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A Little Love Goes a Long Way

Dr. Richard Love. Photo courtesy of IBCRF.

Researcher promotes adjuvant treatment for breast cancer

By Ji Hyun Lim

It is a misconception that Asians and Asian Americans are not susceptible to cancer. Breast cancer is the leading cause of death in Filipino American women. And for those who have been in the United States for 10 years or more, their incidence of the disease mirrors the rates of the general population. Worldwide, some 1 million women are afflicted with breast cancer each year, with half of the cases occurring in developing nations, according to a 1999 study by the American Cancer Society. Of those, 450,000 are women of Asian descent.

In light of those statistics, Dr. Richard Love, president of the International Breast Cancer Research Foundation Inc. (IBCRF), is pushing for further studies on Asian women. In his most recent research, he proposes that adjuvant — or “additional” — treatment, begun at the time of breast surgery, increases chances of survival. He presented his findings at the American Society of Clinical Oncology (ASCO) annual meeting at San Francisco’s Moscone Center on May 15.

Love based his research on 709 pre-menopausal patients with operable breast cancer at six hospitals in Vietnam and one in China. According to Love, oophorectomy, the removal of one or both ovaries, plus tamoxifen, a drug to increase estrogen, taken for five years reduced the chance of cancer recurrence by almost 20 percent and increased the likelihood of survival by 11 percent.

“The thing I’d like to emphasize is that there are multiple things that could go wrong,” Love said. “[Our body is] an intricate circuit. You take care of one pathway and block it right there, but [the cancer] gets around another way … It has been found giving systemic treatment can affect cells that have spread to other parts of the body...”

Love and his colleagues conducted the study with two control groups. The first group had oophorectomies and tamoxifen; and the second group received tamoxifen alone. After five years, 73 percent of the first adjuvant group and 54 percent of the second group remained free of recurrence. However, only patients with tumors that tested positive for receptors to estrogen (ER) and progesterone (PR) benefited from the adjuvant treatment. Of the women Love studied, 62 percent tested positive for ER receptors and 62 percent were positive for PR receptors.

Said Love: “If this combined hormone treatment is given to 450,000 pre-menopausal women, mostly in Asia, who now get no adjuvant treatment or get highly toxic chemotherapy of uncertain benefit, 50,000 of these young women could be saved each year.”

Tamoxifen also helps guard against bone loss. When the ovaries are removed in the oophorectomy procedure, estrogen levels go down, increasing the risk for reduced bone density. Since Asian women have lower bone density to begin with, those who receive an oophorectomy are even more susceptible to osteoporosis and spontaneous fractures. Tamoxifen, which increases estrogen levels, reduces the chances for bone loss.

Furthermore, those who receive adjuvant treatment exhibit few adverse reactions. For Asian women, that is an important factor, considering many are genetically predisposed to the negative side effects of chemotherapy, Love said. He points out Asian women are smaller on average, with a surface area of 1.4 square meters versus 1.7 to 1.8 square meters for American women. High dosages of medicine, such as those given in chemotherapy, cause increased toxicity in women with smaller surface areas. Asian women also metabolize drugs differently, and thus, may not respond to lower therapeutic dosages.

“My experience in Asia has been, with normal doses and normal regimens of chemotherapy, Vietnamese women get sick, literally, until death,” Love said.

Chemotherapy is also very expensive for patients in developing countries. Public health policy makers, Love said, should determine if oophorectomy and tamoxifen are financially sound alternatives to chemotherapy for countries with limited economic resources.

“When a young woman dies, you lose someone from the labor force,” he said. “A mother at home educates her children and provides nutritional care for her family. The economic loss is enormous.”

Adjuvant treatment may have similar positive effects for Asian American breast cancer patients.

But there are still barriers to successful breast cancer treatment. For example, many Asian American women fail to catch the disease early. According to a U.C. Davis medical report, only 19 percent of Vietnamese American women have had a clinical breast exam and mammogram within the past two years. Moreover, 66 percent of Southeast Asian immigrants live in poverty.

“Language barriers, lack of transportation and reluctance to seek medical care for non-emergencies are among the obstacles Vietnamese women face in getting cancer screenings,” Thomas Bui, president of the Vietnamese Cancer Awareness Research, and Education Society (VN CARES) said. “Culturally, Vietnamese women are hesitant to talk about [breast cancer] with a doctor.”