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Breat strides in breast cancer research continue to shake up the medical field and change treatment options. Recently four genetically distinct types of breast cancer were identified in a research study that was part of a large federal project, the Cancer Genome Atlas, tasked with building maps of genetic changes in common cancers. The four major types of breast cancer are basal-like (also called triple-negative), luminal A, luminal B and HER2-enriched (Human Epidermal Growth Factor Receptor 2). These four groups are based on whether each tumor has or does not have estrogen and progesterone receptors or HER2/neu (another tumor marker/oncogene).
The discoveries published last month in the journal Nature, and also reported in The New York Times, were based on an analysis of tumors from 825 patients and focused on the most common types of breast cancer that are thought to arise in milk ducts and have not yet spread to other parts of the body. The results are expected to lead to new treatments with drugs already approved for cancers in other parts of the body and new approaches for precise treatments.
While clinical trials will be needed to further explore the findings of this study, local physicians were asked if the way they treat cancer will change. “This has been evolving and for years we have been treating breast cancer differently depending on the molecular protocol,” says Jeffrey J. Kirshner, M.D., partner and director of research at Hematology Oncology Associates of Central New York. “Our research studies take the biology into account.”
Kara Kort is associate professor of surgery and director of the Patricia J. Numann Breast and Endocrine Surgery Center, both at SUNY Upstate Medical University. “In many ways these new research findings don’t really surprise me,” she adds. “Those of us familiar with breast cancer treatment and who see a lot of breast cancer patients treated have realized for awhile that not all cancers respond the same way to chemotherapy.”
As a result, she sees individualized treatment of women’s cancers in the future being based more on the biology of their cancer, not just prior criteria such as size of the tumor and if lymph nodes are involved. Further, she suggests that the results of the study will allow better tapering and individualized treatment of each woman’s cancer with likely better outcomes. She cites as an example two different types of cancer that are both 2 centimeters with one affected lymph node. Currently they might be treated with similar chemotherapy after surgery.
But Kort thinks that will change as we see more closely how differently these tumors “behave.” The impact of these changes or the outcomes will likely be many years down the road. “Major changes in treatment like this require thousands of women in clinical trials and years of follow-up and analysis of the results before any conclusions can be drawn.”
As breast cancer research continues, healthcare providers also encourage education about healthy lifestyle practices that may reduce breast cancer risk and recurrence. “Limiting alcohol may lower the risk of breast cancer and avoiding prolonged postmenopausal estrogen treatment,” explains Kirschner. “Nothing else has been proven to decrease the risk of developing the disease.”
Kort agrees that alcohol consumption is associated with increased risk of cancer. “Even apparently three to six drinks per week increases breast cancer risk slightly and heavier drinking more so. This, however, has to be weighed against the potential cardiovascular benefits of moderate drinking.”
“Weight, being moderately overweight, has been found to be associated with a higher chance of a woman’s breast cancer coming back,” she adds. “I think most of us try to encourage routine exercise and healthy eating with our patients. Discussing weight during cancer treatment and even follow-up can be tough. Weight gain or inability to lose weight is probably the biggest complaint I hear from my patients.
“It’s tough: a huge national problem and a delicate topic at times to address. It is unfortunate because there is even some evidence that basic exercise and physical activity can reduce breast cancer risk.”
Lisa Smith, regional vice president for the American Cancer Society’s Central New York Region, also commented on the new research findings. “Perhaps the most important message from this research is to confirm that we are seeing the fruits of decades of research,” she says. “At the same time, the very support for that research is in jeopardy due to decreases in government funding, business investment and private philanthropy.”
She encourages Central New Yorkers to help fund cancer research through the myriad fundraising events in the area, and to contact legislators to make funding cancer research a priority. “Without money for research, the research findings from this study may not move forward.”
For example, 5,600 Central New Yorkers gathered for the Sept. 30 American Cancer Society’s Making Strides Against Breast Cancer walk in Clinton Square, raising $340,000 for breast cancer education, services and research. Smith thanks Making Strides walkers and supporters, “who can be proud that their efforts are helping 2.6 million breast cancer survivors living in the Unites States celebrate another birthday this year.”
Anyone wishing to support the American Cancer Society and add to the total raised by Syracuse’s Making Strides Against Breast Cancer event can donate online by visiting makingstrideswalk.org. For more information about breast cancer, contact the American Cancer Society at (800) 227-2345 or visit cancer.org.
Marnie Blount-Gowan is a member of the Crouse Hospital Integrative Health Alliance, which advocates mind-body health awareness, and editor of realewell.com. She can be reached at realewell@gmail.com.
