Good news for postmenopausal women with a high risk of breast cancer

As an oncology nurse Lorrie Kurth has seen the effects of breast cancer first-hand.

Lorrie has a high risk of breast cancer. She has lost her grandmother, her mother and a cousin to the disease, another cousin has had breast cancer and so has an aunt.

Ten years ago, Lorrie joined the anastrozole medical prevention trial to help researchers find a way to prevent the disease.

“It’s was such a good opportunity to help other generations of my family and other families”.

At the time of enrolling in the trial, Lorrie knew that it could take 10 years for the trial to determine whether the drug would help prevent breast cancer.

Ten years have now passed and the long-term results of using anastrozole for breast cancer prevention were published recently and its good news for wāhine like Lorrie that are at high risk of breast cancer and ductal carcinoma in situ (DCIS).

The results show that anastrozole maintains a preventative effect for postmenopausal women at high risk of breast cancer for at least 12 years.

Anastrozole inhibits the production of oestrogen in postmenopausal women and has been used for several years now in the treatment of postmenopausal women with oestrogen receptor-positive breast cancer.

The use of anastrozole, which is part of a class of drugs called aromatase inhibitors, is more effective than tamoxifen in women who have already had breast cancer.

This research shows that anastrozole is a safe drug in the long-term and provides women with greater options when it comes to managing their risk. Other options include regular breast screening, preventative surgery and a healthy lifestyle.  

Lorrie has not been diagnosed with breast cancer, she is in good health and has never dwelled on her higher chances of getting the disease. “It’s not something I spend a lot of time thinking about. I work on the theory that if it happens, I’ll deal with it then. “I have had excellent surveillance throughout the trial, particularly with my family history, and this has been very comforting.”

Lorrie is philosophical about cancer and death because of her years of working as an oncology nurse. “I’ve learned from looking after people with cancer that you have to live every day and make the most of that day.”

Research continues to answer questions about sentinel lymph node biopsy

Whether or not breast cancer has spread to the axillary or armpit lymph nodes, remains an important indicator of outcome for women/wāhine with breast cancer, and may help predict the need for further treatment (e.g. chemotherapy or radiotherapy). Historically axillary node status has been determined by removal of most of the nodes (axillary clearance).  This operation may lead to arm swelling (lymphoedema), pain, some abnormal skin sensation or shoulder stiffness.

Waikato Hospital surgeons and researchers introduced “sentinel node biopsy” to breast cancer surgery in 2002. Sentinel node biopsy involves the removal of only a small number of lymph nodes most closely related to the breast cancer.

The Waikato is now a centre for a fourth international sentinel node biopsy trial. It is important we carefully evaluate the benefits and risks of introducing this lesser surgery to the axilla for women/wāhine with different types of breast cancer. Helen is a participant on the “Sentinel Node biopsy versus Axillary Clearance Part 2 (SNAC 2) trial, she recently shared with us her journey.

As the daughter of a pharmacist and a nurse, being an occupational therapist myself and married to a medical man, particpating in a clinical trial seemed sensible

“It has been difficult to remember many details about this story as it began 10 years ago, and my mind has proven to have the ability to forget the actual pain and discomfort.

I had had a history of cysts over the years so when a routine mammogram indicated I should have an ultrasound; I assumed more cysts. I was surprised to be told I had breast cancer and disbelief was my initial reaction as I felt remarkably fit and healthy and well! My next reaction was “Tell me the plan to get rid of it”. The label for my breast cancer was multifocal grade 2 invasive lobular carcinoma and the advised plan was to have a total mastectomy with reconstruction. ‘In for a dime, in for a dollar’ – get it all over and done with in one hit was my reasoning.

With this plan timetabled, my surgeon, Ian Campbell, asked if I would participate in a clinical trial. As the daughter of a pharmacist and a nurse, being an occupational therapist myself and married to a medical man, this seemed sensible. I reasoned that it may help with future treatments and improve life expectancy for others. It was SNAC 2 trial, Sentinel Node biopsy versus Axillary Clearance.

Needless to say, I ascertained there was no additional risk to myself, only a couple of extra appointments and another ultrasound with dye injected to trace which lymph nodes were feeding / draining the three tumours.

My surgery proceeded as expected but then came the news that one lymph node had cancer cells and with that news, another date with the surgeon was organised. Following this I was discharged with a drain in place which the district nurse encouraged me to keep until there was no more fluid to drain. I have been lucky enough to escape any issue with lymphoedema.

For some weird reason I had thought that the surgeries would suffice to beat this cancer but no … chemotherapy, followed by radiation, gave me better survival stats so again – ‘in for a dime in for a dollar’. I took all the drugs to combat the side effects of chemo, wore my wig and managed.  The radiation was a chore and I remember feeling weary towards the end. Now, 10 years later, the whole experience is a bit of a blur, but I know it irrevocably changed my life and furnished me with the resilience and understanding to dual with further life events.

I know that I would not have come to this place without the comfort and kindness of friends and family.”

Clinical trial “ Examining Personalised Radiation Therapy (EXPERT) for low-risk early breast cancer

The current standard of care for women with early breast cancer is radiation therapy after breast conserving surgery to reduce risk of recurrence and improve survival. However, breast cancer is a complex disease and the absolute benefit of radiation therapy in individual patients varies substantially. 

The EXPERT clinical trial is investigating whether a laboratory test called a genomic assay can help doctors select out women with low risk breast cancer, who may be able to avoid radiotherapy and its associated side effects.This research aims to improve personalised use of radiation therapy in early breast cancer patients, according to individual risk of local recurrence.

Waikato Hospital is a centre for this international clinical trial coordinated by Breast Cancer Trials Australian & New Zealand. Other centres in New Zealand are Palmerston North, Wellington and Christchurch Hospitals.

To learn more visit: https://www.breastcancertrials.org.au/current-clinical-trials/expert

Waikato led research, highlights the importance of early detection

Data from the Waikato and Auckland Breast Cancer Registers on women aged 45-69 years and diagnosed with invasive breast cancer between January 2005 and May 2013 was analysed by researchers from the Universities of Waikato, Otago and Auckland and the Waikato DHB. The research team was led by Professor Ross Lawrenson (Waikato Medical Research Centre) and included Associate Professor Ian Campbell (WBCRT Chair).

Results from this research were published in the Journal of Medical Screening in March 2019,and concluded that– breast cancers detected through breast screening are diagnosed at an earlier stage, showed a greater proportion of subtypes,with better outcomes.

For screen-detected breast cancer, survival between different ethnic groups was similar.

Variations in survival for Māori and Pacific women are only found in women with non-screen detected breast cancer. One of the main reasons that outcomes of breast cancer in Māori and Pacific women are poor compared with NZ European women, is the late stage at diagnosis.

Remind the wāhine/women you love, to book their screening mammogram.

To book a mammogram today, phone 0800  270 200 (Breast Screen Aotearoa).

WAIKATO CLINICAL TRIAL OF A NEW SURGICAL TECHNIQUE FOR THE TREATMENT OF BREAST CANCER RELATED ARM LYMPHOEDEMA – SEEKING PARTICIPANTS

Waikato researchers are now seeking participants with breast cancer related lymphoedema for a larger clinical trial to determine whether lymph node grafting produces a greater reduction in lymphoedema volume and improved quality of life, compared with standard treatment.

Lymphoedema is a condition experienced by 10-20% of people who undergo axillary lymph node dissection – an operation often performed as part of breast cancer surgery.  The current standard of care for lymphoedema is conservative management which includes self-administered massage, therapeutic exercise, and use of a compression garment.

When conservative management does not help enough, surgery can be considered.  There is some evidence to suggest that transferring lymph nodes from elsewhere in the body to the affected limb can help to reduce the size of the affected arm.

A new, surgical technique, called lymph node grafting, has been developed and tested in a pilot study in the Waikato. The results of the pilot study demonstrated that lymph node grafting showed promise as a treatment for moderately severe treatment-resistant lymphedema.

Local researchers need further evidence to be certain that this technique is safe and effective, and to standardise and develop the lymph node grafting technique further.  In both the pilot study, and to date in the clinical trial there have been some patients who have experienced a reduction in lymphoedema, but also some who have not.  We need to learn more about why this is the case. We also need to ensure that lymph node grafting doesn’t make lymphoedema of the arm worse, and doesn’t lead to lymphoedema of the donor leg.

Participants who agree to participate will be randomly assigned to either:

  • the control group (standard care): Will receive standard lymphoedema therapy alone. This includes self-administered massage, therapeutic exercise, use of a compression sleeve and skin/nail care; OR
  • the intervention group: Will undergo lymph node grafting surgery as well as standard lymphoedema therapy.

Waikato Plastic Surgeon Mr Winston McEwan who has developed the lymph node grafting technique, is heading this trial.

For more information, or if you or anyone you know  may be interested in this research, please contact Heather Flay, Research Nurse on telephone 07 8398726 Ext 97960 or email Heather.Flay@waikatodhb.health.nz; or Jenni Scarlet, Research Nurse on phone 07 8398726 Ext 97916 or email Jenni.Scarlet@waikatodhb.health.nz

A few minutes is all it takes – a mammogram can save your life

WBCRT researchers were part of a team working with Professor Ross Lawrenson (Professor of Population Health, University of Waikato) on a Health Research Council funded research project investigating the outcomes for Māori and Pacific women diagnosed with breast cancer.

Information from over 12,000 women with newly diagnosed breast cancer from the Waikato and Auckland Breast Cancer Registers was analysed.

Results showed that women with early screen detected cancers have a high chance of cure with 93% of these women alive at 10 years after diagnosis. The outcomes for women with screen detected cancers, are the same regardless of ethnicity, or socioeconomic status.

On the other hand, Māori women presenting outside of the breast screening program with symptomatic cancers e.g. a breast lump, were more than twice as likely to die from their cancer than women of European ethnicity, and Pasifika women fared even worse. Women from poorer socioeconomic backgrounds also did significantly worse if diagnosed outside the screening program.

To save lives we need to focus on early detection and presentation to healthcare services for more women. Improving access to breast screening has the potential to significantly improve the situation for those women most at risk, and for all women.

Regular mammography screening works best for early detection of breast cancer, less radical treatments and better survival outcomes.