Dr Sparano on Advances in Breast Cancer Screening, Treatment, and Drug Development

Joseph A. Sparano, MD, FACP, Ezra M. Greenspan, MD Professor in Clinical Cancer Therapeutics, chief, the Division of Hematology Oncology, deputy director, the Tisch Cancer Institute, Icahn School of Medicine, Mount Sinai, discusses developments in breast cancer diagnosis and treatment, which he presented during the Greenspan Lecture at the 

. In particular, he highlighted the influence that breast cancer screening has had on decreasing breast cancer mortality rates.

Over the past 40 years, several advances in breast cancer treatment have resulted in an approximately 40% reduction in breast cancer mortality rates, Sparano says. This progress can be primarily attributed to 3 factors, Sparano emphasizes. Firstly, the widespread adoption of breast cancer screening has played a pivotal role in early breast cancer detection. This enhances the curative potential of localized therapies, Sparano explains. Secondly, recognizing that breast cancer is a systemic disease from its inception has led to the widespread use of adjuvant systemic therapies, including endocrine therapy and chemotherapy. These therapeutics have substantially decreased the risk of breast cancer recurrence, according to Sparano. Lastly, efforts to accelerate thedevelopment of effective therapies for advanced-stage disease have now extended to earlier disease stages, Sparano notes.

The widespread adoption of mammographic screening, despite its imperfections, has led to an approximate 20% reduction in breast cancer mortality rates, Sparano says. Ongoing evaluations are exploring alternative screening modalities, such as digital mammography, contrast-enhanced mammography, and magnetic resonance imaging, Sparano explains. Furthermore, a new generation of tests, including multi-cancer detection tests that use simple blood tests to identify early-stage cancer, is under development and testing, Sparano notes. Although the advantages of these novel tests over standard breast cancer screening methods are not yet established, these tests may become widely used in the future, Sparano concludes.

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Joseph A. Sparano, MD, FACP, discusses developments in breast cancer diagnosis and treatment. 

Joseph Sparano, MD, associate chairman, Clinical Research, Department of Oncology, Montefiore Medical Center, associate director, Clinical Research, Albert Einstein Cancer Center, discusses the ways in which the role of endocrine therapy has evolved over the years as a treatment for patients with breast cancer.

Tamoxifen alone was once routinely given to both pre- and postmenopausal women with breast cancer, typically for a period of 5 years. However, research eventually moved towards the use of aromatase inhibitors as a treatment for postmenopausal women, with a continued use of tamoxifen as a treatment for premenopausal women. In both patient populations, the standard treatment duration was 5 years.

In the last couple of years, research has supported the use of ovarian function suppression with aromatase inhibitors to treat premenopausal patients with breast cancer. Moreover, recent data suggest that extended adjuvant therapy with aromatase inhibitors, when given for more than the standard 5 years, may be a significantly more effective treatment for patients.

Joseph Sparano, MD

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