National Breast Cancer Coalition

Call to Action Online - December 2015

"Action, Not Awareness" Update

We kicked off Breast Cancer Awareness Month (BCAM) in October with an “Action, Not Awareness” theme. The BCAM strategy included Huffington Post blog articles, press releases, advocacy profiles, an advocate toolkit and social media posts. The kickoff press release resulted in an article in the New York Times, which got significant re-posts in other media outlets and was our highest re-tweeted, shared, viewed and liked social media post in years.

NBCC Responds to New Mammography Screening Guidelines

On October 20, the American Cancer Society released new mammography screening guidelines. In short, the ACS recommends that most women begin mammography screening at age 45. NBCC's Fran Visco released a statement that read, in part, "...While we at the National Breast Cancer Coalition appreciate that ACS is moving closer to the weight of the scientific evidence and in the direction that the data support, we do not believe this new interpretation of the data will in fact help women."

Fran has weighed in on the new guidelines in the media nationwide, including on NPR and in USA Today.

Artemis Project Update Released

National Breast Cancer Coalition (NBCC) released a two-page update on The Artemis Project®, which is the research component of Breast Cancer Deadline 2020® focused on (1) primary prevention and (2) preventing metastasis. The Artemis update summarizes the Project’s origins as well as gives a read-out on the most recent meetings on the two areas of focus, which took place in March of this year.

Other News:

  • Our annual Les Girls cabaret was held in Los Angeles on October 11. Hosted by actress Dana Delany and featuring talented actors and actresses from television, film, and Broadway, hundreds gathered to enjoy the show while raising funds to help us reach Breast Cancer Deadline 2020®.
  • We hosted our 20th Annual Gala in New York City on November 19, where we honored U.S. Senator Dick Durbin, along with NBCC Advocates Kathleen Harris (WI) and Sheila Johnson-Glover (IL). 


MATCHING GIFT OPPORTUNITY
Through December 31, every contribution we receive from dedicated friends like you will be matched by the Joyce Goldman Matching Fund, a major supporter of NBCC. Joyce Goldman died of breast cancer and her children and their families decided to focus part of the Joyce and Irving Goldman Family Foundation funds to help end breast cancer. Now your tax-deductible gift will double and every dollar you give today will go twice as far! Will you give $20, $50, or $100 to help us know how to end breast cancer?


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Research Links

 Aromatase Inhibitors vs. Tamoxifen vs. Both

In hormone-receptor positive breast cancer, also known as ER+ cancer, estrogen promotes the growth of breast cancer cells. It does so by binding to the estrogen receptor alpha (ER) in the cancer cells which then turns on growth genes.  Blocking or preventing this interaction between estrogen and the estrogen receptor prevents tumor cell growth.

Today, two classes of drugs are used to impede the action of estrogen in estrogen-receptor positive breast cancer: selective estrogen receptor modulators (SERMS), such as tamoxifen (TAM), and aromatase inhibitors (AI), such as Arimidex or Femara. Both Tamoxifen and AIs fundamentally do the same thing: prevent estrogen-driven growth, although they do so in very different ways. TAM is a SERM, which means it physically blocks estrogen from binding with the estrogen receptor, thus prohibiting tumor growth. AIs, on the other hand, turn off the enzyme that creates estrogen. Because estrogen binds with the estrogen receptor in the breast cancer cells to activate growth genes, turning off estrogen production inhibits tumor growth.

 TAM was FDA approved for treatment of ER+ breast cancer patients in 1977. AIs received approval in 2000. This approval was based on clinical trials that compared the efficacy of AIs versus Tamoxifen and not from data of AIs versus no treatment. Recent studies have been looking at the efficacy of AIs given along with ovarian suppressive drugs in premenopausal women.

Today, both are used for treatment of postmenopausal women with ER+ cancers. TAM effectively reduces the risk of recurrence, breast cancer mortality and overall mortality in post-menopausal women during treatment and for up to 10 years after treatment ends [1] (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163848/). Likewise, AIs, given alone or in combination with TAM, have shown improved reductions in breast cancer recurrence in ER+ women [2] (http://jco.ascopubs.org/content/28/3/509.full.pdf). Prior to this, no study looked at the effect of AIs on overall mortality and no study systematically looked at scheduling of the drugs—in other words, the order and combination in which Tamoxifen and AIs are administered in postmenopausal women. Is providing AI prior to TAM better than AI alone? What about giving an AI after TAM treatment? Until now, these questions were unanswered.

Since AIs and Tamoxifen are effective in the treatment of ER+ breast cancer and AIs are increasingly used for treatment, the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) evaluated the data (meta-analysis) from 11 clinical trials conducted between 2005 and 2011 to understand if AI treatment affects breast-cancer-specific (mortality from breast cancer) or overall mortality (mortality from any cause – breast-cancer-specific or not) and to determine what combination or order of AI and TAM improves recurrence and mortality [3] (http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)61074-1.pdf).  In this study, published in July in the Lancet, researchers looked at the data, which, viewed as a whole, included nearly 32,000 postmenopausal women with ER+ breast cancer in the analysis. There were 5 different drug combinations that fell into two main categories: 5 years of AI vs. 5 years of TAM each given individually, or up to 5 years of various combinations of AI and TAM.

Either treatment reduced recurrence and both breast-cancer-specific and overall mortality when given for 5 years. These improved outcomes, both the rate of recurrence and the overall mortality, continued to be reduced up to 5 years after termination of the drug. So, treatment with either TAM or AI reduced mortality for at least 10 years. When conducting the head-to-head comparison of providing either AI alone or TAM alone, AI reduced recurrence and reduced morality more than TAM alone; however, this difference in reduction was small.

When they looked at patients given an AI followed by TAM treatment and compared this to the efficacy of TAM treatment alone, the rate of recurrence and mortality was lower with the AI compared with TAM but only during the time that the AI was given. Once treatment was switched to TAM, the rate of recurrence and mortality was the same for all patients, regardless of if the patient received AIs prior to TAM.

The overall conclusion that can be drawn from this work is that AIs do work slightly better in postmenopausal women than TAM if given alone. When given sequentially with TAM, AIs have improved outcomes while the AI is being administered, but do not maintain this prolonged benefit after the drug has stopped. As always, other side effects from these drugs must be taken into account when contemplating treatment options.

1.            Early Breast Cancer Trialists' Collaborative, G., Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. The Lancet, 2011. 378(9793): p. 771-784.

2.            Dowsett, M., et al., Meta-Analysis of Breast Cancer Outcomes in Adjuvant Trials of Aromatase Inhibitors Versus Tamoxifen. J Clin Oncol, 2010. 28 (3): p. 509-518.

3.            Early Breast Cancer Trialists' Collaborative, G., Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. The Lancet, 2015.