Paula O
12-18-2012, 03:08 PM
SABCS Navigating Survivorship: Sexuality,Cognitive Changes, Risk of Developing Second Primary Breast Tumor
[ES4-1] Navigating the Obstacles and Risks of Survivorship: Breast Cancer Sexuality: Issues and Answers
Krychman M. The Southern California Center for Sexual Health and Survivorship, Newport Beach, CA; University of California Irvine, Irvine, CA; University of Southern California, Los Angeles, CA
The sexual consequences of breast cancer and its treatments are well known. Sexual difficulties include alteration in hormonal levels, changes in sexual organs and anatomy, vaginal and vulvar dryness, changes in libido, increased latency to orgasm and decreased intensity of orgasmic response. Changes in body image, sexual self-esteem and relationship dynamic tension may present as survivorship challenges for the breast cancer patient and her partner. Severe vulvo vaginal and clitoral atrophy as a result of chemotherapy and/or adjuvant hormone therapy, and loss of libido secondary to dyspareunia are widespread. Cytostatic medications that are prescribed for long-term use (aromatase inhibitors) can impact bone health, sexual functioning/satisfaction and overall quality of life. Many women on aromatase inhibitors have severe complaints of vulvar and vaginal atrophy.
Sexual dysfunction is common for breast cancer population and limited acceptable treatments are available. Minimally absorbed local vaginal estrogen use in this population remains controversial and a hotly debated controversial topic. More data should be forthcoming. There are multiple new innovative treatments in the research pipeline for female sexual dysfunction. DHEA intravaginal suppositories, Flibanserin and Bremelanotide (PT 141) remain promising although they have not been adequately studied in the breast cancer population. Ospemifene a novel estrogen agonist/ antagonist has demonstrated a strong estrogenic effect on the vaginal epithelium during a three month trial period and did not stimulate the endometrium; however, the medication did mildly aggravate hot flashes (this did not lead to drug discontinuation). Although not studied in breast cancer patients, pivotal Phase 3 data confirmed effectiveness of ospemifene as effective treatment for vulvovaginal atrophy. In a recent article in Menopause, Ospemifene and 4-hydroxyospemifene effectively prevented and treat breast cancer in Mtag.TG Transgenic Mouse.
Testosterone use remains off label and is not FDA approved, yet it is widely used in the non cancer population. New emerging safety data will be presented. Vaginal moisturizers, lubricants and dilators in association with genito pelvic floor therapy and intravaginal valium suppositories can be considered front line treatment for atrophy, dyspareunia and hypertonic vaginismus. New innovative data on non hormonal management of hot flashes is and important initial step in the overall management of the breast cancer patient who is suffering from sexual dysfunction.
A multi model treatment paradigm will be presented which will include pharmacologic, nonpharmacologic, and psychosocial interventions.
Tuesday, December 4, 2012 4:00 PM
[ES4-2] Cognitive Changes and Breast Cancer Treatments
Ganz PA. University of California, Los Angeles
Cognitive difficulties after cancer treatment are among the most feared outcomes voiced by patients who are approaching the start of chemotherapy. This phenomenon, sometimes referred to as "chemo brain" or "chemo fog," is quite common during the acute course of chemotherapy treatment. This may result from direct antieneoplastic drug toxicity, use of premedications and anxiolytics to prevent nausea and vomiting, as well as the expected anxiety, depression, and sleep deprivation that accompanies a new diagnosis of cancer and initiation of treatment. For most patients, this fog clears after the completion of acute treatments, and as with many physical symptoms, resolves in the following months. However, 15-25% of post-treatment patients, cognitive complaints persist long after treatment ends. Reports of difficulty concentrating, remembering recent events, multi-tasking, and paying attention are frequent in such patients. For those used to carrying on demanding executive function activities prior to cancer treatment, this can lead to substantial disruption in work and home life. Most of the studies conducted to date with early stage breast cancer have not accounted for the impact of adjuvant endocrine therapy alone or added to adjuvant chemotherapy. This presentation will review emerging data regarding self-reported cognitive complaints, neuropsychological testing, and brain imaging as they related to adjuvant therapies for breast cancer. In addition, some of the developing information about potential mechanisms associated with this late effect will be discussed.
Tuesday, December 4, 2012 4:00 PM
Educational Session 4 (4:00 PM-5:30 PM)
[ES4-3] Risk of Developing Second Primary Breast Cancer among Survivors of Breast Cancer
Bernstein JL. Memorial Sloan-Kettering Cancer Center, New York, NY
Of the nearly 226,870 US women expected to develop breast cancer in 2012 and the over 3 million breast cancer survivors currently residing in the US, five to ten percent will develop a subsequent primary in the contralateral breast (CBC) (www.cancer.org). This risk of developing CBC is higher than the overall risk of breast cancer in the general population. The rising incidence of breast cancer, coupled with an improved survival potential after cancer diagnosis has placed an increased number of women at risk for CBC, yet the epidemiology is poorly understood. Despite common genetics and exposures shared by both breasts, only a fraction of women who survive their first primary will develop a second primary in the contralateral breast. Epidemiologic studies have identified factors associated with an increased risk of developing CBC, including family history of breast cancer, early age at diagnosis, hormonal factors, reproductive history, body-mass index, and tumor characteristics of the first primary e.g., lobular histology, stage and estrogen receptor (ER) status. The risk of developing CBC has also been associated with mutations of specific genes including BRCA1, BRCA2, and CHEK2. Importantly, the treatment a woman receives for her first primary breast cancer can also influence her risk of developing CBC; chemotherapy, hormonal therapies and tamoxifen significantly reduces the risk of developing CBC while the radiation received to the contralateral breast during radiotherapy increases the risk of CBC. Despite the number of established risk factors for increased CBC risk, their combined effect accounts for only a small portion of the CBCs that develop each year. It is unclear whether, and to what extent, genetic factors and radiation, individually or via interaction, contribute to the development of CBC. This talk will review the state of the field.
Tuesday, December 4, 2012 4:00 PM
Educational Session 4 (4:00 PM-5:30 PM)
[ES4-1] Navigating the Obstacles and Risks of Survivorship: Breast Cancer Sexuality: Issues and Answers
Krychman M. The Southern California Center for Sexual Health and Survivorship, Newport Beach, CA; University of California Irvine, Irvine, CA; University of Southern California, Los Angeles, CA
The sexual consequences of breast cancer and its treatments are well known. Sexual difficulties include alteration in hormonal levels, changes in sexual organs and anatomy, vaginal and vulvar dryness, changes in libido, increased latency to orgasm and decreased intensity of orgasmic response. Changes in body image, sexual self-esteem and relationship dynamic tension may present as survivorship challenges for the breast cancer patient and her partner. Severe vulvo vaginal and clitoral atrophy as a result of chemotherapy and/or adjuvant hormone therapy, and loss of libido secondary to dyspareunia are widespread. Cytostatic medications that are prescribed for long-term use (aromatase inhibitors) can impact bone health, sexual functioning/satisfaction and overall quality of life. Many women on aromatase inhibitors have severe complaints of vulvar and vaginal atrophy.
Sexual dysfunction is common for breast cancer population and limited acceptable treatments are available. Minimally absorbed local vaginal estrogen use in this population remains controversial and a hotly debated controversial topic. More data should be forthcoming. There are multiple new innovative treatments in the research pipeline for female sexual dysfunction. DHEA intravaginal suppositories, Flibanserin and Bremelanotide (PT 141) remain promising although they have not been adequately studied in the breast cancer population. Ospemifene a novel estrogen agonist/ antagonist has demonstrated a strong estrogenic effect on the vaginal epithelium during a three month trial period and did not stimulate the endometrium; however, the medication did mildly aggravate hot flashes (this did not lead to drug discontinuation). Although not studied in breast cancer patients, pivotal Phase 3 data confirmed effectiveness of ospemifene as effective treatment for vulvovaginal atrophy. In a recent article in Menopause, Ospemifene and 4-hydroxyospemifene effectively prevented and treat breast cancer in Mtag.TG Transgenic Mouse.
Testosterone use remains off label and is not FDA approved, yet it is widely used in the non cancer population. New emerging safety data will be presented. Vaginal moisturizers, lubricants and dilators in association with genito pelvic floor therapy and intravaginal valium suppositories can be considered front line treatment for atrophy, dyspareunia and hypertonic vaginismus. New innovative data on non hormonal management of hot flashes is and important initial step in the overall management of the breast cancer patient who is suffering from sexual dysfunction.
A multi model treatment paradigm will be presented which will include pharmacologic, nonpharmacologic, and psychosocial interventions.
Tuesday, December 4, 2012 4:00 PM
[ES4-2] Cognitive Changes and Breast Cancer Treatments
Ganz PA. University of California, Los Angeles
Cognitive difficulties after cancer treatment are among the most feared outcomes voiced by patients who are approaching the start of chemotherapy. This phenomenon, sometimes referred to as "chemo brain" or "chemo fog," is quite common during the acute course of chemotherapy treatment. This may result from direct antieneoplastic drug toxicity, use of premedications and anxiolytics to prevent nausea and vomiting, as well as the expected anxiety, depression, and sleep deprivation that accompanies a new diagnosis of cancer and initiation of treatment. For most patients, this fog clears after the completion of acute treatments, and as with many physical symptoms, resolves in the following months. However, 15-25% of post-treatment patients, cognitive complaints persist long after treatment ends. Reports of difficulty concentrating, remembering recent events, multi-tasking, and paying attention are frequent in such patients. For those used to carrying on demanding executive function activities prior to cancer treatment, this can lead to substantial disruption in work and home life. Most of the studies conducted to date with early stage breast cancer have not accounted for the impact of adjuvant endocrine therapy alone or added to adjuvant chemotherapy. This presentation will review emerging data regarding self-reported cognitive complaints, neuropsychological testing, and brain imaging as they related to adjuvant therapies for breast cancer. In addition, some of the developing information about potential mechanisms associated with this late effect will be discussed.
Tuesday, December 4, 2012 4:00 PM
Educational Session 4 (4:00 PM-5:30 PM)
[ES4-3] Risk of Developing Second Primary Breast Cancer among Survivors of Breast Cancer
Bernstein JL. Memorial Sloan-Kettering Cancer Center, New York, NY
Of the nearly 226,870 US women expected to develop breast cancer in 2012 and the over 3 million breast cancer survivors currently residing in the US, five to ten percent will develop a subsequent primary in the contralateral breast (CBC) (www.cancer.org). This risk of developing CBC is higher than the overall risk of breast cancer in the general population. The rising incidence of breast cancer, coupled with an improved survival potential after cancer diagnosis has placed an increased number of women at risk for CBC, yet the epidemiology is poorly understood. Despite common genetics and exposures shared by both breasts, only a fraction of women who survive their first primary will develop a second primary in the contralateral breast. Epidemiologic studies have identified factors associated with an increased risk of developing CBC, including family history of breast cancer, early age at diagnosis, hormonal factors, reproductive history, body-mass index, and tumor characteristics of the first primary e.g., lobular histology, stage and estrogen receptor (ER) status. The risk of developing CBC has also been associated with mutations of specific genes including BRCA1, BRCA2, and CHEK2. Importantly, the treatment a woman receives for her first primary breast cancer can also influence her risk of developing CBC; chemotherapy, hormonal therapies and tamoxifen significantly reduces the risk of developing CBC while the radiation received to the contralateral breast during radiotherapy increases the risk of CBC. Despite the number of established risk factors for increased CBC risk, their combined effect accounts for only a small portion of the CBCs that develop each year. It is unclear whether, and to what extent, genetic factors and radiation, individually or via interaction, contribute to the development of CBC. This talk will review the state of the field.
Tuesday, December 4, 2012 4:00 PM
Educational Session 4 (4:00 PM-5:30 PM)