Struggling for Earlier Detection, Better Treatment

The Fight Against Breast Cancer

In a ten-year period in the 1960's when 58,000 men and women died in the Vietnam War, 330,000 women in this country died of breast cancer.

This frightening statistic, presented by Nancy Brinker in her 1990 autobiography of one woman's struggle against breast cancer, brings home the staggering reality of the disease--a disease which remains second only to lung cancer as the major cause of cancer deaths in women.

The malady claims the lives of 46,000 women each year and drastically alters the lifestyles of 182,000 others who contract the disease. One in every nine women is predicted to develop breast cancer before the age of 85.

Scientists at Harvard and elsewhere have gained some insight into the mechanism of the disease, but while the five-year survival rate of women with breast cancer has risen from 78 percent in the 1940s to 93 percent today, the disease still baffles scientists who attempt to explain its origins, and a cure remains a distant goal.

In the vital struggle to design new strategies for fighting a disease about which few specifics are known, scientists have traditionally followed two routes of investigation: studying the causes and the actual mechanism of the disease, and working on developing treatments.

Researchers opting for the first path hope to devise an exact mechanism for the initiation and the growth of a tumor in the hope of blocking the process in its early phases.

Included in current lines of research are the analysis of varying stages of tumor development, ranging from genes present before the tumor is formed to the development of blood vessels which spur the growth of the tumor to the exact location and movement of the tumor.

Medical School Assistant Professor of Pediatrics Stephen H. Friend and his colleagues at the Massachusetts General Hospital (MGH) hope to find a definite genetic link to the development of breast cancer.

BRCA1, a gene believed to suppress tumor development, has recently been linked to breast cancer. Altered forms of BRCA1, which occur in one woman in 200, prevent it from functioning properly, and tumors can begin to grow. Another gene, p53, has also been determined to be a useful indicator of many cancers, including breast cancer.

According to Dr. Daniel F. Hayes, assistant professor of medicine at the Medical School and a medical oncologist at the Dana-Farber Cancer Institute, BRCA1 was the first gene to be "clearly associated as a cause of common malignancy."

"[Studying genetic predispositions for cancer] is clearly a worthwhile venture," Friend says. But he is quick to add that identifying an altered gene which may cause cancer does not necessarily enable doctors to prevent it from bringing on the deadly disease.

For the past five years, scientists have studied several different genes thought to be related to breast cancer. If several genes can be identified as positively correlated to breast cancer incidence, doctors can then screen women and identify those high-risk women who possess the genes before a tumor has actually formed.

Clinical studies involve developing better methods of screening women to determine whether or not a tumor is present and treating those who test positive accordingly.

Unfortunately, physicians are able to characterize only a fraction of breast cancer patients as belonging to the "high risk" category before a tumor is actually identified.

Approximately a quarter of breast cancer cases are associated with a family history of the disease or a hormonal abnormality. But the majority of patients lack characteristics which might have been considered precursors for breast cancer, leaving their risks undetectable.