Lani's two cents Improved survival of breast cancer over past 6 decades!

[Lani]

At the first breast cancer conference I attended Dr. Daniel Hayes stated that Stage IV disease represented uncurable disease, that no matter what the treatment, patients only lived about two years and the only question was what order to give treatments and, with respect to chemotherapy, was it better to give two together or two successively (and in what order)

Since then he has sat on many committees deciding what tests are to be given the approval of ASCO and other organizations, which ends up meaning which tests will be approved by Medicare ...and ultimately private insurances.

Such a predetermined attitude, it seems to me, stifles research into subtypes of metastatic breast cancer which respond differently (better) than others to specific types of treatment and an open mind into discovering, perhaps later, what these might be by improving testing(see my earlier post about 80% response rate to herceptin AVASTIN taxane where I opine that the FDA is about to take away approval of AVASTIN for ALL breast cancers, when a subgroup obviously responds beautifully to it). Dr Slamon often reports that he almost had to give up research on herceptin, as without giving it to the right group of patients (her2+s) it was not going to be deemed efficacious. Dr. Hortobagyi
of MD Anderson has said there may be a small group of Stage IVs with one or very few bone mets who might "theoretically" be curable. Very little research has been done on them.

All breast cancer researchers agree that breast cancers are very heterogeneous. Doesn't it therefore seem necessary to divide to conquer?

All this leads to the abstract I wanted to post...showing that all stages of breast cancer !,!!,!!!, and even IV are showing increased survival as we learn better how to diagnose and treat them (perhaps there is some contribution from the decreased popularity of post-menopausal hormone replacement therapy in the last few years, but I have yet to read how this might have brought these findings about, rather it seems to have decreased the number diagnosed in the first place) It is possible that it has prevented some more aggressive disease, but most articles state that those tumors felt to be due to/encouraged by HRT are of the less agressive type...

In any case, here it is:

ASCO Breast: Big Advances Seen in Breast CA Survival


NATIONAL HARBOR, Md. -- Breast cancer survival has progressively improved over the past 60 years, researchers affirmed in a single-center study.

The 10-year survival rate reached 76.5% for women diagnosed with any stage breast tumor in 1995-2004, Aman U. Buzdar, MD, and colleagues at MD Anderson Cancer Center in Houston discovered when looking back at outcomes at their institution.

This rate marked a steady rise from just 25.1% in 1944-1954 (P<0.0001 for trend), they reported at a press briefing in advance of presentation at the American Society of Clinical Oncology's Breast Cancer Symposium here
Explain to interested patients that a retrospective review of 10-year survival rates of breast cancer diagnosed and treated at MD Anderson Cancer Center from 1944-2004 found significantly increased survival over time for all stages.

Dramatic improvements were also seen across the various stages of cancer, which the group attributed to advances in early detection and combined modality treatment.

"This study shows us how our care of patients has evolved at a rapid pace," commented Jennifer Obel, MD, an ASCO Communications Committee member and moderator of the press briefing. "I think we can hope that the next decade will show similar gains."

The retrospective review included all 12,809 patients diagnosed and seen for their initial breast cancer therapy at MD Anderson between 1944 and 2004.

For local disease, the number of women alive at 10 years rose from 55.0% in the first decade of the study period when radiation therapy was the mainstay of treatment to 86.1% by 1995-2004 (P<0.0001 for trend).

For regional disease with skin or lymph node involvement, 10-year survival improved from a dismal 16.2% to 74.1% over the same period (P<0.0001 for trend).

"This is a dramatic shift because of the combined modality approach" -- often utilizing systemic therapy before or after surgery, Buzdar told reporters. "A dramatic shift in natural history is evident."

Even for those who presented with cancer disseminated to distant sites, improvements were seen from 3.3% alive at 10 years among those seen in 1944 to 1954 up to 22.2% by 1995-2004, again a significant trend at P<0.0001.

"This improvement can be attributed to a number of therapeutic agents available to treat these patients," he suggested in the press briefing.

The findings likely generalize to other centers since similar trends have been seen in the Surveillance, Epidemiology and End Results (SEER) databases, Buzdar noted.

And while the results represented outcomes at an academic medical center, the same treatments can be offered in community hospitals, he added.

Obel agreed. "The approach to cancer care in the U.S. has moved to a multidisciplinary coordinated approach across the country and in community hospitals," she told reporters.

Dramatic improvements in medication have played a role as well, she explained.

"Research advances are quickly taken up in the oncology community such that advances with the use of trastuzumab [Herceptin] in adjuvant therapy when they are presented at national meetings are quickly taken up at smaller, more regional hospitals," she said at the briefing.

The researchers reported having no conflicts of interest to disclose.


Primary source: ASCO Breast Cancer Symposium
Source reference:
Buzdar K, et al "Improving survival of patients with breast cancer over the past 6 decades: The University of Texas M.D. Anderson Cancer Center experience" ASCO Breast 2010.

[TriciaK]

Thanks for this article, Lani, and all the others you post. I think it shows once again that we just can't get bogged down in generalized predictions. My theory is that if even one person has survived a situation, I can too---and so can you! As most of you know, I have had stage 4 BC since 1990 when cancer mets went from breast(1985) to spine. I was in remission for 15 years before it showed up again, now her2, in my lungs (2004). Fifteen months on Herceptin gave me 5 more years remission. Now at age 80 it's back in my lungs, and I plan to keep on fighting BC and will probably die someday "in my old age" of something else.... Stage 4 may be uncurable, as the good doctor said, but I think my experiences with it show that it is certainly treatable, and the 20 years I have lived beyond a diagnosis of stage 4 debunks his prediction of only 2 years life span after such a diagnosis. At ages 16 and 17 I went through severe rhuematic fever, then again at age 30. I wasn't supposed to live from that, either, or ever be able to live a normal life, marry or have children. I was able to give birth to only 2, but along with adopted and step children, there are now 9, plus 32 grands and 40+ greats. I guess when somebody tells me I can't do something, being half Swedish, my stubborness kicks in. My first oncologist told me I could expect to live about a year after the her2 diagnosis in 2004. I laughed at him and said "I'll still be around when you retire! Just watch!" So here we are 5 years later, still fighting, and he is retired. I don't know how much time I have left now, but I will make the most of it, consider myself blessed with every year, and when the time comes go cheerfully, still expecting the best.If my story inspires anyone to keep fighting, it's been worth it! I have certainly received a lot of inspiration from this website. God bless you all. Hugs, TriciaK

[ElaineM]

Thanks Lani. We should all e-mail the information to our doctors or print it out and put it on their desks !!
Love your style Tricia !! I am with you 100%.
I told my doctors I will be showing up when I am 90 +. They told me they will be retired by then. I said, "Okay. No problem !! I will train some new people to take care of me." Smile.
A cancer doctor temporarily on assignment in Hawaii from Yale told me I remind her of one of her other patients in Connecticut who outlived three of her doctors and was still going strong. A surgeon she consulted was afraid to help her thinking he will be next.
I have already outlived two of my doctors who predicted I didn't have long to live many years ago. I am still here almost 12 years after their predictions. I plan to be here many years from now too.
Another woman loaned me a book titled "My doctor is dead, but I am still here" or "I am still here, but my doctor is dead", which is about a breast cancer patient who outlived her doctors. I can't remember the exact title, but I enjoyed the book very much.
Good luck to us all !!!!!!!!! We are all going to live a long time if spunk has anything to do with it.

[Jeanette]

Tricia my dear, you are the original wonder woman. Hope my stubborness keeps me around just like you. I hate to lose a fight. You have a few years on me, but not much, but with my Scottish heritage I am stubborn as all hell. Keeping you in my prayers, Jeanette

[TriciaK]

I didn't mention, Jeanette, that my grandfather on my mother's side had strong Scots ancestry, the McIntoshes, who came to this continent from the Scottish highlands in the early 1700's. Maybe Swedish and Scot makes for even more stubborness! And Elaine, I loved your post, too! I'm sure there are a lot of us stubborn warrior women on this website. Hugs, TriciaK

[ElaineM]

and I am not even Scottish or Swedish !! I am just stubborn and determined to live a normal life span.
Yes. We have some great women warriors from many ethnic groups on site site.

[Ellie F]

Well said tricia! I often feel that us stage 4 girls get written off as hopeless cases! The truth is that they haven't YET found a drug combo that works for us long term therefore turning this disease from a killer into a chronic manageable condition.
We must be nearing that stage by now.I guess it just takes the one breakthrough to clinch the cure!
Ellie