Advances in science and technology have vastly improved the way doctors detect and treat breast cancer.
These breakthroughs will lead to more personalized, effective treatments for the thousands of women diagnosed with breast cancer each year, said Roderick M. Quiros, MD, FACS, a surgical oncologist with St. Luke's University Health Network, who spoke recently during a short program in Jim Thorpe.
"This is about the ways that cancer is attacked or cured. It's not one big thing, but a lot of little things," said Quiros.
He explained that cancer is typically caused when the DNA in a cell mutates or changes.
All cells have a typical life cycle, multiplying into new cells and dying but cells with a mutation might grow more quickly than normal, or continue multiplying without dying at a normal rate.
Being able to examine the DNA and genes in individual cells and tumors was a critical turning point in cancer treatment.
The Human Genome Project
The Human Genome Project, which was completed in 2003 after 13 years of research, allowed scientists to identify more than 25,000 human genes.
Some genes provide the blueprint for a person's hair color or eye color. Others indicate a person's lifelong cancer risk, or the chances that a diagnosed cancer will spread quickly.
"With the advent of new technology, we're able to create a 'gene chip' and examine all 25,000 genes," he said.
There are currently more than 450 known cancer-causing mutations, including 45 known to cause breast cancer.
"The hopes of new technology is that we may be able to tell which mutation impacts a given patient, and treat the patient with a personalized treatment plan," said Quiros.
This means a treatment that includes not just a drug that typically works for breast cancer, but the exact drug that works for that patient's type of cancer.
He shared the analogy of trying to fix a massive traffic jam. Once it is understood what is causing this backlog in his example, one stalled car, caused by a faulty spark plug it is possible to fix the problem and restore traffic flow.
Likewise, once doctors know which genes are responsible for an individual's cancer, it's possible to create a personalized treatment plan that increases the chances of remission or a cure.
"Each case of breast cancer is different, not just between the different subtypes but between each patient," he said.
No longer a standard treatment
He noted that chemotherapy was once a fairly standard treatment for breast cancer, especially for women with a larger tumor.
Using this method of treatment, we now know that about one-third of women were overtreated, given chemotherapy or other treatments that weren't necessary.
Perhaps more alarmingly, up to half of breast cancer patients were undertreated when doctors based treatment plans on the size of a tumor.
Doctors are now more selective with chemotherapy treatments, using technology to determine the chances that a tumor will return after surgery or radiation.
"We look at how the tumor behaves, based on its gene expression," said Quiros. "You might have a big tumor that is growing slowly and unlikely to spread.
Or you might have a much smaller tumor that is more aggressive," in which case chemotherapy might be appropriate.
Additional advancements include intraoperative imaging, which allows surgeons to better insure that they have removed the entire tumor before completing surgery.
Surgeons can now also provide a targeted, 30-minute radiation treatment during surgery to reduce the chances of the cancer returning. Compared to the typical six-week radiation treatment, intraoperative radiation takes much less time and has less likelihood of side effects.
One other, less recent breakthrough in breast cancer detection is the change from film to digital mammograms.
Like any digital photograph, digital mammograms are easier to manipulate, zooming in to examine small areas of concern or enhancing contrast levels.
"Subtle changes can be easy to miss," especially on older film mammograms, said Quiros, showing films next to newer digital prints to demonstrate his point.
While it's too soon to tell how advances in technology will change long-term cancer survival rates, doctors are hopeful that more personalized medicine will have a positive impact.
Quiros noted that the first step to detecting breast cancer is still understanding your personal risks. He encouraged women with a family history of breast cancer to consider consulting a genetics counselor, who can walk patients through the process and results of genetic testing.
Insurance companies will often cover the cost of genetic testing in women with a family history of breast cancer.
For more information, go to www.sluhn.org/cancer or call (484) 503-HOPE.