Landmark breast cancer study finds 10 strains, revolutionizes treatment options
In a recent study published in Nature, researchers studied 2,000 women with breast cancer and found that the condition could be classified into 10 separate types. All but a handful of the tumors fell into one of the 10 categories, with each category indicating how aggressive the condition was and how it reacted to specific treatment. This new information may first be used in clinical trials involving select groups of patients, and in three to five years doctors could begin developing more accurate tests to tailor treatments to the needs of individual patients.
There are many risk factors associated with developing breast cancer. Being a woman and aging are the two biggest factors. Having one or more relatives diagnosed with breast or ovarian cancer also increases risk, however approximately 85 percent of people who develop breast cancer do not have a family history of the disease. Little can be done about these risks, but others like hormone replacement therapy, obesity and significant alcohol use can be modified.
Risk factors aside, and despite the recent controversies around when to get a mammogram, I generally recommend annual screenings beginning at age 40. For patients with a family history, it will often depend on the age that the family member developed cancer—a baseline screening at age 30-35 is often recommended. These patients may also benefit from consultation with a genetic counselor. Smilow Cancer Hospital at Yale-New Haven has a wonderful genetic counseling service and a terrific, high-risk, "Take Charge" clinic that really gives women the information they need to make the right decisions for them. These patients, if at particularly high risk, may also be eligible for an annual screening with MRI, also offered at Smilow Cancer Hospital.
The Breast Center at Smilow Cancer Hospital at Yale-New Haven has been granted a three-year full accreditation by the National Accreditation Program for Breast Centers, an accrediting body administered by the American College of Surgeons. The Center's affiliation with Yale Cancer Center makes it the only National Cancer Institute-designated comprehensive cancer center in the Northeast to also have the NAPBC accreditation.
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It's unlikely that there will be dramatic changes to today's therapies based on the results of this study. However, this study, like all of the work that is going on in this area at Yale Cancer Center and around the world, is helping to figure out the genetic underpinnings of breast cancer. Personalized medicine is a cornerstone of care at Smilow Cancer Hospital. It means unlocking the fundamental biology and genetics of cancers so that we can understand how to attack each individual's cancer in a way that is unique to them and to their cancer.
At Smilow Cancer Hospital and Yale Cancer Center, we're working every day to figure out what genes are turned on in some people's cancers and not in others, and how we can make drugs that can specifically target those genes and receptors to make therapies that are more effective and less toxic. We are currently using targeted therapies, like tamoxifen or aromatase inhibitors to target estrogen and progesterone receptors, and trastuzamab to target her-2-neu positive disease. We have clinical trials that are testing novel targeted therapies that are revolutionizing cancer care. That's why patients who participate in clinical trials tend to do better than those who do not. But trials and personalized medicine do not stop only at targeted therapies. We're also looking at ways we can do surgery better, delivering radiation in a more targeted, accelerated and precise way. We're looking at how our therapies interact with the immune system, and how exercise and mindfulness might impact biology.
This is only one part of personalized medicine. The other part, which is also central to the philosophy at Smilow Cancer Hospital, is the concept that every patient is an individual. It's our focus to treat each patient in their personal context. We care about the whole patient — their family, their community — and understand that what works for one patient may not work for another. That's why Smilow Cancer Hospital prides itself on having a host of the best qualified doctors, nurses and staff who will work with patients throughout their journey.
Anees Chagpar, MD, MPH, MSc, MA, is director of the breast center at Smilow Cancer Hospital at Yale-New Haven, assistant director of diversity and health equity at Yale Cancer Center, and an associate professor of surgery at Yale School of Medicine.