The Doctor/Patient Relationship
Now every patient that I’ve taken care of, once the adjuvant treatment’s over, the series of treatments have been completed, there’s always the fear, the fear about not seeing somebody on a regular basis. The fear about recurrent disease; the fear about future treatments that may lie ahead, and again, I can’t tell you that those fears are not grounded in reality because unfortunately they are. There are woman who go through appropriately adequate treatments and despite all that, wind up having recurrent disease; however, again, what I’d like to emphasize is that there are important milestones, okay. Many of the recurrences that happen in the setting of breast cancer do so within the first 36 months. The vast majority of recurrences do so within the first 60 months, following the completion of treatment. Now I know that everybody knows someone who’s had recurrent disease much later on. In my career, I’ve seen it 31 years later, so it doesn’t mean it can’t happen. It can. But if we talk about the frequency of late recurrences, beyond the 10-year mark, they tend to be very, very small numbers: one in a thousand, one in two thousand, maybe one in five thousand. So we’re talking about very, very small numbers, very, very rare event. The fact of the matter is that I think as time goes by, the issue of recurrent disease becomes kind of thought about much less. The issues that people have to deal with in the day-to-day living of their lives come to the forefront, and the anxiety tends to get better over time. Support programs, I think they’re great. We’re fortunate in the Chicago area that we have lots of support groups because I think that nothing beats being able to talk to someone who has gone through what you may be going through and learning that there is a light at the end of the tunnel, the treatments are completed. Life does go on following the completion of treatment, and again, I think those things are very helpful for patients.
At this point, I’d be happy to answer any questions.
Nancy: Yes, Dr. Bitran, thank you for an informative talk. I have one question. It’s a little bit off but you probably would know the answer. My cancer was estrogen-receptive and I’m trying to have a good diet and exercise so you know, it’s hoping that there won’t be a recurrence. Could you tell me about soy products? I’ve been told some doctors think it’s a phytoestrogen. You shouldn’t eat it. Others say, “It doesn’t matter,” and I’m a vegetarian. So it’s kind of important to me. Do you know whether it’s safe to eat soy products?
Dr. Jacob Bitran: Well, everyone’s got lots of opinions about soy.
Nancy: Oh, so there’s no definitive answer. Just stay away from it then?
Dr. Jacob Bitran: Here, let me answer you in this manner: The protein in soy, okay, the soy proteins. There’s a very important chemical called “genestein” which is in soy proteins. That’s the phytoestrogen that people talk about. Now, phytoestrogens are far different than estrogens, mammalian estrogens or cow estrogens or things of that sort. Chemically they look the same but they’re a little bit different. When it comes to genistein, now just to backtrack a second, the way Tamoxifen works is Tamoxifen binds with a protein called “the estrogen receptor”; the estrogen receptor is a nuclear… Okay, the nucleus is the business hub of the cell. That’s nuclear receptor, so when it’s bound with estrogen, it triggers a number of events within the nucleus to stimulate growth. The way Tamoxifen works is that it binds with the receptor, okay, just the same way that estrogen does but it tends to sit there. So it doesn’t cause any of these events in terms of growth events from taking place. Now, genestein binds with the receptor also, but it’s kind of like Tamoxifen. It just sits there and at least in studies that have been done in cell cultures. These are taking breast cancer cells in the laboratory. It doesn’t appear to have any stimulatory effects.
Nancy: Fine.
Dr. Jacob Bitran: The way that I come out on soy proteins is: I think they’re safe. There’s been a lot of hype written about them. I don’t think that you are injuring yourself by using phytoestrogens. Whether they’re helpful or not, in the broad scheme of things, remains to be seen but that’s my viewpoint on it.
Operator: Sandra from Ohio is online. Please go ahead.
Sandra: Hi. In a woman who had DCIS and two lumpectomies and a mastectomy because they couldn’t get it all and then because of a genetic background, you know, with ovarian/breast cancer, had a bilateral mastectomy with a gorgeous reconstruction and, but who’s been told their… Went to a top cancer center in Texas and has been told they were cured and never had CTs, CT scans or MRIs but because of the surgery and the stage they caught it, the nodes were negative and there was no invasive portion. Is that a normal response to get because whenever I go to other doctors, they’re always surprised that I’m not getting CT scans? I do have to go back once a year and I did go back for the hysterectomy and oophorectomy because of the background. My sister died of ovarian cancer
Dr. Jacob Bitran: Right
Sandra: But I feel confident in the doctors I had and that this was that they are treating me properly. I go back. I have blood tests and I’m in some family studies that they’re doing, but I seem to get raised eyebrows and I had shingles this past December and went to another major medical center in the Midwest, and they did a full CT scan with and without contrast and I told them… They said they were just looking for pulmonary embolisms and DVTs but with that, I mean I told them that I was quite confident I did not have cancer and I didn’t. It was just shingles but is that a normal response that I’m going to be getting from people?
Dr. Jacob Bitran: Well, in the setting of breast cancer, that is an invasive which is DCIS. It’s a waste of money to do the scans, okay. We can do them but we’re just wasting money because we’re not going to find anything. So I don’t do CT scans on women who have DCIS. I don’t do bone scans. There’s no need to do any of that.
Sandra: So then my confidence in my doctors was correct?
Dr. Jacob Bitran: Yes.
Sandra: Thank you.
