Targeted Therapies Bring Hope for Breast Cancer Patients

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By Susan Kreimer, MS, contributor

Even with metastatic breast cancer, a glimmer of hope can prevail. Just ask Ellen Moskowitz, president of the volunteer Metastatic Breast Cancer Network, which has 820 female members nationwide.

New targeted treatments, therapeutic advances and preventative measures in the field of breast cancer research and technology have allowed patients’ to experience a better quality of life and an overall decrease in mortality rates.

Now 64, Moskowitz was first diagnosed with breast cancer in1992, with stage-two of the disease found in one breast. Then stage one cancer struck the other breast in 2001, with a local recurrence the following year. In 2004, the diagnosis was dire--metastatic breast cancer.

“Statistics say we will die in two to three years, and sadly, that is true for some,” said Moskowitz, a retired reading coordinator in Manhattan, N.Y. “At the same time, many of us are living seven, eight or nine years with a decent quality of life.”

Therapeutic advances--especially targeted chemotherapy treatments--have enabled women with breast cancer to go on with their lives. Targeted treatments zero in on tumors with a particular hormone status, attacking malignant cells while sparing healthy ones. As newer options appear on the horizon, more patients stand to benefit.

Since the 1990s, breast cancer mortality rates have continued to decline due to earlier detection and effective treatment. There are 2.5 million breast cancer survivors in the United States today, according to Susan G. Komen for the Cure.

“When breast cancer is caught before spreading beyond the breast, the five-year survival rate in the U.S. is now 98 percent,” an increase from 74 percent in 1982, when Komen for the Cure was founded, said Susan Brown, RN, MS, director of health education at the Dallas-based national advocacy organization.

Not only are therapies improving, but research is also focusing on prevention, said Lillie Shockney, RN, BS, MAS, administrative director of the Johns Hopkins Avon Foundation Breast Center in Baltimore, Md. Experts are learning more about complications, as well.

“Some side effects can linger far longer than was originally thought,” said Shockney, who is a two-time stage-one breast cancer survivor. “We may see the day that surgery isn’t done at all. And we will eventually see a vaccine or perhaps intraductal therapy for prevention.”

Mastectomy, the complete or partial removal of the breast, is no longer performed as widely as it was in years past. Today, Shockney noted, 80 percent of women with breast cancer are considered good candidates for lumpectomy. Most of them will elect the less invasive surgery once they find out that the more radical operation does not increase their chances of survival nor allow them to skip chemotherapy if necessary.

For women who need or opt for a mastectomy on one breast, more of them are undergoing bilateral mastectomy. More patients with stage one, two or three of the disease also are choosing a newer type of breast reconstruction that uses tissue from the abdomen but spares abdominal muscles.

“They want to have a natural look and feel, no maintenance, and a low risk of hernia or bulge later,” said Shockney, who has penned two books, Navigating Breast Cancer: A Guide for the Newly Diagnosed, published last year, and 100 Questions & Answers About Advanced and Metastatic Breast Cancer, co-authored with Gary Shapiro, M.D., and released in September 2008.

While surgeries and therapies continue to advance, a better understanding of genetic factors related to breast cancer is also emerging. “Genetics tells us why one person with risk factors skates through without the disease and others with minor risk factors get it,” Shockney said. “How our bodies’ genetics work at the DNA level is going to uncover many mysteries soon.”

This tedious research takes time, but researchers will likely identify additional BRCA genes that heighten the risk for breast cancer beyond the two mutations that have been pinpointed so far.

“Genomics is helping us develop customized treatments for patients, too, rather than relying on everyone basically getting the same drugs,” Shockney said.

Sometimes, though, patients with cancer need more encouragement. “On behalf of all metastatic patients, I ask that medical professionals stop using the words that the patient failed a treatment,” Moskowitz said. “It is the treatment that has failed the patient.”

The Metastatic Breast Cancer Network, founded in 2004 by two women afflicted by the disease, has made some strides. Among them was originating Metastatic Breast Cancer Awareness Day (Oct. 13), which became official when New York City Mayor Michael R. Bloomberg signed a proclamation last year. As of late September this year, 16 cities and seven states have issued similar proclamations for the day.

“It is a step toward bringing awareness to this misunderstood and feared disease,” said Moskowitz, who considers herself lucky to have a top-notch care team that doesn’t give up hope, even though the cancer has spread to her bones. Others with stage-four disease are less fortunate.

Regardless of the disease stage, Moskowitz feels that all patients deserve the same kind of support. “Medical professionals need to be more proactive in recommending clinical trials for all of us,” she said. “Clinical trials are the hope of the future.”

Resources for more information:

Metastatic Breast Cancer Network

Susan G. Komen for the Cure

Johns Hopkins Avon Foundation Breast Center

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