How close are we to a cure for breast cancer?

For decades, governments, charities and pharmaceutical companies have all poured tens of billions of dollars into breast cancer research. Yet each year, some half a million people—mostly women—die from breast cancer.

“In the US, 41,000 women die [of breast cancer] each year,” says Dr Sofia D. Merajver, MD, head of the breast oncology programme at the University of Michigan’s Comprehensive Cancer Center. “That’s three jumbo jets full of women every week, something that you’d think would be a national emergency,” she says. “We’ve made strides, but we still have far to go.”

Helping extend those strides is research in liquid diagnostics, a method aimed at finding early signs of cancer  in blood or urine before symptoms arise. The area is so promising that it could become part of a $20bn market for cancer blood tests within five years, according to a JP Morgan analyst.

Just weeks ago, for example, the journal Nature published the development of a blood test for pancreatic cancer, one of the deadliest kinds. As exciting as this is for those working to eradicate pancreatic cancer, the test could also prove useful for breast cancer screening: Biomarkers in blood from breast cancer patients also “lit up” during the study.

Meanwhile, researchers at the University of Freiburg, Germany, have developed a breast cancer test that needs only a few millilitres of urine. It detects concentrations of microRNAs that have crossed into the sample from the patient’s blood. MicroRNAs help regulate cell metabolism and are often dysregulated in cancer cells. The test, which involved 48 women, looked for concentrations of these microRNAS and was 91% accurate, according to the researchers. Larger sample sizes will be needed to prove its efficacy, however.

While some liquid tests still need work, others are already delivering results. Scanning a person’s blood for tiny fragments of DNA released by tumours—a field known as theragnostics—can help doctors prescribe tailored drugs that work directly against a specific kind of tumour, for example.

This is giving rise to both the development of target-specific drugs (up to about 50 today from just 15 in 2008) and to theragnostic tests themselves. Guardant Health, Illumina and Sequenom all are dipping toes into these new waters.

Aiding the research into targeted therapies are efforts in cancer genomics. Analysis of the genetic sequence of more than 2,000 breast cancer samples by the Cambridge Cancer Centre, for example, revealed that there are at least ten genetically distinct, different kinds of breast cancer tumour types. To support these genomics efforts, the Addenbrooke’s Charitable Trust just launched the “Bracode” Campaign (a play on the word “barcode”) to study 450 volunteer patients at the Cambridge Breast Unit for the next five years.

Understanding the genomics of tumours may aid in the understanding of the third and perhaps most crucial area of breast cancer research: the metastasis of the primary tumour itself. Little is understood about why primary tumours spread to other organs. This is vexing for researchers because metastasis tends to be what kills patients, says Dr Merajver.

Early detection is a significant focus of breast cancer awareness groups. But it is not enough, Dr Merajver emphasises. “Most [US] breast cancers are diagnosed at Stages 1 or 2,” she says. “You don’t have to be a math genius to see that, at one point, most of those who died imagined they had been cured.”

She cautions that cancer is highly complicated and that parsing out the “enormous” number of possible mutations in a bulk tumour is the key to personalised, highly targeted medicine. Understanding the makeup of those mutations and using nanotech platforms to deliver targeted therapies could be key to long-term survival, she says.

The next big leap in the fight against cancer may well happen at the nano level.

This article is published in collaboration with GE Look Ahead. Publication does not imply endorsement of views by the World Economic Forum.

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Author: Holly Hickman writes for GE Look Ahead.

Image: “Umbrellas”, the sculpture by Giorgos Zogolopoulos is illuminated in pink light to mark Breast Cancer Awareness Month in Thessaloniki in northern Greece. REUTERS/Alexandros Avramidis