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Breast CancerIssue Introductions

Advances in Our Understanding of Breast Cancer

Let me share some good news with you: there are more treatment options today than ever before. Here’s what that means for you.
July 2021 Part 2 of 3 – Breast Cancer Special Issue Series
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, Journal of Oncology Navigation & Survivorship®; Co-Founder, Academy of Oncology Nurse & Patient Navigators® (AONN+); University Distinguished Service Professor of Breast Cancer, Professor of Surgery, Johns Hopkins University School of Medicine; Co-Developer, Work Stride-Managing Cancer at Work, Johns Hopkins Healthcare Solutions
Breast cancer survivor

I was diagnosed with breast cancer when I was in my 30s. That was 29 years ago. Back then, there was limited knowledge about the variances that are contained in breast cancer cells. Most of the time, treatment was determined by 2 factors: the stage of the cancer and the hormone receptor status (also known as prognostic factors). But even with this information, there were limitations to what an oncologist could prescribe—tamoxifen was the only drug available at that time to treat a hormone receptor–positive breast cancer.

It is a joy and relief to see the progress we’ve made in our ability to effectively treat patients with breast cancer. Those hormone receptor–positive breast cancers I mentioned above? Well, where there once was only tamoxifen as treatment, there are now many effective treatment options in addition to tamoxifen (see my article in the April 2021 edition of this breast cancer series entitled “Hormone Receptor–Positive Breast Cancer Explained” to learn more about estrogen receptor–positive and progesterone receptor–positive breast cancers).

We’ve made so many advances in our understanding of breast cancer since I was diagnosed—especially about different types of breast cancer. Yes, there’s more than 1 type. If we did a deep dive regarding how many different types there are based on all the biomarkers, gene mutations, genomes, and other factors, there are probably more than 100 different permutations of breast cancers. But for now, let’s focus on the primary prognostic factors. I have mentioned the hormone receptors. Another such example is a breast cancer with human epidermal growth factor receptor type 2—also called HER2/neu or just HER2. We explore this type of cancer in an article by Cathy Friedlander Cole entitled “HER2-Positive Breast Cancer: What You Need to Know” (page 12). HER2 wasn’t even understood when I was first diagnosed. And today it is a key prognostic factor when planning breast cancer treatment, with numerous drugs specifically for patients whose HER2 is deemed to be “positive.”

The good news for women and men diagnosed with breast cancer is that there are many more treatment options today than ever before. Biomarkers, genetic mutations, genomes, and prognostic factors discovered through laboratory research have resulted in the development of new anticancer drugs. What’s even more encouraging is that there are many targeted therapies prescribed specifically for different types of cancer based on the biomarkers, genetic mutations, and prognostic factors of the tumor cells.

Drugs have a long road to travel before they are approved for use in patients. Each new drug is thoroughly researched and studied in clinical trials. During the course of your treatment, you may have an opportunity to participate in a clinical trial. If so, I hope you will seriously consider participating. It might be something as simple as giving a tube of your blood or allowing a section of the tumor that was removed during surgery to be preserved for future studies. A “yes” from you may help to identify a new biomarker. Or your participation might entail a clinical trial comparing the current standard of care with what is hoped will become an improved treatment option. I hope you will consider participating as a way to improve our ability to diagnose and treat this disease. In some cases, depending on the type of clinical trial, you may personally be benefiting by participating. In other situations, you will be paying it forward for future generations who hear the words that you and I have both been forced to hear—“You have breast cancer.”

I hope, too, that you feel empowered after reading this issue. I want you to understand the uniqueness of your treatment, and how it should be based on the biological and pathological results of the breast cancer cells. I want you to feel confident and well able to engage in shared decision-making with your healthcare team.

I encourage you to focus on getting the right amount of exercise, eating a healthy diet, staying on track with your treatments, and most of all, I encourage you to choose joy whenever you can. I know firsthand that a cancer diagnosis is a life-altering experience for you and your family. You are now looking at the world through a different lens. So, embrace joyful moments. Create joyful times. Don’t postpone joy. I know you will come to value the little joys in your life even more, just as I have.

And as you go on this profound journey, know that I will be thinking of you, praying for you, and hoping that you become a long-term survivor with me.

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Last modified: June 14, 2021

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