By Lisa Newman, MD, chief of breast surgery at New York-Presbyterian and Weill Cornell Medicine, as told to Camille Noe Pagán
There are many reasons for women who have advanced breast cancer to be hopeful. For starters, the way we treat and study advanced, or metastatic, breast cancer is improving. Even in the past few years, treatments have become more effective. We’re making a lot of progress in new therapies that help people live longer, which is really important.
But equally exciting, we have more targeted therapies — a type of treatment that targets proteins that play a role in how cancer grows in your body. They have fewer serious side effects. That’s important, because the goal isn’t just to live longer, it’s also to feel better and stronger.
Research on how to find and monitor advanced breast cancer is found is especially promising right now. Some scientists are studying whether keeping an eye on circulating cancer tumor cells, a process sometimes referred to as a “liquid biopsy,” can help show whether a particular breast cancer treatment is working.
Likewise, precision medicine researchers are making exciting progress in profiling tumors. Precision medicine is treatment based on your individual tumor’s unique genetic makeup. This can help doctors better find treatments that work for you.
My research focuses on why breast cancer risk and disease outcomes vary based upon patients’ race and ethnicity. Death rates from breast cancer are 40% higher among African American women. A lot of this is due to the effects of systemic racism in public health. Economic and social disadvantages that are more common in the African-American community can lead to delays in diagnosis. That, in turn, means cancer in African-American women isn’t diagnosed until it’s already at an advanced stage.
But there’s more to it than that. We need more research on the biologic and genetic factors affecting African American women. For example, African American women are more likely to be diagnosed with breast cancer at younger ages. At all ages they’re more likely to be diagnosed with an aggressive form of the disease known as triple negative breast cancer (TNBC).
Research groups like mine (the International Center for the Study of Breast Cancer Subtypes, ICSBCS) have found that TNBC is also more common in western, sub-Saharan Africa. We believe the shared ancestry between African Americans and people who live in this part of Africa accounts for this TNBC prevalence. We’ve been doing genetic research to find more patterns that might help us create screening guidelines and lead to early detection of, and possibly even new treatments for, TNBC.
What’s more, African American people are less likely to be offered genetic testing and chances to take part in clinical trials. (Clinical trials are when researchers test in a medication or treatment to see if it works before it goes to the FDA for approval.) They’re the most important strategy we have when it comes to making progress with advanced breast cancer for women of all races and ethnicities.
There are no guarantees when you’re part of a clinical trial. But we test medicines that we believe are going to work. It takes a clinical trial to figure out if we’re right. They’re not right for everyone, but I do encourage people who are eligible for one and feel comfortable with the risks to consider it. Doctors will watch your treatment closely, so you get a high level of care.
If you have advanced breast cancer, you want to be able to plan your life. That’s why it’s important to talk to your oncologist. You want to understand your options and your outlook. No matter what your future holds, it’s best to work with a cancer care team that includes doctors and health professionals across many fields. They’ll be better able to read and understand your test images. They’re also more likely to have access to advanced treatments and clinical trials that could help treat your breast cancer.
Learn all you can because knowledge is really empowering. Understand the nature of your disease. Ask for pathology reports, and make sure your doctor explains your results and your treatment plan. It’s your right to know. Ask about genetic testing and clinical trials if your doctor doesn’t bring it up. It’s unfair that the burden of asking important questions sometimes falls on patients. But being your own advocate may improve the odds that you live longer and better.
