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Case Studies in Breast Cancer Vol. 6, No. 7

Release Date: November 13, 2008
Expiration Date: November 13, 2009

Publication Overview

Authors

Charles L. Shapiro, MD; Maryam Lustberg, MD

Overview and Purpose

Women with breast cancer are surviving longer due to earlier detection and improvements in multimodality therapies, and the long-term maintenance of bone health is an important issue facing survivors of this disease. Natural menopause, surgical oophorectomy, gonadotropin-releasing hormone agonists, the use of aromatase inhibitors, and ovarian suppression resulting from systemic chemotherapy can all upset the balance between bone formation and resorption, leading to osteoporosis. Preliminary evidence in postmenopausal women suggests that bone-depleting effects that are independent of antiestrogen therapeutic intervention could occur with cytotoxic drugs. Several bisphosphonates are currently approved in the treatment of osteoporosis, and significant reductions in hip and vertebral fractures have been reported with the use of these agents. Supplementing vitamin D intake and new antibody-based therapies designed to inhibit bone-resorption mechanisms also show promise in reducing bone loss associated with natural aging or cancer therapy. Oncologists should be aware of bone health issues related to the treatment of early-stage cancer, particularly in older women who are osteoporotic or have associated risk factors, in order to ensure an acceptable quality of life for patients who could live for many years beyond completion of their therapy.

The purpose of this activity is to educate physicians about existing options for the maintenance of bone health in women undergoing treatment for breast cancer.

Target Audience

This activity is intended for medical oncologists involved in the care of patients with breast cancer. No specific skills or knowledge other than a basic training in oncology is required for successful participation in this activity.

Learning Objectives

Upon completion of this educational activity, you should be able to:

  • Recognize risk factors for increased bone loss and fractures
  • Evaluate the potential effects of cytotoxic chemotherapy on bone loss in women receiving treatment for breast cancer
  • Assess the current options for the treatment of bone loss in women with osteoporosis who are undergoing treatment for breast cancer

Instructions for Participation

  1. Read the following information before entering the educational activity.
  2. Complete the Pretest.
  3. Study the educational activity.
  4. Complete the CME test.
  5. Answer the evaluation questions.
  6. After successful completion of the CME test and evaluation, you will receive your certificate of credit online.

CME credit will be granted for only 1 form of participation, either online or via the printed publication.

Read all of the conditions in the Activity Terms box below. You must accept the Activity Terms in order to continue:

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It is the policy of Physicians’ Education Resource to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), Physicians’ Education Resource requires everyone who is in a position to control the content of an educational activity, including spouses/partners, to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Physicians’ Education Resource has implemented a mechanism to identify and resolve all conflicts of interest prior to the activity.

Maryam Lustberg, MD
No relevant relationships to disclose

Charles L. Shapiro, MD
Research Funding – Genentech, Inc.
Paid Consultant – Genentech, Inc.

PER Editorial Staff
No relevant relationships to disclose

This CME activity might include discussion of investigational and/or unlabeled uses of drugs. If the activity includes discussion of investigational and/or unlabeled uses of a drug, specific information is located on the title page. Please refer to the full prescribing information for each drug discussed in this online newsletter for FDA-approved dosing, indications, and warnings.

Commercial Support
An educational grant for this activity was provided by Novartis Oncology.

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Illustration

The biosynthesis pathway leading to the production of estrogens is complex, requiring a number of enzymatic reactions that convert cholesterol through several intermediaries, leading to the synthesis of active steroid hormones. Cholesterol is initially converted to progestogens, which are then converted to androgens. Androgens can be converted to estrogens by CYP19 in a nicotinamide adenine dinucleotide phosphate–dependent reaction. Estrogens then bind to and activate estrogen receptor (ER), leading to the transcriptional regulation of genes containing an estrogen response element in their promoter. The conversion of androgens to estrogens can occur in peripheral tissues, such as adipose, breast, and skin, or within the tumor cells themselves. Estrogens play a critical role in maintaining normal bone mass. Natural menopause and breast cancer treatments, such as surgical oophorectomy, gonadotropin-releasing hormone agonists, chemotherapy-induced ovarian failure, and aromatase inhibitors all decrease endogenous estrogens and cause bone loss. In contrast, hormone replacement therapy and the selective ER modulators tamoxifen and raloxifene preserve postmenopausal bone.

Disclaimer

The views and opinions expressed in this activity are those of the authors and do not necessarily reflect the views of the sponsor, supporter, or publisher. Although great care has been taken in compiling and checking the information given in this activity to ensure accuracy, the authors and Physicians’ Education Resource and its servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this activity, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

Please consult full prescribing information for any drugs or procedures discussed within.

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Editor, Case Studies in Breast Cancer
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