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BREAST 

CANCER 

ACTION 

Newsletter #80 

February/March 2004 

® 

www.bcaction.org 

I N S I D E 

Executive Director’s Column: 

Of Endpoints and Women’s Lives 2 

FDA Rejects Bid to Market 

Silicone Gel Breast Implants 2 

In Memory: 

Faith Fancher and Karen Holly 7 

Impressions From the 26th San Antonio 

Breast Cancer Symposium 

By Musa Mayer 

If you asked the advocates who were there 

what they thought of the 26th San Antonio 

Breast Cancer Symposium, you’d have 

gotten a decidedly mixed response. Some felt 

excited by and hopeful about what they were 

hearing, while for others there was little of 

genuine interest, and a growing disappointment 

that the promises of genomic research 

have produced so little that is useful so far. 

For some, the pace of emerging research was 

breathtaking; for others, it was vanishingly 

incremental and increasingly distorted by 

industry influences. 

Yet we all watched the same 44 featured 

presentations on nine huge screens arrayed 

throughout the cavernous ballroom of the 

Gonzalez Convention Center. Over the four 

days of the conference, 120 of us advocates 

maneuvered among 6,000 researchers, 

scientists, clinicians and industry people from 

80 countries. We all balanced plates of food 

as we peered at the poster displays detailing 

over 500 studies that had not been selected 

for feature presentation. While we tried to 

make sense of it all, the sheer size and 

diversity of research presented guaranteed 

that the sense we made would reflect our own 

expectations and interests as much as it did 

the research itself. 

Extended coverage 

on our website! 

Visit www.bcaction.org to read Musa Mayer’s 

additional coverage of the San Antonio conference. 

(Or send BCA a self-addressed stamped envelope 

and we’ll mail you printouts of her two articles.) 

Photo: Our booth at the San Antonio Breast Cancer Symposium. 

In the following report on the meeting, 

the names and numbers in brackets refer to 

abstracts available at www.sabcs.org (click on 

“Abstracts Online 2003,” log in as a guest, 

and search by author). 

Let’s get real: Genomic models for 

prognosis, prediction, and treatment 

Since the sequencing of the human genome, 

great excitement—and even greater hype— 

have accompanied the genomic revolution in 

cancer diagnosis and treatment. What became 

clear to me in San Antonio this year was just 

how premature any results and conclusions 

are, at this point in time. 

After the successful development and 

approval of Herceptin® over five years ago, 

it seemed as if we had entered a brave new 

world of precisely targeted, less toxic, more 

effective combined therapies. However, 

developing a cocktail of targeted new drugs to 

switch off the offending proteins that are 

involved in cancer has so far proven an overly 

simplistic model. A major stumbling block is 

that while we know that different tumors 

have different genetic signatures, we don’t yet 

know how to identify these tumors in any 

individual woman, or to determine what a 

particular profile may mean in terms of 

prognosis or treatment. With the exception of 

HER2 and ER/PgR testing, scientists haven’t 

managed to identify which cancers are most 

likely to respond to targeted therapies. Giving 

so-called targeted therapies to all patients in 

hopes of benefiting a small fraction raises 

serious questions about toxicity, resources, 

research priorities, and ethics. 

Faced with initial failures of their new, 

targeted therapies, some companies are now 

struggling to identify subgroups of patients 

for which their drugs may prove effective. 

One example is Biomira, manufacturer of the 

vaccine Theratope ® , which announced the 

continued on page 10 

CALENDAR 

BCA Event 

Saturday, April 24, noon–5 p.m.: 

“Taking Care in a Toxic Time.” 

Anne Lamott will emcee our seventh 

annual Town Meeting for Activists at 

the Oakland Asian Cultural Center, 

388 Ninth Street, Suite 290. Keynote 

speaker Sandra Hernandez, M.D., 

will discuss how we can protect our 

health by implementing the precautionary 

principle. There will be workshops 

on mammography, breast 

cancer politics, the Rachel Carson 

Cancer Research Project, and BCA's 

Think Before You Pink campaign. 

For more information, visit www 

.bcaction.org. 

Other Events 

March 24–28 in Washington, D.C.: 

“From Awareness to Action: The 

Unequal Burden of Cancer.” The 

ninth biennial Symposium on Minorities, 

the Medically Underserved, and 

Cancer is presented by the Intercultural 

Cancer Council and Baylor 

College of Medicine. $150–$450. 

Read the program and register at 

http://iccnetwork.org/symposium. 

April 2–4, 2004, at the University 

of California, Berkeley: “Unite for 

Change: New Approaches to 

Pesticides and Environmental 

Health.” This 22nd National Pesticide 

Forum is sponsored by Beyond 

Pesticides, Californians for Pesticide 

Reform, and Pesticide Action 

Network North America. Visit www 

.beyondpesticides.org for more information, 

including registration fees.

2 


Breast Cancer Action 

From the Executive Director 

Of Endpoints and Women’s Lives: 

Reflections on San Antonio and Beyond 

By Barbara A. Brenner 

When I attend cancer meetings like 

the December 2003 San Antonio 


(SABCS), I try to watch the news coverage to 

see how the information is being presented to 

the public. Often, when I compare the press 

coverage to my own perceptions of the 

meetings, I find myself wondering if I’m at the 

same conference that is being reported. This 

time, my wondering turned into incredulity 

because, more than I remember from previous 

SABCS gatherings, the 2003 oral presentations 

conveyed very early data, and rarely 

focused on the impact of the treatments or 

prognostic tools on women’s lives. Yet the 

press reports of those very same presentations 

suggested that lifesaving breakthroughs would 

be in clinics the next day. 

There are a number of consequences of 

presenting early data—and touting it to the 

press. One is that, way too often, the early 

indications don’t pan 

out, either because the 

drug under study is not 

as effective as it looks 

early on in small, tightly 

controlled studies, or 

because the other effects 

(usually called “side effects”) of the drug 

overwhelm the benefits. If clinical practice 

changes because of early indications, lots of 

people can get hurt if those indications turn 

out to be wrong. When the early data are 

presented orally, it’s not even possible to take 

a close look at the information being presented. 

The oral presentations often don’t 

show up in peer-reviewed journals until 

months later, if at all. And, of course, as the 

press reports the “breakthroughs,” patients 

start asking their doctors and favorite breast 

cancer organizations about them, even though 

they’re probably not ready for prime time. 

A typical scene 

at BCA’s booth 

at the San 

Antonio 

conference. 

Staff and 

volunteers 

stayed busy 

handing out 

materials and 

answering 

questions. 

As the push for faster progress—driven 

in part by patient needs and in another part 

(at least as great) by the potential for private 

profit—starts to reach a fever pitch, researchers 

have begun to use “surrogate 

endpoints” to evaluate the effectiveness of the 

treatments they are testing. The thinking 

behind using surrogate endpoints is very 

logical. When you’re trying to see if a drug 

delays recurrence or reduces the risk of death, 

you generally need to study a lot of patients 

over a long period of time to find out of if the 

drug really does what you hope it does. If you 

continued on page 11 

FDA Denies Application to Market Silicone Implants 

Our Newest 

Breast 

Friend: 

Thomas V. 

Whalen, M.D. 

Tom Whalen 

chaired the 

October 14–15 

FDA panel hearings 

that culminated in a 9-6 vote to 

recommend reintroduction of silicone 

breast implants into the general medical 

marketplace. On October 31, Whalen 

sent a letter to FDA Commissioner Mark 

McClellan, decrying the vote and suggesting 

it was misguided. 

We’ll never know what happened 

behind the scenes, but the important thing 

is that on January 8, the FDA announced 

its rejection of the advisory committee’s 

recommendation. 

We at BCA commend Thomas V. 

Whalen for his vision and courage. He is 

a role model to other physicians and 

policymakers who are in a position to 

speak up for women’s health. ◆ 

Surprise: Good News From Washington! 

In a surprising but exciting step, the Food and Drug Administration (FDA) announced on 

January 8 that it had denied an application from Inamed, a Santa Barbara medical device 

manufacturer, to market silicone gel–filled breast implants. It is very unusual for the FDA to 

move against the advice of its expert panels. The General and Plastic Surgical Devices 

Advisory Panel had voted 9-6 to recommend approval of Inamed’s application in October. 

BCA’s position has been that there is not adequate evidence of long-term safety of the 

devices to warrant women’s elective use of the implants outside clinical trials. The FDA 

agreed. Inamed’s own research found that about 46 percent of the women who received 

the implants for reconstruction after mastectomy required re-surgeries within the two to 

three years in which they were followed. 

The FDA released a 46-page draft guidance document clarifying the conditions by 

which breast implant manufacturers must find and present data supporting the safety of 

their products. BCA will submit comments on behalf of women with breast cancer during 

the 90-day comment period that will lead to issuance of final guidance by the FDA. 

BCA was part of a coalition of women’s health organizations that gave testimony urging 

caution about the devices at the October 2003 hearings to consider the Inamed application. 

We are very pleased that the FDA has placed safety concerns and scientific evidence 

ahead of the commercial interests that lobbied so intensely in favor of the implants. ◆ 

As we go to press, the FDA’s draft guidance document regarding implants is available on 

its website at www.fda.gov/cdrh/ode/guidance/1239.html. 

V 

isit www.bcaction.org for additional coverage, including our own 

Jane Sprague Zones’ firsthand report from the hearings, and Thomas V. 

Whalen’s letter to the FDA (see left). If you send a self-addressed stamped envelope, 

we’ll mail you printouts of the web material.

Breast Cancer Action February/March 2004 3 


Mission Statement 

Breast Cancer Action carries the voices of 

people affected by breast cancer to inspire 

and compel the changes necessary to end 

the breast cancer epidemic. 

Core Principles and Values 

1. We are a membership-based organization 

that values the involvement of grassroots 

activists throughout the country and 

around the world to further our mission. 

2. We honor each person’s commitment 

and energy to our mission. 

3. We are not afraid to examine all sides of 

all issues. 

4. We cannot be bought. 

5. We tell the truth about what we discover. 

6. We serve individuals while reaching the 

broader population. 

7. We address the significance of environmental 

links to human health. 

8. We encourage people to participate fully 

in decisions relating to breast cancer. 

9. We believe access to information is vital. 

10. We work for structural changes toward 

social justice to accomplish our mission. 


55 New Montgomery Street, #323 

San Francisco, CA 94105 

Phone: 415/243-9301 

Toll free: 877/2-STOP-BC [877/278-6722] 

Fax: 415/243-3996 

E-mail: info@bcaction.org 

Web site: www.bcaction.org 

Board Members 

Jo Ann Madigan, President 

Renetia Martin, Vice President 

Denise Wells, Treasurer 

Ellen Lew, Secretary 

Dorothy Geoghegan, Mickey Hall, Jennifer 

Haroon (fellow), Gail Kaufman, Natalie 

Compagni Portis, Belle Shayer (emeritus) 

Staff 

Barbara A. Brenner, Executive Director 

Celeste Janssen, 

Volunteer and Events Coordinator 

Kendra Klein, Community Organizer 

Shelley Merid, Office Coordinator 

Alex Momtchiloff, Development Director 

Lisa Wanzor, Associate Director 

BCA Newsletter 

© BCA 2004, ISSN #1088-386X, published 

bimonthly by BCA. Articles on detection and 

treatment do not constitute endorsements 

but are intended solely to inform. Call for 

permission before reprinting. To subscribe, 

send name and address to BCA. Requested 

annual donation is $50, but no one is 

refused for lack of funds. 

Editor and Layout: Jessica Manly Bucciarelli, 

Bucciarelli Communications 

Editorial Board: Barbara Brenner, Elaine 

Elinson, Lauren John, Jane Sprague Zones 

“Breast Cancer Action” and the BCA logo 

are the registered trademarks of Breast 

Cancer Action. All rights reserved. Not to be 

used without express written permission. 

1 

What You See and What You Get: 

Media Coverage of the San Antonio Symposium 

By Barbara A. Brenner 

The media coverage of news from the December 2003 San Antonio Breast Cancer 

Symposium was often in striking contrast to the studies reported on at the meeting. Three 

examples highlight the difference between what the press reported and what the 

researchers found. The names and numbers in brackets in this article refer to abstracts available 

at the conference website: www.sabcs.org. 

Gene profiles and targeted treatment 

A study of a multigene assay for predicting 

recurrence in node-negative, ER-positive 

patients treated with tamoxifen was reported 

by the New York Times in a story headlined 

“Test May Aid Chemotherapy Decisions” and 

a lead sentence that read: “A new genetic test 

can help predict whether breast cancer will 

recur, providing a way to help women decide 

whether they need chemotherapy.” 

Using an array involving 21 breast cancer 

prognostic genes, Dr. Soonmyung Paik, 

director of pathology at the National Surgical 

Adjuvant Breast and Bowel Project (NSABP), 

and his colleagues at Genomic Health (a private 

for-profit company) developed a recurrence 

score that they say they validated 

prospectively (even though all of the patients 

had long since been treated). Dr. Paik showed 

that the recurrence score provided an accurate 

and precise continuous curve for predicting 

the likelihood of a distant (nonlocal) 

recurrence in node-negative, ER+ patients 

treated with tamoxifen [Paik 16]. (See page 

10 for Musa Mayer’s discussion of this study.) 

This public/private partnership has not 

applied the scoring system to the placebo 

group in the NSABP B-20 trial, so it is not possible 

to tell the real effect of the tamoxifen in 

the trial. And, as a questioner noted, for the 

group that the recurrence score from the gene 

assay indicates to be at low risk, the score misclassifies 

10 percent of patients, meaning that 

the score is not perfect and it doesn’t tell which 

patients will experience a recurrence. In 

answer to that comment, Dr. Paik acknowledged 

that we may never be able to tell an 

individual patient whether her cancer will 

recur. The promise of gene profiling as a key to 

individualized treatment is further away than 

the New York Times would have us believe. 

And the New York Times made only passing 

reference to the next study that was 

presented, which tried unsuccessfully to 

validate the recurrence score system looking 

at untreated patients. In the M.D. Anderson 

study [Esteva 17], there was no statistically 

significant correlation between distant recurrence-free 

survival and the recurrence scores. 

2 

Predicting the risk of recurrence may be 

possible, but we’re not there yet, the New York 

Times story notwithstanding. 

Aromatase inhibitors for ER-positive, 

postmenopausal patients 

One study looked at giving anastrozole to 

patients already on tamoxifen, and whether 

that was better than continuing on tamoxifen 

[Boccardo 3]. The New York Times reported 

this study in a story that began: “In a study 

comparing two drugs designed to prevent a 

recurrence of breast cancer, women who 

switched from the standard drug tamoxifen to 

a newer type of treatment fared better than 

those who continued to take tamoxifen.” 

You would have heard something different 

had you been in the presentation hall, 

though it was clear something provocative 

was about to be presented when the study 

was introduced as likely to stimulate a lot of 

calls to oncologists’ offices. The study looked 

at giving anastrozole to patients already on 

tamoxifen, and whether that was better than 

continuing on tamoxifen. Though the 

researcher, Dr. Francesco Boccardo of the 

National Cancer Research Institute in Italy, 

pointed out that the results were very preliminary 

(426 patients—approximately half in 

each arm of the trial—and median follow-up 

of only two years), the trends show longer 

progression-free survival on the anastrozole 

arm of the trial. Overall survival was also better 

so far on anastrozole, but not statistically 

significantly so. There were more gastrointestinal 

complaints on anastrozole, and 

higher cholesterol levels; and more gynecological 

changes on tamoxifen. 

Despite the lack of statistically significant 

findings, the researcher concluded that, while 

it’s very early and we need to be extremely 

cautious, it appears to be better to switch 

early breast cancer patients to anastrozole 

after two to three years on tamoxifen. He then 

said that only a much larger trial would 

enable us to make definitive conclusions 

about the premise of this study. 

The New York Times did point out the 

inability of doctors to give their patients 

continued on page 4

4 



3 

Media Coverage of San Antonio 

continued from page 3 

sound advice based on a study this small and 

this young, but you would have to read the 

whole story to get that point. 

Abraxane: Better taxane delivery? 

Abraxane is a new way of delivering a breast 

cancer standard—paclitaxel (Taxol ® ) 

[O’Shaughnessy 44]. The New York Times 

business section accurately reported this 

study with a story headlined “New Drug Said 

to Improve Delivery of Cancer Medication.” 

Getting the word out: BCA’s booth at the San Antonio 


Abraxane consists of microscopic 

particles of paclitaxel bound to albumin, a 

blood protein. The albumin appears to help 

the drug reach the tumors. The use of 

albumin means that Abraxane does not 

require Cremophor ® , a toxic solvent now 

used to deliver paclitaxel. Cremophor causes 

some of the side effects associated with 

paclitaxel, such as severe allergic reactions. 

To avoid those reactions, doctors give 

patients steroids before giving them 

paclitaxel, but steroids can also have side 

effects. Cremophor also requires special 

intravenous tubes for delivery because it can 

leach the plastic from normal tubes. Patients 

receiving Abraxane in the trial received 

higher dosages of paclitaxel and in a considerably 

shorter time span. 

At this early phase of this Phase III clinical 

trial, involving 460 women with metastasized 

breast cancer, tumors shrank in 33 

percent of those who received Abraxane, 

compared with 19 percent of those who received 

paclitaxel. It is too early to tell whether 

the drug will prolong women’s lives. In 

addition, Abraxane caused more neuropathy 

than paclitaxel did, though reducing the 

Abraxane dosages might reduce this impact. 

The drug has not yet been approved by 

the FDA, though the stock of American 

Pharmaceutical Partners, the manufacturer of 

Abraxane, has been on the rise on the 

strength of the trial news. The company 

expects FDA approval in 2004. ◆ 

Find Your Own Way of Giving 

We depend on you to be able to do what we do. Almost 60 percent of BCA’s income 

comes from individuals. Your gifts help keep our programs free of the restrictions that 

come with corporate and government funding. Unlike most other national breast cancer 

organizations, BCA is free to ask questions that corporations would rather we didn’t ask. 

Here are some ways you can help BCA: 

◆ Make your annual gift in monthly or quarterly installments and become a member of the 

Susan Stone Circle, named in memory of an activist BCA Board member who believed 

strongly in this form of giving. A regular payment of $25, $50, or $100 gives us 

wonderful and predictable support with minimal shock to your budget. Contact Celeste 

Janssen at 415/243-9301, ext. 17, or via email at cjanssen@bcaction.org, to set up a 

monthly or quarterly payment schedule by check or credit card. 

◆ If you sell items on eBay, you can designate BCA as the beneficiary of all or part of the 

proceeds from your sales, through eBay’s Giving Works program. For more information 

go to www.ebay.com/givingworks, or call Alex Momtchiloff at 415/243-9301, ext. 15. 

◆ If you live in the Bay Area, donate used goods to San Francisco’s Community Thrift 

store and name BCA (account #236) as the beneficiary. Call the store at 415/861-4910 

for more information. 

◆ Designate BCA through your workplace giving program, including the Combined 

Federal Campaign (agency #0207). Many companies will match or even doublematch 

your donation. Check with your employer about their matching-gift program. 

◆ Designate BCA when United Way comes calling. Simply fill in BCA’s name and 

address on your workplace campaign form: Breast Cancer Action, 55 New 

Montgomery St., Ste. 323, San Francisco, CA 94105. 

Consumers Urged to “Think Before You Pink” 

By Carrie Spector 

Last October, as corporations around the world cashed in on 

Breast Cancer Awareness Month with "philanthropic" pinkribbon 

product lines, Breast Cancer Action rolled out the second 

phase of Think Before You Pink, our campaign urging the public 

to think critically about marketing promotions like these. 

BCA’s campaign focuses this year on the cosmetics 

industry, which sponsors several high-profile cause-related 

marketing campaigns around breast cancer—yet whose 

products contain chemicals that may actually be associated 

with the development of the disease. 

With a revamped website and an ad on the op-ed page of the national edition of the 

New York Times (pictured), we drew attention to the troubling trend of corporate 

"pinkwashing" and encouraged consumers to pressure cosmetics companies to clean up 

their products. We provided contact information for companies that manufacture 

cosmetics with parabens and phthalates, two families of chemicals that are of particular 

concern when it comes to breast cancer—and we provided consumers with information on 

numerous lines of cosmetics that are free of these chemicals. 

Ultimately, the campaign urges the public to think about how funds raised for the “fight 

against breast cancer” are spent. As long as we believe we’re doing something meaningful 

about breast cancer by buying into these corporate marketing schemes, the real work 

that needs to be done around treatment, access to care, and true prevention will continue 

to be underfunded and ignored. ◆ 

After four years as BCA’s communications coordinator, Carrie Spector has moved into a position with 

a public health organization in Berkeley. BCA thanks Carrie for her stellar work. We look forward to 

introducing you to our new communications officer in a future issue of this newsletter. 

Visit www.thinkbeforeyoupink.org to confront the pinkwashing companies.


Clippings 

Pharma-funded Study Says 

Too Many Women Not Getting 

Enough Chemo 

In a study published in the December 

Journal of Clinical Oncology, a group 

called the Awareness of Neutropenia in 

Chemotherapy (ANC) Study Group reports 

on a retrospective study of 20,000 women 

with early-stage breast cancer that found 

that more than half did not receive the recommended 

schedule of chemotherapy. 

The study was reported as alarming on 

the assumption that women who didn’t get 

the full recommended dose or whose treatment 

was delayed for too long may have 

been put at risk for recurrences that could 

have been avoided. However, the study did 

not look at whether the women who 

received less than the recommended treatment 

actually did worse than women who 

got the recommended dose over the recommended 

period of time. So, it is not clear 

whether these women were in fact put 

at risk. 

In addition, the only “side effect” of 

chemotherapy that the study examined as 

explaining the delays or reductions in treatment 

was neutropenia (chemotherapyinduced 

decline in certain white blood cells, 

which increases the risk of infection). There 

are many other things that might cause a 

woman’s treatment to be deferred or discontinued, 

including nausea, fatigue, mouth 

sores, and neuropathy. 

The drug most commonly used to 

correct neutropenia is a colony-stimulating 

factor called Neupogen ® , which can add 

$20,000 to the cost of a chemotherapy 

regimen. Amgen, the funder of the study, 

produces Neupogen. An Amgen representative 

declined to state how much Amgen 

paid for the study. 

Lyman, G. et al., “Incidence and Predictors of 

Low Dose-Intensity in Adjuvant Breast Cancer 

Chemotherapy: A Nationwide Study of 

Community Practices,” Journal of Clinical 

Oncology, December 15, 2003. 

Update: Genetics and Risk for 

Ashkenazi Jewish Women 

Mary-Claire King, continuing her work 

on the genetic underpinnings of 

breast cancer risk, has coauthored an 

important article with the New York Breast 

Cancer Study Group on BRCA-related risk 

for Ashkenazi Jewish women (published in 

Science, October 24, 2003). 

In order to accurately calculate risk, the 

research group determined the BRCA1 

and BRCA2 genotypes of more than 2,000 

relatives of women with breast cancer. 

They report an 82 percent lifetime risk of 

developing breast cancer in women with 

the genetic mutations associated with 

Ashkenazi ancestry. Half the women in the 

study who carried BRCA mutations and 

developed cancer did not have a family 

history of breast cancer; in these cases, 

they were most likely to have inherited the 

genetic mutations from their father. Women 

who were born before 1940, those who 

exercised as young women, and those who 

had normal weight during adolescence 

developed breast cancer at a later age 

than those born after 1940. 

Research on Ashkenazi Jewish 

women’s genetic risks for breast cancer has 

shown inconsistent results. We are working 

on an article that summarizes the research 

for our next issue. Dr. King is a member of 

BCA’s Scientific Advisory Board. 

King, M.-C. et al., “Breast and Ovarian Cancer 

Risks Due to Inherited Mutations in BRCA1 and 

BRCA2,” Science, October 24, 2003. 

Adjuvant Letrozole Study 

Discontinued; Long-term Effects 

Still Unknown 

Astudy designed to test five years of 

letrozole (Femara ® ) treatment after 

tamoxifen therapy was discontinued in 

October 2003, after a median follow-up of 

only 2.4 years. 

Letrozole has previously been found to 

work better than tamoxifen for patients with 

metastatic disease who have HER2- 

positive tumors. This study was discontinued 

because the researchers observed 

fewer recurrences in the letrozole group 

compared with the placebo group. There 

were 5,187 women in the study. Local or 

metastatic recurrences of breast cancer or 

new cancers in the contralateral breast 

were noted in 75 women in the letrozole 

group, compared with 132 in the placebo 

group. The difference was statistically significant, 

meaning that it was 95 percent 

likely to be the result of a difference related 

to the drug, rather than chance. 

The discontinuation of the study leaves 

some important questions unanswered. We 

have no idea what the long-term effects of 

the drug might be, given that the median 

follow-up was only 2.4 years. In addition, 

the risk of osteoporosis in those in the trial 

was considerably higher for women on 

letrozole than for the placebo group. And 

even the study’s authors stated in the 

report that their results “leave the optimal 

duration of treatment undefined and the 

question of long-term toxicity unanswered.” 

The research community's tendency to 

shoot first and ask questions later when it 

comes to drug protocols is fraught with peril, 

as we recently learned with the controversy 

over the benefits of hormone replacement 

therapy. The long-term effects of cancer 

“prevention” drugs—whether intended to 

“prevent” recurrence or primary disease— 

can and do take decades to uncover. 

Goss, P. et al., "A Randomized Trial of Letrozole 

in Postmenopausal Women After Five Years of 

Tamoxifen Therapy for Early-Stage Breast 

Cancer,” New England Journal of Medicine, 

November 6, 2003.

6 

Long-time AIDS Activist Discovers BCA 

By April Dembosky 



Since her childhood 

days of watching 

the lawyer Perry 

Mason on television, 

Kathy Fisher has 

always believed in the 

power of the law to 

achieve justice for all. Now a partner at 

Morrison & Foerster in San Francisco, with 

28 years of legal practice under her belt, 

Kathy dedicates much of her time and skill to 

the service of social causes. 

To honor the many dear friends she has 

lost to AIDS and who are currently living with 

the disease, Kathy serves as general counsel 

for Pangaea, the SF AIDS Foundation’s 

international affiliate, and tries cases on behalf 

of AIDS organizations. She also makes regular 

donations in support of AIDS advocacy 

efforts. Recently, in the course of her pro 

bono work, Kathy added breast cancer to the 

top of her list of activist concerns. 

With an extensive family history of 

breast cancer, and a number of friends and 

colleagues affected by the disease, it seems 

logical that Kathy’s activist activities would 

extend to breast cancer. But for many years, 

the thought of working on breast cancer 

issues was too close for comfort. “I didn’t 

want breast cancer in my life any more than it 

already was,” Kathy says, “I felt for a long 

time that breast cancer was just an inevitable, 

genetic destiny for me, my daughter, and 

other women I care about.” 

Kathy Fisher and her husband recently joined BCA’s Elenore Pred Circle, whose 

members have included BCA in their estate planning. For more information about 

planned giving and BCA, please contact Alex Momtchiloff, development director, at 

(415) 243-9301, ext. 15, or via e-mail at amomtchiloff@bcaction.org. 

There’s 

nothing 

like it! 

Get inspired 

and get 

involved at 

BCA’s 

seventh 

annual Town 

Meeting. 

JOIN US: 

Saturday, 

April 24, 

Oakland 

Asian Cultural 

Center. 

When her mother became ill with breast 

cancer, and later her younger sister did as 

well, both women chose to keep the illness 

very private. Her mother was diagnosed in the 

late 1970s, a time when the stigma around 

the disease was so great that her illness 

became the great family secret. Fifteen years 

later, Kathy’s younger sister faced a different 

kind of silence in her battle with breast 

cancer—the uneasy quiet of the traditional 

support groups that seemed to support, above 

all, the cultural notion of female passivity 

around the disease. 

“My sister was not a shrinking violet,” 

Kathy says, recalling her distaste for the 

message that women ought to succumb to the 

disease without question or protest. 

When Kathy’s sister died in 1995, Ruth 

Borenstein, one of her colleagues at Morrison 

& Foerster, gave a donation to Breast Cancer 

Action in her sister’s memory, introducing 

Kathy to an approach to the epidemic with 

which she could identify. Kathy was impressed 

with BCA’s straightforward and 

outspoken “Cancer Sucks” attitude toward 

breast cancer. “I admire how BCA is honest 

about the science and single-minded about 

ending the breast cancer epidemic. And 

frankly,” Kathy notes, “I love their irreverence 

and sense of humor.” 

Kathy credits BCA’s realism, compassion 

and activist strategies for allowing her to 

confront her fatalistic perspective on the 

disease and realize that there was a way to do 

something about it. She began giving yearend 

donations to BCA. 

Reviving an issue that she had long 

relegated to a small corner of her life, Kathy 

wanted to solidify her commitment to ending 

the disease that had affected her and her 

family so directly. She and her husband 

decided to include a bequest to BCA in their 

mutual wills. “We wanted to make sure that 

our lives and deaths were about giving to 

causes that really affected us personally,” 

Kathy explains, “I signed up for life to give to 

BCA because in addition to what BCA does 

and the materials they produce, they use 

money so well. BCA has immense integrity 

about that.” 

While a lot of organizations claim they 

are working to put themselves out of business, 

BCA member Kathy Fisher feels that 

BCA is one agency that really means it. 

“Unfortunately,” she says, “I’m confident they 

will be around long enough to make use of 

my bequest.” ◆


7 

Photo: Gwen Rodgers 

In Memory of Two Good Friends 

Faith Fancher and Karen Holly, dear friends both to each 

other and to BCA, died within 10 days of each other last 

October. These remarkable women are sharply missed by 

their families and friends, as well as by thousands of women 

and men whom they never met, but whose lives they touched. 

Faith Fancher, 1950–2003 

We are deeply saddened by the loss of Faith Fancher, an 

Emmy-winning television news reporter and outspoken 

breast cancer activist who helped raise hundreds of 

thousands of dollars for local community breast cancer 

organizations serving low-income women and women of color. 

She died of metastatic disease at age 53. 

When Faith was first diagnosed with breast cancer in 1997, 

she made the courageous decision to share her journey through 

treatment in an award-winning series called “Faith’s Story,” which 

aired on KTVU, the San Francisco Bay Area’s Fox TV affiliate where 

Faith had worked since 1983. She later channeled her phenomenal 

energies into “Friends of Faith,” an organization founded in her name 

by her friends and colleagues to provide grants to community 

organizations helping underserved women with breast cancer. 

Faith was a keynote speaker at BCA’s 2003 Town Meeting last 

April, where she talked about the power of community. In a nod to a 

tradition from her church in Tennessee where she was raised, Faith passed 

a box of tissues around the lecture hall before her speech, asking members 

of the audience to take one and wave it in the air—in lieu of applause— 

whenever they felt her words resonate. 

Here at BCA, we hold dear our memory of Faith on stage at that 

event, her spirit full and strong—her bald head from chemotherapy the only sign of her illness— 

with white tissues waving from all corners of the room, carrying affirmation from the crowd. ◆ 

— Carrie Spector 

Karen Holly, 1954–2003 

A life is not measured by its length but by its depth. 

Karen Teresa Holly died of breast cancer on October 29, 

2003. She was 49. First diagnosed with breast cancer in 

1989, Karen was a vibrant and luminous spirit who celebrated 

life in spite of four recurrences of the disease. 

Karen was well known as a poetic and impassioned public 

speaker who rallied providers, legislators, scientists and fellow 

activists to call for increased research, treatment, and outreach. 

She was a vital member of many organizations, including Breast 

Cancer Action. 

Karen continued, until her death, to promote the early 

detection and treatment of breast cancer for all women, particularly 

African Americans. A year before her death, Karen spoke to 

California legislators at the Joint Informational Hearing on Breast 

Cancer and the Environment. She was the cover model for the 2004 edition of the Celebrate! 

calendar produced by the Contra Costa County African American Task Group. 

Karen once wrote: “When you paint a picture of me, don’t paint me as a saint. I’ve done 

some good, I’ve done some wrong, so use all your paint. Not the bright and light tones, use some 

grey and dark. In fact, don’t put me on canvas, paint me in your hearts.” ◆ 

— Kim Cox 

Kim Cox, MPH, works for Contra Costa Health Services and was the coordinator of the former Contra 

Costa County Breast Cancer Partnership. Kim is an ovarian cancer survivor; she and Karen Holly met 

as patients at the Alta Bates Comprehensive Cancer Center. Contact Breast Cancer Action for a copy of 

Karen’s moving testimony at the 2002 legislative hearing. 

Are You Moving? 

Don’t leave the BCA newsletter 

behind! Please let us know your 

new address so that we can continue 

to send you breast cancer news and 

analysis that you won’t get anywhere 

else. Contact Celeste Janssen at: 

cjanssen@bcaction.org or (415) 

243-9301 or (877) 278-6722 

¿Habla usted español? 

Saber Es 

Poder 

(Knowledge 

Is Power) is 

the Spanishlanguage 

newsletter of 

Breast Cancer 

Action. It is published three times a 

year. Past issues are archived at 

www.bcaction.org (click on “Get 

Informed”). 

Saber Es Poder covers a wide 

range of breast cancer topics, including 

treatments, clinical trials, environmental 

links, and much more. To suggest 

topics for future issues, contact Carmen 

Ortiz, project director, at 415/243-9301, 

ext. 19, or coboricua@aol.com. 

BCA mails single and multiple 

copies of Saber Es Poder to individuals 

and institutions around the world. If you 

would like to add yourself or an 

organization or clinic to our mailing list, 

please contact Shelley Merid, smerid@ 

bcaction.org, 415/243-9301, ext. 10, or 

(toll-free) 877/278-6722. 

Alerts by E-mail 

Want up-to-the-minute news, 

notices, and action alerts on 

breast cancer—but hate to see your 

e-mailbox cluttered with unwanted 

messages? 

Sign up for BCA’s monthly listserv! 

The newsletter goes out on the first 

Wednesday of the month, with an 

occasional midmonth update for special 

events and alerts on short notice. Call 

415/243-9301 or e-mail cjanssen@ 

bcaction.org or visit www.bcaction.org.

8 



Donations in Memory 

BCA gratefully acknowledges donations made in memory of the following individuals between September 19 and December 16, 2003. 

Bella Abzug 

from Shane Snowdon 

Mrs. Wm. C. Atwater Jr. 

from Anonymous 

Lori Beckerman 

from Amy Markowitz 

and Bob Wachter 

Ruth Boldt 

from Jill Gallagher 

and Alicia Hasper 

Joan Silverman Bratman 

from Amy Logun 

and Steve Bratman 

Carol Cabell 

from Noemi Levine 

Kristina Calegari 

from Judith Gruber 

and Joseph Houska, Jr. 

Karen Camilleri 

from Marilee Ford 

Susan Campbell 

from Linda H. Johnson 

“Cancer victims sacrificed to 

cancer-business” 

from Jean Clelland-Morin 

Lucia Centrone 

from Dora Weaver 

Susan Claymon 

from Betty and Martin Slavney 

from Allan W. Claymon 

Laura Cole 

from Miriam Stombler 

and Kevin Kelem 

Carolyn Costello 

from Elaine S. Costello 

Their daughter-in-law 

from Barbara and Howard 

Rood 

E. Claire Dawson 

from Patricia Dawson 

Maryalice Derderian 

from Robert Blumengarten 

from Alexis Derderian 

Joanne Dumas 

from Joyce McKinney 

Juanita Englander 

from Joanna McKee Beam 

Carol Cameron Escobar 

from Alise and Willis 

Longyear 

Noel Evans 

from Joan Ferraris 

and Jon Norenburg 

David Faison 

from Barbara Wunsch 

and the Faison kids 

Faith Fancher 

from Michele R. Coleman 

from Margaret and F.G. 

Elizares 

Barbara Fetterolf 

from Equipment Brokers Co. 

from Jeanette Griffith 

from William Griffith 

from Ingrid Riegler 

Doris Fisher 

from Sue and Gary Thompson 

Helen Furness 

from Linda Paroubeck Patch 

Allen Hagan 

from Dee Dee Bloom 

Karen Jean Hall 

from Arlene De La Mora 

Karla Hansen 

from Geneva Jones 

and Vernon Jones 

Sandra Harris 

from Ben Harris 

Laura Hatounian 

from Lorraine Kupferschmidt 

Laurel Hedley 

from Mary Hedley 

and Stephen P. Morrell 

Lorraine Hirsch 

from Elizabeth Crabtree 

and William Hirsch 

John Hoey 


Karen Holly 

from Kimberlee Sue Cox 

Helen and Charles Jenkins 

from Kathryn and Jeffrey Hall 

Tamar Kaufman 


Jane Gibbons Knopf 


Gayla Lacatena 



Betty Lamb 

from Linda and Curtis Boles 

Lauren Langford 

from Linda H. Johnson 

Rebecca Lepere 

from Suzanne Gooding 

Bess Krepistman Levine 

from Susan Laskin 

Elisa Lopez 

from Elsa Raitt 

Ellen Lowery 

from Margaret Walsh 

Alicia Madocks 



Elaine Masser 

from Vicki Schnitzer 

Jennelle Ashley Morris 

from Joyce Malmborg 

from Wayne Williams 

Josepha Moseley 

from Nancy Levin 

Rebecca Nataloni 

from Frances and John 

Nataloni 

Lorraine V. Painer 

from Merrill Clarke Hunn 

and Robert W. Hunn 

Roz Perry 

from Donna Brogan 

Anne Pietrafesa 

from Nancy Pietrafesa 

Joan Crowley Pires 

from Ellen Crowley 

Lula Mae Rohrer, 


Dixie Rose 

from Elizabeth and Ralph 

Long 

Elaine Rosenberg 

from Robin Spence 

Helen Savitz 

from Dee Dee Bloom 

Consuelo Segal 

from Robert Segal 

and Ju Zhen Segal 

Miriam Shapiro 

from Nelson and Dianne 

Shapiro 

Ronni Shapiro 

from Shirley Lidowsky 

Suzanne Snow 

from Mary Lou Creek 

Virginia Soffa 

from Annis Karpenko 

Barbara Somerville 

from Robin Somerville 

and Ann Hudson 

Doris (Maya) Sprangler 

from Robin Germain 

Susan Stone 

from Diana EtsHokin 

from Margaret Norris 

and Nadine Navarro 

from Nancy Russell 

and Sharon Dinkin 

Susan Stone’s birthday 

from Ellen Schwerin 

Anselm Strauss 

from Frances C. Strauss 

Margi Stuart 


Louise Taub 

from Barbara Rhine 

Auntie Helen Tonegato 

from Barbara Attard 

Margo Trombetta 

from Deena Glass 

Jane Wilson 

from Anne Gurvin 

Jackie Winnow 

from Del Martin 

and Phyllis Lyon 

Carla Wofsy 

from Nancy Shemick 

Donations in Honor 

BCA gratefully acknowledges donations made in honor of the following individuals between September 19, 2003 and December 16, 2003. 

Kathy Addleson 

from April Dembosky 

All Cancer Patients 

from JoAnn and Terry O’Brien 

All women, especially 

survivors 

from Mary Lou Krenz 

Dipti Anderson 

from Leslie and Steve Rein 

Auntie Babs Attard 

from Barbara Attard 

BCA Board of Directors 

from Kyra Subbotin 

and Henry Siegel 

BCA Newsletter 

from Eva and Daniel Langton 

BCA Staff and Volunteers 

from Susan and Robert 

Vanneman 

The BCA staff! 

from Kyra Subbotin 

and Henry Siegel 

Martha Bennett 

from Jennifer R. Macleod 

and Roderick K. Macleod 

Maggie Bernard 

from Cae Turner Bernard 

Patricia Bezalel 

from Shira Bezalel 

Marcia Billings 

from Margot Smith Chmel 

Linda Blackman 

from Hillery Jaffe-Urell 

Michelle Bourgault 

from Hedda Orkin 

Barbara Brenner 

from Mary Gregory 

from Carl Grunfeld 

from Connie Herrick 

from Chris Kitchel 

and James Hirabayashi 

from Laura Nathan 

from Tanya Neiman 

from Stuart and Ruth 

Newman 

from Jeanne Maddox 

Toungara 

from Lisa Westerback 

Barbara Brenner’s birthday 

from Joan MacQuarrie 

and Ellen Slack 

from Hedda Orkin, M.D. 

Barbara Brenner 

and Susie Lampert 

from Beverly Burns 

and Lynn Fountain 

from Gerald Epstein 

and Fran Deutsch 

from Sara Markel 

and Lloyd Altman 

Karen Brodi 

from Merle Woo 

Marilyn Brown 

from Joy Simha and Vasu, 

Anand and Maya Sudarsana 

Beverly Burns 

from Tanya Neiman 

Marilyn Cantlay 

from Marilyn Wallace 

Elizabeth Cheek 

from Cathy Kral 

Christian, Jennifer, Harriet 


Audrey Clark 

from Laura Guido-Clark 

Catherine Classen 



Lanie Cohen 

from Deborah Cohen 

Jeannine Collins 

from Barbara Thomason 

and Anna Crawford 

Natalie Compagni Portis 

from Lifetime Enterprises Inc. 

from Deborah and Michael 

Sosebee 

Patty Crown 

from Meg Conkey 

Ms. Susan Diamond 



Pat Dinges 

from Janet Burati 

from Adeline and Dennis 

Anderson 

from Helen Fisher 

from Paula and Kenneth 

Boshart 

from Janine Sloth 

from Deb Merritt 

from Linda Kimmel 

from Jane Petrone 

from Dorothy Camenga 

from Marjorie Variano 

Carol Doyle 

from Muffy Kibbey 

Shelley Eisner 

from Julie Gordon 

and Richard Eisner 

Family, friends, and 

professionals who helped her 

survive 

from Sally Saunders 

Helen Feihey 

from Denise and Mark 

Erickson 

50th Birthdays of: Kathy, 

Natalie, Vicki, Kristen and 

Herself 

from Janet Calmels 

Mary “Nana” Flyntz 

from Suzanne L. Dibble 

and Jeanne F. DeJoseph 

Marcy Fraser 

and Lana Sandahl 

from Gary Johnson 

Elizabeth Frey 

from Mary Margretta Love 

Margot Friedman 

and Nancy Delahoyd 

from Bruce Majors 

Jennifer Craig Gaines 



Nanci Grail’s birthday 

from Nickie (Alice) Hilbert 

Boukitza Grinberg 



Deanne Hanes 



Linda Healy 

from Gloria Brickman 

Herself 

from Melinda Cogen 

Herself 

from Holly Kurzman 

Lisa Hoffman’s birthday 

from Alex Momtchiloff


Donations in Honor continued 

Camille Howard 

from Catharine E. Kibira 

Julia Hunkins 

from Barbara Aamodt 

from Anna Laura Archer 

from Mary Ann Gerber 

from Eleanor Murphy 

from Sally and Donald Romig 

Charlotte Sue Imboden 

from Angela Johnson Meszaros 

Mr. and Mrs. Robert Kanner’s 

50th wedding anniversary 

from Beverly Robbins 

Linda Kanter 

from Patsy Policar 

Meredith McGovney Kaplan 

from Sarah Kaplan 

Anne Kasper’s support for 

Lila’s cousin 

from Lila Suna 

Judee King 

from Kathleen and Ralph 

Harms 

Chris Kitchel 



Kendra Klein 

from Joan Swirsky 

Nancy Klein 

from Carol and Jerry Schmidt 

Lisa Marks Kujawsky 

from Linda Marks 

and Rafael Lopez 

Esther Lande 

from Chiqui Somers 

Robbie Lipsman 


Sharon Lund 


Adrienne Misson 


Mothers Living Stories Project 

from Hillery Jaffe-Urell 

Renetia Martin 

from Jeffrey Benevedes 

from Joseph Massey 

Katherine McKenney and her 

daughter 

from Pam Hewitt 

Liz Miles 

from Margot Smith Chmel 

Gerri and Larry Miller 

from Sara Gordon 

and Jane Balin 

Maria Minuzzo 

from Michael Minuzzo 

Rachel Morello-Frosch 


Adelita Moore 

from Karen Stevenson 

and Bill McClave 

Glendon Morreale 

from Sharon Izen 

Sara O’Donnell 

from Deborah Forter 

and Benjamin Hansbury 

The birth of Daisy Tomoko 

Orenstein 

from Barbara Brenner 

and Suzanne Lampert 

Anita Pagan 

from Robin Germain 

The successful treatment 

of Eileen Raihill 

from Arlis Grossman 

Dorothy Reed-Sleeper 

from Ruth Sleeper 

Daniel and Florence Rivel 

from H. Iris Schorr 

Ralph Roan 

from Sadja Greenwood 

Simone Rosen 

from Phyllis and Howard 

Cordover 

Louise Rothman Riemer 

from David Irons 

Nancy Russell 

from Nancy Treverton 

Nancy Russell’s birthday 

from Sam Morrow 

Carole Scholler 

from Kathleen and Ralph 

Harms 

Evelyn Shaw 



Joy Simha, Vasu, Anand, 

and Maya 

from Bella D. August 

Joy Smith 



The 1973 Smithies 

from Roberta Lipsman 

and Eric Wright 

Sharon Solkowitz 

from Carolyn Stroebe 

Carrie Spector 

from Barbara Anger 

David Spiegel 



Peg Stone 

from Nancy Stone 

and Charles Miller 

Leslie Stone’s birthday 

from Arlene Shmaeff 

Roxy, Alana, and Jeanell 

Sudkamp 

from Jennifer Marschand 

Anne Swallow-Gillis 



To celebrate 10 years of life 

after breast cancer 

from Jane Tolar 

Barbara Terrinoni 



Adrienne Torf 

from Michael Dunn 

from Hilda Karp 

Shawn Murphy Verbrick 

from Nancy McKimens 

and Bob Murphy 

Marilyn Wallace 

from Marilyn Cantlay 

Lisa Wanzor 

from Laura Burrus 

Andrea Werlin 

from Leslie Rundell 

Mrs. Barbara Williams 

from Inez Sasse 

and Richard Sasse 

Connie Wofsy 



Micky Wolfe 

from Virginia Wolfe 

The good health of Rochelle 

Wunsch 

from Barbara Wunsch 

and the Faison kids 

Henryka Yakushev 



Abby Zimburg 

from Cae Turner Bernard 

Jane Zones 

from Sheryl Ruzek 

from Susan Schacher 

An Expression of Our Gratitude 

Special thanks to: 

◆ 

◆ 

◆ 

◆ 

Our generous volunteers and interns: Barbara Anger, 

Wendy Botwin, Beverly Canin, Barbara Carberry, Mary 

Jo Cargill, Marie Carmel, Jean Clelland, Anne Cohen, 

Sara O’Donnell, the Employment Plus volunteers, Carol 

Fong, Deb Forter, Cornelia Gates, Jami Gazzaniga, 

Alyssa Haeusslein, Tiffani Jessup, Ari Krakowski, Jody 

Kyle, Emily Lash, Nancy Oster, Kim Stiner-Zercoe, Stephen 

Wechsler, and Maria Wetzel. And the many individuals who 

take action in response to our e-alerts. 

All who helped with our fall major donor drive: Ruth 

Borenstein, Charlotte Burchard, Claudia Cappio, 

Natalie Compagni Portis, Laurie Earp, Martin 

Elsbach, Barbara Ehrenreich, Jessea Greenman, 

Mickey Hall, Mandy Hawes, Genevieve Howe, Gail 

Kaufman, Suzanne Lampert, Ellen Lew, Jo Ann Loulan, 

Jo Ann Madigan, Renetia Martin, Rachel Morello-Frosch, 

Raven~Light, Diane Sabin, David Salk, Diane Simpson, 

Sylvia Sokol, Ingrid Tischer, Angela Wall, Denise Wells, 

and Jane Zones. 

Stefanie Atkinson, Angela Padilla, Ruth Borenstein, Deborah 

Mosley, and the Morrison and Foerster Foundation for the 

“Angela’s Journey” photographic exhibition benefiting BCA on 

November 14. 

David Salk and Focal Point Opticians, and Tulip Graphics for 

their generous assistance in promoting BCA’s Totally Chocolate 

benefit. 

◆ Matt Howe and Rebecca Booth for 

hosting a benefit for BCA at their home. 

◆ Christopher Esposito and his colleagues in the 

Corporate Services division of Charles Schwab & Co. 

for contributing to BCA through a silent auction held on 

November 6. 

Our Super Fans Challenge Fund was a great success! 

The fund was used to match $20,000 of new and 

increased gifts by major donors ($250 and above) in our fall 

fundraising campaigns. We are deeply grateful to the BCA 

Super Fans: Ruth Borenstein, Claudia Cappio, Rachel 

Morello-Frosch, Suzanne Lampert, Sylvia Sokol, 

Peg Stone, Karen Strauss, Kyra Subbotin, and 

Jane Sprague Zones; as well as the following 

individuals who contributed to the Super Fans 

Challenge Fund: Lawrence Brenner, Christine 

Grumm, James C. Hormel, Gail and Barry 

Kaufman, Melina Linder, Jo Ann Madigan, 

Marjorie Randolph, Denise Wells, and Eileen Hansen. 

To volunteer or to intern with BCA, please contact our Volunteer 

Coordinator, Celeste Janssen, at cjanssen@bcaction.org. For 

information on holding a benefit for BCA, contact our development 

director, Alex Momtchiloff, at amomtchiloff@bcaction.org. 

Both Alex and Celeste can be reached at 415/243-9301 or 

877/ 2STOPBC (877/278-6722).

10 



Impressions From San Antonio 


disappointing results of its Phase III trials in 

metastatic breast cancer patients last summer. 

In San Antonio, the company presented a 

subset analysis that, while not conclusive in 

itself, offers a possible direction for new trials. 

Patients with ER+ tumors receiving hormonal 

treatments while undergoing Theratope 

showed a trend (not a statistically significant 

difference) toward better time to disease 

progression and overall survival [Miles 36]. 

Determining which patients are most 

likely to respond can transform a drug failure 

into a success. The monoclonal antibody 

Herceptin would never have shown a benefit 

in breast cancer, Genentech researchers say, 

had they not been able to develop a test that 

predicted Herceptin response. 

To date, however, Genentech 

has been unable to devise such a 

test for its new drug Avastin ® , 

which targets VEGF, a gene 

responsible for angiogenesis (the 

growth of blood vessels that feed 

tumors). 

Straightforward tests for 

gene expression are not always 

useful, it seems. Many if not most of the new 

agents don’t show enough activity by 

themselves, at least not in a general patient 

population. So, for rational combinations to 

be designed, much more must be learned 

about the complex signaling pathways within 

cancer cells, crosstalk between genes, and 

messages from outside the cancer cell that 

govern cell proliferation and cell death 

(apoptosis). 

Although it is now “hot,” the genomic research 

paradigm is not the only avenue worthy 

of exploration. Which cancer cells researchers 

target may be important, as Max Wicha, of the 

University of Michigan, suggested in a plenary 

talk in San Antonio [Wicha P1]. His research 

elegantly demonstrates that tumor stem cells, 

the original cells from which all other cancer 

cells differentiate, may turn out to be of crucial 

importance in explaining drug resistance and 

the incurability of many cancers. Pointing to 

the notable success in curing metastatic testicular 

cancer, Wicha suggested that therapies 

designed to target only stem cells may be 

much more effective. 

Mining the Past to Predict the Future: 

Is It Possible? 

With the introduction of microarray and 

related technologies a few years ago, where 

the entire genetic fingerprint of a cancer (or 

the most relevant genes) could be analyzed on 

a single chip, the door seemed to swing wide 

to precise individualization of treatment. 

A single test would have the power to predict 

the risk of recurrence, and then to tell a 

woman with breast cancer exactly which 

treatments she needed—or whether she 

needed no further treatment after surgery, an 

even more powerful revelation for the 

majority of newly diagnosed women whose 

breast cancers are actually cured by surgery 

alone. The concept was mind-boggling. 

Imagine no more overtreatment or 

undertreatment. No more one-size-fits-all. 

And for many if not most of us, there would 

be the certainty of knowing we were cured. 

Such were the hopes. So far, the possibilities 

have proven to be just that—possibilities. 

Determining which patients are 

most likely to respond can transform 

a drug failure into a success. 

The study poised to be this year’s 

breakthrough news involved the use of the 

multi-gene RT-PCR test to predict recurrence, 

a new 21-gene microarray developed by 

Genomic Health. This test is derived from a 

combination of genes known to govern primarily 

cell proliferation and hormonal 

regulation in tumor cells. The revolutionary 

premise here is that this test is done on 

standard diagnostic pathology specimens, 

namely, archived, paraffin-embedded tumor 

tissue. If this is proven useful, researchers will 

be able for the first time to correlate archived 

tumor tissue with known patient outcomes 

from studies initiated and completed years 

ago, avoiding lengthy and costly “prospective” 

clinical trials. 

The validation study for RT-PCR was 

done through the National Surgical Adjuvant 

Breast and Bowel Project, one of the cancer 

cooperative groups responsible for many 

important clinical trials. Researchers hoped to 

predict who was most and least likely to have 

a recurrence, based on tumor tissue alone. 

Using samples of the tissue of 668 nodenegative 

breast cancer patients with ER+ 

tumors who were treated with tamoxifen 

during the 1980s, the study authors said that 

they were able to predict outcome better than 

any single prognostic factor, apart from tumor 

grade. The “low risk” group they identified 

had a risk of recurrence of 6.8 percent at 10 

years, while the “high risk” group had a 

recurrence rate of 30.5 percent [Paik 16]. 

Genomic Health, who will be marketing 

this test as Oncotype DX early in 2004 for a 

minimum of $3,000, claims that it will help 

women with node-negative ER+ tumors 

taking tamoxifen (as most such patients do) 

select treatment more wisely. But even if the 

test is confirmed in other studies, how much 

will it really help the individual woman? How 

will the results be confounded if Arimidex ® is 

widely accepted as standard of care, rather 

than tamoxifen? Is a 6.8 percent risk of 

recurrence low enough for a woman to feel 

comfortable refusing tamoxifen? Wouldn’t a 

woman in the highest risk group be 

considering chemotherapy anyway? Today, 

oncologists combine factors 

when considering prognosis, 

including tumor size, involved 

lymph nodes, tumor grade, etc. 

Several complex algorithms that 

feed recent data from clinical 

trials into a computer program 

are freely available to assist in 

this task, such as Adjuvant at 

www. adjuvantonline.com. So, 

it’s unclear what this test will add to the 

picture, even if its results are widely 

confirmed. 

And speaking of confirmation, another 

study presented at the conference, using the 

same test in a similar population, some of 

whom who did not receive tamoxifen, was 

conducted at M.D. Anderson Cancer Center. 

This study failed to show any predictive value 

for recurrence [Esteva 17]. So, much more 

work is clearly needed. A fundamental 

question to be asked here, according to 

statistician Donald Berry of the M.D. 

Anderson Cancer Center, is whether these 

incredibly complex analyses of genetic 

expression are likely to ever provide reliable, 

reproducible results, given the multiplicity of 

potential data points, the difficulties with 

uniform data collection and pathology, and a 

variety of other statistical and methodological 

issues that make interpretation of tests like 

this fraught with problems. ◆ 

Musa Mayer is a 14-year survivor and the author 

of four books including, most recently, After 

Breast Cancer: Answers to the Questions 

You’re Afraid to Ask (O’Reilly, 2003). She 

provides information and support for women with 

metastatic breast cancer daily at www.bclist.org 

and www.bcmets.org. 

THE NEXT SAN ANTONIO BREAST CANCER SYMPOSIUM WILL BE DECEMBER 8–11, 2004…


From the Executive Director 


can establish that some early change during 

the treatment process (the “surrogate 

endpoint”) indicates that a woman will have 

longer disease-free survival (DFS), more time 

to progression (TTP), or better chances of 

overall survival (OS), then you can move 

more quickly with smaller trials to complete 

evaluation of the treatment without waiting 

the many years it takes to establish DFS or OS 

themselves. 

But this logic only works if, in fact, the 

interim change correlates to the ultimate goals 

that you’re trying to achieve. What those goals 

are, of course, will be different depending on 

the stage of disease being treated. Overall 

survival is important to everyone who’s ever 

had a diagnosis, while TTP will be of greater 

concern to women living with metastatic 

breast cancer. But, whatever the goal of the 

therapy, the “surrogate” has to work as a 

stand-in. And there’s the rub. 1 

Several of the early (and theoretically 

“hot”) presentations at this meeting used the 

surrogate endpoint of Ki67 expression as 

evidence for DFS and, ultimately, OS. Ki67 is 

one of a number of genes that control cell 

proliferation. If a tumor expresses a lot of 

Ki67, the theory is that this will lead to more 

cell proliferation, and ultimately new or 

growing tumors. Basing their work on this 

theory, researchers are using Ki67 reduction 

as a surrogate endpoint in drug analysis. But 

after the presentation of two different studies 

that relied upon this surrogate endpoint, a 

member of the audience asked whether Ki67 

had been validated as a marker for clinical 

outcome. And, lo and behold, it turns out 

that, in the words of the researcher who was 

asked, the evidence that Ki67 is a good predictor 

of recurrence is “very sketchy.” For that 

matter, there is no standard for measuring 

Ki67, and therefore no way to consistently 

evaluate its increase or decrease. And no 

studies were cited showing that changes in 

Ki67, in fact, correlate to an improved (or to 

a worse) outcome in patients. 

Yet, despite this lack of a validated surrogate 

endpoint, researchers pointed to 

suppression of Ki67 as evidence that anastrozole 

(Arimidex ® ) alone may be more effective 

than tamoxifen (Nolvadex ® ) alone or tamoxifen 

and anastrozole combined in the neoadjuvant 

setting for postmenopausal ER+ 

women [Dowsett, 2]. This conclusion was 

reached even though the trial showed no 

statistical difference between anastrozole and 

tamoxifen in terms of clinical response in this 

very short (two-week) study involving 330 

patients. 

The same nonvalidated endpoint was 

used to evaluate the short-term effects of 

gefitinib (Iressa®) on ductal carcinoma in situ 

(Abstract 14). I was surprised—in fact, 

appalled—that anyone would test a drug as 

unproven as Iressa in a group of patients with 

non-life-threatening disease. 2 The trial showed 

a trend—but not statistically significant 

results—of Ki67 reduction from Iressa. Based 

on trend data of a nonvalidated endpoint, the 

researcher concluded that EGFR inhibitors 

such as Iressa should be studied in ERnegative 

DCIS. He also noted that, while drugs 

like Iressa may not work alone, they may work 

in combination with other compounds. 

How many drugs are healthy people 

going to have to take in the brave new world 

of cancer chemoprevention? And what will 

the long-term effects be? These questions 

weren’t answered at San Antonio. They 

weren’t even asked. 

In fact, the great thing missing in most of 

the presentations I heard at San Antonio was 

information about what the drugs under 

study meant for women’s lives. Given how 

little we know about surrogate endpoints and 

their relationship to patient outcomes, will 

patients really do better on the new drugs 

than on the old ones, taking into account not 

only the breast cancer outcome but also the 

other effects of the drug? 

Many of the studies presented at San 

Antonio either did not consider the clinical 

impacts of the treatments, or minimized them. 

In a presentation I missed, researchers 

showed that docetaxel (Taxotere ® ) gave 

women with metastatic disease almost three 

more months of life than paclitaxel (Taxol ® ). I 

was entering the lecture hall as the talk was 

ending, but a breast surgeon from San 

Francisco who was on her way out whispered 

in my ear that these patients were trading 

three additional months of life against 

extraordinary bone pain. Apparently, this 

trade-off wasn’t discussed in the presentation 

or the questions afterwards. 

Someone—everyone—needs to remind 

the presenters at this meeting that what 

matters to patients is what these drugs do for 

them and to them, in both the short and the 

long run. Yet the breast cancer advocates at 

this meeting—120 registered out of the more 

than 6,000 people in attendance—were 

remarkably silent during the question-andanswer 

portions of the presentations I heard. I 

think we need to have more activists at the 

Community Organizer Kendra Klein shares BCA’s 

perspective with a visitor to our booth at the San 

Antonio conference. 

San Antonio meeting to make sure that the 

concerns of women living with and at risk for 

breast cancer don’t get drowned out by the 

marketing hype that drives so many of the 

presentations. ◆ 

If you’re interested in joining BCA at the 2004 

San Antonio Breast Cancer Symposium, contact 

Kendra Klein at 415/243-9301 or kklein@ 

bcaction.org. 

1.The medical journals are filled with stories of 

surrogate endpoints that didn’t work out. Best 

known in breast cancer is probably the use of 

“tumor response rates” in evaluating high-dose 

chemotherapy/autologous bone marrow 

transplant treatment. The tumor response rates 

did not, as it turned out, predict accurately for 

either overall survival or time to progression of 

disease. But we didn’t learn this before many, 

many women had had this often devastating 

treatment. See “Preliminary Results for NCI Show 

HDC Offers Little Benefit,” BCA Newsletter 

#54 (June/July 1999), viewable online at 

http://www.bcaction.org/Pages/SearchablePages/ 

1999Newsletters/Newsletter054A.html. 

2.I was astonished to see this study because I 

recalled the presentation at San Antonio in 2002 

about Iressa in the metastatic setting (which was 

a failure—see “Changing Goals for Iressa,” BCA 

Newsletter #76, viewable online at http:// 

www.bcaction.org/Pages/SearchablePages/2003N 

ewsletters/Newsletter076I.html). I also know the 

controversy that arose over the FDA’s approval of 

Iressa for lung cancer despite lack of evidence of 

efficacy. At the 2003 conference, the presenter of 

the Iressa studies acknowledged that the latest 

studies are geared toward “chemoprevention,” 

not treatment. 

…HOW MANY ACTIVISTS WILL BE THERE?

BREAST 

CANCER 

ACTION 

55 New Montgomery 

Suite 323 

San Francisco 

California 94105 

Non-Profit Org. 

U.S. Postage 

PAID 

San Francisco, CA 

Permit No. 2500 

Return Service Requested 

Save the Date! 

BCA’s Seventh Annual Town 

Meeting: April 24, 2004. 

“Taking Care 

in a Toxic Time” 

Resources 

National Organizations: 


415/243-9301 

877/2-STOP-BC (toll-free) 

www.bcaction.org 

Mautner Project for Lesbians with Cancer 

202/332-5536 

www.mautnerproject.org 

National Latina Health Organization 

510/534-1362 

www.latinahealth.org 

National Lymphedema Network 

800/541-3259 

www.lymphnet.org 

National Women’s Health Network 

202/347-1140 

www.womenshealthnetwork.org 

National Y-ME 

(referrals to local support groups) 

800/221-2141 

www.y-me.org 

Patient Advocate Foundation 

(insurance issues) 

800/532-5274 

www.patientadvocate.org 

Richard & Annette Bloch Cancer Foundation 

(free second opinion and peer referral) 

800/433-0464 

www.blochcancer.org 

U.S. Government: 

National Breast and Cervical Cancer 

Early Detection Program 

(free or low-cost mammograms) 

888/842-6355 

www.cdc.gov/cancer/nbccedp 

Information on breast cancer/clinical trials 

sponsored by the National Cancer Institute 

800/4 CANCER (800/422-6237) 

www.cancer.gov/cancerinformation 

Information on adverse reactions 

to drug therapy 

800/FDA-1088 (800/332-1088) 

www.fda.gov/cder 

Tell Washington 

White House Hotline 

202/456-1111 

House & Senate Main Switchboard 

202/224-3121 

State of California: 

California Women’s Law Center 

888/774-5200 

www.cwlc.org 

California Department of Corporations 

(HMO complaints) 

800/400-0815 

www.dmhc.ca.gov 

San Francisco Bay Area: 

Charlotte Maxwell Complementary Clinic 

(for low-income women with cancer) 

510/601-7660 

www.charlottemaxwell.org 

Community Breast Health Project, Palo Alto 

650/326-6686 

www.cbhp.org 

Project Open Hand (meals) 

415/447-2300 or 510/596-8200 

www.openhand.org 

The Wellness Community, Walnut Creek 

925/933-0107 

www.twc-bayarea.org 

Women’s Cancer Resource Center, Oakland 

510/420-7900 

www.wcrc.org 

Additional Resources: 

Medical Complaints 

Medical Boards (selected states) 

www.aimmembers.org/boarddirectory 

For Help on the Final Journey 

Hospice Education 

800/331-1620 

www.hospiceworld.org 

For more resources, visit www.bcaction.org

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