In the United States, more than 2 million women are living with a history of breast cancer. Because of past advances in chemotherapy, the vast majority of women diagnosed with breast cancer will survive for many years, but they will also have increased risk for long-term complications related to estrogen deficiency, lymph node dissection, and other effects of chemotherapy on health tissue Evidence suggests that women who survive breast cancer have an increased risk for osteoporosis. This risk is highest for premenopausal women who become menopausal with chemotherapy. However, controversy exists regarding the extent of bone loss, and only a few studies have evaluated mechanisms to prevent it. A double- blind randomized control trial of weekly alendronate in premenopausal women treated with adjuvant chemotherapy for breast cancer will be performed to define and compare the changes in BMD and bone turnover that occur during and after adjuvant chemotherapy for breast cancer. We expect to characterize the natural history of bone loss during chemotherapy and define risk factors that contribute to this loss in newly diagnosed premenopausal breast cancer patients. By defining factors that predict accelerated bone loss we hope to help guide preventive therapy. With the results of this trial, cost- effectiveness of bisphosphonate treatment will be modeled. We expect that bisphosphonates will significantly reduce the rate of bone loss in this patient population and that bisphosphonate use for the prevention of osteoporosis and its related complications will be cost-effective. The training portion of this proposal includes regular mentoring with Dr. Karen Antman and Dr. Elizabeth Shane; extensive interaction with Dr. Alfred Neugut, Dr. Victor Grann, and Dr. Richard Gralla; and continued formal coursework at the Mailman School of Public Health at Columbia University. My goal as an independent investigator is to conduct clinical research that will identify approaches to cancer treatment that will minimize toxic effects, prevent long- term complications, and maximize survival, quality of life, and cost- effectiveness.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Academic/Teacher Award (ATA) (K07)
Project #
5K07CA095597-02
Application #
6603234
Study Section
Subcommittee G - Education (NCI)
Program Officer
Gorelic, Lester S
Project Start
2002-07-01
Project End
2007-06-30
Budget Start
2003-07-01
Budget End
2004-06-30
Support Year
2
Fiscal Year
2003
Total Cost
$133,761
Indirect Cost
Name
Columbia University (N.Y.)
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Spencer, Benjamin A; McBride, Russell B; Hershman, Dawn L et al. (2013) Adjuvant intravesical bacillus calmette-guérin therapy and survival among elderly patients with non-muscle-invasive bladder cancer. J Oncol Pract 9:92-8
Yu, Bo; Douglas, Nataki; Ferin, Michel J et al. (2010) Changes in markers of ovarian reserve and endocrine function in young women with breast cancer undergoing adjuvant chemotherapy. Cancer 116:2099-105
Hershman, Dawn L; McMahon, Donald J; Crew, Katherine D et al. (2010) Prevention of bone loss by zoledronic acid in premenopausal women undergoing adjuvant chemotherapy persist up to one year following discontinuing treatment. J Clin Endocrinol Metab 95:559-66
Tager, Felice A; McKinley, Paula S; Schnabel, Freya R et al. (2010) The cognitive effects of chemotherapy in post-menopausal breast cancer patients: a controlled longitudinal study. Breast Cancer Res Treat 123:25-34
Crew, Katherine D; Shane, Elizabeth; Cremers, Serge et al. (2009) High prevalence of vitamin D deficiency despite supplementation in premenopausal women with breast cancer undergoing adjuvant chemotherapy. J Clin Oncol 27:2151-6
Hershman, Dawn L; McMahon, Donald J; Crew, Katherine D et al. (2008) Zoledronic acid prevents bone loss in premenopausal women undergoing adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 26:4739-45
Grann, Victor R; Ziv, Elad; Joseph, Cecil K et al. (2008) Duffy (Fy), DARC, and neutropenia among women from the United States, Europe and the Caribbean. Br J Haematol 143:288-93
Magai, Carol; Consedine, Nathan S; Adjei, Brenda A et al. (2008) Psychosocial influences on suboptimal adjuvant breast cancer treatment adherence among African American women: implications for education and intervention. Health Educ Behav 35:835-54
Hershman, Dawn; Neugut, Alfred I; Jacobson, Judith S et al. (2007) Acute myeloid leukemia or myelodysplastic syndrome following use of granulocyte colony-stimulating factors during breast cancer adjuvant chemotherapy. J Natl Cancer Inst 99:196-205
Grann, Victor R; Hershman, Dawn; Jacobson, Judith S et al. (2006) Outcomes and diffusion of doxorubicin-based chemotherapy among elderly patients with aggressive non-Hodgkin lymphoma. Cancer 107:1530-41

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