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By Jacqueline Lisk
| October 15, 2019
This article is a part of BG BrandLab’s Breast Cancer Special Report, assessing the progress we’ve made in the battle against breast cancer and the barriers that we still need to overcome.
If Boston-based research is any indication, the future of breast cancer treatment in the U.S. will include continued advancements in early detection, more effective treatments, and more personalized and precise care. Medical facilities, research centers, laboratories, and universities in the Boston area are leading the way, investigating new treatments, as well as new methods for determining and delivering the right treatment to the right patient, and for reducing disparities in patient care.
Researchers have made progress in their understanding of genes, the use of targeted drugs, and their ability to detect cancer early, to name just a few advancements. Immunotherapy is a treatment that stimulates a person’s immune system to fight diseases such as cancer, and Dr. J. Leonard Lichtenfeld, interim chief medical and scientific officer for the national office of the American Cancer Society (ACS), believes we are just beginning to see its potential impact on reducing cancer death rates.
He also noted that raising awareness about cancer risk factors and encouraging people to make healthier life choices would markedly reduce cancer and cancer deaths.
Fighting cancer with light
Dr. Darren Roblyer, associate professor of biomedical engineering at Boston University, is leading research that uses optical imaging to predict how well chemotherapy (chemo) will treat breast cancer—earlier than previously possible. His work is funded by a grant from the ACS.
Robyler’s lab is leading a clinical study for women receiving neoadjuvant chemotherapy—chemo administered to shrink a tumor before radiation or therapy. Roblyer explained that while neoadjuvant chemotherapy is effective for some patients, it has no noticeable effect on the tumor for 20 percent of people. (He called this group the “non-responders.”) That means these patients are undergoing grueling treatment, for no apparent benefit.
In a 2011 study, Roblyer found that by using near infrared light to measure what was happening inside tumors, they could identify who was responding and who wasn’t within the first week of therapy. That study was retrospective, meaning they compared measurement data to outcomes. Now, they hope to validate the work in a new clinical study using a wearable probe, a more patient-friendly version of the handheld medical device used in past research. The wearable probe makes it easy to measure patients at a lot of time points in a way that is hard to do with an MRI or PET scan.
The ability to assess if chemo is working quickly, and then adapt the treatment plan accordingly, would be transformative, Roblyer says.
Cancer and genes
Boston-area researchers are also working to improve our understanding of genetics in cancer. Earlier this year, the American Society of Breast Surgeons released a statement suggesting genetic testing be available to everyone diagnosed with breast cancer. Dr. Huma Rana, a physician and clinical director, Cancer Genetics and Prevention at Dana Farber explained this statement caused controversy because it is a departure from previous recommendations, and because is hard to execute, since there is a shortage of genetic specialists in the U.S.
But, she believes cancer care is heading in this direction. “We are currently studying efficient and novel ways to identify people who harbor germ line mutations or hereditary risks for cancer so we can make the right treatment decisions upfront,” she says.
Genetics informs not only how we treat breast cancer, but also how we screen for it. Regina Barzilay, a professor at M.I.T. and co-lead of the Abdul Latif Jameel Clinic for Machine Learning in Health, or J-Clinic, noted that today’s breast cancer screening methods, while critical, are not nuanced enough.
All women of a certain age are screened the same way, and women with high breast density are categorized as high-risk. That is 42 percent of the population, she says. The goal of her work is to create more accurate and precise risk assessment models that can analyze myriad factors, including images from mammograms and MRIS, to assess the likelihood of a woman developing breast cancer. Then, based on that likelihood, patients and their doctors can take appropriate next steps.
“Right now, 85 percent of women who develop breast cancer don’t have a clear family history. For most of them, the diagnosis is a surprise. Our hope is if we can identify it much earlier, we can be proactive in treatment,” says Barzilay.
She described “Amazon-level personalization,” in which clinicians detect breast cancer and determine effective treatment as effectively as Amazon makes personalized product recommendations based on factors like previous purchases. “If we can collect more information via measurements, imaging, genetic testing, and more, we can create a model for truly personalized treatment.”
Barzilay is a survivor herself. Before her diagnosis, she had never worked with medical data. She credited Dr. Constance Lehman, head of breast radiology at Massachusetts General Hospital (MGH), and Kevin Hughes, an oncology surgeon at MGH, for sharing her vision for using AI to advance cancer research. “It is not all about computer science—this wouldn’t be possible without partnership with clinical doctors,” she noted.
Removing barriers to care
Beyond the science of cancer and cancer treatment, some medical professionals study clinical integration—”the means to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused,” as defined by the American Medical Association. Dr. Rachel Freedman, a practicing breast oncologist at Dana-Farber Cancer Institute, co-chair of the Boston Breast Cancer Equity Coalition, and an ACS-funded researcher, says this research area doesn’t always get attention, but it is incredibly important.
One example is Translating Research into Progress (TRIP), a five-year grant that aims to improve the delivery of quality breast cancer care among vulnerable patients through a coordinated delivery model. The program includes a patient navigation network, in which patients partner with navigators who strive to identify barriers to care, develop plans to overcome these barriers, and help patients coordinate and manage their care. White, middle-aged women have benefited tremendously from advances in breast cancer treatment, but other populations are not feeling the effects to the same degree. Freedman hopes projects like these will help ensure the future of breast cancer means better care—for everyone.
Rana noted there is also disparity in access to, and uptake of genetic testing. “The rates at which people who are eligible for genetic testing are referred for genetic counseling or testing is abysmal, but even worse in communities that have overall less access, such as minorities and people in rural areas,” she says.
Dr. Karen Freund, vice chair for faculty affairs and quality improvement at Tufts Medical Center and a professor of medicine at Tufts University School of Medicine also studies how patient navigators can be used to address disparities in care. “We can do so much to reduce cancer deaths in this country if everyone gets access to the same quality care,” she says.
Getting it earlier
Early detection reduces cancer death rates. Mammograms are invaluable, but they evoke fear for many women. Researchers are trying to develop a blood test for breast cancer which could someday serve as a replacement or supplement to mammograms, says Freund. Researchers are also working to develop vaccines for preventing cancer. For example, the HPV vaccine is already in use and reduces the risk of cancers of the mouth and cervix.
This is just a smattering of the research underway to improve the way cancer is detected, treated, and perhaps even prevented. Clinical trials are happening all over Boston.
Freund stressed there is a lot of reason for hope. “We have made huge strides, and this progress will continue.”
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