More women than ever before are winning the fight against breast cancer, thanks to dramatic improvements in early detection and treatment. And for the most part, long-term survivors enjoy an equally good quality of life as women who have never had the disease, according to a new study published in Journal of Clinical Oncology.
“One of the most important advances is the ability to tailor treatment based on the risks and benefits for that specific patient, leading to better outcomes and fewer side effects,” says Jame Abraham, MD, FACP, director of the breast oncology program at the Taussig Cancer Institute, Cleveland Clinic.
“We used to consider all breast cancer the same, but now we know it’s actually at least 10 different diseases,” each with its own genetic signature and weak spots, adds Dr. Abraham. That groundbreaking discovery has spurred development of highly targeted drugs for certain breast cancer subtypes and has helped patients avoid ineffective treatments.
Here’s a look at breakthroughs that are transforming breast cancer care, including new ways to prevent the disease, which strikes one in eight women over a lifetime.
Women ages 35 or older who are at increased risk for breast cancer should discuss with their doctor the potential benefit of taking one of two FDA-approved medications to combat the threat, according to new recommendations from the U.S. Preventive Services Task Force (USPSTF). The selective estrogen receptor modulator drugs tamoxifen and raloxifene have been shown to cut a woman’s risk of developing breast cancer by interfering with estrogen’s effects on breast tissue. However, because the drugs can cause blood clots and other serious health issues, the USPSTF warns that the potential negative side effects outweigh the benefits for women at average risk for breast cancer.
An FDA panel has recommended accelerated approval of Perjeta as the first drug for pre-surgical treatment of early-stage breast cancer. In clinical trials, women with early-stage HER2-positive breast cancer were 18 percent more likely to be cancer-free after 12 weeks than those who received other cancer drugs. The FDA approved Perjeta last year as a therapy for aggressive breast cancer that had spread to other parts of the body. Doctors hope that using the new drug during the earliest stages of the disease will shrink tumors, making them easier to remove, or even help some women avoid mastectomies.
After suspicious mammogram results, many women have the scary experience of additional tests, some of which could be unnecessary. A new study published in Lancet Oncology found that adding 3D digital breast tomosynthesis to standard 2D breast X-rays could reduce stress-inducing false alarms (results that look like cancer, but aren’t) by 17 percent, without missing any actual cancers. The study included 7,292 women who were screened with both methods to see which one worked best. The FDA-approved 3-D technique, available at about 300 US centers, was hailed as one of the top 10 medical innovations for 2013 by the Cleveland Clinic.
Every year, more than one million American women undergo breast biopsies, but only about 20 percent of them have cancer. A new FDA-cleared device, the Aixplorer Ultrasound System, could reduce unnecessary biopsies by helping doctors tell which lumps are malignant. In a 2012 multi-center study, the device correctly classified 78.5 percent of suspicious breast lumps analyzed, compared to 61.1 percent accuracy when conventional ultrasound was used. The Aixplorer measures tissue stiffness. (Stiffer tissue is more likely to be cancer). The technology’s 3D images could also be helpful for screening women with dense breast tissue for cancer, since mammography doesn’t work very well in such patients, says Jacque Souquet, PhD, founder and CEO of SuperSonic Imagine, the device’s manufacturer.
The FDA has cleared a new test that calculates the 10-year risk that a woman with certain types of early-stage breast cancer will suffer a recurrence. Intended only for patients who have undergone standard surgical and oncological treatments, the test analyzes cells from the woman’s tumor to check for 50 genes involved in the growth and spread of cancer. It then classifies the woman’s risk of cancer recurrence from low to high. The test is expected to be widely available in clinical laboratories in early 2014, and is currently being studied to determine if it will affect doctors’ treatment recommendations.
Cleveland Clinic researchers have discovered that a single vaccination can prevent breast cancer in mice that are genetically predisposed to the disease. The center plans to test the vaccine in humans, with clinical trials expected to begin in 2015. The first clinical trial will include women with the highly agressive triple negative breast cancer (TNBC) who have recovered from standard treatment. A second trial will include healthy women who have undergone mastectomies to lower breast cancer risk, as Angelina Jolie recently did.
This form of the disease is tough to treat because it lacks the three receptors that fuel most breast cancer growth. As a result, TNBC doesn’t respond to conventional targeted therapies. While the disease can sometimes be treated effectively with chemotherapy, it remains the most deadly form of breast cancer. Large genetic studies have revealed that TNBC has molecular similarities to certain ovarian cancers, a discovery that could lead to new therapies. Additionally, researchers have identified several promising new targets that are now being studied in clinical trials, a new paper published in Oncology reports.
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