For the week of February 26 - March 4, 2003

Expedition Inspirations continues to inspire

Breast cancer symposium 
informs discussion

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By DANA DUGAN
Express Staff Writer

"It’s remarkable what we get in this valley," a woman said as she departed a recent public forum on breast cancer research. "We’re lucky to live here." The woman, a cancer survivor, had just spent two hours listening to some of the foremost doctors and researchers on breast cancer in the country.

The forum was part of the Expedition Inspirations’ Seventh Annual Laura Evans Memorial Breast Cancer Symposium.

Titled "Breast Cancer Metastases: Formation, Detection, Treatment," the symposium was held in Sun Valley, Feb. 20 through Feb. 23.

The public forum included featured speakers who made presentations on timely subjects and general breast cancer research and developments. It concluded with a flurry of questions from the audience.

Featured speakers were Dr. Julie Gralow, chair EIFBCR Medical Board, associate professor of medical oncology at the University of Washington School of Medicine and Fred Hutchinson Cancer Research Center in Seattle; Dr. William Gradishar of Northwestern University Medical School and director of Breast Medical Oncology at the Robert H. Lurie Comprehensive Cancer Center, Chicago; Dr. Marc Lippman, chair of the Department of Internal Medicine Research and Developments at the University of Michigan Health System in Ann Arbor.

Dr. Ron Dorn and Dr. Kathleen Grant, two of Laura Evans’ doctors who were on the groundbreaking climb on Argentina’s Mount Acongagua in 1995, also participated on the panel. They are both also on the Expedition Inspirations board.

Another board member, Dr. Robert Vestal, from Boise was on the panel. Other speakers included Dr. Cliff Hudis, chief of Breast Cancer Medical Service at Memorial Sloan Kettering in New York; Dr. Donald Cleveland of the Ludwig Institute for Cancer Research, at the University of California in San Diego; Dr. Chris Benz, of the Buck Institute in Novato, Calif., and Dr. John Lung of Mountain States Tumor Institute, Boise.

Dr. Gralow began the talk by discussing the risk factors involved with breast cancer. The No. 1 risk is being female, she said. Although, men can and do get breast cancer. The No. 2 risk factor is age, with the average age of a breast cancer patient being 62.

The third largest risk factor is reproduction history. Several components factor into this issue. The history of a woman’s menstrual cycle, how many pregnancies a woman has had, whether babies were breast-fed and at what ages the pregnancies occurred.

"The more pregnancies," Gralow said, "the less the risk. Does this mean we should go into schools and promote pregnancies? No. That’s a whole other problem. But pregnancy does protect us."

Part of the reason the incidence of breast cancer has risen in the past 20 years is that women have put off having babies. In many cases the later a woman bears a baby, the higher the risk of breast cancer.

Life style is also a risk factor. Factors such as stress, smoking, extreme weight gain, lack of exercise, exposure to pollutants and toxins, alcohol intake, and diet play a role.

The fifth largest risk factor is family and genetic history. Many people assume it’s the most important factor, but Gralow said 70 percent of cancer patients do not have a history of cancer in their family.

Dr. Gradishar added that it remains a pertinent issue if the "family history has multiple close family members—mother, sisters—who have cancer."

Regarding prevention, Dr. Lippman discussed, as he did last year, phytoestrogens, progesteron and clinical trials. "I don’t think it matters what kind of progesterone you use if the risk goes up," he reiterated. "If you’re taking enough phytoestrogen to reduce hot flashes, you’re more likely stimulating breast cancer cell growth."

In addition he said, "Oral contraceptives are wonderful anti-cancer" drugs for the average women who has no risk factors.

Despite the necessity of exercise, he said that a woman who over exercises—marathoners in particular—runs the risk of decreasing her menstrual cycles, thus putting her at risk.

Lippman had hopeful words as well, though. Death from breast cancer will fall below 40,000 a year. The chances of a patient dying are now down to one in five, which is a significant improvement, he said. Much of this is because of better drugs coming on the market after long trial periods. Breast cancer is not just one disease, he said. "We have to match the drug to the disease.

"We can now look at 30,000 genes on a slide. We can see which gene is on or off. What is the pattern and how is this cancer changing? What makes this a bad cell?"

Cancer cells have unlimited growth and have the ability to spread, he said. Normal cells don’t migrate to other sites. And unlike normal cells, cancer cells don’t know when to die.

"What’s really cool, is that we have figured out how to treat them by looking at them and understanding what is making a cancer cell behave metastatically," Lippman said. "But that’s the tip of the iceberg."

Cancer cells not only know how to feed themselves, they can grow proteins, which keeps them from dying.

"Cancer is a metaphor for what we feel we can’t control. We have to get rid of the metaphor. Cancer is running out of places to hide."

Many pencils were scribbling across paper as Lippman talked. A valley health care provider in the audience leaned over and whispered, "The study of cancer is the study of immortality."

The audience for the forum at the River Run Lodge was filled with informed cancer survivors.

Dr. Cleveland said, "Within all cells there exists a suicide pathway. However, some drugs, including Taxol, are being looked at which may encourage cancer cells to commit suicide." This finding is so important that the 2002 Nobel Prize for Medicine went to three doctors for their discoveries concerning genetic regulation of organ development and programmed cell death.

Researchers also know now that the impact is not just limited to the tumor. The immune system throughout the body is compromised. Tests show that Taxol disables cancer cells, particularly in the cancers that affect women's reproductive systems.

If tumors didn’t metastasize we’d just cut off the breast and be done, Lippman said. But they do.

The speakers ended on a high note. They said they would be exchanging ideas and discoveries over the following two days and would then go home to spread the word.

The Idaho Mountain Express is distributed free to residents and guests throughout the Sun Valley, Idaho resort area community. Subscribers to the Idaho Mountain Express will read these stories and others in this week's issue.