Looking back over 2014, what are the highlights of the year when it comes to major stories about breast cancer and developments in cancer research?
Here are my picks for the top ten stories that taught me something new, or that seemed to me to offer fresh insights or helpful reinforcement on issues that have been around for a while.
- A major study on breast cancer screening reviewed what is known about the benefits and harms of screening mammography from the many trials and other studies that have been conducted over the last 50 years. The study concluded that decisions about screening need to be based on an individual woman’s estimated risk for breast cancer, as well as the woman’s own values and preferences.
- A study on breast cancer mortality over the twenty-year period from 1990 to 2009 examined trends by ethnic group and by city for 41 U.S. cities. The study found that disparities in breast cancer mortality between ethnic groups, in addition to increasing over time, also differ widely across cities. Much of the increase in disparity over the twenty years occurred because mortality rates for whites improved while those for African American women did not.
- Seventeen categories of chemicals that have been shown to cause breast cancer in lab animals, and are also likely to cause breast cancer in humans, were identified in a study reported in the journal Environmental Health Perspectives. The report listed specific actions that women can take to reduce their exposure to these likely carcinogens, and provided a road map for future research to establish the specific effect of each of these types of chemicals on women’s bodies.
- In view of the increasing numbers of women who are choosing contralateral prophylactic mastectomy (CPM), despite having no known genetic mutation that would increase breast cancer risk, researchers conducted a study to evaluate the actual survival benefits conferred by CPM. The study found that, for women with stage I or II breast cancer and no BRCA mutation, there is very minimal survival benefit from the surgery. Subsequent discussion in the media and blogs revealed how individual the choices are that women must make and reinforced that, in medical decison-making, the evidence from scientific studies is an essential starting point, but it is just that–an educated starting point for decisions to be made based on an individual’s own unique set of circumstances.
- The respected geneticist Dr. Mary Claire King proposed that all women in the United States be offered genetic testing for the BRCA gene mutations that increase risk for breast and ovarian cancer at about age 30 in the course of routine medical care. Her recommendation followed a study of population-based screening in the Ashkenazi Jewish population of Israel that was conducted by her research group. While there were varying reactions to her specific recommendation, at a minimum the study seemed to reinforce that members of higher-risk populations, as well as those with a family history of breast or ovarian cancer, may obtain valuable information about their personal risk though genetic testing.
- New international guidelines for the treatment of advanced breast cancer were published, and included a plea for research to address the treatment needs of a number of critical subsets of patients with advanced breast cancer, including metastatic breast cancer. The guidelines stressed the urgent need for clinical trials to address issues other than new drug development, including determining the best drugs to use for patients with specific metastatic conditions or treatment responses, as well as selecting individualized treatment based on predictive biomarkers.
- The shockingly high prices for the newer cancer medications and other financial hardships that go along with cancer treatment now make financial toxicity one of the risks of treatment that doctors increasingly must discuss with their patients along with physical side effects and risks. Recent coverage of this problem included a 60 Minutes segment on the cost of cancer drugs, and piece by a physician in the New York Times on the unacceptable tradeoffs that patients must face.
- Celebrities often are in a position to educate or inform when they share their experiences with cancer or other illnesses with the public, but publishers of celebrity stories need to be careful to clearly distinguish what is opinion from what is factual in these stories. We saw an example of how such stories can be misleading when two celebrities’ personal opinions about dealing with a breast cancer diagnosis were presented in a widely-read magazine as “lessons for all of us.”
- In September, an immune system boosting drug called pembrolizumab (Keytruda), became the first in a new class of drugs known as “PD-1 inhibitors” to receive FDA approval when it was approved for the treatment of advanced melanoma. The drug’s effect has been described as “releasing the brakes” on the immune system. In those patients for whom it works, it can be effective for a very long time. At the San Antonio Breast Cancer Symposium in December, results were presented for a small study of Keytruda in patients with advanced triple negative breast cancer. The results were considered encouraging enough to move forward with further studies of the treatment in breast cancer patients.
- The first in another new class of drugs called “PARP inhibitors” received approval in December, when the FDA granted accelerated approval to the drug olaparib (Lynparza) for the treatment of advanced ovarian cancer associated with defective BRCA genes. The FDA also approved a companion genetic test to be used specifically to identify ovarian cancer patients with BRCA mutations who may be candidates for treatment with the new drug.
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