Joanne Mortimer, MD: Impact of Treatment on Bone & Breast Cancer Recurrences
Dr. Joanne Mortimer discusses the impact of treatment on bone and breast cancer recurrences as well as quality of life issues including menopause, vaginal pain during intercourse, diabetes, obesity and how all of these relate to cancer. This interview was conducted at the 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium.
Dr. Mortimer is the Director of the Women’s Cancers Program and a Professor in the Department of Medical Oncology and Experimental Therapeutics at the City of Hope Comprehensive Medical Center.
The Group Room at the 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium was made possible by support from:
VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International:
Hello and welcome to The Group Room where we’re at the 34th annual CTRCAACR San Antonio Breast Cancer Symposium. I’m very pleased to be joined now by Dr. Joanne Mortimer- Director of Women’s Cancers Programs, Professor in the Department of Medical Oncology and Experimental Therapeutics, the City of Hope Comprehensive Medical Center in Duarte, California. So, as you’ve been in the sessions here for a few days now, I’d like to ask you what has really stuck with you? What presentations? And what sessions have made the biggest impact on you?
Joanne Mortimer, MD, Director, Women’s Cancer Program, City of Hope Cancer Center:
I think one of the biggest areas of interest, to me personally, is somebody who studies survivorship. It’s the impact of treatment on bone and how that potentially relates to breast cancer recurrences. So, we heard an update of the Austrian breast cancer study where young women were randomized after treatment with endocrine therapy, they either got zoledronate or not, and it turned out that they had fewer breast cancer recurrences. And then, the ZO-FAST trial that looked at the use of either starting a bisphosphonates, starting zoledronates, whether early or waiting until they had more bone loss was associated with fewer breast cancer recurrences. And then the NSABP chlodronate trial that again showed fewer recurrences.
There is something that the bone is telling us about breast cancer and disease recurrence because women who have osteoporosis very seldom get breast cancer- yes it happens, but it’s less common. Women who have very dense bones get breast cancer fairly often. So, the fact that these agents now have an impact on now breast cancer recurrence is telling us something about a biology that we need to understand more of and hopefully will help us to impact disease recurrence.
Selma Schimmel:
Quality of life is such an important area that you, despite your real important clinical research that you have taken this interest in… the quality of life of the patient, not just in response to treatment, but in general, you’re very passionate about the way your patients live and coexist with their cancer. So, since we last spoke, maybe you could talk a little bit about what you’re involved in with your quality of life studies. And also, maybe, if you have a little Living With Menopause update.
Joanne Mortimer, MD:
Yes, so you know, the biggest problem that young breast cancer patients have is those as who either are given chemotherapy before menopause or even older women who get these hormones that cause them to have hot flashes and night sweats… I reported several years ago that women who experienced hot flashes actually had fewer breast cancer recurrences so that’s sort of a positive aspect to having a hot flash. But, most women are actually pretty uncomfortable with these hot flashes and night sweats and difficulty sleeping and mood problems and they need not really suffer with those because there are a number of interventions that actually can be very effective in minimizing hot flashes- whether it’s antidepressants or gabapentin, neurontin, can control hot flashes and also help with the sleep in these women.
We have a survivorship program that we enroll women with newly diagnosed breast cancers at the time of their initial diagnosis and we run through all their symptoms and they fill out questionnaires and 6 months later we see them; by then they’re usually done with their chemotherapy. And because we have a nurse practitioner there we’re able to ensure that if women have hot flashes, and they really are uncomfortable, that we address them; problems sleeping, mood disorders… so we try to be very proactive about these side effects so that we can maximize the quality of life with these women.
Selma Schimmel:
Are you currently involved in some research that is ready to be discussed?
Joanne Mortimer, MD:
The one study that we’re hopefully going to get started with in the next 3 months is a study looking at estrogen for women who have pain with intercourse. So, this is a very dicey issue because we always worry about giving breast cancer patients estrogen. And vaginal estrogen, estrogen applied to the vaginal area, has been approved for the treatment of painful intercourse in women who have menopause, and we’re going to look at it in women who have triple negative breast cancers. Pain with intercourse can be anything from uncomfortable to incredibly uncomfortable and it may manifest itself- that dryness that women get as a result of menopause may manifest itself, in all sorts of weird ways.
I recently had a woman who developed a urinary tract infection. She was taking one of the aromatase inhibitors, had vaginal dryness and she had a very tight pair of jeans on, and that’s what caused her to have a bladder infection. So it’s really not just about sex, I mean, it’s about bladder function, recurrent bladder infections… So, I think that’s an area that we spend very little time on and one that we probably need to spend more on and hopefully we’ll come up with interventions that can be effective without harming people.
Selma Schimmel:
There was one study here that, I don’t know how significant it is, so I want to ask you about the diabetes and obesity increased risk for breast cancer development. I don’t know if we know a lot but I found that correlation, because we always, well we have known for a long time now, that obesity and breast cancer, they’re, they don’t, this is not good, and that being overweight is a risk factor to diabetes, which we know can be a byproduct also of weight- tied it to breast cancer, it’s rather fascinating.
Joanne Mortimer, MD:
It is incredibly fascinating, the diabetic discussion because some of the medicines that we use to treat diabetes, specifically metformin, are being tested as a treatment for breast cancer. In colon cancer, it turns out that, individuals who have diabetes actually do better. And so, we kind of hypothesized, maybe it’s because of the medicines they were taking. So in this Scandinavian trial it was sort of interesting that it wasn’t favorable to be diabetic and whether the diabetes is just part of being obese and getting this metabolic syndrome where your cholesterol becomes elevated and you also get diabetes, maybe that’s different than just diabetes that occurs at a young age or obesity individually.
Selma Schimmel:
And you were mentioning a drug for one indication that was for diabetes that you’re for…
Joanne Mortimer, MD:
Right, so metformin is a drug that is used to treat diabetes and it actually, and it’s a very common one that is used in people who develop adult-onset diabetes, and it actually does have anti-tumor effects. It is currently in trial in Canada as a cancer preventive agent.
There are some other instances where the medicines we use to treat common medical problems may have effects on cancer, you know, the lipid-lowering drugs… there is an ongoing debate about whether they lower the risk of prostate cancer or whether they alter the course of the disease. So these drugs are not, they don’t have a single function, necessarily, and they do affect other organ systems.
Selma Schimmel:
And I guess it’s the Valero study where a drug that was used for organ rejection, to prevent organ rejection you suddenly find in common with aromatase inhibitors have benefits in the treatment of metastatic breast cancer, so…
Joanne Mortimer, MD:
Yes. All these chemical pathways really do cross over from cancer to other diseases, yes.
Selma Schimmel:
Dr. Joanne Mortimer- Director of Women’s Cancer Programs and Vice Chair of the Department of Medical Oncology, also Professor in the Department of Medical Oncology and Experimental Therapeutics at the City of Hope Cancer Center, Comprehensive Cancer Center in Duarte, California. Thank you, Dr. Mortimer.
Joanne Mortimer, MD
Thank you, Selma.
END OF VIDEO