Nancy Tafoya was diagnosed with breast cancer in February 2014.
By the end of March, Tafoya, 58 at the time, had been accepted into a clinical trial at the University of Miami Miller School of Medicine’s Sylvester Comprehensive Cancer Center.
Dr. Joyce Slingerland, director of the Braman Family Breast Cancer Institute at Sylvester, is leading the trial that uses standard anti-estrogen therapy and combines it with a targeted therapy in postmenopausal women with estrogen-receptor positive breast cancer. The goal: Shrink tumors before surgery.
By the time Tafoya had surgery on Oct. 6, her tumor had shriveled from 10 centimeters to less than 0.5 centimeters.
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This type of targeted therapy is an indicator of where breast cancer treatment is headed.
“Mine wasn’t a tumor you could hold onto,” she said. “When doctors did the MRI, half of my breast lit up.”
Now, 10 months since her surgery and more than a year since she was diagnosed, Tafoya, 59, said she feels great and is “pretty much back to normal.”
Targeted treatments are tailored to the genetic makeup of a patient’s cancer. Because they single out the mutations or pathways that cause cancer cells to grow, they selectively kill the cancer cells and leave healthy tissue, which is often damaged by chemotherapy, unaffected. Side effects are minimal or nonexistent.
Tafoya was part of a pre-surgery trial that treats breast cancers that have not spread to other parts of the body. Two-thirds of trial participants receive standard antiestrogen therapy together with a new specific inhibitor drug, and one-third received only the standard therapy and a placebo.
“Although the standard treatment effectively decreases cancer size in nearly all patients, we hope to see the cancers shrink even more with the addition of this new drug,” Slingerland said. “The molecular profiles of the cancers will be compared before and after treatment to help us figure out the molecular ‘signatures’ of the cancers most responsive to this new targeted therapy.’’
Slingerland’s lab is also trying to understand how a specific gene activates cancer stem cells, and the molecular causes of breast cancer seen in obese and overweight women.
Early diagnoses and effective screening are crucial to the success of a patient’s treatment, doctors say. Tomosynthesis, or 3-D mammography, is helping to provide a more detailed look.
Conventional 2-D mammograms provide one image of overlapping tissue, making it difficult to detect cancers.
3-D mammograms take multiple images of the entire breast — like slices — allowing for more comprehensive imaging. Benefits include earlier detection of small breast cancers, and greater accuracy.
“Overlapping tissues make it difficult to see subtle signs of cancer,” said Dr. Cristina Vieira, a board-certified radiologist at Baptist Health Breast Center.
Tomosynthesis increases cancer detection rates by 30 percent and decreases the number of unnecessary callbacks by 30 percent as well, she said.
And while it’s too soon to tell the impact of 3-D mammograms, patients definitely benefit, said Dr. Mary Hayes-Macaluso, director of Women’s Imaging at Memorial Healthcare System.
Patricia Lewis, 67, has had 3-D mammograms for about three years. Lewis has never been diagnosed with cancer, but has very dense breast tissue, making cancer more difficult to detect.
“My mother had breast cancer at 52, so I lived that with her. Mammograms are important to me,” Lewis said. “The new technology has made it very good for people like me.”
Memorial uses CView, an addition to 3-D mammography that uses less radiation with a shorter scan time.
CView takes the individual slices, or images, and turns them into a composite image — eliminating the need for additional 2-D mammograms and resulting in half of the radiation exposure.
“Cancers get diagnosed earlier that would otherwise go undetected for years,” Hayes said.