Here’s How Breast-Cancer Treatments Have Changed For The Better
About 240,000 new cases of breast cancer are diagnosed in women in the U.S. each year, which means it’s still the second-leading cause of cancer death in women. However, over time deaths from the disease have dropped significantly, which doctors say is due to huge advances in treatment options over the past five decades. So today, a diagnosis of breast cancer isn’t the death sentence it once felt like. It’s also no longer an illness that people try to hide, and there are now many active communities to help support breast-cancer patients on their health journey.
But imagine a world in which breast cancer is never talked about and doctors don’t have the tools needed to treat it. That’s what things were like when Gabriel Hortobagyi, MD, Nellie B. Connally Chair in Breast Cancer at the University of Texas MD Anderson Cancer Center, in Houston, started practicing medicine in 1970. “In the ’60s and ’70s, people didn't talk about cancer and breast cancer. It was like sex and money—you just didn’t talk about it,” he says. And it wasn’t just that there was avoidance of the topic; there also weren’t many treatment options available.
“When I was in training, we would often bypass the rooms of patients with breast cancer, because we were told there was nothing we could do for them,” Dr. Hortobagyi says. “Things have changed dramatically.” Treatment options have advanced “enormously” since then, he notes, and with them has come a better quality of life for breast-cancer patients.
Surgery Used To Be The Only Treatment Option
“Breast cancers have been described since ancient Egyptian times, but for centuries little was known about what drove these cancers to form or how to treat them,” says Hatem Soliman, MD, a medical oncologist specializing in breast cancer at Moffitt Cancer Center in Tampa, Florida. So doctors would simply remove a cancerous body part and hope for the best.
As modern surgical techniques developed, along with anesthesia, surgeons in the late 1800s and early 1900s found that some women could be cured by removal of their breast cancers, or had their cancers shrink when their ovaries were removed. “At that time, there were no drugs that were known to treat breast cancers,” Dr. Soliman says. Surgery was the sole option.
War Brought A Surprising Discovery: Treatment Options.
Chemotherapy developed out of a World War II tragedy, when navy personnel who had been exposed to mustard gas were found to have toxic changes in their bone-marrow cells, which develop into blood cells, according to the American Cancer Society (ACS). “Physicians found that this was terrible but, in some circumstances, could help [stop] cells growing out of control, like cancer cells,” Dr. Hortobagyi says. This finding, along with other discoveries about how different drugs affect or kill certain cancers, signaled the birth of chemotherapy.
Then in 1956, a drug called methotrexate, which is used against cancer as well as other diseases today, was the first to cure a metastatic cancer when it was found to treat a rare tumor called choriocarcinoma, which tends to spread rapidly. Nearly 20 years later, researchers would realize that a regimen using methotrexate paired with two other drugs, cyclophosphamide and fluorouracil, in a chemotherapy called CMF could stop breast cancer before it metastasized through the body, and lower the odds of cancer coming back in women without metastatic cancer.
“For the first time, we had practice-changing evidence that we could cure more women by administering systemic chemotherapy to eradicate cancer cells that spread from the breast,” Dr. Soliman says. “This formed the foundation for medical oncologists to build on over the years, by testing more effective drugs as they became available to improve outcomes for millions of women afflicted with breast cancer.”
Additional scientific discoveries involving radiation and targeted therapy were also occurring simultaneously. “There have been layers and layers of scientific advances since then,” Dr. Hortobagyi notes.
Eventually, It Was Time To Target Breast-Cancer Behavior
It wasn’t just the therapies’ effects on breast-cancer cells that were getting noticed. “We realized that even when we did these radical surgeries, breast cancer still came back some of the time,” says Bhuvaneswari Ramaswamy, MD, a breast medical oncologist with The Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, in Columbus, Ohio. “We found that cancer cells were spilling into the blood, hiding, and reappearing in a bit. We knew that those tumor cells needed to be killed as well—people shouldn’t just have surgery.” So scientists learned more about how certain types of breast cancer behave and how to target them.
This allowed researchers to move past the single type of chemotherapy then used to treat cancer. “We developed more therapies—and targeted ones,” Dr. Ramaswamy says. One of these was biological therapies that enlist the body’s own immune system to kill cancer cells. They now treat several forms of breast cancer.
Today, doctors have an arsenal of treatment options at their disposal, and they’ve learned which work best for different types of breast cancer. “The medications we have now are increasingly more precise in their ability to target cancer cells while reducing effects on normal tissues,” Dr. Soliman says. These advances, combined with screening methods like mammograms, have increased the odds that breast cancer will be detected early and can be cured, Dr. Hortobagyi adds.
Survivorship Is Better
There are many different forms and stages of breast cancer. But the overall five-year survivorship for people with all stages of breast cancer is now 91 percent, according to the ACS. That’s a huge change from when Dr. Hortobagyi started practicing medicine.
“When I started training, people with breast cancer usually died from it,” he recalls. “One of my mentors used to say that there was no worse quality of life than dying from cancer, since many of our tools produced quite a bit of toxic side effects. It was called ‘slash, burn, and poison.’”
Today’s doctors have the tools to make treatments safer and more effective, while also helping lessen the impact they have on patients’ quality of life by minimizing side effects and treating comorbidities. They even have options in cases of multidrug resistance, which is when a cancer doesn’t respond to the usual treatment medications.
“Before, we never really talked much about survivorship,” Dr. Ramaswamy says. “We were just focused on treating the cancer and making sure it didn’t come back. Now there is a huge emphasis on it. We don’t just shove it under the carpet—we talk about it.”
The result: Patients are being offered more resources. “As more women are cured of their breast cancer, survivorship has become very important,” Dr. Soliman says. “Many cancer accreditation programs require breast-cancer teams to provide women with survivorship resources such as treatment summaries, and education for patients and providers on what are best practices for survivorship.”
Until Breast Cancer Is Eradicated, Screening Is Still Important
None of the many advances over the past century-plus in the treatment of breast cancer change the fact that there is still a one-in-eight chance that a woman will develop breast cancer in her lifetime. So it’s still very important for women to be aware of their risk. “Have a conversation with your family and with your physicians early,” Dr. Hortobagyi says. “If your family history of breast cancer is strong, you may need to start heavy screening earlier than others.”
But Dr. Hortobagyi also stresses this: “Even if you’re diagnosed with breast cancer, there is now a high probability of a cure. Instead of thinking of breast cancer as a death sentence, it should now be thought of as another illness—and one that can be met with favorable outcomes.”
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