For 39 years, Breast Cancer Awareness Month has served as a constant reminder and call to action for both patients and practitioners to educate themselves and others about breast cancer prevention, detection, and novel research.
Although progress has been made within the realm of breast cancer management, it is still vital for patients to be informed about the signs and symptoms of this disease, according to Sunil Adige, MD, who added that increased understanding of breast cancer presentation could be the difference between an early– vs a late-stage diagnosis.
“The biggest thing is to always ask your patients a lot of questions and try to hear them out as much as possible. Our patients tell us such important things, and listening to them can catch things early, or even prevent something from happening,” Adige emphasized. “Just keep listening to your patients.”
In an interview with OncLive®, Adige discussed the importance of Breast Cancer Awareness Month, expanding on the integration and adoption of personalized treatment approaches, key data read out at recent academic meetings, and the need to address remaining disparities in breast cancer care.
Adige serves as an assistant professor at The George Washington (GW) Cancer Center, George Washington University, in Washington, DC.
OncLive: What is the importance of Breast Cancer Awareness Month, and how can awareness efforts encourage timely breast cancer screening and early detection?
Adige: Breast Cancer Awareness Month is extremely important and something that is good to keep reminding people about every year, because it's such a big issue. This is a good reminder for women to get their screening mammograms and keep on top of that. [Screening mammograms are] important for detecting early breast cancer when it does show up. When we catch these breast cancers early, it can make such a big difference as far as treatment management.
How has the use of personalized medicine evolved in breast cancer management?
[Personalized medicine] is a very exciting part of breast cancer management, and can be a lot of different things. One of the things that we do for breast cancer is we look at the markers that are used to define the type of cancer that we're treating. We're [increasingly] utilizing next generation sequence [NGS] testing, which looks at the DNA of the tumor itself to help guide treatment decisions. We are using various mutations that the cancer develops to target it best when treating it.
Some new examples [of tailored treatment] are in the hormone receptor [HR]–positive breast cancer setting. We have a lot of new treatments for patients with a PIK3CA mutation; when people have this mutation, we can target it. There have been medications in the past, such as alpelisib [Vijoice], which have been used in conjunction with fulvestrant for treatment. Now we have some new medications, such as capivasertib [Truqap], that are helping us to better treat these patients with even less adverse effects [AEs] than before, which is great.
What significance does the new HER2 ultra-low classification hold for expanding treatment eligibility for fam-trastuzumab deruxtecan-nxki (Enhertu; T-DXd) in breast cancer?
A very exciting drug in the space, T-DXd, has been used in various lines of treatment for metastatic HER2-positive breast cancer. This medication is redefining how we think about HER2-positivity. In the past, if somebody was HER2 3+ or HER2 2+ [by immunohistochemistry] and FISH [fluorescence in situ hybridization]–positive, they were considered positive for HER2. However, some recent studies have shown that even patient who are HER2 2+ and FISH-negative, and HER2 1+ are obtaining benefit from this drug. The new update from the 2024 ASCO Annual Meeting is that there's a new classification for HER2-positivity called HER2 ultra-low, which [encompasses patients] still seeing benefit from this drug, which we otherwise would have thought of as a HER2-positive drug. There are patients who would have never been [eligible to receive T-DXd] who are now being considered for it and [achieving] great results. It's been showing a lot of promise, so that's one great thing to [take away from the 2024 ASCO Annual Meeting].
What research is being conducted to improve the field’s understanding of racial disparities in breast cancer care and reduce treatment-related toxicities for underserved patient populations?
One theme that we have in breast cancer is trying to minimize the toxic effects of some of the treatments. We know that in Black women, especially, the risk of developing peripheral neuropathy is increased with taxanes. There's a new study showing that using the 3-week dosing of [docetaxel] is shown to have less neuropathy in Black women compared with weekly taxol dosing. This is exciting, because it allows us to better target patients who would benefit from this specific regimen, when there are 2 regimens we thought to be mostly equivalent [in toxicity profile]. This is pushing us in one direction or the other to minimize toxicity and make life more tolerable for patients on treatment.
How can increased awareness of early detection strategies and potential symptoms improve outcomes and access to care for patients with familial or personal risk factors?
A lot of things are being done as far as increasing awareness. Interviews, like this and others, are just going to increase awareness about mammograms. That's the starting point for getting people into the care system. This also makes people aware of some of the symptoms they should be looking out for, [and which] could be a sign of early breast cancer that they may [identify] in themselves.
[Signs of early breast cancer] can include a new lump in their breast, if their nipple is more puckered inside of the breast, or development of a new rash on top of the breast. If [a patient] does notice any of these things, they should go to their primary care doctor to get evaluated, and get a mammogram or an ultrasound done as well.
Something else to be aware of is [one’s] family history. If [a patient has] several first-degree relatives who have developed breast cancer, especially earlier in life, these are all reasons to go talk to their doctor and see if they need to see a genetic counselor to get tested. This will help them understand if they do have a high-risk mutations that may put them at an increased risk [of developing breast cancer].
Another thing that is important from a screening perspective is to [understand screening age considerations]. There is some agreement in the breast cancer community that we should [perform] screening for women at the age of 40 years, [in contrast] with some groups that have been saying 45 years up until recently. We do recommend that women age 40 years and older get a breast mammogram at least once every other year for screening purposes.
What factors should be prioritized in post-treatment care to improve long-term quality of life and reduce the risk of recurrence for breast cancer survivors?
The number one thing is regular visits with their oncologist after they finish treatment. Breast cancer is a very curable disease, and we can get rid of it completely; unfortunately, there's always a chance of it coming back, so we do need to continue to monitor. For breast cancer, CAT scans and PET scans are not part of the regular surveillance process after treatment, unless there's a symptom. That's one of the things that your oncologist is able to monitor. Getting patients [into the clinic] to look for new symptoms that [could indicate] recurrence of the breast cancer, either in the breast or somewhere else in the body, [is vital].
As far as survivorship, there are a lot of patients who have developed various AEs after chemotherapy. We're increasingly looking into how we can help patients to manage and overcome some of these long-term toxicities. One that I commonly see is brain fog, where patients don't [retain] as much of their normal mental clarity after getting chemotherapy.
At GW Cancer Center, we are opening a clinical trial [evaluating] various mental stimulation exercises to see whether that helps to improve mental capacity in women dealing with this brain fog. We're hoping to see some positive results there [so we can] offer more support after chemotherapy.
