Breast Cancer Advances: Prevention, Diagnosis, Treatment and Research
Breast cancer is one of the more visible cancers in the United States today. Research is rampant; thanks to fund-raising efforts by numerous private organizations, foundations, biotechnology and pharmaceutical companies, American Cancer Society and Federal grants, totaling well over a billion dollars a year. National Cancer Institute alone spent $630 million on breast cancer research in 2010. Additionally, enhanced public awareness and media presence sparked by prominent celebrities such as Angelina Jolie has given a much needed new footprint to this age old devastating ailment.
The survival statistics, although improved, still leave much to be desired. Breast cancer incidence rates started declining in the year 2000, possibly due to increased awareness of the association with supplemental hormone therapy after menopause. This was well substantiated by Women’s Health Initiative study published in 2002. We slowly reached a five year survival rate of 90% in a few decades, but have plateaued there. Regretfully, we are still losing about 10% of the afflicted women. In the year 2013 for instance, 232,340 new cases of invasive and 64,640 cases of non-invasive female breast cancer will be diagnosed in the United States alone, with a staggering 39,620 expected deaths.
So what is new and cutting edge in the field?
For the sake of simplicity, we will divide female breast cancer into Prevention, Diagnosis, Treatment and Research. Large randomized trials have been done to establish all of the facts.
1. Prevention: There are proven beneficial and cancer-protective effects of low fat diet, exercise, normal Body Mass Index, avoidance of estrogen supplements and tobacco, modest or no consumption of alcohol and normal circadian rhythm if possible. The additional risk factors of family history, genetic mutations, ionizing radiation exposure and advanced age are unfortunately unavoidable.
2. Diagnosis: Offering annual mammograms to average risk women ages 40 and above has been the single most important step forward in early diagnosis and timely curative treatment for the majority. Higher sensitivity digital mammograms, 3D mammograms, ultrasound and MRI have greatly improved the breast cancer detection today, albeit with the attendant false positives.
3. Treatment: After an accurate staging, surgery with or without radiation is the first step followed by systemic therapy. Depending upon the unique composition of receptors, markers and genetic expression of each individual cancer, we can customize the treatment to cytotoxic chemotherapy, anti-estrogen therapy, anti-Her-2 therapy or any combination. Oncotype-Dx, Immunohistochemistry, FISH (Fluorescent In-Situ Hybridization) for Her-2 receptor and BRCA 1/2 are some of the exciting tools that are used for that determination.
4. Research: Even though prevention and early diagnosis should be on the forefront of cancer eradication, no major breakthroughs seem to be on the horizon. This leaves us with Treatment becoming the most important variable of interest. Indeed a plethora of new research focuses on difficult to treat subtypes such as the highly aggressive and lethal triple receptor negative breast cancer found mainly in young women of minority. Newer class of drugs called PARP (Poly ADP Ribose Polymerase) inhibitors in various combinations are currently being studied for these resistant cancers, as are angiogenesis inhibitors, ravaging young women,.
As per FDA new drug approvals for breast cancer, here is the list of the new drugs:
*Ado-trastuzumab emtansine (KADCYLA) is a targeted therapy for Her-2 positive advanced breast cancer. Approved Feb 2013
*Everolimus (Afinitor) in combination with Exemestane (Aromasin) for estrogen receptor positive (and Her-2 negative) breast cancer in postmenopausal women progressed on aromatase inhibitors. Approved July 2012
*Pertuzumab (PERJETA) is another targeted treatment for Her-2 positive advanced breast cancer as first line treatment. Approved June 2012
With 2.9 million breast cancer survivors in the United States alone, we have come a long way but need to remember the 40,000 additional women that still need to be saved each year from breast cancer. Hopefully the scientists will one day unlock and destroy the responsible gene, rendering the world cancer free.
Dr. Archana Maini, Broward Health Medical Center, can be reached at (954) 355-4975.