Advances in Research

[Belleview Teacher]

While talking with a group of casual acquaintances yesterday about financial donations to cancer research, one of them said, "I can't see where donations do any good as they are still doing the same thing they did 50 years ago..cut and poison."  As a breast cancer survivor whose treatment consisted of a mastectomy (cut) and chemotherapy (poison) completed in April, 2004, she used me as an example of lack of progress.  I found myself at a loss to argue about advances in cancer treatment.  I did mention monoclonal antibodies, but many in the group freaked out at the word "clone" in monoclonal.  Can you give me some idea of advances in recent years that I can use with this group when I see them again on Tuesday?

[CCF-RN,MSN-rf]

Dear Belleview Teacher:  50 years ago the "cut" was a total mastectomy, which included removing the breast and part of the muscles of the chest wall, leaving a concave area on the person's chest.  Today, in many cases a lumpectomy + radiation can be done with better survival rates.  Even if a lumpectomy is not feasible, a mastectomy now, though still removing a body part, is not nearly as disfiguring nor does it affect function the way the old surgery did.  In terms of progress in "poison," 50 years ago, we had a handful of drugs that we gave in large doses that caused significant toxicity for which we had no real rememdies.  Today, several generations of "poison" later, we now give drugs that specifically have an improved survival rate and with the new medications for nausea and other side effects, most people tolerate treatments reasonably well, though we realize it is not a walk in the park.  Also, treatments can be given outpatient so that people can recover, if needed, in their own homes.  50 years ago, the mortality rate was quite high.  To give you some statistics, although the incidence of breast cancer is higher, the mortality rate is lower.  For example, as recently as 1991, deaths from breast cancer were 25 percent. In 2003, only 12 years later, deaths from breast cancer are down to 18 percent.  This seven percent improvement can be attributed entirely to research on early detection (including mammotome, MRI, mammogram, ductal lavage, and ductoscopy, to name a few), research on surgery (lumpectomy, modified radical mastectomy, and now nipple sparing surgery research is underway), research on radiation therapy (including ways to reduce toxicity to the opposite breast and some new research on implanted radiotherapy - brachytherapy), and research on chemotherapy (including the drugs like paclitaxel[taxol] and trastuzumab[herceptin], new and improved schedules that have improved survival, and growth factors such as filgastrim[neupogen] and the longer acting peg-filgastrim[ neulasta] that have practically eliminated death from overwhelming infection due to low white blood cell counts from chemotherapy, not to mention better antinausea medications and venous access devices such as port-o-caths that allow medication to be given when venous access is a problem).  In terms of the "clone" issue, a better way to explain this might be to refer to this as targeted therapy.  Herceptin is a newer drug that targets the HER2neu antibody that is expressed on the surfaces of some breast cancer cells.  This technology (including the identification of this antibody and the ability to test for this) is less than 10 years old.  And...let's not forget that there are three new medications to address positive estrogen receptor status on tumors that have shown increased disease free survival in postmenopausal women (research is underway in premenopausal women).  These drugs are called aromatase inhibitors and have better toxicity profiles than the already well tolerated tamoxifen. One of the most recent studies to be published is a direct result of the Human Genome Project in which a blood test has been identified that looks to determine risk of recurrence by identifying circulating tumor cells.  This, as the research moves forward, will help doctors identify which patients require more aggressive therapy.  So, while your friends may have a point if the topic is oversimplified to "cut" and "poison,"  I would argue that research has improved both the quality and quantity of many lives.  If your friends think research dollars don't matter, tell them to look at you.  You are "living" evidence that they do, indeed, matter.

[Belleview Teacher]

Thank you for your rapid response.  I now feel better equipped to make my case for contributions to cancer research.  It seems that the people who make the "cut and poison" type comments are those who choose to be uninformed and negative about life in general. This individual continued to make comments about everyone she knew who had died from cancer with no regard for my feelings or those of my daughter who was also part of the conversation. Sometimes it is hard to deal with the negativity you get from people when they talk about cancer, but I will try to be the positive force to shed light on their ignorance.