M. D. Anderson Physician Takes the Lead in Cancer Prevention

Step into the office of Dr. Therese Bevers, and you can't help but catch it.

Enthusiasm is in the air.

This high-energy physician directs the Cancer Prevention Center at The University of Texas M. D. Anderson Cancer Center and leads M. D. Anderson in a national breast cancer prevention study, with the same enthusiasm that sent her mountain-climbing for vacation.

Dr. Bevers with a patient.

She is compelling in her ability to motivate a listener to adopt healthy lifestyle changes to prevent cancer, including annual cancer screening and early detection examinations.

"We know that 65 to 85 percent of all cancers may be prevented through lifestyle changes," Dr. Bevers says.

"We encourage people to take charge of their health. We can help individuals determine their cancer risk. Additionally, we counsel clients about making healthy lifestyle changes, such as quitting smoking and eating a healthier diet."

As medical director of the Cancer Prevention Center, Dr. Bevers directs the care of the hundreds of individuals each month who come for cancer screening and early detection examinations. "I have always believed in the concept of prevention," says Dr. Bevers, who trained as a family practice physician.

"We take steps to prevent heart disease. Why not take steps to prevent cancer?" She also is medical director of of M. D. Anderson's Prevention Outreach Programs and of LifeCheqÔ Corporate, a cancer screening and early detection program that performs on-site examinations at many Houston-area businesses.

Dr. Bevers stresses the main tenets of cancer prevention: avoid tobacco, limit sun exposure, limit alcohol consumption, eat 5 servings of fruit and vegetables daily, exercise regularly and know your family's history of disease.

Even as a practicing family physician before coming to M. D. Anderson, Dr. Bevers made sure her patients received annual cancer screenings and other preventive measures.

Her belief in disease prevention motivated her to join M. D. Anderson in 1996.

"No one else in the United States is offering as comprehensive a cancer prevention program as what we offer here. Early detection of cancer provides the best chance for cure," says the physician who recently returned from climbing Wheeler Peak, New Mexico's tallest mountain, and white-water rafting down the Rio Grande River.

"We have made very rapid strides forward in preventing cancer. The cancer mortality rate has decreased since 1991, and a significant portion of this can be contributed to cancer prevention activities," says Dr. Bevers, who is board-certified by the American Board of Family Practice, and is a member of the Texas Medical Association's task force for preventive medicine.

Additionally, Dr. Bevers serves on the National Comprehensive Cancer Network Breast Cancer Screening Guideline Panel and served on the National Comprehensive Cancer Network Breast Cancer Screening Guideline Panel, which established the recent recommendations for prescribing tamoxifen for women and high risk of developing breast cancer.

With her level of concern for helping individuals prevent cancer, leading a breast cancer prevention study was a natural next step for Dr. Bevers.

She is principal investigator at M. D. Anderson for the Study of Tamoxifen and Raloxifene (STAR).

M. D. Anderson currently is recruiting women for one of the largest breast cancer prevention studies conducted to date. The institution is among more than 400 centers across the United States, Canada and Puerto Rico participating in STAR. Organizers of the medical study, part of the National Surgical Adjuvant Breast and Bowel Project supported by the National Cancer Institute (NCI), plan to enroll 22,000 women in STAR, all postmenopausal women at increased risk for breast cancer. M. D. Anderson plans on enrolling 400 participants in STAR.

"The term `chemoprevention' is sometimes frightening for people. But chemoprevention has been around for years," Dr. Bevers says.

"For decades, we have used interventions to prevent a number of diseases, such as polio. Unlike childhood immunizations, chemoprevention for cancer doesn't provide an absolute barrier to disease development. But it does reduce risk of developing breast cancer in women who are at high risk for the disease."

STAR is a follow-up investigation to the NCI's Breast Cancer Prevention Trial that ended in May 1998.

That groundbreaking chemoprevention study showed for the first time that breast cancer can be prevented. Tamoxifen reduced by half the incidence of breast cancer in women at risk of developing the disease.

"For years now, the standard of care is prevention of polio and several other diseases. Fifty years ago, we had no idea that polio could be eradicated - but today, with immunization, this is not a disease people worry about in their lifetime," Dr. Bevers says. She cautions that chemoprevention does reduce risk, but without the guarantee of preventing breast cancer for every woman.

"In the same way, our ultimate goal is to prevent breast cancer," she says. "Fifty years from now, maybe women will be able to expect to never develop breast cancer because of new ways of intervening, either through chemoprevention or perhaps through detection of a premalignant state."

STAR compares tamoxifen (Nolvadex® to a newer drug called raloxifene (Evista® to determine the most effective drug with the least side effects. Tamoxifen has been approved by the FDA for more than 20 years to treat women with breast cancer, and it has been in clinical trials for about 30 years. An important part of STAR will be to compare the long-term safety of raloxifene and tamoxifen in women at increased risk for breast cancer.

Women who participate in STAR must be postmenopausal, at least age 35 and have an increased risk of breast cancer as determined by their age, family history of breast cancer, personal medical history, age at first menstrual period and age at having their first child.

Once a woman chooses to participate, she will be randomly assigned to receive either 20 milligrams of tamoxifen or 60 milligrams of raloxifene daily for five years and will have regular follow-up examinations, including mammograms and gynecologic exams.

AstraZeneca Pharmaceuticals of Wilmington, Del., which produces tamoxifen, and Eli Lilly and Company of Indianapolis, Ind., which produces raloxifene, are providing the drugs free for STAR.

As medicine moves into the new millinneum, Dr. Bevers provides a fast-forward look at cancer prevention.

"In the future, we will add other cancer preventive measures to annual screening and early detection," she says.

Rather than vigilantly watching for the first signs of cancer, through cancer screening examinations, Dr. Bevers and other cancer prevention proponents hope to see an aggressively proactive type of cancer prevention that identifies risk at the molecular level, before any cancer has developed.

"We can look for genetic testing to become more widely used as a tool for identifying risk, as well as having more tumor markers to identify risk. Following risk identification, we will be able to implement preventive strategies, such as chemoprevention," she says.

For more information about STAR, call the "STAR line" at M. D. Anderson at 713-792-8064 or check the STAR site on M. D. Anderson's website at www.mdanderson.org.

- ALISON RUFFIN

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©2006 Texas Medical Center

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