BREAST CANCER
MEDICAL ONCOLOGIST AND SCIENTIFIC ADVISER TO BREAST CANCER TRIALS, FRAN BOYLE, TALKS ABOUT THE LATEST RESEARCH AND TREATMENTS
HOW HAVE SURVIVAL RATES CHANGED? Over the last 20 years, survival rates for women diagnosed with early breast cancer have risen from 50 per cent at 10 years to over 80 per cent, and at five years more than 90 per cent of women will be alive. For metastatic breast cancer there have also been improvements, but as we don’t collect data on the time a cancer spread occurs, it’s harder to quantify.
WHAT IS THE REASON BEHIND THIS? Survival rates have increased, largely due to new drugs being used in metastatic breast cancer, and then over the past 10 years, in early breast cancer. This reduces the risk of spread. These include newer hormone blockers (aromatase inhibitors), Herceptin (used for Her2-positive breast
cancer) and newer chemotherapy drugs. In some women chemotherapy might also be given before surgery to shrink the cancer more rapidly and make surgery easier. Early detection with mammographic screening has also played a role.
HOW HAVE TREATMENTS IMPROVED? Breast cancer is divided into four main biological categories now, which helps us to choose drugs better and tailor treatment more effectively. Two of these categories are Luminal A (slow growing) and Luminal B (faster growing) within the hormonal category. The two other groups are HER-2 positive (where Herceptin is used) and triple negative (where chemotherapy is almost always used).
IS GENETIC TESTING HELPING? There are some tests on the gene profile of the cancer that can help us separate Luminal A from B, and to avoid chemotherapy in those with Luminal A cancer. These are not tests for inherited gene mutations – such as BRCA 1 and 2 – those are tested on a woman’s normal cells. Several of the gene profile tests are available in Australia now, and some can be accessed by sending samples of the cancer overseas. Unfortunately none of them are covered by Medicare yet, so expense is a major factor getting in the way of their more widespread use.
WHAT ABOUT FAMILY HISTORY? Tests for inherited mutations are covered by Medicare for those with a suggestive family history, after seeing a genetic specialist. If the likelihood of an inherited gene is low based on their calculations, a patient can still pay to have those tests done (on a blood sample). More information on risk can be found on the Cancer Australia website.
THE LATEST BREAKTHROUGHS New developments for women with metastatic disease include new drugs that can be added to hormone-blocking treatments called CDK inhibitors. These have just gone on the PBS for some women. There are also new clinical trials testing immune-boosting therapies in breast cancer, similar to those used in melanoma.