The War Against Breast Cancer

I was once told that treating breast cancer is like fighting a battle. Initially, general practice physicians fought this battle. They fought hard, but were ill prepared, as they did not understand what made their enemy work. However, as our treatments improved, it became clear that breast cancer was vulnerable. For example, when women with metastatic breast cancer had their ovaries removed, about half of the patients had their cancers shrink in size, and many of them lived much longer than expected.

We are now armed with chemotherapy, radiation, and new, targeted therapies. All of these treatments take advantage of our understanding between the biology of normal cells and breast cancer cells. This understanding has shown us that breast cancer is heterogeneous, that not all breast cancers are the same. Medical Oncologists now have insight into the biology of breast cancer, which has allowed us to tailor a patients treatment and target the relevant biological pathways. It is no longer a one-shoe fits all approach. Therefore, the treatment of breast cancer has become more personalized.

I clearly recall my first week of clinical practice. I was fresh out of fellowship, and I was well equipped to join the fight against cancer. My first patient was a young female, who had been in remission from her breast cancer for the last ten years. Her family told me that in recent weeks she was active, lively, and enjoying life. She then started to experience progressive fatigue, headaches, and stomach pain, which caused her to stop eating and drinking. Our nursing staff had placed her in an infusion chair, because she was too weak to sit in an exam room. It was clear that this young woman was dying from recurrent breast cancer.

Our team quickly admitted her to the hospital where she was stabilized, and then underwent a complete body imaging. Unfortunately, the results showed that she had recurrent disease in the liver, lungs, and brain. She subsequently underwent a biopsy of one nodule that had invaded her liver.

The pathologist told us our patient had metastatic breast cancer that was overexpressing a target receptor, called Her2/neu. This receptor, when activated, is believed to allow breast cancer cells to continue to grow by shutting down apoptosis, programmed cell death. She was treated with standard chemotherapy, and a new medicine called Herceptin. Herceptin is not chemotherapy, rather, it is an antibody that binds to Her2/neu. When bound, it turns off this receptor, and allows the cell to undergo programmed cell death.

After three months of treatment, our patient had a complete response; we could not find her disease on any scan. Now, five years later, our patient remains in complete remission with no breast cancer or side effects from her treatment.

Although not all women are cured of breast cancer, recent developments and breakthroughs continue to improve treatment outcomes. Personalized and targeted therapy, for the treatment of breast cancer, is here. I believe that if we start with the basic science researchers, academic medical centers, community physicians, and the strength that each woman brings, we will beat breast cancer. Until that day comes, we will continue to fight and keep the spirit of hope alive; in memory of all of those who at one time fought this battle.