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Times Have Changed

Posted 1/3/2013

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  As you know, I have been working at BIDMC for a very long time--specifically since 1979. There have been many changes in cancer care and treatment through all those years, and we are surely better off than we were then. Important comment: however, we are far from better off enough as many women continue to die of breast cancer. Treatments are much easier to tolerate than they were in the 1980s; I remember that we handed people little plastic buckets as they left the Infusion Area. We knew that they would not make it home, might not even make it to their cars, without vomiting. Now most people go through an entire course of chemotherapy without ever vomiting. Nausea, sure, "unright" stomach, yes indeed. But no more nights spent kneeling in front of the toilet or lying on the bathroom floor.

  There have been many advances in treatment, too. In 1979, the standard of care for adjuvant chemotherapy was one year of CMF. That sounds pretty dreadful, but it had just been changed from two years of CMF, so people were pretty happy about the reduced treatment time. By the time I had CMF in 1993, the standard of care was six months, and I can promise you that was bad enough. I cannot imagine how women got through two years--except that we all have learned that we can get through just about anything.

  There was one treatment available in 1979 for metastatic breast cancer: adriamycin. When it stopped working, there was nothing left to offer. There are now long lists of possible treatments, some new targeted therapies that are generally much easier physically, and many things in the pipeline.

  Another major advance in my years here has been the widespread availability of wide excision/lumpectomy/partial mastectomy with radiation therapy. In 1979, there were exactly three hospitals in the whole country that offered this treatment choice to many women. BID (then Beth Israel Hospital) was one of them, so we always had many women living in hotels or with friends/family while they went through radiation. Women came from far away to save their breast, and the logistics and stresses of being far from home during cancer treatment surely made the experience more difficult.

  If you are interested in learning more about how it was, read Betty Rollins' classic book, First You Cry or Rose Kushner's Why Me?  This is a nice article from the Komen Foundation's website about all of these changes--and more. Here is the beginning and then a link to read more:

Breast Cancer in 2012: Not Your (Grand)Motherʼs Disease

Guest blog from Kelly Graham-Seyed

Susan G. Komen for the Cure Scientific Grants Manager

In the 1970ʼs, breast cancer was a disease that no one talked about, and doctors found very difficult to treat. The methodology used to identify estrogen receptor (ER) status was just being developed, and not commonly used. Fast forward 20 years, to the 1990s, and testing for the estrogen receptor was optimized and widely used in pathology labs to split breast tumors into ER+ and ER- types and help doctors to offer treatments that would be most effective in specific patients. In the late 1990s, recommendations from the American Society of Clinical Oncology to test for the HER2 receptor led to an additional division of breast cancer types. The early 2000s brought the analysis of breast tumor types to a genetic level, with the identification of 5 distinct subtypes of breast tumors based on the genes present in individual tumorsʼ genetic fingerprints. The year 2012 has further defined (and thus subdivided) breast tumor types, providing us with a better understanding of breast cancer, a roadmapto personalized medicine, and revealing more questions to answer in the years to come.

Susan G. Komen for the Cure Scientific Grants Manager

Read more at:  http://blog.komen.org/?p=2620

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