The recent announcement by celebrity and TV host Giuliana Rancic on the "Today" show about her newly diagnosed breast cancer at the age of 36 illustrates the emotional toll this disease takes.
Breasts define our Class in the animal kingdom, which is called Mammals. These mammary glands distinguish us from other animals because we nurse and nurture our young. However, no other mammal has objectified or sexualized them, the way humans have.
We have many slang names for them, such as boobs, tits, ta-tas and cans, just to name a few. But whatever you call them, we humans are obsessed with breasts. And it is not just men; many women are obsessed too, about their shape, their firmness and their size. For many, we let our breasts define us.
The art world has glorified them in sculptures and paintings. Hollywood reveres them. The fashion industry celebrates and decorates them, padded and pushed up with revealing low-cut décolletage and cleavage.
Perhaps our attachment to our breasts comes from the fact that our mothers did nurture us with them. Therefore it makes the ironic twist even crueler that an organ, which at one time literally sustained life, can turn so sinister in the cancerous state.
Breast cancer is one of the most emotional diseases for women. It invokes literally armies of advocates trying to defeat it, even though heart disease is women's number one health threat. Heart attacks kill six times more women than breast cancer every year. However, the heart awareness "red" campaign is years behind the strides that breast cancer's "pink ribbon" campaign has made, every October. But I sometimes wonder if all this "awareness" feeds into women's fears and emotions.
Avastin is the brand name for the drug Bevacizumab. It is a new class of medication called targeted therapy. Unlike chemotherapy, which kills good cells along with the cancer cells, targeted therapies are aimed at genetic differences specifically found in cancer cells. They are aimed at molecules in the cancer that promotes growth and spread of the disease. Avastin is an anti-angiogenesis drug that attacks the formation of new blood vessels in cancerous tissue. Blood vessels are needed to feed and fuel the cancer so it can grow and spread. While many targeted therapies are less toxic to non-cancerous tissue, all tissue and organs need blood vessels therefore Avastin can damage them too. Even as a targeted therapy Avastin has some serious potential side effects, such as bleeding and hemorrhage, intestinal perforation, problems with wound healing and high blood pressure, as well as heart attack and heart failure.
The FDA believed it initially showed promise, despite their committee's recommendation and in 2008 Avastin qualified for an accelerated temporary approval. Later studies in 2009 found it did not prolong survival therefore an FDA advisory panel voted to withdraw approval in 2010. However, the FDA scheduled two more hearings this summer on an appeal from Avastin's manufacturer, Genetech. The final decision has yet to be made by the FDA Commissioner, Dr. Margaret Hamburg.
At these last hearings there was moving testimony from patients and family members who believe that Avastin was keeping them alive. These patients are called "super-responders" and unfortunately, we don't understand yet why some people respond to medications while others don't. But according to the statistics they are in the minority. Dr. Kevin J. Cullen, M.D., director of the Marlene and Stewart Greenenbaum Cancer Center at the University of Maryland states, "The FDA has to walk a fine line looking at the data as a whole." He goes on to say, "It is clear more research needs to be done to determine who will benefit the most from target therapies such as Avastin."
And while it's true we can't let our emotions get in the way of treatment for breast cancer. As a women and physician, I do find it hard to separate the statistics from the faces of our mothers, sisters, aunts, grandmothers and friends who have breast cancer.
Well-known breast cancer researcher, Dr. Katherine Tkaczuk, M.D., director of Breast Evaluation and Treatment Program, also at the Marlene and Stewart Greenenbaum Cancer Center at the University of Maryland, says we have not seen the last of Avastin use in breast cancer patients. "We are still conducting studies for Avastin's use in early breast cancer, hopefully this will help us identify and define the subset of women who will benefit from its use," she says.
My hope as a physician is that as we enter this age of personalized medicine and crack more of the genetic code, we will find that just as it determines the individual characteristics of our faces so too will we unlock the individual characteristics of our cancers. Then maybe someday, we can come up with the perfect personal cure for each and every one of us.