Another National Breast Cancer Awareness Month brings essential and heartwarming community concern, important reminders of the effectiveness of mammography and pink ribbons. This annual public awareness has, without question, saved lives by encouraging early detection and generating millions of dollars in research that continues to improve treatment.
We have made, and continue to make, important progress on a disease that will affect more than 12 percent of American women at some time in their lives.
The markers of progress are considerable: Breast cancer rates have decreased since 2000, and survival rates have increased over the last three decades.
Yet progress remains woefully inadequate, as more than 40,000 women will die from breast cancer in the United States in 2018. Breast cancer remains the second leading cause of cancer death in women (after lung cancer). It is the second-most commonly diagnosed cancer in women (after skin cancer) and represents almost one-third of newly diagnosed cancers in American women each year.
While we have much to celebrate about breast cancer, there is still much more to accomplish. For patients and families affected by breast cancer, and by other cancers, the generally positive news regarding prevention, detection and treatment may be small comfort against the suffering that diagnosis, treatment and illness too often bring. Statistics and theories explaining causes, risk factors and survival paint an informative and useful overall picture, but the fact remains that each case of breast cancer is as unique as the individual person with the disease.
It is the individuality of breast cancer (and all cancers) that represents one of the most exciting opportunities in risk assessment, prevention and treatment. In recent years, the medical community’s understanding of the genetic and molecular differences between normal cells and cancer cells has led to remarkable progress in personalized and precision medicine.
We have identified, for example, many specific inherited genetic abnormalities that predispose to breast cancer. In fact, 5 to 10 percent of breast cancers arise in the setting of one of the many known genetic abnormalities that are passed through generations and are present at birth.
At Penn Medicine Lancaster General Health’s Cancer Risk Evaluation Program, we analyze individual medical histories, map out family trees and do simple blood or saliva tests that screen for genetic mutations. Our genetic counselors and physicians use this information to estimate an unaffected person’s lifetime risk of developing cancer, so that individualized screening, surveillance and prevention plans can be recommended, thereby reducing risk, preventing some cancers and leading to earlier diagnosis for some.
In individuals who are already affected with cancer, we use this same information to help understand why the cancer developed in the first place, how the information can be used to select newer and more effective therapies and how to identify family members who can benefit from genetic testing as well. We can also analyze the cancer cells themselves for acquired, rather than inherited, genetic abnormalities that drive the cancer cells’ misbehavior. Identifying genetic abnormalities in cancer cells themselves has identified precision targets that can be effectively blocked to control breast cancer, lung cancer, melanoma and many blood cancers.
And we must not stop until we know more. More that can prevent cancer. More precision targets that can be blocked and more ways to harness the immune system. LG Health physicians and Penn Medicine researchers are deeply engaged in innovative research expanding immunotherapy and precision medicine that brings much-needed help for patients with breast and other cancers.
Breast Cancer Awareness Month, first recognized in 1985, continues to represent a persistent and complex disease that requires research, care, caring and remembrance every month of the year.
Dr. Randall A. Oyer is medical director of the Ann B. Barshinger Cancer Institute’s Cancer Risk Evaluation Program. It is part of Penn Medicine Lancaster General Health.