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CNN SUNDAY MORNING

Weekend House Call

Aired October 19, 2003 - 08:29   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL. Today we're talking about breast cancer. October is Breast Cancer Awareness Month and just last week a breakthrough treatment was announced. The drug Femara has been shown to decrease by half the chances of recurrence of breast cancer. As our Dr. Sanjay Gupta reports, it's just the tip of the iceberg when it comes to improvements and treatments for breast cancer.
(BEGIN VIDEOTAPE)

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT (voice-over): When most people think of chemo, they think of getting sick, throwing up, losing their hair. No one knows better than Dolores McMullins. She took the drugs for breast cancer 20 years ago.

DELORES MCMULLINS, BREAST CANCER PATIENT: From the chemotherapy there was the actual vomiting which was just awful. It was -- you know, just awful.

GUPTA: Even worse, she has cancer again. Today therapy is much easier.

MCMULLINS: Now, when I leave the doctor's or when I leave the infusion center, I can go to lunch, I can go to work, I can go play, so to speak. And that, for me, has made this time different.

GUPTA: It's different because of new medicines that fight nausea, infections, and other side effects.

RUTH O'REGAN, WINSHIP CANCER INSTITUTE: The chemotherapy drugs are actually very similar to what we used before, but we -- over the last ten years we have these new anti-nausea medicines that have, really, I think, revolutionized the way we give chemotherapy.

GUPTA: Radiation therapy often follows chemo therapy and can leave patients like Carolyn Runowicz feeling fatigued.

DR. CAROLYN RUNOWICZ, BREAST CANCER PATIENT: I thought there was something wrong with me, that maybe my disease had spread and that that was why I was so tired.

GUPTA: But, here again, recent improvements in the form of targeted therapy allow precise treatments that can reduce some of the fatigue and skin irritation.

DR. LAWRENCE DAVIS, EMORY UNIVERSITY: The machines are more fully developed and they are higher energy. There are better ways to direct the radiation to the parts of the breast that should have the higher doses of radiation, so that it's more focused.

GUPTA: Better treatments are making a difference in the day-to- day lives of cancer patients, whether her first time facing the disease or a recurrence.

MCMULLINS: The combination of the different methods of treatment has made this easier, this round. Not that I've wanted to repeat it, you know, to see this, but it has made it better.

GUPTA: Dr. Sanjay Gupta, CNN, Atlanta.

(END VIDEOTAPE)

COHEN: Several more treatment options are on the horizon for breast cancer. Dose-dense chemotherapy has been shown to increase survival rates in some women. That means that the therapy is given at shorter intervals and treatment takes less time. Two new developments in radiation therapy are also coming down the pike. Experts are looking at administering radiation sooner after surgery and implanting so-called radiation seeds inside the breast to retard cancer growth.

Now, earlier we mentioned the drug Femara and the study they found that it cut the risk of a breast cancer reoccurrence by half. They actually stopped that study early so they could get out that good news to all breast cancer patients. We're going to be taking all your questions about new breast cancer treatments. Call us at 1-800-807- 2620 or e-mail us at housecall@cnn.com.

We're joined by Dr. Kristen Zarfos a breast cancer surgeon at the University of Connecticut Health Center.

Welcome, Doctor. Thanks for joining our show.

DR. KRISTEN ZARFOS, BREAST CARE SPECIALIST: Good morning, thank you.

COHEN: Well, let's get started right on in with some e-mails that we have lined up. The first one is about the drug Femara which is being called a huge breakthrough in breast cancer. Actually, this isn't an e-mail, a question I have. Does this work for all women or just postmenopausal women?

ZARFOS: Well, it only works for postmenopausal women. But, let's be clear how Femara is used. In women who've received a drug called Tamoxifen for five years after their initial diagnosis, we've been at a quandary what to do after five years. We know that Tamoxifen has been beneficial, but not beneficial beyond five years. The study you referred to looked at Femara, also known as Letrozole, to decrease the risk of breast cancer recurring after the initial five years. Now, the study showing that women who go on Femara have a 50 percent decreased risk of the cancer recurring after that initial five years. And, this is a great breakthrough for women diagnosed with breast cancer. To answer you questions specifically, this is only applicable to postmenopausal women who have estrogen responsive tumors.

COHEN: And I think it's important to note also, that they only followed these women for two-and-a-half years. So, if another, let's say, year later they get breast cancer, that didn't show up in this study. So, the follow-up period was relatively short.

ZARFOS: Well, that's true. Initially the follow-up was supposed to be five years. But, they saw such great benefit that it was felt that it was imperative that all women -- all women who could benefit from this drug should have the opportunity to do that.

COHEN: All right. Well, we have an e-mail now, from Mary in New York who wants to know: "As a breast cancer survivor (estrogen related) and having successfully completed my five years of Tamoxifen last spring, is it too late to start on this new Letrozole treatment?"

Letrozole, as you just said, before is the generic name for Femara. So, women who have already had their surgery, had their Tamoxifen, and they're more than five years out, can they start Femara, now?

ZARFOS: Well Mary, that's a good question. The studies show it should be started within three years. So, if a woman is at high risk for developing recurrence after her Tamoxifen, she may benefit even if it's beyond the three months. This is a discussion that she should have with her physician directly.

COHEN: OK. We have an e-mail now, from Peggy in New York who writes: "The recent reports on Femara show there's a high incidence of osteoporosis. What can be done to avoid the weakening of bones as a trade-off to the reduced chance of recurrence?"

ZARFOS: Peggy, the people who wrote this study addressed that issue directly and it's a very good question because there is a slight increased risk of developing osteoporosis on Femara. What you can do is take calcium in divided doses, 1,500 milligrams a day, combined with vitamin D and do weight bearing exercise, such as walking, climbing stairs, 15 to 30 minutes a day, four to five times a week. Women also -- Femara should also have a bone density study to get a baseline study to see what the character of their bones are and if there's any progression, there are other drugs that can be used in addition to calcium and exercise.

COHEN: We have a phone call question now, from Dean in Florida.

Dean, thanks for calling WEEKEND HOUSE CALL. You can go ahead with your question.

DEAN, FLORIDA: Yes, good morning folks. My question's regarding families that have a history of breast cancer. Is there anything that young women can do, as far as prevention, whether it be diet, exercise, or even perhaps medication, natural or pharmaceutical they can do for prevention aids?

ZARFOS: Dean, yes there's some wonderful strategies. First of all, there have been studies that show that exercising at least four hours a week can decrease your risk of developing breast cancer 37 percent. Also, avoiding excessive alcohol, because studies show that more than seven alcoholic beverages a week increase your risk of developing breast cancer. Obesity is a risk factor for developing breast cancer, so exercise combined with diet control can temper that. As far as women with a strong familiar history there's always the consideration of genetic counseling. But, one should proceed cautiously because genetic testing once in the records has a lot of implications.

COHEN: Well, we'll be talking more about preventing breast cancer when we come back. We'll be talking about the controversy over self- breast exams. How important are they and should you be doing them? We'll have the answers next. And, we'll hear more of your questions. Call us as 1-800-807-2620 or try our e-mail at housecall@cnn.com.

But first, let's check our "Daily Dose Health Quiz." How accurate are mammograms in detecting breast cancer? Here are your choices: 90 percent; B. 85 percent; or C. 70 percent.

Stay with us for that answer when WEEKEND HOUSE CALL continues.

(COMMERCIAL BREAK)

COHEN: Checking the "Daily Dose" quiz we asked: How accurate are mammograms in detecting breast cancer. The answer is "A" 90 percent of breast cancer is detected by mammograms before women have any symptoms. Just a reminder to women out there, if you're 40 and over, you should be getting a mammogram every year.

Welcome back to WEEKEND HOUSE CALL. When it's time to get that mammogram you should ask your doctor if you have dense breast tissue. That's because a new study says dense tissue can mask cancer in mammograms. So, women with dense breast tissue should also consider getting an ultrasound in addition. If you're a woman with a familiar history of breast cancer or in some other high risk group an MRI, Magnetic Resonance Imaging, can be used in addition to mammograms to detect tumors early. We're joined by this morning by Dr. Kristen Zarfos.

First we have a question from Dana in Wisconsin, "Are MRI's becoming the way to do instead of mammograms?"

ZARFOS: Dana, that's a very good question. MRI's are an adjunct to mammograms and there's a small group of women who benefit from having an MRI in addition to their mammogram and those women are women at high risk by virtue of carrying the mutated BRCA1 or 2 gene, women who have a strong familiar history, and have difficult to examine breasts because of dense tissue. No, it's not a replacement for mammography, but used as an adjunct in certain women. Now, women who've already been diagnosed with breast cancer, MRI's are very valuable to look for extent of disease or if there's a second spot in the breast or if there's breast cancer in the opposite contra lateral breast. But for now, MRI's are an adjunct.

COHEN: We have a phone call now, from Rosemary in Massachusetts. Rosemary, welcome to the show. You can go ahead with your question for Dr. Zarfos.

ROSEMARY, MASSACHUSETTS: Thank you. Hello, ladies. I'm postmenopausal. I have a fibroid cystic condition and I have yearly mammograms and have for many years to follow this condition. I've been recently experiencing pain in one breast, and a lot of discomfort. We discovered a lump and it was followed for several weeks, it seemed to disappear. My doctor is now telling me that the pain is a good sign as a serious problem is usually no pain. However, I'm concerned with that diagnosis. Would I benefit from ultrasound along with mammogram? And my second question also is, recently I saw something about a procedure, ductal aspiration, I don't know if I'm quite right in that. But if that is something that can be done, would I benefit from that?

ZARFOS: Well, Rosemary, thank you for calling this morning. As far as the role of an ultrasound, it's very helpful when a woman has a lump you can feel or a nodule that you see on the mammogram. If your lumpy area has resolved, that's reassuring. As far as ductal (UNINTELLIGIBLE), and I'm glad you asked that question, that's a procedure used in high risk women. And, what is done is the breast the aspirated to see if any fluid comes out of the nipple. If it is, then it can be analyzed through a special procedure. Your physician is right that absence of pain and resolution of the lump are good signs. But continue to do self-exam and keep your follow-up appointments with your physician.

COHEN: We have an e-mail now, from Tiana in California. She's got a question I know a lot of women have, "I'm 22 and I've just started performing monthly exams. What am I supposed to be looking for and how do I know if I'm examining myself correctly?"

ZARFOS: Tiana, this is a question a lot of women in this country are asking because of the recent study that came out that said maybe breast self-examination isn't good for women. In this country today, women should be proactive in their health care by watching this show, reading, and getting all the information they can, but as well as being observant of their breasts. Certainly breast self-examination should still be done once a month, the last day of your period, if you're still menstruating, and if not menstruating, any day of the month, but the same day each month.

Look for any change in the texture of your breast. Most women who feel uncomfortable with self-exam feel that way because they don't know what they're looking for. But, all you need to know is the texture of your breast and what they look like. If on feeling your breast, you feel any change, any firmness, lump, anything that's different, see your physician. On looking at your breast, look for a difference in -- difference in appearance of each breast. Now, in most women, one breast looks a little different than the other, usually in size. But if you notice a change in the texture of the skin, a roughness of the skin, scaling of the nipple, or puckering, then that's something else that you should consult your physician about. COHEN: Now, I know many women have said that they have lumpy breasts and they're lumpy, they're benign lumps, but they say, I can't tell the difference. How do I know if what I'm feeling is an OK lump or a not OK lump?

ZARFOS: Well, those women are one of 70 percent of women with lumpy breasts and so it's a common concern, and again, what they should do is get to know the texture of their breast, at the point in their menstrual cycle where the breasts are least stimulated. If they have any questions then see their physician, nurse practitioner, or physician's assistant to have it evaluated, and then consistently continue to examine the breast just to look for a change. No, you don't have to find a specific lump to know what it is, all you need to do is know your breast and find that there's been a change.

COHEN: Well, questions continue about the link between the link between hormone therapy and breast cancer. Next, is HRT putting you at risk for breast cancer? We'll tell you what you should be talking to your doctor about. That's when WEEKEND HOUSE CALL continues.

(COMMERCIAL BREAK)

COHEN: For women at high risk for brents cancer -- breast cancer, there are some preventive steps that they can take. Taking Tamoxifen or Raloxifene has been shown to lessen the likelihood of developing the disease, those are prescription drugs. Very high risk women may also consider having preventive mastectomy, and studies have shown some women can lower their chances of getting by having breast cancer by having their ovaries removed once they're finished after having children.

Welcome back to WEEKEND HOUSE CALL. October is Breast Cancer Awareness Month and it's our topic today. Kathy from California sent us an e-mail, she want to know, "Why would a doctor say to get off of hormone replacement therapy when you're diagnosed with breast cancer?"

We're talking with Dr. Kristen Zarfos. There's been some controversy, actually a lot of controversy surrounding HRT and breast cancer. Where do we stand now?

ZARFOS: Well, Kathy's question's good. First of all, many breast cancers are hormone responsive. So, if you have a tumor that responds to estrogen, that's why you don't want to take hormone replacement therapy. But, for the rest of the population, three studies have shown that being on combined hormone replacement therapy for more than five years can increase your risk of developing breast cancer 1.4 times. That translates to be 8 in 10,000 women. Women need to look at what hormone replacement therapy can do for you. It certainly is the only way to effectively take care of menopausal symptoms, but it does not prevent heart disease and there are other ways to prevent osteoporosis in addition to HRT, there are alternatives. So, women need to weigh quality of life issues around their menopausal symptoms versus the risks and benefits of hormone replacement therapy.

COHEN: Ina Ray, is on the phone, right now, from South Carolina. Ina Rae, welcome to the show and you can go ahead with your question.

INA RAE, SOUTH CAROLINA: Thank you. I was just diagnosed with bilateral breast cancer during a routine mammogram -- quite a is shock. And, I've had bilateral lumpectomies and now I've just completed my first week of radiation and I'm told that at the end of this six-and-a-half weeks of radiation, I should begin taking an Arimidex, which is an aromatase inhibitor, very much like Femara. I'm wondering would I benefit more from Femara. I still have my uterus that's why I was told no Tamoxifen.

ZARFOS: It's a good question Arimidex has been shown in studies to be excellent and actually superior to Tamoxifen. Femara has not been studied in women in this particular situation, immediately after the diagnosis of breast cancer. Femara has just been studied in women who have taken Tamoxifen for five years. There are ongoing studies, but for now I believe Arimidex, based on the information you've given us, is an excellent choice.

COHEN: Well, if you know someone who's been affected by breast cancer, grab a pen, when we come back we're going to give you some heartfelt helpful tips on what you can do to help from someone who knows.

Plus, we also encourage you to go to cnn.com/help -- slash health for more information and links on today's topic. We'll be right back.

(COMMERCIAL BREAK)

COHEN: For more information on breast cancer causes, treatments, and prevention go to the American Cancer Society's Web site: www.cancer.org, or try breastcancer.org. Among other things they have a celebrity talking dictionary that gives you simplified definitions.

(BEGIN AUDIO CLIP)

LINDA ELLERBEE: Mammogram: An x-ray picture of the breast.

JOHN MAHONEY: Malignant: Cancerous. A growth that tends to spread into nearby normal tissue and can travel to other parts of the body.

OLIVIA NEWTON-JOHN: Mastectomy: Surgery that removes the whole breast.

(END VIDEO CLIP)

COHEN: CNN owns -- CNN's Daryn Kagan has some advice for those who have a loved one dealing with breast cancer. Daryn's mom was diagnosed last year and Daryn wrote about it in this month's "Self" magazine. Her tips include lend your brain, even though Daryn and her mom live thousands of miles apart, they would find time to brainstorm on the phone together.

Also, do something normal, even a shopping spree can ease the stress. And, spread the love. Cut out chaos by setting up a schedule for visitors. Avoid "surfing," Daryn says that giving patients scary information from the web is not helpful. Also, ditch the casseroles. Many women explore healthier eating options after being diagnosed, and lastly, don't overstep your boundaries. Remember breast cancer treatment is not a social occasion. One survivor told Daryn that sometimes getting a wonderful note instead of a visit is much more helpful. Daryn says her mom had a lumpectomy and radiation and is on her way to a full recovery.

We here at WEEKEND HOUSE CALL want to wish Daryn's mom the best and thank Daryn for her terrific advice.

Dr. Zarfos, we're just about out of time, but what's your final piece of advice for women who are battling breast cancer?

ZARFOS: Get as much information as you can, not only in general, but about your own health. Have your annual mammograms, if you're over 40, ask your doctor all the questions you need to ask, have yearly breast exams, and monthly self-examinations. And most important, don't be shy about asking for more information, be proactive.

COHEN: Be your own advocate that is always good advice.

Thank you Dr. Zarfos, for enjoy -- for joining us. And, thanks for our viewers for your great questions. We hope you found today's program helpful.

Tune in next weekend when we have a new look at the newest diet craze, the South Beach Diet. The book's author, Dr. Arthur Agatston, will be our guest. That's next weekend, 8:30 Eastern on CNN.

Thanks for watching, I'm Elizabeth Cohen. "CNN SUNDAY MORNING" continues right now.

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