Modern breast cancer research has traveled deep inside rogue cells to better understand how they work at a molecular and genetic level, helping doctors find new ways to shut them down with treatments that target specific variations of the disease. Yet it remains a long way from a cure as the U.S. marks its 27th annual National Breast Cancer Awareness Month this October.
Modern breast cancer research has traveled deep inside rogue cells to better understand how they work at a molecular and genetic level, helping doctors find new ways to shut them down with treatments that target specific variations of the disease.
Oncologists say recent years also have brought advances in mammography and better cooperation among doctors who research and treat breast cancer.
Gains like these have greatly improved a woman’s chances of surviving the disease. The likelihood that U.S. women diagnosed with breast cancer will live another five years has climbed from 77 percent in 1982 to about 98 percent today if confined to the breast, according to advocacy group Susan G. Komen for the Cure.
“I think the vast majority of women will survive breast cancer, almost certainly in the short term, and most in the long term,” said Dr. Ann Partridge, a medical oncologist and clinical director of the Breast Oncology Center at the Dana-Farber Cancer Institute in Boston.
Yet the disease remains a long way from a cure as the U.S. marks its 27th annual National Breast Cancer Awareness Month this October.
Breast cancer remains widespread. The National Cancer Institute estimated about 207,000 women would be diagnosed with breast cancer in the U.S. last year, and nearly 40,000 were expected to die from the disease the same year.
In Massachusetts, about 5,640 women will be diagnosed with breast cancer this year, and 760 will die of the disease, according to American Cancer Society estimates. The disease was the most commonly diagnosed form of cancer among Bay State women from 2001 to 2005, Komen’s Massachusetts affiliate said.
Massachusetts has among the highest rates of breast cancer diagnoses in the nation, but advocates said that is likely because more Bay State women get mammograms than the national average. Yet disparities exist in both breast cancer screening rates and deaths, particularly among the state’s minority and low- to middle-income women.
“It’s well known that access to health care is a problem,” said Dr. Robert Quinlan, director of the Comprehensive Breast Center at UMass Memorial Medical Center in Worcester and a professor of surgery at UMass Medical School.
Breast cancer advocates are working to close the gaps. Komen’s state affiliate has put a significant portion of its $950,000 grant program this year toward funding community organizations that help women in underserved areas.
That includes women who struggle to pay for treatment, transportation or child care, and those who face language and cultural barriers, said Ronni Cohen-Boyar, executive director of Komen's Massachusetts affiliate.
“Dollars are short,” said Cohen-Boyar, a breast cancer survivor. “Everybody knows that. We need to maximize how we do it.”
GateHouse Media New England and Wickedlocal.com will donate a portion of newsstand sales, subscriptions and advertising proceeds during its Paint it all Pink program in October to Komen's Massachusetts affiliate.
A better understanding of the different forms of breast cancer has greatly improved treatment since the 1990s, oncologists said.
“We’re getting much better at tailoring our treatment to the type of breast cancer (patients) have,” Partridge said.
Some breast cancer cells are fueled by hormones – estrogen and progesterone –found naturally in the body. Drugs such as tamoxifin are now widely used to shut off parts of cancer cells that pick up these hormones, while other medications can block the body’s production by these hormones, Quinlan said.
Doctors also have seen gains in medications such as Herceptin that target a more aggressive kind of breast cancer cell with a gene known as HER2/neu, Partridge said.
Better treatments and a clearer understanding of which genetic strains of breast cancer are most aggressive have reduced the number of patients receiving harsh chemotherapy about 25 percent in the last decade, Quinlan said.
“The underlying tumor biology, the tumor aggressiveness, has become paramount in our thinking nowadays,” he said.
Cooperation is also improving. Physicians from different institutions work together more often than in the past on their research, Quinlan said. Hospitals also focus more today on treating “the whole patient,” including medical issues beyond cancer and psychological needs, and try to involve them in deciding the course of their treatment, Partridge said.
“Informed decision-making is what you aspire to,” she said.
Research also is bustling. “At no time in the last 10 years have they tested so many types of trials,” Partridge said.
There are still types of breast cancer doctors struggle to fight. For example, in about 10 percent of patients, breast cancer does not respond to estrogen, progesterone or HER2 therapy, a “triple-negative” strain that is more difficult to treat, Quinlan said.
UMass is among a number of institutions carrying out genetic analysis on this type of cancer, hoping to find common aspects that doctors can target, he said.
“Everyone is chasing that in the United States,” Quinlan said. “It would be so helpful if we had that.”
While mammography has improved in the digital age, it remains “a good, but not great tool,” Partridge said. She also hopes to see further improvements in determining the risk women face for breast cancer.
UMass is working with a $500,000 federal grant, matched through private donations, to build and test a new type of CT scanner for breast cancer next year, Quinlan said.
“We need a screening that’s not painful,” he said, stressing the importance of better detection. “When we detect (breast cancer) at an early stage, we’re not worrying about death.”
Work also is underway to unravel and address disparities in cancer rates. While more white women get breast cancer, for example, African-American women die from the disease at a higher rate.
From 2006-08, about 29 out of every 100,000 black women in Massachusetts died of breast cancer, compared to 22 of 100,000 white women, according to state Department of Public Health statistics.
For immigrants and women who do not speak English, language and cultural differences can present barriers to getting screened for breast cancer, Cohen-Boyar said.
“For some people, cancer equals death in their own culture,” she said. “They don’t know that it can be controlled or cured.”
Women with access to care do not always take advantage of it. In a focus group, Bay State women of higher incomes and education levels admitted to skipping mammograms, Cohen-Boyar said, prompted by fear of the unknown and the discomfort of the exam.
Organizations like Komen and the American Cancer Society play an important role in funding work to address challenges like these. Raising awareness of the importance of screening also is a key part of Komen’s mission, said Cohen-Boyar.
If awareness efforts convince one woman to get screened for breast cancer, “you can plaster the world with pink as far as I’m concerned,” she said.
(Reporter Michael Morton contributed to this story. Reporter David Riley can be reached at 508-626-3919 or email@example.com.)