Breast cancer is a treatable and highly curable illness if detected early and treated appropriately. Many people equate cancer treatment with chemotherapy, and while it is commonly used, chemotherapy is a less specific form of therapy than other options and more toxic. Chemotherapy is not selective — it can kill cancerous cells but may also harm healthy ones.
Not all patients benefit from chemo. Therefore, depending on the type and stage of breast cancer, other treatment options may include surgery, hormonal and targeted therapy and radiation.
The most common variety of breast cancer is the kind that feeds on estrogen, referred to as estrogen receptor or hormone-positive. Hormonal therapies are frequently effective in treatment of this disease and are prescribed for most patients with all disease stages.
Other less common types of breast cancer include the HER2-positive and triple-negative varieties. HER2-positive breast cancer responds to targeted drugs such as Herceptin (trastuzumab), but triple-negative breast cancer is typically more difficult to treat because of the absence of a specific target. For triple-negative cancer, chemotherapy is the only treatment option.
More detailed tumor gene profiling can help categorize the risk of disease — for example, whether the cancer is at risk for metastasis — and whether chemotherapy can be avoided in some instances. These tumor profiling tests are performed on a small amount of the tissue removed during the original breast cancer surgery. Some of these tests, such as Oncotype Dx and Mammaprint, are being increasingly used to help individualize therapy.
Other advances in breast cancer research may soon allow us to profile individual patient tumors and find the appropriate targets to treat the patient specifically, rather than indiscriminately.
Recently published findings from the Cancer Genome Atlas project are painting clearer portraits of what individual breast cancers look like at the molecular level, including what "druggable" or "actionable" genes are present in each individual tumor. The excitement is palpable in the research world and is likely to radically change how we do cancer clinical trials and treat patients in the very near future.
These findings, along with the recent FDA approval of a plethora of targeted cancer drugs, will tremendously expand our options for treatment of patients with breast cancer, especially those with metastatic disease.
In October, we get to highlight achievements and spread the word about new and exciting developments in breast cancer, but breast cancer awareness is a year-round affair for researchers and physicians.
We have always talked about the future of cancer care. The difference now is that the future is in our lifetime.
Dr. Suleiman Massarweh is a breast oncologist and researcher at the UK Markey Cancer Center.