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Dr. Melody Cobleigh Six years ago, when she was 24, Elizabeth Esposito learned she had breast cancer when a lump that she had felt but ignored became so enlarged that it broke through her skin. “I didn’t do anything about it for a long time because I didn’t think anything was wrong with me,” she says. “I didn’t feel sick.” Since then, she has had chemotherapy and radiation for breast and ovarian cancer and now takes several drugs (Tykerb, Herceptin, and Zometa). “You name it, I’ve had it,” she says. And, obviously, she is still alive, even though a physician in 2004 warned her that she had only two years to live.
Like one in five women with breast cancer, Esposito has the form of the disease that comes from a nonhereditary gene mutation. The mutation leads to the overproduction of a protein called human epidermal growth factor receptor 2 (HER2), which in turn promotes the growth of malignant cells.
Despite all the pink ribbon campaigns, breast cancer continues to be the second leading cause of cancer deaths in women (after lung cancer). When younger women, such as Esposito, get the disease, they tend to get more aggressive forms. “Breast cancer is not just one disease any more,” says Dr. Melody Cobleigh, an oncologist who is the medical director of the breast cancer clinic at Rush University Medical Center. And breast cancer does not have only one treatment. Cobleigh is studying a drug called T-DM1, an antibody made by Genentech/ Roche, that may help with HER2-positive breast cancer. (The Food and Drug Administration (FDA) recently turned down early approval of the drug for this use.)
About 50 to 80 percent of women born with the hereditary BRCA1 and BRCA2 gene mutations get breast cancer. Their bodies “can’t repair DNA damage very well,” says Cobleigh. They can take steps such as getting mammography or magnetic resonance imaging (MRI) screenings; they can even get prophylactic mastectomies, like the actress Christina Applegate. Some BRCA-positive women also choose to get ovariectomies—removal of the ovaries. Without ovaries, estrogen levels drop—along with the risk of both breast and ovarian cancer, says Dr. Virginia Kaklamani, an oncologist and codirector of the cancer genetics program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
Short of resorting to such drastic measures, all women can reduce the risk of getting breast cancer by drinking less alcohol and losing weight. “Patients want to know what they can do,” says Cobleigh. “It used to be you could say, ‘There really isn’t anything.’ Now you can say, ‘If you control your weight after a diagnosis of breast cancer, you’ll be less likely to die.’”
Weight control is important for young and otherwise healthy girls, too. Obesity makes menstruation occur earlier and last longer. “It’s called the estrogen window,” says Cobleigh. “And the wider that window is, the higher the risk of breast cancer.” That’s why the obesity epidemic among young girls worries cancer researchers. At Northwestern’s Feinberg School, Kaklamani is working with a team trying to identify new genes associated with obesity-related breast cancer.
Though in general white women are more likely to get breast cancer in their lifetimes, Chicago researchers are trying to figure out why women of color (both African Americans and Latinas) appear to be at greater risk of getting the more lethal early-onset form of the disease. One theory: Many live in challenging environments, and the accompanying stress can interfere with their immune systems. In fact, University of Chicago researchers have found that women who have been sexually abused or who feel lonely and depressed are more likely to get breast cancer at a younger age. At UIC’s Center for Population Health and Health Disparities, researchers are studying how to make community health centers better able to identify and treat young women at risk of the disease. “[The young women] don’t expect to get it,” says Richard Warnecke, the UIC professor who codirects the center. “They don’t necessarily establish relationships [with doctors or hospitals].” To better treat women after diagnosis, community health centers also need to be able to work more in tandem with big research hospitals, he says.
HEART DISEASE | FERTILITY | PREGNANCY | BREAST AND OVARIAN CANCER
CERVICAL AND ENDOMETRIAL CANCER | OSTEOPOROSIS
HEADACHES, MULTIPLE SCLEROSIS, AND OTHER NEUROLOGIC DISORDERS | DEPRESSION
EATING DISORDERS | INCONTINENCE | IMMUNE DISORDERS | SLEEP DISORDERS
Photograph: Taylor Castle Assistant: Ace Ujimori Hair and Makeup: Anthony Balthazar