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Debu Tripathy, MD
Professor of Medicine, University of Texas Southwestern Medical Center
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ANNOUNCER: One of the more confusing aspects of any illness can be the host of medical terms that doctors use. One such phrase in breast cancer treatment is "adjuvant therapy."
DEBU TRIPATHY, MD: "Adjuvant therapy" refers to treatments that are given after someone has had surgery for early stage breast cancer. When women have had surgery, there's still a risk that the cancer may come back, either in the breast or it may spread to other parts of the body. Adjuvant therapy, which indicates either chemotherapy or hormonal therapy can lower the risk of recurrence.
ANNOUNCER: Adjuvant therapy can include radiation treatment.
MARISA WEISS, MD: Radiation is very effective. It reduces the risk of recurrence by about two-thirds, and it's very important for women with early stage breast cancer. Most of those women have choice between keeping their breast and mastectomy. Radiation therapy combined with lumpectomy is the alternative to mastectomy, and it's very important for many women who want to keep their breast.
ANNOUNCER: Chemotherapy can also be used to lower the risk of cancer recurring.
MARISA WEISS, MD: The principle behind chemotherapy is to kill the cancer cells that may be left behind.
Generally, chemotherapy works by blocking the growth of cells, keeping them from making new cells and preventing them from repairing themselves.
DEBU TRIPATHY, MD: We use drugs that stop cell division and are known to have side effects, such as hair loss and lowering of the white count. Most chemotherapy drugs are given by vein. They are given either every week or every three weeks. And the typical course of chemotherapy lasts And this typically is given for anywhere from three to six months.
ANNOUNCER: A third type of adjuvant therapy is hormonal treatment, which can only be used if the cancer is hormone receptor positive
MARISA WEISS, MD: Breast cancer that has estrogen or progesterone receptors present will grow in the presence of estrogen. So the goal of hormonal therapies is to remove the effective estrogen from the body so that the breast cancer cells are not stimulated to grow.
Tamoxifen is a form blocks the estrogen receptor, that keeps estrogen out of the estrogen receptor and prevents it from stimulating the cells to grow. In a woman beyond menopause there are drugs called aromatase inhibitors that block the production of estrogen in muscles and fat throughout the body.
ANNOUNCER: The aromatase inhibitor Arimidex is currently the only one in its class approved for adjuvant therapy, although others, including Femara and Aromisin, are being studied for this use.
And while tamoxifen works in pre- and post-menopausal women, these aromatase inhibitors are only appropriate for women after menopause.
ANNOUNCER: The term "adjuvant therapy" can sometimes be confused with a very different approach to breast cancer, "alternative therapy."
MARISA WEISS, MD: When women refer to alternative or complementary medicine, they're thinking about nutrition, about supplements, about herbal medicine, about meditation and acupuncture, and things that are pulled in from other cultures, like Chinese medicine, ayurvedic medicine, homeopathic medicine.
ANNOUNCER: These therapies can be valuable for some although they are not standard practice.
Alternative medicine can be very helpful for women who are dealing with the uncertainty and the fear about breast cancer, as well as the anxiety and the depression that can occur.
ANNOUNCER: While the jury's still out on alternative therapies, there is a very positive verdict on the benefits of adjuvant therapy.
DEBU TRIPATHY, MD: Adjuvant therapy is important in the management of early stage breast cancer. It can clearly lower the risk of recurrence and, by doing that, lower the mortality from breast cancer.
MARISA WEISS, MD: I think that many of the advances that we've seen in the last 20 years are all around adjuvant therapies. That the advances in breast cancer, women living longer is largely related to the adjuvant therapies. Definitely.
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