One year ago this month, my mom, Nancy Rowe, learned she had breast cancer. She was treated for the disease, which is now in remission, but it was a life-changing event.
According to data from breastcancer.org, one in eight women in the United States will develop invasive breast cancer, and 316,120 new cases of breast cancer in women are expected to be diagnosed this year. The statistics are high, yet few people think it will be them, their mother, grandmother, or sister who will be included in that data.
October is National Breast Cancer Awareness Month, and I’m writing a four-part, weekly column about my mom’s experience with the disease. For this installment, I talked with an oncologist and a breast surgeon to learn more about the advancements made in breast cancer research and reconstruction. And my mom’s oncologist, Dr. Sibel Blau in Puyallup, gave me more insight into the subset of cancer my mom had.
Surviving Breast Cancer
In 2010, I went to my first breast cancer fundraising event and the theme struck a chord with me — “create more birthdays.”
For me, that slogan totally flipped the script. I’d always thought of surviving cancer as a proverbial coin toss of living or dying. Never had I thought of it as a celebration of life. I’d never thought of it as blowing out one more candle on a cake each year. And because of the strides in breast cancer research, every year more men and women can celebrate their birthdays, including my mom.
A few weeks ago, I called Dr. Julie Gralow, who is the director of breast cancer oncology at the Seattle Cancer Care Alliance and professor of the oncology division at the University of Washington School of Medicine. All I knew was that more people are surviving breast cancer, and Gralow confirmed.
“Absolutely,” she said. “There’s no question that in countries like the U.S. where we have access to early detection and treatment that death rates have dropped dramatically.”
The five-year survival-rate in the 1960’s was 63 percent, Gralow said. Today it’s 90 percent in white people and about 80 percent for black people, who tend to have less access to health care and more aggressive types of breast cancer.
Gralow has been in the medical industry for more than 30 years. When she came to Seattle to do her oncology fellowship, she decided to dig into a project focused on HER2 genes before much was known about it. She said the HER2 gene is “critical” for the development of a fetus, and research revealed it can malfunction and turn normal cells into breast cancer cells. The development was a gamechanger, she said.
“When I was a fellow, this was in the early 90’s, we just had a couple drugs for breast cancer,” she said. “The main thing we use to distinguish between breast cancer is estrogen receptors. We only had one class of drugs that targeted estrogen receptors — 80 percent of breast cancer is estrogen receptor positive — but all breast cancer isn’t the same. Some are estrogen receptor negative and some are positive. It’s been 25 years since then and there have been a lot of incremental changes.”
Fighting HER2 Positive Breast Cancer
My mom had Stage III, invasive breast cancer — meaning it had spread beyond her breast — and had the HER2 positive biomarker.
Gralow said the HER2 biomarker is an aggressive feature that only appears in about 20 to 25 percent of patients.
To better understand the type of cancer my mom had, I talked with her oncologist, Dr. Sibel Blau, medical director at Hematology/Oncology at Northwest Medical Specialties, PLLC. She’s been an oncologist since 1998, and practicing at her clinic in Puyallup since 2001.
In the Puyallup area, she’s very well-known among the breast cancer community. So much so, that my mom was approached by a woman at a Bonney Lake Home Depot because she recognized her as one of Blau’s patients. If you’re a breast cancer patient in the South Sound, there’s a good chance you’re being treated by Blau.
Blau confirmed that my mom had a very aggressive form of breast cancer “that tends to metastasize early on and process rather rapidly without treatment.” It had spread to her lymph nodes, but nowhere else. My mom was treated with chemotherapy and anti-HER2 targeted therapy, including Herceptin, which stops the receptors from multiplying.
The Herceptin drug was first used among a handful of women — including a Puyallup woman, Barbara Bradfield — in the 1990s, Blau said. In 2015, PBS interviewed Bradfield as the last surviving woman in the trial.
“This is a disease (where) we had so little available before Barbara’s time,” Blau said. “Patients died quickly and half of the patients who developed HER2 positive disease eventually relapsed despite chemotherapy. The addition of HER2 targeted therapies (with) chemotherapy — and more available agents to enhance the effects — improved the care and cure rate significantly. It is not uncommon to achieve the good result we had with your mother anymore. One of the most untreatable diseases became curable after the discovery of (Herceptin) and other agents.”
So, when my mom told me that 20 or 30 years ago she would have died from her cancer, she wasn’t exaggerating. Research into the subgroups of breast cancer types saved my mom’s life and countless others.
Zeroing in on Different Types of Breast Cancer
A lot of research is now focused on developments for the various subsets of breast cancer — based mainly on the tumor’s expression of the HER2 gene or estrogen receptor — and finding treatment plans tailored to those groups. Gralow said recent developments in research are leading to treatments for inherited breast cancer that have already been approved for certain types of ovarian cancer.
“It’s been slow and steady along the way,” she added. “Every year or two we have something new and different that we learn. That’s where we are right now. We’re in the genomic area (where) we’re finding some rare gene changes associated with targeted therapies that may only benefit a small number of patients, but those that they benefit will benefit a lot.”
Cancer treatment used to be a one-size fits all plan with chemotherapy. Gralow said chemotherapy is “non-specific.” It works best with cancer cells that are rapidly dividing, but it doesn’t discriminate between cancer cells and healthy cells in our bodies, and it’s toxic to lots of tissue. With the use of tailored treatment plans, Gralow said researchers are developing treatments that aren’t as toxic to the body and doctors are prescribing a lot less chemotherapy.
When a patient is newly-diagnosed with cancer, the first step is to know where it is in the body. Is it confined to the breast? Has it traveled to the lymph nodes? How big is it and where is it? The next step is to understand the biology of it, which is where genomic developments come in. The type of breast cancer a person has will determine their course of treatment.
Developments in Reconstructive Surgery
Advances have also been made on the surgery side of breast cancer treatment.
Dr. Sara Javid, a Seattle Cancer Care Alliance breast surgeon and associate professor at the Department of Surgery at the University of Washington, said 20 years ago women were limited to implants alone or more invasive tissue reconstruction using abdominal or back muscles.
Surgeons are using more modern tissue reconstruction, known as DIEP, or tummy tuck reconstruction, by using the skin or fat from the tummy tuck to reattach tissue and create a new living structure. Javid said it’s a highly detailed operation and its only performed by skilled reconstructive surgeons who receive an additional two to three years of training in microvascular reconstruction surgery.
Women who opt for or need a mastectomy now have the option to “spare” their nipple, making the appearance more natural. Those who have a lumpectomy can also have reconstructive surgery to create more symmetry in their breasts, but Javid said fewer women need to go down that road.
Some patients who get mastectomies are eligible for reconstruction at the time of their mastectomy, Javid said, so they wake up with breasts that look natural and healthy.
“It offers a lot of benefits,” Javid said. “Women are having to undergo fewer operations, (are) waking up more whole, feeling like they’re somewhat restored, or getting closer to that, as opposed to making women wait for a second operation.”
Javid said it’s so gratifying to help women feel more like themselves with whatever option they choose. She’s typically one of the first people women meet after their diagnosis. They often come to her filled with anxiety during one of the most stressful times in their life, and she can be there to ease their worries.
“I enjoy teaching patients about their different treatment options and discussing with them the best treatment choice for them,” Javid said. “It’s not one size fits all. They’re all coming from a different place with respect to both cancer type and priorities. I consider my job to help patients decide what’s best for them.”
Next week will be the final segment of this series. Many of us understand — somewhat — what the treatment process is like for cancer patients, but what about life after breast cancer? Visit southsoundmagazine.com on Monday for the last piece of this series.