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By Zach Giordano
| September 19, 2017
The numbers are still staggering. In 2017, an estimated 252,710 women—more than the populations of Cambridge and Lowell combined—will be diagnosed with breast cancer. Who among us doesn’t have at least one person in our lives, a mom, friend, daughter, grandmother, or husband (yes, it strikes men, too), who’s been diagnosed with breast cancer.
But there’s another side to this story: The outlook for these patients has never looked more promising.
“We’ve seen considerable improvement in the outlook for breast cancer patients,” says Dr. Arnold Baskies, chairman of the American Cancer Society Board of Directors. “Since the late 1980s, breast cancer mortality has declined 38 percent.”
Medical and technological advances have had a big impact, with improved early detection and prevention techniques also playing a critical role.
The history of breast cancer treatment—inclusive of all the successes and failures, risks and breakthroughs—is a long story, co-written by many of the most brilliant minds in history. And more minds are working today on the breakthroughs of tomorrow.
The beauty of scientific progress like the kind that’s defined the history of breast cancer treatment is that it builds, gradually and continuously, from one scientist to another, across labs and across generations, accumulating facts and findings like a rolling ball of snow.
For breast cancer, multiple generations of researchers took part in the discovery of one of the most profound insights for the treatment of the disease: the notion of personalized medicine.
“The way I think of it is, in 1985, we had one kind of breast cancer,” says Dr. Otis Brawley, chief medical officer of the American Cancer Society. “Over the years, we’ve learned to think of breast cancer as a number of different types of breast cancer with a number of different prognoses and a number of different treatments.”
Depending on a patient’s specific tumor markers, going as minute as certain changes in their DNA, doctors can prescribe a patient’s treatment like a tailor would prepare a businessman’s suit—to their exact specifications. A patient’s markers dictate how doctors radiate their breast cancer as well as what chemo or hormonal therapies might be best.
As personalized medicine has evolved into the standard treatment approach, more and more cancer researchers have found that their findings go beyond one specific cancer or another; it all boils down to the building blocks of life.
A cellular focus
In his lab in Charlestown, Dr. Johnathan Whetstine, a Tepper family Massachusetts General Hospital research scholar and associate professor of medicine at Harvard Medical School, and his lab are looking into cells, both normal and cancerous, in search of things that influence our cells and DNA.
However, across years of research, something interesting happened: Dr. Whetstine and his team started their research focused on lung cancer, but, as their findings evolved, refocused after realizing their results directly impacted the treatment of breast cancer.
In cancer research, this is typical. As researchers study deeper into the cell, the body part or organ system where that cell lives becomes less important. What’s more important is what happens to cells on a molecular level, like what mutations are present, what gene changes occurred, and what reactions cells have to certain drugs. All of this provides insight into the treatment of cancer.
“We know certain things, like how changes in our DNA are selected, are a major feature of resistance [to medicine] in aggressive cancers, whether they be breast, lung, or a variety of others,” says Dr. Whetstine.
The future is now
One key area of focus now in breast cancer treatment is finding a better alternative to mammography. Currently, mammograms reduce the relative risk of death by close to 20 percent — still leaving room for improvement.
This has led to the creation and implementation of tomosynthesis. Essentially a scan of the breast that takes multiple images to form a 3D composite, tomosynthesis allows doctors to examine the breast from multiple angles. This eliminates the risk of not detecting something that might be hidden by tissue in a standard digital mammogram.
Just this past August, the FDA approved a gene-altering therapy for treatment of childhood leukemia. This treatment is aimed at reprogramming a patient’s own cells to attack cancer. The success of this cellular defense approach to cancer treatment could lead to major breakthroughs for the future of overall cancer treatment. The next step would be to adapt this approach to solid tumors — like breast cancer.
And this could happen sooner than most realize: According to the Alliance of Regenerative Medicine, there are currently 34 gene therapy treatments in the final stages of testing necessary for FDA approval, with hundreds more in clinical trials. While not all of these treatments are aimed specifically at cancer, the more scientists learn about gene therapy, the more optimistic we can be about the treatment of certain rare or life-threatening diseases overall.
Overall, the more researchers and scientists learn, the more hungry they become to apply their results or train their successors in the field to carry their mantle forward. Whether studying the disease on a cellular level, improving access to technologies for screenings, or enlightening patients about the methods of prevention, one thing, as Dr. Baskies has said, is certain:
“Have no doubt about it, we’re attacking cancer from all sides.”
To donate to the American Cancer Society or sign up for a walk, visit www.makingstrideswalk.org/bostonma.