Less Toxic Drug Combos
If you’ve been diagnosed with early breast cancer, ask about chemo without Adriamycin. There are now three such regimens. "Adriamycin has been a part of treatment for 30 years, but it causes a lot of nausea and vomiting, and it puts you at risk for heart failure and leukemia. I’m the father of Adriamycin, so I can talk about my child this way," says Stephen Jones, MD, medical director of U.S. Oncology. "Taking it out increased the benefit with far fewer side effects. This new novel chemotherapy is at least as good as conventional chemo and is slowly being adopted around the country."
A More Accurate Mammogram
"Tomosynthesis is a big improvement over what we have now," says Elizabeth Rafferty, MD, director of breast imaging, Massachusetts General Hospital, in Boston. "It takes a number of angled images of the breast and, using a computer, reconstructs them into a 3-D mammogram." That means routine screenings will flag more cancers — with fewer false positives. "The fundamental flaw of mammography is that because we have so many normal breast structures — such as connective tissue, ducts, and lobules — it’s sometimes hard for radiologists to see cancers," Rafferty says. "We’re looking for white cancer in a sea of white structures." Pending FDA clearance, you may be able to get this test in addition to a traditional one by the time you’re due for your next mammogram. Eventually, researchers hope, it will replace standard mammography.
Tests That Help Peg the Best Treatment
Two new tumor gene tests, Oncotype Dx and MammoPrint, can help doctors better understand your cancer, including whether chemotherapy can beat it and how likely it is to recur. "This is a big first step toward selecting treatment that is best for you. These tests can be done at the time of surgery and can look at the activity of lots of genes in the tumor," says Julie Gralow, MD, a medical oncologist at the Seattle Cancer Care Alliance. "In my experience, most insurance companies cover the cost."
A Pill to Help Prevent Breast Cancer
Raloxifene, the osteoporosis drug, also helps fight cancer, according to recent research. "This drug not only reduces the risk of osteoporotic fractures but may also reduce the risk of breast cancer by 50 percent," says Monica Morrow, MD, of Fox Chase Cancer Center, in Philadelphia. "This could have a dramatic impact on the incidence of breast cancer in the U.S." If you are using raloxifene for osteoporosis, you need to take it indefinitely. But a 2006 study found that women at high risk for breast cancer needed to be on it for only five years to reduce their chance of getting the disease.
What the Future Holds for Breast Cancer
Three promising developments:
A Breast Cancer Vaccine
Some research has found a virus in a high percentage of breast cancers. "If breast cancer was viral," says Susan Love, MD, "not only could we find a way to screen for it, we could develop a vaccine, much like the HPV vaccine for cervical cancer."
More Cancer Genes Found
The gene mutations BRCA1 and BRCA2 may increase your risk of breast cancer tenfold; they are known as "high-penetrance" genes. Now researchers have identified several "low-penetrance" genes as well. "These can increase your risk 20, 40, or 60 percent," says Larry Norton, MD, of Memorial Sloan-Kettering Cancer Center. When there are tests for these genes, doctors will be able to catch the disease even earlier.
A Blood Test for Cancer
"Using nanotechnology, we may be able to build a machine that could screen blood and detect the presence of molecules correlated with breast cancer," predicts Mauro Ferrari, of the University of Texas M.D. Anderson Cancer Center, in Houston. In the future, Ferrari says, "If there’s an imbalance in some of these biological markers, we’ll be able to pick up a cancer years before a mammogram would."
Originally published in MORE magazine, October 2007.