Breast cancer news spans huge spectrum

Breast surgeon Dr. Melissa Hulvat says new research in breast cancer covers an amazing spectrum.

“There’s just so much exciting stuff,” she said. “It’s for people who don’t have cancer all the way through people who are going to be 20-year survivors with metatastic breast cancer.”

For the 2012 October Breast Cancer Awareness Month, Hulvat, director of the Bass Breast Center in Kalispell, took inspiration from the preventive end of the spectrum for Kalispell Regional Healthcare’s “Pink in Action” campaign of healthy lifestyle events all month.

“What mostly my passion is is trying to make less work for myself by having less people get breast cancer,” she said. “And having people find it early when it’s a bump in the road and very treatable.”

Hulvat said the American Cancer Society estimates that people could prevent 30 percent of all cancers through healthy weight, diet and exercise. She said that takes in a large number of people but doesn’t provide a guarantee.

“That doesn’t take into account that I took care of a 36-year-old marathon runner or a nutritionist I take care of who leads classes in vegan lifestyles who got breast cancer,” she said. “You can’t prevent all of it. But a 30 percent reduction is a big deal.”

 Pink in Action events include four healthy cooking classes at the Sunny View Cafe at Kalispell Regional Medical Center and a panel discussion focused on the link between weight and breast cancer risk. Hulvat said multiple publications in the last three to four months have focused on this connection.

Hulvat said an enzyme called aromatase interacts with fat to produce the hormone estrogen, a significant risk factor for breast cancer. 

“So if you weigh less, you have less chance of getting breast cancer,” she said. 

For survivors of breast cancer, losing weight decreases their risk of breast cancer returning.

Hulvat said a couple of her patients who lost weight plus some timely words from her own physician inspired her to slim down. She was amazed at what a difference she felt after losing 10 pounds.

“So I lost 50 more and I feel so good,” she said. “It changed my life.”

With her overweight patients, Hulvat said she now gets on her soapbox and has the difficult conversation. The hospital now offers them support such as new medical nutrition classes for survivors and a weight loss program at The Summit called One2One.

 “It’s a one-to-one food coaching and exercise coaching program,” she said. “You get weekly access to a registered dietitian and physical trainer and access to The Summit.”

With people now “getting” the breast cancer awareness message, Hulvat said this was the year to add lowering risk through lifestyle to the message about the importance of mammograms for early detection. For those diagnosed, the last year brought exciting advances in treatment. 

Hulvat said it’s all about personalized and targeted therapies.

“I tell my patients that it more like a sniper bullet than a hand grenade where you throw it and hope the rest of you survives and the tumor dies,” she said. “Now we’re getting these sniper bullets and figuring out who really needs them.”

She pointed to the recently announced mapping of the breast cancer genome as really significant because it revealed new targets for drug therapies. The project revealed the genetic heredity of the four types of breast cancer: Luminal A, Luminal B, Her2-enriched and Basal-like.

“We knew that we were calling it breast cancer because it was cancer in the breast,” she said. “This genome mapping has let them figure out that these literally are different diseases.”

Hulvat said researchers found some genes very common to the Luminal A group that afflicts elderly women. These genes provide new targets for drug development.

“Basal-like breast cancers are what the 32-year-old I’m operating on next week has,” Hulvat said. “It’s already in her lymph nodes. That’s crazy.”

The discovery about these really aggressive Basal-like cancers found in young women was that they look much more like ovarian cancer on the genomic level. Hulvat said that amounts to a game changer in thinking about treatment.

“Maybe we should give them chemo that works with ovarian cancer instead of breast cancer chemo,”  she said. “In the short term, it will change how we treat basal-like breast cancers. Tomorrow, hopefully in the near term, we’ll have targeted therapies for the Luminal A cancers which are the most common kind in the United States. That’s very exciting.”

Along the same line, Hulvat said many innovations of the last year have been in chemotherapy. One was in the treatment of HER2/neu positive breast cancers.

Hulvat said Herceptin has been the main drug used for these breast cancers. Two articles published in the last year unveiled research that found adding a class of cousin drugs of Herceptin significantly prolonged survival in some metatastic patients.

Previously, the cousin drugs were used when Herceptin started to fail.

“Every time we can make something work in metatastic patients then we can translate that to women who don’t have metatastic disease,” she said. “That’s really changed the way we’ve treated HER2/neu breast cancers.”

While this type of breast cancer affects only 20 percent of patients, Hulvat said she finds this exciting because it shows the field of medicine getting better at targeted therapy.

“We really have things to offer women that are specific to their tumor,” she said.

Another innovation making waves in the oncology community involves a class of drugs call mTOR  inhibitors. 

A protein in cells, mTOR acts like a signal that tells cells to pull in more nutrients so they can divide and proliferate. Hulvat described breast cancer cells with excess mTOR as really bad players.

“They have a tendency to chew up and spit out chemo,” she said. “They can proliferate in a really hostile environment.”

In women with later-stage Luminal A breast cancer, researchers obtained good results combining mTOR-inhibiting drugs along with their traditional estrogen-blocking therapy. Hulvat said oncologists previously switched one estrogen-blocking drug for another as cells developed resistance.

“So having this mTOR inhibitor that you can add to the anti-estrogen therapy is a different thing that we’ve got in our pocket now,” she said. 

She called this innovation an example of targeting of mTOR and estrogen receptors. In the future, Hulvat see breast cancer treatment continuing to move toward targeted and individualized medicine. 

“The era of personalized molecular medicine is here but we’re not good at it yet,” she said. “These things all coming out in short order are pretty encouraging to me that we’re getting that way.”

 Reporter Candace Chase may be reached at 758-4436 or by email at cchase@dailyinterlake.com.