Oct 11, 2022 Breast Cancer: What You Need To Know Now

The latest developments in detection, treatments and clinical trials.

In recognition of Breast Cancer Awareness Month in October, we talked with Michele Blackwood, MD, Northern Regional Director of Breast Services for RWJBarnabas Health (RWJBH), about the latest advancements in breast cancer detection and treatments, as well as a promising new clinical trial.

What are you most excited about in terms of new breast cancer treatments and technologies?

One of the biggest developments in recent years in terms of approaches to treatment is that everything is much more personalized than it used to be. Treatment has also become “deescalated.” For years, we gave patients with breast cancer every treatment—surgery, chemotherapy, radiation therapy, medicines. Now, in many cases, we can choose certain treatments based on individual factors such as a patient’s type of cancer, their age and other health issues. Not every patient with breast cancer needs all of those treatments.

Why had it been done that way in the past?

We were giving patients all treatment modalities in the past—based on clinical research conducted in the 1980s, 90s and early 2000s—to maximize survival. Of course, that is still the goal; it is what we do as cancer doctors. However, people are not the same at 30, 50, 70 or 80 years old. For instance, a 70-year-old with ductal carcinoma in situ (the presence of abnormal cells inside a milk duct in the breast, the earliest form of breast cancer) may not need to receive every treatment. Maybe, depending on her specific cancer and other considerations, we can give her just a lumpectomy with no radiation. In some women, we can just watch certain types of cancers and pre-cancers. The hard-and-fast rules of the past are becoming softer rules. Each person is different. Each person’s cancer is different.

Is this newer approach based on science or are there other factors as well?

Yes, it’s based on science, first and foremost. But it’s also based on a better understanding of the disease process and of the patients themselves. We treat the whole patient, not just the cancer. And I think that’s where we differentiate ourselves at RWJBH. Back in the 1990s, if a patient’s cancer didn’t recur within five years, that was considered a win. Now, we’re looking at it a little differently. We want that patient to get to age 100 without a recurrence—but how we keep a 30-year-old healthy for the next 70 years might be different than how we keep a 70-year-old healthy for the next 20 or 30 years.

How are treatment regimens determined now?

When we’re planning treatment for a patient, we look at how much each part of the treatment contributes to the patient’s overall health. Surgery can contribute 80, 90 and sometimes even 100 percent of a cancer cure for some patients. If it cures 100 percent, does the patient need anything else? Alternatively, I think people are shocked when they come in with their 85-year-old mother and find out that she doesn’t necessarily need to have surgery. The relief is palpable. The patients are happy; their families are happy. We call this “the deescalation of treatment.” Even people with stage 4 breast cancer can do okay for a long time managed on certain medicines—and we can change those medicines or add to them.

Are there any new medicines or developments that are exciting?

Yes. One exciting development came about from a recent study that showed that the drug Enhertu® may be used to treat breast cancers other than the one it was specifically meant for. According to the National Cancer Institute, in August 2022, the Food and Drug Administration (FDA) approved trastuzumab deruxtecan (Enhertu®), which had originally been designed to treat HER2-positive breast cancers, for the treatment of HER2-low metastatic breast cancers. This is significant because only 15 to 20 percent of people with breast cancer have HER2-positive tumors. The rest have undetectable or low levels of HER2.

Are there any new developments in detection and diagnosis?

Yes. In diagnosis, we have better imaging, such as 3D digital mammograms that help us look for cancers early on and often find things that the human eye might not notice immediately. Also, there’s greater recognition and understanding of the need for—and efficacy of—MRIs for women at higher risk for breast cancer or who have dense breast tissue.

Have there been any advances in breast cancer surgery?

There are more options today than in the past. We can sometimes perform nipple-sparing mastectomies and can often do immediate reconstruction. Nowadays, when we do a lumpectomy, we can do a breast lift or a breast reduction at the same time. We have very talented plastic surgeons who really contribute to a woman feeling good about herself. A cancer diagnosis can make you feel that you have no control over your health or your life. Options give patients a sense of control.

Some people are afraid to consider clinical trials. What do you say to those who think of clinical trials as a “last resort”?

I understand the hesitancy. And, at one time, clinical trials may have been presented or perceived that way. But again, a clinical trial is another option. People who have participated in the I-SPY2 clinical trial at Cooperman Barnabas Medical Center (CBMC) have thanked me. It offers eligible patients a novel approach to treating advanced breast cancer and is going to be a template for how we treat breast cancer now and in the future. We have a large, coordinated team of professionals to support patients during clinical trials, and that is very comforting for them.

Breast Cancer In Men

Breast cancer is generally thought of as a woman’s disease, but, while it’s much less common, men can get breast cancer, too. “Thankfully, there’s more awareness about breast cancer in men today,” says Dr. Blackwood. “However, men should be aware of the symptoms, which include bloody nipple discharge and a lump under one nipple.” Other symptoms include:

  • Skin dimpling or puckering
  • Nipple retraction (turning inward)
  • Redness or scaling of the nipple or breast skin

Diagnosis and treatment is similar in both women and men with breast cancer. “Men can have mammograms, mastectomies and, in some cases, breast reconstruction,” says Dr. Blackwood. “And, as with women, there are more options today than in the past.”

RWJBarnabas Health and Cooperman Barnabas Medical Center, together with Rutgers Cancer Institute of New Jersey—the state’s only NCI-Designated Comprehensive Cancer Center—provide close-to-home access to the latest treatment options. Learn more.