Study Supports Chemotherapy for Estrogen-Negative Cancers
RENEE MONTAGNE, host:
Some 70,000 American women will be diagnosed this year with a type of breast cancer that is not fueled by the hormone estrogen. That's about a third of women with breast cancer.
Doctors used to think that the outlook was much worse for women with these so-called estrogen-negative breast tumors, but a study in this week's Journal of the American Medical Association finds that's changed.
Joining me now is Dr. Eric Winer. He's a co-author of the study and director of the Breast Cancer Center at Dana-Farber Cancer Institute in Boston.
Dr. ERIC WINER (Director of the Breast Oncology Center, Dana-Farber Cancer Institute, Boston): Good morning.
MONTAGNE: Dr. Winer, why have the breast cancer specialists and patients especially, dreaded the diagnosis of estrogen-negative tumors?
Dr. WINER: Well these cancers have been harder to treat then the estrogen sensitive cancers--harder, at least partially, because we didn't have hormone blocking drugs to use. We, to a large extent, only had chemotherapy to rely upon.
MONTAGNE: How then have things changed, and why have they changed?
Dr. WINER: What we looked at in our study is we looked at chemotherapy as it was administered in the 1980s, so let's say 20 years ago, and chemotherapy as it's been administered over the course of the past five to ten years.
There've been improvements over this time. And what we've found, is that in women who have these tumors that are not fueled by estrogen, that the improvements from chemotherapy are very substantial, and actually far greater than in women whose cancers are fueled by estrogen.
MONTAGNE: Any reason for that?
DR. WINER: It probably relates to the differences in the biology or the personality of these cancers, that they are more sensitive to chemotherapy. It doesn't mean that the other cancers are entirely insensitive, but for women with these estrogen-insensitive cancers, the benefits are just much greater.
MONTAGNE: Has chemotherapy also improved the outlook for women who have breast cancer that does depend on estrogen?
Dr. WINER: It does improve the outlook. But the benefits are quantitatively smaller. Of course, the other weapon we have for women whose tumors are estrogen sensitive, are the hormone blocking drugs. Drugs like Tamoxifen and the newer drugs that are often called aromatase inhibitors.
MONTAGNE: Does this mean that women with either type of breast cancer have an equally good chance of cure?
Dr. WINER: Maybe not quite yet. And we still have reason to be more concerned about women who have estrogen-insensitive breast cancer. When those women develop recurrences, the recurrences tend to happen earlier rather than later, and they sometimes are somewhat harder to treat.
On the other hand, I think this is good news for women who have those estrogen-insensitive cancers. But, there's still a ways to go, and this doesn't mean that we don't need to continue to work hard to find new and better drugs.
MONTAGNE: Then, what should a woman with a new diagnosis of breast cancer of either type, do if she wants the best shot at beating the disease?
Dr. WINER: Well, in the past, the way we made breast cancer decisions, was almost exclusively based on, what I would call, anatomy. That is, how big the tumor is and whether or not it has spread to the lymph nodes. Increasingly, we're making more decisions based on the biology of the cancer, or what I would call the personality of the cancer. Characteristics like, whether it is fueled by estrogen or not.
And so, a woman and her doctor need to understand what type of breast cancer she has. And, more than in the past, pay attention to that in making decisions about what kind of treatment to consider.
MONTAGNE: Dr. Eric Winer is Director of the Breast Cancer Center at the Dana-Farber Cancer Institute in Boston.
Dr. WINER: Thank you very much.
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