Breast cancer and bone health

Does breast cancer affect bone health?

It is very likely that there is a connection, according to Dr. Ethel Siris of Demarest.

Just before she headed off to her grandson’s bar mitzvah in Jerusalem, Dr. Siris spoke to the Jewish Standard about the groundbreaking study on breast cancer and osteoporosis that she is co-leading at Soroka Medical Center in Beersheva.

Dr. Siris (pronounced like “Cyrus”) is a professor of medicine at Columbia University Medical Center and directs its Toni Stabile Osteoporosis Center. She also is a past president of the National Osteoporosis Foundation and a member of the National Bone Health Alliance’s executive committee.

“I do some public policy work and take care of a lot of patients,” she said.

She shares some of these patients with Dr. Larry Norton, medical director of the Evelyn Lauder Breast Center at Memorial Sloan Kettering Cancer Center.

Breast-cancer patients always have been assumed to be less susceptible to osteoporosis, and vice versa. “This simplistic concept did not account for the fact that many of our patients had both breast cancer and osteoporosis, and we needed to look at this,” Dr. Siris said.

Although long-term medications to control breast cancer can lessen bone density because they lower estrogen levels, Dr. Norton suspected that breast cancer itself impacts bone metabolism.

So with funding from the New Jersey-based Cure Breast Cancer Foundation, a retrospective study of 15,000 breast-cancer patients began in 2010 at Soroka, which serves all of southern Israel. Preliminary results were published in the journal PLOS One, and the study moved into a seven-year prospective phase.

“The retrospective study taught us that when people with breast cancer have fractures, those fractures seem to occur at better levels of bone density. Normally, the risk of fracture goes up as density goes down,” Dr. Siris said.

“It seems breast-cancer patients had better bone density than peers who did not have breast cancer. Something unusual is going on here, and it also happens in people with type 2 diabetes and those who take large amounts of steroids.

“It could be that density alone does not address the quality of the bone. Steroids and diabetes, and maybe breast cancer, impact the quality of the bone even if it is dense and does not have metastases. This is a totally new concept, and a complicated, fascinating area to explore.”

The Israeli hospital’s diverse population of Jews from different ethnicities, as well as Bedouin Arabs, provides an unusually rich testing environment.

“Soroka was carefully chosen for this research,” Dr. Norton said when he was visiting Israel in April with colleagues, including Dr. Siris, for a cancer conference at the Beersheva teaching hospital.

“It is one hospital serving many people in one geographic area; it keeps immaculate records; it has superb clinicians and great science; and it has Ben-Gurion University right there.”

The “immaculate records” can be credited in part to the Israel Health Foundation, formed in America at the request of Israel’s Clalit health maintenance organization, which runs Soroka and other hospitals.

“Healthcare in Israel is wonderful because everybody gets it, but resources are limited,” Dr. Siris said. “I enthusiastically got involved in the IHF, and one of the efforts is to support Soroka. We now have good electronic medical records there partly as a result of the IHF.”

Years ago, as a member of American Friends of Soroka Medical Center, Dr. Siris helped raise funds to buy bone-density equipment for Soroka. She recognized its potential for U.S.-funded research.

Hundreds of women newly diagnosed with breast cancer at the southern hospital are being matched with cancer-free control partners who have similar clinical characteristics.

“We will collect data on them so that over time we can look at what happens to their bone density and what correlates with ultimately having fractures,” Dr. Siris said.

Cure Breast Cancer Foundation founder Andrew Abramson of North Caldwell, whose wife Lisa has suffered three bouts of breast cancer, says this is the first Israeli study his foundation is supporting.

“It was a byproduct of research we’re done in New York with Dr. Siris,” he said. “My wife is on the verge of osteoporosis, so she could very well be helped by the results of these studies.”

Dr. Siris first got interested in Israeli healthcare when her son, Benjamin (Boruch) moved to Israel in the late 1990s. She and her husband, Sam, a psychiatrist, began visiting several times a year.

“We wanted to give back, so when IHF got organized it was an obvious opportunity for me to share knowledge and expertise with the excellent people in Israeli healthcare and raise some money for them,” she said. “The current study is an example of how the IHF’s efforts are helping to do good things in Israel and will help others around the world.”

Dr. Siris notes that her son was hosted in Teaneck and Bergenfield homes several years ago, when his first wife was being treated at Sloan Kettering for osteosarcoma, or bone cancer. After she died, he wrote a book called “Noa’s Strength,” using the name Boruch Sirisky. It was published by Mosaica Press. In the book, Benjamin Siris expresses his gratitude to these Bergen County families.

He has since remarried and now has four children. The eldest just celebrated his bar mitzvah, and his New Jersey grandparents were proudly in attendance.

The Sirises also have a daughter, Sara Siris Nash, a psychiatrist at Columbia University Medical Center.