By Dr. Numa Rahman, Hematologist and Medical Oncologist, White Plains Hospital Center for Cancer Care
Hearing the words “you have breast cancer” can make everything that follows overwhelming. Suddenly, there may be new doctors to meet, tests to undergo and treatment decisions to make—all while you are still processing the diagnosis itself.
“You never thought this would be your life, and all of a sudden it is,” says Dr. Numa Rahman, a hematologist and medical oncologist at White Plains Hospital’s Center for Cancer Care. “The uncertainty about what’s going to happen can be one of the hardest parts.”
But breast cancer treatment has advanced significantly, giving patients more reason for hope. In fact, breast cancer death rates among U.S. women have declined 44% since 1989, due in large part to earlier detection and advances in treatment.
“We know much more about the biology of different types of cancers, and we have more targeted treatments available,” Dr. Rahman says. “That allows us to be much more precise about what we recommend—and is helping patients achieve better outcomes.”
What comes next depends on the individual cancer—and understanding its specific characteristics helps doctors determine
he treatment approach most likely to benefit each patient.
The Details That Guide Treatment
Breast cancer treatment has to be tailored to the patient’s specific kind of tumor. Doctors look at the biological makeup of the cancer to determine what signals are causing tumor growth. For example, a majority of breast cancers are “hormone-receptor positive” meaning they are fueled by estrogen and/or progesterone. This makes hormone blocking medications a cornerstone of treatment of these particular cancers.
On the other hand, HER2-positive breast cancers have abnormally high levels of the HER-2 protein which promotes cancer cell growth – these tumors can be treated with targeted HER2-directed therapies. About 10-15% of breast cancer cases are “triple-negative” meaning the tumor cells do not have estrogen, progesterone or HER2 receptors – these tumors may require chemotherapy as part of the treatment plan.
These differences, along with information regarding the size and extent of spread of the tumor, help doctors determine which treatments are most likely to work and whether surgery or medical treatment should come first.
For some hormone receptor-positive cancers, for example, a test called Oncotype can help determine whether chemotherapy is likely to provide additional benefit.
“In the past, many women with hormone-receptor positive cancers received chemotherapy,” Dr. Rahman says. “Today, using the information from the Oncotype test, we can safely omit chemotherapy in a subset of patients and avoid the side effects from a treatment she doesn’t need”
More Options, Better Outcomes
At the same time, advances in breast cancer treatment are giving doctors more effective ways to target the disease.
One example is a newer class of targeted medications called CDK4/6 inhibitors. For some patients with hormone receptor-positive metastatic breast cancer, these oral medications can be used with anti-estrogen therapy instead of traditional chemotherapy.
“These treatments are helping patients live longer while maintaining a better quality of life,” Dr. Rahman says. “Even with metastatic breast cancer (breast cancer that has spread to other parts of the body), some patients are able to manage their disease for longer periods and continue living full, active lives.”
For some patients with advanced breast cancer, “liquid biopsy” blood testing can even help doctors identify changes in cancer cells over time and potentially guide the next treatment if a cancer stops responding to its current therapy.
Making Treatment Decisions Together
Determining the right treatment plan often involves multiple specialists.
At White Plains Hospital’s Center for Cancer Care, breast radiologists, pathologists, breast surgeons, medical oncologists and radiation oncologists collaborate to review complex cases and determine the appropriate sequence of care. When appropriate, patients may also be referred to the Hospital’s robust clinical trials program for access to promising new treatment options.
Just as important, the patient is part of those decisions.
“I try to understand the patient before expecting her to understand me,” Dr. Rahman says. “Knowing what matters to her and what she’s worried about helps me guide her through the decisions ahead.”
Patients also benefit from the support of a clinical navigator, on-site support groups and ancillary services such as art therapy at every stage of their journey.
Dr. Rahman’s advice for anyone beginning the breast cancer journey is simple: ask questions, write them down as they come to you, turn to trusted medical sources for information and don’t hesitate to ask for clarification.
“There will be a lot of questions along the way, and that’s okay,” Dr. Rahman says. “We’re here to answer them, talk through the decisions with you and help you feel confident about the path forward.”
Learn more about the comprehensive, personalized and advanced care available at White Plains Hospital’s Center for Cancer Care.
Dr. Numa T. Rahman is a hematologist and medical oncologist at the White Plains Hospital Center for Cancer Care. To schedule an appointment, call 914.849.7630.
