THE BLOG
10/14/2013 11:08 am ET | Updated Jan 23, 2014

The Balkanization of Breast Cancer

In the middle of the celebratory Pink Cloud, that we in the breast cancer business call October, I think we need to stop and recognize that we are all in this together. Our collaboration with Susan G. Komen and Young Survival Coalition and our focus on the collateral damage of treatment has shown me how important solidarity is. While there is room for subgroups based on biology (triple negative, metaplastic, Her-2 neu, phylloides, ER positive, lobular) stage (previvors, metastatic and DCIS) and ethnic or gender group (young, Lesbians, men, African-Americans, Latinas, Asians, Persians), it is becoming very clear from the insights of the molecular biology and genetic analysis of tumors that our current categorizations may be more limiting and less accurate than we think.

A recent study showed that even cancers starting in different organs have many of the same genetic mutations. It is not unlike infectious diseases, where in the past you had doctors who specialized in lung infections versus those who did kidney infections until we realized that the type of bacteria mattered more than the organ and that the treatment for strep is the same no matter which organ it is in! In cancer the driving mutations may be key and not the organs in which they occur. Some stomach cancers overexpress Her-2 neu and respond to Herceptin for example. In addition recent data shows that cancers can indeed change their stripes. In other words a tumor that starts out as one kind such as estrogen positive can recur as estrogen negative! And even worse not all the cancer cells in a particular tumor are the same. This means that your tumor can harbor cells of more than one subtype and the one that is dominant and causing trouble can change over time! If this is the case it doesn't make sense to look for the cause or even the cure of only one type of cancer but to understand breast cancer as a whole.

The successful treatments for women with metastatic disease also point the way for early breast cancer treatments while vaccines being developed as treatments may teach us how to control if not cure cancers that have spread. We just don't know what research will benefit which patient.

For this reason if no other, we need to be working all together to get better treatments with less collateral damage for everyone and to figure out how to prevent breast cancer from occurring in the first place!

It is with this in mind that, I continue my quest to gather together the best and the brightest from all the breast cancer organizations to help us bring more focus on these issues. We cannot slice and dice the research as a percentage being focused on one type or another but have to encourage scientists to look across the arbitrary boundaries of early vs. metastatic and one molecular subtype versus another to look at ending it all together. We are taking the first steps including all women and men with and without a breast cancer diagnosis to participate in the Health of Women (HOW) study and to send us their collateral damage questions at questionthecure.org. To those organizations that have joined us thank you and for those still on the sidelines we need you, all of you! We can do this together and in fact that is probably the only way we can bring about a future without breast cancer.

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