Guest post by Komen Scholar Ann H. Partridge, M.D., M.P.H.
Over the past decade, there has been a substantial increase in the number of women with early breast cancer who are choosing to undergo prophylactic contralateral mastectomy (e.g., removal of the healthy breast, usually in conjunction with mastectomy for the breast that has breast cancer), particularly among young women. Reasons for this trend and whether it improves how women do in the long run are under active study.
At the ASCO Breast Cancer Symposium in San Francisco last week, researchers from Canada used the Ontario Cancer Registry to compare outcomes between young women who underwent bilateral mastectomy and those who only underwent unilateral mastectomy.
The study found that among 628 women age 35 or younger at diagnosis who underwent surgery for early breast cancer, those who had bilateral mastectomy (16 percent) did not experience better survival compared with women who underwent unilateral mastectomy. The median follow-up was only 11 years, and other recent data have suggested that even among women with a known BRCA 1 or 2 mutation, who have a higher risk of developing a new breast cancer in the remaining breast in the future, the modest benefit may not be seen for several years. Further, it is possible that a subset of patients may experience benefit, emphasizing that further research to tease out different benefits for different types of breast cancer is needed.
Another study presented at the conference and led by Catherine Parker, M.D., of the University of Alabama, compared outcomes among women who underwent mastectomy, breast-conserving surgery plus radiation, or breast-conserving surgery alone. Prior studies comparing breast-conserving therapy (both with and without radiation) to mastectomy for early-stage breast cancer found no difference in patient outcomes. However, Parker and colleagues challenged this tenet when considering tumor subtype (e.g., triple negative, HER-2 positive, ER-positive), finding breast-conserving surgery plus radiation was significantly associated with longer survival, suggesting that type of local therapy makes a difference in survival rates.
An analysis of breast surgery types within that study confirmed the survival benefit associated with breast-conserving surgery plus radiation among patients with hormone receptor-positive disease, but not among those with hormone receptor-negative disease. Additionally, breast-conserving surgery plus radiation was associated with longer survival than breast-conserving surgery alone, regardless of tumor type.
These recent studies underscore our evolving understanding of how the type of surgery can affect outcomes for women with breast cancer, and that further research is definitely needed. Moreover, they highlight the fact that when women have choices about how to treat breast cancer, they need information and support in order to make the best personal decisions. When I discuss surgical decisions with my patients, especially given the growing body of research suggests that lumpectomy followed by radiation is as good as (if not better than) mastectomy which is as good as bilateral mastectomy in terms of overall survival for most women, I try to help them focus on what will make them feel best, both physically and emotionally, when they are into their survivorship. Findings like those presented at the ASCO meeting are important for both patients and physicians as they make treatment decisions, and I’m pleased to see continued progress in research that will help identify the best treatments for individual patients.
The following blog appeared in The Huffington Post on September 11, 2014.
This month, Mary Woolley, president of Research!America, and I have written a joint blog about why funding for medical research must be a national imperative.
February 23, 1954, was a milestone in the history of American medical research. That day, children atArsenalElementary SchoolinPittsburghlined up to receive injections of a promising vaccine. Within months, school children all over the country were doing the same, and polio was on its way to being eradicated in theUnited States. The disease which had killed and paralyzed children and adults alike would no longer be a threat.
This remarkable achievement would not have been possible without the work of Dr. Jonas Salk and his team at theUniversityofPittsburgh, and — equally significant — grant support from the National Foundation for Infantile Paralysis, now known as March of Dimes. Policymakers played a role, too, when the Polio Vaccine Assistance Act of 1955 made possible federal grants to the states for purchase of the vaccine and for the costs of planning and conducting vaccination programs.
A generation or two later, millions of individuals worldwide benefited from another major medical breakthrough. Remember when being diagnosed as HIV-positive was an automatic death sentence in the 1980s? Accelerated research supported by the National Institutes of Health (NIH), in partnership with Burroughs Welcome and Duke University, resulted in the development of AZT, the first drug that slowed the replication of HIV. By 1987, the drug won FDA approval and marked the first major treatment in extending the lives of HIV/AIDS patients.
Life-saving wonders such as the Salk vaccine and AZT can’t come fast enough for patients suffering from debilitating and deadly diseases. That’s why there is a coordinated push this month by medical research organizations for Congress to increase funding for federally supported research that lays the groundwork for private sector innovation.
Efforts to combat Ebola, dengue fever, and other deadly diseases with a rapid, coordinated response would be hamstrung without well-funded federal agencies, as well as successful partnerships between the public and private sectors, worldwide. In addition, federal research agencies like the NIH and the National Science Foundation fuel scientific discovery at academic institutions, providing the resources critical to supporting small and large-scale projects that could lead to promising new therapies and medical devices. Without such research, we would have not discovered the use of Vitamin D and aspirin as preventative measures for dementia, heart attack and stroke. The critical boundary-pushing science being undertaken by federal government researchers and their academic and private sector partners has been slowing over the last decade, as policymakers seemingly take progress for granted. We can’t allow this to happen; there is too much at stake.
For example, scientists at UC Berkeley are working to grow human organ tissues, like heart and liver, on tiny chips. If successful, the project could lead to “a personalized medicine, patient-specific readout of any drug you want to test,” according to Anurag Mathur, one of the researchers atBerkeley. This bioengineering technique could one day replace years of tedious testing on humans and animals. This research is happening thanks to funding by the Cures Acceleration Network, which is overseen by theNationalCenterfor Advancing Translational Sciences (NCATS), an agency within NIH.
Furthermore, NIH, Novartis, and the Banner Alzheimer’s Institute, a Phoenix-based non-profit, are testing drugs that could potentially prevent Alzheimer’s in people with a genetic predisposition to that terrible disease. Another public/private partnership of NIH-funded researchers, scientists at the biotech company Genentech, and Belgian researchers resulted in the mass production of t-PA, a clot-dissolving enzyme that dramatically reduces mortality and disability when promptly delivered to victims of heart attack and stroke.
There are hundreds of vital research projects underway; many of them threatened by loss of support. For advances to continue, for patients’ hope to be kept alive, the public, scientists, and advocates must urge Congress to boost funding for research and restore NIH’s purchasing power which is 25 percent lower than it was a decade ago. That’s why are are now seeing an unprecedented level of collaboration on congressional outreach by organizations such as Research! America, Susan G. Komen, and the American Association for Cancer Research As policymakers make funding decisions for the next fiscal year, it is imperative that Congress realizes what is at risk.
Cancer in all its forms, Alzheimer’s, ALS, Multiple Sclerosis, Parkinson’s, and painful, chronic conditions such as rheumatoid arthritis and Crohn’s Disease will only be overcome if we, as a nation, have the will and commitment to once again make funding the type of essential research that led to the eradication of polio in the United States such a high national priority.
In sum, policymakers must support substantial investments in medical research and policies that advance public and private innovation. They must offer that support as if it were a matter of life and death—because history shows us it is.
On Thursday, September 18, 2014, Honoring the Promise will bring together the heroes of the breast cancer movement for a celebratory evening of inspiration and world-class entertainment. Whether you already have your tickets or you’re not sure about your schedule, here are five reasons you should definitely join us at the Kennedy Center next Thursday night.
1) It’s Saving Lives of Women and Men across the National Capital Region
The National Capital Region, which includes Washington, D.C., and surrounding areas in Maryland and Virginia, has the highest incidence and mortality rates for breast cancer in the entire country. Incidence rates are 20 percent higher than the national average, and mortality rates are nearly 40 percent higher than the national average. In addition, it has one of the highest rates of late-stage diagnosis of breast cancer.
We are determined to overcome these disparities. Komen has invested $23 million in breast cancer research taking place at local institutions (like Georgetown University), and more than $35 million in programs that reach, educate, screen and provide assistance to the medically underserved and women of color. Komen President and CEO Dr. Judy Salerno writes more about this vital work in a recent piece for Washington Life Magazine.
Funds raised at Honoring the Promise help us continue to fund these lifesaving programs. Last year, we raised $2 million dollars for these critical initiatives, and we intend to make an even bigger impact this year.
2) You’ll Be in the Company of Breast Cancer Leaders
Victoria Reggie Kennedy and Susan Ford Bales will present the Betty Ford Lifetime Achievement Award to Representative Debbie Wasserman Schultz; Nancy G. Brinker and Dr. LaSalle D. Leffall, Jr. will present the Mission Advancement Award to David M. Rubenstein.
These two individuals have made huge contributions to Komen’s mission, and to the fight against breast cancer. Congresswoman Schultz has worked tirelessly to pass critical women’s health legislation on the state and federal level and labored to implement programs to empower young women faced with breast cancer. As a Global Ambassador to Susan G. Komen and Founding Chair of Honoring the Promise, Rubenstein has played an integral role in Komen’s mission, attending and speaking at many of Komen’s largest fundraising events, and donating over $1.3 million to critical breast cancer research and global and community initiatives for vital health education and screening and treatment services.
3) Julia Murney and Bruce Hornsby Will Serenade You
Renowned musicians Bruce Hornsby, the creative icon behind the hit song “The Way It Is,” boasting a two-and-a-half decade recording career, and Julia Murney, who most recently appeared on Broadway and toured the country as Elphaba in Wicked, will make the evening truly one to remember. Accompanying Murney as she sings the classic song “Defying Gravity” from Wicked will be the NEWorks String Quartet, led by Nolan Williams, Jr. We won’t say singing along is encouraged, but if it’s your dream to do a duet with Elphaba, we won’t stop you!
4) The Post-Party Will Be a Blast
If you like music, food and dancing, that is! After the ceremony, entertainment group Charizma will help us celebrate the 5th year of this important event by cranking up the energy and the music. We’re proud of the work taking place in the D.C. area and across the country, the progress our organization has made over the past 32 years, and the three million breast cancer survivors enjoying life today, so let’s celebrate!
5) You’re Honoring the Promise
Our organization was founded on a promise between two sisters. But now it’s a promise we’ve made to women and men everywhere – and one we intend to keep. For five years, Honoring the Promise has done just that: honored our commitment to ending breast cancer. We invite you to join us this year, at this incredible event, as we continue to work toward our vision of a world without breast cancer.
For more information and to purchase tickets, please visit our website www.komen.org/honoringthepromise.
Guest post by Glendon Zinser, Ph.D., Komen Scientific Grants Manager
The last 30 years have brought about astounding changes in the way people look at, talk about, diagnose and treat breast cancer. The more than three million breast cancer survivors in the U.S. today are proof of how far we’ve come in both early detection and improved treatments. We know now that, just like the women and men it affects, breast cancer varies greatly from person to person, and therefore, breast cancer therapy is not a one-size- fits-all approach. Now, with more than $150 million invested into research focused on personalized medicine, Komen is proud to be a leader in this important area of discovery.
Today, we’re excited to share news of work led by a Komen-supported researcher, Dr. Aleix Prat, who is a pioneer in the field of personalized medicine. Dr. Prat is helping to ensure that all patients receive the very best treatment for their breast cancer and he is also helping healthcare providers better understand the unique properties of breast tumors.
Last year, Komen announced that Dr. Prat, Principal Investigator of the Translational Genomics Group at the Vall d’Hebron Institute of Oncology (VHIO), would receive a Career Catalyst Research (CCR) Grant for $450,000 over three years to study HER2-positive breast cancer. CCR grants are awarded to promising early career scientists who have had extensive training in the field of breast cancer but who have only recently begun directing the research focus of their own laboratory. The CCR recipients’ hypothesis-driven research has significant potential to advance our mission of a world without breast cancer.
Dr. Prat’s CCR funded project focuses on HER2-positive breast cancer, which is a very aggressive type of cancer and it accounts for 15-20 percent of all diagnosed cases. With this CCR grant, coupled with previous research funded by Komen, Dr. Prat and his team have shown that 1) HER2-positive breast cancer can be classified as four different subtypes of breast cancer according to respective molecular characteristics and, 2) this sub-classification can help predict response to chemotherapy and anti-HER2 treatment, such as Herceptin (trastuzumab).
While this type of tumor profiling requires additional investigation before it becomes a clinical standard, the implications of this work for patients are extremely promising. In short – it means that physicians and oncologists will have access to essential information for determining the benefits of treatment, as well as a better understanding of both the short-term and long-term risks of breast cancer relapse. Oncologists will be able to better advise their patients about which anti-HER2 therapy, endocrine therapy, or chemotherapy may be the most beneficial for their individual breast cancer.
We look forward to many more important findings from Dr. Prat and our other Komen-funded researchers around the globe as we continue, together, towards our vision of a world without breast cancer.
The following blog written by Dr. Judy Salerno appeared in the September issue of Washington Life.
Here is a sobering fact: Washington, DC is the city with the highest incidence and mortality rates from breast cancer in the United States. According to Centers for Disease Control and Prevention data for 2006-2010, breast cancer death rates are 40 percent higher than the national average in the National Capital Region—the District, Northern Virginia, and Prince George’s and Montgomery counties in Maryland.
And the situation for African American women in the region is alarming: the latest data show that breast cancer death rates for African American women here were 33.8 percent higher than Caucasian women, largely because African American women were almost 23 percent more likely to be diagnosed at late stages of the disease.
At Susan G. Komen we are determined to overcome these shocking disparities. In addition to the $23 million we’ve provided for breast cancer research at local institutions, we’ve also invested more than $35 million in programs that reach, educate, screen and provide assistance to the medically underserved and women of color, especially in Wards 7 and 8 in the District and in Prince George’s County.
In the DC region alone, Susan G. Komen paid for 18,000 screenings, assisted 6,000 women with services that helped them get treatment and follow-up care, and reached 190,000 women with breast health awareness and education programs in 2012 alone.
One of the education and outreach programs we are especially proud to support is DC Pink Divas. Since 2012, the volunteers of this unique program have reached 10,000 women in the Capital Region. This is a true “boots on the ground” effort, as volunteers go to neighborhoods, houses of worship, and places of employment to share information about breast health as well as cancer prevention and treatment.
As a former volunteer physician at clinics serving the medically vulnerable in the District, I know firsthand how important it is to reach, and treat, the most needy populations in our communities. Programs like the Pink Divas – and others funded by Komen — truly make a difference in outcomes for women facing cancer.
We will honor the work of DC Pink Divas and present awards to Rep. Debbie Wasserman Schultz and philanthropist David Rubenstein for their fight against breast cancer at the 5th annual Honoring the Promise gala, an evening of inspiration and entertainment, to be held in the Eisenhower Theater at the Kennedy Center on Thursday, September 18th.
I hope you can join us on the 18th—and in our work to overcome health disparities in the Washington, DC region. Full information on Honoring the Promise can be found at www.komen.org/honoringthepromise