Beyond Pink: Advances That Are Changing Breast Cancer Care

Looking Beyond the Type and Stage of Breast Cancer

Breast cancers that may appear similar can behave very differently. That is why treatment planning often considers several characteristics of the cancer in addition to its stage.

After a breast cancer diagnosis, tumor tissue is typically tested for biomarkers such as estrogen receptors (ER), progesterone receptors (PR), and HER2. These results can help classify the cancer and identify treatments that may be more likely to work.

Other factors, including a patient's overall health, menopausal status, medical and family history, and how the cancer responds to treatment, may also influence the treatment plan. The result is approach that is increasingly focused not simply on treating breast cancer, but on treating the specific breast cancer in a specific patient.

How Is Genomic Testing Used in Breast Cancer Care?

Genomic testing can provide information about the genes or patterns of gene activity within breast cancer cells that may help guide treatment decisions. Depending on the type and stage of breast cancer, these tests may help predict how the cancer is likely to behave, whether it may return or whether certain treatments are likely to provide benefit.

For some patients with early-stage breast cancer, gene expression tests can help estimate the likelihood that cancer will return and whether chemotherapy is likely to provide additional benefit.

It is important to distinguish genomic testing of a tumor from inherited genetic testing. Tumor genomic testing looks for characteristics within cancer cells that may help guide treatment. Inherited genetic testing looks for changes a person was born with, such as certain BRCA1 or BRCA2 variants, that can be passed through families and may affect cancer risk.

Not every patient needs every type of testing. A care team can determine which tests may provide useful information based on the individual diagnosis.

Targeted Therapies Are Expanding Treatment Options

One of the most significant changes in breast cancer care has been the development of therapies designed to target specific features that help cancer cells grow and survive.

For example, targeted therapies may be used for certain cancers depending on the specific characteristics of the cancer and clinical situation:

• HER2-positive or HER2-low breast cancers
• Hormone receptor-positive breast cancers
• Triple-negative breast cancers
• Breast cancers associated with BRCA1 or BRCA2 mutations

Targeted therapy is a form of precision medicine. Rather than approaching every breast cancer in the same way, these treatments are selected based on characteristics of the cancer that may make it vulnerable to a particular therapy.

As researchers continue to identify new biomarkers and molecular targets, treatments options continue to evolve.

Who May Benefit From Immunotherapy for Breast Cancer?

Immunotherapy works differently from treatments that attack cancer cells directly. Instead, it helps the immune system recognize and fight cancer.

While immunotherapy is not appropriate for every breast cancer, it has become an important treatment option for some patients with triple-negative breast cancer. Biomarker testing may also be used in certain situations to help determine whether a cancer is likely to respond to immunotherapy. Depending on the stage and characteristics of the cancer, immunotherapy may be used in combination with other treatments, such as chemotherapy.

Research continues to explore how immunotherapy may benefit additional groups of patients and how it can be combined with other treatments.

Personalized Treatment Means Finding the Right Approach for Each Patient

Personalized breast cancer treatment is not one specific test or therapy. It is an approach that brings together multiple pieces of information to determine the treatment plan that makes the most sense for an individual patient.

A care team may consider:

• Cancer stage and tumor size 
• Hormone receptor and HER2 status
• Tumor grade
• Genomic or biomarker test results
• Inherited genetic factors when relevant
• Overall health and medical history
• Previous treatments
• Patient preferences and goals

Treatment may still include established approaches such as surgery, radiation therapy, chemotherapy and hormone therapy. Advances in testing and precision medicine help providers determine which treatments, or combinations of treatments, may be most appropriate.

For some patients, personalization may mean adding a targeted therapy. For others, it may help identify when a particular treatment is unlikely to provide enough benefit to justify its risks.

Looking Ahead in Breast Cancer Care

Breast Cancer Awareness Month is represented by pink, but the progress happening in breast cancer care extends far beyond a ribbon.

Advances in genomic testing, targeted therapy, immunotherapy and personalized treatment are giving care teams more tools to understand each cancer and tailor care accordingly. At the same time, a growing focus on survivorship is helping address the needs of patients beyond active treatment.

Research continues to move breast cancer care forward. For patients, that progress means more information, more individualized treatment options and care that increasingly reflects the unique characteristics of both the cancer and the person facing it.