Dana-Farber at the forefront of advances against breast cancer
by Saul Wisnia
Dirk Iglehart, M.D.
Fewer than three decades ago, a diagnosis of breast cancer meant basically one thing for a patient regardless of her age: a radical mastectomy. Today this surgery — which includes removal of the diseased breast as well as the lymph nodes and muscle beneath it — is recommended only in rare cases where the cancer has spread to the underlying chest muscles and lymph nodes.
In many ways, options for breast cancer patients have never been more encouraging. Thanks to advances in research and clinical care under way at Dana-Farber Cancer Institute and elsewhere, women with this disease are requiring far less invasive surgery and are often able to keep their breasts. Investigators are beginning to uncover the tumor markers enabling oncologists to detect cancer at earlier stages of development. And although the stigma once attached to breast cancer has all but disappeared, Dana-Farber is at the forefront of making sure all women — including those in underserved communities — are well educated about steps they can take to help prevent and more quickly recognize the disease.
"We now understand more about the biology of breast cancer than probably any other cancer with the exception of leukemias and lymphomas," says Dirk Iglehart, M.D., director of DFCI's Women's Cancers Program and chief of Surgical Oncology at Brigham and Women's Hospital (BWH). "We know at least some of the genes that directly cause it or increase its susceptibility, and some of the best new medical therapies directed at specific molecular targets have been developed for breast cancer. We're able to do smaller and smaller surgical operations, and we have improved therapies to the point where today most women don't need mastectomies to treat the disease."
While it remains the second-leading cause of cancer deaths among women, mortality rates for breast cancer have dropped significantly in recent years. According to the National Cancer Institute (NCI), 40,800 women in the U.S. were expected to die from the disease in 2000 — down 6 percent from 1999 (43,300). Research and clinical advances are a major factor in the decline, along with an increase in the number of women undergoing regular mammograms and conducting breast self-examinations.
"There are still far too many deaths, but these numbers should be looked at as a measure of some success," says Eric Winer, M.D., director of the Breast Oncology Center at Dana-Farber. "More women are aware of the disease, more women are getting mammograms, and more doctors are suspecting breast cancer in women in whom they might not have a few years ago. The drop in mortality is almost certainly a function of continued success in both early detection and improved treatment."
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