Healthy choices and active screening for breast cancer are your best defenses in beating the disease. Also learn about today’s breast cancer treatments so you can discuss them with your doctor.

A new and experimental treatment for breast cancer means that patients and doctors must choose treatments based on incomplete research.

Every year, thousands of babies are born with spina bifida. It’s a birth defect where the spinal column does not close properly, exposing nerves to the environment. Most babies born with spina bifida in the United States have surgery soon after birth. But some children in other countries aren’t so lucky. A little boy from Algeria suffered terribly for more than two years until his community helped raise money to send him to Mayo Clinic.

Using a combination of a targeted cancer-fighting agent called DFMO and a low dose of an anti-inflammatory drug, UC Irvine researchers have reduced the risk of reoccurring colorectal polyps, an early sign of colon cancer, by as much as 95 percent with fewer toxic side effects.

The study marks a breakthrough in the effort to combat colon cancer, the third leading cause of cancer in men and fourth in women, according to Dr. Frank L. Meyskens Jr., the Daniel G. Aldrich Chair at UC Irvine and director of its Chao Family Comprehensive Cancer Center.

“There is a great hope that we will be able to prevent colon cancer effectively using this method,” said Meyskens, who led the clinical trial effort to test this drug combination. He presented his findings at the American Association for Cancer Research annual meeting in San Diego.

In earlier studies, Meyskens had established a safe and well-tolerated dose of DFMO (difluoromethylornithine) that was 1/50 of what would typically be used to treat advanced cancers. By combining this reduced dose of DFMO with a non-steroidal, anti-inflammatory drug called sulindac, researchers believed they could improve treatment and decrease the reoccurrence of potentially cancerous colon polyps with reduced toxic side effects.

DFMO is the basis of the drug eflornithine, which was initially developed as a cancer medication and is no longer manufactured commercially for that purpose. Sulindac is sold commercially as Clinoril and is used to treat arthritis and other inflammatory conditions.

The researchers enrolled 375 patients who had a history of at least one colorectal polyp, or adenoma, within the previous five years. Patients were randomly assigned to either a combination of 500 mg of daily DFMO and 150 mg of sulindac or placebos. Patients were followed for three years, and adenoma recurrence was measured by colonoscopy. Among the results:

* Overall risk for recurrent adenoma: 41.1 percent in placebo group to 12.3 percent in treated patients, a 79 percent reduction

* Risk for recurrent advanced adenomas: 8.5 percent in placebo group to 0.7 in treated patients, a 92 percent reduction

* Risk for adenomas larger than one centimeter: 7 percent in the placebo group to 0.7 percent in the treatment group, a 90 percent reduction.

* Rate of repeating adenoma among patients who had previously had more than one adenoma: 13.2 percent in the placebo group to with 0.7 percent in the treatment group, a 95 percent reduction.

The rate of reduction was so pronounced that the trial’s independent data and safety monitoring board stopped the trial early.

An analysis of side effects and toxicity found no difference between the treatment and placebo groups. There also was no difference in side effects requiring an overnight hospitalization, gastrointestinal side effects or cardiovascular side effects between the two groups.

“What we have shown here is that there is value in testing these agents at lower doses and in combination to determine if we can achieve the same effect without the damaging side effects,” Meyskens said.

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The lesson learned in eradicating dandelions from your yard could apply in treating breast cancer as well, said researchers from Baylor College of Medicine in Houston in a report that appears online in the Journal of the National Cancer Institute.

“It’s not enough to kill the dandelion blossom and stalk that appear above ground,” said Dr. Michael Lewis, assistant professor of molecular and cellular biology and a faculty member in the Lester and Sue Smith Breast Cancer Center at BCM. “You have to kill the root beneath the soil as well.”

In a study involving women with breast cancer, he and colleagues at BCM showed that while conventional anti-cancer drugs can kill the bulk of breast cancer tumors, they leave behind many of the breast cancer stem cells from which tumor cells arise, setting the stage for the tumor to come back.

“What we found is that one reason chemotherapy frequently does not work is that you kill the bulk of the tumor but leave many of the stem cells behind,” said Lewis. “It appears that these cells, by their nature, are resistant to the effects of anti-cancer drugs.”

However, treatment with the drug lapatinib and anti-cancer drugs appears to kill both the tumor and the stem cells, reducing the threat of relapse in patients whose tumors carry a protein marker called HER2, Lewis said.

In their study, he and colleagues took biopsies from the tumors of patients before and after treatment.

The study had two parts. In the first, 31 patients whose tumors did not have the HER2 marker received conventional chemotherapy. In the second part of the study, 21 patients whose tumors carried the HER2 marker, received treatment with lapatinib and two other common breast cancer drugs. (The HER2 marker meant that the tumors would be susceptible to lapatinib.)

The researchers stained the samples to highlight the subset of tumor cells that contained the stem cells, which can be identified by the presence of certain markers on the cell surface. This enabled them to estimate the percentage of stem cells in the biopsy. In addition, stem cells in the laboratory can grow into colonies of cells that scientists call mammospheres. Because of this, they could also measure those to estimate what proportions of stem cells are present in a sample.

In the group that received conventional chemotherapy, the number of tumor cells decreased markedly. However, after the treatment, the proportion of cancer stem cells (identified by special markers and mammosphere formation) to differentiated tumor cells was greater than before treatment. In other words, there was a higher percentage of stem cells because the chemotherapy killed the regular tumor cells but left stem cells behind.

In the group that received lapatinib, the number of tumor cells again decreased dramatically. However, the percentage of breast cancer stem cells did not change or even went down slightly (although the change did not reach statistical significance). Consistent with this, the percentage of patients who received lapatinib had significant tumor shrinkage at greater rates than that seen in patients who received conventional therapy.

“The tumor shrank dramatically,” said Dr. Jenny Chang, associate professor of medicine at BCM and medical director of the BCM Breast Care Cancer Center. “But in contrast to treatment with conventional chemotherapy, the relative proportion of stem cells did not go up. This means the stem cells were killed off with the same frequency as the bulk of the tumor. This is the first time this has been demonstrated.”

Finding drugs that work specifically against stem cells is a course for the future, said Lewis. He plans to start by characterizing the markers specific to breast cancer stems cells, and inhibiting them one-by-one.

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