How targeted therapies have helped improve breast cancer outcomes

This year, approximately 30% of newly diagnosed cancers in women are expected to be breast cancers. That's a sobering thought. But also consider that breast cancer incidence rates in the U.S. started to decrease beginning in 2000 after two previous decades of increases. The rate of death from breast cancer declined from 40% between 1989 and 2017.

This slowdown in new breast cancer cases can be attributed to several factors, including increased awareness of the need for a healthier diet and lifestyle. But it's the latest screening methods, techniques, tools and treatments that have helped matters considerably, as well.

“The changes that have been made in the treatment of breast cancer over the past few years have been amazing,” says Dr. Dean Tsarwhas, medical director of the Cancer Center at Northwestern Medicine Lake Forest Hospital. “Previously, all we had to offer was surgery, chemotherapy and hormonal therapies. Now, we also have targeted biological therapies and immunotherapy to help breast cancer patients live longer and better lives. We can offer advanced surgeries with more opportunities for breast conservation along with enhanced reconstruction options for superior cosmetic results, too.”

One of the biggest advancements in recent years is the development of radiation therapy that can be delivered with more precision and shorter treatment courses that spare healthy tissue from side effects. Tools have also been developed to ensure the administration of chemotherapy to those who truly benefit based on their tumor biology, which prevents chemotherapy from being used in situations where it won't help.

“Research has led to targeted therapies both oral and intravenous that are specific to molecular changes in the breast cancer cell that has enhanced response to treatment and improved the ability to cure many breast cancers,” Tsarwhas said. “Immunotherapy is a particularly novel approach that enhances a patient's immune system to recognize a cancer cell as foreign; when combined with chemotherapy, it has improved treatment responses of specific types of breast cancer.”

Better screening tools are being developed, such as blood-based tests that will identify women with a high chance of having breast cancer. This will reduce the number of mammograms being performed.

Better screening tools are also forthcoming, like blood-based tests currently in the final stages of clinical development, according to Hannah Mamuszka, CEO of Cambridge, Massachusetts-based Alva10.

“Current screening guidelines emphasize mammography upfront, which can be expensive, painful and time-consuming and has a high rate of false positives and disparate access across populations,” she says. “But blood-based tests will soon be available that will triage patients into mammography so that only patients with a high chance of having breast cancer will need to have imaging tests done. This will increase access, reduce cost and waste, and improve survival by diagnosing more women at earlier stages.”

Indeed, the way pathologists diagnose breast cancer and oncologists manage their patients is undergoing rapid change. Many of these experts are looking forward to new systems and innovations being implemented in the coming years, including 4D Path's precision oncology platform, which was recently granted Breakthrough Device Designation by the FDA. This platform promises a faster, more efficient approach to computer-aided cancer diagnosis and tumor profiling.

“4D Path's technology will make it easier, faster and cheaper to more accurately diagnose breast cancer and understand more about its nature from an initial biopsy than previously possible,” said Dr. Nic Orsi, chief pathologist for 4D Path in Boston.

Additionally, recent advances in breast reconstruction are helping women move forward with their lives after mastectomies, allowing them to look and feel natural and normal.

“The newest surgical treatments are nipple-sparing mastectomies, perforator flap breast reconstruction, and restoring sensation after mastectomies in breast reconstruction,” Dr. Constance Chen, a board-certified plastic surgeon and breast reconstruction specialist in New York City, says. “Now, many women who choose surgeons trained in these more advanced techniques no longer have to put up with painful and deformed breast mounds that are hard and cold and don't really look like real breasts.”

Targeted chemotherapies, both oral and intravenous, are being developed that are specific to different types of breast cancer.

Data analytics are also expected to advance breast cancer detection and enable more women to be diagnosed at an earlier stage. This can increase chances of survival by identifying patients most likely to be at risk, regardless of age, and suggesting that they need to be screened earlier.

“Early detection is heavily dependent on diagnostic quality images, and this is an area where artificial intelligence can help support the screening workflow,” says Seattle-based Dr. Christopher Austin, chief medical officer for Kheiron Medical Technologies Inc., with headquarters in London; his company is developing a system called Mia IQ, which uses AI to assess breast positioning and overall quality of an image, determining if the image is sufficient for diagnostic interpretation.

The experts agree that breast cancer research and development continues to rapidly progress and improve patients' chances of survival - providing fresh hopes and optimism to patients and survivors in remission alike.

“A major key has been the discovery and implementation of biomarkers to determine what type of breast cancer patient has, how quickly it is spreading, and the best treatment options for that patient,” Mamuszka adds. “Make sure you are asking your oncologist about biomarker testing and what the results from each test mean.”

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