Breast cancer surgery updates
D. JOSEPH JERRY, PhD
Science Director of the Pioneer Valley Life Sciences Institute and Co-Director of the Rays of Hope Center for Breast Cancer Research
Advocacy Advancing Funding and Discoveries in Breast Cancer
As Rays of Hope approaches its 30th year, it is a time to look back as well as look forward. In the 50 years prior to 1990, mortality due to breast cancer was stubbornly constant. Between 1990 and 2020, mortality has declined by nearly 40%. While many changes contribute to the improved outlook, it is notable that advocacy for breast cancer research grew rapidly in the 1990s.
Grassroots efforts that raised awareness and the need to change the approaches to diagnosis and treatment were established. Partnerships among advocates and clinicians emerged as leading voices advocating change. Dr. Susan Love is one clinician who, together with breast cancer survivor Fran Visco, co-founded the National Breast Cancer Coalition (NBCC). Similarly, Lucy Giuggio Carvalho was the spark in western Massachusetts who found a partner in Dr. Grace Makari-Judson and together they ignited the Rays of Hope Walk. Rays of Hope was among the first organizations that began in the early 1990s and continues to change the outlook for breast cancer treatment and prevention today.
Advocacy was part of a national trend that changed policies and medicine in the 1990s. The NBCC found a receptive ear in both Congress and President Bill Clinton in 1992. It may be no accident that the number of women in Congress almost doubled that election year and that healthcare was a national focus. In 1993, Congress appropriated $200 million to foster breast cancer research. Through an oddity of political circumstances, these funds were administered by the Department of Defense. While at first reluctant, Army General Richard Travis said to the NBCC, “Ladies, I’m going to lead you into battle and we are going to win this war.” I suspect the General may have learned a lot about tactics from these alliances. The new funding was focused on understanding the origins of breast cancer and supported higher risk research projects. The funding by the Department of Defense complemented support from the National Cancer Institute and has resulted in a range of improvements that include less invasive surgeries, improved diagnostics and therapeutics that target cancer cells more efficiently. This has ushered in a more personalized approach to cancer treatments that are tailored to the individual.
Rays of Hope and Breast Cancer Research in Western Massachusetts
Rays of Hope was part of the national effort toward the need of a two-pronged strategy to support the needs of those diagnosed with breast cancer and spur engagement in research to ensure that advances reached the Pioneer Valley quickly. The local investment in research led to the creation of the Rays of Hope Center for Breast Cancer Research in 2011. Enrollment of women from Western Massachusetts is a centerpiece of the research effort. This provides a growing resource through which we’re able to match samples of tissues at the time of diagnosis and to follow long-term outcomes for individuals. This is especially valuable as breast cancer treatments continue to evolve, providing a means to measure success and identify emerging needs. During the past 10 years, the Center has awarded approximately $1 million in grants supporting individual researchers at Baystate Medical Center, UMass Amherst, and UMass Medical School. Grants totaling over $5 million have been awarded to research directly involving the Center. The resources of the Center
and its team have supported many other research projects locally and nationally. As a result, these efforts have led to scientists funded by Rays of Hope appearing as authors of publications more than 80 times. Advocates have also been instrumental in stimulating outreach through Girls Inc. of the Valley and the Eureka! STEM programs, providing young women experiences in science and educating them on how they may limit environmental exposures to chemicals that can influence breast health. These collaborative efforts among advocates, clinicians and researchers have had impacts that show the importance of advocates in guiding research.
While we celebrate the successes, challenges remain. In 2023, breast cancer is expected to remain the most common tumor, with nearly 300,000 new cases in women. New treatments have improved survival for patients, however prevention remains a distant hope. One of the key challenges is identifying the approximately 12 percent
of women who will develop breast cancer and provide targeted guidance for prevention. Discovery of breast cancer susceptibility genes BRCA1 and BRCA2 in 1994 and 1995 led to enthusiasm for genetic tests that could identify those at risk. However, the most common inherited mutations in these genes account for only 5 percent of breast cancers. That leaves around 25 percent of breast cancers in which inherited risk plays a role but the genes responsible for this risk remain unknown, often referred to as “missing inheritance.” Since that time over 300 differences in our DNA code have been linked to breast cancer risk. These genetic differences can identify new individualized strategies for prevention but will require additional work to understand their effects and provide clinical interventions. These genetic differences are also likely to amplify detrimental effects of environmental chemicals in some individuals, leading to increased breast cancer susceptibility.
To address these challenges, the Rays of Hope Center for Breast Cancer Research has created a biorepository of tissues and cells from diverse individuals ranging from those developing breast cancer at very early ages to those who never develop breast cancer. These are being used to create a repository of breast cells with which to understand the
basis for why one out of eight women develop breast cancer and why seven out of eight women remain disease-free. The participants in the Rays of Hope Breast Research Registry are a key part in research that will continue to improve breast cancer treatments and fulfill the promise of preventing breast cancer in the future.