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HOUSE CALL WITH DR. SANJAY GUPTA

An In-Depth Look at Breast Cancer

Aired May 21, 2005 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


SANJAY GUPTA, HOST: Good morning and welcome to HOUSECALL. Our topic today is cancer. Experts met earlier this week and released some exciting new treatment options for this deadly disease. We're going to start with breast cancer and a new way to use a common cancer drug.
And as Elizabeth Cohen explains, it could lead to big changes in how doctors treat cancer.

(BEGIN VIDEOTAPE)

ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): She found the lump herself one morning.

ELIZABETH RUSSO, HERCEPTIN PATIENT: I was petrified.

COHEN: Then her doctor confirmed the worst.

RUSSO: I had only been married for about a year and a half. And I felt like my world was falling down around me. You know, the first question that goes through your head is am I going to die? And that really was what I thinking at the time. It was extremely frightening.

COHEN: At age 29, Elizabeth Russo had breast cancer. And there was more. Doctors told her she had a particular kind that grew quickly, and was more likely to come back. This happens to one out of every four patients.

But there was a twist. Because she had this particular type of tumor, she was a candidate for a study on a drug called Herceptin. Doctors knew it worked when the cancer had spread to other parts of the body, but they weren't sure if it could help women like Elizabeth who were at the early stages.

At first, she wasn't sure what to do, because the drug in a small number of women had caused heart failure.

RUSSO: There was a little bit of fear there. But obviously, in my situation, the chances absolutely outweighed the frightningness of the whole situation. I mean, I had to take the risk, because there was still the chance that I could die.

COHEN: She took Herceptin, along with chemotherapy and radiation. And a year after finding that lump, she's cancer-free. In the studies of the National Cancer Institute, when women did not take Herceptin, 30 percent had the cancer come back. When they did take Herceptin, only 15 percent had the cancer come back. It cut the recurrence rate in half, an extraordinary impact, experts say, meaning this drug is one of the most promising in a new generation of cancer treatments.

Unlike chemotherapy or radiation, which attack healthy and unhealthy tissue, medicines like Herceptin are designed to attack only the specific protein that causes problems.

DAVID JOHNSON, DR., VANDERBILT CANCER INST.: Targeted therapies which we've talked a lot about for the last couple of years are really coming to fruition.

COHEN: Now Elizabeth Russo, once afraid she would die, is alive for the big moments, like her godson's christening last month. The cancer could come back, but now, it seems that's less likely.

Elizabeth Cohen, CNN reporting.

(END VIDEOTAPE)

GUPTA: All right, Elizabeth, thanks.

The news about Herceptin and breast cancer is just one of several studies that came out this week. Other possible breakthroughs we'll be talking about, a former breast cancer drug helping to prevent prostate cancer in some men.

In two studies showing a common drug and being active may help stop colon cancer before it returns. Plus from taking statins to eating a low-fat diet, even more news on breast cancer.

This latest research has the potential to change the way thousands of cancer sufferers are treated. And here to help us understand how important these changes are is Dr. Len Lichtenfeld. He's the deputy chief medical officer for the American Cancer Society.

Thank you very much for joining us.

LEN LICHTENFELD, AMERICAN CANCER SOCIETY: Good morning, Sanjay. Pleasure to be here.

GUPTA: Good morning. A busy conference this past week as well. How big a deal is this Herceptin study?

LICHTENFELD: I think it's huge. In fact, if you were at the conference what you saw were literally thousands of doctors who applauded the results of this study.

This is a type of cancer when you have Herceptin-positive breast cancer, where women, unfortunately, don't do well, even with the best treatment we have available, by giving them chemotherapy, radiation therapy. The cancer still comes back.

And this Herceptin, this drug, made a remarkable difference in the frequency of how often the cancer returns.

GUPTA: Some of the most aggressive cancers being treated by Herceptin. You know, one thing that always strikes me, sometimes you hear these studies, but it doesn't translate into actual changes the way doctors practice medicine. Is this going to change immediately the way doctors prescribe medications?

LICHTENFELD: Well, it's my opinion and it's the opinion of many others who were at the conference that this is going to change what we call the standard of care, how doctors treat patients. It's going to make that change almost immediately.

In fact, one doctor was quoted as saying she was going to go out, and one of the leading experts in this field, that she was going to go out and start giving Herceptin to her parents who have been treated for primary therapy and who had not had a recurrence, she was going to go out and treat those patients now.

GUPTA: They talk a lot about these targeted therapies. One of the things you got excited about, I know from talking to you, was that you may be able to figure out ways to -- figure out if a cancer's going to grow before you could ever image it on a CT scan or a mammogram or something like that. Is that true? Is there a way to predict whose cancers are going to grow?

LICHTENFELD: Well, not yet. Let's remember that this didn't just happen yesterday. This whole field has been in development for 20, even 30 years. It's taken us a long time and a lot of research to get here.

But one of the talks at the meeting, a little comment was made that excited me a great deal, because you try to look to the future. Maybe 15, 20, 30 years. I don't know how long it's going to be, but what this leading researcher had to say was that by measuring proteins in the blood, actually on blood cells, they may be able to find cancer just by doing that test. And perhaps even treating patients with some of these targeted therapies before you can ever find the cancer in the body.

That really is what we would call our - it's our goal, or our holy grail if you would.

GUPTA: Yes.

LICHTENFELD: We'd like to be able to find cancer when those cells first start to develop. And maybe we'll get there one day. Not tomorrow, not next year, but sometime in the near future.

GUPTA: That's the future. That's what everyone's talking about. These statin medications, a lot people talk about them for lowering cholesterol. You see all these different uses of them. What is the relationship between statin drugs and cancer?

LICHTENFELD: Well, it's very interesting. There was a report last year about colorectal cancer and the use of statins. And they found that it significantly reduced the incidence of colorectal cancer. They took a population of people and they looked backwards, so to speak. And they said who took statins, who didn't take statins? What was the risk of colon cancer? And they found that the risk of colon cancer was much less.

And that article was actually published recently in the New England Journal, one of our leading medical journals. At this conference, they talked about the same kind of results in breast cancer.

The problem is that we don't have the types of studies that we call prospective studies, that is studies that look forward into the future, where we take people, divide them into groups to try to prove whether or not it works.

So it's interesting. And it looks promising, but there's still a lot more work to be done. And I, you know, personally and many others would not recommend people just go out and start taking statins, because you know, they have, they want to lower their risk of breast cancer. Those are drugs that are effective in heart disease as many of us know, but I wouldn't recommend that you take it as a cancer prevention at this time.

GUPTA: You and I were talking earlier about everything is old is new again, and talking specifically about estrogen. At one time being used to treat breast cancer, and now maybe prostate cancer as well? Is that right?

LICHTENFELD: Well, it's not actually estrogen. It's a drug - there's a new drug that's been around actually for many years, a drug called Teremaphine. Many people are familiar with a drug called Tamoxifen, which is used to treat women with breast cancer. Been around for 30-some years almost, and has been very effective with some side effects.

Well, there's another drug similar to Tamoxifen. It's called Teremaphine. And a doctor down in Shreveport, Louisiana, did a study where he put men who had a pre-cancerous lesion in heir prostate gland, put them on Teremaphine. And he found that it reduced the frequency of those men going on to develop prostate cancer after one year.

Still, very preliminary kinds of data. And there's some questions about, you know, the dosing and so forth. So this is one of those things that I would say, stay tuned.

GUPTA: All right, lots of stuff coming up. Dr. Len Lichtenfeld taking our questions today. All of our cancer questions being answered when HOUSECALL returns. Stay tuned.

UNIDENTIFIED FEMALE: Coming up on HOUSECALL, new treatment options in the fight against one of the deadliest forms of cancer. Plus, an aspirin a day. Could it keep the cancer away? We're bringing you the latest breakthroughs, coming up.

First, take today's "daily dose quiz." How long does cancer take to develop? The answer may surprise you.

(COMMERCIAL BREAK) UNIDENTIFIED FEMALE: Checking the "daily dose quiz", we asked how long does cancer take to develop? The answer, years. By the time a mass is detected, the original cancer cell may have been dividing into thousands of cells for five years or more.

GUPTA: All right. More than 1.3 million new cases of cancer will be diagnosed this year. What does that mean to you? Well if you're a man, you have a 50 percent chance of getting cancer in your lifetime. Women have a one in three chance during their lives.

Here to help us learn more about new ways to treat cancers, Dr. Len Lichtenfeld of the American Cancer Society. Lots of questions coming in from all over the country.

You get these questions a lot. Let's jump into some of our e- mails. First of all, Manuel in Texas writes this. "My brother and dad died from pancreatic cancer. Is anyone making headway in the treatment or diagnosis?"

And doctor, you know, this is a particularly nasty type of cancer. Let's begin first of all treatment. Anything new there?

LICHTENFELD: Well, this information that came out this week at the meeting was the fact that a drug that's commonly used to treat - excuse me, pancreatic cancer...

GUPTA: Right.

LICHTENFELD: ...Gemzar or Gemsiderbeam (ph) has been shown in a study in Germany to actually delay recurrence, what we call agitive therapy.

Once again, that's a promising study. It's not something that could be applied widely, but I'm sure will start further interest in trying to find other regimens that work early on in the disease.

The problem with prostate - oh not...

GUPTA: Pancreatic.

LICHTENFELD: I'm sorry. Pancreatic cancer...

GUPTA: Yes.

LICHTENFELD: The problem with pancreatic cancer is that it's silent. It's usually not found until late in the course of the disease. So unfortunately, most people who develop that disease will die from it.

GUPTA: Anything diagnosis-wise, though? Is there anything they can do to find it earlier?

LICHTENFELD: Well there are always the incidental findings. And the question is could you do cat scans or whatever.

For example, this gentleman had a family history of pancreatic cancer. So once again, it's felt to be at higher risk. That's something that's relatively new. We now understand is in fact a risk factor for pancreatic cancer.

So perhaps seeing the doctor more often, more regularly. There's no recommended test that's going to be done, but I would suspect at somebody in this situation may get some sort of a screening test, whether it be an ultrasound or a cat scan, but there's no formal recommendation in that regard at this time.

GUPTA: OK. And Manny, I hope that's some good information for you. Another question now. Jean in California wants to know this, some doctors advise taking two baby aspirin a day, not only for the heart but also to fight cancer. And what research supports this and what cancers does it pertain to?

I've heard this before as well. Two baby aspirin. Of course, everyone knows about it for the heart. What about it for cancer?

LICHTENFELD: Well, is it one baby as aspirin? Is it one regular aspirin?

GUPTA: Right.

LICHTENFELD: We don't know because actually, there were studies done a number of years ago that showed that a baby aspirin once a day helped prevent colorectal cancer, but it didn't do - at the higher dose, it didn't work as well.

GUPTA: Yes.

LICHTENFELD: And it seemed a little strange that was the case.

GUPTA: Yes.

LICHTENFELD: The new information again came out during these meetings - the cancer meetings in Orlando this past week was that in a study of people who had been diagnosed with colorectal cancer - advanced colorectal cancer, but cancer that could be treated by surgery.

In that particular group of people, it turned out when they looked, sort of went back and looked through the records and talked to the people, they found out that those who took aspirin were some of what we call the Cox 2 inhibitors that are now been pulled off the market. They actually did better. They didn't have their cancer recur.

Once again, you know, it gets real complicated, but the bottom line is the way the study is conducted, it gives us the confidence in the results. And these results, based on how the study was done, once again, it's suggestive. And so, it's got to be looked at further.

I actually talked to my colleagues at the American Cancer Society because all of this information rolls around. And there's a lot of evidence to show that aspirin's effective in preventing colorectal cancer. But we still can't make a definite recommendation that people take it for that reason.

And in no small part, that's because these drugs do have some adverse side effects, some bad effects.

GUPTA: Sure.

But it's exciting. You know, a lot of people looking at these. Sometimes, you know, drugs as old as aspirin and statin medications having some benefit. Really good information there.

More cancer news coming up, though, as we find out the latest weapons in the fight against cancer. Stay with us.

UNIDENTIFIED FEMALE: Diet and breast cancer, could what you eat be as important as the drugs you take?

And...

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: To maintain good health and to maintain your weight, it's all about calories in and calories out!

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: The government's plan to keep you eating right. But first, this week's medical headlines in "the pulse".

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Mothers taking antidepressants during the last trimester of pregnancy may put their newborns at risk for a condition some call neonatal behavioral syndrome says a new report. Babies with this syndrome develop withdrawal like symptoms such as jitters, irritability and respiratory problems after birth. But the symptoms often go away within weeks.

Many doctors caution that for some severely depressed mothers, the benefits of taking the drugs outweigh the short-term risk for their children.

And a new study out this week found a majority of Americans with Type II diabetes do not have their disease under control, putting them at risk for complications such as stroke, heart attack, and blindness.

The survey found that 67 percent of those questioned have blood sugar levels that were out of control, even though many of them believed they were effectively managing their disease.

Christy Feig, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSECALL. Well, the link between diet and good health is well known, but there's new evidence that is especially interesting to breast cancer survivors.

Christy Feig has the details.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Angie Christian was diagnosed with breast cancer four years ago. In addition to treatment, she started eating better to lose weight. That included a low-fat diet.

ANGIE CHRISTIAN, BREAST CANCER SURVIVOR: I'm always very conscious of turning labels around and reading what's what from sodium, to the fat, to the calories.

FEIG: According to a new study from UCLA, it might help keep her cancer from coming back. Researchers randomly assigned more than 2400 women into two groups. One followed a standard diet. The other, a low-fat diet of only about 33 grams of fat every day.

ROWAN CHLEBOWSKI, DR., HARBOR-UCLA MEDICAL CTR.: Instead of French toast or a sweet roll in the morning, they'd have coffee with - they'd have cereal with milk. Instead of chips or cheese and crackers in the afternoon, they'd have popcorn.

FEIG: After five years of follow-up, those on the low-fat diet had a 24 percent reduction of risks their cancer would come back.

MARC BOISVERT, DR., WASHINGTON HOSPITAL CTR.: It was the first randomized controlled trial that I'm aware of, that shows any influence of diet in the recurrence of breast cancer.

FEIG: More research is necessary, but if future studies confirm the link, the researchers say it will be very significant because the reduction of risk in this study is comparable to the impact of adding a new drug.

In Washington, I'm Christy Feig.

(END VIDEOTAPE)

GUPTA: And we should point out as well that the women in that study were in the early stages of breast cancer and were postmenopausal as well.

Dr. Len Lichtenfeld, the deputy chief medical officer for the American Cancer Society, is our guest this morning. Interesting. You talk about all of these drugs, targeted therapies and everything. This is a dietary change preventing a recurrence of breast cancer. How big a deal is it?

LICHTENFELD: Something as simple as that, and the results were equivalent in some of the chemotherapy trials that we've done in the past.

GUPTA: That's remarkable. LICHTENFELD: It is remarkable. And it wasn't -- there are other remarkable things. It wasn't that much of a reduction in the fat and the diet. And the women stuck to it.

And the bottom line, what's wrong with following a low-fat diet anyway?

GUPTA: It's already good for you.

LICHTENFELD: It's good advice for anybody. So I think in this case, this study suggested that it's also good for women with estrogen receptor negative breast cancer, women who are also post menopausal.

GUPTA: Really interesting stuff.

And let's keep on with some interesting developments as well. This is an e-mail that we got from June in Georgia, who writes this, "I am a nine-month survivor of colon cancer. Is there something else I can do other than diet and frequent colonoscopies to ensure that the cancer does not return?"

And doctor, again, we talked about low-fat diets now. And we also talked about the value of exercise. How does exercise play role in preventing the return of colon cancer?

LICHTENFELD: Well, again, another study from the ASCA meeting this past week showed that if you engage in some fairly intensive exercise, you will reduce the risk of the cancer coming back, if you are diagnosed with a more advanced but still local form of colon cancer.

GUPTA: Why is that? Why exercise?

LICHTENFELD: We don't know. I mean, there are all sorts of reasons. And we can get into a lot of, you know, chemistry and science and things like that.

But the bottom line is the author suggests, you know, found a suggestion that works. So now you have to follow through.

I'd like to point out, this is no like just taking a 20-minute light walk once a day. This is a commitment to a fairly intensive exercise program, including when you consider the fact that most people with colorectal cancer are in their late 60s when they're diagnosed.

GUPTA: Right. Low fat diets and exercise, who'd have thunk that would cure cancer as well potentially, or at least prevent it from coming back? Good information there.

Grab a pen. When we come back, websites that can help you at home fight cancer.

UNIDENTIFIED FEMALE: Coming up on HOUSECALL, it's a fact. What you eat can help save your life. Find out what needs to be in your diet after the break. (COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSECALL. Well, you've heard how important diet is, but should your diet include? Our bod squad has the latest recommendations.

(BEGIN VIDEOTAPE)

HOLLY FIRFER, CNN CORRESPONDENT (voice-over): The food pyramid we all know is getting a makeover. Gone is the one size fits all plan.

The new version has 12 different eating options tied to exercise. The same foods for everyone, but the more you work out, the more you get to eat. That means more fruits, vegetables and whole grains.

The food groups are color-coded. Orange for grains, green for vegetables, red for fruits, blue for milk, purple for meat, beans and proteins, and yellow, the narrowest band, for oils.

DENISE AUSTIN, FITNESS EXPERT: As we know, it's all about eating right and exercise. They truly go hand in hand to maintain good health and to maintain your weight. It's all about calories in and calories out!

FIRFER: The new pyramid also switches from servings to household measures.

KATHERINE TALLMADGE, AMERICAN DIETETIC ASSOCIATION: People can identify better with cups and ounces than they can with servings.

FIRFER: You can get your individual tailored plan by logging on to the USDA website.

Holly Firfer, CNN, Atlanta.

(END VIDEOTAPE)

GUPTA: All pyramid sort of looks like a rhombus there, I think. Holly, thanks.

We're talking with Dr. Len Lichtenfeld of the American Cancer Society. We've got time for one more e-mail question, an important one as well.

Gillian from Michigan writes this. "How many years have been added to cancer survivors' lives with recent drug therapies?"

We hear about all these studies. We've been talking about that all half hour so far. And are people living longer with cancer than before?

LICHTENFELD: There's no question. When I started in cancer medicine 30 years ago, maybe a third of the people survived. Kids, almost none of them survived. Now we're talking about 75, 80 percent of the children with cancer surviving long term and living lives with problems, but nonetheless surviving and going on.

And we have about maybe almost two-thirds of the people - the adults diagnosed with cancer and surviving. We've made real progress.

It's not going to happen from today 'til tomorrow. This is the result of a lot of research, a lot of work, a lot of effort over a very long time. But we are definitely making progress.

GUPTA: I sense hope and optimism from you. And that's a good thing.

Cancer used to be a terminal diagnosis for everybody. And people are living now with it as a chronic disease sometimes. To find out more about the newest cancer treatments as well, go to www.cancer.org. That's a website for the American Cancer Society. You can search for the latest clinical trials or research various forms of cancer.

Unfortunately, that's all the time we have for today. I want to thank Dr. Len Lichtenfeld.

LICHTENFELD: Thank you, Sanjay.

GUPTA: Very, very helpful advice today. Thank you at home as well for all of your e-mail questions. Make sure to watch next week when we continue our series on getting summer ready. And we're going to go to Los Angeles to find out the secret workout tips of the stars from a celebrity trainer.

That's next weekend at 8:30. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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