An Ounce of Prevention

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As cancer specialists from around the world gather this week in Orlando, Fla., for the annual meeting of the American Society of Clinical Oncology, a new sense of optimism is in the air. It's not that cancer has been cured — there are too many different types of malignancies to hope for a universal treatment. Rather, it's that doctors are beginning to piece together new strategies for keeping cancer from recurring and, in some cases, preventing it from taking root in the first place. As asco president Dr. Larry Norton puts it, "Cancer is not a bolt of lightning. It's more like a thunderstorm. We have plenty of time to close the windows if we know what to do."

One of those windows opens up right after a patient's initial treatment. It's becoming clear that whatever form that treatment takes — surgery, chemotherapy, radiation, medication — what doctors and patients do in the weeks afterward may determine whether a cancer comes back.

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Breast cancer is a prime example. For more than two decades, women with early-stage, estrogen-sensitive breast cancers have been treated with surgery followed by a combination of tamoxifen and chemotherapy. Adding tamoxifen seemed to make sense, since it blocks estrogen's cancer-promoting effects. It turns out, however, that tamoxifen may act as a spoiler, preventing the chemotherapy agents from entering cancer cells and doing their job. In a paper being presented this week, researchers will report on a finding that should change the way doctors treat patients from now on; after eight years of follow-up exams, women who waited until their chemotherapy was complete before taking tamoxifen were 18% more likely to survive without a recurrence than women who took them together.

In another study, women with early-stage breast cancer that had spread to several lymph nodes significantly cut the risk of recurrence simply by replacing one of the standard chemotherapy agents with a drug called docetaxel (Taxotere). By blocking cancer cells' division and growth process, docetaxel reduces the risk of tumor recurrence 50%.

And in a preliminary but promising finding in lung cancer, doctors discovered that a special form of vitamin A might reverse some of the changes in lung tissue caused by smoking. In a small study, former smokers who took the vitamin A derivative produced higher levels of a protein thought to be important in suppressing tumor growth than ex-smokers who took a placebo.

Because cancer research is moving quickly, it pays for cancer survivors — and their loved ones — to be vigilant. Think of cancer as a chronic condition, one you will have to stay on top of for the rest of your life. (This is also true for people at high risk for cancer who have been lucky enough to escape it so far.) Ask your doctor regularly if you're doing everything you can to keep the tumors at bay. The latest studies suggest that prevention really is the best medicine.

For more, visit www.asco.org or e-mail alcpark@aol.com