Dr. Spector Discusses Breast Cancer Heterogeneity

Neil L. Spector, MD, co-director, Experimental Therapeutics, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, explains the need for an ample interpretation of breast cancer heterogeneity.

A breast cancer biopsy may reveal several different mutations, depending on the location examined on the biopsy. Even moving a short distance down the sample may reveal a completely different mutation profile. This complexity can easily become overwhelming, since over 50 mutations may be present on a single biopsy. However, Spector suggests that despite the large amount of data there may only be 2 mutations that are driving the entire tumor.

As an example, Spector compares breast cancer heterogeneity to a beehive. There may be multiple worker bees but only one queen. If you target the workers the hive will continue, but if you remove the queen it will die. Tumors operate in a similar fashion.

The true heterogeneous nature of a tumor has only recently been revealed. Due to current sequencing technology, several mutations that weren't visible before can now be detected. However, this information needs to be carefully interpreted, since it is not all essential.

Spector adds that there is a large amount of bioinformatics, such as genomics, proteomics, and metabolomics, which demonstrate the underlying complexities of the tumor system. There is a need to synthesize this data into something that can be discussed with an individual.