Barbara Brenner, Former Executive Director

Traveling to San Antonio for the big breast cancer meeting is always interesting, because there are lots of people who come here, and I get to talk to some of them as we stand in lines or wait for luggage to arrive.

This morning fun started at the Southwest Airlines line when someone behind me asked someone else behind me if he had been attending the ASH meeting? The response was no, so the questioner turned to me and said, you must have been at the ASH conference. When I said no, I asked what the ASH conference was—American Society of Hematology. The questioner assumed I was at the ASH meeting because of my Cancer Sucks button. When I told him I was headed to a breast cancer meeting in San Antonio, he said, “There have been a lot of advances in breast cancer therapies.” When I responded, “But who’s getting them?” he replied, “Well, that’s a different issue.”

It seems to me that as long as we think about medical advances as divorced from the issue of their affordability, we won’t be able to make real progress in cancer. Isn’t it time that the researchers and doctors developing new treatments thought about the problem of access? In an editorial in today’s New York Times, the paper takes on the medical culture of resisting generics that work as well or better than more expensive treatments for which doctors often receive compensation. The editorial concludes: “it is disturbing that medical opinion leaders were so reluctant to accept the finding that generic drugs worked as well as their costlier competitors.” The reluctance to look at issues of cost is a very large problem in all of health, and especially with the astronomical cost of new cancer therapies.

And speaking of medical advances, I had another encounter en route today that was an important reminder of the difference between what will be talked about at this conference and what’s going on in the world. A flight attendant admired my Cancer Sucks button, so I asked her if she wanted it. She was delighted, and told me about her sister in Orlando, Florida, who has just finished six months of chemotherapy. A PET scan was done after the treatment ended, and showed things that were “indeterminate”—not cancer, but not not cancer. So, she’s now having another 4 months of chemotherapy, and is very, very sick. She has two teenage kids.

One of the pleasures of getting on an airplane is that I get to read the New York Times more carefully than I usually do. One of the articles in today’s business section was about biotech companies who are asking for financial help from the federal government. Another item was an editorial about the need for new business models for the U.S. auto industry. With the statement in the first article about the scale of losses in the development of biotech therapies (a Genentech official put the losses at $100 billion since the 1970′s—even in these times, that’s real money), maybe it”s time for a new business model for developing new cancer drugs, too. After all, much of the discussion here at SABCS will be about new and exciting therapies, many of them not yet ready for use by patients, and some of which will never reach the market.

This evening, I attended the welcoming dinner for the Alamo Breast Cancer Foundation’s patient advocacy program. This is a terrific program that brings advocates to this meeting and provides them with mentors to help them understand the science presented here. One nice thing they did at the dinner was ask everyone present to introduce themselves, and say who they work with. I was absolutely struck by how many of the women work with so many different breast cancer organizations. Very few devote themselves to one particular approach to the issues in breast cancer advocacy.

The other thing that struck me at this gathering was that the only person who got unsolicited applause was the male doctor in the room—Peter Radvin. Peter is an oncologist who works closely with the Alamo program. Everyone in the room does remarkable work in the breast cancer world, but it’s the guy with oncology degree that gets the notice.

Which brings me back to today’s New York Times. In an article about the new generation of gay rights activists, Larry Kramer, the founder of ACT UP is quoted saying that the progress in AIDS has robbed the gay rights movement of its momentum. He is quoted as saying “For activism to work, you have to be scared and you have to be angry. Nobody’s frightened anymore. The drugs have taken care of that.” At the dinner tonight, there was a representative from Novartis, the company that makes Femara and that is a donor to the Alamo program. One of the advocates, in introducing herself, thanked Novartis for their drug. Activism?

And then there’s the buzz among advocates. Today it’s that the Komen Foundation last week laid off 39 staff members in Dallas. Everyone is having trouble, even the richest breast cancer organization in the world.

That trouble was evident in the airport when we arrived in San Antonio. Unlike previous years, there were no drug ads to greet the arriving conference participants. You could hardly tell there was a cancer meeting happening.

And there was other good news. When we arrived here and checked in at registration, we got our conference materials, including a re-usable plastic water bottle that is bis-A free. Good for the SABCS people!

So, let’s see what we can learn at this meeting about what’s working—and not—for people with and at risk for breast cancer. Stay tuned.