The Future of Breast Cancer


"We're starting to understand the molecular and genetic basis of tumors, which is helping us develop better ways to treat the disease and even prevent it in high-risk women," says Leslie Ford, M.D., associate director for clinical research in the National Cancer Institute's Division of Cancer Prevention. These advances have made a significant impact: Death rates from breast cancer have declined steadily since 1990. When diagnosed and treated early, more than 90 percent of women with breast cancer now survive at least five years.

Doctors all over the country are conducting many types of clinical trials, studying new ways to prevent, detect, diagnose, and treat breast cancer. Some are also studying therapies that may improve the quality of life for women during or after cancer treatment.

Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Women who join clinical trials may be among the first to benefit if a new approach is effective. If you are interested in being part of a clinical trial, talk with your doctor. Trials are available for all stages of breast cancer.

Research on prevention

Scientists are currently testing several different drugs that lower hormone levels or prevent a hormone's effect on breast cells. In one large study, the drug tamoxifen reduced the number of new cases of breast cancer among women who were at an increased risk of the disease. Initial results of STAR (Study of Tamoxifen and Raloxifene), one of the largest breast cancer prevention studies ever, found that the drug raloxifene is as effective as tamoxifen.

Research on detection, diagnosis, and staging

At this time, mammograms are the most effective tool we have to detect changes in the breast that may be cancer. But researchers are studying the combination of mammograms and ultrasound. They are also exploring positron emission tomography (PET) and other ways to get detailed pictures of breast tissue.

In addition, researchers are studying tumor markers. Tumor markers may be found in blood, in urine, or in fluid from the breast (nipple aspirate). High amounts of these substances may be a sign of cancer. Some markers may be used to check breast cancer patients for signs of disease after treatment. At this time, however, no tumor marker test is reliable enough to be used routinely to detect breast cancer.

Ductal lavage also is under study. This technique collects cells from breast ducts. A liquid flows through a catheter (very thin, flexible tube) into the opening of a milk duct on the nipple. The liquid and breast cells are withdrawn through the tube. A pathologist checks the cells for cancer or changes that may suggest an increased risk of cancer.

Research on treatment

Researchers are studying many types of treatment and their combinations. Different types of surgery are being combined with other treatments. Doctors are studying whether radiation therapy can be used instead of surgery to treat cancer in lymph nodes. They are looking at the effectiveness of radiation therapy to a larger area around the breast. In women with early breast cancer, doctors are studying whether radiation therapy to a smaller part of the breast may be helpful.

Researchers are testing new anticancer drugs and doses for chemotherapy and looking at new ways to combine them with other treatments. Several types of hormone therapy, including aromatase inhibitors, are under investigation. And new biological treatments also are under study. For example, researchers are studying cancer vaccines that help the immune system kill cancer cells.

In addition new drugs, used alone or in combination with existing ones, are broadening treatment options and helping tackle the disease like never before. For example, Herceptin, which has been approved for early- and advanced-stage breast cancer, is still the first choice for women with tumors that test positive for HER-2, a protein that spurs cancer cells to grow and proliferate. But for some women, the drug stops working and the tumor returns. Fortunately for them, there's the newly approved Tykerb, which is being used successfully in conjunction with oral chemotherapy for women with advanced HER-2 breast cancer.

Researchers are also looking at ways to lessen the side effects from treatment. One method under study is sentinel lymph node biopsy. Today, surgeons have to remove many lymph nodes under the arm and check each of them for cancer. Researchers are studying whether checking only the node to which cancer is most likely to spread (sentinel lymph node) will allow them to predict whether cancer has spread to other nodes. If this new procedure works as well as standard treatment, surgeons may be able to remove fewer lymph nodes. This could reduce lymphedema for many patients.

Next on the horizon for breast cancer researchers: testing the effectiveness of drugs that work on a cellular level, which could significantly shorten the amount of time between trials and FDA approval. Preventive vaccines, which use your immune system to extinguish the disease, are also being studied.

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