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Doctors predict revolution coming in breast cancer care

| Saturday, Jan. 3, 2015, 11:39 p.m.
University of Pittsburgh breast cancer researchers Dr. Adrian Lee and Dr. Shannon Puhalla at Magee-Womens Research Institute in Oakland, on  Wednesday, Dec. 31, 2014.
Jasmine Goldband | Trib Total Media
University of Pittsburgh breast cancer researchers Dr. Adrian Lee and Dr. Shannon Puhalla at Magee-Womens Research Institute in Oakland, on Wednesday, Dec. 31, 2014.

A breast cancer diagnosis once loomed as a likely death sentence, a traumatizing battle fraught with chemotherapy, radiation or radical surgery, even in a best-case scenario.

Today doctors predict new treatments will revolutionize care during the next decade, knocking mortality rates to dramatic lows with genetic tests and personalized medicine.

“Now that we've made such big advancements by giving everybody similar types of therapy, we need to see how we can pull back on therapy for some patients and be smarter about therapy for people who are at higher risk,” said Dr. Rachel Jankowitz, an oncologist and breast cancer researcher at Magee-Womens Hospital of UPMC and the University of Pittsburgh in Oakland.

Strengthened detection and therapies cut breast cancer death rates by more than a third since 1990, although the disease remains the most common cancer among women. Survivors in the United States exceed 2.8 million; their ranks grow by as many as 190,000 a year.

Most have years ahead of them. Eighty-two percent of patients diagnosed will live for at least a decade, according to the National Cancer Institute and the American Cancer Society. The five-year survival rate tops 93 percent for those treated by the second stage of the disease.

Those figures reflect a 34 percent drop in death rates since 1990 — a pattern that researchers attribute to earlier, more useful mammograms, refined hormonal therapies and potent treatments for many patients.

“Once you've driven the mortality rate down, we have a lot of people who are living with the disease for a long time. They might live 10, 20 years now. Twenty years ago, that didn't exist,” said Adrian Lee, director of the Women's Cancer Research Center at Pitt and Magee-Womens Research Institute.

Yet powerful treatments can have lasting side effects — including exhaustion, foggy brain function and early menopause — and their effectiveness is limited with some tumors. Clinicians are rethinking the uniform approaches to care, trying to weed out collateral damage from the most intense therapies.

“In the past, we've said they all need radiation. Now we're realizing some patients don't need as much radiation as we are giving, and they will do as well with less or maybe nothing at all,” said Dr. Thomas Julian, director of breast surgical oncology for North Side-based Allegheny Health Network.

The shift coincides with a roughly 30 percent dip in chemotherapy for early-stage cases during the past decade, when a basic genetic test began helping doctors gauge the severity of many breast cancers. Experts said less aggressive tumors often don't demand chemotherapy, which is notorious for nausea, blood disorders and shooting pain, among other side effects.

Three-year survivor Sharon Herring, 63, of Observatory Hill endured severe constipation from a couple of months' worth of chemo before her surgery in 2012. More than 30 daily radiation sessions tired her.

“I think it would be better if you didn't have to go through so many treatments that take so long. That's hard,” said Herring, whose cancer remains in remission. “They're long and tedious.”

Doctors say the next crop of treatments should blunt complications and make life more comfortable for survivors. Drugs that cause fatigue can lead to “a vicious cycle of weight gain and a sedentary lifestyle,” said Robert Smith, senior director for cancer screening at the American Cancer Society in Atlanta. “We don't do as good a job of meeting the rehabilitation and survivorship needs of women as we could.”

Jankowitz said researchers recognize that breast cancer has nuanced subtypes with differing strengths. Doctors have started digging into the discrepancies with so-called genomic sequencing.

The laboratory process uses a tumor tissue sample to try to reveal broader genetic inconsistencies that could contribute to, or explain, each ailment and lead clinicians to an individualized therapy.

Doctors estimate that fewer than 10 percent of breast cancer patients undergo the process, but they expect the number to climb as costs decline and data uncovered become more useful. Prices can run more than $20,000 for patients without full insurance coverage, said Dr. Shannon Puhalla, a Pitt faculty member and breast cancer research director at the Magee-Womens Cancer Program.

Pitt researchers are helping to develop a blood test that could identify genetic mutations without relying on a tissue sample, she said. The school announced in December that a newly discovered mutation could help explain how the disease spreads.

“We can do (the sequencing test), but we don't necessarily know what to do with these genomic answers once we have them,” Puhalla said. She estimated doctors will learn within five to 10 years how to interpret and use the genetic information more effectively.

“Ideally, I'd love to do this in every single patient,” Puhalla said.

Kathy Purcell, executive director of the Susan G. Komen Race for the Cure Pittsburgh chapter, said the nonprofit group believes researchers will figure out how to stop the disease for good.

“It has multiple reasons and causes, so there will be multiple cures,” Purcell said.

Adam Smeltz is a Trib Total Media staff writer. Reach him at 412-380-5676 or asmeltz@tribweb.com.

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