Results of the study showed that the women who took tamoxifen longer did better. The women who stopped taking tamoxifen at five years had 711 recurrences, while the women who took tamoxifen for ten years had about 100 fewer recurrences (617). In the group taking tamoxifen for ten years there were fewer breast cancer-related deaths and no statistically significant increase in the risk of death due to other causes. Taking tamoxifen longer resulted in an additional 30 women (of 1,000) becoming long-term survivors and only two deaths due to endometrial cancer, a known tamoxifen-related risk. Concerning the question of the risk:benefit ratio, particularly the higher risk of endometrial cancer associated with tamoxifen, Dr. Richard Gray, professor of medical statistics at the University of Oxford in the UK and one of the researchers involved in the study, said that the increase in this risk proved to be only 2% and that “the benefits are about 10 times the risks.”

At Wednesday evening’s Hot Topics Mentor Session, which is hosted by Alamo Breast Cancer Foundation, Dr. Peter Ravdin — director of the Breast Health Clinic at the Breast Health Clinic at the Cancer Therapy and Research Center in San Antonio — made the point in his Hot Topic presentation that while the thinking has been that “after five years, any cancer that was left behind would perhaps be resistant to tamoxifen and it wouldn’t make any difference to use it longer,” the Atlas study showed this not to be the case. Although it’s the first five years when the risk of breast cancer recurrence is greatest, it remains fairly high after five years. Ravdin added that while the current standard for postmenopausal women is to take an aromatase inhibitor — anastrozole (Arimidex), letrozole (Femara) or exemestance (Xeloda) — as adjuvant therapy for five years, there are ongoing studies exploring whether a longer course of aromatase therapy would be better in preventing recurrences. Of course, how long any of these drugs should be taken is a decision to be made by each individual woman, based on side effects and other considerations, but these studies are providing better information on clinical efficacy, enabling a woman to weigh benefits versus risks and thereby make an informed decision.

References
Davies C, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 2012 (Dec 4).

Ravdin P. Hot Topics Mentor Sessions presentation at San Antonio Breast Cancer Symposium, December 5, 2012.

In September, Diana Covone, a long-time volunteer and board member of Alamo Breast Cancer Foundation (ABCF), was honored with ABCF’s Volunteer of the Year award. For years, Diana has faithfully spearheaded the organization’s community outreach program as Volunteer Coordinator with remarkable dedication and commitment, even through difficult times.

In addition to volunteering her time and effort in a pivotal role on the outreach program, Diana serves on the ABCF board of directors, is an invaluable HELPLINE volunteer, particularly because she is bilingual, and is a member of the Patient Advocate Committee for the San Antonio Breast Cancer Symposium. Her quiet determination, selflessness and kindness are evident to all who know her. Diana was born in the Republic of Panama, but the United States has been her home for the past 44 years. Her determined efforts to do her part to conquer breast cancer arose from her own personal battle with the disease. She was diagnosed with breast cancer in 1992, and because 22 lymph nodes were involved, she endured five rounds of chemotherapy, a bone marrow transplant and radiation, all within a year. She was cancer free until last year, when her physician told her the cancer had metastasized to her bones. Diana’s positive attitude and indomitable spirit are reflected in what she has said about her recurrence: “It was a shock to me and my family, but the cancer has been stable for over a year now, and I have faith that it will stay that way for many years. Meanwhile I will keep on doing my part with Alamo Breast Cancer Foundation to defeat this disease.”

Return here for information on various large group meetings attended by ABCF members

ABCF Founder and Chair of Advocacy 

After Dale Eastman was diagnosed with breast cancer in 1990, she became an advocate for other women with the disease. As a healthy, active woman with no history of breast cancer, her diagnosis was a shock not only to her but also to the healthcare providers who had been assuring her for years her lumpy breasts were no more than a fibrocystic condition.

During her breast cancer journey, Dale discovered that treatment options available in 1990 had not changed since the 1970s. Many women, after being diagnosed, had only two or three days to make major decisions regarding surgery and treatment. This was not acceptable to Dale. She wanted to ensure women the right to receive the most up-to-date information in order to make educated decisions about their health care, and she wanted to find ways to combat the mounting epidemic. The cause, cure and prevention of breast cancer as well as access to quality care for all women became her quest. With the help of four women around Dale’s dining room table, Alamo Breast Cancer Foundation (ABCF) was founded in 1993.

During the early years of the organization, Dale organized a signing petition campaign to Congress that secured 27,000 signatures requesting increased funding for breast cancer research and national action. As a result, she was invited to the White House for recognition. Her leadership has helped pass Texas legislation that protects individuals from discrimination from health and life insurers due to the results of genetic testing. In addition, her endeavors assured passage of a bill providing coverage for reconstruction after mastectomy, including the non-affected breast to promote symmetry. Another major accomplishment in which Dale played a major role is passage of the federal Breast and Cervical Cancer Treatment Act, which provides treatment to uninsured women diagnosed with breast or cervical cancer through the Breast and Cervical Cancer Program (BCCP). In addition, she spearheaded the efforts to locate an Avon grant to bring mobile mammography back to San Antonio.

Dale’s remarkable success as a leader at the forefront of the breast cancer movement stems from her fearless advocacy for education and assistance of others with breast cancer.

• CPRIT should be overseen [6] and its grants awarded by committees that have a meaningful number of cancer patient advocates trained in the science of cancer and best practices for clinical trials. The statute currently contains only a general goal of including cancer survivors or their families as members of the Oversight Committee. There is no requirement to include them on the committees reviewing grants.[7]  Trained patient advocates are essential to ensuring that research grants go to proposals most likely to meet the statutory goals.[8]  “Best practices” followed by other major grant programs like the DOD and  the National Institutes of Health (NIH) include this requirement, and Texas should implement it. As trained advocates, we can credibly challenge scientists in a way that untrained survivors and their families cannot.

• We need a better and more public annual report. Texas does not need to reinvent the wheel. The DOD BCRP “Era of Hope” Conference is a great model. Every other year, DOD hosts a public conference at which grant recipients present the outcome of their research. Advocates and scientists meet and discuss the most important research. It puts a face on the disease that many scientists have said is critical to incenting them to keep at their research. It is a public accountability that ensures the knowledge developed, good or bad, with our tax dollars is shared.

• Finally, we urge that the legislation expressly recognize and require use of the Clinical Trials Network of Texas.[9] As some of you may know, the national average for adults participating in clinical trials is abysmal. I am not aware of Texas-specific statistics, but it is safe to assume we are no better. We need to encourage clinical trials and the availability of trials throughout the state. CPRIT could be a big part of that effort.

THANK YOU.  I AM AVAILABLE FOR ANY QUESTIONS.