SUPPORTING PATIENTS, CHANGING OUTCOMES, DISCOVERING CURES
THREE MEDICAL EXPERTS SPEAK TO THE DIRECT AND LASTING IMPACT THE BREAST CANCER ALLIANCE HAS HAD ON RESEARCH, TREATMENT AND THE ONE OUT OF EIGHT WOMEN WHO WILL RECEIVE A BREAST CANCER DIAGNOSIS IN THEIR LIFETIME.
ZDRAVA MEDROVA, PHD.
A geneticist and cancer biologist who has received two BCA-funded research grants while on the faculty of Mass General Hospital. Her research has led to the development of TTX-MC138, a targeted therapy designed to treat cancer patients with metastatic disease. She is now the scientific cofounder and chief technology officer of Transcode, a clinical-trial company focused on bringing this treatment to market.
GM: How important was receiving your first grant from a BCA program?
Zdrava Medrova, PhD.: It is critical for someone early in their careers to get this kind of support and in my case, as a more junior female researcher, it was really important. The truth is the research world can almost be a bit of a boys’ club. There’s a tendency for these things to go to an older male, someone in khakis and tennis shoes, whose received grants before. This funding allows someone who is interested in developing new ideas and systems a way to push their ideas forward. BCA provided the seed money, and what we’ve accomplished would not have happened without it. The second grant we got from BCA was a significant one, which really helped us move this project forward.
GM: Why focus your research on metastatic breast cancer?
ZM: I always wondered why so much cancer research was focused on treating the origins of the disease rather than treating the disease in the stage it was in. It goes from cells that are invisible to tumors to cancer that has spread throughout the body. In my case, I was interested in cancer that has spread, because that tends to be the fatal kind. It felt like there was a huge gap in the way we were approaching things.
GM: In simple terms, can you explain how the treatment you’ve developed works?
ZM: The drug targets a molecule, a noncoding RNA [micro RNAs] which is known to play a role in the metastasis of tumors. So, the work was focused on developing agents that target and deliver treatment directly to them. That pathway is a puzzle we were trying to solve.
GM: And what has the research shown?
ZM: When we treated mice with metastatic disease, we were able to achieve states of remission. We tested it on other animals, too, and had similar results.
GM: Is this treatment available to cancer patients yet?
ZM: That’s the next step and why we founded Transcode. We’re working on getting it to people with cancer. We think this has promise not just for breast cancer but several other kinds of cancer.
GM: How do you envision the future of breast cancer treatment?
ZM: The future is already happening, and we’re experiencing some of these changes today. We’re going to be looking at this disease in different categories. We’re going to be thinking of something like an early-stage breast cancer very differently from metastatic disease, almost as if they are a completely different kinds of cancer, because really, they are. The therapies of the future will be more targeted.
DR. STARR MAUTNER
Breast cancer surgeon at Miami Cancer Institute, part of Baptist Health South Florida. She joined its team in 2015 after completing a breast surgical oncology fellowship funded by the BCA at Memorial Sloan Kettering Cancer Center in New York City.
GM: How did your BCA fellowship impact your career?
Dr. Starr Mautner: It meant being able to train at Memorial Sloan Kettering [MSK], one of the busiest and best places in the world to treat breast cancer patients. It was a true privilege that set me up for a successful career here in South Florida, where I’m from. At [MSK] I did upwards of 1,000 cases during my fellowship year. That, in itself, was incredible training, but it also made lifelong connections for me with the MSK team. In fact, I’ve become a liaison for an alliance between my hospital and MSK.
GM: BCA is passionate about its commitment to training breast-cancer focused surgeons. Why is such a specialty needed?
SM: Breast cancer is the most common disease in women. By supporting these fellowships, BCA is sending surgeons like me back to the community to treat them. In a lot of communities these surgeries are still being done by general surgeons. And there are some truly excellent ones out there. But when you’ve trained in this as a specialty, you go a step further in terms of technique. For example, our training enables us to offer options such as nipple sparing treatment, which has gained a lot of popularity. The end result is that the cancer is removed, but the patient retains her nipples. It’s not just a curative surgery, but one that helps the patient feel better about herself.
We have learned a lot of other innovative techniques to spare lymph nodes. A lot of breast cancer patients suffer complications from their removal. These things matter in terms of side effects. If you offer a cure, but there are is a lot of morbidity after treatment, it impacts your quality of life. To me that’s not the outcome we ever want. It’s important not just to cure the disease but to give people their lives back and make them feel whole again.
GM: How many patients have you treated since completing your fellowship?
SM: Thousands over the past eight years. Today alone, I saw twenty-eight patients. I operate twice a week, usually on about ten women. It’s a lot. Some people say your work must be depressing, but it’s not depressing at all. In most cases, I know we’re going to be providing a cure. The first thing I tell my patients is you’re going to be OK—and I mean it. So much has changed with this disease because of research and training and early diagnosis and intervention. It’s exciting to be doing this right now.
GM: Any myths about breast cancer you would like to dispel?
SM: So many! I always tell my patients, “Don’t Google anything,” because there’s so much misinformation out there.” One is that this is a one-size-fits-all disease. It’s not true that if your neighbor had breast cancer and needed a mastectomy, chemotherapy and radiation that you will, too. We’re in an era where treatment for breast cancer is becoming much more personalized.
The other one is that this is a disease of older women. I am seeing women in their 20s and 30s with breast cancer. And I am really interested in raising awareness with younger women. They’ll notice something or feel something and be told, “It’s nothing,” even by their doctors. I want them to know they need to investigate. I hate seeing young women who’ve waited to get care and are really sick because they thought they were too young.
GM: Why are you still connected to BCA?
SM: It’s such a great group of women who are making such an impact on the future of breast cancer treatment. These things they do every year, like the fashion show, make a real impact. I’m really honored that eight years after receiving my fellowship they’ve reached out and asked me to be involved in an event we’re having here in Miami in October. It’s going to be a very cool event in the Design District, and I love the idea that maybe we’ll reach some younger women who may not have breast cancer on their minds.
DR. ALYSSA GILLEGO
Surgical breast oncologist at Greenwich Hospital and Assistant Professor of Surgery at the Yale School of Medicine. She’ll be a panelist at BCA’s October 6 Breast Cancer Awareness Month Flag Raising Ceremony.
GM: Have you treated women who’ve delayed breast cancer screenings, including mammograms or ultrasounds, because they couldn’t afford them?
Dr. Alyssa Gillego: Absolutely. I have, and it’s often women who are uninsured or underinsured who delay that screening. It’s unfortunate that they see these barriers, because it can mean a delay in both diagnosis and treatment. And that can mean they are ultimately diagnosed at a later stage. It can affect the overall outcome.
GM: How does BCA supporting free mammograms in communities like Greenwich and throughout the state make a difference?
AG: What BCA is doing is extremely important. Their generosity enables us to better reach out to patients who may not have access to this type of care and may not have the resources to access even regular, basic medical care. We really can give these patients more by connecting with them through these free services, and we are often able to offer them even more comprehensive medical care.
GM: You recently operated on a patient who was a direct beneficiary of a BCA-supported mammography screening. How’s she doing?
AG: When I met her last year she was fifty and had never had a mammogram. She felt a lump and didn’t have any insurance. But because of the support of BCA, she was able to receive one here at Greenwich Hospital for free. The mammogram showed she had abnormalities in both the left and right breasts. She ended up being diagnosed with two different types of cancers. The good news is that they were both stage two, still very curable. Her getting that screening when she did was important. She’s still in treatment, but I’m happy to say she’s doing quite well. And she’s very grateful for the care she has received.
And the really interesting thing in her case is that she went on to have genetic testing and learned she has a genetic anomaly that can cause breast cancer. She didn’t know about that either. That has real implications, not only for her, but for her children and their children. Having that information means they can be vigilant and have testing if they need it in the future. It’s a very big deal to have that personal health knowledge.
GM: The question of when women should start having mammograms is still the subject of some debate. Do you have a message for women about when they should begin?
AG: Here at Greenwich Hospital, we recommend women start getting them every year at age forty and also getting an ultrasound if they have dense breast tissue. We recommend starting even earlier if they’ve had a first-degree relative with breast cancer. If you’re a woman with a mother or sister who’s had breast cancer, we would recommend starting about ten years before the age that relative was when they were diagnosed. So, if your mom was diagnosed with breast cancer at forty-five, we would recommend you begin screenings at thirty-five.