Clifford Hudis on Breast Cancer Prevention
Clifford Hudis, M.D. is Chief of the Breast Cancer Medicine Service and attending physician at Memorial Sloan-Kettering Cancer Center in New York City, where he is also a professor of medicine at the Weill Medical College of Cornell University. He is co-leader of the Breast Disease Management Team at MSKCC, co-chair of the Breast Committee of the Cancer and Leukemia Group B (CALGB), past chair of the Internet Services Committee and present chair of the Information Technology Committee of the American Society of Clinical Oncology (ASCO). He is also past president of the New York Metropolitan Breast Cancer Group and chair of the Scientific Advisory Board of the Breast Cancer Research Foundation.
Well, as a group, that is to say globally, we can do something about the breast cancer risk but I am very quick to say that I don’t know whether individual women can directly and certainly prevent their own breast cancer. I have to expand a little bit to explain why. To prevent breast cancer you have to understand the risks for breast cancer. The first risk that we clearly understand is the inheritance of a mutated gene from a parent. If you inherit that gene, there is an overwhelming likelihood that you’ll develop breast and maybe ovary cancer and for that subset of breast cancers prevention is pretty difficult short of risk-reducing surgery, meaning removal of the breasts. The second thing that one has to recognize is that the single most common risk factor for breast cancer is aging and none of us are seeking to prevent aging. So now you get in to more subtle things like diet, lifestyle and similar, and we probably can prevent breast cancer in that reign-- in that domain but it takes a little bit of work to show it. For example, people who are more sedentary and obese or overweight have a higher risk of breast cancer but-- so those are things you can modify. There are even some drugs that you can take that lower the risk of breast cancer though they’re not wildly popular. The anti-breast cancer drug tamoxifen and other drugs like that have been shown to reduce the risk but most people seeking to prevent breast cancer aren’t looking for a medical intervention; they’re looking for something more generally applicable and presumably less toxic.
Question: What is tamoxifen?
Clifford Hudis: It is a very old drug actually. It’s one of the earliest effective treatments for breast cancer. To tell you about tamoxifen I feel like I have to back up to the beginning of breast cancer medicine. The very first effective medical treatment for cancer as opposed to surgical removal of the cancer was removal of a woman’s ovaries. It was reported by a Scottish surgeon in 1896. His name was Beatson and what he was fundamentally doing was depriving the tumors of estrogen. So tamoxifen leapfrogs as many generations ahead. Tamoxifen can be thought of as a modified estrogen. It attaches to something called the estrogen receptor the same way that estrogen does except when it attaches to the estrogen receptor different things happen in the cell. If estrogen tells a cell to grow, tamoxifen tells a cell stop growing and die. I’m being very simplistic but that’s a simple way to think about it. So tamoxifen is an oral drug. It’s broadly available. It has some side effects that can be attributed to an antiestrogen effect. Interestingly, it has some side effects that are consistent with those of estrogen itself so it’s a very complicated drug. It’s generic, it’s inexpensive, so around the world it may be the most broadly available anti-breast cancer medicine and because it’s inexpensive it’s really cost effective. It has a tremendous worldwide impact. In most parts of the world it’s used to treat established breast cancer. In most parts of the world it’s used to prevent recurrence of early-stage breast cancer, meaning after an operation, and in some parts of the world it’s actually used to prevent breast cancer, which is what we’re talking about right now.
Question: What are other popular drugs?
Clifford Hudis: Well, popular is a different question. I’m not sure what is the most popular drug. Tamoxifen is a broadly available drug. In order to answer that question, one has to start to talk about the biology of breast cancer. Breast cancer is not just one disease. It is better thought of as a collection of diseases and in the same way that you don’t lump pancreas cancer, breast cancer and leukemia together, you say they are different kinds of cancers with different treatments, the same is true within breast cancer. So there’s one kind of breast cancer that’s hormone responsive. It’s described microscopically by the pathologist clearly because it has the estrogen receptor. For breast cancers that have the estrogen receptor there are a collection of hormone therapies that interfere with it as I described for tamoxifen, and after tamoxifen the most commonly used drugs certainly have to be the aromatase inhibitors with the caveat that those drugs are really only useful after menopause. Tamoxifen is useful regardless of menopausal status. For the estrogen receptor-negative breast cancers there’s a very exciting subgroup that have something called HER2. That stands for H-E-R-2, the human epidermal growth factor receptor. Those cancers are targeted with a very exciting antibody called trastuzumab. You may know it by its brand name, Herceptin. They’re also targetable by other exciting new drugs as well not having to do directly with chemotherapy, and for the cancers that don’t have any of these receptors chemotherapy treatments remain the mainstay.
Question: What are the latest advances in breast cancer prevention?
Clifford Hudis: Well, there are tremendous advances. It’s never been more exciting in terms of the molecular biology of breast cancer and cancer in general and the translation of that understanding in to medications. So one of the things we’ve been trying to do is find better, safer drugs than tamoxifen. A class of drugs called aromatase inhibitors is widely available. They offer marginal advantages over tamoxifen in terms of efficacy and also safety, and right now in early looks at data they appear to have the same or better prevention effect as does tamoxifen and they may represent just the next step but there are many more yet to come.
Memorial Sloan-Kettering's Clifford Hudis on what is known about breast cancer prevention and treatment.
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Minimoons<p>Scientists have confirmed just two prior minimoons. One was <a href="https://en.wikipedia.org/wiki/2006_RH120" target="_blank">2006 RH120</a>, which orbited us from September 2006 to June 2007. The other was <a href="https://en.wikipedia.org/wiki/2020_CD3" target="_blank">2020 CD3</a>, which got stuck in the 2015–2016 timeframe, and is believed to gotten away in May 2020.</p><p>2020 SO, the new kid on the block, is expected to arrive in October 2020 and pop out of orbit in May 2021.</p><div id="37962" class="rm-shortcode" data-rm-shortcode-id="f4c0fc8a2cba6536ea4cd960ebed3e6e"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1307729521869611008" data-partner="rebelmouse"><div style="margin:1em 0">Asteroid 2020 SO may get captured by Earth from Oct 2020 - May 2021. Current nominal trajectory shows shows capture… https://t.co/F5utxRvN6Z</div> — Tony Dunn (@Tony Dunn)<a href="https://twitter.com/tony873004/statuses/1307729521869611008">1600621989.0</a></blockquote></div>
Identifying 2020 SO<p>The first clue 2020 SO isn't your ordinary asteroid is its exceptionally low velocity. It's traveling much more slowly that a typical asteroid — their <a href="https://www.lpi.usra.edu/exploration/training/illustrations/craterMechanics/" target="_blank">average rate of travel</a> <a href="https://www.lpi.usra.edu/exploration/training/illustrations/craterMechanics/" target="_blank" rel="noopener noreferrer"></a>is 18 kilometers (58,000 feet) per second. Even <a href="https://en.wikipedia.org/wiki/Moon_rock" target="_blank">moon rocks</a> sent careening into Earth orbit by impacts on the lunar surface outpace pokey 2020 SO.</p><p>For another thing, 2020 SO has an orbital path very similar to Earth's, lasting about one Earth year. It's also just slightly less circular than our own orbit, from which it's barely tilted off-axis.</p><p>So, what is it? <a href="https://cneos.jpl.nasa.gov/ca/" target="_blank">NASA estimates</a> that the object has dimensions very reminiscent of a discarded Centaur rocket stage from the <a href="https://en.wikipedia.org/wiki/Surveyor_2" target="_blank" rel="noopener noreferrer">Surveyor 2 mission</a> that landed an unmanned craft on the moon. Back in the day, rocket stages were jettisoned as craft were aimed toward their desired position. This stuff, if released high enough, remains in space. It appears that this Centaur rocket, launched in September 1966, is now making its way back homeward, at least for a little bit.</p><p>When 2020 SO arrives at its closest point in December, the rocket is expected to be about 50,000 kilometers from Earth. Its next closest approach is much further: 220,000 kilometers, in February 2010.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQzMDk3NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyODg1MTQ1MX0.HGknDwqp0GmeuczKY_AS7vrPG7KMFUc_XO95tNoI2xo/img.jpg?width=980" id="e5cda" class="rm-shortcode" data-rm-shortcode-id="85eb1f790d8c3ee5b261f7ba13eaa5e1" data-rm-shortcode-name="rebelmouse-image" alt="Centaur rocket stage" />
Centaur rocket stage
What we may be able to learn<p>Earthly space programs being as young as they are, scientists would love to know what's happened to our rocket during a half century in space.</p><p>While 2020 SO won't get close enough to drop into our atmosphere, its slow progress has scientists hopeful that they'll still get some kind of a decent look at it.</p><p>Spectroscopy may be able to reveal what the rocket's surface is like now — has any of its paint survived, for example? Of course, being out in space, it's likely to have been hit by lots of dust and micrometeorites, so the current state of its surfaces is also of interest. Experts are curious to know how reflective the rocket is at this point, valuable information that can help planners of future long-term missions anticipate how well a craft out in space for extended periods will remain able to reflect sunlight.</p>
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- Eighty percent of respondents said they want to reduce their risks.
- An estimated 7.1 million Americans over the age of 65 will suffer from Alzheimer's by 2025.
Credit: logika600 / Shutterstock<p>Remaining healthy requires regular screenings. Here again we see a disassociation between risk reduction and proactivity. Seventy-seven percent of respondents don't talk to their doctors about lifestyle habits that support brain health; 51 percent have never been screened for depression; 44 percent have never had a neurological exam; and 32 percent have never been screened for hearing problems. </p><p>Common early warning signs of dementia, <a href="https://news.yahoo.com/americans-worry-alzheimers-disease-survey-140644803.html" target="_blank" rel="noopener noreferrer">according to</a> Dr. Jason Karlawish, co-director of the Penn Memory Center, include repetitive questions and stories, difficulties with complex daily tasks, and trouble with orientation. </p><p>In terms of intervention, <a href="https://bigthink.com/21st-century-spirituality/does-lack-of-exercise-lead-to-dementia" target="_self">exercise</a>, <a href="https://bigthink.com/surprising-science/obesity-dementia" target="_self">diet</a>, building a <a href="https://bigthink.com/mind-brain/brain-reserve" target="_self">brain reserve</a>, and challenging your brain (such as learning a new language or musical instrument) are all proven methods for staving off the ravages of Alzheimer's. Oxytocin has also <a href="https://bigthink.com/mind-brain/alzheimers-oxytocin" target="_self">showed promise</a> in brain-addled mice, while researchers found positive results for a <a href="https://bigthink.com/mind-brain/intermittent-fasting" target="_self">group of intermittent fasters</a> in promoting neurogenesis. </p><p>Epidemiologist Bryan James says that dementia is <a href="https://www.npr.org/sections/health-shots/2013/04/15/176920391/how-exercise-and-other-activities-beat-back-dementia" target="_blank">not an inevitable result</a> of aging. </p><p style="margin-left: 20px;">"It's simply not pre-destined for all human beings. Lots of people live into their 90s and even 100s with no symptoms of dementia." </p><p>Professor of neurology at Boston University School of Medicine, Andrew Budson, <a href="https://news.yahoo.com/americans-worry-alzheimers-disease-survey-140644803.html" target="_blank" rel="noopener noreferrer">recommends</a> aerobic exercise and the Mediterranean diet. As has long been known, whole grains, fruits and vegetables, fish and shellfish, and healthy fasts like nuts and olive oil seem to have brain-boosting properties. </p><p>To learn more, take the <a href="https://www.mdvip.com/brain-health-iq-quiz" target="_blank">Brain Health IQ quiz</a>.</p><p><span></span>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank" rel="noopener noreferrer">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>