As Breast Cancer Awareness Month is observed nationwide through October, the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) is mobilized on several fronts to treat—and someday prevent—the disease, the second most common cancer in women.
Directed by Tari A. King, MD, the DF/BWCC brings together clinical trialists, cancer surgeons, radiation oncologists, medical oncologists, and physician scientists to advance both better treatment and new understanding of the disease. In January 2018, Dr. King recruited Elizabeth A. Mittendorf, MD, PhD, from the MD Anderson Cancer Center in Houston to help lead the groups research efforts which are focused on four pillars spanning the continuum of breast cancer, from prevention through treatment and survivorship:
• Breast cancer Personalized Risk assessment, Education, and Prevention (B-PREP). The B-PREP program, established and led by Dr. King, provides every patient access to a full assessment of their breast cancer risk, so clinicians can personalize their risk management strategies. New, forthcoming research in collaboration with pathology and radiology at the institutions could apply artificial intelligence to diagnostics such as mammography and biopsy, to fine-tune the identification of risk categories—and ultimately, prevent cancer from developing.
• Ductal carcinoma in situ (DCIS) management. Considered pre-cancer or non-invasive cancer, DCIS is marked by tumor cells contained in the milk ducts of the breast—and has notoriously ambiguous options for treatment. As clinicians try to thread the needle between too much treatment and too little, researchers at the DF/BWCC are working to put tools in place using decision aids to help patients and their providers determine the best course of treatment. They are also conducting clinical trials and collecting biopsies and blood samples to learn more about DCIS and treatment options.
• Subtype-specific cancer management. While colleagues in medical oncology routinely use the subtype of breast cancer to determine systemic treatment strategies, less is known about how to tailor surgery based on subtype. Surgeons in the division of breast surgery are proposing and defining new treatment algorithms to determine the best course of action based on tumor biology—for both surgical and medical treatment.
• Tumor immunology. An international leader in breast cancer vaccines, Dr. Mittendorf and colleagues are examining the immunologic aspects of breast tumors that predict their therapeutic response, with the goal of making tumors more immunogenic—and susceptible to therapy.
To support these efforts, under the direction of Drs. Andrea Pusic and Laura Dominici the DF/BWCC is expanding its use of patient-reported outcome measures (PROMs) through its Patient Reported Outcomes, Value and Experience (PROVE) program, in order to better track patient outcomes. As part of a larger effort focused on value-based health care, the PROVE center promises to transform the way breast cancer patients are cared for.
Dr. Mittendorf believes immunology advances have unlocked new hope for patients, as breast cancer clinicians may now have a new therapy in their arsenal that enhances breast cancer survival. She points to recent research demonstrating the effectiveness of combination chemotherapy-immunotherapy treatments and vaccines to elicit an immune response—and increase survival—in certain breast cancer types. “But wouldn’t it be great if no one got the diagnosis?” she notes. “Immunotherapy is becoming our fourth pillar of cancer care, and many of us hope that in the future, we will have the opportunity to actually prevent cancer much like we prevent infectious disease, with vaccines.”
Until that time, Dr. Mittendorf recommends that every woman maintain an awareness of their breast health and any changes, schedule a clinical examination every year, get annual mammograms starting at age 40, and live healthfully through exercise and diet. Women interested in a comprehensive risk assessment can learn more through the B-PREP program at Brigham and Women’s Hospital.