Edwards fighting cancer, misperceptions

Less than a month after Elizabeth Edwards said that her breast cancer has returned in an incurable form, she is fighting not just the disease but perceptions about those who have it.

Edwards, 57, has been overwhelmed with e-mail messages and letters of support. But she also has had to confront speculation that she won't live much longer. She has heard concerns, even criticism, about her choice to battle cancer while continuing to campaign alongside her husband, Democratic presidential hopeful John Edwards.

During a campaign stop this week with her husband in Iowa, Edwards revealed that she has a type of breast cancer that responds well -- typically with few or no side effects -- to the latest estrogen-inhibiting drugs.

"When we found that out, I was enormously relieved," Edwards said Friday in a telephone interview from her Chapel Hill home. She was there taking a break from the campaign to spend time with her youngest child Jack, 6, who has a stomach bug.

Tests indicate that Edwards' cancer feeds and grows in response to both estrogen and progesterone. As breast cancer diagnoses go, it's not a bad one.

Some of the most powerful advances in care during the past decade include drugs that foil tumors' ability to take in estrogen, considered the most important driver of hormone-responsive breast cancer.

Ten years ago, there was a single drug for such a cancer -- tamoxifen. Today there are five, including three in a new class of drugs called aromatase inhibitors, which reduce the amount of estrogen a woman produces.

Edwards, who had been taking tamoxifen until her recurrence was discovered, is now taking an aromatase inhibitor called Femara, which is a once-a-day pill. Edwards also has had an initial infusion of an intravenous bone-builder that she now will get monthly, most likely at UNC Hospitals in Chapel Hill. That treatment represents state-of-the-art care for women with advanced disease.

The new details about Edwards' illness may help quiet questions about the wisdom of balancing the pace of a presidential campaign with a battle against terminal cancer. Edwards said continued fretting over the effect of a campaign on her health is unwarranted.

"My normal days for the past few years have been packed with an incredible amount of activity," Edwards said. "I know some people would find it daunting, but it's actually a schedule with which I feel pretty comfortable."

Edwards' treatment regimen should not prevent her from continuing her normal activities, according to cancer doctors who are not directly involved with Edwards' care.

Unlike chemotherapy, which can leave patients exhausted and struggling with symptoms such as hair loss, mouth blisters and nausea, drugs such as the one Edwards is taking have few or no side effects in most patients. The aromatase inhibitors, which include Edwards' drug, Femara, and the medicines Arimidex and Aromasin, do not weaken a patient's immune system.

"Assuming things work, this is a very easy treatment," said Dr. Alan D. Kritz, a Raleigh oncologist who practices with Cancer Centers of North Carolina, one of the state's largest private oncology practices. "I don't think being on the campaign trail is going to affect her one bit. Really, she ought to be able to continue to function 100 percent. She can go around kissing babies and shaking hands and all that."

Dr. Kim Blackwell, an oncologist at Duke University Medical Center who specializes in breast cancer, agrees. Blackwell said that if Edwards is managed as other patients are, she will need to return to the hospital only about every few months for scans to determine whether therapy is shrinking her cancer, or at least keeping it from growing.