In the first century AD, the Roman physician Aulus Cornelius Celsus described cancer as a single disease. He saw treatment for that disease as hopeless, remarking that “after excision, even when a scar has formed, nonetheless the disease has returned and caused death.”
For some people outside of medicine, that popular perception of cancer — of an incurable, intractable and single disease — has not changed much. Those of us who are closer to the research and the advances being made know that the opposite is true on both counts. We know that cancer is not one disease but rather many diseases that share common characteristics and that it is not static, and may even evolve over time. But it is precisely the multifaceted nature of cancer that allows us to tailor treatment to the specific cancer faced by each patient, which has, in turn, driven innovative and thoughtful new approaches to personalized cancer treatment and care.
What this personalization also means is how critical it is to give patients access to the newest and the best technology in breast cancer treatment. As I have heard over and over from advocates, patients, and physicians on my Breast Practices program, we collectively need to do more to ensure that race, geography, or socioeconomic status do not prevent access to these patient-centered and life-saving technologies.
That said, here are four developments in breast cancer detection and treatment that deserve more attention, broader adoption, and greater access:
- Molecular diagnostic testing – Genetic testing can help some patients assess the risk of developing cancer — for example, those with a family history, or those diagnosed at a young age. It can also tell us how well a person’s cancer will respond to treatment, identify which therapies their cancer will likely respond to, and help assess the risk of recurrence. Molecular genetic tests have come a long way since the 90s, and can now sequence multiple genes, helping doctors develop a risk profile. It’s also important to note that genomic testing of existing tumors can help inform treatment decisions and target therapies. Analyzing the genes in breast cancer can also help predict the likelihood of recurrence. Patients need to make sure they are informed about their PIK3CA, HER2 and hormone receptor statuses, as these can drastically affect which chemotherapy drugs will be most effective. According to a study published in the American Society of Clinical Oncology Educational Book, “molecular testing is now part of the clinical management for the majority of patients with breast cancer.”
- Advanced diagnostic imaging – The earlier we can detect breast cancer, the better the outcomes for patients. For example, relative to a healthy person, you have a 99 percent chance of surviving at least 5 years with a diagnosis of localized breast disease. Advances in diagnostic imaging make earlier detection possible, which is why patients with dense breasts need greater access to technologies such as digital breast tomosynthesis (DBT). DBT uses the same technology as a regular mammogram, however, it is only available in some hospitals. Traditional mammograms are 2-D, whereas tomosynthesis creates a 3-D image. It has been found to improve cancer detection rates. Access to technology like DBT, breast ultrasound, and breast MRI are vital because they can detect cancer before it is palpable. This is especially important for patients with a genetic predisposition to cancer risk.
- Wire-free localization – Lumpectomy patients can now forego uncomfortable guide wires for implantation of a magnetic or radioactive marker as small as a sesame seed. At MOLLI Surgical, we set out to simplify health care for patients and providers so that more people can get the care that they need quickly. MOLLI is intuitive to use with no extensive learning curve. In a 2020 study, the MOLLI system was shown to be “a reliable and accurate method for intraoperative localization of non-palpable breast lesions.” It helps breast cancer patients have a more comfortable surgery experience and do it in a way that fits better with their life schedule — especially if they need to travel to their medical center — while it helps surgeons remove the lesions more efficiently.
- Multimodal pain therapies – This approach uses a combination of medications for pain relief after surgery — rather than only opioids — without the concern of dependency. According to a study by Amy E. Cyr, MD, “the next step is for the breast surgery community to define more clearly the pillars of ERAS (Enhanced Recovery After Surgery) as they apply to our patients and, ultimately, to measure its impact on patient outcomes, including perioperative opioid needs.” Jacob L. Hutchins, MD, in his paper, Improving Patient Outcomes Through State-of-the-Art Pain Control in Breast Cancer Surgery, reports that “In addition, uncontrolled acute postoperative pain is associated with longer stays in the postanesthesia care unit, longer hospital stays, decreased patient satisfaction and quality of life, and increased costs.” Multimodal analgesia uses nonopioid medication protocols that are coordinated across all phases of care: preoperative, intraoperative, and postoperative. While it requires more integration between surgical, anesthesia, and nursing teams, the benefits are that pain and unwelcome side effects of these medications are minimized.
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