Dealing with the Side Effects of Treatment Now and Later
ARLINE KALLICK: Hello everyone, and welcome to the Breast Cancer Network of Strength, ShareRing Network national teleconference. Our call will begin with tonight’s speaker Dr. Banu Arun. Dr. Arun is Associate Professor at the Department of Breast Medical Oncology and Clinical Cancer Prevention at MD Anderson Cancer Center at the University of Texas. She is Co-Medical Director of Clinical Cancer Genetics and Director of High Risk Breast Clinic. Dr. Arun earned her Fellowship in hematology and oncology at the Lombardi Cancer Center at Georgetown University in Washington DC. Her clinical research involved identification of targeted therapies for breast cancer treatment and breast cancer prevention. She’s the principle investigator of several medical, clinical trials evaluating agents in metastatic breast cancer. Her clinical research in prevention is focused on identifying novel agents and risk biomarkers for breast cancer prevention, is the principle investigator of several prevention trials. Another focus is characterizing risk factors in high risk women with or without the BRCA mutations.
We’re very happy to have her with us this evening. Our topic is “Dealing with the Side Effects of Treatment Now and Later”. The presentation will be followed by a question and answer session and will end with small group discussions. We realize it is 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 at the end of the hour, you may contact the Network of Strength hotline at 800-221-2141. The hotline is answered by certified peer counselors who are breast cancer survivors and it’s available to you 24/7.
When presenting a question to Dr. Arun, please be courteous to other callers by keeping your question brief and realizing that this cannot be a private consultation. A transcript of each call will be available at our website one week following the call. Visit our website at www.networkofstrength.org. Recording of past ShareRing calls are also available now as pod casts through iTunes. To download past calls or to subscribe to the ShareRing pod cast, search for ShareRing within iTunes. You can also listen to ShareRing calls at networkofstrength.org/podcasts.
We are now ready to begin tonight’s teleconference and we welcome Dr. Banu Arun.
DR. BANU ARUN: Hi everyone, it’s a great pleasure for me to be here with you tonight. What I would like to do is give you a very brief overview about breast cancer, a little bit about risk factors, treatment and then go into the side effects and how we manage them in general. Then I will be available for questions as Arline mentioned.
So a few words about general information about breast cancer, as I think everybody now knows that breast cancer is the most common seen cancer amongst women and a woman’s lifelong risk to develop breast cancer is about 10 to 11%. And so the prevalence is very high.
There are those certain risk factors which would put a woman at a little bit higher risk than the average population, so higher than 11%, and those are for example, women who have had previous biopsies in the lab showed some benign but risk lesions, such as the atypical hyperplasia or (inaudible) we now know that having had these lesions increases subsequent breast cancer risk by about two to three fold. So the 10% then goes up to 20, 30%. But I want to mention that not all of the benign lesions increase risk, so if any of you have had biopsies before and you were told it’s benign, don’t panic and you can go back to the past reports or discuss it with your doctor. For example, fibrocystic disease, fibro adenomas, and many, many other changes in the breast are benign and they don’t increase risk. But a few of the benign lesions do increase risk.
The other risk factors include hormonal replacement for example, you most probably are aware of the recent publications that estrogen and progesterone given in the post-menopausal setting for a prolonged time does increase breast cancer risk by about 1.3 fold. It’s not very high and one obviously has to weigh the risks and benefits of this approach, however I think it’s important to know that while hormone treatment therapy can fix some of the problems, it can increase the risk of breast cancer.
One important aspect we discuss with our patients and I’m sure that you are familiar with that as well and your doctors discuss it with you also, is the importance of family history. So I’m sure that you are concerned about relatives who have breast cancer and the unaffected relative if their risk is increased, mothers, sisters, daughters and we know that if a woman, for example, has a family history of two first degree relatives with breast cancer and first degree is defined as mother, daughter or sister, then the healthy woman’s risk is at least two fold increased. So that 10% again goes up to 20%. So I think it’s important to let your healthcare providers know there’s a family history of breast cancer.
Recently, about 10 to 15 years ago, you might have heard that two genes were cloned. They are called BRCA1 and BRCA2 genes and now we know that individuals who have a mutation in one of those genes has an up to eight to 10 fold increased risk of breast cancer, so the lifelong risk jumps from 10% to anywhere between 60 and 80%.
The good thing is that only 10% of breast cancers are these genetic cancers. 90% are not. So again, I don’t want anyone to panic and think that they have the gene, however, there are some red flags we look at when we want to go after this and see if there’s a gene mutation in the family. And those red flags are if a woman was diagnosed with breast cancer at early age, pre-menopausal, if they’re multiply young females with breast cancer, if there’s male breast cancer, if there’s breast and ovarian cancers. So there are certain clinical features which would make your healthcare provider think that there might be a genetic component and would then counsel with you and maybe perhaps refer you to a genetic counselor. But again, only 10% of the breast cancers are genetic and 90% for the majority is actually not genetic. And, but this means that people who don’t have the reason in, specific reason why that cancer happened, but it’s most probably related to many factors, but not necessarily to the inherited genetic mutation.