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Breast cancer research, treatment more 'personal'

LAWRENCEVILLE -- Breast cancer has always been a personal thing. Now its research and care are starting to catch up.

"In the old days it was pretty straightforward," said Dr. Hisa Yamaguchi, a surgeon at Snellville's Eastside Medical Center since 1995. "You had cancer, you had your breast removed and you had chemotherapy."

It's not like that anymore. More women are winning their battle with breast cancer than ever before, and for many reasons: better technology, better awareness, better medicine and earlier detection. But the current survival rate -- almost 99 percent for early-stage, localized breast cancers -- is also the result of a more personalized approach.

The focus of every facet, from research to treatment to prevention, has shifted far away from the one-size-fits-all strategies of yesteryear. Thanks in large part to the identification of molecular subtypes of the disease, breast cancer is now a very individualized thing.

Dr. Ruth O'Regan is the director of the translational breast cancer research program at the Winship Cancer Institute of Emory University.

By the numbers

2.6 million: Estimated number of American women that are breast cancer survivors

230,000: Estimated number of American women that will be diagnosed with breast cancer this year

40,000: Estimated number of American women that will die from breast cancer this year

12.5 percent: Estimated percentage of American women that will be diagnosed with breast cancer during their lifetime

60 percent: Estimated percentage of breast cancer incidences diagnosed in early, localized stages between 2001 and 2007. Nearly 99 percent of these women survived.

"Ten years ago, even five years ago, when we were doing trials it basically didn't matter what type of breast cancer you had," she said. "We looked at new agents with basically anybody that had breast cancer."

"Now in 2011, almost all the trials are specific for different subtypes of breast cancer."

The goal, O'Regan said, is to match each woman not only with the treatment known to be effective for her particular breed of breast cancer, but to avoid subjecting her to the nasty side effects of treatment proven to be ineffective for her subtype.

Women are getting better results in part because they're getting cocktails designed specifically for them.

The individualized approach has also left doctors, surgeons and patients with better, less invasive options.

"If you look at the history of the surgery, it went from a very disfiguring surgery, removing everything on the chest wall, to where now it's just basically having the cancer removed in radiation," Yamaguchi said. "You're seeing it create less and less disfiguration for the woman."

A more targeted attack has translated to detection of the disease as well.

Women are being scanned, diagnosed and treated at earlier stages than ever before, thanks primarily to an increased awareness and focus on annual mammograms. But breast cancer facilities like the one at Gwinnett Medical Center are also doing a better job identifying women at high risk for the disease, then keeping closer tabs on them so they can squelch the cancer in its early stages if it does pop up.

"When I first started in this area, we didn't really get into people's level of risk or try to stratify women into a risk category," Cindy Snyder said.

Snyder, an advance practice nurse in genetics and manager of oncology services at GMC, said that's far from the case now. The GMC staff uses the National Cancer Institute's breast cancer risk assessment tool to classify women that come in for exams; women with a greater than 20 percent risk for the disease (using factors like age, family history, and cell makeup) are monitored more closely and get yearly MRIs in addition to mammograms.

Doctors like Yamaguchi often follow cancer patients as far as 10 years into remission, trying to catch relapses as early as possible.

"It definitely is a life-changing diagnosis, but so is diabetes. People live with diabetes," Snyder said. "We're finding things so early, Stage 0, Stage I, with all this improved imaging and improved screening rates that we can have women be diagnosed with cancer, but they're going to live."

"That wasn't always the way people thought."

The biggest battle for the future, O'Regan said, is figuring out how to battle breast cancer in those that aren't so lucky -- the ones who weren't diagnosed early on, who all of a sudden found themselves in Stage III or IV and battling for their lives. She anticipates further division among the four subtypes now commonly accepted, as researchers try to solve what drives the genes and proteins that in turn drive the disease.

Progress is being made more rapidly than ever.

"There's no question we're doing much better," Yamaguchi said.