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Interview with Dr. Laura Esserman: Finding New Treatments for Breast Cancer

Audio Interview

Hear a Patient Power interview with Dr. Laura Esserman, discussing the progress being made through clinical trials to treat breast cancer, and patient Jessica Galloway, who shares her experience as a breast cancer patient.

Interview Transcript

Andrew Schorr:

A cancer diagnosis is always scary. Breast cancer is the second most common cancer among women. Well, the good news is that survival rates today are higher than ever due to advances in diagnosis and treatment. Coming up you'll hear from a woman who is winning her fight against breast cancer and her doctor, director of the UCSF Carol Franc Buck Breast Care Center next on Patient Power.

Hello and welcome to Patient Power sponsored by UCSF Medical Center. I'm Andrew Schorr. As a leukemia survivor, I know how terrifying that diagnosis is. For many of my women friends who I talk to about cancer, their fear is breast cancer. Unfortunately, there are a significant number that over a long life hear that diagnosis. It is scary, but there is great hope, and most women are treated well, survive and go on and live a very high quality of life.

We're going to hear about that. We're also going to meet a leading expert from UCSF who is the director of the UCSF Carol Franc Buck Breast Care Center. But first, let's meet someone who received that diagnosis in San Francisco at just age 40, Jessica Galloway. Three small, young children, and you were told maybe you had a clogged milk duct, but months later what did you find out, Jessica?

Jessica Galloway:

I originally was told I had a blocked milk duct right after I had my third baby, and when she was 9 months old I found out I had a stage III breast cancer and immediately started treatment.

Andrew Schorr:

And that just rocks your world, I guess.

Jessica Galloway:

Yes. It was the last thing that I ever, ever expected to have happen to me. I was healthy and had eaten well and had taken care of myself, so it came as a complete shock.

Andrew Schorr:

And you had been an athlete. I mean, you were always active.

Jessica Galloway:

Yes. Yeah, as a kid up until I was a teenager I was a ski racer and participated in other sports as well, but that was my main sport.

Andrew Schorr:

Now, that brought you to UCSF. How come?

Jessica Galloway:

Well, I was originally misdiagnosed at another hospital, so that was one reason. But I think that the main reason really was that it was a teaching hospital that was involved in research and the latest advances in every aspect of healthcare.

Andrew Schorr:

Now, you're a nurse practitioner.

Jessica Galloway:

That's correct.

Andrew Schorr:

Professionally. So did you have a sense, well, if the healthcare field is moving on I want to be where this action, where ground zero for healthcare progress is, a place like UCSF?

Jessica Galloway:

Yes. Absolutely.

Andrew Schorr:

Yeah, I understand that too as a leukemia survivor, and that was a benefit to me. We're going to talk about clinical trials in a minute, but you had surgery.

Jessica Galloway:

Well, I actually did chemotherapy first, so I participated in a trial called the I-SPY clinical trial that sort of looked at breast cancer treatment and turns it on its head. So instead of taking the tumor out you keep the tumor in. I had a seven centimeter tumor, so a very, very large tumor, so if you took that tumor out you wouldn't know if it had responded to the chemotherapy. So I did four months of chemotherapy, then surgery, then radiation, and then participated in another clinical trial after that.

Andrew Schorr:

One word about clinical trials, and I was in one too, is why did you want to do that? I mean, somebody could say, it's experimental, I don't want anything experimental. Why did you do it?

Jessica Galloway:

Well, I felt like my risk of metastatic breast cancer was relatively high, and I was willing to do anything to prevent that in happening. I also sort of knew from being in medicine myself that some of the greatest advances that are going to happen have, you know, still not been FDA approved and I wanted to be a part of just the newest things that were going on.

Andrew Schorr:

Right. It's in a sense the chance of tomorrow's medicine or clinical approach today.

Jessica Galloway:

Exactly.

Andrew Schorr:

One story I want you to tell is, so you go through chemotherapy and that, you know, depending on the medicines used in your own situation, that can be tough, but women often say, well, gee, the side effects, one is losing your hair. Tell us the story of the hike on Mount Tam near San Francisco and about your hair.

Jessica Galloway:

I think one of the things that I was most terrified about was being public with this disease, and, you know, once you've lost your hair you're forced to be a public sick person, and that was very, very scary to me. And my son was just about to start kindergarten and I had sort of a pre- introduction to kindergarten for the parents. And before I went to this I decided I was going to go on like a four-mile hike on Mount Tamalpais. And I left on the hike, and I had had my second chemotherapy treatment, and when I left on the hike I had a pretty solid head of hair, I had all of my hair, and by the time I came back my hair had basically blown away in the wind.

And it felt like it was this tragic thing and I cried and I was so sad, but I love Mount Tamalpais, and it sort of became a place of healing for me, knowing that sort of that was the beginning of my journey of being treated, and I continued to go back and hike in the same place throughout my treatment.

Andrew Schorr:

One other quick thing I wanted to ask about having read about you, Jessica, is a lot of us who have had cancer call ourselves cancer survivors. You don't. How come?

Jessica Galloway:

It's not that I feel that rigid about it. I tend to take the middle road in everything, so I'm not adamantly opposed to it. I guess I feel uncomfortable about it because, one, I don't know that I am going to survive. Even though I am five years out I still feel that I have such a high risk of developing metastatic breast cancer that it still makes me nervous.

And then the other reason I think I feel uncomfortable is I feel like with the term survivor it sort of implies that I have done something better than someone who has developed metastatic breast cancer. And I feel like I got great treatment and I was lucky and I did take care of myself, but I guess I feel that I don't want people who do have metastatic breast cancer to feel any less brave or that they've failed in some way.

Treatment & Clinical Trials

Andrew Schorr:

Very well said. Let's meet really the key member of your team, and there is a team of course, but who has helped you and even sang to you, and we're going to tell that story, that's Dr. Laura Esserman. Dr. Esserman is a breast cancer surgeon. She's director of the Carol Franc Buck Breast Care Center at UCSF. Dr. Esserman, so some points we want to make about breast cancer. Here's a woman who first of all maybe didn't get the right information, gets to you though, she's in clinical trials, doesn't know what's going to happen, and now five years later we get to do this program together, yet many woman would say, oh, my god, it's over, that day when they get a diagnosis. It's not that today, is it, for many.

Dr. Laura Esserman:

Well, for many of course that's true. I think it's important for people to understand that breast cancer is not one disease. There's actually a number of different diseases, and when you're diagnosed with breast cancer the first thing to do is take a deep breath and take a step back and get some information and learn more about the kind of breast cancer you have and make sure that you're aware of the different options you have for treatment. Some cancers actually, some very small screen-detected cancers can be very indolent and not particularly life threatening, and you want to make sure you don't overtreat those. But on the other extreme there can be some cancers that present that are quite large and present a big risk, and so you want to make sure you have every opportunity to do as much as you can to reduce your risk at the time you're first diagnosed.

As I told Jessica, breast cancer is not emergency. It's an emergency because you know about it. For the people whose risk is not that high, what you do sort of locally, sort of the surgery and radiation arm, can be perhaps the more important part of your treatment decision. For people who have higher risk that their disease might spread, and again that's the risk with breast cancer, the cancer that you have may already have sent out some cells that could be lying in wait to show up in another organ someplace. That's what we call metastatic disease. That's what systematic therapies are for, trying to reduce that treatment.

Now, for many women our systemic treatments today are very successful, but we still have much more work to do. And the kind of trial that Jessica participated in, the I-SPY 1 trial, we have evolved it to I-SPY 2, and we know these women with the most risk, getting the treatment right at the beginning is so important, and we have now convinced the FDA and the NCI to let us do this very exciting new trial called I-SPY 2, which allows us to bring in kind of the new and exciting medicines right at the beginning of treatment and add that to the standard treatment.

It's important for people to understand in clinical trials that the standard treatment is always part of the trial, and what we're testing now is the new treatments to see if we can improve the chance that someone's tumor will shrink or completely disappear with the benefit of knowing their chance of survival then will be that much greater and we'll know which drugs really are important to develop.

Andrew Schorr:

Right. I was in a clinical trial ten years ago and there remains with me for leukemia no signs of leukemia. Interestingly, the treatment I had ten years ago was just approved by the FDA two months ago. So I did, like Jessica, we were saying getting tomorrow's medicine today. The point is though things are moving in breast cancer, right? It's a field where new things are being tried, there are new trials. You even established a website to help people connect with that, right?

Dr. Laura Esserman:

We did, and so one of our goals is to make it so that there isn't that ten- or 11-year gap between the time something is identified as being helpful and the time that it's FDA approved. 11 years is a long time, and for lifesaving medicines you'd like that time period to be as short as possible.

So there are two important ways that we can change that. One is we can make sure that people are aware that clinical trials are a great opportunity for them and not to be afraid, to get more information about it. And in fact we developed a website called clinicaltrials.org which allows women to go to website, or anyone to go to the website, put their information in, again Breastcancertrials.org, you put your own information in, and we actually have almost 300 trials now across the country that are in that database, increasing the number every day, and it will match you, kind of like a dating service. It's going to match you to the trials that are right to you, that are specific to the kind of cancer you have, gives you all the information, and if you want to connect to a clinical site you can do so.

This really helps bring awareness to women and makes trials more accessible. You can send them to your own physician and review them. If a clinical trial is right for you it's a great thing to try and participate. You don't get substandard care. You always get at least what we consider the standard of care, and you might get something that we think is better. And if we knew it was better we'd just give it to everyone, but in fact there's a lot of things that turn out not to be as good and we want to learn about it. The reason why every year we're able to offer new things to patients is because we make sure that we continue to study in clinical trials all the new things that are coming forward.

The second thing we can do is try and really develop innovative clinical trials where we can learn as we go and try and find ways to introduce these new and exciting drugs that we hope will be more effective, try and do that in a much more timely way, up front in the therapy when someone is first diagnosed, not when they get metastatic disease. And we do it for the women like Jessica who show up with these big cancers.

I think one other thing I think is important to understand is that we used to think that a lot of these big cancers were because someone missed a diagnosis or had neglected to take care of themselves, and occasionally that's true but most of the time people who show up with big cancers do so because the cancers grow quickly, and that's the nature of a more aggressive biology. So it's not a woman's fault and it's often not a practitioner's fault, but it is something if you are a woman and you notice something new growing in your breast you need to get clinical attention, even if you've had a recent normal mammogram.

Andrew Schorr:

That's great information. I mentioned that there was a song sung to Jessica as she was about to have her surgery. Is it right that you sing to patients before they undergo anesthesia?

Dr. Laura Esserman:

I do, actually. I used to do a lot of theater and I love music and I love to sing, and it's a way for me to sort of combine my hobbies with my work. And the operating room can be a very scary place, not for those of us who are there every day or are very familiar with it, but it's kind of nice to know that the person who is taking care of you or operating on you is paying attention to you and can hold your hand and sing a song that you love or makes you feel safe and warm and comforted. And it's something I love to do, and most of my patients love it too.

Andrew Schorr:

That's so neat. And they make requests. Jessica, what did you request?

Jessica Galloway:

"Somewhere Over the Rainbow" was my request.

Outlook for the Future

Andrew Schorr:

So what's your outlook for the future now, Jessica? You know you're in a situation, you had a big tumor, undergone a lot of care, and you always have the understanding that it could show up. How do you think of it? You have three little kids. How do you think about every day?

Jessica Galloway:

Well, you know, I think that people say that cancer is going to change who you are, and I don't feel like in my particular case that happened. I think it made me sort of more of who I am, and I think that I had gratitude about life before I had cancer, but I have even more gratitude, if that could be possible. I used to say that I would never wake up in a bad mood. Now, five years out I do sometimes wake up in bad moods.

I'm so grateful for my children, and I also feel like now that they're older I think they're sort of beginning to understand sort of what happened to me, and they now go back and ask me questions about something that happened. Of course the baby, who is now five, doesn't remember anything, but they do ask me a lot of questions, and I think that in certain ways, somebody told me that this was sort of an opportunity for me to model brave parenting and that a lot of parents don't get to do that, and I really took that as an opportunity. So I feel like it just gives me an opportunity to be very real about life.

Andrew Schorr:

Well, it's great that you speak out like this, and I know it's an inspiration to a lot of other women, just really sharing your very real thoughts about all this. Dr. Esserman, people look to you as director of the center as sort of a barometer of how thing are going generally in the fight against breast cancer. Are you encouraged?

Dr. Laura Esserman:

I am very encouraged. I am encouraged because a lot of the exciting tools that have come out of the last 10 to 20 years of scientific research are now showing up and are available to us where we can profile the tumors in different ways and understand how to target or tailor or personalize medicine and how to give more treatment when appropriate, how to give less treatment when appropriate. And there are many cancers for which now we may be able to do less just as safely, and that's I think very exciting.

Also I'm excited because there is opportunity like the I-SPY 2 trial which help us to try and figure out how to quickly get some of these new drugs into the clinic and give women access to them as quickly as possible, and I'm hoping that what we're doing will make the time line for approving drugs that are helpful much shorter.

Andrew Schorr:

Well, I hope you're right about this. Thank you for all the work that you do, Dr. Esserman.

Dr. Laura Esserman:

I want to add just one other thing, and I think that cancer of course is the opportunity, you know, when you are first diagnosed it's so scary, but I think that women also have this opportunity to make really important changes in their lives. Just remember that life is not a dress rehearsal and to say it gives you really a different perspective, and all the bad things come with cancer, you can't help that, but one good thing is that people can develop a new perspective and think about what's important to them and make their life even more meaningful than they were before. And the whole idea of treatment is to return you to a life that you love living, and that's sort of one of the important things we need to do.

Andrew Schorr:

Right. And, Jessica, you've faced those thoughts and thought about life moving on.

Jessica Galloway:

Yes, and in certain ways I think that I should feel like it's, this chapter of my life is over, that I had cancer, and it's been five years now and I don't feel that way. I'm not panicked anymore, but it's very much a part of who I am.

Andrew Schorr:

And you're enjoying those kids every day.

Jessica Galloway:

Oh, yes. I love my life. I love my life. Every day is just a fabulous day. And, you know, I also think I sort of have a sense of responsibility to talk about my experience, and in San Francisco I think I've sort of become known as somebody who was young with a diagnosis of breast cancer. I talk to people all the time who have been recently diagnosed.

Dr. Laura Esserman:

You know, one thing that's interesting I think for people to understand just how great the idea of clinical trials can be, we actually are starting a clinical trial to save people's hair.

Andrew Schorr:

That would be cool.

Dr. Laura Esserman:

It's actually going to open in about a month and a half, and there are actually some devices that can be used to help save the hair that we're testing, and this is something that I think would be very meaningful. So there are a lot of trials that have to do with quality of life, and how we test it and if we can test and show that they're safe and effective not only do the people who participate in the trial get to experience that but the quicker we get them available to all women. That's why clinical trials are so important.

Andrew Schorr:

And for our friends in the Bay area or even if you come from afar what's exciting is so much of this work happens, one of the places it often happens is at UCSF. Dr. Laura Esserman, director of the Carol Franc Buck Breast Care Center at UCSF, thanks for being with us and sharing your passion for helping women do better.

Dr. Laura Esserman:

It's a pleasure.

Andrew Schorr:

And Jessica Galloway, every day is special, but thank you so much for being special for us today.

Jessica Galloway:

Thank you so much for having me.

Recorded March 2010

 

Reviewed by health care specialists at UCSF Medical Center.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

Related Information

UCSF Clinics & Centers

Carol Franc Buck Breast Care Center
1600 Divisadero St., Second Floor
San Francisco, CA 94115
Phone: (415) 353-7070
Fax: (415) 353-7050

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