What`s new in breast cancer research?

Research into the causes, prevention, and treatment of breast cancer is being done in many medical centers throughout the world.

Causes of breast cancer

Studies continue to find lifestyle factors and habits that alter breast cancer risk. Some studies are looking at the effect of exercise, weight gain or loss, and diet on breast cancer risk. We are also learning more about how genes influence breast cancer. This should happen more quickly now that the human genome has been mapped out.

A large, long-term study is now going on to help find the causes of breast cancer. It is known as the Sister Study and it will follow 50,000 women whose sisters (not they themselves) have had breast cancer. Over 10 years, information will be gathered on many factors that might cause breast cancer. An offshoot of the Sister Study, the Two Sister Study, is designed to look at possible causes of early onset breast cancer. If you want to find out more about these studies, you can call 1-877-4-SISTER (1-877-474-7837) or visit the Web site at www.sisterstudy.org.

Chemoprevention

Fenretinide, a drug related to vitamin A, is being studied as a way to reduce the risk of breast cancer. In a small study, this drug reduced breast cancer risk as much as tamoxifen. Other drugs are also being studied to reduce the risk of breast cancer. For more information, see our document, Medicines to Reduce Breast Cancer Risk.

New lab tests

Gene studies

One of the problems with early stage breast cancer is that doctors cannot always tell which women have a higher risk of cancer coming back after treatment. That is why almost every woman gets some sort of adjuvant treatment after surgery. To try to better decide out who will best benefit from adjuvant therapy, researchers have looked at many aspects of breast cancers.

In recent years, scientists have been able to link certain patterns of genes with more aggressive cancers — those that tend to come back and spread to distant sites. Some lab tests based on these findings are already available, but doctors are still trying to figure out the best way to use them. Other tests are being developed, too.

Tumor cells in the blood

Researchers have found that in many women with breast cancer, cells may break away from the tumor and enter the blood. These tumor cells can be found with sensitive lab tests. While these tests are available for general use, it is not yet clear how helpful they are for patients with breast cancer

Newer imaging tests

Some newer imaging methods are being studied to see how they can be used to look at areas of change in the breast that might be cancer. You can find out more about these methods in our document, Mammograms and Other Breast Imaging Procedures.

Treatment

Oncoplastic surgery

Sometimes after breast surgery the breasts can be different sizes or shapes. Some doctors are trying to address this problem by combining cancer surgery and plastic surgery. This is called oncoplastic surgery. It involves reshaping the breast at the time of first surgery, and may mean operating on the other breast as well to make them look more alike. This approach is still fairly new, and not all doctors are comfortable with it. The main concern is whether or not oncoplastic surgery might be more likely to leave tumor tissue behind.

Breast reconstruction surgery

Advances in re-attaching blood vessels (microvascular surgery) have led to improvements in breast reconstruction.

To learn more about the types of reconstructive surgery now available, see the American Cancer Society document, Breast Reconstruction After Mastectomy.

Radiation treatment

For women who need radiation after breast-conserving surgery, newer methods such as hypofractionated radiation or accelerated partial breast irradiation are being studied to see if they work as well as standard treatment in keeping breast cancer from coming back. They can make it easier to get treatment since the treatment can be done on in a shorter time. They are described in more detail in the section, "Radiation therapy for breast cancer."

New chemotherapy drugs

Because advanced breast cancers are often hard to treat, researchers are looking for newer, better drugs. A drug class has been developed that targets cancers caused by BRCA mutations. This class of drugs is called PARP inhibitors and they have shown promise in clinical trials treating breast, ovarian, and prostate cancers that had spread and were resistant to other treatments. Further studies are being done to see if this drug can help patients without BRCA mutations.

Targeted therapies

Targeted therapies are a group of newer drugs that take advantage of gene changes in cells that cause cancer.

Drugs that target HER2: Three drugs approved for use target excess HER2 protein: trastuzumab (Herceptin) and lapatinib (Tykerb), and pertuzumab (Perjeta). Studies are being done to see how best to use these in treating early breast cancer. Other drugs that target the HER2 protein are being tested in clinical trials. Researchers are also looking at using a vaccine to target the HER2 protein.

Anti-angiogenesis drugs: For cancers to grow, blood vessels must be made to feed the cancer cells. Some studies have found that breast cancers with many new, small blood vessels are likely to spread more quickly. Bevacizumab (Avastin) is an example of anti-angiogenesis drug. Although bevacizumab does not seem to be very helpful in the treatment of breast cancer, clinical trials are currently testing several other anti-angiogenesis drugs.

New drugs are being made that may be useful in stopping breast cancer growth by keeping new blood vessels from forming. Some of these drugs are now being tested in clinical trials.

Other targeted drugs: Everolimus (Afinitor) is a targeted therapy drug that seems to help hormone therapy drugs work better. It is approved to be given with one certain hormone therapy drug to treat advanced hormone receptor-positive breast cancer in women who have gone through menopause. It has also been studied with other hormone therapy drugs and for treatment of earlier stage breast cancer.

Other possible targets for new breast cancer drugs have been identified in recent years. Drugs based on these targets are now being studied, but most are still in the early stages of clinical trials.

Bisphosphonates

Bisphosphonates are drugs that are used to help strengthen bones and reduce the risk of fractures in bones that have been weakened by metastatic breast cancer Some studies have looked at the effect of giving a bisphosphonate (like zoledronic acid) with other adjuvant treatment (like chemo or hormone therapy) for early breast cancer. So far, the results have been mixed. More data are needed to find out if bisphosphonates should become part of standard treatment for early breast cancer.

Denosumab

Denosumab (Xgeva, Prolia) can also be used to help strengthen and reduce the risk of fractures in bones that have been weakened by metastatic breast cancer. It is being studied in early breast cancer patients to see if it can help adjuvant treatments work better.

Vitamin D

A recent study found that women with early stage breast cancer who had low levels of vitamin D were more likely to have their cancer come back in a distant part of the body and had a poorer outlook. More research is needed to confirm this finding, and it is not yet clear if taking vitamin D supplements would be helpful. Still, you may want to talk to your doctor about testing your vitamin D level to see if it is in the healthy range.