Physicians and researchers across Florida are exploring innovative ways to make a diagnosis of breast cancer less formidable and frequent, especially for underserved populations such as Black women and prison inmates.
October is Breast Cancer Awareness Month, and combined with the Oct. 4 announcement that Florida’s First Lady, Casey DeSantis, was diagnosed with breast cancer at age 41, many are looking for more information on the disease.
Across the state, researchers at a number of academic and professional cancer institutions are helping lead the field with cutting-edge treatments, diagnostics and preventions.
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Breast cancer backgroundBreast cancer is the most prevalent cancer across the globe, according to the World Health Organization. At the end of 2020, 7.8 million women worldwide had been diagnosed with it in the past five years.
In the U.S., about 1 in 8 women will be diagnosed with breast cancer in her lifetime, and there are over 3.8 million survivors.
National Breast Cancer Foundation says breast cancer will account for about 30% of all cancer diagnoses in women in 2021. On average, a woman is diagnosed with breast cancer every two minutes in the country.
Men can also develop breast cancer, though it is far less common.
They found a lump. Doctors said not to worry. These are the stories of men with breast cancer.
According to the American Cancer Society’s Cancer Statistics Center, over 20,000 new cases of breast cancer are estimated for women in Florida this year and more than 3,000 deaths.
Across the entire U.S., those numbers rise to 281,000 new cases of breast cancer in women and 2,650 in men, along with 43,600 and 530 deaths, respectively. Florida has the third-highest number of estimated cases and deaths for females in 2021, following California and Texas, the two states with higher populations.
The ACS website listed the following statistics for five-year relative survival rates in women diagnosed with breast cancer compared to women in the overall population:
Localized, meaning no sign that the cancer has spread outside of the breast: 99%Regional, meaning the cancer has spread outside the breast to nearby structures or lymph nodes: 86%Distant, meaning the cancer has spread to parts of the body farther way, such as the lungs, liver or bones: 28%New breast cancer treatments: New treatments are changing the lives of people with breast cancer. And the future holds greater promise.
Why is research so important?For a disease impacting millions of people, research is critical, experts say.
Advancements in treatment, diagnosis and prevention can help save lives and improve many aspects of an individual’s battle with cancer, like faster detection, fewer negative side effects, higher survival chances and better healthcare equity.
Annette Khaled, who has a doctoral degree in molecular genetics and microbiology from the University of Florida and completed postdoctoral training with the National Cancer Institute, is head of the University of Central Florida’s Division of Cancer Research.
She said while much work has been done with breast cancer so far, there is a great need for continued research on aspects like treatment resistance, developing new therapies, curing aggressive types and improving disparities Black women face.
“We’ve made significant strides, I will tell you,” Khaled said. “But we still have far to go to get to that point (where) everybody survives.”
From a survivor’s perspective, research is an important bringer of hope, according to Fitz Koehler, a Gainesville woman who was first diagnosed with breast cancer in February 2019.
Koehler, a fitness expert, speaker, race announcer and author of “My Noisy Cancer Comeback: Running at the Mouth, While Running for My Life,” discovered she had a cancerous lump just weeks after leaving her doctor’s office with a clean mammogram.
The wife and mother of two, who has since finished her over yearlong battle with chemotherapy, radiation and surgical treatment, said research is fantastic because it not only gives hope for survival to more people but also hope that they will have an easier time with treatments.
“I won’t be satisfied until everyone diagnosed with breast cancer is cured,” she said. “If there was something less horrible than the chemo I endured, you know, if I didn’t have to be as sick or I could have kept my hair, (that) would have been nice.”
Koehler said it is amazing to see new scientific developments coming out, especially as she faces the threat of her breast cancer coming back.
“I’m always at risk for reoccurrence, and I’m really hoping that doesn’t happen. But I hope if it does happen, the doctor says, ‘Oh, this one’s an easy fix,'” she said. “I’m hoping these researchers work their magic quickly.”
She also wants improvements for her daughter Ginger’s chances.
“I want to know that, God forbid, breast cancer comes looking for her,” Koehler said, “there is a very, very quick and easy solution, and it’s just less difficult to manage.”
Innovative work around the stateTracy Jacim is CEO of the Florida Breast Cancer Foundation, a charity that raises money to support breast cancer research and education in the state. During the COVID-19 pandemic, she said, her organization alone has funded $900,000 worth of work.
Some of the ongoing projects financially supported by FBCF, according to the research page on its website, include University of Florida studies on early detection and metabolic weaknesses, H. Lee Moffit Cancer Center & Research Institute work with metastatic breast cancers and cure rates and a UCF analysis of racial and ethnic disparities in outcomes.
“It’s kind of exciting being here. UCF, Moffit, UF, they’re all leading institutions when it comes to research,” Jacim said. “Just from a living here standpoint, when folks get diagnosed, they can rest easy that they’re in a good location … when it comes to research and treatment, Florida is right at the top.”
At UF, radiation oncologist Dr. Oluwadamilola T. Oladeru said she is currently working on clinical trial development to see if shorter radiation treatment is better than longer for patients. She also has an interest in health disparities and is researching cancer outcomes in prisons and triple negative breast cancer, an aggressive subtype found more often in African American women.
“The cancer itself, we’re still learning more about it, how it develops, why it develops. But most importantly, we want to make sure that people can live cancer free,” she said. “I think we have a lot more work to do in the space of cancer inequity and making sure the outcomes are equal and better for all populations, not just a particular population of women.”
Also at the university, Dr. Coy Heldermon is a breast cancer specialist who researches many types of treatment, like targeted therapy and gene therapy. Using mouse models, he said, he is able to test different treatments and determine which are more viable for clinical trials with people.
Heldermon said breast cancer work has become more individualized over the years, with research now focusing on identifying and targeting mutations specific to cancer cells.
With more specific therapies, he said, the idea is patients can have less chemotherapy and radiation, helping reduce treatment morbidity.
“The better we get at that, the better we’ll be able to prevent not only the disease but also the side effects that come along with our treatments,” he said.
Khaled at UCF is working on treatment for more aggressive spreading or returning breast cancers, which are harder to stop, based off a specific chaperonin protein responsible for folding other proteins in cancer cells.
Proteins are needed for cell growth and multiplication, she said, and in order to work, they must be folded from a long strand into a sort of 3D shape. When cancer cells are trying to multiply and spread, the demand for chaperonin increases. Without it, the cells die.
“It’s only, thankfully, a small number of cancers that actually become these metastatic or recurrent cancers. But they’re there. And so we don’t have 100% cure for all breast cancers,” Khaled said. “We hope that, you know, what we’re doing in the lab will help maybe bring up those numbers and help people survive longer.”
Khaled said her lab is in the preclinical stage of research right now to develop a drug. She and other scientists there are working on ways to deliver the drug to cancer cells, optimize its uptake, understand the biology of how chaperonin works in the cancer cells and detect cells that have it.
“It’s a really good target because we don’t have to know what mutation caused the cancers. What we’re targeting is completely downstream,” she said.
At Mayo Clinic in Jacksonville, Dr. Saranya Chumsri, an associate professor of medicine, is researching cancer vaccines to stimulate patients’ immune response to attack cancer cells.
“It’s kind of similar concept like a vaccine to prevent infection,” she said. “I think our ultimate goal in the future is probably [to] try to prevent the disease entirely.”
What can help reduce your risk?Even though breast cancer is common, there are a number of things people can do to improve their odds of avoiding and beating the disease, doctors and advocates say.
Many of them, you likely already know.
Getting an annual mammogram is a critical tool for diagnosis. Most women are recommended to begin screening at 40 or 45 years old, Heldermon said. But if you have a family history of the cancer, you should start getting mammograms 10 years before your relative’s age at diagnosis.
Heldermon said it is important for families to discuss major illnesses like breast cancer than can be hereditary.
“If you don’t talk about them, then you don’t know what your risks are,” he said.
The doctor said exercising is the best thing people can do to reduce their breast cancer risk. He recommended 30 minutes a day, as well as eating healthy foods and avoiding smoking and drug use.
Koehler, who was a fit athlete at the time of her diagnosis, said her foundation of physical health and strength was a big help getting through the disease’s difficult treatment.
Chemotherapy was especially hard, the survivor said, and she struggled with hair loss, rashes and violent illness. But she was able to maintain an active lifestyle as a traveling race speaker and announcer, wife and mother, doing more during her months-long treatment than many do without cancer.
“I can tell you that my health and fitness up front dramatically improved my ability to get through care,” Koehler said. “Health and fitness really matter. And the moral of the story for everybody is prepare your body to do battle today because you never know when an injury will strike.”
Minimizing stress can be beneficial as well, according to Jacim.
These actions, while not a guarantee, can help limit the carcinogens your body is exposed to, control estrogen levels and build or maintain physical and immunological fitness.
“I love the idea that people don’t just have to be sitting ducks,” Jacim said. “You might do some of these things and you might still get breast cancer, but the facts are it reduces your risk, so why not?”
Oncologist Dr. Carmen Calfa of the University of Miami Braman Family Breast Cancer Institute also shared some lesser-known protections.
Breastfeeding for longer periods, like six months, is known to reduce the risk of developing breast cancer, she said. Having children earlier in life before the age of 30 can also help.
Liz Freeman of the Naples Daily News / The News-Press contributed to this article.