May 12, 2000
By Carolina Camacho
UCSD Cancer Center Health Journalism Intern
Ask yourself the following questions: Are Mexican-American women equally represented in current breast cancer research? Is the typical Mexican-American woman willing to participate in scientific studies? If we refuse to get involved in helping to evaluate new therapies, can we be sure that such new treatments will be effective for us? The answer to all these questions is no.
Our lack of involvement introduces us to health care that has been tested on women of other ethnic groups. In our culture, traditional norms and values usually frown at scientific research participation. There is a fear of being someone's guinea pig.
However, involvement is necessary if we are to benefit from today's scientific advances. Through these studies, researchers learn how to prolong life and improve its quality. Research studies also provide insight into preventing diseases from occurring in the first place. Your involvement may save someone's life, maybe even your own. If we want to benefit from these studies and the results they can provide, we should find ways of getting involved in the fight against breast cancer.
Women should visit their physicians regularly to avoid health problems and complications. As we get older we face a number of health risks. Breast cancer is the most common type of cancer in women in the United States, but it is less prevalent among Mexican-American women. In 1999 the National Cancer Institute Surveillance, Epidimiology, and End Results Program reported that out of 100,000 white women, 113 will develop breast cancer. In comparison, out of 100,000 Hispanic women, 69 will develop breast cancer. One out of eight women will be diagnosed with breast cancer during her lifetime. Approximately 182,000 new invasive cases are expected in the year 2000 along with 40,800 deaths. Prevention of breast cancer, especially among women at high risk, is an important goal to the National Cancer Institute and to many other research projects.
The newly announced STAR trial is a nationwide study focuses on comparing the effectiveness of two drugs in the prevention of breast cancer. "STAR" stands for Study of Tamoxifen and Raloxifene. The purpose of the study is to find out if Raloxifene's ability to prevent breast cancer is equal to, or greater than, that of Tamox-ifen. Researchers are seeking postmenopausal women age 35 and older to participate in this study.
Evidence from a large clinical trial shows that Tamoxifen helps to reduce the incidence of breast cancer in women who are at increased risk for developing the disease. The U.S. Food and Drug Administration (FDA) has approved Tamoxifen for such use. Raloxifene has been approved by the FDA and the Canadian Health Protection Branch (HPB) for the prevention of osteoporosis in postmenopausal women. Researchers think Raloxifene may also reduce the risk of developing breast cancer and have fewer side effects than Tamoxifen. The FDA and the HPB consider the use of Raloxifene for reducing the risk of breast cancer to be experimental at this time.
Tamoxifen has side effects such as hot flashes, vaginal symptoms, leg cramps, constipation, pain with intercourse, sinus irritation or infection, or bladder problems. This makes it less desirable for women who have never had breast cancer to consider as a prevention option. Thirty years of clinical use reveal a slight increase in the risk of developing endometrial cancer, pulmonary embolism and deep vein thrombosis as the most serious side effects.
This research study is being conducted to answer the following: is Raloxifene effective in reducing the chances of developing breast cancer in women who are at increased risk of developing this disease? If it is effective, how does Raloxifene compare to Tamoxifen in reducing the incidence of breast cancer? How do the side effects (good or bad) of these two drugs compare?
Participants in the STAR trial have an equal chance of receiving either Tamoxifen or Raloxifene. The process is known as "double blinding" because neither the participant nor her physician will know which pill she is taking. All women participating will take two pills, Tamoxifen plus a placebo (an inactive pill) or Raloxifene plus a placebo for five years. Women will have exams and follow-ups with research doctor to carefully monitor their health and well being. Participants will be monitored for the earliest sign of side effects and treated appropriately.
To find out more about this study, women can call one of the five San Diego centers participating in this study. You can also contact the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) to locate the STAR study nearest you.
In time, I believe science will discover a way to lower a women's risk of developing breast cancer. When this occurs, it will be great to know that such therapy is as safe and effective for Mexican-American women, as it is for women of other ethnic groups. This will only happen if we get involved in on-going research and in the fight against breast cancer.
Carolina Camacho is an undergraduate General Biology major at UC San Diego. She is a Health Journalism Intern at the UCSD Cancer training with Dr. Georgia Robins Sadler, Ph.D., Director for Community Outreach at the UCSD Cancer Center.