It’s really a great time for breast cancer research

Breast cancer is a disease most women don’t see coming, especially not at age 34. This was the case for Joya Harris, now director of research integration for the American Cancer Society, whose children were 3 and 5 when she was diagnosed with stage 3C breast cancer in 2007. Harris has a background in public health and has always been diligent about her own — in fact, she had been checked out by a doctor just weeks before her diagnosis.

“It wasn’t like I felt a lump and ignored it,” Harris said. “I had just gone for a routine exam and the doctor did a breast exam. He said look out for changes, but he didn’t notice anything."

Three weeks later, Harris felt a lump that wasn’t there before. She set up a mammography, which she paid for out of pocket because she wasn’t old enough to be getting annual mammograms yet.

“The crazy thing was cancer was the farthest thing from my mind, because I had just been to the doctor,” she said.

Fortunately, Harris’ cancer hadn’t spread, but because it was such an advanced stage, her treatment was very aggressive. She underwent a double mastectomy, six months of chemotherapy and six weeks of radiation and hormone therapy.

“The first thing I thought was, ‘how long do I have?’” Harris said. “I thought about my children.”

During her treatment, she was recruited by a friend to join a now-defunct cancer nonprofit, and this led to her working at the American Cancer Society (ACS), whose headquarters are in Atlanta. She is now cancer-free, thanks in large part to ACS funding of foundational research that led to the development of a drug that was part of her treatment. She now devotes her career to helping others with the disease.

“It makes working here that much more fulfilling because of my personal experience,” she said.

Not all that long ago, doctors and scientists were looking for a single cure for what they thought was one type of disease. Now it’s known that breast cancer affects women of all ages, and it is as unique as each woman who has it. Today’s research is increasingly personalized, based on family history, genetics, obesity, health disparities and a host of other variables. And much of this groundbreaking research is taking place in Georgia, where 1,260 women are expected to die of breast cancer this year.

“It’s really a great time for breast cancer research, because a lot of technological advancements and improvement of our understanding of basic biology occurred in the early 2000s that allowed us to accelerate our understanding,” said Mia Gaudet, strategic director of breast and gynecologic cancer research at the ACS. “Breast cancer is not one type of disease... personalized and targeted treatments are really taking hold.”

A big focus in breast cancer research is contributions from genetics and how this might improve genetic testing in the future, because according to Gaudet, over 100 regions of the human genome have common variations that contribute to breast cancer risk. Cecelia Bellcross, associate professor at Emory University’s School of Medicine, developed a two- to three-minute risk assessment questionnaire that can be filled out on a tablet during routine mammography appointments. Those who do appear to have an elevated risk for hereditary breast and ovarian cancer are referred to genetic counselors, who further analyze family histories and factors that might warrant actual genetic testing, which can be expensive.

The most recent version of this tool has demonstrated a 93 percent sensitivity for identifying individuals with the BRCA1 and BRCA2 mutations.

“We’ve demonstrated the tool is valid, but we have to figure out the best way to implement it and maximize the number of individuals that receive cancer genetic services,” Bellcross said. “By testing one person, we can dramatically affect the health of the entire family. When you think about it, that’s extremely cost-effective.”

Although genes are important, breast cancer risk factors may play an equal role. Lauren McCullough, a faculty member in Emory University Rollins School of Public Health’s epidemiology department, is investigating the link between obesity and the disease.

“I think in general everyone knows that physical activity is good and obesity is bad, but we don’t necessarily understand the mechanisms behind it,” she said. “Obesity may change DNA, altering how it is expresseed or read. It could be turning on bad genes or turning off good genes, leading to cancer.”

McCullough proposes to explore these changes using samples from Emory’s Glenn Family Breast Center and the American Cancer Society’s Cancer Prevention Study.

“[ACS wants] to communicate how people can take ownership and control of their cancer prevention, and we put a large focus on modifiable risk factors like body size, alcohol intake and smoking,” Gaudet said.

Dr. Jayanthi Srinivasiah, an oncologist with Northside Hospital-affiliated Georgia Cancer Specialists and a principal investigator, head of cancer committee and clinical trials at DeKalb Medical, studies breast cancer that has metastasized, meaning it has spread into different parts of the body. If the cancer has spread to regional lymph nodes, the five-year survival rate is still 85 percent, but if it has spread to a distant part of the body, that rate plummets to 26 percent.

“We have many trials looking at combinations of drugs to prevent cancer from spreading, and also to kill the cancer,” she said.

Stanislav “Stas” Emelianov, Joseph M. Petit Endowed Chair at Georgia Tech and professor of Biomedical Engineering at Georgia Tech and Emory, and a Georgia Research Alliance Eminent Scholar, has a $240,000 grant from the Breast Cancer Research Foundation for clinical research about using light and sound rather than radioactive material and biopsy to test whether tumors have metastasized. Last week, his team moved forward on a clinical phase that will use a non-radioactive contrast agent to find the sentinel lymph node, or first lymph node the tumor drains to, and determine whether cancer has spread into that lymph node. But in the future, “smart” contrast agents could potentially identify where the cancer cells are in the lymph node and treat them without surgery.

“Moving this contrast media to clinical trials will be very difficult because it is considered to be pharmaceutical, so there are lots of hurdles on the way,” Emelianov said. “That’s fantasy, but the reason it’s fantasy is because it will take 10 years or so to go through the regulatory process.”

Ritu Aneja, professor of cancer biology and university distinguised professor at Georgia State University, is combining two hot research topics: health disparities and triple negative breast cancer (TNBC). TNBC tests negative for estrogen receptors, progesterone receptors and HER2 receptors, which means it doesn’t respond to common targeted treatments like hormonal therapy.

“It is really one of the most fatal forms because we have no targeted treatment for it,” Gaudet said. “Chemotherapy is the only drug we have to treat most women with triple negative breast cancer.”

African-Americans are twice as likely as European-Americans to get TNBC and tend to have worse outcomes, Aneju said.

“There are so many socioeconomic inequalities between African-Americans and European-Americans,” Aneja said. “But even after adjusting for grade, stage and socioeconomic status, the disparity in outcomes persists. That means there is an inherent difference in tumor biology between TNBCs in the two races.”

Aneja and her team have a $1.5 million grant from the National Institutes of Health and a grant from the U.S. Department of Defense for this study, which involves comparing TNBC samples from African-Americans and European-Americans to find intrinsic cell biological differences that may explain their disparate biology.

“TNBCs are genetically very diverse and we have discovered some new biomarkers that can help us distinguish differences... that may make some TNBCs more aggressive than others,” Aneja said. “This is getting into the realm of personalized medicine, the ability to stratify TNBCs to identify those with higher risks and those without, those who respond to current chemotherapy regimens and those who might need additional treatments.”

Great strides are being made in treatments and survival rates; according to the NIH, the five-year survival rate has climbed from 75 percent in 1975 to close to 90 percent for less advanced stages.

“We are advancing science, and I can tell you that the quality of life of my patients has improved,” said Srinivasiah, who has been practicing for over 20 years. “We are nowhere close to a cure, of course, once you have metastatic diseases, but our understanding of its underlying molecular biology, genetics and genomics is improving tremendously. That’s why we need people to participate in these trials.”

Ellie Hensley is an entertainment, health care and general assignment reporter.

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