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Carol J. Fabian, MD
Professor of Internal Medicine
Director, Breast Cancer Prevention and Survivorship Centers
Morris Family Endowed Chair in Cancer Prevention
University of Kansas Medical Center
Kansas City, Kansas
Goal: To develop strategies to prevent breast cancer in moderate- to high-risk women and to improve health and quality of life for breast cancer survivors.
Impact: Dr. Fabian is studying the medication Duavee®, which is approved for relief of hot flashes and prevention of osteoporosis, to determine if it might have a role in breast cancer prevention. If so, the drug could be a safe alternative to current hormone-based chemoprevention in women at risk of breast cancer.
What’s next: She and her team will continue their investigations of Duavee® and its potential use as a chemo-preventive in women at high risk of developing breast cancer.
Hormone replacement therapy (HRT) is the most effective way to reduce the vasomotor symptoms of menopause (hot flashes, flushing and night sweats), but there is concern that HRT might increase the risk of developing breast cancer, particularly in women with a higher than average risk. In her BCRF studies, Dr. Fabian has found that a drug that is a safer alternative to HRT in women with a high risk of breast cancer may also reduce the risk of breast cancer, potentially providing an alternative to current hormone-based chemoprevention.
Full Research Summary
Research area: Identifying ways to prevent breast cancer in moderate- to high-risk women and improving the health and quality of life for breast cancer survivors.
Impact: Chemoprevention drugs such as tamoxifen or aromatase inhibitors, dramatically reduce the risk of developing breast cancer, but many women will discontinue their use due to side effects that can initiate or worsen menopausal symptoms. Therefore, Dr. Fabian is focused on finding a potential alternative for breast cancer chemoprevention that is safer and that will not cause these side effects. Duavee® (the combination of conjugated estrogen and bazedoxifene) is FDA approved for relief of hot flashes and prevention of osteoporosis. Dr. Fabian is conducting studies to assess the utility of Duavee® for breast cancer prevention.
Current investigation: Dr. Fabian and her team are evaluating Duavee® as a safe and effective option for women at high risk of breast cancer who cannot tolerate current endocrine-based chemoprevention agents.
What she’s learned so far: Dr Fabian’s studies have shown that women who took Duavee® had a reduction in breast density and breast tissue proliferation (cell growth) as well as a reduction in blood progesterone, testosterone, and IGF-1 levels—factors known to promote breast cancer growth. These observations suggest that Duavee® might be helpful for breast cancer prevention.
What’s next: Based on the results of both preclinical studies and a pilot clinical trial study, Dr. Fabian and her colleagues will launch a multi-institution, Phase II NCI-sponsored randomized clinical trial of Duavee® versus placebo to assess its effects on risk-associated biomarkers. Prior to the trial launch, they will also assess further candidate biomarkers, and the potential for using changes in MRI as a secondary biomarker in these trials. The results of these trials will assure patients and clinicians that Duavee® will not increase the risk for breast cancer and is safe to take for relief of hot flashes.
Carol Fabian received her MD, internal medicine and oncology training from the University of Kansas School of Medicine in Kansas City, Kansas. Dr. Fabian joined the faculty at the University of Kansas Medical Center in 1977 and currently holds the rank of Professor. She serves as the Director of the Breast Cancer Prevention and Survivorship Centers. These centers are heavily involved in translational research in addition to providing clinical services. She leads the Cancer Prevention Research Program within the University of Kansas Cancer Center and holds the Morris Family Endowed Chair in Cancer Prevention.
Dr. Fabian pioneered the use of random periareolar fine needle aspiration to acquire breast epithelial cells for refinement of breast cancer risk assessment. The technique is also used for evaluation of biomarkers to monitor response in early phase breast cancer prevention clinical trials: 1) weight loss in combination with omega-3 fatty acid supplementation; 2) a flaxseed lignin derivative; and 3) an aromatase inhibitor in postmenopausal women taking hormone replacement. She is also involved in clinical studies to promote health and quality of life for breast cancer survivors and serves as a Co-Chair for the Cancer Survivorship Committee of SWOG.