SABCS 2014: A Bullet Against Breast Cancer Women Aren’t Using

Guest Post by Anees B. Chagpar
Yale Cancer Center

Amid all the headlines coming out of the San Antonio Breast Cancer Symposium last week—and there were plenty—there was one story that I hope to see again and again. A technical version of that headline might be: An inexpensive, nontoxic therapy can reduce cancer risk and improve survival. To put it in terms the public can relate to: Diet, exercise, and other healthy behaviors can reduce the risk of developing breast cancer and improve survival.

You’d think that if we had discovered such a regimen in pill form, women would be clamoring to get it, and it would be one of the most widely prescribed treatments. The truth of the matter is that we have such a treatment, and we’ve known about its effectiveness for years. Yet, few women take advantage of it. More curious is that it is hard to tell how many oncologists are even prescribing it.

Diet, exercise, and general healthy behaviors continue to show significant risk reduction in the setting of prevention, and are increasingly demonstrating their effect in reducing mortality and improving quality of life in survivors. The WINS study finding of a 56 percent mortality reduction in the ER/PR negative (potentially triple negative) subgroup with a low-fat diet was striking to me—here’s a cheap, effective, nontoxic therapy that has a HUGE impact, yet how many of us write prescriptions for “low-fat diet”? If we were able to create a pill that had such an effect, I’m pretty certain it would revolutionize our treatment paradigms.

In another study presented by my colleague Erin Hofstatter, MD, women who felt they were at high risk for developing cancer were found to be no more likely to follow diet and exercise guidelines for prevention than those who thought they were at low to average risk, despite a plethora of data supporting these recommendations not only for cancer risk reduction, but also for improvement in overall health.

The World Health Organization found that nearly half a million cancers worldwide were attributable to high body mass index. Women are disproportionately affected, with postmenopausal breast cancers being one of the key culprits. Obesity is arguably a reversible condition. So why aren’t women “choosing wisely” to take care of their own health? Is it a lack of knowledge? Or motivation? As we think about how we can help our patients, perhaps we can whip out our prescription pad and exercise our pens with scripts for “5 servings of fruits and veggies daily” or “150 min moderate to vigorous activity per week.”

This year’s symposium was filled with new science—from genomics to immunotherapy—a real sign of the times as we begin to understand the biologic underpinnings of breast cancer and search for the ammunition needed to allow our patients to live longer, healthier lives. Amid all the warranted attention paid to novel therapeutics, however, we may discover that we already have at least one such bullet waiting to be fired.

Anees Chagpar, MD, MPH, MBA. Photo courtesy of Yale Cancer Center.

Anees B. Chagpar, MD, MPH, MBA, is the director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven; associate professor, Department of Surgery, Yale School of Medicine; program director of the Interdisciplinary Breast Fellowship at Yale University; and assistant director for Diversity/Health Equity at Yale Cancer Center. She is a breast surgical oncologist who participates in investigator-initiated and cooperative group clinical trials, as well as translational and clinical research. She has been a member of the AACR since 2004.