A blog post by our community expert, Dr. Carly Bess Williams:
Throughout my life, I have heard that all things good come in threes, or better known as “the rule of three.” This concept emerged as a writing principle that suggested a trio of items is better than another number. To be honest, I have always believed in this writer-based concept; life, liberty, and the pursuit of happiness; three books in a trilogy; the three great pyramids at Giza. It was not until I embarked on a career in breast cancer research that I realized there was another concept dealing in three’s, metastatic breast cancer (MBC) – three letters that hit harder than Mike Tyson but are spoken of in a whisper.
This disease has dispensed an uncountable number of blank stares and head scratches to many medical professionals. MBC is breast cancer that has metastasized to other areas in one’s body (e.g. brain, bones, liver, and/or lungs). The definition of metastasis is to change one’s position, state, and/or form. For MBC, this means that breast cancer cells from the primary tumor have traveled to a different location in the body. Why did the cells have to leave in the first place? Probably for reasons very similar to the reasons we decide to put food in our stomachs and fuel in our cars; cancer is a system that needs nutrients and fuel just as we do. However, the ability of breast cancer to metastasize makes it extremely difficult to treat.
Breast cancer treatment has come along way since the days of Hippocrates, and there are multiple treatment options available. Over ~90% of women diagnosed with breast cancer will be alive after 5-years. However, only ~25% of women diagnosed with MBC will be alive after 5 years. This statement always provokes the question I get most frequently, “Why?” Three letters. Three of the hardest letters to answer, which unfortunately cannot be answered with just three words, or even three book chapters. I will try to give some insight into the “why” MBC has such a terrible prognosis by focusing on MBC and the three common treatment options: surgery, radiation, and chemotherapy.
The treatment of breast cancer normally starts with surgery to remove the tumor from the breast, followed by radiation and/or chemotherapy to kill off any remaining breast cancer cells. Surgery and radiation treatment options are straightforward, but chemotherapy selection can be a bit tricky. Selection of chemotherapy is based on breast cancer characteristics (aka identity). The characteristics that medical professionals look for are those known to promote breast cancer progression. The drugs designed for chemotherapy are looking for those breast cancer cells with a particular characteristic to then only kill those cells.
However, these treatment options face a multitude of obstacles in MBC. Surgery and radiation become harder to use if breast cancer has metastasized to an area such as the brain because those treatment methods can have life-altering side-effects, or cannot be used due to the location of the tumor. In addition, chemotherapy is challenged by MBC’s identity crisis. Once a cancer cell leaves the primary tumor in the breast to go to a new location, it might have picked up a new identity along the way. These new identities could mean that more drugs are needed that might be too toxic for the patient or these new identities prevent chemotherapy from working. If the drug being used is looking for a particular characteristic on a cancer cell, and the cell gets a new identity, the new identity can prevent the drug from killing the cell. I know. It is depressing to hear. MBC is the thief that takes the lives of too many.
Could these three letters be any more depressing? Unfortunately, they get three times more depressing when considering a type of MBC, triple-negative breast cancer (TNBC). Triple-negative represents the fact that this subtype of breast cancer lacks three of those breast cancer characteristics (identities) that medical professionals use to select chemotherapy treatments; triple threat. This means TNBC cannot be treated with most of the common chemotherapies used to treat breast cancer. Not only that, but over half of women diagnosed with TNBC have passed away after 4 years. Unbelievable.
I did not want to believe that there was such a cancer lurking in the world. Sadly, it is very real and has affected the lives of thousands. More efforts are needed to prolong the survival of the individuals who are already in the midst of a battle against this disease, and for those who might succumb to MBC.
The dedicated people of Racing for MBC are laced-up and ready to go!
Carly Bess Williams, Ph.D.
Vanderbilt University School of Medicine
Department of Pharmacology
Postdoctoral Scholar – MICTP Trainee
(912) 531-7388
“Research is formalized curiosity. It is poking and prying with a purpose.” – Zora Hurtson
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