The Cancer Journey
Breast cancer is not a cookie cutter disease. Those affected are diverse, its treatment unique to each patient and its prognosis often dependent on how early it’s caught. Fortunately, our understanding of breast cancer continues to evolve.
And more than ever before, today’s breast cancer patients are playing essential roles in advancing research, spreading awareness, and advocating for accessible resources. The modern treatment plan can vary widely, beyond radiation and chemotherapy, and likely includes participation in clinical trials, immunotherapy and genetic testing. And those on the frontlines of the fight—the clinicians, researchers, nurses, entrepreneurs, advocates and more—work hand in hand with a patient to ensure they get the best prognosis possible. They also strive to make cancer care more equitable. Read on for the mosaic of people involved in the fight against cancer and learn how their contributions are bringing us one step closer to ending cancer for all.
Screening Access: Working for Change
Cancer screening and prevention have the potential to save hundreds of thousands of lives each year—so why are many cancer cases still not caught early? The answer is a complicated web involving a lack of awareness and barriers to screenings. A new partnership between the American Cancer Society and Color Health, a healthcare technology company, could help mitigate this by making cancer screenings more accessible through the workplace. “We’re focused on how we bring the screening to you, rather than having you have to go in for the screening,” says Alicia Zhou, chief science officer at Color Health. The Cancer Prevention and Screening Program enables employers to offer at-home screening, connections to clinical services and education, and more.
According to Zhou, getting more people to test is crucial. “There are types of breast cancer that are very genetically linked, and if you know early, there are steps you can take in terms of prevention,” she says. It can also impact your treatment, she says. However, genetic testing can be expensive and time-consuming. But through Color, out-of-pocket tests cost $20-50 and include genetic counseling so that people understand the results. “We’re trying to remove every piece of friction you might have as a patient,” Zhou says.
Advancements in Care
The first biomarkers oncologists tested were molecules expressed in a patient’s cancer, which helped specify the type of cancer at work and treat it accordingly. It was a step in the right direction towards increasingly personalized care, but proteins aren’t the full picture. Two cancers expressing the same protein still might not have an identical response to a given drug. More biomarkers were needed, and oncology began to look at DNA and RNA mutations.
Today, oncologists connect with genetics counselors, multidisciplinary molecular tumor boards, and specialized experts to review tumor biomarkers, liquid biomarkers, and germline biomarkers, all of which influence care. For certain cancers, these results dramatically impact a patient’s treatment, quality of life and even survival. Nearly half of lung cancers can be treated with targeted care and avoid chemotherapy.
Biomarker testing is typically anchored to a particular drug, helping to identify those patients who have the best chances at responding well. Still, even for those cancers without tailored treatment options, biomarkers help determine a more accurate prognosis.
As research continues, new sources for biomarkers emerge. Data from CAT scans and pathology imaging might supplement a patient’s tumor, molecular, and genetic profiles to create more robust understandings of their nuanced cancer. Still, testing as early as possible remains key to keeping a patient’s disease at bay while optimizing their quality of life.
Clinical Trials: Breaking Barriers to Advanced Care
Over half of patients are eager to participate in a clinical trial, according to data from the American Cancer Society Cancer Action Network (ACS CAN), yet only about a quarter end up meeting the eligibility criteria available at their treatment center.
“Your ability to participate in a clinical trial should not be so controlled by which institution you happen to go to,” says Mark Fleury, a policy principal for ACS CAN. “That inspired us to think, how could we overcome that barrier?”
That conversation led to the Blue-button program, a new tool targeting the disparity in clinical trial availability across institutions by integrating clinical trial matching within electronic health records (EHRs). Currently, patients who go to a large, well-resourced cancer treatment center often have more options for trials than patients at smaller, community-based centers, particularly ones that cater to a lower-income or rural community.
While third-party matching services exist, using them is a time-extensive process for the provider or patient that involves entering the patient’s health history manually. Speeding up the process is particularly critical in oncology, as the eligibility for a clinical trial is usually time-limited.
The initial pilot program for Blue Button targets providers, but ACS CAN hopes to also have a version available to patients where they can survey trials available within their region.
“While patients can do this research themselves, it’s hard,” Fleury says. “More marginalized patient groups, such as those of a low socioeconomic status or non-native English speakers, may not be able to do this work on top of their other barriers to care.”
Research: Screen Protector
As a researcher and professor of epidemiology at UPenn, Anne Marie McCarthy has seen great strides in breast cancer medicine, but nothing overrides the power of screenings—early detection remains our best attack against it. “That’s why I’m really interested in screening research,” says McCarthy, “because I’m really interested in preventing women from having to suffer from cancer.”
Still, screenings are not a perfect science and disparities in care and outcomes persist—Black women are still 40% more likely to die of breast cancer than white women, and socioeconomic status parallels treatment access in predicting mortality. Historically, research into these gaps has merely noted their existence, enacting little change. For McCarthy, genetic research and advanced technology can lead to improved outcomes— beginning with accessible, accurate screenings.
Determining a patient’s risk level is essential to providing adequate care, but it involves a deep understanding of genetic research; a field that has historically centered populations with European ancestry.
Diversified genetic studies help inform outcomes for all patients, but to ensure that new information does more than merely intensify existing disparities, implementation is key. This is where technology comes in; it can synthesize the patient’s entire dataset of images, genetics, and risk factors and point both patients and providers towards the appropriate screening regimen—a regimen that will, pending continued research, account for the diverse makeup each patient brings.
Activism: Changing Perspectives
Just a few months after a clean mammogram in 2013, Roberta Albany discovered lumps in her left breast and underarm. She’d had regular mammograms since age 30, when she learned she had fibrocystic, dense breasts. What no one told her was that she needed ultrasound mammograms, as well. Doctors soon diagnosed her with breast cancer: stage 2B invasive ductal carcinoma.
In her support groups, Albany noticed she was the only Black person in the room. “I didn’t understand that,” she said, “because I saw plenty of people that looked like me getting chemo or radiation.” Worse, the white, affluent women discussed resources shared with them by their medical teams, resources she’d never heard of.
After successful treatment, she joined forces with ACS to advocate for marginalized communities in breast cancer, especially Black women. “Not talking about this stuff hurts us,” Albany says. That’s why education and conversation motivate her advocacy as she attends conferences and panels speaking on Black relationships to medicine and cancer.
Ultimately, Albany has one piece of advice for medical professionals working with marginalized patients: Treat them like humans. Checking stereotypes and biases at the door allows for a more open sharing of resources that enables patients to make their own, informed decision about which support networks are right for them. It also expands the potential for empathy and authenticity between doctor and patient.
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