cancer

GLOW Magazine Highlights Breast Surgery Expertise at NYP/Columbia

by Columbia Surgery on November 8, 2011

GLOW magazine’s Isabel Stoltzman has just published highly informative interviews with Sheldon Feldman, MD, Chief of the Breast Surgery Section, and Robert T. Grant, MD, Chief of the Division of Plastic Surgery, at NewYork-Presbyterian/Columbia.

In ‘The Silver Lining,’ Dr. Grant highlights the latest procedures available to women undergoing surgery for breast cancer, including nipple-sparing mastectomy and the multiple options for reconstruction of the breasts. He describes the ‘silver lining’ in undergoing cancer surgery – the opportunity to recreate breasts that are cosmetically as good as (or even better than!) they were before cancer.

In the second article titled ‘Breast Cancer,’ Dr. Feldman discusses the current state of the field of breast cancer detection and treatment. He describes some of the cutting edge research now underway, such efforts to develop a test for breast cancer involving nothing more than a simple, non-invasive PAP smear of the breast. These and many other research projects of Dr. Feldman’s are discussed in detail in the article.

Together, Dr. Feldman and Dr. Grant address the history of breast cancer treatment, comparing the routine mastectomies of the past with the way recent research allows each patient to receive fully customized care, with a treatment plan that takes into account the stage, size, and location of her specific form of cancer, among other things. They discuss some of the complexities of treating patients who want to have their breasts entirely removed even when it might not be advisable, and, Dr. Feldman summarizes the prevailing thought and research regarding the prevention of breast cancer.

In addition to this objectively useful information, we are also given a moving glimpse of the tragic personal influences that eventually led Dr. Feldman to specialize in breast surgery. “I always say I didn’t choose this specialty – it chose me,” he says. To find out more read the full articles in the Fall 2011 issue of GLOW magazine.

Glow Magazine Fall 2011

Glow Magazine Fall 2011

Tagged as: breast, cancer, Feldman, Grant, plastic

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Profile in Compassion: Sue Mirza Carries Husband’s Legacy, Potentially Transforming the Treatment of Pancreatic Cancer

by Columbia Surgery on November 8, 2011

On first glance, the story may appear cliché; a spouse dies, and the surviving spouse gives to a charitable cause, hoping to confer some measure of permanence to his or her loved one’s memory. Repeated in infinite variations, the uplifting closure softens just a little bit of the survivors’ sadness and pain, and makes a small contribution that lasts a little while before fading.

This time, the story is a bit different. This time, the legacy started by one grieving spouse is fueling research that is already saving lives, and that may be the most important work in pancreatic cancer in the last 40 years, experts say.

Muzzi Mirza was a 46-year-old husband, father of three, and a partner in a private equity firm when he learned he had stage 4 pancreatic cancer in 2005. His diagnosis shattered what his wife, Sue Mirza, called “the perfect life” they were then living in Greenwich, CT. Muzzi began treatment, which included chemotherapy at New York Hospital and consultations at NewYork-Presbyterian Hospital/Columbia University Medical Center. Although Dr. John Chabot and Dr. Robert Fine worked with Muzzi to determine his optimal treatment plans based on their research at NYP/Columbia, there was no structure in place at the time to coordinate patient care in tandem. Instead, Muzzi and other patients had to travel to multiple physicians’ offices for different parts of their care – a burden made even more onerous by their serious illness. According to Sue, “It was clear to Muzzi that this was not the way it should be done.”

Sue Mirza, Dr. John Chabot, Francine Castillo

From L to R: Sue Mirza, Dr. John Chabot, Francine Castillo

Indeed, Dr. Chabot was already laying the groundwork for a comprehensive center dedicated to research and treatment of pancreatic cancer, and had begun discussions about establishing and funding the new Pancreas Center at NewYork-Presbyterian/Columbia.

Meanwhile, not only did Muzzi want to improve the way he and other patients received daily care for their disease, but he also wanted to spare other families the same devastation of receiving a pancreatic cancer diagnosis at such a late, largely untreatable stage. He talked with Drs. Chabot and Fine in depth, and he learned about the work Dr. Harold Frucht was conducting regarding genetic causes of pancreatic cancer and methods for early detection.

It became clear that although a cure might be years away, the possibility of early detection and prevention likely held the best promise for successfully reducing mortality from pancreatic cancer in the near term, explains Sue. With his keen business acumen, Muzzi could see that with the right resources, physicians who were working in parallel could together accomplish even more, both in their research and also in optimally treating their patients. “Muzzi could see that the Pancreas Center was a blueprint waiting to happen,” Sue says. “There was a very timely collision of two forces – Dr. Chabot’s in the medical world, and Muzzi’s with his business and fundraising experience.”

His vision and commitment firm, Muzzi pledged one million dollars to the establishment of a program within the new Pancreas Center that would focus specifically on prevention and early detection of pancreatic cancer. His business associates in the Odyssey Partners matched that pledge with another million, and matching funds from a wider circle soon brought the total to about four million, which launched the first five years of the Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program.

In addition, Sue and members of the Odyssey Partners, plus others in the Muzzis’ circle, began the tradition of the fall golf event, an invitational outing held in CT both to celebrate Muzzi’s life and also to raise additional funding for the program. This year’s event on September 19, 2011 brought the total raised to over $400,000 in the five years the event has been held.

With that generous backing, the Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program has coalesced into a dynamic program within the Pancreas Center for the prevention and detection of pancreatic cancer – the first such effort of its kind. Led by Harold Frucht, MD, the program’s comprehensive clinical practice is integrated with a robust research program focused on early detection and prevention. Unique in this country, the program not only pioneers some of the most promising and unique research in pancreatic cancer today, but it quickly translates these research findings to clinical therapies for patients at the center.

At this time, Dr. Frucht and other researchers in the Mirza Program are conducting cutting-edge studies including a trial of stool DNA testing, which shows promise as the first noninvasive test to detect pancreatic abnormalities at a very early stage. Early results are very promising, with tests for DNA mutations in stool samples showing high levels of sensitivity in identifying precancerous lesions such as IPMN (intraductal papillary mucinous neoplasm). If further testing bears out this simple method, fecal testing has the potential to become a routine, standard screening method akin to mammography, and would represent an unprecedented improvement in our ability to detect and treat pancreatic cancer. As Sue puts it, “If the test could be developed into something internists used routinely to screen for pancreatic cancer, that would be the ‘home run’ in fighting pancreatic cancer.”

The Mirza Program maintains a registry and tissue bank for individuals at high risk; this invaluable infrastructure facilitates ongoing clinical, basic, and translational research that would not be possible without the availability of sufficient tissue samples, clinical data, and family and epidemiologic information. In addition to the study of stool DNA testing, the tissue bank supports numerous other studies, such as one on a new vaccine for pancreatic cancer. A newly opened trial, led by M. Wasif Saif, MD, is investigating whether a new vaccine, developed specifically to target pancreatic cancer cells, will help to prevent recurrences among patients who have had pancreatic tumors surgically removed.

Yet another important trial, led by Kenneth Olive, PhD, is evaluating the use of a therapy that could extend survival among patients with metastatic pancreatic cancer. This agent, called IPI-926, inhibits the ability of tumors to build protective walls around themselves, which act as barriers to chemotherapy. Inhibiting this process could allow therapies to work far more effectively, and because of its potential, IPI 926 is currently under study as an approach to numerous types of cancer.

These are just a few of the innovations currently underway at the Pancreas Center and the Mirza Program (for more, see the Pancreas Center’s web site and the Department of Surgery blog). Together, these efforts are making inroads into a disease that has remained almost uniformly fatal for the last 40 years. As they have done each year at the fall golf tournament, Drs. Chabot and Frucht have shared stories about how the program has helped to detect patients’ cancers earlier and to save their lives. According to Sue Mirza, those who contributed to the establishment of the Muzzi Mirza program are extremely pleased that they can already see tangible results in such a short time. “My husband firmly believed that supporting research efforts would pay off and help to lower the mortality rate of this disease,” says Sue. “I am thrilled that following through on his wishes is proving to be successful.”

Related Links:
Promising Pancreatic Cancer Trial (IPI-926) Enrolling Patients at Columbia
Pancreatic Cancer Vaccine Trial Opens at NYP/Columbia’s Pancreas Center

Tagged as: cancer, Chabot, clinicaltrials, Fine, Frucht, Olive, pancreas, Saif

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Pancreatic Cancer Awareness Day 2011: Interview with Bonnie Badenchini, Coordinator of the Pancreas Center at NYP/Columbia

by Columbia Surgery on October 25, 2011

Bonnie Badenchini

Bonnie Badenchini

The Pancreas Center will hold its Annual Pancreatic Cancer Awareness Day Saturday, November 12, 2011 at the Vivian and Seymour Milstein Family Heart Center. At this free event, experts from NewYork-Presbyterian Hospital, Columbia University Medical Center, The Pancreas Center, and The Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program will provide a free patient education program about screening and early detection of pancreatic cancer.

In the following interview, Bonnie Badenchini, Coordinator for the Pancreas Center, explains the history behind this event.

Question: When was the first NYP/Columbia Pancreatic Cancer Awareness Day held? Why did the doctors and staff decide that an event like this was needed?

Bonnie: The initial group of doctors that would later form The Pancreas Center came together in the mid-1990′s. The medical field was starting to realize that pancreatic cancer required a multi-disciplinary approach that included interventional gastroenterologists, oncologists, and surgical specialists. In 2005, our group at NewYork-Presbyterian/Columbia was officially launched as The Pancreas Center.

Dr. John Chabot felt that a forum was needed where findings, new research, and our innovative approaches could be communicated to other NYP/Columbia doctors and the community at large. This meeting could also provide patients and their families an opportunity to speak with Pancreas Center doctors outside the confines of a medical office. So from that need, the first Pancreatic Cancer Awareness Day was planned.

Question: How has Pancreatic Cancer Awareness Day changed over time?

Bonnie: As can be the case with first-year events, it was difficult to get the word out for our first event and attendance was low. But we believed in the purpose and necessity of this event and have proudly watched it grow in attendance to 125 in 2010.

Another important and more exciting difference is our agenda of topics. Today, there are more research studies and clinical trials to discuss. Since our center’s formation we’ve started to address pancreatic cancer prevention and screening techniques, and can provide attendees with the news on our findings in those areas.

We will also discuss the addition to the Pancreatic Cyst Surveillance Program headed by Dr. John Allendorf. With this program we are establishing methods to monitor pancreatic cysts that could potentially turn into cancer.

Question: What differences will attendees see this year compared to last year’s event?

Bonnie: For the first time this year we are going to have a patient speaker. We believe that others who have been touched by this disease will draw strength and support by hearing from a peer. As Dr. Chabot has said, “All a patient with pancreatic cancer and their family have is hope.” Our goal is to provide as much hope as it takes to inspire patients to push through, families to stay strong, and physicians to keep looking for a cure.

Question: What was one of your most inspiring moments at a Pancreatic Cancer Awareness Day?

Bonnie: Every Awareness Day inspires me. I have been with the Pancreas Center from the beginning and have watched this center grow and achieve goals that have affected so many lives. What has touched me the most has not only been the growth in attendees but the increase in number of survivors.

Question: Pancreatic cancer has been in the news recently with the stories of Steve Jobs, Pavarotti and Patrick Swayze. Do you think this is making a big difference in the general public’s awareness of pancreatic cancer?

Bonnie: I do believe this does makes a difference. If the passing of a celebrity from pancreatic cancer helps to make people more aware of it, and they take steps to obtain screening for themselves or loved ones, then some positive effect has happened.

Question: Will those who cannot attend the Pancreatic Cancer Awareness Day be able to see copies of the presentations?

Bonnie: Yes, we will put these on our web site www.pancreascenter.org and post them to our Facebook page at www.facebook.com/pancreascenter. The best thing to do is to “like” our Facebook page. Then our messages will appear on readers’ walls when they are posted.

Question: Is there anything else about the services and facilities within the Pancreas Center that you would like to share?

Bonnie: At the Pancreas Center we know all too well that being diagnosed with pancreatic cancer is devastating for patients as well as their families. We do everything possible to provide the best care for everyone involved with the diagnosis. The staff, nurses, and doctors all work tirelessly to help patients not just survive, but maintain as full and vibrant a life as possible. Meanwhile we continue to strive for the ultimate goal of finding a cure for this disease.

For more information on the Pancreatic Cancer Awareness Day and to register, please visit our Annual Pancreatic Cancer Awareness Day event page. Free parking is available and should be requested at the time of registration.


Interview by Bradley Jobling

Tagged as: Allendorf, cancer, Chabot, pancreas

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Landmark Study Finds CT Screening for Lung Cancer Saves Lives

by Columbia Surgery on October 24, 2011

Lyall A. Gorenstein, MD, FRCS (C), FACS

Lyall A. Gorenstein, MD, FRCS (C), FACS

A recent study funded by the National Institutes of Health found that CT screening reduced deaths from lung cancer by 20%. While it may seem intuitive that screening would help to detect lung cancers and reduce deaths, until now, that had not been definitively proven.

“This is a landmark study,” said Lyall A. Gorenstein, MD, Director of Minimally Invasive Thoracic Surgery at NewYork-Presbyterian/Columbia University Medical Center, who lauded the study’s design and its clear implications for treating patients at risk for lung cancer. Lung cancer is the leading cause of cancer-related deaths in the United States, but the merits of screening — whether or not it actually improves patient outcomes – has been a topic of debate for the last 30 years. Dr. Gorenstein believes that controversy has now been settled: “Finally there is conclusive evidence demonstrating that CT screening in patients who are at high risk for the development of lung cancer can significantly lower mortality from the disease.”

The National Lung Screening Trial enrolled more than 53,000 people, current and former smokers, assigning half to receive low-dose CT scans and the other half to be screened by chest x-ray. After eight years the group assigned to receive CT screening had a 20% lower mortality rate than those screened by chest x-ray.

The low-dose CT (computed tomography) screening of the lungs studied in this randomized controlled trial takes from 7-15 seconds of one held breath for a scanner to rotate full circle around the body and compiles that information into images of the chest and lungs. While chest x-rays produce a single snapshot, CT produces a complete 3D image that allows doctors to view cross-sections of the entire lungs, frame-by-frame.

The Thoracic Surgery Section at NYP/Columbia uses CT screening in its High-Risk Lung Assessment Program. Some lung diseases (both cancerous and non-cancerous) that can be detected by CT may have no symptoms early in their development when treatment can be most effective. A hallmark of the High-Risk Lung Assessment Program is its proactive screening of people at high risk for lung disease—a standard that the National Lung Screening Trial has now shown to save lives.

Tagged as: cancer, Gorenstein, lung

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Sharsheret: Serving Jewish Women with Breast Cancer

by Columbia Surgery on October 18, 2011

Sheldon Feldman, MD

Sheldon Feldman, MD

It has been a great pleasure and distinct honor to be involved with Sharsheret for the past decade. I care for a large number of young orthodox Jewish women with breast cancer. In the pre-Sharsharet era, many of my patients felt very isolated and frightened without being able to connect with “experienced” patients who had already walked in their shoes. It seemed a paradox for me that is spite of their deep faith and dedication to Judaism, many women were unable to receive support from their community due to issues of stigmatization and concerns about confidentiality. There was a great deal of misinformation and lack of understanding, particularly relating to the Askenazi “Jewish” breast cancer gene.

With the birth of Sharsharet, I was able to witness first-hand the enormous culturally sensitive support that my new patients could receive. They now can be fully supported by peers and receive medically correct information in a caring way. I have been pleased to be a member of the Sharsharet Medical Advisory Board since 2003. I am firmly committed to helping expand the work and scope of this wonderful organization so as many patients as possible can be helped.

Sheldon Feldman, MD, Chief, Breast Surgery Section at NewYork-Presbyterian/Columbia

Tagged as: breast, cancer, Feldman

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Promising Pancreatic Cancer Trial Enrolling Patients at Columbia

by Columbia Surgery on October 18, 2011

Kenneth P. Olive, PhD

Kenneth P. Olive, PhD

NewYork-Presbyterian Hospital/Columbia University Medical Center is participating in an important trial of a new drug known as IPI-926 that could improve survival outcomes in patients with metastatic pancreatic cancer. Kenneth P. Olive, PhD, Assistant Professor of Medicine and Pathology and member of the Pancreas Center, led the original basic science study that provided the scientific foundation for the clinical use of this drug.

According to Dr. Olive, pancreatic tumors build protective walls around themselves that prevent chemotherapy from getting into the tumor. IPI-926 works by inhibiting a tumor’s ability to build and maintain that wall. With this wall weakened, already existing therapies could prove much more effective, doing more damage to the cancer and less to the patient. If it turns out that other cancers behave in a similar manner, IPI-926 could potentially improve the outcomes of tens of thousands of cancer patients around the world — which explains the excitement that the latest developments in IPI-926 research generated when presented at the American Society of Clinical Oncology (ASCO) in early June.

An early trial designed primarily to test the toxicity of IPI-926 in combination with gemcitabine (the national standard-of-care treatment for pancreatic cancer) found a very positive early outcome. In this Phase I-b trial, 31% of patients with metastatic pancreatic cancer had partial responses after treatment with IPI-926 + gemcitabine, which compares favorably with the historical rate of 5% in patients treated with gemcitabine alone. Even more notably, the regimen was extremely well-tolerated with very little additional toxicity over gemcitabine alone.

With these early promising results, Infinity Pharmaceuticals, the company behind the IPI-926 research, is now conducting a larger Phase II trial across 29 institutions to further evaluate the drug’s efficacy. M. Wasif Saif, MD, MBBS, and Dr. Olive are directing the NYP/Columbia arm of this 118-patient, randomized, double-blind trial.

It’s still too early to say what the results of this important study will be, but Dr. Olive believes that the level of hope in the pancreatic cancer research field is higher than it has been in many years. Pancreatic cancer outcomes have scarcely improved in the past 40 years — but that may soon change, he says. “This is an extremely dynamic and exciting time in pancreatic cancer research. There is so much happening right now, and this is one example. There are many other investigative drugs working their way through research pipeline and into the clinical trial process. My level of hope and enthusiasm for a breakthrough in pancreatic cancer is tremendously elevated. We are starting to make inroads against this devastating disease, which has not been true for decades.”

Tagged as: cancer, clinicaltrials, Olive, pancreas

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M. Wasif Saif, MD, MBBS, Authors Study in Anticancer Research, March 2011

by Columbia Surgery on October 17, 2011

Study finds pancreatic cancer drug helps to overcome resistance to chemotherapy.

M. Wasif Saif, MD, MBBS

M. Wasif Saif, MD, MBBS

Erlotinib (Tarceva) is an oral medication approved by the FDA as a first-line therapy for stage 4 pancreatic cancer. In an article published in Anticancer Research in March 2011, M. Wasif Saif, MD, MBBS, describes previously undocumented findings about additional benefits of this drug.

The article, Does erlotinib restore chemosensitivity to chemotherapy in pancreatic cancer? A case series, explains that not only does erlotinib work as a first-line treatment, but it works in second and third lines, even after a patient may fail chemotherapy. “If a person becomes resistant to chemotherapy,” Dr. Saif explains, “adding erlotinib to chemotherapy such as gemcitabine helps the patient respond to chemotherapy again.” The ability of erlotinib to restore sensitivity to gemcitabine was a significant discovery in itself, but the study also found it restored sensitivity to different kinds of therapy as well. “That is beautiful,” says Dr. Saif. “We did not know the drug worked like that.”

Dr. Saif is a clinical trialist and translational researcher, meaning that he collaborates directly with researchers in the laboratory and helps to translate their work into clinical therapies for faster study and use in patients. Dr. Saif joined the faculty at NewYork-Presbyterian/Columbia in 2010 and is currently working on several new drugs for pancreatic cancer.

For more information about clinical trials of pancreatic cancer therapies, see Pancreas Center: Clinical Trials.

M. Wasif Saif, MD, MBBS, is Medical Director, Pancreas Center, NewYork-Presbyterian/Columbia; Director, GI Oncology Section, Division of Hematology/Oncology; and Professor of Clinical Medicine, Division of Hematology/Oncology, Department of Medicine, Columbia University College of Physicians and Surgeons.

Tagged as: cancer, pancreas, Saif

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Breast Cancer: New Options & New Promise WABC Special Highlights Intraoperative RFA Protocol at Columbia

by Columbia Surgery on October 6, 2011

A WABC special program titled Breast Cancer: New Options & New Promise featured Sheldon Marc Feldman M.D. FACS, Chief, Division of Breast Surgery. The program included discussion of intraoperative radiofrequency ablation (RFA), a novel therapy available to patients at NewYork-Presbyterian/Columbia as part of a special protocol. According to Dr. Feldman, RFA may help to eliminate tumor cells remaining in the surrounding tissue after a breast tumor is removed via lumpectomy, thereby lowering the need for reoperation in the future.

The WABC special aired October 1, 2011 on national television but can be viewed online in full here.

Learn about the RFA protocol at NYP/Columbia at Breast Cancer Trial: NYP/Columbia Tests Intraoperative Radiofrequency Ablation after Lumpectomy.

For more information about treatment of breast cancer, see breastmd.org.

Tagged as: breast, cancer, Feldman

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Breast Cancer Research: Dr. Feldman Explains New Study on Exemestane

by Columbia Surgery on September 26, 2011

As reported in the New York Times June 5, 2011, the drug exemestane (Aromasin) was found to significantly reduce the occurrence of breast cancer in post-menopausal women at high risk of developing breast cancer. Not only was the risk of breast cancer reduced by 65% in the study, but the drug was found safe and more tolerable than other drugs in its class.

The ensuing media attention has generated a flurry of questions among patients with breast cancer, many of whom are asking whether they can take exemestane instead of tamoxifen, with the hope of avoiding the side effects associated with the latter medication.

To clear up some common misconceptions and put this study in perspective, Sheldon Feldman, MD, Chief of the Breast Surgery Section at NewYork-Presbyterian/Columbia, talked with the Columbia Surgery blog.

Q: What did this study find?

Dr. Feldman: The study included about 4500 postmenopausal women at moderately high risk of developing breast cancer. Half the participants took exemestane and half took a placebo for three years. At that point, 11 of the women taking exemestane had developed breast cancer, and 32 taking the placebo had developed breast cancer. That translates to a 65% reduction in risk associated with this medication.

The drug also reduced the incidence of precancerous lesions including ductal carcinoma in situ, lobular carcinoma in situ, atypical ductal hyperplasia, and atypical lobular hyperplasia.

Q: What kind of drug is exemestane?

Dr. Feldman: Exemestane is an aromatase inhibitor, which are agents that suppress estrogen production and inhibit the development of breast cancer after menopause.

After menopause, a woman’s body makes very little estrogen. The little that is made is produced by the adrenal glands, which make testosterone, and then the aromatase enzyme converts the testosterone into estrogen. Aromatase inhibitors block this conversion, thereby shutting of the main source of estrogen production in postmenopausal women.

Before menopause, the body is flooded with estrogen because the ovaries are still working. So if aromatase inhibitors like exemestane are given to premenopausal women, the drug won’t stop the estrogen production from the ovaries.

Q: What does this study suggest for women interested in preventing breast cancer?

Dr. Feldman: This is the question that needs to be carefully looked at, because there are some common misconceptions arising in the wake of this study.

First, women need to understand that exemestane is only effective after menopause. If women take it before menopause, they will not receive the estrogen-suppressing benefit.

Second, this study investigated using exemestane for preventing breast cancer from occurring in the first place — not treating it after it has been diagnosed. Exemestane has previously been shown to be effective to treat women with breast cancer, and like tamoxifen, exemestane is commonly used for treatment. The importance of this study is that it provides clear evidence about its value in preventing breast cancer as well.

Third, the patients in the exemestane study were at higher risk of developing breast cancer than the general population, based on a risk assessment model called Gail, but the study did not include women who have BRCA1 or BRCA2 gene mutations, who are at the highest risk.

Q: Is exemestane effective in preventing all forms of breast cancer?

Dr. Feldman: In short, no. There are many different types of breast cancer. This study found exemestane was only effective in preventing estrogen receptor or progesterone receptor positive breast cancers, which are easier to treat and less dangerous than other types of breast cancer. The drug had no significant effect in preventing other types of breast cancer.

Clearly it is an important thing to prevent any type of breast cancer, but in the long term no survival benefit has been demonstrated with the use of exemestane.

If we could find ways to prevent the more aggressive forms of breast cancer with the worst prognosis, such as HER2 or triple-negative breast cancer, then we would be better able to improve survival rates associated with breast cancer. The ‘home run’ in breast cancer research will be to develop an agent to prevent estrogen receptive negative breast cancer and to be able to offer that prevention to younger women with many years of potential future risk.

Q: How does exemestane compare to tamoxifen and raloxifene?

Dr. Feldman: Historically, tamoxifen was found to be effective in preventing breast cancer because women who took it for treatment of cancer in one breast were found to have a significantly reduced risk of developing cancer in the opposite breast. We know that taking tamoxifen before menopause, earlier in life, has a long-term protective effect, and that tamoxifen and raloxifene are effective in preventing breast cancer in both pre- and post-menopausal women. Exemestane, on the other hand, is effective only after menopause. It can’t be used to protect women during the important years before menopause, but only in their later years.

The research so far indicates that exemestane appears to be safer than tamoxifen and raloxifene, which are associated with a higher risk of endometrial cancer and blood clots, as well as effects such as fatigue and depression. Because of these risks and effects, many women are reluctant to take tamoxifen and raloxifene. Although bone loss has been a concern with other aromatase inhibitors, exemestane did not produce any measurable changes in bone health. Its main side effects included aches, hot flashes, joint pain, and fatigue – but overall these effects were less problematic than those associated with tamoxifen. So overall, exemestane’s safety profile appears to be very reassuring.

Q: How do you counsel women about preventing breast cancer?

Dr. Feldman: Reducing risk for breast cancer may involve many options. Lifestyle choices, especially diet and weight management, are extremely important. I counsel women to maintain a healthy weight, because fat cells have estrogen receptors in them, and more fat cells promote breast cancer. Good nutrition and good quality food are both very important.

When we are considering methods of prevention, medications have to be nontoxic and have acceptable side effects, or women will not take them. If there were a completely nontoxic pill to prevent breast cancer, people would take it – but there isn’t, so the better option is to exercise and eat well.

Beyond lifestyle measures, we can offer many options, both medical and surgical. Exemestane is one more tool we now have available, which may be a good choice for post-menopausal women at high risk based on their family history. Women at very high risk, such as those with BRCA1 or BRCA2 gene mutations, may choose surgical prevention; at the Breast Surgery Section we have great surgical techniques including excellent reconstructive methods, and the rate of risk-reducing mastectomies has been increasing.

In short, anyone concerned about risk of breast cancer should come to NYP/Columbia for an evaluation and to learn about the options for prevention.

Full text of the study on exemestane is available at the New England Journal of Medicine: Exemestane for Breast-Cancer Prevention in Postmenopausal Women.

Tagged as: breast, cancer, clinicaltrials, Feldman

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Columbia Lends Support to the Pancreatic Cancer Research and Education Act

by Columbia Surgery on September 14, 2011

This summer, Kenneth P. Olive, PhD traveled to Washington DC to ask members of Congress to pass the Pancreatic Cancer Research and Education Act. He was joined by Gloria H. Su, PhD, NewYork-Presbyterian/Columbia patient-activist Ralph Cheney, as well as 550 patients, family members, and advocates from all 50 states, as a part of the annual Pancreatic Cancer Action Network Advocacy Day.

This legislation, if passed, would direct the National Cancer Institute (NCI) to develop a strategic plan to combat pancreatic cancer. Because overall survival rates against pancreatic cancer have scarcely improved in the past 40 years, Dr. Olive and the Pancreatic Cancer Action Network believe it is extremely urgent that an organized plan of attack be enacted to enable new approaches to fighting this disease.

Since surviving a pancreatic cancer diagnosis while being treated by the Pancreas Center at NYP/Columbia, Ralph Cheney and his wife have devoted themselves to making sure that the Pancreatic Cancer Research and Education Act is passed. Mariann Cheney explains that at this time, there is a version of the bill both in the House and the Senate. With enough support, these bills may pass, providing cancer researchers like Dr. Olive and Dr. Su with the opportunity to continue doing their important work.

Tagged as: cancer, pancreas

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