Advancing Breast Cancer Awareness
Introduction
Each year, advances in screening, diagnosis, and treatment bring new promise to breast cancer patients. With early detection and improved therapies, the outlook for many patients has never been brighter.
The 5-year relative survival rate for localized breast cancer—when the disease is caught before it has spread—is over 90%, according to the American Cancer Society and the National Breast Cancer Foundation. About 1 in 8 women in the US will develop invasive breast cancer during their lifetime. While breast cancer is far more common in women, men also face risk, estimated at about 1 in 726.
Dr. Diane Drugas, Assistant Professor of Clinical Surgery at the University of Illinois Chicago (UIC) and general surgeon at UI Health, specializes in the treatment of cancer and benign conditions of the breast. “Since breast cancer cannot be prevented, we focus on early detection and advancing treatment.”
At UIC, a multidisciplinary team of surgeons, oncologists, radiologists, and pathologists work together to design individualized treatment plans for every patient. This collaborative approach also drives ongoing innovation. In recent years, UIC has advanced several surgical techniques, including advanced imaging and minimally invasive procedures, to improve patient outcomes.
Advancements and New Challenges
“In the last decade, there has been a tremendous amount of knowledge gained in breast cancer treatment,” Dr. Drugas stated. These innovations have greatly improved patient outcomes. Since the peak of breast cancer-related deaths in 1989, advances in targeted treatments have helped reduce mortality by 44%.
Yet, with these advancements come new challenges—including examining genetic data and selecting the right combination of therapies. “This has made treatment incredibly complex, requiring a multidisciplinary team approach. It is not a one-size-fits-all.
“Tumors are studied on a molecular level. And we determine subtypes and molecular profiles. This is what determines which kind of treatment the patient receives,” Dr. Drugas said. Studying the biological behaviors and gene expression of breast cancer patients may also offer a better understanding of tumor progression and/or recurrence.
MammaPrint
One of the most significant advancements in breast cancer care has been the use of genomic testing. UIC utilizes the MammaPrint, an FDA-approved system that helps in understanding gene activity in early-stage cancer for the best treatment options.
The test analyzes the activity of 70 specific genes within a breast tumor to assess the risk of metastasis and distant recurrence. By revealing whether a patient’s cancer is more or less likely to spread or return, this test helps determine who may safely avoid chemotherapy and who might benefit from it.
Immunotherapy
“The integration of immunotherapy, especially for complex tumors, has seen a lot of progress in amplifying one’s immune response,” Dr. Drugas said.
Immunotherapy is provided in a number of ways, each of which works differently based on the type of cancer, size, and location. Since some cancer cells can evade detection, immunotherapy helps the immune system perform more effectively, enabling it to recognize, destroy, and eliminate cancer cells.
Advancements have been especially effective in treating Triple Negative Breast Cancer (TNBC), which, in the past, had limited treatment options. TNBC is a type of breast cancer that tests negative for three receptors: Estrogen receptor (ER), Progesterone receptor (PR), and Human epidermal growth factor receptor 2 (HER2). It is an invasive breast cancer commonly known for its rapid growth and expansion. Immunotherapy helps the immune system uncover those hidden cancer cells that chemotherapy often misses.
Targeted Therapies
Advancements in targeted therapies—such as HER2-targeted drugs—obstruct proteins that lead to breast cancer cell growth. By focusing on these proteins, physicians can control how the cancer grows while minimizing damage to healthy cells.
Antibody-drug conjugate (ADC) is an additional kind of targeted therapy that works to kill breast cancer cells while sparing the healthy tissue in the area.
“This is what precision medicine looks like,” Dr. Drugas said. “By using these gene assays, treatment is designed for each individual patient and their unique situation.”
Such advances have transformed the practice of treating breast cancer. There is no longer one prescription for everyone, but treatments are individualized based on the genetic makeup of the tumor and how it responds to specific medications. This level of personalization not only improves results but also has patients tolerate more, with fewer side effects and a better quality of life upon recovery.
Minimally Invasive
UIC has been at the forefront of developing minimally invasive breast cancer surgeries, including lumpectomies (removing a lump or tumor from the breast) and axillary surgeries (procedures performed through the armpit). These approaches work hand-in-hand with targeted treatments and immunotherapies.
“In terms of surgical treatment, with these advances, surgeons are able to conserve breasts far more commonly today than in the past,” Dr. Drugas explained. “For larger, locally advanced tumors, these treatments can allow them to be downstaged and made smaller so that they are more resectable.”
These treatments also allow surgeons to perform more limited axillary surgery, which leads to a lower risk of lymphedema. We can sometimes clear the disease in the lymph nodes and target only the ones that need to be removed.
This stresses the importance of early detection, screenings, and regular check-ups to catch tumors when they are most treatable, allow for less invasive procedures, and improve overall outcomes and quality of life for patients.
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