Dr Feldman on the Utility of Personalized Medicine in Breast Cancer Management

Sheldon M. Feldman, MD, chief, Division of Breast Surgery and Breast Surgical Oncology, director, Breast Cancer Services, professor, Department of Surgery, Montefiore Einstein, discusses how the use of personalized medicine has evolved in breast cancer management, highlighting the importance of this topic during Breast Cancer Awareness Month.

Patients must recognize that breast cancer is not a single disease; it encompasses various stages and subtypes, each influencing prognosis and treatment, Feldman begins. Cancer stages range from early to advanced, with each stage requiring different treatment approaches, Feldman notes. Additionally, breast cancer subtypes vary greatly in their biological characteristics, which directly affect treatment options, he says.

In breast cancer care, treatment plans consider the cancer’s stage and subtype, as well as the patient’s unique medical factors—such as age, reproductive history, and other health conditions, Feldman continues. For example, a younger woman with early-stage breast cancer may opt for breast conservation, he explains. This typically involves a lumpectomy, which is a minimally invasive surgery preserving most of the breast, followed by adjuvant radiation therapy to reduce recurrence risk, according to Feldman. However, studies indicate that for older women, particularly those older than 65 or 70 years of age, radiation may be unnecessary, as its benefits do not significantly improve outcomes in this age group, he says. Therefore, non-radiation treatments are a safe option for many patients, he reports.

The complexity of treatment increases across differing tumor types, Feldman expands. Tumor markers, such as estrogen and progesterone receptors, indicate a tumor’s responsiveness to hormones. Tumors expressing these receptors can be treated effectively with hormone-blocking therapies, he adds. Furthermore, approximately 25% of breast cancers involve HER2 overexpression, a genetic mutation previously associated with poor outcomes, he elucidates. Fortunately, advancements in targeted therapies, such as monoclonal antibodies directed against HER2, have significantly improved outcomes for these patients. This diversity in cancer subtypes and stages highlights the need for personalized treatment plans tailored to cancer biology and each patient’s unique medical background, Feldman concludes.