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Innovations in Breast Cancer Diagnosis and Treatment

New Jersey’s healthcare institutions are developing targeted, individualized treatments to improve breast cancer outcomes and provide patients with a better quality of life.

Although New Jersey is often ranked among the top 10 states in the nation for breast cancer incidence and mortality, the state’s healthcare institutions are identifying innovative ways to fight the disease every day. Beyond improving outcomes, the Garden State’s hospitals have made incredible strides in early detection and more effective treatments for breast cancer, all while taking steps to improve patients’ quality of life both during and after treatment. 

Along with skin cancer, breast cancer is the most commonly diagnosed cancer among women in America. This year, it’s estimated that some 30% of newly-diagnosed cancers in women will be forms of breast cancer. Additionally, 2020 has created new challenges as many New Jerseyans delayed or cancelled preventive screenings, including mammograms, in the face of the COVID-19 pandemic. 

“The biggest thing we’ve had to deal with this year is not only delays in the diagnosis of breast cancer, but also ensuring that people are taking care of their general health needs, like seeing their primary care physicians,” says Dr. Deena Atieh Graham, medical oncologist at the John Theurer Cancer Center at Hackensack University Medical Center (HUMC). “On top of that, it’s always been our goal to provide both innovative and compassionate care. Being able to do both of those things in these times of limited contact has been a challenge.” 

“Over the past few months, many people have put off screenings like mammograms that are critical to detecting cancer at its earliest stages, when it’s most treatable,” adds Dr. Eleonora Teplinsky, head of breast medical oncology at Valley-Mount Sinai Comprehensive Cancer Care. “If you have not yet received your recommended screenings, especially if you have a family history of cancer or other risk factors, please don’t delay seeing your doctor.”

Valley offers online mammography scheduling with fast, same-day results, according to Dr. Teplinsky. “Put your health at the top of your list and make an appointment for your mammogram today,” she advises. “If your doctor has recommended follow-up care with a cancer specialist, don’t delay – early treatment is critical,” she advises. 

With proper COVID-19 safety protocols in place, the state’s healthcare institutions have continued to advocate for routine screenings and physician visits, as they know the importance of early detection when it comes to breast cancer outcomes. Memorial Sloan Kettering Cancer Center’s (MSKCC) RISE program (Risk Assessment, Imaging, Surveillance and Education) has already been making efforts to screen patients who are at increased risk, such as anyone with a strong family history of breast cancer or certain genetic mutations, and provide a customized long-term surveillance plan. To that end, the center is also involved in an array of clinical trials that investigate novel therapies as well as explore various factors in outcomes for breast cancer, such as using exercise to prevent and even help fight the disease. 

“A lot of what we’re doing these days is trying to minimize exposure while maximizing outcomes,” explains Dr. Louise Ligresti, medical oncologist at MSKCC, noting options such as contrast-enhanced mammography instead of an MRI or proton beam therapy instead of traditional x-ray beams to help minimize long-term side effects of radiation. “We’ve made our clinical trials more specific to come up with smarter therapies, so that we’re not taking a trial-and-error approach, but more of a mutation-direct approach … and all while trying to avoid over-treatment,” she adds. 

Along with clinical trials, one of the ways New Jersey’s healthcare networks remain on top of the ever-changing landscape of breast cancer diagnosis and treatment is by providing patients with a multi-disciplinary approach. At the Rutgers Cancer Institute of New Jersey (CINJ), specialists ranging from plastic surgeons to radiation oncologists work collaboratively to best meet the needs of each individual patient. 

According to Dr. Deborah Toppmeyer, Rutgers CINJ’s chief medical officer and director of the Stacy Goldstein Breast Cancer Center and LIFE Center, the facility holds weekly tumor study groups where physicians practicing in all of the sub-specialties can weigh in. “It’s a very cohesive, collaborative program. For patients, having every aspect of their care coordinated and everybody on our team working side-by-side means that all of their needs are met quickly and effectively…and they know they have every player on the field working for them, which is especially important for more challenging cases,” she says. 

Over the past several years, there has also been a significant shift in the way New Jersey’s healthcare institutions treat breast cancer. There was a time when patients diagnosed with breast cancer were offered a handful of treatment options to try and hope that something worked, but today’s rapidly-changing technology and the results of cutting-edge clinical trials have allowed New Jersey healthcare institutions to provide more personalized, targeted treatment plans. 

“I think the most exciting breakthroughs we’re dealing with are highly-personalized therapies based not just on a patient’s anatomy and staging, but also her precise form of breast cancer. Cancer isn’t one disease, it’s a spectrum of diseases … and over the course of my career, I’ve seen the transformation from a one-size-fits-all approach to a more targeted approach,” Graham explains. 

“Understanding the enemy is half the battle,” agrees Toppmeyer. “We now know that chemotherapy is not the answer for every patient.” Part of the push to provide more individualized treatment protocols is an effort to make quality of life part of the equation when it comes to treating breast cancer. Graham notes that HUMC is exploring same-day radiation protocols to allow certain patients to complete surgery and radiation on the same day, as well as pre-operative therapies for patients with particular forms of breast cancer. 

Another shift in the way New Jersey’s healthcare institutions are treating patients with breast cancer is focusing on de-escalating – that is, making an effort to reduce the intensity of treatment without sacrificing its efficacy, such as by avoiding more invasive treatments like chemotherapy whenever possible. Toppmeyer notes that CINJ is always looking for ways to de-escalate potential treatment protocols for patients, such as by leading efforts to shorten courses of radiation from five or six weeks down to just three or four. “We now have the ability to offer patients radiation therapy that’s equally as effective in a shorter period of time,” she explains. “Patients can minimize the amount of time they spend coming to the hospital, which was a bonus even before COVID-19. It’s yet another way to improve our patients’ quality of life as they’re receiving treatment.” 

Among the most innovative treatments for breast cancer revolve around immunotherapy, which is the use of medicines to help stimulate a patient’s immune system to recognize and destroy cancer cells. According to Dr. Alice Cohen, section chief of breast cancer services and director of the Frederick B. Cohen Comprehensive Cancer and Blood Disorders Center at RWJBarnabas Health, immunotherapy treatments have been used successfully to treat patients with other cancers, such as lung, and currently appear to be effective in patients with triple-negative breast cancer. There are ongoing clinical trials across the country to identify different forms of immunotherapy and how they can be most effective in the fight against breast cancer. Cohen notes that there are also new drugs that target specific mutations or recurrent breast cancer. 

“We continue to look for these targets for immunotherapy as well as new drugs, and I think the good news is that, in many cases, breast cancer has almost become a chronic disease. … We might not be able to cure it, but we can help patients live with a controlled disease thanks to these new therapies,” Cohen adds. 

One of her center’s most cutting-edge advancements is chimeric antigen receptor (CAR) T-cell therapy for patients with HER2 positive breast cancer, which is a form that tests positive for a specific protein that promotes the growth of cancer cells. “CAR T-cell therapy is sort of a cross between vaccine therapy and immunotherapy, and we’re looking at it again to serve this population of women, which is something that’s really exciting,” she adds. 

Looking ahead, the state’s breast cancer experts seem well-positioned to continue to combine cutting-edge treatments with compassionate, individualized care. Though hospitals are still making use of virtual options such as telemedicine whenever appropriate, they are assuring New Jersey residents that it’s safe to continue with preventive screenings and seek the medical care they need.

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