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On Cancer: The Breast Cancer Crime Scene: Our Experts Discuss Where We Are Today and Where We’re Headed

By Helen Garey, MPH, Freelance Writer  |  Tuesday, June 10, 2014
Pictured: Larry Norton
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Memorial Sloan Kettering experts describe efforts to improve our understanding — and treatment — of breast cancer.

(90:00)

“Nobody ever died of breast cancer cells. Cells don’t kill you. Cells are only a problem if they form tumors,” explained Larry Norton, Deputy Physician-in-Chief for Breast Cancer Programs at Memorial Sloan Kettering, during a CancerSmart talk in March. And, he added, these cells are “only a problem if they form masses in organs and start to destroy the function of those organs.”

The real danger, Dr. Norton and the other panelists said, is found in the cancer cell’s microenvironment — conditions in the cell’s immediate surroundings that may allow it to survive, grow, and form tumors. “We like to think of cancer cells as criminals, but most criminals can’t commit a crime without some help,” said clinician-scientist Elizabeth Comen.

Studying the Breast Cancer Crime Scene (and Finding New Criminals)

Recently, scientists have begun to employ sophisticated genetic and molecular pathology techniques to scrutinize the tumor microenvironment and identify the proteins, genes, and other substances that assist cancer cells in their growth and spread.

With this approach, researchers are identifying new and different types or subtypes of breast cancer, allowing for improved or more-precise therapies. For example, breast tumors that depend on a steady supply of hormones such as estrogen and progesterone, which drive growth through hormone receptors, can be prevented or treated with various hormone-blocking drugs. Other tumors that may be stimulated by an excess of a receptor called HER2 can be treated with drugs that block this and related receptors.

But what about the cancers that lack all three of these important receptors? Doctors have had to rely on conventional chemotherapy to treat these “triple-negative” breast cancers, but the hunt is on for new targets that drive their growth so that additional treatments can be developed.

Accessories to the Crime

The causes of breast cancer can vary. Most breast cancers are spontaneous and related to aging, although some are caused by inherited mutations, such as in the BRCA1 and BRCA2 genes. (Women with a strong family history of breast or ovarian cancer can talk to their doctor and to a genetic counselor to assess their risk and select the best method of preventing or treating breast cancer.)

For many breast cancers, the answer may lie in the tumor microenvironment. According to Clifford Hudis, Chief of the Breast Cancer Medicine Service, energy imbalance (more calories, less exercise) is increasingly recognized as a risk for some breast cancers.

Inflammation is a key element of the microenvironment. Investigators recently learned that obesity — long associated with postmenopausal breast cancer and other malignancies — is a frequent cause of local, low-grade inflammation of fatty deposits, including in the breast itself. As fat cells die, they are removed by cells called macrophages that secrete inflammatory chemicals that prompt the body to produce estrogen. This may promote tumor growth, said Dr. Hudis, but it also offers an opportunity for treatment as well as prevention.

Bringing in the Police

Recent additions to the treatment arsenal are drugs that can increase the activity of the immune system and unleash it on cancer cells. The development of new breast cancer therapies may depend on our ability to enhance parts of the immune system that may be useful in fighting cancer cells, Dr. Hudis explained.

One promising approach is a new therapy called ipilimumab, currently approved for use in patients with melanoma. By blocking a substance called CTLA-4, the drug prompts the immune system to unleash a flood of powerful T cells capable of destroying cancer cells.

Doctors at Memorial Sloan Kettering are also studying the effectiveness of ipilimumab after cryoablation, a technique that involves freezing tumor tissue in order to stimulate the immune system.

Finally, in collaboration with Memorial Sloan Kettering scientists, Dr. Comen is evaluating an approach in which doctors may one day be able to remove a patient’s neutrophils (a type of white blood cell), increase their cancer-fighting capacity with growth factors, and later reintroduce them into the patient.

Watch the discussion, or explore further information on breast cancer.

Comments

I'm at risk for breast cancer had 3 biopsy's and presently on tamoxifen 20 mg . I'm a patient of Queens General Hospital age 44 yrs old

Carolyn, if you would like to make an appointment at Memorial Sloan Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

My 31 year old daughter, Amy, found a large lump while breastfeeding her 7 month old daughter. Initally it was treated with antibiotics for mastitis. WHEN IT became larger and she could feel it in her axillary lymph nodes, within a couple of weeks of seeing her OB, she went back and the Nurse Practioner, sent her immediately for an ultra sound. Things moved quickly. She tested + for BRCA Gene. MRI, DIAGNOSIS od Triple Negative Stage 2 at this time. However, the tumor was quite large. Chemo, Double Mastectomy, Radiation. When she was was finished, they found it was still there ans had spread to right lung. She then went to Dr. Kimberly Blackwell at Duke for treatment. Nothing worked but she lived out loud and with a purpose. Her Faith in God never waivered. She went to Duke to have fluid removed and was admitted, where she died 3 days later. It is still hard to talk about, but she has a wonderful husband who makes a great dad. Now to the point, her father had prostate cancer for about 7 years. He was admitted to another hospital, and died 19 days after Amy. They said "good-bye" on "face talk". He was never tested for the gene, he didnt think it would change anything. However, we had 4 children, 2 boys and 2 girls with 11 grand children. my third child, Julie was 7 months pregnant when she tested +. I tested negative, although I had Ductal-insitu 10 years before. Back to Julie. She refuses to have anything done. She does have a mammogram yearly, no follow uo MRI in 6 months as was recommended. She has 4 children, two of which are almost 4 year old twins. we understand that the girls will need to be checked at age 18. My daughter, Julie, is still grieving over the loss of her sister and best friend. my concern is Julie. The boys have not been tested and there are two granddaughters growing up. also Amy's little girl who will soon be 5. Why did I write so much? I guess I wanted you to know the whole story, my frustration with Julie and concern for my granddaughters. in April of 2012, I was diagnosed with metatistac Melanoma. My liver and spleen were involved. I have the Melanoma Mutated Gene. In two months (all this during the time Amy was in the midst of her treatment), tumor was wrapped around my colon and throughout my mesentery. i was placed on Hospice care and given less than a month. It was my hope that I could go in Amy's place. But God doesn't work that way, and i knew that. He did however heal me. By September, the cancer was gone. I had NED. Four months later Amy passed away. I was started on Zelboraf and continue to take it 1 tab BID. The MAX dosage is 4 tab BID, with really harsh side effects. I believe the trial was done at the CLEVELAND CLINIC. It had just been approved the beginning of 2012, and it was observed that the max amount of time it was effective was 2 years. This June it will be two years. I believe that NOTHING is impossible with God. I see Dr. Kelli Cawley, my oncologist, every month with labs, and chest, abdomen, and pelvis scans every three months. How can I help my 36 year old daughter? Forgive me for taking up so much of your time. Oh yes, and one more question, is it more likely that if Julie gets breast cancer will it be Triple Negative? Thank you ahead for you recommendations and your time. Sincerely, Nancy Markle

Nancy, we are very sorry about your losses. If you wish to learn more about possible hereditary risk for breast cancer in your family and the options of genetic testing, we suggest you contact our Clinical Genetics Service by calling 646-888-4050 or going to

http://www.mskcc.org/cancer-care/hereditary-genetics

Beyond that, we are unable to answer specific medical questions on our blog. If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

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