Breast Cancer Treatment: Research, Development and Game Changers

Professor Arnie Hill speaks to Sylvia Thompson of The Irish Times about the advances of breast cancer treatment in the past ten years.

Prof Arnie Hill, breast cancer surgeon and head of the medical school at The Royal College of Surgeons for Ireland, jokes that many women with breast cancer could almost have a degree in breast cancer following their treatment, such is the amount of knowledge gained through the experience. Learning about the type of breast cancer you have is just the start of the journey to understand different cancer drugs, the appropriateness or not of chemotherapy, and the types of surgery, as ongoing research changes the approach to breast cancer.

One of the most exciting developments in recent years is the OncoType DX test. This genetic test on tumour tissue clarifies whether chemotherapy is necessary or not. “The oncotype test reduces the amount of chemotherapy given for breast cancer by 50 per cent,” explains Prof Hill. This is a game changer in the treatment of breast cancer as previously – in spite of clinicians’ views that many women didn’t need chemotherapy – most women chose to have it for the 3-5 percent chance that it would improve their survival rates. “The Oncotype test proves which type of breast cancer a woman has. And now we know that chemotherapy is beneficial for early breast cancers (such as HER2-negative, ER-positive and node negative breast cancers) which make up about 45 per cent diagnosed breast cancers”, explains Prof Hill.

Cara McAdam says that she researched all the papers and clinical trials when she was diagnosed with HER2-positive breast cancer. “I’m a biology teacher and I remember thinking this would be very interesting if it wasn’t happening to me”. She was dreading chemotherapy, having read about the severe side effects of adriamycin cyclophosphamide (AC) chemotherapy so was relieved to find out that she would only be administered a newer chemotherapy drug, Taxol (paclitaxel). “I had a grade three tumor so chemotherapy was needed but I benefited from trials that showed the recurrence rates were equal with or without AC chemotherapy which meant I didn’t have to have AC chemotherapy”.

Naoise Coogan (46), who works in corporate communications for Glanbia, feels very grateful for the Oncotype DX test. “It made a massive difference to my diagnosis. I found a lump under my arm five years ago and had a triple assessment – clinical assessment, mammogram and ultrasound – within two weeks. A biopsy of my cancer (ductal carcinoma) was sent to San Francisco for analysis and the Oncotest DX came back with a low reading meaning that it wouldn’t be beneficial to have chemotherapy”, explains Coogan. She says that she had two young children at the time and didn’t want to look sick. “I went into hospital as a day case for a lumpectomy and to have lymph nodes removed and then started 7 weeks of radiation 6 weeks later”, explains Coogan. Five years free of cancer, Coogan will continue to take hormonal drugs, Tamoxifen for another five years.

Another development of breast cancer in the last ten years is to treat is the ability to treat some HER2-postive breast cancer with drugs alone. “There is a panel of drugs that have proven to be effective for this subset of 20 percent of breast cancers,” explains Prof Hill. “We are now at the stage that 50 per cent of these patients will respond to drugs alone making them the first group of breast cancer patients to avoid surgery”. These women will continue to have chemotherapy treatments alongside their medication for four to five months. Women in Ireland who do, however, need to have mastectomy’s to remove malignant tumors from their breast now have greater opportunities to have reconstructive surgery than they would have had ten years ago. “We now have six plastic surgeons at Beaumont Hospital compared with one plastic surgeon when I started here in 2005”, says Prof Hill. The standard reconstructive surgery now involves taking fat tissue from the woman’s lower abdomen (tummy) to reconstruct the breast. It involves a four hour operation and four days in hospital. About one in three women who have had breast cancer surgery opt to have reconstructive surgery.

Triple-negative breast cancer which is breast cancer that doesn’t have oestrogen, progesterone of HER2 receptors is one of the more aggressive and more difficult to treat forms of breast cancer. Currently, researchers at Queen’s University Belfast are studying new treatments for this sub-group of breast cancer patients. “This is one type of breast cancer that we don’t have immediate answers on which is why Breast Cancer Ireland is funding the research at Queen’s University Belfast. We need to look at different pathways in the cell and introduce new drugs to block these pathways”, explains Prof Hill. Through its research and education programmes, Breast Cancer Ireland wants to help transform breast cancer from what can be a fatal disease to one that can be managed and cured throughout treatment. A new Breast Cancer Ireland research centre in the grounds of Beaumont Hospital is due to be completed in 2021.

Source: Sylvia Thompson, The Irish Times, September 2020


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