Why Elizabeth Edwards has reason for hope

WEST PALM BEACH, FLA. -- Elizabeth Edwards' breast cancer has spread to her bones and is "incurable but treatable."

What that means, experts say, is that she'll try to keep cancer cells at bay with drugs.

"Elizabeth will have this for as long as she lives," her husband, presidential candidate John Edwards, said last week.

The good news, says oncologist Eloy Roman of the University of Miami/Sylvester Comprehensive Cancer Center, is that strides in breast cancer treatment have been exceptional.

"There is reason to be hopeful that patients will live a good amount of time after having a diagnosis of metastatic cancer," Roman said. "It's not like what it used to be with breast cancer ... metastatic [meant] dead."

Edwards' physician, Dr. Lisa Carey, said at the Edwardses' news conference last week that cancer has spread to one or more of Elizabeth's ribs and possibly to other bones and her lungs. But the disease is "low volume," meaning that there is not much cancer present, Carey said. The goal of treatment would be to control the cancer without making Edwards sick with side effects.

"I don't expect my life to be significantly different," Edwards said, though her doctor warned her she may feel more tired than normal.

She said she had no symptoms except for a sore spot where one of her ribs had cracked. It was the painful rib, which broke when her husband hugged her, that made her see a doctor and led to the discovery of the cancer recurrence. The rib may have broken because it was weakened by cancer, but that is not clear. The diagnosis was actually made from a biopsy taken from another rib.

"I don't look sickly," said Edwards, whose cancer is at the most advanced stage, Stage 4. "I don't feel sickly."

Edwards, 57, had a regimen of chemotherapy, surgery and radiation after her first diagnosis in October 2004.

But there are several courses of treatment that could help her live many more years.

There is hormonal therapy, which includes the well-known anti-cancer drug, Tamoxifen. It can be effective in women who have so-called estrogen-receptor-positive invasive breast cancer, at any stage. These cancers are fueled by the body's own estrogen.

In 2005, the results of several major worldwide clinical trials showed that drugs called aromatase inhibitors (Arimidex, Aromasin and Femara) worked better than Tamoxifen in post-menopausal women with hormone-receptive-positive breast cancer. So one of those drugs may be used.

There's the possibility of more chemotherapy, bone-strengthening drugs and radiation.

"We have all these bullets," Roman said. "The day will come when you can't take any more, maybe chemotherapy will become detrimental, but there probably will be quite some time until we run out of these little bullets."

Adds Dr. Ellen Mahoney, a breast cancer surgeon with the Community Breast Health Project in Arcata, Calif.: "For a long time, [those with] bony metastases have done very well. It seems to be a place where tumor cells are able to be contained by the immune cells better. And also by better treatments. We just patch, patch, patch. It's impossible to tell in advance who won't respond. The disease is extremely variable."

If the cancer has spread to Edwards' lungs, and she is getting scans to check, it's harder to manage, NBC chief medical correspondent Dr. Nancy Snyderman said on the "Today" show.

"Anytime you add brain, lung or liver it makes the prognosis more guarded. Bone alone would be easier to treat. She definitely has a spot on her rib and a few other bones," Snyderman said.

If cancer moves to soft tissue area, that would be associated with a shorter life span, Mahoney said. "We do worry about people who recur outside the breast earlier than later, but that's the only cloud on the horizon I can see."

Only 26 percent of women with Stage 4 breast cancer survive for five years, according to statistics from the American Cancer Society. That statistic, however, should not be applied to women like Elizabeth Edwards who have recurrences, but only to women who are Stage 4 when the disease is first diagnosed, the society said. Edwards had "regional" disease at the time of diagnosis, meaning it had spread to some lymph nodes; five-year survival for women in that category is 81.3 percent.

Each patient is different, Roman of UM/Sylvester says, and Edwards should feel positive about new treatments. "I have patients who are alive 10 years from time of diagnosis."