The Treatments and Risks Facing Elizabeth Edwards Democratic presidential hopeful John Edwards and his wife Elizabeth announced last week that her breast cancer has returned. Doctor Sydney Spiesel explains the available treatments and the risks.
NPR logo The Treatments and Risks Facing Elizabeth Edwards
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This is DAY TO DAY. I'm Madeleine Brand.


I'm Alex Chadwick.

Coming up, selling beauty to baby boomers in the nude.

BRAND: First, John Edwards is continuing to campaign for president along with his wife, Elizabeth Edwards. She has disclosed that she has inoperable cancer. We've heard a lot about the political implications of her illness. But what lies ahead medically for Elizabeth Edwards?

We're joined again by Dr. Sydney Spiesel. He reviews medical literature for us and for the online magazine Slate. He is also a professor at the Yale Medical School. Hi, Sid.

Dr. SYDNEY SPIESEL (Medical Literature Reviewer, Slate Magazine; Professor, Yale Medical School): Hi. How are you?

BRAND: Well, Sid, she has inoperable cancer, it has spread to her bones. What are the biggest risks for her right now?

Dr. SPIESEL: Well, as is always the case, it's always a little bit dicey to even make some guesses but we have some ideas. I mean, first of all, she is a really, you know, very remarkable and impressive woman, 57 years old. She was treated for cancer, for breast cancer, three years ago with chemotherapy, surgery, radiation. She seemed to do well.

Now in general, 90 percent of unselected women will be disease-free five years after this treatment. But she was, unfortunately, among the five percent of women in whom the disease just reappeared after only three years of treatment.

I think the biggest risk for her is that the disease will continue to spread, that despite our treatments, which are actually good in certain ways, that we won't be able to arrest the spreading. The disease might spread to other places and might spread to other bones. Right now, she has two bones that are affected. One is the rib.

And recently, I understand that it was found there's another nest of cells in her hips. Now, what the effect of this is that at the sites where the bone is affected, it becomes thin and weak and can sometimes be quite painful. Two real issues around bone metastases are local pain and local weakness.

And then as bone, especially if you can't control the breakdown of bone in the vicinity of the tumor, it can lead to high levels of calcium, which can make people quite sick and actually are sometimes fatal, even.

BRAND: And would she likely be treated with chemotherapy or radiation or how would she be treated?

Dr. SPIESEL: Well, she'd probably be treated with some local radiation because that can inhibit, especially when it's so localized, that can inhibit the growth of the metastases that have already appeared in the bone. It will also - if her tumors are sensitive to estrogen, which many of them are - many breast cancer tumors are sensitive to estrogen.

We can use several different drugs that will prevent the tumors from being stimulated by the body's natural estrogen. One is we can use tamoxifen or drugs like that, which block the receptors on the tumor cells from being stimulated by estrogen. And we can also use a new class of drugs called aromatase inhibitors, which block the body's production of estrogen so that the background level of estrogen will be dramatically diminished.

And then we can do things for the bone itself, as the bone is sort of being attacked in the vicinity of these little nests of metastases of tumor cells, we can use the class of drugs which are really wonderful called bisphosphonates. They act by inhibiting the cells, the bone cells, which are causing the breakdown of bone.

And so that can prevent a lot of the damage and weakening and probably pain that's often, in the past, been associated with metastatic breast cancer or cancer that's metastatic to bone.

BRAND: And what are her chances for survival in the long term?

Dr. SPIESEL: Well, I don't want to be flip about this but, ultimately, none of us have very good chances of survival in the very long term.

BRAND: Right.

Dr. SPIESEL: The question is how is this going to affect her life. And yes, it's true that these metastases dramatically worsen her prognosis. You know, had they not occurred, her likelihood of surviving for more than five years would have been somewhere well over 85 percent. Now, it's probably about 20 percent, statistically. And the illness went to one, which might have been cured to one, which might be, sort of, at best controlled.

So it's hard to predict. But on the other hand, I think that - and I certainly hope that she'll fall in this category - there are some patients who, although, they're never fully cured will still have a relatively good outcome with their disease reasonably well controlled with a high quality of life and a good long survival, which is exactly what one would hope for this very exceptional woman.

BRAND: Opinion from Dr. Sydney Spiesel, a pediatrician and also a professor at the Yale Medical School. And you can read Sydney Spiesel's Medical Examiner column at Thanks again, Sid.

Dr. SPIESEL: Thank you.

(Soundbite of music)

BRAND: There's more coming up on DAY TO DAY from NPR News.

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