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Breast cancer fight: an update

Researchers released mountains of new studies on breast cancer -- on new treatment regimens, on more personalized treatments that target a woman's individual breast cancer, and on screening and prevention -- as 2013 drew to a close, most from the San Antonio Breast Cancer Symposium. So, which ones matter to you? Two Long Island breast cancer specialists weigh in.

 

TREATMENT

The idea that the body's immune system can be harnessed to help fight breast cancer has stirred excitement among breast cancer experts.

"The question we've all been grappling with is whether breast cancer elicits an immune response," said Dr. George Raptis, the associate chief of hematology and oncology at the North Shore-LIJ Health System in Lake Success. "If it does, the immune system should be gobbling up and destroying these cancers, and it probably does in some cases," he added.

"In some cancers -- melanoma, renal cell and lymphoma -- the immune system has some input into suppressing those cancers, but breast cancer wasn't considered in that group," Raptis said. "But the latest research says that's just not so. Some breast cancers are more likely to have an immune response. Triple-negative breast cancers may be a subtype for which there is more of an immune response."

These findings could lead to the development of new treatments that could bolster the immune response, or to the development of vaccines for treating certain types of cancer.

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Dr. Nina D'Abreo, a hematologist-oncologist at Winthrop-University Hospital in Mineola and a clinical assistant professor at Stony Brook University School of Medicine, said that another important focus of recent research has been on "personalized, precision medicine." She noted a study that found that women who had HER 2-positive breast cancers who also had one or more mutations in a gene called PIK3CA were less likely to benefit from chemotherapy and HER 2-targeted treatments than women who didn't have those mutations.

Both experts noted that the bone-saving medications known as bisphosphonates were believed to help prevent cancers from spreading to the bones. However, Raptis said study results have been mixed, with some showing a benefit and others showing none.

The most recent research found that when taken by a specific group of women -- postmenopausal women with estrogen receptor-positive breast cancer -- bisphosphonates can help prevent breast cancer from spreading to the bones.

"This study showed a clear line between pre- and postmenopausal women," explained D'Abreo.

In triple-negative breast cancers, Raptis said, a new study found that combining the drug veliparib with the chemotherapy drug carboplatin doubled the complete response rate after surgery, meaning that the tumor was completely gone. Raptis said that veliparib works by interfering with DNA repair and will likely work better in some cancers than in others.

 

PREVENTION

Selective estrogen receptor modulators, such as tamoxifen (Nolvadex) and raloxifene (Evista), block the effects of estrogen in the body and help prevent breast cancers that are fueled by estrogen. However, some women have trouble taking these medications.

New research on an older drug, anastrozole (Arimidex), suggests this drug is also effective at preventing breast cancers and may have fewer side effects.

"Anastrozole will be a new drug in our arsenal," said D'Abreo.

 

SCREENING

Both D'Abreo and Raptis believe the debate about the benefits versus the risks of mammography will probably continue for some time.

Groups such as the American Cancer Society and the American Society of Clinical Oncologists recommend annual mammograms beginning at age 40, but the U.S. Preventive Services Task Force recommends that those screenings begin at 50 and be done only every other year.

Raptis noted that a review presented at the San Antonio Breast Cancer Symposium pointed out that, with all the improvements in treatment, it may become harder and harder to do a study that shows a clear benefit for mammography in terms of survival.

However, he said that when weighing risks and benefits, survival may not be the only benefit that should be looked at: It might also be important to consider factors such as quality of life and treatment side effects if breast cancer is found early versus later.

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