bct logo

Winter 2013
In This Issue
Quick Links


Annie Appleseed Project Evidence-Based Complementary and Alternative Cancer Therapies Conference 

Feb 28- March 2

West Palm Beach, FL

Online options: View in Real-Time or ON Demand, up to 30 days after the conference


American Association for Cancer Research Annual Meeting 

April 6-7  

Washington DC


April 13- 14

Philadelphia, PA

Travel grants are available


May 31- June 4 

Chicago, IL

Patient scholarships are available: contact ASCO at patientadvocate@asco.org or 573-483-1369.


"Long-Term Survivorship: Maintaining a Healthy Body Weight"

Register at Living Beyond Breast Cancer 

Wednesday, March 6 

Noon - 1:00 pm ET


"The Oversimplification of Early Detection: Screening Mammography and Breast Cancer Overdiagnosis"
Register at Breast Cancer Action for Tuesday, March 12, 1pm (PST)/4pm (ET) or Thursday, March 14, 9am (PST) /12pm (ET)


"Understanding the Affordable Care Act in 2013 for People Living with Cancer"

Register at CancerCare.org 

Wednesday, March 20

12:30pm - 2:30pm ET

New to BreastCancerTrials.org?

We welcome patients, long-term survivors, or those at risk to consider clinical trials as a routine option for care. Explore our Matching Tool and QuickView Browser to find a trial that's right for you.

Dr. Elly Cohen, BCT Director
From the Director:

When my mother was diagnosed with metastatic breast cancer in 1978, her doctor told her about tamoxifen, a drug that had been recently approved for women with estrogen sensitive tumors. Unfortunately, her tumor was ER-negative and, despite chemotherapy, she died less than a year later. Twenty years later, when I was diagnosed with stage 1, ER-positive breast cancer, tamoxifen was being used for early-stage patients too. That's because in 1986 a clinical trial showed that tamoxifen lowered the risk of recurrence in patients like me. The studies also had showed that five years of tamoxifen provided the most benefit.


So, I was surprised and confused when a large study presented at the San Antonio Breast Cancer Symposium found that it was better for women to take 10 years of tamoxifen than five. How could the findings from the ATLAS study be so different from the evidence upon which my treatment was based?   


That's why we decided to focus this issue of our newsletter on the ATLAS trial. 


ComplementaryATLAS: When Research Changes Practice
ATLAS put 10 years of Tamoxifen
to the test.

Each year before the San Antonio Breast Cancer Symposium begins, there is always a buzz about what the big news will be. There is little doubt that in 2012 the findings that garnered the most attention were from the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial, which showed that taking the hormone therapy tamoxifen for 10 years was more effective than taking it for five, the currently recommended treatment.


To understand why this was significant, we need go back to 1995. That's when the NSABP B-14 study, a U.S. trial comparing 10 years of tamoxifen to five years of the drug, was stopped early because the trial data suggested that not only was 10 years not better--it might even be worse. (More recurrences were seen among the women taking tamoxifen longer.) From that point on, there was no question, at least in the U.S., that tamoxifen should be taken for five years--and no longer.


Outside the U.S., however, questions remained. And in 1996, convinced that the issue was not settled, the Clinical Trial Service Unit (CTSU) at the University of Oxford launched ATLAS, an international trial that enrolled 6,846 women with ER-positive breast cancer who had already taken tamoxifen for five years.  


Dr. Richard Gray

To learn more about the ATLAS trial, BCT spoke with Dr. Richard Gray, the professor of medical statistics at the University of Oxford who presented the findings at San Antonio on behalf of the ATLAS group.  


ATLAS From A Doctor's Perspective:
Q & A with Dr. Judy Garber
Judy Garber
Dr. Judy Garber 
Dr. Judy Garber is a medical oncologist specializing in breast cancer care at the Dana-Farber Cancer Institute in Boston. BCT spoke with Dr. Garber about how the ATLAS findings will affect breast cancer patients.


Q: Why were people surprised at the finding?
A: I was surprised so many people were surprised. The reason I say that is we have data from the MA-17 study, which looked at women who had had five years of tamoxifen and then went on an AI or a placebo for five more years. That study was stopped early because the additional two years of medication (aromatase inhibitor) showed a profound effect on recurrence, so we started putting women on five years of an AI after five years of tamoxifen.

Our concern was for women who were premenopausal, whose only option was tamoxifen. We didn't have any data saying that it was safe or effective for them to stay on tamoxifen longer. Now, we do.

The challenge is trying to figure out for whom this applies.
The study included women who were at low and high risk of recurrence and it's unlikely that additional tamoxifen will benefit everyone equally. The hope would be that it really benefits those who are highest risk that their breast cancer will return. For women who are at low risk of recurrence, we try to make certain that the side effects will not outweigh the benefits over time.
Q: What about women who stopped taking tamoxifen
years ago?

Read More  

Editor/Writer: Sue Rochman
Design: Claudia Fung