Chances are we all know someone who has had breast cancer. The most common cancer to afflict women, it accounts for 29 percent of all cancers suffered by women, followed by lung cancer at 14 percent and colorectal at 9 percent.
The pink ribbon designating support of breast cancer research is ubiquitous, so we know there’s lots of research ongoing as doctors and scientists look for a cure.
But how close are we to finding one? And will we be much closer by 2015?
Not very likely, says Marisa Weiss, president and founder of breastcancer.org and director of breast radiation oncology at Lankenau Medical Center of Main Line Health.
“There are some kinds of diseases where there’s just one type of problem, but with many cancers, including breast cancer, there are many different kinds of cells. That means you need different forms of treatment that work in different ways.”
Cancer starts out with one cell, but each time you get a new generation of cells there are variations between them that make them different from each other, she explains. “One treatment could knock out one cell population. But if the remaining cells grow back and occupy that space, then you haven’t gotten anywhere,” she says.
In reflecting on the progress made on the path to finding a cure for breast cancer, Dr. Susan Domchek suggests it may be more useful to discuss progress in different tumor types. “Mortality from breast cancer has slowly been falling, so we are making progress in this realm,” says the executive director of the Basser Research Center at the Perelman Center for Advanced Medicine/Hospital of the University of Pennsylvania.
“For example, HER2/neu positive breast cancer used to be the worst type with the highest mortality. But the development of drugs like Herceptin and tykerb has led to a significant increase in survival in those patients.”
The National Cancer Institute estimates that over 226,000 women will be diagnosed with breast cancer in 2012, and that over 39,000 will die from the disease. By contrast, ovarian cancer, which accounts for 3 percent of cancers to afflict women, will occur in 22,000 women this year alone.
The numbers can be overwhelmingly frightening. So it makes sense to look at how far we’ve come in the quest for a cure, agrees Dr. Paula Ryan, director of Breast and Ovarian Cancer Risk Assessment at Fox Chase Cancer Center in Philadelphia.
“There are several different molecular subtypes of breast cancer and we’ll likely discover more in the future,” she says. “This discovery has allowed us to develop drugs that specifically target these subtypes.”
In 2005, a significant advance came in the form of Herceptin, a drug also called trastuzumab. “It’s an antibody that recognizes HER2, a protein that is present in large amounts on some breast cancer cells,” Ryan says.
Patients with HER2 positive breast cancer are treated with trastuzumab and chemotherapy, and this reduces their risk of cancer recurrence by 50 percent.
Ten years ago, a class of drugs called aromatase inhibitors proved very effective in reducing the risk of recurrence in postmenopausal patients with tumors that have estrogen and progesterone receptors, she adds. And over the past year, two new drugs have been approved for treating metastatic breast cancer.
“One, pertuzumab, in combination with trastuzumab and chemotherapy, benefits patients with HER2 positive tumors,” Ryan says. “The other, everolimus, is a drug that works effectively in combination with an aromatase inhibitor to treat hormone receptor positive breast cancer.
“These key discoveries have been added to our armamentarium of targeted agents. Also, new chemotherapy agents such as eribulin have been added to our collection of chemotherapy drugs that are effective in breast cancer.”
Today research is focused on triple negative breast cancers, or breast cancers that are negative for estrogen receptors, progesterone receptors and the HER2/neu receptors. “These triple negative breast cancers have the worst prognosis,” says Domchek. “So we have to develop specific drugs to target those cancers.”
The Basser Research Center is tasked with examining women who have BRCA 1 and BRCA 2 mutations, mutations that are much more common in women with an Ashkenazi ancestry. “Breast cancer is the most common cancer, but ovarian, prostate, pancreatic and male breast cancer all occur from BRCA 1 and BRCA 2,” she says.
For carriers of BRCA 1 and BRCA 2, the risk of cancer is as high as 45 percent. Domchek and her team of 10 principal investigators are trying to develop drugs that target why a cancer develops. “Parp inhibitors have been shown to have some effect on cancers that occur in BRCA 1 and 2 mutation carriers, regardless of the kind of cancer that occurs,” she says.
“The point of this research center is to kick start things and ramp up the research. We want to have many better options for women so they don’t get breast and ovarian cancer,” she reflects. “And if they do, to make sure they’ll survive it.”
Lankenau Medical Center is focused on a public health campaign about breast cancer prevention and just concluded a conference on “Protecting Our Daughters. “We’re hoping to reduce the risk they will ever hear the words, ‘you have breast cancer,’ ” says Ryan.
Breast cancer is much more common today than it was 50-to-100 years ago and that has a lot to do with how we’re living our lives, rather than inherited genes, Ryan adds. These are related to maintaining a healthy weight, exercising three-to-four hours per week, limiting alcohol consumption to fewer than five drinks per week and limiting exposure to extra hormones. “These include hormone replacement therapy after menopause, which should be avoided, and being on the pill for longer than 5-to-10 years,” Ryan says. “Use the lowest dose of extra hormones for the shortest period of time and take breaks whenever possible.”
There are other, emerging environmental concerns about the risk of breast cancer. Breastcancer.org encourages women to eat organic sources of food and to watch what they are eating, drinking and breathing. “Stick to mostly a plant-based diet, minimize consumption of animal proteins, cook in stainless steel cast iron or ceramic pots and pans and avoid non-stick surfaces, particularly at high heat,” Ryan cautions. “Also avoid use of plastics, especially for cooking. Try to use a metal water bottle instead of plastic water bottles.”
The reason has everything to do with chemicals, she explains. “There’s a lot of junk out there that goes up the food chain and bio accumulates, which is why we advise women eat low on the food chain whenever possible.”
“When it comes to public health and particularly the most common cancer to affect women, it’s worth minimizing your maximum risk,” Ryan adds. “We don’t know the level of risk these factors impart, but until then we should invoke the precautionary principle. It’s better to be safe than sorry so we can make the best choices.”
Don’t procrastinate making meaningful changes in your life now, she warns. “Already we have a lot of very effective steps women can take to prevent getting breast cancer, but few of them are effectively utilized. For example less than 50 percent of women in the U.S. are utilizing the early detection mammogram guidelines, which means they’re missing the opportunity for early detection.
“We have this romantic fantasy that some big discovery will occur in breast cancer and it will be The Answer,” she continues. “That’s not the way it works with a disease like this. So take action now to reduce your risk. Don’t postpone it for when ‘the cure’ arrives, because that’s imaginary thinking, and dangerous.”
For more information on curbing your risk, visit: www.breastcancer.org and download the Think Pink With Green brochure, which contains information on the “Dirty Dozen” foods and the “Clean 15.”
South African native Lauren Kramer is an award-winning writer based in Western Canada. This article originally appeared in a special "Fighting Cancer" section of the Exponent.