Imagine a future where breast cancer treatment is as unique as you are. No more blanket approaches, no more unnecessary procedures. That future might be closer than we think, thanks to groundbreaking research exploring the potential of analyzing cancer cells found in your blood.
Currently, over 2.3 million women are battling breast cancer, and a significant portion – around a quarter – are diagnosed at an early stage. This early stage is called ductal carcinoma in situ (DCIS), where the cancer hasn't spread. While the prognosis is often good, the tricky part is that the cancer can become invasive in a concerning 10% to 53% of untreated cases.
Because of these high stakes and the inability to predict the future for each patient, doctors often recommend treatment for all women diagnosed with DCIS. This can involve procedures like lumpectomy or mastectomy. Additionally, radiation therapy is common after a lumpectomy, and hormone therapy may be prescribed for hormone receptor-positive DCIS.
"Since early detection can save lives, physicians are now recommending mammograms at younger ages, so more young women have to make some life-altering choices," explains Sunitha Nagrath, a professor at the University of Michigan.
But here's where it gets controversial: Current treatment often lacks personalized information, leaving patients to navigate options without a clear understanding of what's most effective for them. Some might face aggressive treatments they don't need, while others might not receive aggressive enough treatment. Research indicates that cancer can return within 10 years in roughly 10% of cases treated with surgery alone.
This is where the new research comes in. The goal is to identify specific markers that can distinguish which patients would truly benefit from aggressive interventions, including surgery, radiation, and hormone therapy, from those who might only need surgery or could safely skip treatment altogether.
The key lies in the blood. Researchers believe that blood may contain clues about the disease's progression in the form of cancer cells that have broken away from tumors. These cells, often undetectable by standard lab techniques, can potentially seed new tumors. To find these elusive cells, Nagrath and her team developed a "labyrinth chip" in 2017. This innovative device uses maze-like channels to separate cancer cells and white blood cells from other blood components. After processing just a few milliliters of blood, researchers can gather enough cancer cells for detailed testing.
In a recent study, the researchers used the labyrinth chip to collect cancer cells from the blood of 34 patients with DCIS. They then analyzed the genes active within these circulating cancer cells and compared them to the genes active in cancer cells collected directly from the patients' breast tissue.
The tissue biopsies revealed four distinct subtypes of cancer cells based on their active genes. Two of these subtypes were found at significant levels in the blood. These types exhibited genes linked to disease progression, resistance to chemotherapy, and platelet binding. Some research suggests that platelet binding could help cancer cells evade the immune system. Other active genes may help cancer cells avoid detection by immune cells.
"That helps us narrow down what could have been indicative that these cells would circulate," says Neha Nagpal, a doctoral student.
A particularly interesting finding: The study revealed that the six Black patients involved tended to have a higher concentration of cancer cells in their blood compared to white patients. They also showed more immune suppression, which aligns with the higher breast cancer mortality rates observed in Black patients. However, it's crucial to understand that race is not a biological factor, and these differences likely stem from environmental factors.
"In the future, we plan to identify which of these cell types and biomarkers are able to get to a secondary site and stay there," says Nagrath.
To further investigate, the researchers are transplanting cancer cells from patients into mice. After four months, the mice developed elevated levels of cancer cells in their blood, which the researchers then analyzed. They also plan to track the disease progression in both the mice and the human patients.
This research, funded by several institutions, including the UM Forbes Institute for Cancer Discovery, holds immense promise for the future of breast cancer treatment.
What are your thoughts? Do you think this personalized approach could revolutionize cancer treatment? Are you concerned about the potential for disparities in access to this type of testing? Share your opinions in the comments below!
