Genetic codes. Oncotype DX testing. The role of environmental toxins. New interest in the immune system. Cutting-edge research in breast cancer is taking place in a rapidly expanding variety of fields, from molecular to medical to surgical oncology. It can be hard to get a handle on it all.
The result: women facing a diagnosis today face a much more personalized or individual approach, with testing and treatment options tailored to their own biology, type and sub-type of cancer, stage of growth and family history.
“With time, I am certain this new approach will positively affect survival rates, but already we are minimizing the need for chemotherapy following initial surgical treatment,” says Dr. Katherina Zabicki Calvillo, associate director of the Breast Center, Dana Farber/Brigham and Women’s Cancer Center in clinical affiliation with South Shore Hospital in Weymouth (Mass.).
The latest clinical trials are only a click on a website away: clinicaltrials.gov is recommended by advocates and physicians as the best centralized source, maintained by the National Institutes of Health. And the websites of many community hospitals have links to clinical trials they are participating in.
“Physicians in the community have point-people in the academic centers, and we go out to attend tumor boards at the community level,” Calvillo said. “People can always come into Boston for second opinions and then go back out to their community for ongoing clinical work.”
Dr. Eric P. Winer, director of the Breast Oncology Program at the Susan F. Smith Center for Women’s Cancers at Dana-Farber Cancer Institute, also traced significant changes over the past 12 years.
“We no longer think of breast cancer as one disease, but as a family of four or five distinct types of diseases, each with a different personality,” he said. “We can have a much more detailed understanding of the underlying biology. Our ability to apply that knowledge to the clinical trials we have underway has advanced incredibly.”
Oncologists are also learning more about why the same types of cancer act so much more or less aggressively in different people.
A range of factors, Winer said, are thought to influence why one woman will deal better, from a biological standpoint, with a cancer and its response to treatment — why her disease does not recur or is not as aggressive if it does recur, after the initial treatment.
That has sparked renewed interest in the immune system. “Some of this is very new,” he said. “Something in our immune system has allowed us to create the cancer (the unregulated growth of cells) and something allows some people, with treatment, to enhance their ability to contain that cancer.”
The new genetic code information is helping doctors target which types of cancer will respond to which chemotherapy.
Page 2 of 2 - “The problem with drugs that are thought to prevent cancer can be you end up having a lot of people taking a drug to prevent something that never does develop anyway,” Winer said.
A steady source of research funding for Massachusetts medical centers and other institutions has been the Susan G. Komen for the Cure. Ronni Cohen-Boyar, executive director of Komen MA and a breast cancer survivor, said that this year, $4.7 million in new funding will go to Dana-Farber Cancer Institute and Harvard Medical School to research on environmental factors that influence breast cancer development. Other Komen research grants in Massachusetts are looking at gene mutations, treatments and preventing recurrence.
“The most exciting work going on now is the move towards personalized treatment - getting at the root cause of each individual tumor, what is causing it to occur, why some tumors are receptive and some resistant to chemotherapy, who needs treatment, at what point, when we are over treating versus when we can get to the early stages,” she said.
The Massachusetts Breast Cancer Coalition recently announced a new video series, MBCC Research Updates, designed to present the facts about environmental health and breast cancer prevention. Each short video features an interview with a researcher, medical professional, university professor, breast cancer activist or other prominent figure in the field.