By Maria Wetzel
When I was diagnosed with metastatic breast cancer just about two years ago, I thought I knew a lot about metastasis and thought I had an understanding of what it was like to live it. But I found out the reality was really quite different, and nothing about it was good.
Breast cancer is taking away so many years of lives. Continuous treatment, frequent scans, tests, appointments and drug toxicities significantly affect our quality of life. Children are left without parents, spouses without their mates, friends die. Milestones are missed. Plans are for the immediate future, not for years away. Dreams are turned into more doable bucket lists. “Getting our affairs in order” becomes prudent.
Can we stop this morbidity and mortality? It’s a huge challenge, which will certainly not be met by awareness campaigns, marches, races, ribbons, or merchandising of pink products.
So how can we possibly reach that goal? Primary prevention of breast cancer is one way, certainly the most effective in the long run. Curative treatment for primary disease is another way because the intent is always to prevent the growth of cancerous cells outside the breast. A third way would be to keep those cells quiescent forever. And finally the most difficult way would be to find the cures for metastatic disease.
The National Breast Cancer Coalition’s Breast Cancer Deadline 2020® has made primary prevention of breast cancer one priority and prevention of metastasis the second.
What is metastasis? Is it the spread of cells outside the breast, or is it the growth of a detectable tumor in a distant place? The first seems impossible to prevent because, for many, it is thought to have already happened when a primary tumor is diagnosed. For others, however, it may be that primary treatment does prevent this from happening. Even if cells escape the breast, growth of a detectable tumor is not a given; to do the deadly deed they need to find a suitable place.
A small but significant number of recurrences occur after the oft-mentioned 5-year mark. 10, 15, even 20 years is not unheard of. What awakens those cells? Do they change or does the surrounding neighborhood change? And are there ways to prevent it from happening with relatively non-toxic long term treatment? We hear about vaccines, stem cells, targeted radioactive particles, nanotechnology. What about metformin, COX2 inhibitors, very low dose chemo, Vitamin D, mistletoe extract, cinnamon, curcumin, aspirin, exercise, diet? What about all those promising things that are in the headlines? Surely there have to be some answers out there.
We do know a lot about the whole process of metastasis but, obviously, not nearly enough to consistently prevent it or halt it. What are the differences between primary tumors and metastatic tumors? Do they differ by site? Do subtypes spread in unique ways? To get the answers to so many questions we need many more researchers who will take on the challenges of dedicated metastatic research. Just as important, they need to be well funded.
Only then will we be able to stop the dying from breast cancer.