing that it cannot be a private consultation. A transcript of each call will be available at our Web site one week following the call. Our Web site is www.y-me.org.
We are now ready to begin with tonight’s teleconference, and welcome Dr. Charles Shapiro. You may begin.
DR. CHARLES SHAPIRO: Good evening everyone. I’m going to talk to you about a topic that’s very relevant for survivors and those living with cancer, which I consider survivors too. It’s bone health, and spread of cancer to the bones, we call them bone metastases. First, why are we so concerned about bone health for all women, and especially for breast cancer survivors? Well, bone health is important because everyone loses bone related to age, both men and women. Women have the added effect of going through menopause, which decreases the estrogen levels the body produces when they’re having their menstrual period. In other words, when you become post-menopausal, your estrogen levels decrease. And estrogen has a very protective effect on bone. So women not only have the age related bone loss, which begins at about 35 years of old, but also have the added loss due to estrogen levels decreasing with the menopause. Now why is this important? Because osteoporosis, or fracture due to this bone loss will occur. And hip fractures, for example, and vertebral fractures are a source of much pain, ill health, and would result, typically in hip fractures, in long stays in convalescent homes, and really are a bad thing. So we want to prevent osteoporosis or treat it in a majority of all, you know, in all women essentially.
Now breast cancer women who receive breast cancer treatment have an added burden. For example, young women who are having their menstrual period who’ve developed breast cancer often receive chemotherapy. And that has an effect that is 50% of them will go into early menopause. In other words, if they didn’t have breast cancer their menopausal age would be, say 52. But suppose a woman is diagnosed at age 42 and she receives chemotherapy, standard chemotherapy for breast cancer treatment, as many of you, I assume, have received. A woman who’s pre-menopausal or having her period has about a 40 to 50% chance of going into early menopause as a direct consequence of the chemotherapy affecting the ovaries and decreasing the estrogen. So she’d become, in effect, post-menopausal earlier than she would had had she not received this treatment and had breast cancer. And we know from studies that women who have developed breast cancer and receive this chemotherapy when they’re pre-menopausal lose a lot of bone rapidly. So that’s one consequence that could heighten the risk of subsequent osteoporosis, which is defined as fractures later in life, for breast cancer survivors.
The other frequent problem that breast cancer survivors encounter is, if you’re post menopausal, it seems increasingly that the treatment of choice is one of the aromatase inhibitors for estrogen receptor positive patients. That means that your tumor depends on estrogen, and one of the effective anti-estrogen therapies if you’re post-menopausal is these drugs called aromatase inhibitors. You might know them more commonly as Femara, Aromasin, or Arimidex. And these, in head to head comparisons, you know, are a little bit better than Tamoxifen, although there’s plenty of people on Tamoxophin for all kinds of reasons. But aromatase inhibitors are getting more frequently prescribed to post-menopausal women who have estrogen receptor positive cancers. And they too have bone loss associated with them. It’s not as dramatic as the young women who get chemotherapy, but nonetheless, this is a side effect of all the aromatase inhibitors. And because of those things, because breast cancer women who receive either chemotherapy when they’re pre-menopausal, or aromatase inhibitors when they’re post-menopausal, lose bone in addition to the age-related bone loss. And some of those women, particularly if you’re young, have early menopause before their natural age of menopause would occur. They’re at particular risk for subsequent problems later in life like osteoporosis. So we want to prevent these bone loss from occurring in both those settings.