While the debate over mammograms and self-exams rages, oncologists are looking at new drugs and therapies to treat breast cancer.

Dr. Michele Breden-Borowski, an oncologist with Oncology Hematology Care in Crestview Hills, says Faslodex (fulvestrant), one of a new class of drugs called estrogen receptor downregulators, is gaining popularity for patients who no longer respond to tamoxifen and similar medications.

In women who have "estrogen receptor positive" breast cancer, estrogen stimulates cells with estrogen receptors to divide without regard to the body's needs. Faslodex binds to the estrogen receptor to block the action of estrogen and makes the cell behave normally.

A national trial comparing Arimidex (anastrozole) and tamoxifen citrate to determine which drug - or a combination of the two - would be more effective in treating breast cancer "gave some advantage" to Arimidex in postmenopausal women, Dr. Breden-Borowski says.

Arimidex, a hormone and hormone antagonist, is prescribed for advanced breast cancer. It acts by preventing the body's adrenal glands from making estrogen, which encourages the growth of malignant cells.

Tamoxifen citrate, an anti-hormone prescribed to treat and prevent breast cancer, works by binding to estrogen receptors, which causes cancer cells to die.

Preliminary studies are also beginning to look at whether Herceptin (trastuzumab), a man-made antibody that belongs to a class of substances called biologic response modifiers, would be effective if prescribed after surgery.

Herceptin is a protein that locks with proteins called Epidermal Growth Factor Receptors or HER-2, on certain breast cancer cells. Once the two proteins are joined, Herceptin stimulates the immune system to kill the cancer cells. It's often prescribed in combination with chemotherapy.

Researchers are also looking at how tyrosine kinase inhibitors, similar to the leukemia drug Gleevec, can be used to treat breast cancer. The drugs work by blocking growth signals from estrogen to malignant cells, which causes the cells to die off.

Patients are becoming better educated about treatment options.

"They may not understand everything they see in print, but they are asking more questions," Dr. Breden-Borowski says "We don't see the ones coming in anymore who say, `Yes, doctor; whatever you say.' And that's a good thing."

- Peggy O'Farrell