HRT, Oncotype DX, And Effective Breast Exams: News From The SABCS

PJ Hamel Health Guide
  • The annual San Antonio Breast Cancer Symposium (SABCS), held earlier this month, is the premier scientific symposium in the world for breast oncologists, breast cancer researchers, and associated healthcare professionals. Its mission is to “encompass the full spectrum of breast cancer research and facilitate the rapid transition of new knowledge into improved care for breast cancer patients.”


    To that end, over 800 papers were presented during this year’s 4-day conference.

    My mission, as your “ear to the ground” here at, was to cull through those papers for news that’s actually useful to the layperson: namely, us. And it was a daunting task.

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    For sure, I didn’t skim the abstract of each paper. I mean, most of them just aren’t actionable, as far as the simple reader is concerned. “Identifying stromal-epithelial interactions in the mammary gland through genome-wide siRNA screening,” for instance. It’s not something I’ve been wondering about lately.

    So rather than wade through hundreds of titles similar to the one above, I relied on daily Google News updates to keep me informed of the day’s ”big” stories. Many involved new drugs in clinical trials (often obvious PR pieces launched by the drug companies themselves). And a good number covered ongoing research that’s interesting (e.g., a breast cancer vaccine), but years away from fruition.

    At the end of the day (er, week), here are some topics from the 2009 SABCS that I think you’ll find both interesting and actionable.

    First it was like drinking from the Fountain of Youth. Then it was identified as a major risk factor for breast cancer. And now, HRT (hormone replacement therapy) is somewhere in between: to be used judiciously, for a short period of time.

    For years, women were prescribed estrogen/progesterone replacements to alleviate the hot flashes, weight gain, horrible mood swings, and other difficult side effects that can accompany menopause. For many of us, taking Prempro or Premarin was a lifesaver.

    Then the massive Women's Health Initiative study determined that these HRT drugs increase the risk of breast cancer, and millions of us reluctantly gave up our hormones, and tried to deal with menopause as best we could. It’s been a tough battle; in fact, many have decided they’d rather risk cancer than continue to face menopause without help.

    A study presented at this year’s Symposium affirms that women who take 10 years of HRT double their risk for breast cancer; being on HRT for about 5 1/2 years increases your risk by about 25%. But there’s good news, too. That risk disappears completely within 2 years after stopping HRT. And, counter-intuitively, women who develop breast cancer after taking HRT have a higher survival rate than those who didn’t take HRT before their cancer diagnosis. It seems women who take HRT develop more “treatable” forms of breast cancer than those who don’t.

    •If you’re experiencing severe menopausal side effects, the current thinking is to take the lowest effective dose of HRT for the shortest effective duration.

  • •If you’ve taken HRT in the past, but discontinued it 2 or more years ago, you can stop worrying about it raising your breast cancer risk.  

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    •If you took HRT and then developed breast cancer, here’s the silver lining; your risk of dying is about 47% less than it is for your sister survivors who never took HRT.

    Oncotype DX
    This genetic testing device is becoming a common weapon in the oncologist’s arsenal. Originally used to predict the likelihood of a cancer recurrence, the benefit of chemotherapy, and the chances of survival in postmenopausal women with ER/PR-positive, node-negative breast cancer, the use of Oncotype is now being expanded to include many more women, according to a presentation at the SABCS. 

    Research completed earlier this year reveals that the Oncotype test is a good tool for women with node-positive (as well as node-negative) cancer. In addition, it can also be used to predict how well a woman will respond to tamoxifen or Arimidex, with respect to those drugs’ ability to prevent a recurrence.

    And finally, it’s been determined that Oncotype accurately assesses both a woman’s hormone-receptor status, and HER2-neu status, both of which are critical factors in developing a treatment plan.

    Takeaway: If you’re a newly diagnosed survivor, and haven’t been offered the Oncotype DX test, ask if you’re a candidate for it. It’s becoming a standard tool for early (non-metastatic) breast cancer diagnosis and treatment.

    The yearly breast exam—are you getting a good one?
    A clinical (hands-on) breast exam by a GP or oncologist is a regular occurrence for most of us. But how effective is it, really, in finding suspicious lumps?

    As it turns out, quite effective—if the i’s are dotted and the t’s are crossed, literally.

    A study completed at the California Pacific Medical Center Research Institute in San Francisco reveals that doctors who are required to complete written forms after doing a breast exam identify nearly double the number of breast masses as doctors who aren’t asked for any paperwork. Lead study author William Goodson, MD, theorizes that "If you ask doctors to stop and think, then they will do a better job."

    Added Susan Love, MD, president of the Dr. Susan Love Research Foundation, "You can make a clinical breast exam a high-quality tool simply by having people pay attention." 

    Is your doctor paying attention as (s)he examines your breasts, or do you get a “been there, done that” checkup? To see what a thorough breast exam looks like, watch this video.

Published On: December 28, 2008