Columbus Monthly: Health Matters - Surviving Breast Cancer (2022)

A BETTER PROGNOSIS

Survival rates among breast cancer patients are rising dramatically, in large part due to more personalized treatment plans.

By Nancy Hubbard Byron

Breast cancer deaths in the U.S. have dropped 42 percent since 1989, according to the National Cancer Institute, and five-year relative survival rates have risen above 90 per cent in that same timeframe.

“That’s mostly due to earlier diagno sis and better treatments,” says Dr. Mar garet Gatti-Mays, medical oncologist and researcher with the Ohio State Uni versity Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

“We are seeing breast cancer pa tients live much longer now,” agrees Dr. Shabana Dewani, partner and physician

with Columbus Oncology and Hematol ogy Associates.

Despite the good news, breast cancer is still expected to be the most common cancer diagnosed in women during 2022, according to the Ameri can Cancer Society, with an estimated 287,850 new cases this year alone. It’s so common, in fact, that “one in eight women will have it in their lifetimes,” Gatti-Mays says.

That’s why early detection and per sonalized treatment plans are so vital.

“Outcomes are always better when a patient has an individualized plan,” says Dr. Jeanna Knoble, managing partner

with the Mark H. Zangmeister Cancer Center and a medical oncologist/hema tologist with a focus on breast cancer.

“Years ago, it was chemo, chemo, chemo. Everybody got chemo,” Dewani says. “Now it’s looking at all the details, not just the size or the location of the tumor. We could have 10 patients whose tumors look exactly the same under the microscope, but they behave very differently. Now we can look into the genes within the tumor—the gene biology—that tells us how it’s likely to behave. What’s driving this tumor, what’s in this tumor—that’s how we’re picking treatments now.”

Getting Personal

When designing an individualized treatment plan for breast cancer, doctors consider three main factors, Knoble says.

First on the list is the genetic profile of the cancer, or how it looks and be haves under the microscope.

“Just like each of us has a unique DNA makeup, so does each cancer,” Knoble says. “And this makeup can help us determine who needs more or less aggressive therapy and whether certain specific treatments and target ed therapies may be effective.”

The second factor is the stage of the cancer. Cancers are rated in stages from I to IV, depending on how ad vanced they are at the time of diagno sis. Stages I and II typically see smaller tumors limited to the breast tissue and potentially the surrounding lymph nodes, while Stage III tumors may have spread a little further. Stage IV, or metastatic, breast cancer has spread to other organs.

“This has a role in whether surgery is an option, which type of surgery, and whether the cancer is considered potentially curable or not,” Knoble says.

The third factor is the patient: their health prior to diagnosis, as well as lifestyle, fitness and age.

“It’s not just if they’re 24 or 44 or 94,” Gatti-Mays says. “It’s also their func tional age: What’s the patient’s mobil ity? Do they do strenuous activity or only limited activities? A patient that’s in better shape going into surgery, chemotherapy or radiation is typically set up better to tolerate and even thrive during treatments.”

Age may create other factors for consideration, however.

“We’re seeing a lot of younger pa tients these days,” Dewani says. These younger patients may need to see a specialist to retrieve eggs or sperm to preserve their ability to have children, she says, adding that for people who menstruate, treatments can be impact ed by whether the patient is pre- or post-menopausal. Underlying condi tions, like diabetes or autoimmune dis eases, can also alter treatment plans.

“For breast cancer, it’s not one size fits all,” Dewani says.

Understanding a patient’s responsi bilities and routines prior to diagnosis is another vital part of designing the best treatment plan.

“It is important to collaborate and adapt to a patient’s priorities,” Knoble says. “As long as a patient understands the risk versus benefit of each treatment recommended, it is important to find a common-ground plan, even if it isn’t the ‘preferred standard of care’ treatment.”

For example, if a patient is planning a once-in-a-lifetime vacation later that year or has three small children at home requiring constant care and transpor tation to activities, those details can be factored into treatment options.

“I want to know about the grandchild that’s going to be born in six months, so that’s why treatment has to be done by then,” Gatti-Mays says. “It’s import ant to share that information and ask

those questions to get the most indi vidualized care. It helps me understand them as a patient and a person. When a patient asks questions, it also tells me they’re processing their diagnosis.”

Due to the complexity of factors involved in personalizing plans, it typ ically takes two to eight weeks for pa tients to begin receiving treatment, with the exception of extremely aggressive inflammatory breast cancer patients, who may start treatment sooner.

“This can be frustrating for patients who, understandably, want detailed answers ASAP,” Knoble says. “Cancer rarely progresses or changes over weeks in a significant way, so it is important to have all the information

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But the choice of where to treat it is clear

Leading theWay

The

breast cancer

The vast majority of breast can cers are carcinomas that fall into two main categories—ductal or lobular—based on the specific cells that become cancerous. Ductal carcinoma starts in the milk ducts, while lobular carcinoma starts in the glands that make milk.

Breast cancers are further defined by whether they have spread. Ductal carcinomas that haven’t invaded other breast tissue are labeled “in situ,” or DCIS for short. Invasive or infiltrating breast cancer—also referred to as IDC for invasive ductal carcinoma or ILC for invasive lobular carcinoma—is any type of breast cancer that has spread into surrounding tissue. IDC makes up 70 to 80 percent of all breast cancers, according to the American Cancer Society.

Some less common types of invasive breast cancers include:

✦

Triple-negative breast cancer, an aggressive cancer that takes its name from the fact that the cells test “negative” for estrogen re ceptors, progesterone receptors and a protein called HER2.

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Inflammatory breast cancer, another aggressive cancer that derives its name from the cancer cells that block lymph vessels in the skin, causing the breast to look inflamed.

✦

Jeanna L.

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Paget disease, a rare breast cancer that starts in the breast ducts and spreads to the skin of the nipple and areola.

Angiosarcoma, a very rare can cer that starts in the cells lining blood vessels or lymph vessels within the breast tissue or skin of the breast.

✦

Phyllodes tumors, also very rare, develop in the connective tissue of the breast. Most are benign, but some can be cancerous.

Sonia

M.D. Shabana Dewani, M.D. Christopher George, M.D. Andrew Grainger, M.D.Joseph Hofmeister, M.D.

Lauren Sockrider, CNPBrittany Sweigart, CNP

Frustaci, CNP Jennifer Seiler, CNP Carmen Sidani, CNP

Elizabeth Kander, M.D. Peter Kourlas, M.D. Kavya Krishna, M.D. Erin Macrae, M.D. Nse Ntukidem, M.D.

Thomas Sweeney, M.D.

Shylaja Mani, M.D. Anish Parikh, M.D.

Augustine Hong, M.D.

needed to create the best treatment plan, rather than a fast one.”

Improving Outcomes

“The goal in oncology is always to make the treatment less problematic than the cancer itself,” Knoble says.

Many patients are still concerned about chemotherapy, which uses chem ical substances to attack cancer tumors but can also impact healthy cells.

“Chemo patients are depicted as having a lot of nausea, vomiting and being really sick,” Gatti-Mays says. “But we’ve come a long way since then. There are medications I can give before chemo now, as well as after treatment, to help control those side effects. With individualized plans, it’s not a blanket, high-intensity treatment for all patients anymore. There’s an effort to de-escalate therapy so we’re being as aggressive as we need to be, but not overly aggressive.”

Newer innovations in breast cancer treatments include:

✦ Targeted therapy in the form of pills or monoclonal antibodies that

target a certain protein on cancer cell surfaces or mutations in the cancer cell DNA.

✦ Drug antibody conjugates, some times referred to as “smart bombs,” where a monoclonal antibody not only targets a protein on cancer cell surfaces but also contains a che motherapy particle that is released into the cancer cell to kill it.

✦ Immunotherapy designed to strengthen the patient’s immune system to more efficiently attack cancer cells.

“With the newer treatments, quality of life has improved,” Dewani says.

Other innovative treatments working their way through the pipeline include:

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A way to identify potential recur rences of breast cancer using a blood test in patients who have completed treatment for Stage I, II or III cancers.

✦ A vaccine to help prevent recurrence in patients who have been treated for triple-negative breast cancer.

“Many triple-negatives recur in the first five years,” Dewani says. “So we’re

always looking for strategies to prevent recurrences and increase survival.”

Treating the Whole Patient

While physical treatments are clearly vital, other important—but sometimes overlooked—factors in treatment in clude mental health and emotional care.

“A cancer diagnosis has an under standably huge impact on the mental well-being of a patient,” Knoble says.

“Patients just want to get through treatments, but having someone who can be their advocate is really import ant,” Gatti-Mays says. “It helps the patient emotionally.”

“Studies show that those who go into treatment with a positive attitude actually have better outcomes,” Dewani adds. “Pa tients who do not have a lot of psycholog ical or social support have a more difficult time getting through the treatment.”

Staying active socially and physically can help, too.

“The stronger your body [is], the more resilient your body will be and the better [it will be] able to handle the treatments,” Dewani says.