What's new in NZ treatment?
The NZBCF highlights some of the advances that will make a difference for New Zealand women with breast cancer in 2013
- 10-year Tamoxifen treatment lowers breast cancer recurrence and mortality
Results of the ATLAS study announced at the San Antonio Breast Cancer Symposium in December 2012 show that patients who continued treatment with the widely-prescribed drug tamoxifen for ten years had a 25% lower recurrence rate and a 29% lower breast cancer mortality rate in their second decade after breast cancer diagnosis, compared with women who stopped tamoxifen after five years (the current standard treatment regime). This study will be of particular interest to premenopausal New Zealand women taking tamoxifen with few side-effects. Women taking tamoxifen should discuss this study with their oncologist, says the NZ Breast Cancer Foundation.
2. Perjeta extends survival; some NZ women likely to use on a self-funded basis
Many breast cancer patients will be watching for the Medsafe registration of Perjeta, a new drug that significantly extends survival in people with HER2-positive metastatic breast cancer. Results of the international CLEOPATRA trial announced in December showed the risk of death was reduced by 34% for people who received Perjeta, Herceptin and chemotherapy, compared to those who received Herceptin and chemotherapy.
Medsafe registration is a prerequisite before a drug can be considered for Pharmac funding in New Zealand. In the meantime, women can talk with their oncologists about accessing Perjeta on a self-funded basis under sections of the Medicines Act governing the prescription of unapproved medicines. The drug is already approved in the USA, Switzerland and Mexico.
3. Stem cells help repair tissue damage from radiation therapy
New research shows that fat grafts into the breast can reverse tissue damage caused by the radiation therapy that many women undergo for breast cancer following a lumpectomy or mastectomy. This reversal is due in part to stem cells contained in the grafted fat.
“This is a very exciting area,” said reconstructive surgeon Stephen Mills, chair of the NZ Breast Cancer Foundation’s medical advisory committee. “We’re already performing fat grafts here in New Zealand, but as our understanding of this regenerative process increases, we’ll be able to make better use of the grafts to repair radiation damage.”
4. Microvascular surgery reduces complications of reconstructive surgery
The use of microvascular perforator flaps will become more common in breast reconstruction surgery. Traditional “TRAM flap” reconstruction, where a woman’s own abdominal tissue is used in the construction of new breasts, involves the removal of muscle from the abdomen, as well as skin and fat. This can lead to a weakening of the abdominal wall, causing health problems later. The new microvascular perforator flap surgery is an advanced microsurgery technique that allows surgeons to largely avoid taking muscle from the abdomen.
5. Mammograms go digital throughout BreastScreen Aotearoa
The NZ Breast Cancer Foundation welcomes the ongoing implementation of digital mammography, which will be standard in nearly all BreastScreen Aotearoa screening centres by the end of 2013. Studies show that digital mammograms are more accurate than traditional film screen mammography, particularly for women with dense breast tissue, women under age 50, and premenopausal or perimenopausal women. Digital images can be easily transmitted between sites, potentially allowing greater access to specialist expertise.
6. Lifting of Pharmac restrictions gives more treatment options for metastatic breast cancer
Gemcitabine can now be prescribed for metastatic breast cancer, following the lifting of Pharmac restrictions in December 2012. “Studies show that gemcitabine can delay disease progression and improve quality of life for some breast cancer patients whose disease has progressed following other chemotherapy treatments,” said Dr Anna Bashford, a medical oncologist and member of the NZ Breast Cancer Foundation’s medical advisory committee. “It’s a really good string to our bow.”
Despite these advances, around 650 New Zealand women will die of breast cancer this year. 2800 will be diagnosed with the disease – that’s seven women a day, and of those, one a day will be aged under 45.
“Breast cancer is still a killer disease,” said Van Henderson, chief executive of the NZ Breast Cancer Foundation. “Yes, there’s been some great progress in the treatments available, but going through any kind of cancer treatment is unpleasant and often painful. Women must remain vigilant, so that cancer is detected as early as possible – at any age women should know the normal look and feel of their breasts, and report changes to their doctor. Once they turn 40, they should be getting an annual mammogram.”
Science suggests that lifestyle habits can have a preventative effect, Mrs Henderson added. Reducing alcohol consumption, keeping fit and maintaining a healthy BMI are some of the ways women can help reduce their risk.
The NZ Breast Cancer Foundation launched an interactive e-guide last October, which helps women understand their individual risk and to be aware of the signs and symptoms of breast cancer. Visit www.nzbcf.org.nz/e-guide for more information. The Foundation recommends annual mammograms from ages 40-49, and every two years from age 50.