How Breast Cancer Is Treated
In cancer care, doctors specializing in different areas of cancer treatmentsuch as surgery, radiation oncology, and medical oncologywork together with radiologists and pathologists to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others. For people older than 65, a geriatric oncologist or geriatrician may also be involved in their care. Ask the members of your treatment team who is the primary contact for questions about scheduling and treatment, who is in charge during different parts of treatment, how they communicate across teams, and whether there is 1 contact who can help with communication across specialties, such as a nurse navigator. This can change over time as your health care needs change.
A treatment plan is a summary of your cancer and the planned cancer treatment. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime. Before treatment begins, ask your doctor for a copy of your treatment plan. You can also provide your doctor with a copy of the ASCO Treatment Plan form to fill out.
Learn more about making treatment decisions.
Emerging Areas In Metastatic Breast Cancer Treatment
This is a promising time in metastatic breast cancer research. Many new treatments for metastatic breast cancer are under study and treatment is improving. Most of these new treatments are drug therapies.
Findings from clinical trials will determine whether or not these new treatments become a part of the standard of care for metastatic breast cancer.
Some treatments may even go on to be used for early-stage breast cancer care.
Learn about clinical trials.
Searching For New Treatment Targets
One of Tans passions is helping advance novel therapies for triple-negative breast cancer by serving as an investigator in clinical trials. She was a lead investigator in a phase 2 trial of Cosela , a drug designed to protect the bone marrow from getting damaged by chemotherapy. The drug is currently approved to treat some lung cancer patients, and Tan hoped it would allow triple-negative breast cancer patients to stay on chemotherapy longer by preserving their red and white blood cell counts. She and the other investigators were surprised to discover that triple-negative breast cancer patients taking Cosela along with chemotherapy lived longer than those on chemotherapy alone, even though the drug did not significantly improve their blood counts.
Were still trying to sort out the mechanism it may be immunologic but seeing the gain in overall survival laid the foundation for a phase 3 study, Tan says.
Tan is encouraged by a flood of research that continues to turn up new targets in triple-negative breast cancer. In 2023, she hopes to enroll triple-negative breast cancer patients in a phase 1 clinical trial of an investigational drug thats designed to disrupt ADAM9, a protein on the surface of cancer cells thats essential to tumor growth and spread.
Strawhun is a big fan of Dr. Jaspal Singh, medical director of pulmonary innovation and oncology at Levine Cancer Institute, who recently led a turban-tying event for cancer patients.
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Will Ever Be A Cure For Triple
Triple-negative breast cancer is curable when a doctor diagnoses it during the first three stages , said Dr. Jacoub. He treats stages 13 with everything he can in order to remove and destroy the cancer.
However, the ability to cure triple-negative breast cancer is hindered by recurrence or metastasis past the lymph nodes. Triple-negative breast cancer is the most likely form of breast cancer to return.
The outlook for people with localized triple-negative breast cancer over a 5-year period is good. Around 91% of people will survive to the 5-year mark.
If the cancer spreads to local tissue or lymph nodes, however, the 5-year survival rate drops to 65%. If it spreads to other organs or tissue, the rate falls to 12%.
These figures are based on data for people who received treatment in the past. Newer methods have changed the outlook, which will continue to shift as different treatments become available.
Anecdotally, Dr. Nan has a segment of patients who have responded to immunotherapy treatment for longer than 5 years.
Maybe if follows these long enough, some may still be alive after more than 10 or 15 years, then we can say cured, he said. With developed or newer types of immunotherapy, may be able to cure stage 4 cancer in the future.
Dr. Jacoub agreed that the outlook is changing with newer treatments. He also noted that although some people have a reduced quality of life while undergoing treatment, others can maintain a good quality of life.
Pairing Targeted Treatments With Holistic Therapy
Success in treating and managing metastatic breast cancer doesnt just come down to using new kinds of tests and drugs.
Alternative strategies, such as acupuncture, yoga and exercise, and nutrition, can help with therapy-related side effects or improve a persons sense of well-being, notes Mayer.
While these strategies may help patients tolerate treatment better, Mayer says to check with your doctor to make sure what you choose is helpful and doesnt interact with your overall treatment.
Without fitness, I would most certainly be battling depression and physical ailments typically associated with the aggressive chemotherapy and radiation that have been a part of my treatment plan, says Porter.
Thats why she created the Endorphasm Foundation to empower cancer patients to move past obstacles in their life with the healing power of movement.
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Treatment Options For Metastatic Breast Cancer
Treating metastatic disease differs greatly from early-stage breast cancer treatment in that there is no finish line. Stage IV breast cancer does not yet have a cure. Essentially, women with MBC start a treatment and wait to see whether it controls the growth of the cancer. As long as the side effects are tolerable, the treatment will continue until it no longer works. In consultation with their breast cancer treatment team, they will then move on to the next best MBC treatment options. Because metastatic breast cancers often develop resistance to drugs, itâs common to change therapies multiple times.
Surgery, radiation, chemotherapy, hormonal therapy, and targeted therapies are all used to treat metastatic breast cancer in some situations. Each of these therapies work in different ways, and they can be even more effective in combination. Every personâs breast cancer treatment needs to be specific and tailored.
Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
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Adcs: The New Chemotherapy
Sacituzumab govitecan-hziy and trastuzumab deruxtecan-nxki have made waves for patients with breast cancer, and Rugo said that antibody-drug conjugates may very well be the next chemotherapy mainstays for these patients. Weve seen remarkably positive data in triple-negative and hormone receptorpositive disease with the Trop-2 ADC sacituzumab govitecan and amazing data in HER2-positive and HER2-low with trastuzumab deruxtecan, just earth-shattering information.
The next steps are to better understand HER2 status in the DESTINY-Breast06 trial and evaluate the use of trastuzumab deruxtecan in the first-line setting in the DESTINY-Breast05 study . For sacituzumab govitecan, Rugo noted that first-line studies are also underway, including ASCENT-04 and the planned phase 3 Optimice-RD trial .
Classifying Risk Factors For Breast Cancer
Wood: Gene such as BRCA1 or BRCA2 are not very common in the patient population, but they confer a very high risk for cancer. Then we have what we term moderately penetrant gene , which include CHEK2 and ATM. PALB2 is probably a high-risk gene at this point. Finally, we have low-risk genes or a combination of genes.
It is important to realize that ductal carcinoma in situ and lobular carcinoma in situ are important risk factors for breast cancer and far outweigh a lot of other risk factors.
When we think about genetic risk factor, two back-to-back papers in The New England Journal of Medicine showed that BRCA1 is our highest risk gene. BRCA2 has a little bit of a lower risk. PALB2, as mentioned, is one of the higher-risk genes. CHEK2 and ATM are moderate-risk genes. Other risk genes RAD51C, RAD51D, and BARD1.
What do we do about these risks? We do have some lifestyle modifications. Moderation is important. The same is true for exercise, weight maintenance, and breastfeeding. There are medications that we can offer our patients, and there are surgical options. There are both hormonal options and non-hormonal options.
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Breast Cancer Early Detection And Treatment Research
The Breast Specialized Programs of Research Excellence are designed to quickly move basic scientific findings into clinical settings. The Breast SPOREs support the development of new therapies and technologies, and studies to better understand tumor resistance, diagnosis, prognosis, screening, prevention, and treatment of breast cancer.
The NCI Cancer Intervention and Surveillance Modeling Network focuses on using modeling to improve our understanding of how prevention, early detection, screening, and treatment affect breast cancer outcomes.
The Confluence Project, from NCI’s Division of Cancer Epidemiology and Genetics , is developing a research resource that includes data from thousands of breast cancer patients and controls of different races and ethnicities. This resource will be used to identify genes that are associated with breast cancer risk, prognosis, subtypes, response to treatment, and second breast cancers.
The goal of the Breast Cancer Surveillance Consortium , an NCI-funded program launched in 1994, is to enhance the understanding of breast cancer screening practices in the United States and their impact on the breast cancer’s stage at diagnosis, survival rates, and mortality.
There are ongoing programs at NCI that support prevention and early detection research in different cancers, including breast cancer. Examples include:
Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local integrated care board may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
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Breast Cancer Survivorship Research
NCIs Office of Cancer Survivorship, part of the Division of Cancer Control and Population Sciences , supports research projects throughout the country that study many issues related to breast cancer survivorship. Examples of studies funded include the impact of cancer and its treatment on physical functioning, emotional well-being, cognitive impairment, sleep disturbances, and cardiovascular health. Other studies focus on financial impacts, the effects on caregivers, models of care for survivors, and issues such as racial disparities and communication.
Advances In Breast Cancer Diagnosis And Treatment
Breast cancer remains one of the two most-common types of cancer in the world, according to the World Health Organization. Its the fifth-leading cause of cancer-related deaths annually. And more than 265,000 people will be diagnosed with it in the United States alone, during any given year.
But there is reason for hope. Research has yielded a number of exciting developments in breast cancer diagnosis and treatment that will improve the lives of breast cancer patients for years to come. We spoke with our Senthil Damodaran, M.D., Ph.D.,Jennifer Litton, M.D., and Anthony Lucci, M.D., to learn more.
1. Node preservationreduces lymphedema cases
Axillary lymph nodes used to be removed from the armpit routinely during breast cancer surgery to test for metastasis. This caused chronic pain, numbness and lymphedema in about 1 in 5 patients. But studies have shown that many of those nodes can be preserved without compromising long-term survival rates.
Sentinel node mapping lets surgeons identify which lymph nodes are most likely to be affected by a tumor. Targeted axillary dissection allows surgeons to potentially preserve nodes that once tested positive for cancer, but reverted to negative status after chemotherapy or another treatment. In both cases, if tests come back negative for cancer on the first few nodes taken out, the remaining nodes can be left alone. That means fewer complications, and fewer side effects for our breast cancer patients.
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Circulating Tumor Cells And Circulating Tumor Dna
Circulating tumor cell levels can help predict survival for people with metastatic breast cancer .
The more circulating tumor cells in the blood, the more advanced the metastatic breast cancer tends to be.
Having more circulating tumor cells may also predict a lack of response to treatment.
Circulating tumor DNA is also under study for use in monitoring metastatic breast cancer and predicting treatment response .
Circulating tumor cell and circulating tumor DNA tests are not used today to guide treatment. This is because they havenât been shown to offer benefit .
However, these methods are under study.
Overcoming Disparities In Cancer Care Worldwide
Rugo concluded by noting the slow progress in resolving disparities in cancer care. There is a global initiative to improve breast cancer outcomes, most patients in the world do not have access to the therapies that patients do, she said, adding that the problem of access hits close to home as well. Even within the US, many patients dont have access they are the silent minority. Rugo cited a patient who discontinued her treatments because of the financial implications, without reaching out for help.
We need to reach out to our patients, Rugo said. We need to be vocal about tackling disparities in cancer care in the United States and worldwide.
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New Method Predicts The Right Treatment For Breast Cancer Patients
PNAS
Researchers at Karolinska Institutet have developed a method that should be able to predict whether a patient with breast cancer will benefit from a particular treatment or not. The cell-based method has been tested on patients with promising results, according to a study published in Proceedings of the National Academy of Sciences.
“Today, there are limited possibilities of determining in advance which breast cancer patients benefit from different treatments. This method can predict how patients will respond to certain treatments, which means that unnecessary side effects can be avoided, and costs can be saved. Larger confirmatory studies are needed, but we see that the concept works,” says Johan Hartman, professor at the Department of Oncology-Pathology, Karolinska Institutet, and the study’s corresponding author.
Several different drugs are currently available for the treatment of breast cancer. But the disease is complex and not all patients are helped by the same or all drugs. Some information about which treatment a patient will benefit from can be obtained through, for example, DNA sequencing. However, in many cases, it is not possible to say whether a treatment will help the individual patient or not, and therefore better methods are needed to predict how patients will respond to treatment.
Hormone Cell Receptor Type
Some types of breast cancer, called hormone receptor-positive cancers, are fuelled by hormones such as estrogen and progesterone. These breast cancer cells are further labeled as estrogen receptor-positive or progesterone receptor-positive depending on which hormones they respond to. Knowing the hormone receptor type of your MBC helps doctors determine whether hormone therapy would be an effective treatment.
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More Accuracy Fewer Surgeries
Wire localization is often used to pinpoint the location of abnormal breast tissue that can be seen in a mammogram but not felt by your doctor. To ensure your surgeon removes the right breast tissue, a radiologist first inserts a wire into the breast and uses imaging technology to guide it to and mark the abnormal tissue. Later that day, youll undergo another procedure to remove the tissue.This method can be painful and uncomfortable. It also creates risk for less accuracy because the wire can be bumped or moved while the patient waits for surgery.
A newer technologymagnetic seed localization can locate the cancerous tissue days before its removed. Guided by imaging, a radiologist inserts a tiny magnet into the tissue. It does not move, and a surgeon can easily find it with a magnetic-detecting instrument.
Magseed eases many patients anxiety theyre not surprised by the location of their cancer the day its removed or upset by the sight of a wire protruding from their skin. And because the magnet stays in place, the surgeon is more likely to remove all of the abnormal tissue at once instead of performing another surgery to remove tissue that was missed the first time.
This technology can also be used to identify cancerous lymph nodes, reducing the amount of lymph nodes that are removed and the level of disruption to the lymphatic system.
Breast Cancer Survivor Has Twins After Losing Ovaries
In 2020 with a newborn at home, Shelly Battista headed back to work.
Cancer is a devastating diagnosis. In 2022, there were an estimated 1.9 million new cancer cases in the U.S., according to the American Cancer Society.
Treatments like chemotherapy can cause changes to fertility that can be temporary or permanent, but one cancer survivor who lost her ovaries didn’t lose her hope of having more children.
In 2020 with a newborn at home, Shelly Battista headed back to work.
“I was pumping more at work and that’s when I noticed a lump in my breast,” Battista said.
At first, she thought it was a clogged milk duct, but a biopsy revealed that wasn’t the case. Despite having no family history, the new mother was diagnosed with a triple-negative breast cancer and the BRCA1 mutation.
“What 34-year-old thinks, ‘Oh, I probably have breast cancer,'” Battista said. “So, it was very surreal. Very shocking.”
Almost as devastating was the thought of not being able to have more children in the future. So before chemotherapy, a double mastectomy and the removal of her ovaries and fallopian tubes, Battista met with Dr. Kara Goldman from the Northwestern Medicine Center for Fertility & Reproductive Medicine.
“She knew that this chemotherapy would save her life but would likely take her fertility,” Goldman said.
Eight healthy embryos were frozen, and one year after her cancer treatment, Battista was cleared for pregnancy.
There were two failed embryo transfers, but the third time was a success.
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