Grace Makari-Judson, MD, chair, Baystate Health Network, shares an update from the American Society of Clinical Oncology Meeting.
The 19-year follow-up of an important dietary intervention study was presented at this year’s American Society of Clinical Oncology meeting. In the Women’s Health Initiative (WHI), started in 1993, 48,835 postmenopausal women without breast cancer were randomly assigned to either follow their usual diet or a low-fat diet that included only 20% of calories from fat. The number of women diagnosed with breast cancer was not statistically different between the group following the usual diet versus the low-fat diet.
However, the women following the low-fat diet had a lower risk of dying after the diagnosis. Other studies, such as the Women’s Intervention Nutrition Study (WINS) and the Women’s Healthy Eating and Living (WHEL) study were started in 1980s and 1990s and focused on fat reduction showed benefits but raised the question of what is more important: what you eat (e.g., fruits and vegetables) or what you don’t eat (fat)?
The bottom line is that there is still no breast cancer prevention diet. Women who follow a healthy diet may still be diagnosed with breast cancer, however, once they are treated, they have better outcomes compared to others.
We are fortunate in the abundance of new treatments for breast cancer. Before the year 2000, only four drugs were FDA approved for the treatment of breast cancer. The next decade brought four more drugs, then 2010-2015 introduced five new drugs. Since 2015, 10 more drugs have become available, especially in the treatment of advanced breast cancer. These include hormone treatments, chemotherapy, targeted antibodies, antibody-drug conjugates, small molecule inhibitors and immune checkpoint inhibitors.
Precision medicine has given us the opportunity to tailor treatments to target specific molecular alterations in a tumor so we can better understand what will be the most effective strategy. To keep up with this fast pace, we need to have clinical trials available and be able to identify who will be best served by which treatments.
At Baystate Medical Center, we recently opened the Metastatic Breast Cancer Registry. Metastatic breast cancer is not curable, but is treatable and these new treatments are allowing women to live longer. Individuals with metastatic breast cancer that agree to participate in the registry will have a sample of blood taken, allow access to leftover tissue from a prior biopsy and fill out a questionnaire. The information will allow identification of individuals eligible for clinical trials. This contributes to Baystate Regional Cancer Program being more competitive by having real-time data for industry and cooperative group partners as new drugs become available for testing. For more information about clinical trials at Baystate Health, call 413-794-9875.
FDA textured implants update
We have received a number of questions from women regarding textured implants. In July, the FDA requested that Allergan recall its BIOCELL textured implants from the market. This implant represents less than 5% of the implants sold in the United States. The concern is based on the risk for a very rare condition called breast implant associated anaplastic large-cell lymphoma (BIA-ALCL). This lymphoma has been described in 573 individuals of which 481 had this type of Allergan breast implant. The likelihood of developing BIA-ALCL was six times higher with this specific implant compared to others. Benjamin Schalet, MD, Baystate Plastic Surgery, comments that the likelihood of developing BIA-ALCL was six times higher with this specific implant compared to others.
“The estimated lifetime risk with this implant is approximately 1:6,000 but may vary based on factors such as genetic susceptibility and geography that are still under active investigation,” said Dr. Schalet.
FDA does not recommend that women that currently have these implants have them removed. They do recommend the following:
- Know the symptoms and report any persistent swelling, fluid or pain near the implant.
- Keep a record of the manufacturer, unique device identifier and implant model number.
- You likely received this at the time the implant was placed. If not it should be available from your surgeon or recorded in the operative note from the hospital where your surgery was done.
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