Medical & Surgical Options for BRCA Positive People

Earlier this year, we talked about the BRCA testing for women at high risk for breast and ovarian cancer.  Although only 5-10 % of persons having BRCA analysis actually test positive, this is usually devastating for these few people. They have many decisions to make and it can be a painful process. The screening options that are recommended are:

1. Monthly breast self exam

2. Semi annual clinical breast examination by the same health care provider

3. Semi annual mammograms alternating with breast MRI

4. Annual transvaginal ultrasounds (to visualize the ovaries)

5. Some physicians exam the blood annually for a protein that is often elevated in persons with ovarian cancer (CA-125)

Some BRCA positive people choose medical or surgical options:

1. Tamoxifen (an estrogen inhibitor) decreases breast cancer risk by 49%

2. Bilateral mastectomy reduces risk by 90%

3. Removal of the ovaries reduces the risk of ovarian cancer by 96% and breast cancer by 53%

4. Oral contraceptives have been shown to lower ovarian cancer risk by 54%

These are difficult choices for many patients who are BRCA positive but it has also been my experience that women (in particular) who test negative but have a strong family history of breast cancer often do not hesitate to choose more intense screening and even bilateral mastectomies and removal of their ovaries.   Many of our patients are young with small children or grandchildren and life is precious.  It is their firm belief that being at very high risk for breast or ovarian cancer is an unacceptable reality.  They are aggressive in screening and having surgery to reduce the risk.

What would you do if you were faced with these realities?  I thought I knew before

I met some of these women. Let me know your thoughts.

Tags: bilateral mastectomy, brca positive, brca positive options, brca testing, breast cancer, breast cancer risk, ca-125, clinical breast examination, gynecologic ultrasound, mammogram, mastectomy, ovarian cancer, ovarian cancer risk, tamoxifen, transvaginal ultrasound
Posted in Breast Cancer Surgery, Research and Genetics |

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Exciting Times in Oncology

I had the opportunity to attend and, in fact, participate in the recent American Society of Clinical Oncology (ASCO) Annual meeting. Once a year, up to 45,000 clinicians from around the USA and other countries join together to learn more about the causes, the diagnosis and the treatment of all forms of cancer. I was invited to present at a poster session on a trial I have mentioned previously on this blog. It was information related to a clinical trial I ran while during my last couple years at the National Cancer Institute. The topic was a study of whether or not we would be able to use a combination of drugs to effectively cut off blood supply to solid tumors. The title of the study was “Phase I study of vandetanib (V) and bevacizumab (B) combination therapy evaluating the VEGF and EGF signal transduction pathways in adults with solid tumors and NHL“.

Since this was a Phase 1 study, we only had a few patients enrolled (you probably have read about the different phases of research trials in Carol Brudenell’s research blog posts). We did, however, have promising results with partial response or disease stabilization in 8 of the 11 patients enrolled. Scientists and physicians in many centers now are studying this pathway.

In the next few blog posts I will give you some additional studies and interesting discussions that I heard while at the ASCO meeting. The main theme though is that these are exciting times in oncology. Much progress is being seen in treating every kind of cancer, and there is promise for a better future for caring for those diagnosed with cancer.

Tags: American Society of Clinical Oncology, asco, clinical trials, National Cancer Institute, NCI, vegf
Posted in General Medical, Research and Genetics |

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Clinical Trials 101

I’ve talked a bit about clinical trials but in this column I want to describe the different phases of trials as that is the way the information is disseminated to physicians, nurses, other clinicians and patients. Below are the different categories, keep in mind for cancer related trials, patients always receive at least the standard of care treatment plus something else or in a different dosing schema.

Phase I Trials – these cancer trials are typically the first time a drug or a treatment protocol is offered to humans. These trials are typically quite small in terms of enrollment and are generally only available in top notch cancer programs – we are just launching our Phase I clinical trial and we are excited to be one of the very few non-university based programs in the country to offer this to our patients. The goal of these trials is to determine toxicity levels of the medicine and determine the optimum dose.

Phase II Trials- This level of trial is open to more patients and continues to test the safety of a medicine and starts to analyze how well that new medicine works.

Phase III Trials – these trials compare the new drug or treatment regimen compared to the existing standard of care. Patients will usually be enrolled either in the group using the existing standard of care treatment alone or  the group using the standard of care plus the new type of treatment. These assignments are typically done without the knowledge of any of the people involved so that the results are not biased. Many people are enrolled in these trials and the intent is to then be able to move the new regimen into the main stream of treatment if the trial results are positive for the new regimen.

Phase IV trials- these trials are usually conducted for drugs that have already been approved by the FDA. These trials have the largest enrollments and continue to test the safety, side effects and risks and benefits of the new medicines or regimens. They are also typically open for a long period of time and monitor patients for a long period of time.

In another installment I’ll write about the different kinds of trials – treatment trials, prevention trials, screening trials, and quality of life trials.

Tags: cancer clinical trials, cancer research, clinical trials, phase I trials, phase II trials, phase III trials, phase IV trials
Posted in Research and Genetics |

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Support and Grieving

Cancer support programs continue to be an important component of care for our patients and families. I must always say how honored I am to be able to provide this support at a time when it is so needed. 

A cancer diagnosis affects the individual on every level: emotionally, physically, socially, financially and spiritually. This impacts the people around them in similar ways.  The grief that affects us at every stage of this disease is one that we sometimes talk openly about and other times do not. But even when we remain silent about it, it does not go away.  The grieving involved with a cancer diagnosis surrounds the loss of life as once experienced and can include the loss of a loved one from cancer. 

As I look back at the emotional distress of our country just a few weeks ago when several celebrity persons died, it reminded me about why it is so important for us to always be addressing the issue of grief and death overall.  It is not a topic we talk about very much although it sits quietly like a white elephant in the room each time a new patient gets diagnosed or someone has a recurrence or progression of their disease.  Elisabeth Kubler-Ross contributed so much to our understanding of grief work.  She highlighted what many of us experience when faced with any major loss such as denial, shock, anger, bargaining and acceptance.  These are emotions we may experience in varying degrees and times and sometimes we refer to the process as a roller-coaster because one can go in and out of these stages in a cyclical fashion.  These are some of the emotional topics we deal with in our cancer support groups.  The range of emotion can be unpredictable but always guided to a point of understanding and acceptance during the group.

The Bienes Comprehensive Cancer Center offers several cancer support groups to meet the needs of our patients and families/caregivers.  We also offer weekly and seasonal bereavement support groups.  Remember when seeking online support groups, please make sure it is from a trusted individual or organization, such as Breast Cancer Network of Strength, which offers a men’s support line or Cancer Care, Inc.  On-line support groups have their role but I still encourage face-to-face contact whenever possible or desired. 

I am still soliciting thoughts on support groups or any other aspect of cancer support. What role has cancer support played in your cancer treatment experience?

Tags: cancer support, death, elisabeth kubler-ross, grief, grieving, kubler-ross model, online cancer support groups
Posted in Cancer Support |

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