Advances in Breast Cancer Prevention and Treatment
There have been several recent medical advances in the prevention and treatment of breast cancer that I'd like to share with you. First, let's look at risk factors and prevention.
Breast Cancer Risk Factors
A patient may be at increased risk for breast cancer based on her personal and family history. Some risk factors are lifestyle related, including obesity, inactivity and the use of alcohol. Other risks you cannot control, such as age, gender, family history and genetics.
Most breast cancer patients do not have a family history of breast cancer. Women who have a close blood relative with the disease may be more at risk of developing breast cancer. Only 5 to 10 percent of the breast cancers diagnosed are hereditary, meaning that a defect in a gene is passed down from a parent (either the mother or father) to a child. Most hereditary breast cancers are associated with a change in BRCA1 or BRCA2, the two genes most commonly linked to breast cancer.
At Loyola Medicine, a genetic counselor can meet with patients who have a family history of breast cancer or who are newly diagnosed with breast cancer. Genetic testing may be useful in planning cancer surgery and treatment. Genetic test results may also be helpful to a patient’s family members.
Recent Advances in Prevention
Tamoxifen, Raloxifene, Anastrozole and Exemestane have all shown favorable results in large breast cancer prevention studies. These prevention drugs are taken every day for five years. The benefits of breast cancer prevention may persist beyond the five years of treatment. Most women tolerate these prevention medications well.
Women older than 60 years, those at higher risk of developing breast cancer because of a family history of breast cancer, or those who had a biopsy that showed atypical breast cells may be able to take prevention medications. We recommend that you speak with your doctor to see if taking a medicine to prevent breast cancer makes sense for you.
Breast Cancer Treatment
Cancer is a complex disease, and there are many different types, or “subtypes,” of breast cancer. Some new drugs target certain types of breast cancer.
For early stage HER2+ (Human epidermal growth factor receptor 2+) subtype, three new treatments are notable:
- Chemotherapy plus one year of trastuzumab (a monoclonal antibody targeting the HER2 protein) given after surgery has shown to improve survival compared to chemotherapy alone.
- Pertuzumab, another monoclonal antibody directed against the HER2 protein, plus chemotherapy given prior to, or after surgery. This combination is associated with improved outcomes.
- Neratinib, an oral agent, also targets the HER2 protein.
For advanced stage HER2+ subtype, the Federal Drug Administration (FDA) has approved two newer drugs:
- Ado-trastuzumab emtansine, a novel chemotherapy linked to trastuzumab.
For estrogen receptor positive (ER+) subtype, two advances are worth noting:
- Recent studies show that longer duration of endocrine therapy, often called hormone therapy, (tamoxifen, anastrozole, letrozole, exemestane) may help prevent breast cancer from returning.
- Palbociclib, ribociclib and abemaciclib are a new class of drugs called CDK4/6 inhibitors. The FDA has approved their use when they are combined with endocrine therapy.
The Importance of Clinical Research
The important developments in fighting breast cancer are the result of patients taking part in clinical trials. Loyola is an academic medical center where patients have access to important clinical trials, new drugs and novel approaches to breast cancer prevention and treatment. Offering these trials serves as an example of our commitment to advancing the field in the fight against cancer. Loyola physicians are deeply involved in breast cancer research and have made important advances in cancer-fighting drugs.
The Importance of Supportive Oncology
Loyola’s cancer care team provides support services, from diagnosis through survivorship. Through the backing of the Coleman Foundation, the Cardinal Bernardin Cancer Center learns what kinds of support cancer patients need and helps find ways to provide it. Dietitians, pastoral care, art and pet therapy programs, the Image Renewal Center, palliative care, and our renowned psychosocial oncology and treatment teams all are essential to the care of our breast cancer patients.
Our Multidisciplinary Breast Cancer Clinic
At Loyola Medicine, new patients diagnosed with breast cancer attend our weekly multi-disciplinary breast cancer clinic. During this appointment, they meet their breast surgeon, medical oncologist, and radiation oncologist in one visit. We review patients’ mammograms with our radiologist and the patients’ pathology with our breast pathologist. Patients have access to our specialized breast care nurses, research nurses for clinical trials, psychology support staff, social workers, genetic counselors and art therapists.
Shelly Lo, MD, is an oncology physician who specializes in breast cancer prevention and treatment. Dr. Lo is the director of the cancer risk assessment and prevention program at Loyola Medicine and an associate medical director for Loyola Medicine Hospice. She sees patients at the Cardinal Bernardin Cancer Center and the Loyola Center for Health at Burr Ridge.