U.S. Army Medical Research and Materiel Command

Point of Contact:
Chuck Dasey, (301) 619-7071

July 20, 2000

For Immediate Release:

New Data Clarify Treatment and Family Support Needs of Young Women with Breast Cancer
Research Results from "Era of Hope" Department of Defense Breast Cancer Research Program Meeting

ATLANTA, June 10, 2000 - Research presented at the "Era of Hope" Department of Defense Breast Cancer Research Program meeting focuses on young breast cancer patients from two very different, but important angles. One study challenges the established wisdom about follow-up treatment for women younger than 35; the other quantifies the differing psychosocial needs of premenopausal mothers and their husbands and young children.

Strong Data Support Adjuvant Chemotherapy for Breast Cancer Patients Under Age 35

Researchers today announced study findings that suggest all young women diagnosed with breast cancer should receive follow-up chemotherapy to increase their chances of survival. The new data - from the largest and most detailed study to date and the first to look specifically at the impact of chemotherapy on survival - indicate that the current approach to treating young women, in which those classified as low-risk do not routinely receive chemotherapy, results in poor survival.

"What's new and unexpected about our study is the finding that women under 35 with low-risk disease who do not receive chemotherapy have the poorest outcomes; but if they receive chemotherapy, they have the same chance of survival as middle-aged women with low-risk disease," said Mads Melbye, M.D., Ph.D., professor and head, Statens Serum Institut, Copenhagen, Denmark. The study findings were obtained in collaboration with Danish researchers Niels Kroman, Jan Wohlfahrt, Henning Mouridsen, and others.

Since 1977, the Danish Breast Cancer Cooperative Group in Denmark has collected detailed information about the diagnosis and treatment of women with breast cancer in a population-based registry. In this study, researchers examined the records of all women in the registry who were under age 50 when they were diagnosed with breast cancer. Of the 10,356 women studied, 867 were under age 35 when their disease was diagnosed and 4,402 were 45-49 years of age.

When Dr. Melbye and his colleagues adjusted statistically to account for each woman's tumor characteristics at diagnosis, the treatment she received, and the age-specific mortality in Denmark, they found that women under 35 who had low-risk disease and did not receive follow-up chemotherapy were more than twice as likely to die as women with low-risk disease who were 45-49 when their disease was diagnosed.

Furthermore, when they conducted separate analyses in women who had small tumors and whose tumors were classified as "node-negative," with no metastatic growth (factors that are always considered the hallmarks of "low-risk" disease), they reached the same conclusion: women under 35 who received no chemotherapy had the worst outcomes.

Women diagnosed with breast cancer in their 20s and 30s have long been known to have poorer survival than women who are older at the time of diagnosis. Young women are also more likely to have large, rapidly growing tumors, and until now, it has been assumed that their poorer survival was due to the more aggressive nature of their disease.

According to Dr. Melbye, previous studies looked at fewer patients and did not examine outcome differences between women with low-risk disease who received chemotherapy and those who did not. "By adjusting for whether patients got chemotherapy or not, we have been able to disentangle what lies behind the poor prognosis in young women," he explained.

Though this is a retrospective study - not a randomized clinical trial, considered the "gold standard" of evidence in medical research - Dr. Melbye and his colleagues believe that the strength and consistency of their results support a change in the approach to treating young women. "No matter how we examine the data, the conclusions are the same," he said.

Family-Focused Study of Young Moms with Breast Cancer Finds Gender Differences in Coping Success

A new intervention study is expanding clinical understanding of the special support needs of younger women with breast cancer and their families - populations often bypassed by research on a disease that strikes more postmenopausal than premenopausal women.

Preliminary data from tests administered when current participants entered the study revealed significant differences in psychosocial function between the breast cancer patients and their partners: 86% of the women scored within normal limits compared with 56% of the men; the other 44% of spouses and 14% of women reported clinical-level psychological distress. Additionally, school-age girls scored lower than boys on social acceptance and scholastic competence.

"These findings suggest the value and need for some gender-specific content in interventions for families of young breast cancer patients," said Sally Tarbell, Ph.D., assistant professor of psychology and psychiatry at Pennsylvania's University of Pittsburgh Cancer Institute.

Her study, the Families Coping with Cancer Project, has so far enrolled 30 families of premenopausal breast cancer patients (mean and median age, 41 years; range, 31-52). Recruitment will continue for a year, with a goal of 40-50 families. The study focuses on early-stage cancer and most of the participants enrolled within one year of the woman's diagnosis. This research initiative was funded with a Department of Defense Breast Cancer Research Program "IDEA" grant, an award category designed to support novel, untested and high-risk ideas, as well as the participation of young, promising scientists.

With a background in pediatric psychology, Dr. Tarbell is interested in exploring the effects of serious parental illness on young children. The study includes two interventions designed by Tarbell and colleagues for participant families: the Basic program involves only the parents; the Expanded version includes two groups of children, ages 4-6 and ages 7-12. At the conclusion of the study, the impact of the two interventions will be compared, with evaluations conducted at three intervals: when the intervention begins (baseline), when it ends (four months later), and at one follow-up point (eight months later).

The interventions are organized in four consecutive monthly sessions, delivered separately to the three participant groups: parents, younger children, and older children. The first two sessions move from the challenges raised by a diagnosis of cancer to stress management, with instruction on relaxation and coping techniques. In the remaining sessions, parents and children learn effective communication skills; adults also practice "assertive communication" to help them negotiate through the treatment system. According to Dr. Tarbell, two program participants have changed their treatment after developing the confidence to ask their clinicians questions and express their opinions.

"We have designed these interventions to give the parents and children practical, hands-on skills that help equip them to cope with the complex issues involved with cancer," said Dr. Tarbell.

Dr. Tarbell notes that the present enrollment represents a self-selecting study population, small numbers, and demographic homogeneity. Approximately 97% of the participants are white, and most are in traditional two-parent families of high socioeconomic status. She hopes that as recruitment continues, a larger data pool will support the spread of the targeted interventions that have been developed, adapted as appropriate for groups with different demographic profiles.

"Era of Hope" is a forum for the presentation of research supported by the U.S. Department of Defense's Breast Cancer Research Program (BCRP), an unprecedented partnership between the military, scientists, clinicians, and breast cancer survivors. Since 1992, the BCRP has been working to prevent and cure breast cancer by fostering new directions in research, addressing underserved populations and issues, encouraging the work of new and young scientists and inviting the voice of breast cancer survivors to be heard in all aspects of the program. One of 53 congressional research programs managed by the U.S. Army Medical Research and Materiel Command, the BCRP has received more than $1 billion to date from Congress for innovative breast cancer research.

"Should All Young Woman with Breast Cancer Receive Adjuvant Therapy?"
Niels Kroman, Majbritt Jensen, Jan Wohlfahrt, Henning T. Mouridsen, Per K. Andersen, Mads Melbye

• Poster Session: Friday, June 9, 6:30 p.m.- 8:00 p.m., Galleria, Posterboard A-22

"Coping with Breast Cancer in Young Women and Their Families"
Sally Tarbell

• General Session: Sunday, June 11, 3:15 p.m. - 4:15 p.m., Grand Salon E
• oster Session: Sunday, June 11, 6:20 p.m. - 8:00 p.m., Galleria, Posterboard EE-11