Spotlight on Research
Breast cancer is the most common kind of cancer in women, but many can survive the disease if it’s found and treated early. October is Breast Cancer Awareness Month, an ideal time to think about breast cancer screening, treatment and research.
Connecticut has the country’s highest rate of breast cancer incidence and was the first state to enact the dense breast notification law requiring that women with dense breasts be informed. Fortunately, Connecticut is in the lower half of the country in terms of women dying from breast cancer. “I think a lot of that is due to our screening,” said Dr. Anees Chagpar, M.D., who is nationally recognized for breast cancer care and research and serves as director of the Breast Center at Smilow Cancer Hospital. “There have been a lot of great advancements in technology to help women get screened, some of which have been pioneered right here at Yale.”
Advances in Imaging
There has been controversy surrounding screening guidelines for breast cancer, but doctors have known for a long time that screening makes a difference and improves survival. Mammography is a screening test that has traditionally been used for the early detection of breast cancer and women are generally advised to have annual mammograms starting at age 40.
Yale has taken a leading role in developing a new technology called digital breast tomosynthesis, or 3D mammography. Approved by the Food and Drug Administration in 2011 following clinical trials at Yale and four other medical centers, this technology helps doctors find more cancers in dense breasts and allows them to more precisely determine whether a lesion is suspicious based on the mammogram. This reduces the rate of callbacks, which can provoke anxiety in women who have to return for more tests. “I think this is really the vanguard of breast imaging,” said Dr. Chagpar.
Because 3D mammography is helping so many women, Yale and other institutions are revamping their machines to utilize this advanced technology. If you think of the breast as a loaf of bread, pressing on it and viewing it with traditional 2D mammography makes it dense and often requires additional imaging tests to understand what’s happening. The images generated by tomsynthesis, on the other hand, are very thin slices that allow doctors to view lesions in better detail.
Discoveries to Improve Patient Care
Yale offers multidisciplinary patient and family-centered care, which means that patients often have a team of doctors and nurses working together in a coordinated way, attacking the cancer from different vantage points.
“This is a place where research and clinical care go hand in hand,” Dr. Chagpar noted. “We’re really on the forefront of a lot of discoveries that are making a huge difference in terms of patient care.” For example, Yale is on the cutting edge of targeted therapies for breast cancer. One study taking place at Yale is a clinical trial for those with HER2 positive breast cancer using Herceptin® (trastuzumab) and another HER2 blocking agent to treat the cancer prior to surgery. “We are finding that these cancers are disappearing at the time of surgery,” said Dr. Chagpar.
Yale is also at the pinnacle of personalized medicine in terms of understanding the genetics and biology of each patient’s tumor. Yale doctors and scientists conduct research to study the genetics of particular cancers with the aim of developing targeted therapies that hone in on particular genes.
Yale is also distinguished for being at the leading edge of immunotherapies. The body’s immune system can fight infections, but cancers can cloak themselves to hide from the immune system. “We now have agents that can decloak cancers to help your immune system fight them,” said Dr. Chagpar. These agents have shown to be very effective for melanoma and lung cancer; Yale is now opening clinical trials for immunotherapies to treat breast cancer.
In fact, Yale conducts clinical trials in all areas of cancer diagnosis and treatment. “When we talk about this multidisciplinary team approach to cancer management, these trials that are offering tomorrow’s therapy today are really happening in every single modality,” said Dr. Chagpar. This includes not only research on surgery, drugs, and radiation, but also studies on the day to day management of symptoms to help improve the quality of life for cancer patients.
“I think clinical trials now are things patients should be availing themselves of because this is how you get the cutting edge therapies today,” said Dr. Chagpar, adding that patients who participate in clinical trials tend to do better than those who don’t because they receive the best therapies available.
Including Hard to Reach Populations
Targeted therapies, advanced imaging techniques and personalized medicine are advances that wouldn’t have been possible without clinical research. Dr. Chagpar, who is also assistant director for diversity and health equity at Yale Cancer Center, stresses the importance of ensuring that everybody participates in clinical research. “If a clinical trial accrues only Caucasian patients, then it’s really a bit of a leap to say that the result can be applied to the African American or Hispanic population,” she said. Yale conducts studies to help understand how cancers may behave differently in these populations in order to tailor therapies to more effectively treat these individuals.
Dr. Chagpar is convinced that bringing together the best minds in science with skilled doctors and nurses, focusing on personalized medicine, and engaging patients to participate in clinical trials will ultimately lead to better outcomes. “I think that’s how we’re ultimately going to solve the cancer problem not only for underserved populations, but for everybody,” she said.
For more information on breast cancer clinical trials contact the Breast Center at Smilow Cancer Hospital at 203-200-2328.