Tackling Breast Cancer: The Right Treatment for the Right Woman at the Right Time

By Jacqueline Miller, MD

Although there has been much improvement in breast cancer detection and treatment, I am continually reminded of how breast cancer affects different women in different ways. As I talked to a patient of mine about how breast cancer took her sister’s life at the age of 42, I was reminded of how challenging it is to explain how breast cancer is a different disease in every woman. Each breast cancer has different subtypes—these are kinds of cancer that are sorted by using genes as well as by how they respond to chemicals in the body. The subtypes can mean the cancer grows faster or slower and responds better or worse to certain treatments. Each breast cancer also has different stages of disease, and each different outcomes.

Knowing cancer characteristics is critical for guiding the development of cancer treatment and predicting how well the cancer will respond to the treatment. We have always known that some women get breast cancer that kills quickly. Researchers are learning that some of these women have certain subtypes, like triple-negative breast cancers (breast cancers that do not bond with certain hormones and do not create a certain protein). These cancers have a worse outcome and are diagnosed more often among black women.

In the past, white women were more likely to be diagnosed with breast cancer, while black women were more likely to die from breast cancer. A 2016 paper reported, however, that breast cancer is increasing slowly among black women, and now they are just as likely as white women to get the disease. We don’t fully understand why this has happened; the reason could be anything from women not having regular screening to more women becoming overweight and obese, or even women coming in contact with harmful substances in the environment.

Even though there are more diagnoses, deaths from breast cancer have been going down among all women, which is most likely due to improvements in treatment. Newer understanding of the different types of breast cancer has led to intensive and specialized treatment in women who have these cancers. Still, there is a racial difference in breast cancer deaths: black women die more often than white women. This can be linked in part to the fact that breast cancer in black women is diagnosed more often when the cancer has spread outside of a single tumor or to other parts of the body.

Improved knowledge about how and why breast cancer develops can help us understand why certain women develop specific types of breast cancer. Answering questions like “Why are some breast cancers more aggressive than others?” and “Why are some women more likely to get aggressive breast cancer?” could open the door to new ways to prevent and detect breast cancer, and to use the treatment that is most likely to work for each woman and each type of breast cancer.

Understanding and reducing risk factors, using prevention strategies, improving early diagnosis, and providing personalized treatment may result in reducing new breast cancer cases and deaths nationwide. Ensuring that all women get the most appropriate treatment in a timely fashion can improve overall cancer survival. This means taking subtypes into consideration and looking at why a particular woman may have gotten a particular type of breast cancer. It’s also important to look at social reasons (like fear of testing or treatment) and economic reasons (like not being able to take off work to get screened or not having health insurance).

The key is getting the right treatment for the right woman at the right time.