For PatientsFitting your Cup Size - Personalized Care for Breast Cancer
In 2011, Washington State will contribute 35,360 new cancer cases and 11,740 deaths (1,596,670 and 571, 950 nationwide, respectively) to the vast oncological health toll. Regardless of gender, the chances of developing any kind of cancer in America hover around 50%. Thanks to the development of modern chemotherapy after WWII and the better understanding of metastasis in the 1970s, breast cancer mortality rates have declined steadily, but it still remains the leading cause of death among women in the world.
The chance of a female baby developing invasive breast cancer, according to a 2007 survey, was 1 in 207. However, the rate picks up as age increases, making 1 out of 8 women a victim. Furthermore, 1% of breast cancer cases belong to men despite the fact that one of the main culprits is the production of endogenous estrogen. The similar high-risk rate lingers in every corner of the globe, not just in the U.S.
Many women, unfortunately, put off or ignore their regular check-ups, considering it a time-consuming hassle. A delayed check-up may bring shocking news because breast cancer, in its early stage, does not necessarily show clear physical symptoms. Too often, catches patients off guard: "I had no idea anything could be wrong with me." Regular mammograms and doctor's examinations do not take long and are recommended for women over 40- years-old and women at high-risk.
"You have cancer"—this news changes everything for an individual: physically, emotionally, socially, and financially.
The moment of diagnosis with breast cancer changes a woman's life forever. From that moment on, it is a journey of making difficult decisions about surgery, chemotherapy and other treatments. It is not easy to go through scars, hair loss, and numerous other physical changes, adding to the emotional burden and causing low self-esteem. Emotionally, it is a long-time adjustment with the loss of an important part of the body, and the idea of having cancer. Even if it is treatable or curable, this diagnosis leaves a permanent emotional scar.
For a pregnant woman, the diagnosis can be devastating. While the mother's life could be at jeopardy for delaying treatment, the treatment itself could be detrimental to the growing baby. Dealing with decision of standard chemotherapy for women at their reproductive stage who plan to get pregnant could be also very challenging.
Another problematic complication rising costs of treatment. Financially, the diagnosis of breast cancer as of any other cancer is a burden for individuals, insurances and the society's taxpayers. This is mainly due to the increasing cost of chemotherapy, costly investigations and imaging tests, new surgical techniques, long term drug treatments and possibly in-patient hospital stays. Furthermore, the treatment requires some patients to take time off from work, which interrupts their regular income and thus generates tremendous financial burden.
Although insurance companies advertise "full coverage" for cancer, they tend to have rigid policies concerning its treatment. For example, if drugs A, B, and C are in an "approved" group of medication and a patient shows an allergic reaction to drug A in the process of treatment, then the entire treatment plan has to start over with a different group of "approved" drugs. But the crucial question would remain: will it work specifically for the patient?
In this era of novel medicine, personalized treatment studies have played a major role in the way breast cancer is approached, advancing the treatments available to patients. By looking at surface cell markers and proteins, pathologists and scientists have identified in the last 10 years, several subtypes such as Luminal A, Luminal B, basal cell, and HER2 positive breast cancers. These subtypes help clinicians decide how to best treat their patients. In many instances, they can target the disease with the right treatment available for a particular type of the cancer different than any other. For example a new drug called Herceptin and it is only for a specific target and therefore for specific subtypes of breast cancer. Using gene profiling, scientists discovered that Herceptin is able to inhibit the HER2 oncogene (human epidermal receptor 2), and tamoxifen can "block" estrogen receptors, which tell cancer cells to divide.
Postmenopausal women with receptor positive breast cancer can be treated with aromatase inhibitors, which prevent the production of estrogen. Only 5% of breast cancer cases are hereditary. Of these, BRCA1/2 mutations are the most common. There are some novel targeted therapies being developed for these patients. As age increases, the likelihood of mutations in the copying of genes increases. Targeted therapies attack specific genes that are detrimental to the patient, and take into consideration that every breast cancer case is unique. Clinical trials play the major role for the breakthroughs of such drugs. N-of-1 trials test a particular treatment on one patient to benefit the subtype of group as a whole.
Recently, the Swedish Hospital in Seattle has made a breakthrough by using Lenore the CyberKnife robot. When conventional radiation is applied to kill tumors, more often than not, it also kills healthy tissue. On the other hand, Lenore precisely targets the tumor itself so that the patient does not have to suffer from avoidable side effects. It also reduces treatment time: from half-hour per session for six weeks to one hour per session for five days. The hospital has been using the technology for years, but insurance companies have not approved it for it is still in developing stages.
Although we cannot control the given factors such as gender and age, we can manage controllable factors to prevent breast cancer. For example, to prevent obesity, we can practice healthy diets, stay away from alcohol, and exercise. A week-long course would not prevent cancer, a choice of life-style would. Although the diagnosis of breast cancer is a life changing event, there is a wide spectrum of treatments available now and more coming in the future.
Personalized approach in oncology is aiming to select treatments for specific patients, making these treatments easier to tolerate and more effective.
October is Breast Cancer Awareness Month. Take a few minutes to go see your doctor today—it might save your life.
Jeanne Lee and Julie Feng
for Partners in Personal Oncology
'Personalized cancer medicine is defined as medical care based on the particular biological characteristics of the disease process in individual patients. By using genomics and proteomics, individuals can be classified into subpopulations based on their susceptibility to a particular disease or response to a specific treatment. They may then be given preventive or therapeutic interventions that will be most effective given their particular characteristics.'
In oncology, personalized medicine has the potential to be especially influential in patient treatment because of the complexity and heterogeneity of each form of cancer. However, the current classifications of cancer are not as useful as they need to be for making treatment decisions; current cancer classification evolved from morphology and may be misleading because it does not take into account abnormalities at the molecular level. As a result, treatment needs to evolve toward a focus on targeted treatments based on individual characterizations of the disease.'
Policy Issues in the Development of Personalized medicine in Oncology
National Cancer Policy Forum, Board on Health Care Services
Institute of Medicine of THE NATIONAL ACADEMIES, 2009
'Personalized health care encompasses the transformative vision of breakthrough improvements in the cost and effectiveness of patient care through the practical application of sophisticated scientific research, especially from advanced systems biology; leading diagnostic and therapeutic technologies, proactive new approaches to health care delivery; and greater patient engagement'
Kimball Thomson, September 10, 2010
2010 Summit on Personalized Health Care—Building the Core Roadmap
- Detailed, individualized approach to your case
- Optimal methods for tumor collection and preservation
- Extensive characterization of your tumor
- Access to advice from top experts
- Access to information that is not otherwise readily available
- Access to state of the art technical and scientific expertise
- Direction to appropriate customized treatment