The improved survival rates are due largely to two factors: earlier detection and more effective treatments. Increased clinical vigilance and better diagnostic tools have enabled earlier and more effective clinical intervention. In combination with traditional therapeutic options of surgery, radiation and chemotherapy, oncologists have in recent years turned to a new generation of cancer drugs—so-called targeted therapies—to improve patients’ odds of survival.
The seed for these therapies was planted in 1982, when biomedical researchers found a gene involved in cancer. They eventually demonstrated that this gene, called HER2, played an active role in causing breast cancer. Scientists went on to discover an antibody that attaches to and disrupts HER2. In 1998, the FDA approved that antibody, Herceptin, for use in breast cancers caused by HER2. In the dozen years since, the drug has proved a tremendous success, curing thousands of women. Scientists have similarly discovered that breast cancers with estrogen receptors can be treated with drugs like Tamoxifen and Evista, which interferes with estrogen receptors.
Yet even with breast cancer, not every case has a happy ending. “If your breast cancer has HER2 or estrogen receptors, it likely will respond to treatment,” says Prescott. “But many breast cancers don’t fit this pattern.” As medical researchers continue to work to unmask the molecular codes underlying the many different forms of breast cancer, oncologists are doing their best with the tools at their disposal.
“Surgery can be effective, but a lot of its success depends on the molecular signature of the particular cancer,” Prescott says. “In some cases, no matter how early a cancer is detected and how complete the excision appears to be, it’s going to metastasize.” Chemotherapy, he says, has proven “tried and true” at slowing this process, but in the end its results are not typically dramatic. So sometimes, despite physicians’ best efforts, a patient with breast cancer is going to run out of treatment options.
AFTER DEBBIE’S INITIAL DIAGNOSIS and treatment—a lumpectomy followed by chemotherapy and radiation—her life pretty much returned to normal for four years. But in 2007, she learned that the cancer had spread to her bones. A year of drug therapy didn’t seem to help. She went on an extremely low-carbohydrate diet and lost 65 pounds. Her tumor markers dropped, but her doctor worried that her weight was too low.
In the fall of 2009, just like in each of the previous six school years, she told her students about the cancer. As had become her way—it was almost a part of the lesson plan by now—she waited several weeks into the semester to tell them. And then she opened the floor for questions.
The students were tentative at first. But as it became clear that their teacher meant it when she told them to ask her anything, they took her at her word. How does it feel, Ms. Ocker? What, exactly, are the treatments like?
The questions gave Ocker pause. At that time, she was undergoing assessments of her lymph nodes that involved numerous shots in sensitive areas of her breasts. The procedures were, she says, “excruciatingly painful.”